BACKGROUND The incidence of invasive fungal infections is increasing in immune-competent and immune-compromised patients. An examination of the recent literature related to the treatment of fungal infections was performed to address two clinical questions. First, in patients with proven or probable invasive pulmonary aspergillosis, should combination therapy with a mold-active triazole plus echinocandin

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BACKGROUND The independent, mediation, interaction, and joint effects of socioeconomic status (SES) and phenotypic frailty on the incidence of chronic obstructive pulmonary disease (COPD) are unclear. RESEARCH QUESTION Do SES and frailty increase the risk of COPD independently or jointly ? Is there an interaction between the two factors in incident COPD? Does frailty play a mediating role between SES

Extract Since the original characterisation of cystic fibrosis (CF), its treatment has focused primarily on mitigating its most severe manifestations. However, in the past decade, the emergence of therapies that improve cystic fibrosis transmembrane conductance regulator (CFTR) protein processing and function has been changing the lives of those eligible for these small molecule therapies, first in

Extract We were pleasantly surprised to see that the Wiener Staatsoper scheduled Giuseppe Verdi's La Traviata during another exciting and successful 2024 European Respiratory Society Congress in Vienna. A coincidence perhaps, yet also a stark reminder that respiratory conditions and tuberculosis continue to be a leading cause of morbidity and mortality worldwide; and also a tribute to Phthisiology

Extract The treatment landscape of pulmonary arterial hypertension (PAH) continues to evolve rapidly with the recent international approval of sotatercept in the USA for treatment of adults with PAH. Sotatercept is a fusion protein that traps activins and growth differentiation factors, which has potential anti-remodelling properties on the pulmonary vasculature relevant to PAH pathogenesis. Concerns

Extract Idiopathic pulmonary fibrosis (IPF) is a devastating and usually progressive disease associated with ageing [1]. The incidence and prevalence of IPF have been reported to be higher in males than in females, although the reasons are unclear [2–4].

Extract Chronic respiratory diseases are the third leading cause of death and affect more than 450 million people worldwide [1]. Major risk factors such as cigarette smoking have long been studied in their pathogenesis, but as the global population ages, increasing attention must now be paid to the contributory role of ageing [2]. Epidemiological evidence indicates a decline in lung health over time

Background Elexacaftor/tezacaftor/ivacaftor (ETI), which is approved for people with cystic fibrosis (pwCF) with a F508del variant, was further approved based on in vitro data in the USA for those carrying at least one of 177 rare CFTR (cystic fibrosis transmembrane conductance regulator) variants. Methods PwCF, aged ≥6 years, carrying no F508del variant but with at least one of these 177 rare variants

Background MK-5475 is an investigational inhaled soluble guanylate cyclase stimulator hypothesised to avoid most side-effects of systemic vasodilation. Methods The phase 2 INSIGNIA-PAH (NCT04732221) trial randomised adults with pulmonary arterial hypertension (PAH) on stable background therapy 1:1:1:1 to once-daily dosing with placebo, MK-5475 32 µg, 100 µg or 380 µg via dry powder inhalation for 12 weeks

Extract Pulmonary hypertension (PH) due to left heart disease (PH-LHD; group 2) is the most frequent form of PH and is a growing public health problem with associated high morbidity and mortality. PH often complicates heart failure with preserved or reduced ejection fraction (HFpEF or HFrEF) and negatively impacts outcomes, especially in patients with progressive pulmonary vascular remodelling (the

Background Pulmonary alveolar proteinosis (PAP) is a rare syndrome caused by several distinct diseases leading to progressive dyspnoea, hypoxaemia, risk of respiratory failure and early death due to accumulation of proteinaceous material in the lungs. Diagnostic strategies may include computed tomography (CT) of the lungs, bronchoalveolar lavage (BAL), evaluation of antibodies against granulocyte–macrophage

Background Calcification is common in chronic vascular disease, yet its role in pulmonary hypertension due to left heart disease is unknown. Here, we probed for the role of runt-related transcription factor-2 (RUNX2), a master transcription factor in osteogenesis, and its regulation by the HIPPO pathway transcriptional coactivator with PDZ-binding motif (TAZ) in the osteogenic reprogramming of pulmonary

Primary ciliary dyskinesia (PCD), an inherited motile ciliopathy, is characterised by recurrent upper and lower respiratory tract infections, organ laterality defects, subfertility and neonatal respiratory distress due to impaired ciliary function.1 Over 50 PCD disease-causing genes have been identified that impact the structure and function of the cilia (figure 1, originally in Despotes et al 1).

