Pulmonology and allergology

REPRESENTATIVES OF THE LSMU MA PULMONOLOGY CLINIC AT THE CONFERENCE OF THE LUNG VASCULAR INSTITUTE

Deimantė Hoppenot — 2025-09-24

On June 16–17 this year, Amsterdam (the Netherlands) hosted an international event dedicated to pulmonary vascular diseases, the Drug Discovery & Development Symposium 2025, organized by the Pulmonary Vascular Research Institute (PVRI). Symposium 2025), organized by the Pulmonary Vascular Research Institute (PVRI).

SCIENTIFIC SUMMARY PRESENTED AT THE EUROPEAN CYSTIC FIBROSIS CONFERENCE ON THE FIRST EXPERIENCE OF TREATMENT WITH CFTR MODULATORS IN LITHUANIA

Virginija Kalinauskaitė-Žukauskė — 2025-09-24

The 48th European Cystic Fibrosis Conference, organized by the European Cystic Fibrosis Society, took place in Milan, Italy, on June 4–7 this year.

UPDATED CONSENSUS ON THE DIAGNOSIS AND TREATMENT OF PNEUMONIA IN ADULTS

Skaidrius Miliauskas — 2025-09-24

As is well known, pneumonia, or inflammation of the lungs, is a widespread and dangerous disease. Its course can vary from mild, often undiagnosed and self-limiting without antimicrobial treatment, to severe forms which, despite all modern treatment measures, can result in death.

FOOD ALLERGIES AND INTOLERANCES – A NEW TEXTBOOK FOR STUDENTS AND DOCTORS OF ALL SPECIALTIES INTERESTED IN FOOD ALLERGIES AND INTOLERANCES

Laura Tamašauskienė — 2025-09-24

In 2025, a textbook entitled Food Allergies and Intolerances was published, intended for students of medicine, pharmacy, and other health-related programs at institutions of higher education, as well as doctors of various specialties interested in food allergies and intolerances.

COVID-19 AND PNEUMONIA CAUSED BY INFLUENZA

Neringa Vagulienė — 2025-09-24

Viral pneumonia is a significant cause of community-acquired pneumonia, particularly during influenza seasons and pandemics. Influenza A/B viruses and severe acute respiratory syndrome coronavirus 2 are the most common pathogens, with clinical presentations ranging from mild upper respiratory tract infections to severe pneumonia, respiratory failure, and acute respiratory distress syndrome. Older adults, pregnant women, individuals with chronic comorbidities, and immunosuppressed patients are at the highest risk. Successful treatment is determined by early diagnosis, thorough assessment of risk factors, the rational administration of antiviral agents and other medications, and the prevention of complications.

Multi-omics: the future of asthma research

ANDRIUS JANUŠKEVIČIUS — 2025-09-24

Multi-omics technologies are transforming the understanding and treatment of asthma, a complex and heteroge neous chronic respiratory condition. The integration of genomics, transcriptomics, epigenomics, proteomics, metabolomics, microbiomics, and exposomics enables an in-depth analysis of asthma phenotypes, paving the way for more accurate diagnosis, risk assessment, and personalised therapy. Modern challenges in asthma management, including treatment resistance and the unpredictability of drug effects, highlight the need for precise molecular insight. Advanced tools, such as machine learning, artificial intelligence, and systems biology, offer the capacity to decode intricate biological networks and identify key biomarkers across patient subgroups. Large-scale multi-omics initiatives like Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED), AsthmaMap, and Severe Asthma Research Program (SARP) demonstrate the potential to uncover previously unrecognized disease mechanisms and define endotype-specific therapeutic targets. Although clinical application is still developing, progress in high-throughput technologies and data integration continues to narrow the gap between research and real-world practice. Comprehensive profiling across multiple molecular layers reveals how asthma develops and progresses, offering a path toward truly personalized medicine. Asthma care’s future increasingly lies in combining biological, environmental, and clinical data into cohesive strategies for prevention, monitoring, and treatment.

