Medicine and Pharmacology

Abstract: SRBD encompasses a spectrum of diseases that disrupt ventilation during sleep, that lead to fragmented sleep and impaired gas exchange. Their high prevalence and substantial neurocognitive and mental health outcomes make SRBD clinically significant across multiple medical disciplines. Traditional management includes lifestyle modifications and PAP. When non-surgical measures fail or anatomical factors predominate, a range of surgical approaches may be employed, such as UPPP or MMA. There are many notable emerging surgical advancements, such as hypoglossal nerve stimulation, transoral robotic surgery, and minimally invasive radiofrequency technologies that have offered improved outcomes for select patients. There are evolving advances in diagnostic tools, such as portable home sleep technologies and drug-induced sleep endoscopy, that further support precision-based care. Collectively, the expanding range of therapeutic and diagnostic innovations is enabling clinicians to deliver individualized care and improve long-term outcomes for patients with SRBD.

Abstract: Background/Objectives: Recent trends show a rising incidence of venous thromboembolism (VTE) that does not correlate with increased mortality; however, population aging and the proliferation of comorbidities are fundamentally reshaping the VTE patient landscape. The aim of this study is to evaluate potential differences in clinical characteristics, comorbidities, and survival rates between patients diagnosed with pulmonary embolism (PE) during the pre-pandemic period (2018−2019) and those diagnosed during the pandemic era (2020−2022). Additionally, as a secondary objective, we analyze the clinical profiles, risk factors, and survival outcomes of patients with and without COVID-19 infection during the 2020−2022 period. Methods: A retrospective observational study was conducted to analyse survival and comorbidities in patients admitted for PE at the Hospital Central de la Defensa ‘Gómez Ulla’ between 2018 and 2022, comparing two periods (2018−2019 and 2020−2022). In addition, a sub-analysis was performed within the second period group comparing patients with and without COVID-19. Results: It was observed that the majority of patients in the first period were men, while in the second period, 55% were women. With regard to comorbidity and risk factors, thrombophilia and dementia were more prevalent in the first period, while immobilization, a history of asthma, autoimmune diseases and infections were more prevalent in the second period. No differences were found with regard to mortality. Conclusions: Significant differences were observed between the two periods of the study with regard to age, gender, and some comorbidities. Patients with COVID-19 showed a greater tendency toward immobilization and a higher prescription of thromboprophylaxis during hospitalisation.

Abstract: Background: Continuous positive airway pressure (CPAP) is the primary treatment for Obstructive Sleep Apnea (OSA). Despite improvements in CPAP technology and management, adherence to therapy remains one of the main issues to be fixed. Methods: We conducted a narrative review through PubMed (1995-2025). Studies were selected by clinical relevance, methodological quality and expert consensus. Results: OSA treatment outcomes are poor when CPAP adherence is defined as four hours per night. The first step in improving adherence is active patient involvement. This involves explaining what OSA is, its consequences, what PAP therapy is, and its potential benefits. The right mask should be chosen for each patient; a nasal mask should be the first choice according to the Starling resistor model. OSA endotype and phenotype traits could be used to predict adherence, guide adjunct therapy, or suggest titration. Problems during the first night and the first month are the main predictors of future adherence. Strategies such as cognitive behavioral therapy or motivational enhancement can improve adherence, especially during the initial period. Long-term adherence can be predicted by the initial one and maintained with scheduled follow-up. Group meetings, telephone calls and telemedicine interactions are also a valid way of improving adherence. Conclusions: A Patients should initially be educated about how their symptoms are related to sleep apnoea and how CPAP treatment could resolve them. The key to improving CPAP adherence is to involve patients in personalised treatment with scheduled follow-up, particularly during the initial treatment period.

