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Current Perspectives on the Clinical Management of Respiratory Diseases
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Current Perspectives on the Clinical Management of Respiratory Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 25 January 2027 | Viewed by 3818

Editors

Dr. Pradeesh Sivapalan

E-Mail Website
Guest Editor
1. Department of Medicine, Section of Respiratory Medicine, Herlev & Gentofte Hospital, Kildegårdsvej 28, 2900 Hellerup, Denmark
2. Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N, Denmark
Interests: COPD; bronchiectasis; respiratory infections; corticosteroids; biomarkers; randomized clinical trials; cardiovascular complications
Dr. Alexandr Ceasovschih

E-Mail Website
Guest Editor
Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania
Interests: internal medicine; cardiology; atherosclerosis; inflammation; peripheral arterial disease; MINOCA; metabolic syndrome; electrocardiogram; COVID-19
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Respiratory diseases such as COPD, bronchiectasis, and other chronic airway conditions remain a major global health burden, often complicated by frequent exacerbations and comorbidities. This Special Issue focuses on the clinical management of these conditions, highlighting recent advances in precision medicine, biomarker-driven strategies, and patient-centered care. A key area of interest is the optimization of inhaled corticosteroid (ICS) therapy, including the identification of patients most likely to benefit while minimizing exposure to high-burden or side-effect-prone medications. Contributions to this Special Issue are welcome to include clinical trials, real-world studies that investigate novel therapeutic approaches, risk stratification, and strategies to improve patient outcomes. We particularly welcome studies exploring steroid-sparing regimens, biomarkers predicting treatment response, and interventions targeting respiratory infections. This Special Issue aims to provide clinicians and researchers with actionable insights into improving management strategies, reducing treatment-related adverse effects, and enhancing quality of life for patients with chronic respiratory diseases.

Dr. Pradeesh Sivapalan
Dr. Alexandr Ceasovschih
Guest Editors

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Keywords

  • COPD
  • acute exacerbations
  • biomarkers
  • clinical trials
  • bronchiectasis
  • respiratory infections

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Published Papers (3 papers)

