Current Respiratory Medicine Reviews - Volume 21, Issue 5, 2025

Asthma is a common chronic respiratory condition characterized by inflammation and influenced by genetic and environmental factors. Medication non-adherence is a significant issue that negatively impacts health outcomes and increases healthcare costs globally. This review examines the factors contributing to non-adherence among patients with asthma, its effects on asthma control, and the role of pharmacists in enhancing adherence.

A comprehensive literature review was conducted to explore the issue of medication non-adherence in asthma management and to examine the important role of pharmacists in this context. Utilizing prominent scientific databases, the review presents evidence-based results.

Various factors contribute to non-adherence, including the chronic nature of asthma, complex treatment regimens, economic status, cognitive abilities, and fear of side effects. These factors lead to poor asthma control and increased healthcare costs. Pharmacists can improve asthma management through education, proper inhaler techniques, and personalized care plans. Interventions, including tailored regimens and technology, show promise for improving adherence.

Pharmacists significantly improve asthma management through patient education, ensuring correct inhaler use, and developing personalized care plans. Their involvement is linked to better medication adherence and asthma control, especially when using tailored regimens and digital tools.

Despite challenges in compliance and variability in adherence, evidence supports pharmacist-led interventions as effective for enhancing patient outcomes and quality of life, highlighting the importance of integrating pharmacists into healthcare teams.

Complete or partial collapse of the upper airway for a few seconds during sleep is the cause of obstructive sleep apnea (OSA). OSA affects about half of the world's population. Although there are numerous treatment options for OSA, continuous positive airway pressure (CPAP), mandibular advancement device (MAD), and surgeries are regarded as mainstream therapies.

Since MAD is a better alternative to CPAP for patients who are unwilling to utilize CPAP therapy or who do not comply with it, our current review focuses on how effective MAD is at managing OSA.

To find publications relevant to the safety and effectiveness of MAD in the treatment of OSA, online databases such as Medline/PubMed/PMC, Scopus, Web of Science, Google Scholar, and reference lists were searched.

Through the reduction of apnea-hypopnea index (AHI), snoring, and improved sleep quality, a number of prospective and retrospective observational studies, randomized controlled clinical trials and meta-analyses showed that MADs are beneficial for patients with mild-to-moderate OSA and snoring. Although CPAP therapy is the gold standard for treating OSA, patients who cannot or do not want to utilize CPAP therapy may benefit from MAD therapy as an alternative or as a supplementary treatment. For patients with OSA, the use of oral appliances, including MAD, is advised by the American Academy of Sleep Medicine (AASM), American Academy of Dental Sleep Medicine (AADSM), and National Institute of Clinical Excellence (NICE) guidelines.

Numerous randomized controlled clinical trials, prospective and retrospective observational studies, and meta-analyses have demonstrated that MADs are beneficial in treating OSA patients by reducing snoring, enhancing sleep quality, and lowering the apnea-hypopnea index (AHI). A licensed dentist should utilize a custom, titratable MAD when a sleep physician prescribes oral appliance therapy for an adult patient with OSA. The patients managed with MAD therapy should be advised to pay follow-up visits.

Drug-resistant tuberculosis (TB), including multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB), poses major global health challenges. Conventional regimens achieve only 50-60% success rates compared to 85% in drug-susceptible TB. This review examines recent therapeutic advances in drug-resistant TB management, focusing on novel and repurposed agents, their mechanisms, clinical efficacy, and integration into optimized treatment regimens.

We conducted a systematic literature search of PubMed, Embase, Cochrane Library, and Web of Science databases from inception to December 2024. Search terms included “multidrug-resistant tuberculosis”, “bedaquiline”, “delamanid”, “pretomanid”, and “clinical trials”. We included peer-reviewed studies, systematic reviews, meta-analyses, and clinical trial reports, prioritizing high-quality evidence from randomized controlled trials and prospective cohort studies. Data extraction focused on drug mechanisms, clinical outcomes, safety profiles, and resistance patterns.

Analysis of 125 studies and 15 ongoing clinical trials demonstrated substantial therapeutic improvements. Novel agents achieved treatment success rates of 73-90% compared to 50-60% with conventional second-line regimens. The BPaL regimen (bedaquiline, pretomanid, linezolid) showed 89-90% favorable outcomes within 6 months compared to traditional 18-24 month durations. Delamanid demonstrated a 73.1% success rate with culture conversion rates of 61-95%. However, bedaquiline resistance increased to 5.7% globally, reaching 14% in high-burden regions.

Novel therapeutic agents represent transformative advances in drug-resistant TB management, enabling shortened all-oral regimens that address critical barriers, including adherence, toxicity, and healthcare burden. However, rising resistance underscores the need for stewardship and innovation.

Bedaquiline, delamanid, and pretomanid have revolutionized drug-resistant TB treatment outcomes, positioning the field toward effective universal treatment access and TB elimination goals.

Growing evidence suggests an increased risk of venous thromboembolism (VTE) in chronic respiratory disease (CRD) patients. Persistent lung inflammation, repeated hospitalization, and associated comorbidities render patients prone to VTE. Considering the limited data, we intended to determine the clinical profile and risk factors of VTE in CRD.

