Aim: To provide an updated overview of photodynamic therapy (PDT), emphasizing the evolution of photosensitizers, their mechanisms of action, and current challenges and innovations aimed at improving therapeutic outcomes. Methods: A structured literature review was conducted using PubMed, Scopus, and Embase databases to identify studies published between 2000 and 2025. Search terms included photodynamic therapy, photosensitizers, nanoparticles, reactive oxygen species, and drug delivery systems. Experimental studies, clinical trials, and review articles focused on photosensitizer development and applications were analyzed. Results: Photosensitizers have advanced through three generations. First-generation agents such as Photofrin demonstrated clinical success but were hindered by shallow tissue penetration and prolonged photosensitivity. Second-generation compounds achieved stronger absorption within the therapeutic window (650-800 nm) and higher singlet oxygen yields but encountered solubility and delivery limitations. Third-generation systems integrate targeting ligands or nanocarriers, improving selectivity, bioavailability, and pharmacokinetics. Despite these advances, PDT remains limited by insufficient light penetration, tumor hypoxia, and non-specific toxicity, and is therefore used only in select clinical settings. Recent approaches, such as multifunctional theranostic photosensitizers, gene-encoded PSs, and combination therapies with immunotherapy or chemotherapy, aim to overcome these barriers. Conclusions: Continued innovation in photosensitizer chemistry, nanotechnology-based delivery, and combination strategies promises to enhance PDT’s selectivity, depth, and clinical effectiveness across oncology, dermatology, and infectious disease treatment.

Background: Minimally invasive dentistry increasingly seeks alternatives to conventional surgical and antimicrobial-intensive therapies. Photodynamic therapy (PDT) provides targeted antimicrobial and cytotoxic effects through the activation of a photosensitizer by light in the presence of oxygen, offering a selective and conservative therapeutic approach. Aim: To review the mechanisms of action, clinical applications, current evidence, challenges, and future directions of photodynamic therapy in modern dental practice. Methods: A narrative synthesis of recent experimental, clinical, and review literature was conducted. The review focused on PDT mechanisms, commonly used photosensitizers and light delivery systems, clinical outcomes across dental specialties, and emerging technological developments aimed at improving therapeutic performance. Results: Photodynamic therapy demonstrates strong antimicrobial efficacy, effective biofilm disruption, and selective tissue action without inducing microbial resistance. Clinical evidence supports its use as an adjunctive therapy in periodontology, endodontics, peri-implant therapy, caries management, oral infections, and early oral malignancies. PDT is associated with a favorable safety profile and minimal invasiveness. However, variability in treatment protocols, differences in photosensitizer properties, limited light penetration, and cost considerations contribute to inconsistent clinical outcomes. Conclusions: Photodynamic therapy represents a valuable adjunct in minimally invasive dentistry, offering targeted therapeutic benefits across multiple clinical applications. Despite promising evidence, barriers to routine clinical adoption remain. Ongoing advances in photosensitizer design, nanotechnology-based delivery systems, and light technologies are expected to enhance standardization, clinical effectiveness, and wider implementation.

Wprowadzenie: Bronchofiberoskopia (fiberoptic bronchoscopy – FOB) to małoinwazyjna procedura medyczna, powszechnie używana w diagnostyce i leczeniu chorób układu oddechowego. Zabieg jest na ogół dobrze tolerowany i istnieje niewiele przeciwwskazań do jego stosowania. Podczas FOB wprowadzany bronchofiberoskop powoduje ostre zwężenie dróg oddechowych, mogące skutkować rozwinięciem się lub zaostrzeniem niewydolności oddychania (respiratory failure – RF). Z tego powodu pacjenci z RF mogą zostać zdyskwalifikowani z zabiegu bronchoskopowego. Nieinwazyjne techniki wspomagania oddechu, takie jak donosowa terapia wysokoprzepływowa (high-flow nasal cannula – HFNC) oraz maska do wentylacji nieinwazyjnej (non-invasive ventilation – NIV), są cenionymi metodami wsparcia układu oddechowego u pacjentów z RF, jednak możliwości ich wykorzystania u pacjentów poddawanych FOB są wciąż niejasne.Opis przypadków: W opracowaniu opisano przypadki pięciu pacjentów poddanych bronchoskopii z różnych wskazań. W dwóch przypadkach rozpoznano guza krtani, w jednym obecność ciała obcego powikłanego nawracającymi zapaleniami płuc, u jednej pacjentki zapalenie płuc związane z przedłużoną intubacją, a w ostatnim przypadku RF po udarze niedokrwiennym mózgu. W każdym przypadku podczas FOB zastosowano wsparcie oddychania w postaci HFNC lub NIV z powodu wysokiego ryzyka rozwoju lub zaostrzenia RF. Parametry HFNC i NIV ustawiono zgodnie z założeniami dwóch trwających obecnie badań randomizowanych.Wnioski: Metody wsparcia oddechowego, takie jak HFNC oraz NIV, są obiecującymi metodami u pacjentów z wysokim ryzykiem rozwinięcia się RF podczas FOB.

