Search Results (4,971)

Background: Obstructive sleep apnea (OSA) is common in individuals with obesity, largely due to increased soft tissue causing upper airway narrowing. However, mechanisms of OSA improvement following weight loss are incompletely understood, particularly in Asian population, where craniofacial and soft tissue characteristics differ. This study aimed to evaluate changes in upper airway anatomy before and six months after bariatric surgery. Methods: We prospectively evaluated Indian obese patients with OSA undergoing bariatric surgery. Magnetic resonance imaging (MRI) and polysomnography were performed at baseline and six months post-surgery to assess volumetric changes in upper airway structures and the apnea–hypopnoea index (AHI), respectively. Correlations between MRI-derived structural changes, weight loss, and AHI were also analyzed. Results: Ten obese patients with OSA were included. Bariatric surgery resulted in significant reductions in body weight, body mass index (BMI), Epworth Sleepiness Scale score, and AHI (p < 0.05). MRI demonstrated a significant reduction in overall pharyngeal soft tissue volume, soft palate, pterygoid and parapharyngeal fat pad volume and tongue fat fraction. However, no significant changes were observed in total upper airway volume, retroglossal and retropalatal airway volume. Furthermore, no significant correlation was noted between changes in upper airway anatomy and post-operative changes in AHI or body weight. Conclusions: Bariatric surgery was associated with significant weight loss and improvement in OSA severity, accompanied by reduction in soft tissue volumes without significant increase in airway volume in this pilot study. These findings suggest a possible role of factors other than structural airway changes in the observed improvement in OSA following bariatric surgery. Full article

Exposure to air pollution is linked to adverse health outcomes. To better reflect real-world conditions, we employed a mobile exposure system enabling direct field exposure of the human airway epithelial model MucilAir™ to ambient air in a traffic-burdened locality. This study represents a follow-up to our previous work, in which a 5-day exposure period under extreme traffic-related pollution conditions resulted in premature cell loss. Under different meteorological conditions characterized by increased precipitation and lower particle number concentrations, MucilAir™ cultures were exposed to traffic-polluted air for 2 days. The exposure resulted in a mild but significant increase in cytotoxicity markers, including lactate dehydrogenase release and elevated levels of 15-F_2t-isoprostane, indicating induction of the cellular stress response rather than severe cytotoxicity. A transcriptomic analysis revealed extensive gene expression changes; the enrichment of the pathways related to polycyclic aromatic hydrocarbon detoxification and amino acid biosynthesis suggests adaptive metabolic responses to oxidative and genotoxic stress. In parallel, the pathways associated with epithelial proliferation and repair, extracellular matrix organization, focal adhesion, and immune signaling were suppressed, indicating potential disruption of the epithelial homeostasis. Overall, these findings demonstrate that 2 days of exposure to real-world traffic-polluted air elicits adaptive stress responses in airway epithelial cells while simultaneously impairing the processes essential for epithelial integrity, potentially leading to airway dysfunction. Full article

