Geriatric respiratory medicine 2026: from artificial intelligence to personalised management of the multimorbid patient
Year: 2026
Type: review
Abstract: The profound demographic shift toward an ageing population has decisively moved the burden of chronic and acute lung diseases towards older adults, necessitating a transition from organ-centred models to integrated, multidimensional care. This review outlines a pragmatic framework for managing the complex interplay of immunosenescence, frailty and multimorbidity. In acute care, "pneumonia-associated sarcopenia" is identified as a critical driver of recurrent infections and functional decline, requiring a shift towards aspiration prevention and the aid of diagnostic tools such as lung ultrasound. The selection of noninvasive respiratory support, including high-flow nasal cannulas and noninvasive ventilation, must balance physiological efficacy with the risks of delirium and patient self-inflicted lung injury. Preventive strategies have evolved with the introduction of 20-valent pneumococcal and respiratory syncytial virus vaccines, alongside proactive screening for ɑ1-antitrypsin deficiency to enable precision interventions. Chronic disease management emphasises a "device-centric" inhalation therapy approach, tailoring delivery systems to impaired peak inspiratory flows and cognitive status rather than to pharmacology alone. The advent of biological therapies, particularly the use of dupilumab and mepolizumab in eosinophilic COPD, offers a transformative "steroid-sparing" effect, aiming for clinical stability and preserved independence. Finally, the integration of artificial intelligence as "augmented intelligence" and the "4Ms" multidisciplinary model (mentation, medication, mobility, morbidities) provide the necessary tools to navigate clinical complexity. This holistic strategy ensures that technological innovation remains anchored in patient-centred goals.
Source: European Respiratory Review
Authors: Claudio Sorino, Paolo Cameli, Giorgio Walter Canonica, Giovanna Elisiana Carpagnano, Andrea Cortegiani, Claudio Costantino, Danilo Di Bona, Mario Malerba, Andrea Maresca, Corrado Pelaia, Stefania Principe, Beatrice Ragnoli, Paola Rogliani, Simone Scarlata, Alessandra Tomasello, Luigi Tramonte, Antonino Tuttolomondo, Alessandro Vatrella, Patrizio Vitulo, Anna Zito, Nicola Scichilone
Institutions: Azienda Socio Sanitaria Territoriale Lariana, Ospedale Sant'Anna, Ospedale Santa Maria alle Scotte, IRCCS Humanitas Research Hospital, Ospedale Pediatrico Giovanni XXIII, University of Palermo, University of Foggia, Università degli Studi del Piemonte Orientale “Amedeo Avogadro”, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Magna Graecia University, University of Amsterdam, University of Rome Tor Vergata, Campus Bio Medico University Hospital, University of Salerno, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223131117