A retrospective case-control study was conducted at the Department of Pulmonary Medicine in a tertiary respiratory care center. The medical records of CRD patients from January 2020 to March 2023 were reviewed and data were collected. Confirmed cases with VTE (n = 50) using Doppler and computed tomography pulmonary angiogram (CTPA) and matched controls (n = 50) without VTE were included in the study. Clinical and radiological profiles of these patients, including age, sex, presence of comorbidities, duration of illness, severity of CRD, treatment details, chest radiograph, electrocardiogram, CBC, CRP, and D-dimer levels, were recorded. Predictors for VTE were assessed using univariate and multivariate analyses.

VTE was found more commonly in middle-aged patients and those with TOPD and COPD. Univariate analysis showed high pulse rate, low oxygen saturation (SpO2), higher diastolic blood pressure, higher mMRC grade of breathlessness, evidence of cor pulmonale on 2D echo, elevated WBC count, and CRP and D-dimer levels to be the predictors of VTE. In the multivariate analysis, low SpO2, higher mMRC grade of breathlessness, and elevated CRP and D-dimer levels were found to be independent predictors for VTE. We found 72% and 80% sensitivity and specificity for serum C-reactive protein at 58mg/dl and 84% and 100% sensitivity and specificity for D-dimer values at 560 ng/LFEU, respectively.

VTE was found to be more common in tuberculosis-associated obstructive pulmonary disease (TOPD) than COPD at our centre. Low SpO2, greater severity of breathlessness, and elevated serum CRP and D-dimer levels were considered independent predictors of VTE in CRD. In CRD patients presenting with clinical worsening, evaluation for VTE in the presence of these risk factors can be useful in reducing morbidity and mortality.

Adverse drug reactions (ADRs) to antitubercular therapy (ATT) pose a major challenge in tuberculosis (TB) management, especially in patients with comorbidities. This study evaluated the prevalence, patterns, and risk factors for ADRs among TB patients with and without comorbidities receiving first-line ATT in India.

A prospective observational study was conducted at Erode Tertiary Care Hospital from July 2023 to January 2024. A total of 300 TB patients (207 without comorbidities, 93 with comorbidities such as diabetes mellitus, HIV, hypertension, and COPD) were enrolled. ADRs were assessed through clinical monitoring, lab investigations, and structured interviews using the WHO causality and Modified Hartwig and Siegel severity scales.

The prevalence of ADR was 49.33%, which was significantly higher in patients with comorbidities (55.91%) than those without (46.37%, p = 0.048; RR = 1.20, 95% CI: 0.96-1.52). Diabetes mellitus had the highest ADR rate (60.53%, p = 0.032). ADRs were more frequent in comorbid patients during the intensive phase (59.32% vs. 41.61%, p = 0.018) and in pulmonary TB. Gastrointestinal ADRs were most common, with nausea/vomiting, gastritis, and diarrhea significantly more frequent in comorbid groups. Comorbid patients also had more multiple ADRs (40.38% vs. 33.33%, p = 0.027) and required more medication changes (17.31% vs. 7.29%, p = 0.013). Discussion: Higher ADR frequency in patients with comorbidities may reflect the impact of disease. The increased burden during the intensive phase and in pulmonary TB underscores the importance of tailored pharmacovigilance.

TB patients with comorbidities, particularly diabetes, face significantly higher ADR risks. Enhanced pharmacovigilance is essential. Age-related physiological vulnerability may independently increase ADR risk in elderly patients without comorbidities.

The aim of this study is to systematically review and analyze the incidence and outcomes of COVID-19 in patients with pulmonary hypertension (PH).

We searched PubMed, SCOPUS, Web of Science, and Embase for relevant publications up to March 27^th, 2024. Articles were screened for studies on the incidence or outcomes of COVID-19 in PH patients. Screening, data extraction, and risk of bias assessment were performed independently in duplicate. When possible, relevant results were pooled using the random effects model.

Of the 5,981 articles, a total of 30 were included in the systematic review and 29 in the meta-analysis. The incidence rate of COVID-19 in PH patients was 25 (15-41) per 100,000 person-day. The hospitalization rate was 47% (26.4-68.7), and the mean duration of hospitalization was 10.033 (9.644-10.422) ± 0.198 days. The rate of admission to the intensive care unit was 35.8% (23.9-49.9) and mechanical ventilation was required in 17.4% (11.6-25.3) of hospitalized patients. The in-hospital mortality rate was 23.1% (21.6-24.6). Further analysis of studies comparing COVID-19 patients with and without PH showed a higher mortality rate in COVID-19 patients with PH (OR = 1.722 CI 95% (1.393-2.128), P < 0.0001, I2 = 99%). Meta-regression showed no significant association between sex and the incidence of COVID-19 infection in PH patients.

Pre-existing PH may not be associated with a higher incidence of COVID-19 but may be associated with worsening outcomes of COVID-19 infection.