Background/Objectives: Orofacial myofunctional therapy (OMT) is a system of targeted neuromuscular exercises and behavioral retraining intended to optimize tongue, lip, jaw, and airway function during rest, breathing, swallowing, and sleep. Historically associated with tongue thrust and abnormal swallowing, OMT is now applied across an expanding range of clinical contexts, including sleep-disordered breathing (SDB), tongue-tie rehabilitation, orthodontic stability, and perioperative functional recovery. As its use has broadened, persistent questions have followed: what is myofunctional therapy, where did it originate, and how did a set of oral exercises evolve into an intervention increasingly integrated with airway health, sleep medicine, and surgical care? Methods: This article presents a narrative historical review with a perspective component, synthesizing foundational literature, interdisciplinary contributions, and selected contemporary evidence to examine the evolution of OMT from ancient functional practices to modern clinical science. It is written to trace recurring clinical observations, shifts in educational frameworks, and key inflection points that shaped how OMT has been taught and applied over time. Results: OMT did not emerge from randomized controlled trials or standardized protocols. It arose from repeated clinical encounters with patients with atypical craniofacial development, relapse of structural correction, persistent mouth breathing, and/or unresolved swallowing and speech dysfunction despite technically successful treatment. These patterns suggested that anatomy alone could not account for outcome variability. Over time, clinical attention expanded beyond isolated tongue function to include breathing patterns, posture, neuromuscular tone, and airway behavior. In the past two decades, controlled trials, cohort studies, and systematic reviews have supported selected applications of OMT, particularly in SDB and adjunctive airway care, while also revealing ongoing challenges related to training variability, terminology, scope of practice, and standardization. Conclusions: OMT has historically been described as a system of targeted neuromuscular and behavioral interventions aimed at modifying orofacial rest posture and function. Over time, the field has expanded beyond localized muscle retraining toward a broader functional framework that integrates airway physiology, craniofacial growth, sleep, and interdisciplinary rehabilitation. Full article

Background/Objectives: The airway epithelium plays a central role in host defense, inflammatory signaling, and disease progression across infectious, inflammatory, and genetic respiratory disorders. Human nasal epithelial organoids have emerged as accessible and patient-specific in vitro platforms with increasing translational relevance. This systematic review aimed to critically evaluate the current evidence on nasal epithelial organoid models, focusing on donor characteristics, culture methodologies, differentiation strategies, and translational applications. Methods: A systematic search of PubMed/MEDLINE, Embase, Scopus, Ovid MEDLINE, and Cochrane Library was conducted for studies published between 1990 and April 2026. The review followed PRISMA guidelines and was structured according to the PICOTS framework. Eligible studies included in vitro experimental investigations using human-derived nasal epithelial organoids in infectious, inflammatory, or precision medicine contexts. Risk of bias was assessed using the QUIN tool. Results: Seventeen studies met the inclusion criteria. Applications clustered into three principal domains: infectious disease modeling, inflammatory and epithelial remodeling research, and cystic fibrosis precision medicine. Most studies employed expandable three-dimensional Matrigel-embedded organoids or organoid-derived air–liquid interface systems. Infection-focused studies demonstrated variant-specific viral replication dynamics and epithelial immune responses, while inflammatory models reproduced disease-associated differentiation and remodeling phenotypes. Cystic fibrosis oriented studies showed that organoid swelling and electrophysiological assays correlate with CFTR functional rescue and, in selected cases, clinical response. Methodological heterogeneity across protocols and outcome reporting precluded quantitative synthesis. Conclusions: Human nasal epithelial organoids represent versatile translational platforms bridging accessible patient-derived tissue and advanced airway disease modeling. Although variability in culture protocols and functional benchmarks limits standardization, these models hold significant promise for mechanistic investigation, therapeutic stratification, and precision medicine applications. Full article

Background and Objectives: Patients with obesity undergoing laparoscopic bariatric surgery face elevated perioperative pulmonary risk due to impaired respiratory mechanics, reduced functional residual capacity, and pneumoperitoneum-induced atelectasis. Intraoperative changes in intra-abdominal pressure and surgical positioning substantially alter respiratory mechanics, yet studies evaluating repeated PEEP titration at multiple intraoperative time points remain limited. This study aimed to determine whether dynamic compliance-guided individualized PEEP titration, applied at three distinct intraoperative stages, reduces postoperative pulmonary aeration loss compared to fixed 8 cmH₂O PEEP. Methods: In this single-center randomized controlled trial with blinded outcome assessment, 70 patients with obesity (BMI ≥ 35 kg/m²) undergoing laparoscopic bariatric surgery were randomized 1:1 to the CDYN group (dynamic compliance-guided PEEP titration at T1: post-induction, T2: during pneumoperitoneum, T3: post-deflation; n = 35) or the PEEP8 group (fixed PEEP 8 cmH₂O; n = 35). The primary outcome was the modified lung ultrasound score (mLUSS), assessed 30 min after PACU arrival by a blinded investigator (ClinicalTrials.gov: NCT06994780). Results: Total mLUSS was significantly lower in the CDYN group (2.20 ± 1.16 vs. 5.80 ± 2.14; p < 0.001), with significant differences in both hemithoraces. The PaO₂/FiO₂ ratio at PACU was significantly higher in the CDYN group (425.11 ± 127.13 vs. 311.65 ± 92.59 mmHg; p < 0.001), and the supplemental oxygen requirement was significantly lower (p = 0.001). Dynamic compliance was consistently higher throughout surgery (all p < 0.001) without differences in airway pressures or hemodynamics. Conclusions: Dynamic compliance-guided individualized PEEP titration, applied at three intraoperative stages, significantly reduces early postoperative pulmonary aeration loss and improves oxygenation in patients with obesity undergoing laparoscopic bariatric surgery, without increasing barotrauma risk or hemodynamic instability. Full article