Fibrosis is scarring due to the replacement of tissue architecture by extracellular matrix (ECM), which consists largely of collagen. Scarring progressively destroys organ structure and thereby impairs function. Accumulation of collagen is thought to be due to an increase in production, a reduction in degradation of collagen or a combination of both.1 If so, we might expect the ratio of production

Tuberculosis (TB) is a pressing global human health problem that resulted in over 10 million cases and 1.3 million deaths in 2022.1 The WHO proposes to end this global epidemic by 2035, which would necessitate reducing TB deaths by 95%, TB incidence by 90%, and eliminating catastrophic costs for TB-affected households compared with the 2015 levels. There is doubt this can be achieved. An established

Introduction While associations between ambient air pollution and respiratory health in chronic obstructive pulmonary disease (COPD) patients are well studied, little is known about individuals’ personal exposure to pollution and associated health effects by source. Aim To separate measured total personal exposure into indoor-generated and outdoor-generated pollution and use these improved metrics

Background Interstitial lung diseases (ILDs) include a large number of diseases associated with progressive pulmonary fibrosis (PPF), including idiopathic pulmonary fibrosis (IPF). Despite the rarity of each of the fibrotic ILDs individually, they cumulatively affect a considerable number of patients. PPF is characterised by an excessive collagen deposition leading to functional decline. Objectives

Introduction The pathogenesis of sarcoidosis involves tissue remodelling mediated by the accumulation of abnormal extracellular matrix, which is partly the result of an imbalance in collagen synthesis, cross-linking and degradation. During this process, collagen fragments or neoepitopes, are released into the circulation. The significance of these circulating collagen neoepitopes in sarcoidosis remains

Aims Spirometry is used by many clinicians to monitor asthma in children but relatively little is understood about its variability over time. The aim of this study was to determine the variability of forced expiratory volume in 1 s (FEV1) in children with symptomatically well-controlled asthma by applying three different methods of expressing change in FEV1 over 3-month intervals. Methods Data from

The mechanism of thrombocytopenia during acute pulmonary hypertension (PH) decompensation may be partly due to platelet aggregation in the lung. Platelet aggregates in explanted lung from 16 lung transplant patients during acute PH decompensation with and without thrombocytopenia were identified by immunohistochemistry. Scanning electron microscopy (SEM) was performed. 7 explant lung controls without

Tuberculosis (TB) control efforts are limited by ineffective characterisation of tuberculosis infection (TBI) —a heterogeneous spectrum of pre-clinical infection states, invisible to tools of routine clinical screening, that are associated with variable risk of progression to TB disease. In this prospective study, we use positron emission tomography-CT (PET-CT) as a high-resolution imaging modality

A 90-year-old man visited our hospital with a chief problem of haemoptysis lasting for a month. He had a medical history of bladder cancer, including transurethral resection, 10 years previously. Chest and abdominal CT demonstrated a large cystic lesion with thin walls surrounded by infiltration and ground-glass opacities in the left lower lobe of the lung (figure 1A), with no findings of bladder cancer

Background Childhood interstitial lung disease (chILD) encompasses a group of rare heterogeneous respiratory conditions associated with significant morbidity and mortality. Reports suggest that many patients diagnosed with chILD continue to have potentially progressive or fibrosing disease into adulthood. Over the last decade, the spectrum of conditions within chILD has widened substantially, with

BackgroundClinical remission has emerged as an important treatment goal in severe asthma; however, studies have reported variable attainment due to differences in study populations, definitions, and methods. We aimed to perform a systematic review and meta-analysis of clinical remission attainment, definitions, and correlates among patients with severe asthma who have been treated with biologics. MethodsIn

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Section snippets Two late 18th century manuscriptsBoth of the manuscripts we feature here were written by students hearing the lectures of famous authors, but whose advice on thoracentesis is previously unknown. They are fascinating not only for expanding our understanding of these two important figures but because they provide precise descriptions of the site and technique of thoracic drainage just

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BACKGROUND Pulmonary hypertension in children often progresses despite optimal therapy. This document provides an evidence-based clinical practice guideline for the management of children with progressive pulmonary hypertension despite optimal therapy. METHODS A multidisciplinary panel identified pertinent questions regarding the management of children with pulmonary hypertension that has progressed

BACKGROUND Quantitative chest computed tomography (CT) may be a useful predictor of outcome in rheumatoid arthritis-related interstitial lung disease (RA-ILD). RESEARCH QUESTION What is the utility of deep learning-based lung fibrosis quantitation on CT in assessing disease severity, predicting mortality and identifying progression in RA-ILD? STUDY DESIGN AND METHODS CT scans on a primary cohort of