Abstract: Chikungunya virus (CHIKV), traditionally recognized as a mosquito-borne alphavirus that causes febrile illness and debilitating arthralgia, has increasingly been associated with atypical organ involvement, including respiratory manifestations. These observations raise important questions regarding whether respiratory symptoms reflect severe systemic disease or signal previously underappreciated respiratory exposure routes. This review aimed to synthesize current evidence on respiratory complications of CHIKV infection and to evaluate the plausibility of respiratory or aerosol-associated transmission. A systematic literature search of PubMed, EMBASE, and MEDLINE (Ovid) identified five eligible studies spanning clinical virology, outbreak surveillance, epidemiology, and experimental aerosol models. Across human studies conducted in India, Réunion Island, Puerto Rico, and Brazil, respiratory presentations—including pneumonia, dyspnea, and respiratory failure—were uncommon but consistently associated with increased hospitalization and mortality risk. Respiratory symptoms generally arose in the context of respiratory viral coinfections, systemic inflammation, or cardiopulmonary decompensation rather than primary viral tropism for the respiratory tract. Only one non-human primate study directly evaluated aerosol exposure, demonstrating that cynomolgus macaques could be infected via inhaled CHIKV, confirming biological plausibility but showing no evidence of enhanced respiratory pathology. Importantly, no epidemiologic data support human-to-human airborne or droplet transmission. Collectively, available evidence indicates that respiratory involvement serves as a marker of disease severity rather than a transmission route. Nonetheless, rare aerosol-acquisition events in laboratory settings underscore the need for continued vigilance, strengthened surveillance, and re-evaluation of respiratory risks as climate change and viral evolution expand CHIKV’s global footprint.

Abstract: Background and Objectives: We aimed to analyze the screening accuracy of the STOP and STOP-Bang questionnaires within three distinct populations from the Mediterranean region: Croatia, Greece, and Türkiye. Additionally, we aimed to optimize previously suggested and to establish population-specific cut-off points for body mass index (BMI) and neck circumference (NC) in the questionnaires to enhance their screening accuracy. Materials and Methods: A total of 9,102 patients who underwent polysomnography or polygraphy to evaluate suspected OSA were enrolled from: Split Sleep Medicine Centre (Croatia), Ege University Faculty of Medicine (Türkiye), and Thessaloniki G Papaniko-laou Hospital Aristotle University (Greece). Patients completed the STOP and STOP-Bang questionnaires before sleep assessments. Sensitivity, specificity, and area under the curve (AUC) were calculated to assess the screening properties. Additionally, optimized cut-offs for age, NC, and BMI were determined. Results: The highest AUC values were observed using the STOP-Bang≥5 method, with AUC values of 0.712 for detecting any OSA (AHI≥5/h), 0.684 for moderate or severe OSA (AHI≥15/h), and 0.663 for severe OSA (AHI≥30/h). For individual centers, the STOP-Bang≥5 method performed best in Split, while the STOP≥2+NC method yielded the highest AUCs in Izmir and Thessaloniki for moderate and severe OSA. Optimized cut-off values for age, NC, and BMI improved sensitivity and specificity across all cen-ters. Conclusions: This study highlights the necessity of population-specific considerations in the screening of OSA. Significant differences in demographics, anthropometrics, symptoms, and comorbidities across populations could impact the questionnaire's screening accuracy. Adjusting age, NC, and BMI cut-off points optimizes the STOP-Bang questionnaire.

Abstract: Acute respiratory failure (ARF) often leads to ICU admission, ventilatory support, illness, and death. The usual classification into hypoxemic and hypercapnic types does not capture its full complexity. Precision medicine uses the idea of “treatable traits” to guide care based on traits that are clinically relevant, identifiable, measurable, and possibly changeable. Arterial carbon dioxide pressure (PaCO₂) reflects factors like alveolar ventilation, dead space, respiratory mechanics, and how patients respond to ventilatory support. This makes it a clinically relevant variable in selected situations in certain situations. We carried out a scoping review using PRISMA-ScR and JBI guidelines (OSF post hoc protocol https://osf.io/vszkg) to summarize evidence on hypocapnia and hypercapnia as prognostic, stratification, or clinically relevant variables during respiratory support. We searched PubMed/MEDLINE, ScienceDirect, and Web of Science (1994–2025), and checked references by hand. Thirty-four studies met our criteria and were grouped into four areas: pre-intubation or early acute presentation, non-invasive support (NIV/HFNC), invasive mechanical ventilation, and weaning or post-extubation. In summary, hypocapnia was linked to worse outcomes or failure of support in hypoxemic or cardiogenic cases. Hypercapnia helped identify patients who benefited from NIV, such as those with COPD or obesity-hypoventilation. For invasive mechanical ventilation, the effects depended on the presence and severity of acidosis and how long it lasted. We found that PaCO₂ is measurable and clinically important, but whether it can be targeted for treatment depends on the situation. More research is needed to set safe limits and practical targets.