Background: Fiberoptic bronchoscopy (FOB) is a procedure routinely performed in clinical practice for both diagnostic and therapeutic purposes. FOB frequently impairs respiratory function, which may exacerbate respiratory failure. Currently, conventional oxygen therapy (COT) is the most commonly used form of respiratory support; however, non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) are being used increasingly. The optimal settings and indications for NIV and HFNC in patients with respiratory acidosis undergoing FOB have not yet been determined. Methods: This is a prospective, multicenter, randomized controlled trial including two parallel study populations defined by the indication for bronchoscopy and the type of respiratory acidosis. Therapeutic FOB (Study 1): Patients with decompensated type 2 respiratory failure (pH < 7.35 and PaCO₂ > 45 mmHg) will be randomized to receive one of four methods of respiratory support during bronchoscopy: COT, NIV, HFNC, or invasive mechanical ventilation (IMV) (n = 315). Diagnostic FOB (Study 2): Patients with chronic respiratory acidosis (pH ≥ 7.35, PaCO₂ > 45 mmHg, and/or HCO₃⁻ > 27 mmol/L) will be randomized to receive COT, NIV, or HFNC during bronchoscopy (n = 210). Before FOB, patients in both groups will undergo arterial blood gas (ABG) analysis. During FOB, vital signs will be continuously monitored, including SpO₂, FiO₂, TcCO₂, ECG, and heart rate. After FOB, ABG analysis will be repeated, and study endpoints and complications, if any, will be recorded. The planned study period is from April 2026 to April 2029. Results: Based on the study results, we aim to evaluate the effectiveness and safety of different respiratory support strategies during flexible bronchoscopy, with the primary objective of comparing the rate of treatment failure among COT, HFNC, NIV, and IMV. Treatment failure is defined as the need for endotracheal intubation, premature termination of the procedure, or escalation of respiratory support. Additionally, we aim to identify the optimal NIV and HFNC settings, as well as complication rates in both study groups. Conclusions: The results of this study will help define the role of optimal respiratory support in patients with respiratory acidosis undergoing FOB, potentially leading to a shorter time from admission to diagnosis, better tolerance of the procedure, and faster recovery afterward.

Seria przypadków klinicznych ilustruje wyzwania związane z wykonaniem bronchofiberoskopii (fiberoptic bronchoscopy – FOB) u pacjentów obciążonych kardiologicznie i pulmonologicznie. Standardowe metody wsparcia oddechowego mogą być niewystarczające u tej grupy pacjentów. Pierwszy przypadek dotyczy pacjentki z wrodzoną wadą serca, niewydolnością oddechową i podejrzeniem zmian zapalnych w płucach, wymagającej diagnostycznej FOB z powodu krwioplucia. Zastosowanie wysokoprzepływowej tlenoterapii donosowej (high-flow nasal oxygen therapy – HFNOT) pozwoliło na bezpieczne wykonanie FOB, minimalizując ryzyko powikłań związanych np. z barotraumą. Drugi przypadek dotyczy pacjentki ze zdiagnozowanym zespołem Melnicka i Needlesa, przewlekłą niewydolnością oddechową i chondromalacją chrząstki oskrzelowej, co mogło stanowić przyczynę powikłań podczas standardowej FOB. W trakcie zabiegu również zastosowano HFNOT, co zapobiegło powikłaniom wynikającym z ograniczeń anatomicznych i ewentualnej barotraumy. Opisane przypadki kliniczne mogą sugerować, że zastosowanie HFNOT u pacjentów z wysokim ryzykiem powikłań, zwłaszcza z wrodzoną wadą serca i anomaliami dróg oddechowych, jest skuteczną alternatywą dla tradycyjnych metod wsparcia oddechowego.

Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of surfactant in the alveoli due to impaired clearance or overproduction leading to progressive dyspnea and potentially fatal respiratory failure. This review provides a comprehensive analysis of current and emerging therapeutic strategies for PAP, evaluating their pathophysiological rationale, clinical efficacy and limitations. A structured literature review was conducted using PubMed, Google Scholar, and Cochrane Library databases to identify studies published between 01.01.2002 and 01.07.2026. Search terms included: “PAP,” “whole lung lavage (WLL),” “segmental lung lavage (SLL),” “granulocyte-macrophage colony-stimulating factor (GM-CSF),” “molgramostim,” “sargramostim,” “rituximab,” and “statin therapy.” WLL removes accumulated surfactant, but it remains hindered by its invasive nature, procedural risks, and recurrence rates requiring repeated sessions. To overcome these limitations, less invasive techniques, such as mini-WLL and bronchoscopic SLL, achieve targeted surfactant clearance with reduced volume load, making them valuable alternatives for high-risk patients or bridging therapies. Targeted pharmacotherapies including inhaled recombinant GM-CSF which restores alveolar macrophage clearance functions, improves gas exchange and reduces the reliance on WLL. Statin therapy may reduce macrophage lipid accumulation. Despite these interventions rituximab, extracorporeal membrane oxygenation (ECMO) support, or lung transplantation may be useful in selected cases. Innovations, including gene therapy and gene-corrected macrophage transplantation, aiming to permanently restore cellular function are also being tested. The management of PAP is shifting from global mechanical surfactant removal towards personalized, local lavage or pathogenetically driven pharmacological algorithms, however WLL remains essential for acute rescue in severe hypoxemia.