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

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

Extract In recent years, with the introduction of biologic therapies for the treatment of severe asthma, there has been a shift in the goals of asthma management, from control to remission; although remission is not a cure, it is a meaningful, relevant patient-oriented outcome [1]. However, the definition of asthma remission is evolving [2] and varies across studies [3–5]. In addition, the associated

Extract From the tracheobronchial tree structure models described by Weibel [1], Horsfield and Cumming [2], and others [3, 4], we know that in the normal lung, the airways follow a branching pattern from the trachea to the distal airways, which locks in a progressive increase in cumulative cross-sectional lumen area. In fact, in the healthy lung, this increase in cross-sectional lumen area is exponential

Extract Dyspnoea is defined as a symptom conveying an upsetting or distressing experience of breathing awareness, which can vary in quality (e.g. air hunger, increased work/effort of breathing, chest tightness) and intensity, leading to subsequent physiological and behavioural responses [1–3]. It is the cardinal symptom in widespread pulmonary and cardiac diseases, such as asthma [4], COPD [5] and

Extract The ability to rejuvenate lung tissue and restore function is currently an ideal goal for those working in respiratory science. Understanding the mechanisms involved in lung remodelling and repair are paramount for the development of new treatments for several lung diseases and in particular for emphysema, a major component of COPD. Despite many studies investigating the underlying pathophysiologies

Extract We read with great interest the European Respiratory Society (ERS) guidelines for pulmonary alveolar proteinosis (PAP) by McCarthy et al. [1], which were recently published in the European Respiratory Journal. The task force's recommendations addressed many important questions on the role and hierarchical steps in diagnostic testing and treatment of patients with suspected and diagnosed PAP

Extract We have cured chronic lung diseases, including COPD, in mice many times. However, translation to clinical application has failed in most cases. Why is this the case and what can we do about it? One of the reasons for this is that mice are simply not small humans. Developing novel human lung models will help us in identifying more promising novel therapeutic strategies, thereby hopefully leading

Extract Asthma is a chronic inflammatory disease that arises due to an exacerbated immune response causing narrowing and hypersensitivity of the airways [1]. The full aetiology of asthma is not fully understood; however, several studies have shown the role of genetic, immunological and environmental factors in its development or severity. Asthma remains a significant health challenge, contributing

Research question We previously reported that deep brain stimulation (DBS) of the motor thalamus, in a patient with post-stroke tremor, relieved breathlessness associated with COPD. This raised the question of whether motor thalamus DBS mitigates the ascending dyspnoea signal. We therefore sought to conduct a fully powered cohort study of experimentally induced air hunger, an uncomfortable urge to

Extract Type 2 inflammation (Th2i) – indicated by blood eosinophil counts – and airway-occluding mucus plugs (MPs) on computed tomography (CT) are frequent phenotypes in people with COPD [1–4]. Furthermore, the Th2i pathway involves type 2 helper T cells and epithelial-derived cytokines, such as interleukin (IL)-33 and thymic stromal lymphopoietin (TSLP), that drive a cascade of events, including eosinophil

People with asthma experience many different problems related to their illness. The number and type of problems differ between patients. This results in asthma being a complex and heterogeneous disorder which mandates a personalised approach to management. These features pose very significant challenges for the effective implementation of evidence-based management. "Treatable traits" is a model of

Background Airflow limitation is the hallmark of obstructive pulmonary diseases, with the distal airways representing a major site of obstruction. Although numerous in vitro models of bronchi already exist, there is currently no culture system for obstructive diseases that reproduces the architecture and function of small airways. Here, we aimed to engineer a model of distal airways to overcome the

Background Multiple breath washout is a lung function test based on tidal breathing that assesses lung volume and ventilation distribution. The aim of this analysis was to use the Global Lung Function Initiative methodology to develop all-age reference equations for the multiple breath washout indices lung clearance index (LCI) and functional residual capacity (FRC). Methods Multiple breath washout

Background In asthma, clinical response is characterised by disease improvement with treatment, whereas clinical remission is characterised by long-term disease stabilisation with or without ongoing treatment. The proportions of patients receiving tezepelumab who responded to treatment and who achieved on-treatment clinical remission were assessed in the NAVIGATOR (ClinicalTrials.gov identifier NCT03347279)

