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Macrolides reduce exacerbations when added to inhaled therapy in severe asthma. However, there is little published evidence for effectiveness in patients treated with biologics. We conducted a retrospective audit of all patients who started azithromycin while on biologics in our centre. Compared with those that did not start azithromycin, these individuals had more exacerbations and a phenotype of

Background Limited research exists on screening thresholds for low-dose CT in detecting malignant pure ground-glass lung nodules (pGGNs) in the Chinese population. Materials and methods A retrospective analysis of the Guangzhou Lung-Care programme was conducted, retrieving average transverse diameter, location, histopathology, frequency and follow-up intervals. Diagnostic performances for ‘lung cancers’

Background Uncertainty exists about the beneficial effects of delivering pulmonary rehabilitation (PR) during exacerbations of chronic obstructive pulmonary disease (ECOPD). This study explored the short-term effects and self-reported impact of a home-based PR programme for people with outpatient-managed ECOPD. Methods We conducted a mixed-methods randomised controlled trial in people with outpatient-managed

Objective Community-acquired pneumonia (CAP) is a leading cause of hospitalisation in older adults and is associated with a high likelihood of adverse outcomes. Given the ageing population and lack of therapeutic advances in CAP, new strategies to manage the burden of this disease are needed. Neutrophil dysfunction has been widely demonstrated in CAP and is associated with poor outcomes. We hypothesised

Background Obstructive sleep apnoea syndrome (OSAS) has been recognised as a potential risk factor for cognitive decline, yet its precise relationship with dementia remains uncertain. This study aimed to determine the risk of dementia among individuals with and without OSAS. Methods Data derived from 2.3 million adults (aged ≥18 years) were extracted from the Clinical Practice Research Datalink (2000–2022)

Chronic obstructive pulmonary disease (COPD) is a heterogenous lung condition characterized by progressive airflow obstruction. Despite advancements in diagnosis and treatment, the disease burden remains high; although clinical trials have shown improvements in outcomes such as exacerbations, quality of life, and lung function, improvement may not be attainable for many patients. For patients who do

RATIONALE No systematic investigation into dyspnea in patients receiving prolonged ventilation (>21 days) after recovering from critical-illness has been published. OBJECTIVES To determine magnitude, nature and pathophysiological basis of dyspnea during an unassisted-breathing trial in prolonged-ventilation patients. METHODS Dyspnea intensity and descriptor selection were investigated in 27 prolonged-ventilation

RATIONALE High flow therapy reduces dyspnea in acute respiratory failure but the underlying mechanisms are not fully elucidated. OBJECTIVES To compare dyspnea, airway occlusion pressure (P0.1) and inspiratory work with and without nasal high flow (NHF, FiO2 21%, temperature 31°C) in intubated patients under pressure support ventilation and during a spontaneous breathing trial (SBT). METHODS Dyspnea

RATIONALE Unrecognised coronary artery disease (CAD) may contribute to adverse outcomes in chronic obstructive pulmonary disease (COPD). Improved identification of at-risk groups could inform better preventative care. We aimed to evaluate the burden and relationships of radiologically detectable CAD in COPD, establish frequency of occult disease, and examine potential cardiovascular screening methods

BACKGROUND The management of incidental pulmonary nodules is guided by recommendations set forth by the Fleischner Society. While most pulmonary nodules are benign, timely and evidence-based follow-up can reduce morbidity and mortality. There are known socioeconomic disparities for engagement with recommended cancer screenings, however it is unclear whether disparities exist for follow-up of incidentally

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Background The ever-increasing number of patients diagnosed with obstructive sleep apnoea (OSA) and treated by long-term continuous positive airway pressure (CPAP) overstretches conventional follow-up pathways. New approaches to the management of CPAP-treated patient follow-up are needed to strike a balance between remote monitoring through digital technologies and in-person patient-healthcare-professional

Background With higher valency pneumococcal vaccines on the horizon and new adult immunisation strategies under discussion, we aimed to evaluate the contribution of individual pneumococcal serotypes to the burden of pneumococcal community-acquired pneumonia (CAP). Over 10 years, trends in pneumococcal pneumonia epidemiology in adults hospitalised with CAP were assessed. The risk factors and severity

INTRODUCTION Global migration has increased in recent decades due to war, conflict, persecutions, and natural disasters, but also secondary to increased opportunities related to work or study. Migrants' risk of tuberculosis (TB) differs by reasons for migration, socioeconomic status, mode of travel and TB risk in transit, TB incidence and healthcare provision in country of origin. Despite advances

Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis (C. immitis) and C. posadasii, is recognized as an increasing threat both nationally and worldwide. This is in large part secondary to the expanding range of Coccidioides spp. and increased international travel to endemic regions. The majority of individuals exposed to airborne Coccidioides organisms do not need medical attention

