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Chronic Lung Conditions: Integrative Approaches to Long-Term Care
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Chronic Lung Conditions: Integrative Approaches to Long-Term Care

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 November 2025 | Viewed by 4095

Special Issue Editor

Prof. Dr. Antigona Carmen Trofor

E-Mail Website
Guest Editor
1. Pulmonary Department, Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
2. Clinical Hospital of Pulmonary Diseases Iași, 700116 Iasi, Romania
Interests: chronic pulmonary disease management; tobacco use and cessation; tuberculosis; interstitial lung diseases; post-COVID-19 respiratory implications; air pollution impact on respiratory health; pulmonary rehabilitation; severe asthma; COPD multimorbidity; interventional bronchoscopy techniques and training
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Currently, numerous categories of health professionals are raising awareness of the increasing burden of chronic lung conditions. It is supposed that this status quo will continue to be a major concern in the context of global climate change, environmental air pollution, and tobacco and TB endemics, causing various issues to respiratory health—not to mention the recent COVID-19 pandemic that is still not fully understood regarding its long-term impact on the lungs. This Special Issue of the Journal of Clinical Medicine aims to highlight the major research gaps and progress in the broad area defined as chronic lung conditions. Its goal is to accentuate the need for an integrative approach of these entities, as well as to point out the benefits of long-term care for chronic lung disease course and treatment outcomes.

Prof. Dr. Antigona Carmen Trofor
Guest Editor

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Keywords

  • chronic lung conditions: chronic non-infectious lung disease and post-respiratory infectious syndromes, including TB sequelae, TB MDR, post-COVID-19, and bronchiectasis
  • long-term care
  • integrative approach
  • multidisciplinary
  • multimorbidity
  • outcomes

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Published Papers (4 papers)

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Research

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11 pages, 292 KiB  
Article
The Effect of Aerobic Training on Healthy Small Airways—A Forced Oscillation Technique Approach to Optimize Long Term Care in COPD
by Ioan Emanuel Stavarache, Tudor Andrei Cernomaz, Ionela Alina Grosu-Creangă and Antigona Trofor
J. Clin. Med. 2025, 14(13), 4755; https://doi.org/10.3390/jcm14134755 - 4 Jul 2025
Viewed by 313
Abstract
Limited data exist on the underlying physiological phenomena of aerobic training; the impulse oscillometry method, allowing the assessment of small airways and lung periphery in addition to standard lung function testing, might be a useful addition to rehabilitation programs. Background/Objectives: This study aimed [...] Read more.
Limited data exist on the underlying physiological phenomena of aerobic training; the impulse oscillometry method, allowing the assessment of small airways and lung periphery in addition to standard lung function testing, might be a useful addition to rehabilitation programs. Background/Objectives: This study aimed to determine the immediate effect of a structured low-intensity aerobic training program on small airway function in healthy volunteers to explore potential implications for long-term COPD care. Methods: Thirty-six healthy volunteers were recruited between May 2024 and January 2025; each participant underwent a lung function testing session, followed by low/moderate-intensity aerobic exercise, and, after 15 min, by a second impulse oscillometry assessment. Results: There was a statistically significant reduction in airway resistance following the physical exertion for the whole group (mean difference 0.03 kPa/L/s, 95%CI 0–0.6 kPa/L/s); significantly lower values were recorded for the reactance component X5 (0.02 kPa/L/s, 95%CI 0–0.4 kPa/L/s) for the normal weight subgoup (n = 24). These results, corroborated with literature data, suggest optimization of the distribution of the airflow and possibly alteration of the elastic properties of the thoracic structures following even low-intensity effort. Conclusions: Low-intensity upper body strength and aerobic training seem to have an immediate respiratory beneficial effect on healthy volunteers manifested as a reduction in airway resistance. The underlying mechanism might be related to improved contractility of respiratory muscles, but changes in lung parenchyma elasticity may also be involved, possibly reflecting modifications of ventilation heterogeneity. Impulse oscillometry may be superior to spirometry in monitoring the effects of aerobic training, considering the additional data it provides, and could be used to optimize and personalize rehabilitation protocols. Full article
(This article belongs to the Special Issue Chronic Lung Conditions: Integrative Approaches to Long-Term Care)
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23 pages, 715 KiB  
Article
SMART Multi-Criteria Decision Analysis (MCDA)—One of the Keys to Future Pandemic Strategies
by Gianina-Valentina Băcescu Ene, Mirela-Anca Stoia, Cristian Cojocaru and Doina Adina Todea
J. Clin. Med. 2025, 14(6), 1943; https://doi.org/10.3390/jcm14061943 - 13 Mar 2025
Viewed by 2005
Abstract
Background/Objectives: The COVID-19 pandemic underscored the need for adaptive public health strategies and effective decision-making tools to optimize clinical responses and policy measures based on regional contexts. This study aims to identify key criteria for developing a patient-centered strategy to enhance the resilience [...] Read more.
Background/Objectives: The COVID-19 pandemic underscored the need for adaptive public health strategies and effective decision-making tools to optimize clinical responses and policy measures based on regional contexts. This study aims to identify key criteria for developing a patient-centered strategy to enhance the resilience of Romania’s healthcare system during the pandemic. Methods: This research introduces a Multi-Criteria Decision Analysis (MCDA) model using the Simple Multiple Attribute Assessment Technique (SMART) to integrate quantitative and qualitative data, providing decision-makers with a structured tool for improving healthcare resilience. A survey of 412 Romanian healthcare professionals identified critical risks and opportunities. The study followed a two-phase approach: first, analyzing expert perceptions to determine key challenges; second, applying a mixed-methods evaluation to prioritize resilience-building strategies. Results: Four main challenges emerged: (1) healthcare workforce shortages causing excessive workload and stress, (2) poor communication and systemic inefficiencies limiting patient access, (3) weak crisis management due to delayed control measures, and (4) regulatory gaps leading to fragmented responses. Proposed solutions included workforce training, improved communication, telemedicine integration, increased financial support, and a unified legal framework. The SMART method facilitated the structured prioritization of these measures, with long-term system sustainability emerging as the most effective strategy for preventing future crises. Conclusions: This study demonstrates the value of integrating MCDA into healthcare decision-making, offering a scalable model for policymakers to enhance crisis response and resource allocation. By incorporating expert insights and patient needs, the proposed framework strengthens healthcare system preparedness, contributing to informed, patient-centered decision-making and long-term resilience. Ultimately, our findings not only contribute to the existing literature but may also open new directions to facilitate informed, patient-centered decision making, thereby strengthening the resilience of healthcare systems in crisis situations. Full article
(This article belongs to the Special Issue Chronic Lung Conditions: Integrative Approaches to Long-Term Care)
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14 pages, 1573 KiB  
Article
Metabolic Disturbances Associated with In-Hospital Complication and Mortality in Different Types of Pneumonia
by Iulia Făgărășan, Adriana Rusu, Horațiu Comșa, Maria Cristea, Nicoleta-Ștefania Motoc, Ciprian Cristea, Corina Eugenia Budin, Ruxandra-Mioara Râjnoveanu and Doina Adina Todea
J. Clin. Med. 2024, 13(24), 7832; https://doi.org/10.3390/jcm13247832 - 22 Dec 2024
Viewed by 946
Abstract
Bakground: The mortality rate from community-acquired pneumonia (CAP) or coronavirus disease 19 (COVID-19) is high, especially in hospitalized patients. This study aimed to assess the disturbances of glucose and lipid metabolism with in-hospital complications and short-term outcomes for patients with pneumonia with different [...] Read more.
Bakground: The mortality rate from community-acquired pneumonia (CAP) or coronavirus disease 19 (COVID-19) is high, especially in hospitalized patients. This study aimed to assess the disturbances of glucose and lipid metabolism with in-hospital complications and short-term outcomes for patients with pneumonia with different etiologies. Methods: This observational study comprised 398 patients divided as follows: 155 with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, 129 participants with viral CAP, and 114 with bacterial pneumonia. Results: Fasting plasma glucose (FPG) at admission and glycemic variation during hospitalization was linked with acute kidney injury (AKI) in bacterial CAP. Compared with a value <110 mg/dL for FPG at admission, levels between 110 and 126 mg/dL are associated with mortality in both COVID-19 (OR = 3.462, 95% CI: 1.275–9.398, p = 0.015) and bacterial CAP participants (OR = 0.254; 95% CI: 0.069–0.935, p = 0.039), while a value ≥126 mg/dL was linked with mortality only in patients with SARS-CoV-2 (OR = 3.577, 95% CI: 1.166–10.976, p = 0.026). No relation between lipid biomarkers and complications or in-hospital outcomes was observed in all three participant groups. Conclusions: Patients with bacterial CAP are more prone to developing AKI due to increased FBG at admission and glycemic variations during hospitalization, while elevated FBG values at admission are associated with mortality in both COVID-19 and bacterial CAP. Full article
(This article belongs to the Special Issue Chronic Lung Conditions: Integrative Approaches to Long-Term Care)
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Review