Abstract: Exposure to particulate matter (PM) containing bacterial endotoxins triggers oxidative stress and inflammation in the respiratory epithelium. In this study, we investigated chitosan nanoparticle-encapsulated Cordyceps militaris grown on germinated Rhynchosia nulubilis (GCN) as a potential functional food–derived ingredient against PM- and lipopolysaccharide (LPS)-induced cellular damage in human lung epithelial cells. Nano-encapsulation significantly improved the antioxidant capacity and storage stability of the extract compared with the non-encapsulated form GRC. GCN markedly attenuated PM- and LPS-induced cytotoxicity and intracellular reactive oxygen species (ROS) generation in a dose-dependent manner, resulting in a therapeutic index approximately 4.5-fold higher than that of GRC. PPI network and hub gene analysis identified 120 inflammation-related genes associated with PM- and LPS-induced pulmonary responses enriched in inflammatory response, cytokine–cytokine receptor interaction, Toll-like receptor, and TNF signaling pathways. Protein-protein interaction network analysis revealed TNF, CXCL-10, IL-6, IL-1β, and CXCL-2 as key hub genes involved in these pathways. Consistent with these predictions, GCN significantly suppressed PM- and LPS-induced mRNA expression of TNF-α, CXCL-2, and TRPC6, and effectively inhibited MAPK-mediated NF-κB and AP-1 signaling pathways in A549 cells. Collectively, nano-encapsulation enhances the stability and bioactivity of Cordyceps militaris-based extracts and suggest that GCN may serve as a functional food-derived ingredient for protecting airway epithelial cells from oxidative stress and inflammation induced by environmental stressors.

Abstract: Mucopolysaccharidosis (MPS) are a group of inherited lysosomal storage genetic disorders that affect the body's ability to break down glycosaminoglycans (GAGs) due to the deficiency of required enzymes. This leads to depositions of these GAGs in various tissues and organs resulting in multi-systemic manifestations including pulmonary and sleep related issues. In recent years, there have been significant advancements in therapeutic options and supportive management which has led to overall improvement in respiratory care culminating in improved quality of life for MPS patients. Management of pulmonary and sleep disorders in mucopolysaccharidosis requires a multidisciplinary approach due to the multi-systemic affectation of the genetic disorders. Therapeutic options such as enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation (HSCT) have yielded varying success in mitigating respiratory complications. Emerging treatments such as gene therapies have shown exciting and promising results thus far. Supportive therapies such as airway clearance, regular vaccination and use of positive airway pressure devices are also essential. Pre-operative airway and anesthesia planning is critical to mitigate peri-operative and post-operative complications. Early diagnosis, close monitoring and a patient focused individualized approach are essential for respiratory optimization and overall improvement in clinical outcomes. This review article aims to discuss these advancements in a comprehensive format, making it accessible to medical providers who care for this subset of patients.

Abstract: Background. Alpha-1 antitrypsin deficiency (AATD) is an under-diagnosed hereditary disorder that predisposes individuals to lung and liver disease. While its prevalence is higher in Northern Europe, data from specific, isolated populations in other regions are scarce. Methods. This study assessed the prevalence of pathogenic SERPINA1 variants in the adult population of Ponte di Legno, a secluded town in the Italian Alps. A cross sectional screening was conducted on March 5–6, 2022. Asymptomatic adult residents were invited to undergo spirometry and provided venous blood samples for serum AAT and CRP measurement, while buccal swabs were collected from all participants for genotyping. Genotyping was performed using a validated multiplex Luminex xMAP assay detecting 14 common and rare SERPINA1 variants, with isoelectric focusing and Sanger sequencing for further characterization when required. Results: Ninety‑one subjects were enrolled (median age 61 years; 37.4% male). Five individuals (5.5%) carried pathogenic SERPINA1 variants: one PiMS heterozygote (1.1%), two PiMZ heterozygotes (2.2%), and two individuals homozygous for the rare PiMheerlen variant (2.2%). Median serum AAT levels were significantly lower in carriers of deficient alleles compared with PiMM individuals (100 mg/dL vs. 125 mg/dL, p = 0.0218). Conclusions: This population‑based screening revealed a notable prevalence of AATD carriers in a geographically isolated Italian community, including two cases of the rare Pi*Mheerlen variant. These findings underscore the value of targeted screening programs to identify at‑risk individuals who may benefit from counseling and clinical monitoring, and suggest that AATD may be more common than previously recognized in specific populations.