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Research

13 pages, 1366 KB  
Article
Evaluating the Predictive Potential of an AI-Driven Deep Learning Model for Pneumonia-Associated Sepsis
by Ki-Byung Lee, Chang Youl Lee, Jaewon Jang, Yeeun Jeong and Kyung Hyun Lee
J. Clin. Med. 2026, 15(6), 2125; https://doi.org/10.3390/jcm15062125 - 11 Mar 2026
Viewed by 895
Abstract
Background: Pneumonia-associated sepsis constitutes a significant portion of all sepsis cases and is a leading cause of sepsis-related morbidity and mortality. The clinical burden is especially pronounced in general ward settings, where delayed recognition can hinder timely intervention. This underscores the necessity [...] Read more.
Background: Pneumonia-associated sepsis constitutes a significant portion of all sepsis cases and is a leading cause of sepsis-related morbidity and mortality. The clinical burden is especially pronounced in general ward settings, where delayed recognition can hinder timely intervention. This underscores the necessity for advanced tools that facilitate early detection. Methods: This retrospective, single-center study assessed an AI-driven deep learning model designed to predict in-hospital sepsis up to four hours in advance. We analyzed 7715 pneumonia cases identified through chest radiography or CT. The model’s performance was evaluated using AUROC, sensitivity, specificity, and lead time to sepsis onset and was compared against established scoring systems: NEWS, MEWS, SOFA, and qSOFA. Sepsis was defined according to the CDC Adult Sepsis Event criteria in alignment with Sepsis-3 guidelines. Results: The AI model exhibited strong performance in the early detection of sepsis among pneumonia patients, achieving an AUROC of 0.870, with a sensitivity of 76.7% and specificity of 84.1%. It significantly surpassed conventional scoring systems: NEWS (0.697), MEWS (0.661), SOFA (0.649), and qSOFA (0.678). Importantly, the model identified sepsis a median of 183 min earlier than recognition based on the operational definition. This lead-time advantage was consistent in the pneumonia cohort, where 18.3% of patients developed sepsis. Conclusions: The AI model demonstrated strong predictive capabilities for pneumonia-associated sepsis, facilitating earlier clinical decision-making. Integrating this model into EMR systems could be an effective strategy to enhance sepsis outcomes in general ward settings. Further prospective studies are needed to validate its effectiveness in real-time clinical applications. Full article
(This article belongs to the Special Issue Current Perspectives on the Clinical Management of Respiratory Diseases)
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16 pages, 1794 KB  
Article
Impact of COVID-19 on Respiratory Function: A Post-Recovery Comparative Assessment
by Daniela Robu Popa, Corina Marginean, Mona Elisabeta Dobrin, Radu Adrian Crisan Dabija, Oana-Elena Melinte, Stefan Dumitrache-Rujinski, Ioan Emanuel Stavarache, Ionel-Bogdan Cioroiu and Antigona Carmen Trofor
J. Clin. Med. 2026, 15(2), 717; https://doi.org/10.3390/jcm15020717 - 15 Jan 2026
Viewed by 1653
Abstract
Background: Post-COVID-19 syndrome (PCS) is defined as the persistence or development of new symptoms 3 months after the initial infection with the SARS-CoV-2 virus, these clinical aspects being most often associated with functional respiratory changes, as well as imagistic modifications. This study [...] Read more.
Background: Post-COVID-19 syndrome (PCS) is defined as the persistence or development of new symptoms 3 months after the initial infection with the SARS-CoV-2 virus, these clinical aspects being most often associated with functional respiratory changes, as well as imagistic modifications. This study aimed to evaluate longitudinal changes in pulmonary function among patients with PCS, in relation to the severity of the acute COVID-19 episode and the time elapsed since infection. Methods: A retrospective, observational study was conducted at the Clinical Hospital of Pulmonary Diseases Iași, Romania, between January 2021 and December 2022, including 97 adult patients with confirmed PCS. Demographic, clinical, and functional data were collected from medical records. Pulmonary function tests (PFTs) were performed according to ATS/ERS standards, assessing Forced Vital Capacity (FVC), Forced Expiratory Volume in the First Second (FEV1), FEV1/FVC ratio (Tiffeneau Index), Maximal Expiratory Flow at 50% and 25% of FVC (MEF50, MEF25), Diffusing Capacity of the Lung for Carbon Monoxide (adjusted for haemoglobin) (DLCO), Carbon Monoxide Transfer Coefficient (KCO), Alveolar Volume (AV), Total Lung Capacity (TLC) and Residual Volume (RV). Patients were grouped by time elapsed since infection (1–3, 4–7, 9–12, and up to 22 months). Statistical analyses included the Mann–Whitney U test, Spearman’s correlation, ROC curve analysis, and Principal Component Analysis (PCA). Results: A progressive improvement in FVC was observed up to 9–18 months post-infection (p < 0.05), while FEV1 remained stable, suggesting a predominantly restrictive ventilatory pattern. Patients with moderate acute COVID-19 presented significantly lower FVC%, FEV1%, DLCO%, and KCO% values compared with those with mild disease (p < 0.05). Diffusion abnormalities (DLCO and KCO) persisted beyond 12 months, indicating lasting alveolar-capillary impairment. ROC analysis identified TLC (AUC = 0.857), AV (AUC = 0.855), and KCO (AUC = 0.805) as the most discriminative parameters for residual dysfunction. PCA revealed three major functional domains—airflow limitation, diffusion capacity, and lung volume—explaining up to 70% of total variance. Conclusions: We are facing the emergence of a new phenomenon, namely a secondary post-COVID-19 pandemic of patients confronting with persistent post-COVID-19 symptoms who present with functional respiratory changes and who require careful monitoring in dynamics, personalized treatments and a multidisciplinary approach. Full article
(This article belongs to the Special Issue Current Perspectives on the Clinical Management of Respiratory Diseases)
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17 pages, 1730 KB  
Article
Inhaled Corticosteroid Use and Risk of Haemophilus influenzae Isolation in Patients with Bronchiectasis: A Retrospective Cohort Study
by Dil Afrose, Christian Philip Rønn, Josefin Eklöf, Anna Kubel Vognsen, Louise Lindhardt Tønnesen, Barbara Bonnesen Bertelsen, Jonas Bredtoft Boel, Christian Østergaard Andersen, Ram Benny Christian Dessau, Mette Pinholt, Jens-Ulrik Jensen and Pradeesh Sivapalan
J. Clin. Med. 2025, 14(23), 8557; https://doi.org/10.3390/jcm14238557 - 2 Dec 2025
Cited by 1 | Viewed by 831
Abstract
Background: Non-cystic fibrosis bronchiectasis (BE) is a chronic lung condition characterized by irreversible bronchial dilation and presented with persistent respiratory symptoms, recurrent respiratory infections, and decreased quality of life. Inhaled corticosteroids (ICSs) are frequently prescribed in patients with bronchiectasis, despite limited evidence supporting [...] Read more.
Background: Non-cystic fibrosis bronchiectasis (BE) is a chronic lung condition characterized by irreversible bronchial dilation and presented with persistent respiratory symptoms, recurrent respiratory infections, and decreased quality of life. Inhaled corticosteroids (ICSs) are frequently prescribed in patients with bronchiectasis, despite limited evidence supporting their clinical efficacy. Inhaled corticosteroids have been associated with increased risk of respiratory infection with Haemophilus influenzae (H. influenzae) in other groups of lung diseases. We aimed to evaluate the association between ICS use and the risk of isolating H. influenzae from lower respiratory tract samples in patients with bronchiectasis. Methods: A retrospective cohort study was conducted using data from 2010 to 2018, encompassing all patients diagnosed with bronchiectasis in outpatient clinics in Eastern Denmark. ICS use was standardized in budesonide equivalent doses and categorized in tertiles: low (<210 μg/day), moderate (211–625 μg/day), and high (≥626 μg/day) based on cumulative budesonide equivalent doses redeemed in the 12 months before cohort entry. The primary outcome was the first isolation of H. influenzae from lower respiratory tract samples post-cohort entry. Cox proportional hazards models, adjusted for relevant confounders, estimated hazard ratios (HRs), and inverse probability-of-treatment weighting (IPTW) was used in sensitivity analyses. Results: Among 3663 patients (mean age 66 years; 61% female), 2175 (59.4%) did not use ICS, while 484 (13.2%), 508 (13.9%), and 496 (13.5%) were in the low-, moderate-, and high-dose ICS groups, respectively. Furthermore, 594 (16.22%) patients had a lower respiratory tract culture positive for H. influenzae during follow-up. High-dose ICS use was associated with an increased risk of H. influenzae; HR 1.63 (95% Cl, 1.19 to 2.12, p < 0.005) compared with no ICS use. No association for low or moderate ICS use was found: low-dose ICS HR 0.75 (95% Cl, 0.52 to 1.07, p = 0.11) and moderate-dose ICS HR 1.27 (95% Cl, 0.93 to 1.72, p = 0.12). IPTW analysis confirmed the main finding. Conclusions: High-dose ICS use in patients with bronchiectasis was associated with an increased risk of acquiring H. influenzae in the lower respiratory tract. Hence, patients with bronchiectasis should be cautiously prescribed high-dose ICS. Full article
(This article belongs to the Special Issue Current Perspectives on the Clinical Management of Respiratory Diseases)
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