Background Luminal narrowing is a hallmark feature of airway remodelling in COPD, but current measures focus on airway wall remodelling. Quantification of the natural increase in cumulative cross-sectional area along the length of the human airway tree can facilitate assessment of airway narrowing. Methods We analysed the airway trees of 7641 subjects enrolled in the multicentre COPDGene cohort. Airway

Emphysema, the progressive destruction of gas exchange surfaces in the lungs, is a hallmark of COPD that is presently incurable. This therapeutic gap is largely due to a poor understanding of potential drivers of impaired tissue regeneration, such as abnormal lung epithelial progenitor cells, including alveolar type II (ATII) and airway club cells. We discovered an emphysema-specific subpopulation

Background The diagnosis, severity assessment, and development of therapeutic strategies for asthma are crucial aspects of disease management. Since biomarkers are reliable tools in disease management, we aimed to identify and explore asthma-associated biomarkers and investigate their mechanisms. Methods Lipidomics was used to profile serum glycerophospholipids in asthmatic patients and controls. The

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 Interstitial lung disease (ILD) is rarer in children (chILD) than adults, but with increasing diagnostic awareness, more cases are being discovered. chILD prognosis is often poor, but increasing numbers are now surviving into adulthood. AIM To characterize chILD-survivors and identify their impact on adult-ILD centers. METHODS European study (34 adult-ILD and chILD centers) reporting incident/prevalent

RATIONALE Adherence to Continuous Positive Airway Pressure (CPAP) for Obstructive Sleep Apnoea (OSA) continues to be low with high termination rates. Alternative therapies to CPAP are needed. OBJECTIVES To compare objective adherence to CPAP and Mandibular Advancement Splints (MAS) and to evaluate their effectiveness. Additionally, to identify treatment usage patterns and the clinical effectiveness

RATIONALE Lung transplant recipients have the worst long-term outcomes of all solid organs due to acute rejection and chronic lung allograft dysfunction (CLAD). OBJECTIVE To investigate the efficacy of ECP as a prophylactic treatment to prevent acute cellular rejection (ACR), CMV infections and reduce the risk of CLAD. METHODS Single-center prospective randomized controlled trial conducted at Medical

The Global initiative for chronic Obstructive Lung Disease (GOLD) report states that the diagnosis of chronic obstructive pulmonary disease (COPD) should be considered in individuals with chronic respiratory symptoms and / or exposure to risk factors. Forced spirometry demonstrating airflow obstruction after bronchodilation is required to confirm the diagnosis using a threshold of forced expiratory

Extract The inter-relationship between human lungs and airborne Aspergilli is both complex and dynamic. Our daily intake of Aspergillus spores and hyphal fragments varies from a few 100 to 100 000s; the latter in mouldy environments, certain occupations such as whisky making or tobacco picking, and after certain activities such as turning or distributing compost. Rarely are Aspergilli breathed in alone

Extract We thank our esteemed colleague R. Naeije for his interest in our meta-analysis [1], and agree that the discussion around the correct upper limit of normal (ULN) for the pulmonary arterial wedge pressure (PAWP) is not new. We also agree that even a PAWP difference of a single mmHg matters in clinical practice, as it can have direct and profound implications for clinical decision-making, emphasising

Extract I read with great interest the meta-analysis by Zeder et al. [1], concluding that the upper limit of normal (ULN) of pulmonary arterial wedge pressure (PAWP) may be lower than generally assumed; that is 13 mmHg, instead of the 15 mmHg value mentioned in current guidelines [2]. Based on mean±sd measurements in a total of 960 healthy subjects reported in 49 studies, the authors derived a resting

Background Sensitisation to Aspergillus fumigatus is linked to worse outcomes in patients with COPD; however, its prevalence and clinical implications in domestic (residential) settings remains unknown. Methods Individuals with COPD (n=43) recruited in Singapore had their residences prospectively sampled and assessed by shotgun metagenomic sequencing including indoor air, outdoor air and touch surfaces

Fungal lung disease encompasses a wide spectrum of organisms and associated clinical conditions, presenting a significant global health challenge. The type and severity of disease are determined by underlying host immunity and infecting fungal strain. The most common group of diseases are associated with the filamentous fungus Aspergillus species and include allergic bronchopulmonary aspergillosis

Aim To elucidate the important cellular and molecular drivers of pulmonary long COVID, we generated a single-cell transcriptomic map of the airway mucosa using bronchial brushings from patients with long COVID who reported persistent pulmonary symptoms. Method Adults with and without long COVID were recruited from the general community in Greater Vancouver, Canada. The cohort was divided into those

As part of the November issue, the European Respiratory Journal presents the latest in its series of podcasts. Chief Editor James Chalmers interviews editorial board member Sanjay Chotirmall about articles published in the current issue.