BACKGROUND The screening strategy for interstitial lung disease (ILD) in rheumatoid arthritis patients is currently debated. While high-resolution computed tomography (HRCT) is the gold standard for diagnosing ILD, its systematic use as a screening tool is not yet recommended. The role of lung ultrasound (LUS) in assessing ILD has been previously explored. RESEARCH QUESTION What is the performance

BACKGROUND Low-dose morphine may be prescribed to reduce chronic breathlessness in chronic obstructive pulmonary disease (COPD). Recent subjective findings suggest morphine may influence breathlessness through sleep-related mechanisms. However, concerns exist regarding opioid safety in COPD. The effects of morphine during sleep in COPD have not been objectively investigated. This study aimed to objectively

Extract We thank A.I. Papaioannou and K. Bartziokas for their interest in our study of the relationship between exacerbation history and blood eosinophil count prior to a diagnosis of COPD and the risk of subsequent exacerbations [1]. As they point out, it is well known that in patients with an established diagnosis and on maintenance treatment, the prior exacerbation history is the best predictor

Extract Throughout time, and in many cultures, the heart has been considered the centre of the human body. This core (Coeur!) organ dominates all other parts of the body and rules our emotions; its functioning determines the difference between life and death. Arguably, the lungs are of less importance and deserve less consideration. In reality, the heart and lungs are anatomically and functionally

Extract Primary ciliary dyskinesia (PCD) is a rare, inherited disorder characterised by abnormal ciliary structure or function, leading to impaired mucociliary clearance. The condition primarily affects the respiratory system, where dysfunctional cilia fail to effectively move mucus, microorganisms and particles out of the airways, resulting in chronic respiratory infections, bronchiectasis and rhino-sinusitis

Extract Pneumococcal pneumonia remains an important clinical problem. Globally, Streptococcus pneumoniae is the organism responsible for the largest proportion of lower respiratory tract infections and associated deaths [1]. Serotype replacement driven by vaccination programmes, non-response to vaccination in some individuals, and inequitable global availability of vaccines and treatment all contribute

Extract We have read with great interest the article from Halpin et al. [1] showing that a single moderate COPD exacerbation in the year prior to COPD diagnosis significantly increases the risk of future exacerbations over the next 12 months, while more frequent or severe exacerbations prior to diagnosis are associated with a higher risk.

Background The "Baveno classification" replaced the apnoea–hypopnoea index (AHI) with symptoms and comorbidities for treatment indication in obstructive sleep apnoea (OSA). This study evaluates a modified Baveno classification which adds a validated cardiovascular disease (CVD) risk score and acknowledges severe breathing disturbances. Method OSA patients from the European Sleep Apnoea Database (ESADA)

Sleep disordered breathing (SDB) is considered a risk factor for cardiovascular disease (CVD). Obstructive sleep apnoea (OSA) can be treated with continuous positive airway pressure (CPAP), and central sleep apnoea (CSA), in patients with heart failure with reduced ejection fraction (HFrEF), by peak flow-triggered adaptive servo-ventilation. Presently, there is equipoise as to whether treating SDB

Background Lung structure and cardiac structure and function are associated cross-sectionally. The classic literature suggests relationships of airways disease to cor pulmonale and emphysema to reduced cardiac output (CO) but longitudinal data are lacking. Methods The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study was a multicentre longitudinal COPD case–control study of participants 50–79 years

Background Primary ciliary dyskinesia is a rare genetic disorder caused by insufficient mucociliary clearance leading to chronic airway infections. The diagnostic guideline of the European Respiratory Society primarily recommends an evaluation of the clinical history (e.g. by the PICADAR prediction tool), nasal nitric oxide production rate measurements, high-speed videomicroscopy analysis of ciliary

Extract Human exposure to Mycobacterium tuberculosis (Mtb) is thought to result in a spectrum of outcomes, including bacillary clearance, quiescent Mtb infection, incipient tuberculosis (TB), subclinical TB and active TB [1]. Incipient TB – defined as a prolonged asymptomatic phase of early disease preceding clinical presentation as active disease [2] – may be distinguished from quiescent Mtb infection

Extract Transmission continues to drive the tuberculosis (TB) and drug-resistant TB epidemics, making infection control an essential component for public health agencies worldwide [1–3]. Transmission of TB is complex, influenced by factors linked to patient behaviour, the form of disease, the exposed individual, the microbe and the environment [3–6]. Each year, more than 10 million people develop TB

Streptococcus pneumoniae is the most common causative agent of community-acquired pneumonia worldwide. A key pathogenic mechanism that exacerbates severity of disease is the disruption of the alveolar–capillary barrier. However, the specific virulence mechanisms responsible for this in the human lung are not yet fully understood. In this study, we infected living human lung tissue with Strep. pneumoniae