FOOD ALLERGY AND FOOD INTOLERANCE: SIMILARITIES AND DIFFERENCES

Laura Tamašauskienė — 2025-09-24

Food can cause various adverse reactions that develop through immune or non-immune mechanisms. Food allergy is defined as an adverse food reaction that results from a specific immune response following repeated exposure to a particular food. Food intolerance is defined as a non-immune reaction to food arising from metabolic, toxic, pharmacological, or otherunknown mechanisms. This review article discusses the clinical manifestations, diagnostic approaches, and management principles of food allergy and food intolerance.

IMMUNE RESPONSE IN ATOPY: POLYMORPHISM OF VITAMIN D RECEPTOR AND VITAMIN D-BINDING PROTEIN GENES

Daina Pavalkienė — 2025-09-24

Daina Pavalkienė successfully defended a doctoral dissertation “Immune response in atopy: polymorphism of
vitamin D receptor and vitamin D-binding protein genes“ at the open session of the Biology Research Council of the Lithuanian University of Health Sciences on February 21, 2025. The dissertation has been prepared at the Department of Immunology and Allergology of Faculty of Medicine of Lithuanian University of Health Sciences during the period of 2020–2024 year. The article presents the main results of the dissertation.

Scientific Supervisor:
Prof. Dr. Brigita Gradauskienė (Lithuanian University of Health Sciences, Natural Sciences, Biology – N 010).
The Defense Council:
Prof. Habil. Dr. Vaiva Lesauskaitė (Lithuanian University of Health Sciences, Natural Sciences, Biology – N 010).
Prof. Dr. Edgaras Stankevičius (Lithuanian University of Health Sciences, Natural Sciences, Biology – N 010).
Prof. Dr. Vilmantė Borutaitė (Lithuanian University of Health Sciences, Natural Sciences, Biology – N 010).
Prof. Dr. Algimantas Paulauskas (Vytautas Magnus University, Natural Sciences, Biology – N 010).
Prof. Dr. Madeleine Radinger (University of Gothenburg, Natural Sciences, Biology – N 010)

RETROSPECTIVE ANALYSIS OF THE DIAGNOSIS AND TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN LITHUANIA

Virginija Kalinauskaitė-Žukauskė — 2025-09-24

Chronic obstructive pulmonary disease (COPD) diagnosis and management in Lithuania remain suboptimal. A
retrospective analysis of Foxus system data (2023–2024) revealed that out of 1.1 million patients, only 11,693 had a recorded COPD (J44) diagnosis, although diagnostic algorithms identified as many as 146,740 patients at risk. The first electronic alert for potential COPD was triggered 147,022 times; however, referral to a pulmonologist was made for only 7.8% (n=11,494), with COPD confirmed in 13.5% of those cases. When COPD was first diagnosed, 57.4% of patients were prescribed a combination of a long-acting β2 agonist and a long-acting muscarinic receptor antagonist (LAMA/LAMA), 41.1% were prescribed a combination of LABA, LAMA, and inhaled corticosteroid (ICS), and 5.6% of patients were not prescribed pharmacotherapy. The treatment optimization algorithm generated 4,610 alerts, yet only 21.6% (n=995) of patients were referred for a pulmonologist consultation to review and adjust therapy; treatment was subsequently modified in 37.2% of them. Patients referred for treatment optimization were most often those already on LABA/LAMA/ICS triple therapy, indicating more severe disease, frequent exacerbations, and burdensome symptoms. These findings highlight the issue of clinical inertia: COPD is often diagnosed late, patients are referred to pulmonologists too infrequently, and treatment adjustments are delayed. Earlier intervention and optimization of therapy could potentially slow disease progression before compensatory mechanisms are exhausted, thereby improving patients’ quality of life. Systemic, technological, and educational measures are needed to ensure effective COPD management in Lithuania.