Background and Objectives: Adherence to positive airway pressure (PAP) is often suboptimal, and current monitoring relies on device logs that, by design, cannot detect respiratory events outside the therapy window. This creates a physiological blind spot during periods of non-usage. This study aimed to demonstrate the clinical necessity of independent, continuous monitoring using a smartphone-based home sleep apnea test (S-HSAT) by validating treatment effectiveness on adherent nights and quantifying the untreated apnea burden caused by partial adherence. Methods: We prospectively monitored 63 obstructive sleep apnea (OSA) patients commencing PAP therapy. Nightly apnea–hypopnea index (AHI) and usage time were recorded simultaneously by an S-HSAT (ApnoTrack) and the PAP device over a 30-day period. Nights were categorized by the duration discrepancy between S-HSAT and PAP (full-use, ≤5 min; intermediate-use, 5–30 min; partial-use, >30 min) using physiologically and operationally derived thresholds. Results: Final analysis included 39 participants contributing 667 nights (24 participants excluded due to non-use of one or both devices). Full-use nights (46.2%) showed close agreement between S-HSAT and PAP mean AHI (2.8 ± 4.3 vs. 2.5 ± 2.0 events/h; p = 0.13). On intermediate-use and partial-use nights (20.7% and 33.1%, respectively), substantial AHI discrepancies emerged (7.3 ± 5.5 vs. 3.8 ± 3.3 and 11.0 ± 7.4 vs. 2.8 ± 2.5 events/h, respectively; both p < 0.001). Conclusions: Independent S-HSAT monitoring quantified an untreated apnea burden that is invisible to PAP logs alone, while confirming therapeutic efficacy on well-adherent nights. These findings suggest that continuous independent monitoring may help bridge the gap between prescribed therapy and actual physiological outcomes in OSA care. Full article

Bronchopulmonary dysplasia (BPD) remains a major complication of extreme prematurity, driven in part by persistent inflammation. Interleukin (IL)-1–mediated signaling plays a central role in sustaining lung injury, making IL-1 blockade a potential therapeutic target. Evidence on the use of anakinra, a recombinant IL-1 receptor antagonist, in neonatal BPD is still limited. We report the case of a female preterm infant (28⁺² weeks’ gestation, birth weight 800 g, −1.41 zs) affected by BPD requiring prolonged respiratory support. Due to persistent respiratory failure despite standard therapies, off-label treatment with subcutaneous anakinra (5 mg/kg twice daily) was initiated at 150 days of life. Clinical respiratory parameters and exploratory salivary inflammatory biomarkers (IL-6 and soluble urokinase plasminogen activator receptor, suPAR) were longitudinally monitored. Following anakinra initiation, the patient showed a gradual improvement in respiratory parameters, with reduction in oxygen requirement, mean airway pressure, and improved gas exchange. Respiratory support was gradually de-escalated from nasal intermittent positive pressure ventilation to continuous positive airway pressure and subsequently to high-flow nasal cannula. Salivary suPAR levels demonstrated a decreasing trend, while IL-6 showed transient fluctuations, partly associated with intercurrent infections. Treatment was generally well tolerated during the observation period. The infant was discharged on minimal respiratory support, with continued improvement during follow-up. This case suggests a possible role of IL-1 blockade in the modulation of persistent inflammation in BPD with a refractory clinical course, although the observed clinical course may also reflect the natural evolution of the disease. Longitudinal salivary biomarkers may represent a feasible, exploratory, non-invasive approach to describe inflammatory dynamics over time. Larger prospective studies are needed to evaluate the efficacy, safety, and optimal treatment protocols of anakinra. Full article