Abstract: Background: Neoadjuvant therapy, particularly chemoimmunotherapy, has transformed the management of locally advanced non-small cell lung cancer (NSCLC). However, treatment-induced hilar fibrosis and tissue adhesions may increase the complexity of subsequent surgical resection, especially for technically demanding procedures such as sleeve lobectomy. The optimal surgical approach—robotic-assisted thoracic surgery (RATS), video-assisted thoracoscopic surgery (VATS), or open thoracotomy—remains uncertain in this setting. Methods: A systematic review and network meta-analysis (NMA) were conducted in accordance with PRISMA and PRISMA-NMA guidelines. PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to present. Studies comparing RATS, VATS, and open sleeve lobectomy in NSCLC patients following neoadjuvant therapy were included, while mixed cohorts were excluded to ensure data homogeneity. Primary outcomes included postoperative complications, 30-day mortality, operative time, and intraoperative blood loss. Secondary outcomes included R0 resection rate, lymph node harvest, conversion rate, bronchial anastomosis time, and length of hospital stay. A frequentist network meta-analysis was performed. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using I² statistics, and treatment ranking was performed using SUCRA. Results: Five retrospective studies comprising 175 patients were included (RATS: 39, VATS: 114, Open: 22). Postoperative complications were comparable across approaches, with no statistically significant differences between RATS and VATS (OR 1.35, 95% CI 0.38–4.7), RATS and Open (OR 1.9, 95% CI 0.25–13.8), or VATS and Open (OR 0.22, 95% CI 0.03–1.6), although a trend favoring VATS was observed. Mortality rates were low and did not significantly differ between groups. Minimally invasive approaches (RATS and VATS) were associated with reduced intraoperative blood loss (MD approximately −70 to −100 mL) and shorter hospital stay (reduction of ~1–3 days) compared to open thoracotomy. RATS demonstrated a trend toward higher lymph node harvest (mean difference ~2–3 nodes) and showed a 0% conversion rate, whereas VATS conversion ranged from 4.7% to 30%. SUCRA ranking indicated that RATS had the highest probability of being the optimal approach (0.78), followed by VATS (0.64) and open thoracotomy (0.21). Heterogeneity was low to moderate (I² 0–40%), with no significant inconsistency detected. Conclusions: Minimally invasive sleeve lobectomy, including both RATS and VATS, appears to be safe and feasible for NSCLC patients following neoadjuvant therapy. RATS demonstrated favorable trends in technical outcomes, including lower conversion rates and improved lymph node harvest, and ranked highest in SUCRA analysis. However, given the limited sample size and observational nature of the included studies, these findings should be interpreted with caution. Further large-scale prospective and randomized studies are required to determine the optimal surgical approach in this setting. Systematic Review Registration: PROSPERO CRD420261358976.

Abstract: Background/Objectives: The global spread of multidrug-resistant pathogens complicates the treatment of ventilator-associated pneumonia (VAP), causing significant hospi-tal-acquired morbidity and mortality. This study was designed to evaluate the efficacy and safety of the non-traditional antibacterial drug Fluorothiazinone (FT) to prevent VAP caused by Gram-negative bacteria in patients on mechanical ventilation. Methods: We conducted a multicentre, randomised, double-blind, placebo-controlled, parallel-group, phase 2 pilot trial at 14 hospitals in Moscow and St. Petersburg. Treatment arm patients received FT at a dose: 2400 mg/day for the first 2 days and 1800 mg/day from the third day and further (but no more than 14 days) until the occurrence of VAP caused by gram-negative bacteria, confirmed clinically and microbiologically, or until the participant completed the study for other reasons. Results: Statistically significant differences were observed between the FT and placebo groups in the proportion of patients without clinically and microbiologically confirmed VAP caused by Gram-negative bacteria that developed 72-120 hours after tracheal intuba-tion and initiation of mechanical ventilation, as well as throughout the entire treatment period. Treatment with FT was associated with a 56% reduction in the risk of developing VAP, following adjustment for relevant clinical and demographic variables. Safety out-comes in the group receiving the study drug FT were not different from those in the place-bo group. Conclusions: The possibility of antibacterial prophylaxis with FT, to which resistance does not develop, which has a broad spectrum of action, a high degree of tissue distribu-tion, and a favorable safety profile, was demonstrated.