IDENTIFYING SUBJECTS AT RISK FOR OBSTRUCTIVE SLEEP APNEA: A COMPARISON OF SCREENING METHODS

Miglė Jurgelėnaitė — 2025-09-25

Obstructive sleep apnea (OSA) is a common but often underdiagnosed condition that negatively affects quality of life and increases the risk of developing cardiovascular diseases and risk of traffic accidents. Early diagnosis and management are essential for reducing complications. A full-night polysomnography (PSG) is the gold standard for detecting OSA, however, its accessibility is limited due to the complexity of the procedure. Screening questionnaires and scales are particularly useful for identifying individuals at the highest risk for OSA who require further testing. The diagnostic value of the NoSAS scale and STOP BANG questionnaire in OSA diagnosis is widely discussed worldwide. Daytime sleepiness is one of the most common symptoms of OSA. The Epworth Sleepiness Scale (ESS) is also used as one of the screening criteria for PSG, therefore, its diagnostic value for OSA was also assessed. Aim of the study. To determine the diagnostic value of different screening methods for sleep testing – STOP-BANG questionnaire and the NoSAS scale, compare their results with the ESS scale. Methods. Analysis of patients evaluated at the Lithuanian University of Health Sciences Department of Pulmonology due to suspected sleep-related breathing disorders was performed. OSA was diagnosed when the PSG apnea–hypopnea index (AHI) was >5 events/hour. The STOP-BANG questionnaire (snoring, tiredness, observed apneas, high blood pressure, BMI, age, neck circumference, gender) and NoSAS scale (neck circumference, obesity, snoring, age, gender) were compared using ROC curve analysis. ESS results were also analysed. STOP BANG and ESS results collected prospectively in 2018 were used, while NoSAS scores were assessed retrospectively from medical records. The findings were compared to 2023 data. Results. The study comprised 589 patients (69,4% men, 30,6% women). The mean age of participants was 54,29 ± 12,42 years. Mild OSA was diagnosed in 20,5%, moderate OSA in 22,4%, and severe OSA in 46,9% of patients. In 10,2% of cases, OSA was ruled out. The highest sensitivity and specificity were observed with a STOP-BANG score ≥5 and a NoSAS score ≥10 (AUC = 0,789, 0,769, and 0,842, respectively). The optimal cutoff value for the ESS was ≥8, with a sensitivity of 52,7% and specificity of 52,4%. The ESS did not demonstrate reliable prognostic properties. Conclusions. The 2018 and 2023 STOP-BANG questionnaire and NoSAS scale demonstrated high sensitivity and specificity in diagnosing OSA. The ESS should be used only as a method for assessing sleepiness, not as a primary screening tool for OSA diagnosis.

EVALUATION OF THE EFFICACY OF PEMBROLIZUMAB TREATMENT IN NON-SMALL CELL LUNG CANCER. A SINGLE-CENTRE EXPERIENCE

Pijus Ruokis — 2025-09-25

Lung cancer remains the leading cause of cancer-related death worldwide. In advanced non-small cell lung cancer (NSCLC), programmed death-ligand 1 (PD-L1) expression serves as a key predictive biomarker, determining the use of immune checkpoint inhibitors like pembrolizumab. Clinical trials have shown that pembrolizumab monotherapy improves survival in patients with high PD-L1 expression (≥ 50%), while adding pembrolizumab to platinum-based chemotherapy enhances outcomes across subgroups with lower PD-L1 expression (< 50%). In Lithuania, pembrolizumab has been approved as a first-line treatment for advanced NSCLC since 2018, but real-world data on its effectiveness remain limited. Aim of the study. To evaluate and compare the treatment effectiveness of pembrolizumab monotherapy and pembrolizumab combined with chemotherapy in patients with NSCLC treated at the Hospital of the Lithuanian University of Health Sciences Kauno klinikos. Methods. A retrospective analysis of medical records was conducted for patients treated at Kauno klinikos between 2020 and 2023 who received either pembrolizumab monotherapy or combination therapy with chemotherapy for advanced NSCLC. Results. Patients receiving pembrolizumab monotherapy were older (median age 70 [range 37–84]) than those receiving combination therapy (median age 64 [range 37–82]) (p = 0.019). The treatment groups had no statistically significant differences in progression-free survival (PFS) or overall survival (OS). Survival outcomes did not vary significantly according to tumor histological type. In the subgroup with PD-L1 expression ≥ 50%, median PFS was 233 days (95% CI: 176–272; p = 0.647), and median OS was 590 days (95% CI: 262–918; p = 0.020). Male sex (p < 0.001) and lymph nodemetastases (p < 0.001) were associated with poorer overall survival. Regarding treatment safety, adverse events related to chemotherapy were significantly more frequent in the combination therapy group. Conclusions. Treatment effectiveness was comparable between pembrolizumab monotherapy and combination therapy, regardless of tumor histological type. Higher overall survival was observed in patients with high PD-L1 expression. Patient sex and disease spread significantly influenced treatment outcomes. Chemotherapy-related adverse events were more frequent among patients receiving combination therapy.