Background and Aims: This study investigates the feasibility of performing anorectal surgery in neonates in a prone position via epidural anesthesia and sedation without an instrumented airway. Methods: Twenty infants, scheduled for surgery for anorectal malformations, were included in this study. The primary endpoint was the success of the anesthesia method without invasive airway manipulation after skin incision, and secondary endpoints were defined as the need for additional opioids or sedation drugs during the perioperative period. The study was approved by the Ethics Committee of the Medical University of Vienna (ref. 1133/2017—approval date 24 August 2017), and was registered in the German Clinical Trial Register (DRKS ID: DRKS00012683, approval date 15 July 2019, updated 30 July 2020). Results: The primary outcome parameter could be achieved in 95% of the cases, and 85% of the cases could be managed without additional opioids (secondary outcome parameter). Only one infant (5%) needed endotracheal intubation due to laryngospasm during prone positioning. Conclusions: Surgery for infantile anorectal malformations in a prone position is possible with epidural anesthesia and sedation without an instrumented airway. Full article

Global climate change and air pollution jointly threaten respiratory health. Asthma, a prevalent chronic inflammatory airway disease, is exacerbated by both traditional air pollutants such as particulate matter (PM_2.5), ozone (O₃), nitrogen dioxide (NO₂), sulfur dioxide (SO₂) and emerging contaminants like microplastics (MPs) and per- and polyfluoroalkyl substances (PFAS), with effects amplified under extreme temperature conditions. In reality, individuals face complex combined exposures, yet the synergistic effects of these factors on asthma pathogenesis remain poorly understood. This narrative review synthesizes epidemiological and toxicological evidence. It aims to elucidate both the individual and the notably synergistic effects of these factors on asthma pathogenesis. The central mechanistic pathway is initiated by oxidative stress, which activates key inflammatory signaling pathways, thereby driving immune imbalance and airway inflammation. Our review underscores that the combined exposure to traditional pollutants, emerging pollutants, and extreme temperatures may pose a greater threat than individual factors. These findings underscore the critical need for an integrated perspective in asthma research and public health policy. Moving beyond single-pollutant approaches, we advocate for combinatorial risk assessment and synergistic intervention strategies to effectively mitigate the growing burden of asthma in a changing climate. Full article

Background/Objectives: Respiratory dysfunction in Parkinson’s disease (PD) is a clinically relevant but frequently underrecognized manifestation associated with functional impairment and increased risk of respiratory complications. This study compared spirometry and impulse oscillometry (IOS) in the assessment of respiratory function in PD, with particular focus on the detection of subtle or peripheral airway abnormalities. Methods: A prospective, single-center, cross-sectional study was conducted, including 108 participants (55 patients with PD and 53 control subjects). Pulmonary function was evaluated using standardized spirometry and IOS protocols. Group comparisons were performed using non-parametric tests, while multivariable regression analyses adjusted for potential confounding factors, including age, body mass index, smoking status, pollutant exposure, and cardiovascular comorbidities. Results: IOS identified a higher frequency of abnormal categorical findings compared with spirometry, including among subjects with normal spirometric values. Although dyspnea was more frequent in patients with PD in unadjusted analyses, multivariable regression demonstrated that PD was not an independent predictor of respiratory dysfunction. Pollutant exposure was significantly associated with abnormal IOS findings (p = 0.011). No significant differences were observed between PD and control groups regarding continuous spirometric or oscillometric parameters. Only a weak association between disease severity and FEV1 (%) was identified, whereas no significant correlations were observed for oscillometric parameters. Conclusions: IOS may provide complementary information regarding subtle or peripheral respiratory abnormalities in patients with PD. The findings suggest that respiratory alterations in this population are likely multifactorial and not independently determined by PD itself. Incorporating oscillometric assessment into respiratory evaluation may contribute to the identification of subtle respiratory mechanical alterations in patients with PD. Full article

