Davor Plavec

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Identifying patients with early COPD remains challenging; however, even at this stage, substantial biological disease progression and irreversible lung injury may already be present. Considerable effort has therefore been directed toward identifying parameters that detect early pathophysiological changes before airflow limitation develops. The importance of this stage has recently been recognized and is described using terms such as “pre-COPD” and “early COPD”. Exhaled breath temperature (EBT) is a non-invasive method for detecting and monitoring respiratory inflammation. Most EBT studies have been conducted in asthma and have demonstrated the utility of this approach for assessing changes in airway inflammation. In patients with COPD, the number of airways and their vasculature is reduced, and EBT decreases proportionally with the degree of structural destruction; however, EBT may still increase during COPD exacerbations. In recent studies, the change in EBT after cigarette smoking in individuals without a COPD diagnosis significantly predicted disease progression after 2 years. Early interventions based on these findings should be tested for efficacy in preventing the development of overt COPD.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Finding patients with early COPD is already difficult, but even those have already an advanced disease in the biological point of view with irreversible lung damage. A lot of effort is done to find the parameters for detection of patients with early pathophysiological changes before they develop airflow limitation. The importance of this stage is recently recognized and has different labels as “pre-COPD” and “early COPD”. Exhaled breath temperature (EBT) is a non-invasive method to detect and monitor inflammation in the respiratory system. Most studies on EBT have been performed in asthma and showed the utility of this approach to assess changes in airway inflammation. In the COPD patients, the number of airways and their vasculature is reduced and EBT decreases proportionally to the level of destruction, but is still increased during the COPD exacerbation. In recent studies, change in EBT after smoking a cigarette in patients without a diagnosis of COPD was significantly predictive for disease progression after 2 years. Early interventions based on these results should be tested for efficacy in prevention of the development of overt COPD.

Background: T2 low asthma in children is an emerging yet underexplored endotype that challenges traditional views of type 2 inflammation. Recent data suggest that it is more prevalent than previously thought and is defined by low type 2 biomarkers, non-allergic clinical profiles, and strong associations with modifiable comorbidities such as obesity, passive smoke exposure, and recurrent respiratory infections. This phenotype often shows a poor response to standard inhaled corticosteroid therapy and T2-targeted biologics, underscoring the urgent need for improved diagnostic and therapeutic approaches. Methods: This narrative review conducted a literature search from PubMed and WoS databases (2020–2025), focusing on T2-low asthma defined by low blood eosinophils (<150–300/µL), FeNO (<20–25 ppb), and absent atopy in children under 18. Results: This review highlights the heterogeneity of T2-low asthma, including subtypes from neutrophilic/Th 17-high to paucigranulocytic airway remodeling and metabolic driven forms, as well as diagnostic challenges from biomarker supresssion by high-dose therapies. Pragmatic phenotyping algorithms using routine tests enable identification, directing comorbidity management over ineffective biologics. Conclusions: Systematic T2-low phenotyping in pediatric practice, alongside prospective studies and non-T2 therapy trials, promises precision medicine to enhance outcomes for these children, moving beyond eosinophil-centric care.

Type -2 (T2) low asthma in children represents a clinically important yet still insufficiently recognized endotype. Current data suggest that it is more prevalent than previously thought and is defined by low type 2 biomarkers, non-allergic clinical profiles, and a high burden of comorbidities such as obesity and passive smoke exposure, while remaining largely understudied phenotype in terms of validated biomarkers and specific targeted therapies. This review aims to highlight and clarify T2-low asthma in children by summarizing emerging evidence on risk factors, pathophysiological mechanisms, bi-omarkers, and treatment strategies, with the goal of informing and improving future care for affected children.