BLEEDING RISK ASSESSMENT WITH THE PE-SARD, PEBSI, AND RIETE SCORES IN PATIENTS WITH ACUTE PULMONARY EMBOLISM DURING THE EARLY ANTICOAGULATION PERIOD

Agnė Kaunienė — 2025-09-25

A retrospective study was conducted, including patients treated for acute PE at the Department of Pulmonology, Hospital of the Lithuanian University of Health Sciences Kauno Klinikos, between December 1, 2023, and September 1, 2024. Demographic data, risk factors, and comorbidities were collected. Bleeding risk was assessed using the RIETE (sp. Registro Informatizado de la Enfermedad TromboEmbólica), PEBSI (Pulmonary Embolism Bleeding Score Index), and PE-SARD (Syncope, Anemia, Renal Dysfunction) scores. Associations between major bleeding (MB) events and high bleeding risk were analyzed. MB was defined as bleeding causing organ damage (intracerebral or internal organ bleeding) or a hemoglobin drop ≥20 g/L. Results. During the study period, 124 cases of acute PE were identified, of which 23 were excluded due to incomplete data. Among the included patients, 58 (57.4%) were men and 43 (42.6%) women; mean age was 66.8 ± 15.9 years, with no significant sex-related differences. High bleeding risk was identified in 22 (21.8%) patients by PEBSI, 18 (17.8%) by RIETE, and 6 (5.9%) by PE-SARD. MB occurred in 14 patients (13.9%). The sensitivity and specificity for predicting MB were: RIETE – 28% and 90.7%; PEBSI – 45.5% and 94.9%; PE-SARD – 33.3% and 93.2%. The odds of MB increased 3.77-fold for a RIETE score higher than 3.5 (p=0.02, AUC 61.6%), 3.47-fold for a PEBSI score higher than 1.5 (p=0.057, AUC 64.5%), and 6.9-fold for a PE-SARD score higher than 2.25 (p=0.002, AUC 72%). A positive correlation was observed only between RIETE and PE-SARD scores (r = 0.481, p<0.001). Conclusions. All three scoring systems demonstrated high specificity but low sensitivity. This study confirmed the predictive accuracy of the MB risk score and identified its highest effectiveness in assessing MB.

GOOD COPD CONTROL AND THE EUROPEAN GREEN DEAL – WHAT DO THEY HAVE IN COMMON?

Kristina Biekšienė — 2025-09-25

The European Green Deal is the European Union’s growth strategy, a set of policy initiatives that kick-starts the EU’s green transition and aims to achieve climate neutrality by 2050. In this strategy, inhaled drugs were included, so the budesonide/ glycopyrrolate/ formoterol (BUD/GLY/FORM) Aerosphere inhaler has replaced the HFA-134a propellant with the next-generation HFA-1234ze propellant. The next-generation propellants are virtually zero greenhouse gas emissions, non-toxic, non-persistent, and non-biodegradable. On 25th July 2025, the BUD/GLY/FORM Aerosphere was approved by the European Medicines Agency as the first inhaler with an environmentally friendly propellant. The “greenest” patient is the one whose disease is under control. Poorly controlled chronic obstructive pulmonary disease (COPD) has the greatest impact on greenhouse gas emissions. BUD/GLY/FORM as a triple therapy is associated with cardiopulmonary risk prevention, effectively reducing COPD exacerbations. BUD/GLY/FORM results show that prompt administration of triple therapy after an exacerbation can ensure a lower risk of comorbidities and have a significant impact on long-term outcomes. Triple therapy in a single inhaler BUD/GLY/FORM reduced the risk of death from all causes in patients with moderate, severe, or very severe COPD.