BACKGROUND Obstructive sleep apnea (OSA) causes episodes of fragmented sleep and intermittent hypoxia and leads to excessive daytime sleepiness (EDS). Deficits in cognitive function are a troublesome symptom in patients with OSA and EDS. RESEARCH QUESTION How does solriamfetol affect cognitive function in patients with cognitive impairment associated with OSA and EDS? STUDY DESIGN AND METHODS SHARP

BACKGROUND The current guidelines do not recommend β-blockers in pulmonary arterial hypertension (PAH) unless indicated by comorbidities. However, the evidence regarding the role of β-blockers in PAH is contradictory. RESEARCH QUESTION What are the effects of β-blockers on clinical outcomes in patients newly diagnosed with pulmonary arterial hypertension (PAH), and how do these outcomes differ based

BACKGROUND The optimal strategy to prevent reintubation in obese patients remains uncertain. We aimed to determine whether noninvasive ventilation (NIV) with active humidification is superior to high-flow nasal cannula (HFNC) in preventing reintubation in obese patients at intermediate risk. METHODS Randomized controlled trial in two intensive care units in Spain (June 2020‒June 2021). We included

RATIONALE The global burden of sepsis is concentrated in sub-Saharan Africa, where inciting pathogens are diverse and HIV co-infection is a major driver of poor outcomes. Biological heterogeneity inherent to sepsis in this setting is poorly defined. OBJECTIVES To identify dominant pathobiological signatures of sepsis in sub-Saharan Africa and their relationship to clinical phenotypes, patient outcomes

BACKGROUND Response to pulmonary rehabilitation is not equal for all participants, and may vary across health outcomes for any one individual. Alternative modes of pulmonary rehabilitation delivery, e.g. telerehabilitation, may improve program access but could also affect response to rehabilitation. RESEARCH QUESTIONS What is the rate of clinical response to home-based telerehabilitation compared to

BACKGROUND There are limited FDA-approved medications and real-world data on sarcoidosis treatment in the U.S. and concordance of practice patterns with guideline recommendations have not been well characterized. RESEARCH QUESTION What are the practice patterns and factors associated with treatment for patients with sarcoidosis in the year following diagnosis? STUDY DESIGN AND METHODS We conducted

Extract In 2021, the World Health Organization (WHO) issued recommendations for the use of artificial intelligence (AI), affirming the technology could be used instead of human readers for the interpretation of chest radiograph (CXR) images for the screening and triage of tuberculosis (TB), marking a historic precedent for a guideline on AI in health [1]. The forward-looking guidance highlights the

Extract It is of utmost importance that medicines are available at all times for our patients. Historically, medication unavailability has typically, if not exclusively, affected low- and middle-income countries [1]. More recently however, drug shortages have also been reported in high-income European countries [2]. Drug shortages have negative health consequences for patients [3], and a profound economic

Extract There is an expanding literature on the association between obstructive sleep apnoea (OSA) and cancer risk [1, 2]. Evidence is growing from population- and clinic-based cohort studies that the severity of OSA and sleep-related hypoxaemia may adversely affect both overall cancer risk and incidence of certain cancers [3–7]. These clinical findings are supported by the identification of the intermediate

Extract With a disproportionate burden of tuberculosis (TB) amongst migrants in Europe [1], Burman et al. [2] have highlighted the pressing need for alternative approaches to make TB infection (TBI) screening comprehensive and accessible. Across high-income Organisation for Economic Co-operation and development countries, a median of 52% of TB cases occur in foreign-born individuals, who are at their

Extract In cystic fibrosis (CF), Pseudomonas aeruginosa acquisition represents a turning point in disease progression. The presence of chronic P. aeruginosa infection is associated with worsening lung function and increased risk of earlier death, whereas treatment substantially improves lung function and survival [1, 2]. Efforts to diagnose and eradicate early P. aeruginosa provide lasting benefits

Background Computer-aided detection (CAD) systems hold promise for improving tuberculosis (TB) detection on digital chest radiographs. However, data on their performance in exclusively paediatric populations are scarce. Methods We conducted a retrospective diagnostic accuracy study evaluating the performance of CAD4TBv7 (Computer-Aided Detection for Tuberculosis version 7) using digital chest radiographs

Background The real-world consequences of a Philips Respironics recall for positive airway pressure (PAP) devices distributed between 2009 and 2021 are unknown. Methods We conducted a retrospective population-based study using health administrative databases (Ontario, Canada) on all new adult PAP users identified through the provincial funding system, free of cancer at baseline, who initiated (claimed)