Abstract: COVID-19 may worsen in patients receiving immunosuppressants. Furthermore, drug-drug interactions and concomitant use of anti-inflammatory drugs 　complicate treatment. We report the clinical course of severe COVID-19 pneumonia in a 74-year-old Japanese male kidney transplant recipient. Case report: The patient had been taking tacrolimus (TAC) (2.5 mg/day), mycophenolate mofetil (1000 mg/day), and prednisone (5 mg/day) since his kidney transplant 7 years earlier. Twenty days before admission, he tested positive for SARS-CoV-2 antigen and was administered molnupiravir for 5 days. At admission, real-time PCR testing of a nasopharyngeal specimen revealed high viral loads, with Ct values of 22.2 and 27.9 for the E and N2 genes, respectively. An oxygen flow rate of 15 L/min was required to maintain arterial oxygen saturation above 90%. TAC was continued, and antibiotics, steroids, anti-interleukin-6 receptor antibodies, intravenous immunoglobulin, and ensitrelvir (ESV) were administered. With invasive positive-pressure ventilation, positive end-expiratory pressure (PEEP), and prone positioning, the arterial oxygen tension/inspired oxygen tension (P/F) improved from 61.3 to 386 within 7 hours. The patient was extubated 30 hours after admission. The TAC dose was adjusted from 2.5 mg/day to 1 mg/day to achieve the target trough level. The patient was discharged on hospital day 8. PCR testing at discharge showed a decrease in viral load. Conclusion: This study provides insights into the treatment of COVID-19 in patients receiving immunosuppressants. Combination therapy of ESV and TCA was feasible in kidney transplant recipients with dose adjustment. The use of other anti-inflammatory drugs should also be considered

Abstract: Background: Medical thoracoscopy (MT) represents the gold standard for undiagnosed pleural effusions, traditionally performed in the presence of pleural fluid. Recent technical advances have enabled MT in "dry space" conditions (minimal or absent pleural effusion), raising questions about comparative diagnostic efficacy and safety profiles. Objective: This literature review aims to evaluate diagnostic yield and complication rates between traditional MT performed in patients with current pleural effusion and dry medical thoracoscopy (DMT). Results: MT demonstrates diagnostic sensitivity ranged from 80% to 96.3% and specificity close to 100% for malignant pleural disease and diagnostic accuracy is 99.1% for tuberculous pleuritis. DMT using ultrasound guidance achieves comparable diagnostic yield, with recent studies reporting optimal success rates in pleural access and tissue sampling, and diagnostic sensitivity for malignancy up to 100%. Major complication rates are comparable between MT and DMT, with no significant differences in overall adverse events. Mortality rates remain exceptionally low (≤0.1%) for both approaches. Conclusions: MT remains a highly effective diagnostic tool for pleural diseases. DMT represents a valid and safe alternative in patients without significant pleural effusion, offering comparable diagnostic yield. Although technically more demanding, DMT expands diagnostic possibilities in selected clinical scenarios.

Abstract: Ischemia-reperfusion injury (IRI) is a primary driver of graft dysfunction following lung transplantation, yet effective therapeutic strategies remain limited. Through integrated multi-omics analysis, target prediction, and experimental validation, this study identifies barbaloin as a potent dual-target agent that alleviates lung IRI by simultaneously inhibiting interleukin-6 (IL-6) and purine nucleoside phosphorylase (PNP). Mechanistically, barbaloin reduces intracellular Reactive Oxygen Species (ROS) accumulation by suppressing both IL-6 and PNP, thereby abrogating the ROS-dependent NF-κB/NLRP3 signaling cascade and subsequent immune-inflammatory responses. These findings highlight the pivotal role of the IL-6/PNP axis in mediating barbaloin’s antioxidant and anti-inflammatory effects. Furthermore, barbaloin’s favorable ADMET profile supports its potential as a novel therapeutic candidate for lung transplantation and other oxidative stress-driven inflammatory disorders.