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19 pages, 967 KiB  
Review
Hematologic and Immunologic Overlap Between COVID-19 and Idiopathic Pulmonary Fibrosis
by Gabriela Mara, Gheorghe Nini, Stefan Marian Frenț and Coralia Cotoraci
J. Clin. Med. 2025, 14(15), 5229; https://doi.org/10.3390/jcm14155229 - 24 Jul 2025
Viewed by 341
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease characterized by chronic inflammation, vascular remodeling, and immune dysregulation. COVID-19, caused by SARS-CoV-2, shares several systemic immunohematologic disturbances with IPF, including cytokine storms, endothelial injury, and prothrombotic states. Unlike general comparisons of viral [...] Read more.
Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease characterized by chronic inflammation, vascular remodeling, and immune dysregulation. COVID-19, caused by SARS-CoV-2, shares several systemic immunohematologic disturbances with IPF, including cytokine storms, endothelial injury, and prothrombotic states. Unlike general comparisons of viral infections and chronic lung disease, this review offers a focused analysis of the shared hematologic and immunologic mechanisms between COVID-19 and IPF. Our aim is to better understand how SARS-CoV-2 infection may worsen disease progression in IPF and identify converging pathophysiological pathways that may inform clinical management. We conducted a narrative synthesis of the peer-reviewed literature from PubMed, Scopus, and Web of Science, focusing on clinical, experimental, and pathological studies addressing immune and coagulation abnormalities in both COVID-19 and IPF. Both diseases exhibit significant overlap in inflammatory and fibrotic signaling, particularly via the TGF-β, IL-6, and TNF-α pathways. COVID-19 amplifies coagulation disturbances and endothelial dysfunction already present in IPF, promoting microvascular thrombosis and acute exacerbations. Myeloid cell overactivation, impaired lymphocyte responses, and fibroblast proliferation are central to this shared pathophysiology. These synergistic mechanisms may accelerate fibrosis and increase mortality risk in IPF patients infected with SARS-CoV-2. This review proposes an integrative framework for understanding the hematologic and immunologic convergence of COVID-19 and IPF. Such insights are essential for refining therapeutic targets, improving prognostic stratification, and guiding early interventions in this high-risk population. Full article
(This article belongs to the Special Issue Chronic Lung Conditions: Integrative Approaches to Long-Term Care)
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