Although laboratory testing to assess aerobic capacity has been a ‘gold standard’ in sports science, its high costs and time-consuming protocols may not be feasible for monitoring and tracking progress in limited conditions. In dancesport athletes, several field-based aerobic tests have been proposed, but the majority of them have been developed for ballet or contemporary dancers at the individual level, while the data among dance couples engaging in standard dance styles is lacking. Therefore, the main purpose of this study was to validate a newly developed Ballroom Aerobic Test (BAT) protocol against objective methods. Twelve standard dancesport couples (age: 20.4 ± 3.9 years; height: 172.1 ± 8.7 cm; weight: 60.1 ± 9.4 kg) with 8.2 ± 3.4 years of training and competing experience participated in this study. Ventilatory and metabolic parameters were generated using the MetaMax^® 3B portable gas analyzer (the BAT), while the KF1 (an increase in speed by 0.5 km * h⁻¹ by every minute) and Bruce protocols were followed in laboratory-based settings on the running ergometer. Large to very large correlations were obtained between the BAT and KF1/Bruce protocols for the absolute maximal oxygen uptake (VO₂max; r = 0.88 and 0.87) and relative VO₂max (r = 0.88 and 0.85), respiratory exchange ratio (RER; r = 0.78 and 0.76), expiratory ventilation (VE; r = 0.86 and 0.79), tidal volume (VT; r = 0.75; 95% CI = 0.57–0.87; p < 0.001), ventilatory equivalent for O₂ (VE/VO₂; r = 0.81 and 0.80) and CO₂ (VE/VCO₂; r = 0.78 and 0.82), and dead space (VD/VT; r = 0.70 and 0.74). The Bland–Altman plots indicated no systematic and proportional biases between the BAT and KF1 protocols (standard error of estimate; SEE = ± 3.36 mL * kg⁻¹ * min⁻¹) and the BAT and Bruce protocols (SEE = ± 3.75 mL * kg⁻¹ * min⁻¹). This study shows that the BAT exhibits satisfactory agreement properties against objective methods and is a valid dance protocol to accurately estimate aerobic capacity in dancesport athletes participating in standard dance styles.

Background/Objectives: Continuous renal replacement therapy (CRRT) is an important treatment method that is becoming a commonly-used procedure in neonatal intensive care units (NICUs), especially in critically-ill neonates. Methods: We conducted a retrospective study aimed to evaluate factors influencing the outcomes of CRRT in neonates and preterm infants. The study analyzed data from 41 newborns treated with CRRT at our NICU over a ten-year period. Demographic, clinical, and laboratory parameters were assessed, including gestational age, birth weight, PRISM III score, and laboratory markers like urea, creatinine, and potassium levels, as well as characteristics of CRRT. Results: Our research found that the duration of CRRT, the presence of anuria, and higher potassium levels after initiation of CRRT were significant predictors of a poor outcome. Despite the lack of significant correlation between demographic characteristics, PRISM III score and the outcome, our findings highlight the importance of timely CRRT initiation and efficient management to improve survival. Conclusions: Our study identified several significant prognostic indicators in neonates undergoing renal replacement therapy. While these findings provide valuable insights, further research is needed to establish clear theoretical guidelines and improve clinical decision-making.

Food allergies are becoming more common globally. The strict elimination diet, as the main approach so far, has a negative impact on different areas of the lives of children suffering from food allergies, as well as on their caregivers. Oral immunotherapy (OIT), which consists of ingesting small, gradually increasing amounts of food allergens, is a promising approach. Although efficient, this approach is accompanied by frequent adverse reactions (AR), some of which are as severe as anaphylaxis. It seems that, generally, slow dose escalation, as well as low maintenance doses with longer durations, make OIT safer, especially in children with severe food allergies. Furthermore, less allergenic forms of allergens, such as baked milk or egg, also contribute to OIT safety. Adjuvant therapy in combination with OIT has the potential to improve OIT efficiency and safety. Treatment with monoclonal antibodies such as omalizumab and dupilumab in combination with OIT is promising. While both could improve efficiency, omalizumab seems to have a better effect on safety. Interferon γ shows promising results. In contrast, the effect of probiotics and vitamin D supplementation in combination with OIT is still controversial, and new trials about their synergistic effect are needed.

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of morbidity and mortality worldwide. The lung damage in COPD is associated with an enhanced chronic inflammatory response in the airways and lung tissue to harmful particles or gases. Early detection and treatment of COPD can help manage symptoms and slow the progression of the disease. Status of knowledge regarding early diagnosis, definition of pre-COPD, possible new tools for an early diagnosis, possibilities of an early treatment and the results of studies in this population is discussed. Literature search (2014-2024) was done in PubMed, EMBASE and WoS databases using the keywords COPD, early diagnosis, treatment, smoking, prevention; with additional search of literature in found articles. No early case-finding programs have been proposed or validated, so we still have many patients diagnosed in the late stage of the disease. Clinically manifest COPD is characterized as typically progressive and irreversible with current therapeutic options. If we aim to reduce the mortality and morbidity from COPD we should target these steps: Prevention; Early diagnosis; Form registries of persons at risk for COPD development; Diagnose preclinical COPD; and discover new preventive therapeutic interventions.

Asthma is a chronic lung disease characterized by reversible bronchoconstriction and inflammation of the bronchi. Its increasing prevalence in childhood as well as different triggers make asthma a challenging disease in several ways: defining its phenotype/endotype, the diagnostic approach (especially in younger children), therapeutic options, and systematic follow-up. Considering these problems, this review approaches the current status and limitations of guidelines used for asthma management in children. It also emphasizes the key points which could lead to a better understanding and the direction to take in future studies.