Background/Objectives: Small airway dysfunction (SAD) may occur early in children with Mycoplasma pneumoniae pneumonia (MPP), but pulmonary function testing is often deferred until clinical stabilization and may be limited by poor cooperation. Early risk stratification may therefore help identify children who warrant further testing. We aimed to identify early predictors of subsequent spirometry-defined SAD and to develop an internally validated risk-stratification model in hospitalized children with MPP. Methods: In this single-center retrospective cohort study conducted between July 2022 and July 2024, 172 hospitalized children with confirmed MPP were included. Clinical characteristics, immune-inflammatory indices, and chest computed tomography (CT) findings were collected during early hospitalization. Pulmonary function testing was performed after clinical stabilization, and SAD was defined as at least two of forced expiratory flow at 25%, 50%, and 75% of forced vital capacity being <65% of predicted values. Multiple imputation, LASSO selection, and multivariable logistic regression were used for model development and bootstrap internal validation. Results: SAD was identified in 76/172 children (44.2%). Wheezing, CT evidence of small airway involvement, and higher soluble interleukin-2 receptor levels were more common in children with SAD; wheezing remained independently associated with SAD. A model based on routine clinical and chest CT variables showed good discrimination (AUC, 0.885; optimism-corrected AUC, 0.869). Adding interleukin-17 provided limited incremental value. Conclusions: SAD was common in hospitalized children with MPP. An internally validated model based on readily available clinical and chest CT variables may help prioritize children for pulmonary function testing after clinical stabilization, whereas interleukin-17 added limited predictive value. External validation is required before broader clinical application. Full article

Background: Non-invasive respiratory supports (High-Flow Nasal Oxygen, HFNO; Continuous Positive Airway Pressure, CPAP; Non-Invasive Ventilation, NIV) are frequently used in Acute Hypoxemic Respiratory Failure (AHRF). However, the experience of assisted breathing may profoundly affect patients’ psychological balance, particularly during acute critical illness and subsequent rehabilitation. Aims and objectives: This longitudinal study investigated the psychological burden associated with non-invasive respiratory support use in patients with COVID-19-related AHRF, exploring changes in psychological functioning from acute hospitalization (RICU/ICU) (T0) to follow-up, conducted at a mean of 6.0 ± 3.1 months after respiratory rehabilitation (T1). Methods: Fifty-two patients (mean age = 66.9 ± 9.17 years) were assessed at T0 and T1. Standardized measures evaluated anxiety, psychological distress, post-traumatic stress symptoms, depression, and resilience, in relation to perceived illness severity and subjective experience of non-invasive respiratory support. Results: During acute care, patients reported high levels of fear and anxiety related to illness severity and uncertainty. The experience of non-invasive respiratory support, often perceived as a marker of critical condition, was associated with increased fear and anxiety (t(14) = 2.79, p = 0.014) compared to the recovery phase, leading to feelings of loss of control and diminished psychological well-being (t(17) = 2.35, p = 0.031). However, resilience significantly improved over time (t(16) = −4.78, p < 0.001). Conclusions: Non-invasive respiratory support may represent a psychologically demanding experience, often perceived as challenging to patients’ sense of safety and control. Encouragingly, psychological adaptation and resilience can improve during rehabilitation. Integrating structured psychological support within respiratory rehabilitation pathways may promote recovery and restore psychological balance in patients requiring assisted ventilation. Full article