BACKGROUND Macrolide maintenance therapy (MMT) has demonstrated notable efficacy in reducing exacerbation in patients with bronchiectasis, which is a major risk factor for cardiovascular events. However, a comprehensive assessment of the cardiovascular benefits and safety profile of MMT in this population is lacking. METHODS This territory-wide cohort study analyzed patients diagnosed with bronchiectasis

INTRODUCTION Outpatient management of pulmonary embolism (PE) remains controversial in patients with cancer due to their higher risks of mortality, recurrent venous thromboembolism (VTE) and bleeding complications. This systematic review and meta-analysis aimed to evaluate the safety and feasibility of outpatient management of cancer-associated PE. METHODS We searched MEDLINE, Embase, Cochrane Central

BACKGROUND The number of young people who use electronic cigarettes (e-cigarettes) is rising. It remains unclear whether e-cigarettes use impairs lung function. We aimed to compare ventilation distribution between young adults exposed to e-cigarettes with an unexposed group. METHODS Study participants included otherwise healthy young adults (18 to 24 years) who self-reported e-cigarette use, and participates

BACKGROUND Exercise pulmonary hypertension (exercise PH) was defined by a mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope >3 mmHg·L-1·min-1 between rest and exercise in the 2022 ESC/ERS PH guidelines. However, large, multi-center studies on the prognostic relevance of exercise hemodynamics and its added value to resting hemodynamics are missing. PATIENTS AND METHODS The PEX-NET (Pulmonary

OBJECTIVE Gene expression (transcriptomics) studies have revealed potential mechanisms of interstitial lung disease (ILD), yet sample sizes of studies are often limited and between-subtype comparisons are scarce. The aim of this study was to identify and validate consensus transcriptomic signatures of ILD subtypes. METHODS We performed a systematic review and meta-analysis of fibrotic ILD transcriptomics

BACKGROUND Risk prediction tools are routinely utilised in cardiothoracic surgery but have not been developed for pulmonary endarterectomy (PEA). There is no data on whether patients undergoing PEA may benefit from a tailored risk modelling approach. We develop and validate a clinically-usable tool to predict PEA 90-day mortality (90 DM) with the secondary aim of informing factors that may influence

Extract Tuberculosis (TB) treatment is not quick and fast. Currently, the World Health Organization (WHO) recommends either a 6–9 month standard TB treatment regime of isoniazid, rifampicin, pyrazinamide and ethambutol initially or the 4-month regime of rifapentine, isoniazid and pyrazinamide with moxifloxacin for drug-susceptible pulmonary TB, which is a substantial duration [1, 2]. A key burden of

Extract Asthma and COPD have long been recognised as heterogeneous diseases, characterised by diverse clinical presentations and responses to treatment [1, 2]. Traditional approaches have often relied on a trial-and-error method to identify effective therapies, leading to suboptimal outcomes. However, the integration of omics data (genomics, proteomics, metabolomics, and more) into clinical practice

Background Concerted efforts aim to reduce the burden of 6 months of anti-tuberculous treatment for tuberculosis (TB). Treatment cessation at 8 weeks is effective for most but incurs increased risk of disease relapse. We tested the hypothesis that blood RNA signatures or C-reactive protein (CRP) measurements discriminate 8-week sputum culture status, as a prerequisite for a biomarker to stratify risk

Background Lung quantitative computed tomography (qCT) severe asthma clusters have been reported, but their replication and underlying disease mechanisms are unknown. We identified and replicated qCT clusters of severe asthma in two independent asthma cohorts and determined their association with molecular pathways, using radiomultiomics, integrating qCT, multiomics and machine learning/artificial

Extract This article was originally published with incomplete author disclosures. The statement for M.R. Toshner was omitted and should have been presented as follows:

Arousal Threshold Modifies the Effect of CPAP on Executive Function Among Individuals with Obstructive Sleep Apnea. BACKGROUND Obstructive Sleep Apnea (OSA) is associated with neurocognitive dysfunction. However, randomized trials evaluating the effects of continuous positive airway pressure (CPAP) on neurocognition in those without dementia do not show a benefit. We thus aimed to assess whether arousal