THE ROLE OF FLUTICASONE FUROATE/UMECIDINIUM/VILANTEROL IN THE TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: ADVANTAGES IN EFFICACY AND TREATMENT ADHERENCE

Ieva Dimienė — 2025-09-25

Triple therapy, consisting of an inhaled corticosteroid, a long-acting β₂-agonist, and a long-acting muscarinic
antagonist, is recommended for patients with chronic obstructive pulmonary disease who continue to experience symptoms and non-infectious exacerbations while on treatment with dual bronchodilation. To achieve the best possible treatment outcomes, it is essential to compare the effectiveness of the chosen medication with other triple therapy agents and to select the most convenient inhaler device and dosing regimen for the patient. Studies have shown that treatment with fluticasone furoate/umeclidinium/ vilanterol in a single inhaler provides greater improvements in lung function and reductions of exacerbation and mortality rates compared with other triple therapies. Moreover, once-daily administration is associated with better treatment adherence.

IMPACT OF THE BECLOMETASONE/FORMOTEROL/GLYCOPYRRONIUM ON SMALL AIRWAYS DYSFUNCTION IN COPD

Virginija Kalinauskaitė-Žukauskė — 2025-09-25

The article reviews the importance of small airway dysfunction and its effective management in chronic obstructive pulmonary disease (COPD). The MASCOT and TRIFLOW studies are discussed in detail. The extrafine beclometasone/ formoterol/glycopyrronium combination significantly improves small airway function, concurrently alleviates clinical symptoms, and reduces the risk of exacerbations. One of the key methods capable of detecting early changes is oscillometry.

EFFICACY AND SAFETY OF ALECTINIB IN PATIENTS WITH ADVANCED ALK-POSITIVE NON-SMALL CELL LUNG CANCER: DATA FROM THE ALEX CLINICAL TRIAL

Jurgita Matulionė — 2025-09-25

Targeted therapy has significantly improved the survival and quality of life of patients with NSCLC. Alectinib, a highly selective inhibitor of anaplastic lymphoma kinase (ALK), has shown systemic and central nervous system (CNS) efficacy in the treatment of advanced ALK-positive non-small-cell lung cancer. ALEX was the first global phase III head-to-head comparison of two ALK inhibitors (alectinib and crizotinib) in the first-line setting. ALEX was the first trial to directly compare two ALK inhibitors in the first-line setting of advanced ALK-positive NSCLC patients. Follow-up results from the ALEX study continue to support alectinib as the first-line, preferred standard of care for patients with previously untreated, advanced ALK-positive NSCLC.

THE ROLE OF DRY POWDER INHALERS IN MODERN ASTHMA AND COPD MANAGEMENT: THE COMBINATION OF BUDESONIDE AND FORMOTEROL FUMARATE

Sabina Gasperovič — 2025-09-25

Asthma and chronic obstructive pulmonary disease (COPD) are among the most common chronic respiratory
diseases, in which inhalation therapy plays a central role. Dry powder inhalers (DPIs), recommended by the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, are suitable for most patients. An inspiratory flow rate (PIF) of ≥ 30 L/min is sufficient to ensure effective DPI dose delivery. Studies demonstrate that patients with asthma or COPD are generally able to achieve adequate PIF, and DPIs provide consistent budesonide dosing regardless of environmental conditions (temperature, humidity), mechanical stress, or variations in inhalation manoeuvers. The combination of budesonide and formoterol fumarate improves lung function parameters, patient-reported quality of life, and disease control, making it an effective, reliable, and patient-friendly treatment option in everyday clinical practice.

IDIOPATHIC AND PROGRESSIVE PULMONARY FIBROSIS: A REVIEW OF NEW CLINICAL TRIALS

Kęstutis Malakauskas — 2025-09-25

Data from the FIBRONEER-IPF and FIBRONEER-ILD studies demonstrate the clinical efficacy of the
phosphodiesterase 4B inhibitor nerandomilast, administered alone or in combination with other antifibrotic agents, in slowing the decline in lung function in patients with idiopathic and progressive pulmonary fibrosis

TREATMENT OF NON-SMALL CELL LUNG CANCER PATIENTS WITH NEGATIVE PROGRAMMED CELL DEATH LIGAND EXPRESSION

Gediminas Vasiliauskas — 2025-09-25

Summary. Lung cancer remains one of the most commonly diagnosed and fatal oncological diseases in the world. Patients with metastatic non-small cell lung cancer and programmed cell death ligand-1 expression less than 1% constitute a significant and difficult-to-treat population. According to meta-analyses, the combination of immunotherapy and platinum-based chemotherapy significantly improves progression-free survival, overall survival, and objective response rate in these patients compared with chemotherapy alone.