Abstract: Chlorine Dioxide (ClO2) is a neutral oxidant molecule having a short life-span once in contact with electron donors (organic matter). ClO2 solutions have antiviral, antibiotic, anti-inflammatory, anticancer and wound healing activity and it was used at safe concentrations with patients of different countries during the COVID-19 pandemic. In Mexico 1067 COVID-19 patients received compassionate treatments with ClO2 during the 2020/2021 pandemic years. We describe the treatments and clinical report of these patients, as it concerns the Oxygen saturation (SpO2) recovery and we give a biochemical explanation. The number of healed patients was 1057, >99% of the total and SpO2 showed a hyperbolic fast increase. This happens because ClO2 attracts one electron from the organic matter and produces a Chlorite anion (ClO2-). This new molecule has a known metabolic activity in the blood stream. On the one side, it will have the mentioned anti-viral, antibiotic and on the other side it will also allow producing Oxygen (O2) to be transported by the hemoglobin. This reaction is mediated by an intermediate state of a Ferryl molecule (Fe=O) in the allosteric site of methemoglobin, which behaves as a reductase enzyme. This reaction explains the rapid and steady increase of O2-saturation in healed patients.

Abstract: Tuberculosis (TB) remains a leading cause of infectious mortality worldwide, reflecting persistent gaps in diagnosis, risk stratification, and treatment monitoring. Host RNA transcriptomic signatures have emerged as promising tools for capturing dynamic im-mune responses across the TB disease spectrum. Among these, the six-gene RISK6 signa-ture has attracted attention due to its parsimonious design and potential for clinical translation. This review provides a clinically oriented synthesis of current evidence on host transcriptomic biomarkers, with a particular focus on the application of RISK6 in di-agnosis, prediction of disease progression, and treatment monitoring. Available data suggest that RISK6 demonstrates robust diagnostic performance and reliable short-term prognostic value, while also reflecting dynamic changes during therapy. However, varia-bility across populations and the limited evidence in multidrug-resistant TB remain im-portant constraints. In practice, RISK6 is unlikely to function optimally as a standalone biomarker. Its clinical value appears greater when interpreted within integrated frame-works that combine transcriptomic, microbiological, and clinical data. Further validation in diverse populations and real-world settings will be essential to support meaningful clinical implementation.

Abstract: Background/Objectives: Childhood non-cystic fibrosis (non-CF) bronchiectasis is clinically heterogeneous. We aimed to describe fractional exhaled nitric oxide (FeNO) levels in affected children and examine associations with etiology, spirometry, and CT-defined disease extent. Methods: This single-center prospective observational study included 100 clinically stable children aged 6–18 years with CT-confirmed non-CF bronchiectasis evaluated between September 2014 and December 2015. FeNO was measured before spirometry using an online single-breath electrochemical technique. Chest CT was reviewed at the lobar level, with the lingula counted separately, and disease extent was summarized by the number of involved lobar regions. Associations were assessed using Spearman correlation and non-parametric tests. Results: Mean age was 14.9 ± 2.0 years, 55% were male, and mean FeNO was 20.9 ± 14.0 ppb. FeNO correlated positively with FEV1 (% predicted), FVC (% predicted), and FEF25–75 (% predicted) (all p < 0.01). FeNO was higher in males and adolescents than in females and younger children, respectively. FeNO did not differ by CT-defined lobar extent. It was lower in primary ciliary dyskinesia than in asthma overlap. Conclusions: FeNO was associated with selected functional indices and etiologic subgroups, but not with CT-defined structural extent, suggesting a greater role in clinical phenotyping than in reflecting radiologic burden.