Obstructive sleep apnea (OSA) is a sleep-disordered breathing condition characterized by recurrent upper-airway obstruction, leading to intermittent hypoxemia, sleep fragmentation, and sympathetic activation. OSA is highly prevalent in patients with cardiovascular diseases and is strongly associated with hypertension, atrial fibrillation, coronary artery disease, heart failure, and adverse prognosis. This review summarizes current evidence on the pathophysiology of OSA, its cardiovascular consequences, and available diagnostic and therapeutic strategies, with particular attention to clinical implications in cardiology practice. We discuss established treatments such as lifestyle interventions, continuous positive airway pressure, mandibular advancement devices, and selected surgical options, as well as emerging therapies, including pharmacological approaches targeting weight loss and ventilatory control. While OSA treatment improves symptoms and quality of life, evidence for cardiovascular event reduction remains heterogeneous and appears strongly influenced by patient selection and treatment adherence. Identifying patients most likely to benefit from targeted OSA management remains a key challenge. Full article

Aspergillosis encompasses a heterogeneous spectrum of diseases caused by filamentous fungi of the genus Aspergillus, ranging from allergic airway disorders and chronic pulmonary infection to rapidly progressive invasive disease. Aspergillus fumigatus is the predominant pathogen worldwide, although other species, including Aspergillus flavus, Aspergillus terreus and cryptic species, contribute to morbidity and may exhibit intrinsic or acquired antifungal resistance. Early and accurate laboratory diagnosis is essential for timely treatment, appropriate antifungal selection, and stewardship. Traditional culture remains foundational, enabling confirmation of viable organisms, species-level identification, and antifungal susceptibility testing, but sensitivity is limited and turnaround times are prolonged. Non-culture approaches—including galactomannan, β-D-glucan, lateral flow assays, PCR, and next-generation sequencing—enhance diagnostic sensitivity, facilitate early detection, and allow identification of resistance-associated mutations. Optimal diagnostic performance is achieved through integrated, multimodal strategies combining laboratory tests with clinical and radiological findings. In invasive disease, concurrent use of biomarkers and molecular assays improves specificity and positive predictive value, while in allergic bronchopulmonary aspergillosis, immunological markers remain central. Future directions include standardised molecular protocols, novel antigenic and host-based biomarkers, and cost-effective, risk-adapted diagnostic algorithms to refine detection, guide therapy, and improve patient outcomes. Full article

Cystic fibrosis (CF) lung disease is characterized by chronic infection and progressive airway damage, driven by interactions between epithelial dysfunction, immune dysregulation, and microbial adaptation. Defective cystic fibrosis transmembrane conductance regulator (CFTR) function disrupts airway hydration and mucociliary clearance, creating a microenvironment that facilitates infection, particularly with Pseudomonas aeruginosa (P. aeruginosa). Within this environment, P. aeruginosa undergoes adaptive changes, including biofilm formation and metabolic reprogramming, which support long-term survival in the airway. Concurrently, host immune responses become dysregulated, with ineffective bacterial clearance and sustained neutrophil-dominated inflammation contributing to tissue injury. These processes establish a self-reinforcing cycle that drives disease progression. Importantly, early infection represents a critical therapeutic window during which bacterial populations remain more amenable to eradication before irreversible airway remodeling occurs. Delayed intervention promotes transition to a more treatment-refractory state and accelerates disease progression. Despite the clinical benefits of CFTR modulators, airway damage and established infections often remain. The relative contributions and interactions of epithelial dysfunction, immune dysregulation, and bacterial adaptation in sustaining chronic infection remain incompletely defined, representing a key knowledge gap. In this context, this review aims to integrate current evidence on host–pathogen co-adaptation in CF lung disease, with a particular focus on P. aeruginosa, and highlight emerging therapeutic strategies. Full article