Annual lung cancer screening using low dose computed tomography (LDCT) effectively reduces mortality from lung cancer and is recommended for persons who are at high risk of developing the disease. The utilization of the lung cancer screening, however, has remained low. Due to significantly higher cigarette smoking rates, patients with behavioral health disorders (those living with mental illness and/or

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TOPIC IMPORTANCE Asthma is a common multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes/endotypes and the availability of targeted biologic treatment options, a substantial proportion of patients remains uncontrolled with risk of exacerbations, requiring systemic corticosteroids, and progressive disease

Asthma affects over 20 million (8%) of adults in the United States (US) each year.1 2 As with many chronic conditions, poor control can be attributed to low medication adherence and a reduced quality of life, and can translate into a high burden on the healthcare system and economy.3 4 Of importance is cost-related medication nonadherence, as people face heavy financial barriers to accessing US healthcare

Background Uncontrolled asthma is possibly caused by medication non-adherence, and financial hardship can be a major contributor to non-adherence. Since economic conditions and asthma management have changed over time, a comprehensive investigation of cost-related medication non-adherence (CRN) among adults with asthma is crucial. Objective To evaluate trends, prevalence and determinants of CRN, and

A 69-year-old never-smoker was referred to a lung cancer assessment clinic in June 2022 with 4 weeks of exertional breathlessness, haemoptysis and fever, persisting despite three antibiotic courses. Medical history included a kyphoplasty and paroxysmal atrial fibrillation (PAF) requiring radiofrequency catheter ablations in July 2019 and February 2022. He had a previous episode of fever and haemoptysis

Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are treatments for type 2 diabetes (T2D). Beyond glucose-lowering and cardiorenal protection, these drugs may protect against pneumonia and sepsis. Aims This study assesses the impact of SGLT2i and GLP-1 RAs on the risk of incident pneumonia and severe sepsis. Methods A retrospective

As of 2021, 537 million adults are living with diabetes, globally. This is expected to reach 800 million in 20 years.1 Patients with diabetes live with a significantly heightened risk of morbidity and mortality from various causes.2 Among such causes are infections. Diabetes is associated with a significantly increased risk of infections like pneumonia and sepsis, due to immune system impairments from

BACKGROUND Traditional approaches for learning anatomy for curvilinear endobronchial ultrasound (EBUS) require learners to mentally visualize structures relative to the position of the bronchoscope. Virtual reality (VR) can demonstrate anatomy from the perspective of bronchoscopic tools. RESEARCH QUESTION Does the use of a VR anatomy trainer for teaching EBUS-associated anatomy improve procedural performance

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BackgroundTezepelumab is a human monoclonal antibody that blocks thymic stromal lymphopoietin, which has shown increased expression in patients with chronic obstructive pulmonary disease (COPD) compared with healthy individuals. We aimed to assess the efficacy and safety of tezepelumab in patients with moderate to very severe COPD despite receiving triple inhaled therapy. MethodsCOURSE was a double-blind

Childhood interstitial lung diseases (chILD) are rare and usually severe disorders. Among them, very rare cases of surfactant protein (SP)-B deficiencies have been reported so far and are usually associated with fatal forms of chILD. The RespiRare network allows the collection of precise phenotypic and genotypic information. This study that reports a series of 11 SP-B-deficient patients underscores

Introduction Alveolar macrophages (AMs) are the first line of defence against pathogens that initiate an inflammatory response in the lungs and exhibit a strong affinity for surfactant protein A (SP-A). Extracellular vesicles (EVs) have emerged as a promising drug delivery platform due to their minimal cytotoxicity. However, precise targeting of specific cell types and the rapid lysosomal degradation

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Digital technologies (eg, smart inhalers, wearables, and sensors) allow for remote, objective, granular, and non-invasive data collection, making them attractive for research evaluating interventions in airways diseases with variable trajectories, such as asthma. Such technologies offer the opportunity to move towards decentralised clinical trials that are done partly or fully outside the classic clinical

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In this cohort study involving 9399 current and former smokers from the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease study, we assessed the relationship between artificial intelligence-quantified mucus plugs on chest CTs and all-cause mortality. Our results revealed a significant positive association, particularly for those with COPD GOLD stages 1–4, with HRs of 1.18 for 1–2 mucus-obstructed

Rationale: C-reactive protein (CRP)-based tuberculosis (TB) screening is recommended for people with HIV (PWH). However, its performance among people without HIV and in diverse settings is unknown. Objectives: In a multi-country study, we aimed to determine whether CRP meets the minimum accuracy targets (sensitivity ≥90%, specificity ≥70%) for an effective TB screening test. Methods/Measurements: Consecutive