Abstract:

Oral health has significant implications for pulmonary outcomes, particularly among individuals with dysphagia who are at risk for aspiration. Moreover, oral health and condition affect nutrition accessibility and status. Inadequate oral hygiene promotes bacterial colonization, plaque accumulation, and aspiration-related respiratory complications. This review aimed to synthesize current evidence and expert perspectives across palliative medicine, pulmonary and critical care, and dentistry on the role of oral hygiene in supporting pulmonary health and maintaining opportunities for oral nutrition. Relevant literature was reviewed to examine associations between dysphagia, oral health and condition, oral hygiene/care protocols, feeding route, salivary composition and function, and respiratory outcomes. Emphasis was placed on studies addressing pneumonia, oral versus tube feeding, and evidence-based oral care practices. Findings indicate that pneumonia, depression, and mortality rates are higher in patients receiving tube feeding compared to oral feeding. Evidence-based oral care practices inclusive of mechanical plaque disruption, oral cleansing products (Chlorhexidine, hydrogen peroxide, and sodium bicarbonate), and structured oral hygiene protocols can reduce pulmonary consequences of aspiration and support safer/least risk oral intake. Saliva plays a pivotal role in plaque breakdown, microbial defense, and host immunity; oral feeding helps to preserve salivary function. Results of this review highlight the importance of oral hygiene in both restorative and palliative care contexts. By integrating available evidence and clinical guidance, this review establishes a framework for embedding oral cleansing agents and protocols into a nutrition-focused health care infrastructure. Clinical guidelines and consensus recommendations were developed from this extensive literature analysis to provide well-grounded, expert leadership. Adherence to best practices in oral care can mitigate pulmonary consequences of aspiration amid dysphagia, make oral nutrition more accessible and comfortable, sustain opportunities for least risk oral feeding across diagnoses and health care settings, and improve quality of life for patients with dysphagia amid life-limiting illness.

Abstract: The management of chronic obstructive pulmonary disease (COPD) and asthma depends critically on the effective delivery of aerosolized medications to the respiratory tract. Clinical efficacy is determined not only by the active pharmaceutical ingredient but also by a complex interplay among drug formulation, aerosol particle size, inhaler device characteristics, dosing frequency, and patient-specific factors. This review evaluates the technical specifications and clinical performance of major inhaled therapeutic systems, including the Ellipta platform, the Respimat soft mist inhaler (SMI), conventional pressurized metered-dose inhalers (pMDIs), and dry powder inhalers (DPIs). We examine the impact of particle size and extra-fine formulations on peripheral deposition and small airway disease (SAD), and synthesize comparative clinical evidence linking deposition patterns to symptom control and exacerbation reduction. In addition, we explore clinically relevant determinants of personalized device selection, including peak inspiratory flow rate (PIFR) limitations, pneumonia risk, dosing frequency, and rescue inhaler requirements. By integrating inhaler design with real-world clinical considerations, this review provides a practical framework for individualized inhaler selection in obstructive lung disease. A patient-centered approach that accounts for airway phenotype, infection risk, inspiratory flow capability, and adherence patterns is essential to optimize drug delivery and improve long-term outcomes.

Abstract: Background/Objectives: Vaccination against respiratory viruses—such as respiratory syncytial virus (RSV), pneumococcal disease, influenza, and COVID-19—may reduce the risk of adverse outcomes in older adults with cardiovascular disease. This study conducted a scoping review of the effects of respiratory vaccines in older adults with cardiovascular disease. Methods: We included studies evaluating adults aged ≥60 years with cardiovascular disease who received different types of respiratory vaccines. Eligible designs comprised clinical trials, observational cohort studies, and other relevant studies. Editorials, commentaries, and non-original publications were excluded. A comprehensive and targeted literature search was conducted in PubMed, Scopus, EMBASE, and Web of Science from database inception through January 2026. Results: A total of 26 studies were included, encompassing 1,782,787 adults aged ≥60 years with cardiovascular disease who received various respiratory vaccines. RSV vaccines were associated with a lower incidence of cardiorespiratory hospitalization and stroke among vaccinated individuals. Pneumococcal vaccines showed that sequential dual vaccination strategies were associated with a lower risk of cardiovascular events. Influenza vaccination was associated with improved cardiovascular outcomes, lower mortality, and reduced adverse events. COVID-19 vaccines were associated with reductions in mortality and hospitalizations. These benefits are particularly relevant in an older population with a high burden of comorbidities; therefore, complete vaccination schedules, including booster doses, should be considered a central strategy for prevention and comprehensive management in this high-risk group. Conclusions: Vaccination against respiratory viruses in older adults with cardiovascular disease demonstrates an overall favorable/acceptable profile of efficacy and safety, with reductions in mortality, hospitalizations, and cardiovascular events, without a significant increase in serious adverse events.