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)

The management of chylothorax remains challenging given the limited evidence and significant heterogeneity in practice. In addition, there are no practical guidelines on the optimal approach to manage this complex condition. We convened an international group of 27 experts from 20 institutions across five countries and four specialties (pulmonary, interventional radiology, thoracic surgery and nutrition)

Non-invasive ventilation (NIV) is the mainstay to treat patients who need augmentation of ventilation for acute and chronic forms of respiratory failure. The last several decades have witnessed an extension of the indications for NIV to a variety of acute and chronic lung diseases. Evolving advancements in technology and personalised approaches to patient care make it feasible to prioritise patient-centred

Background Pseudomonas aeruginosa is a common pathogen that contributes to progressive lung disease in cystic fibrosis (CF). Genetic factors other than CF-causing CFTR (CF transmembrane conductance regulator) variations contribute ~85% of the variation in chronic P. aeruginosa infection age in CF according to twin studies, but the susceptibility loci remain unknown. Our objective is to advance understanding

Background Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in the management of CAP in a contemporary

Background Control of latent tuberculosis infection (LTBI) is a priority in the World Health Organization strategy to eliminate TB. Many high-income, low TB incidence countries have prioritised LTBI screening and treatment in recent migrants. We tested whether a novel model of care, based entirely within primary care, was effective and safe compared to secondary care. Methods This was a pragmatic cluster-randomised

Extract Alterations in specific signalling pathways within the bone morphogenetic protein/transforming growth factor-β (BMP/TGF-β) family, involving several precisely regulated activator or inhibitor ligands, have been identified as pathogenic drivers of pulmonary arterial hypertension (PAH). These alterations, particularly affecting BMPRII and activin-dependent pathways, have led to innovative therapies

Considerable progress has been made in the genomics of pulmonary arterial hypertension (PAH) since the 6th World Symposium on Pulmonary Hypertension, with the identification of rare variants in several novel genes, as well as common variants that confer a modest increase in PAH risk. Gene and variant curation by an expert panel now provides a robust framework for knowing which genes to test and how

Paediatric pulmonary arterial hypertension (PAH) shares common features with adult disease, but is associated with several additional disorders and challenges that require unique approaches. This article discusses recent advances, ongoing challenges and distinct approaches for caring for infants and children with PAH, as presented by the paediatric task force of the 7th World Symposium on Pulmonary

Left heart disease (LHD) is the most common cause of pulmonary hypertension (PH), which may be classified further as isolated post-capillary (ipcPH) or combined post- and pre-capillary PH (cpcPH). The 7th World Symposium on Pulmonary Hypertension PH-LHD task force reviewed newly reported randomised clinical trials and contemplated novel opportunities for improving outcome. Results from major randomised

Pulmonary arterial hypertension leads to significant impairment in haemodynamics, right heart function, exercise capacity, quality of life and survival. Current therapies have mechanisms of action involving signalling via one of four pathways: endothelin-1, nitric oxide, prostacyclin and bone morphogenetic protein/activin signalling. Efficacy has generally been greater with therapeutic combinations

Pulmonary hypertension (PH) is a haemodynamic condition characterised by elevation of mean pulmonary arterial pressure (mPAP) >20 mmHg, assessed by right heart catheterisation. Pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) distinguish pre-capillary PH (PAWP ≤15 mmHg, PVR >2 Wood Units (WU)), isolated post-capillary PH (PAWP >15 mmHg, PVR ≤2 WU) and combined post-

Risk stratification has gained an increasing role in predicting outcomes and guiding the treatment of patients with pulmonary arterial hypertension (PAH). The most predictive prognostic factors are three noninvasive parameters (World Health Organization functional class, 6-min walk distance and natriuretic peptides) that are included in all currently validated risk stratification tools. However, suffering

The right ventricle and its stress response is perhaps the most important arbiter of survival in patients with pulmonary hypertension of many causes. The physiology of the cardiopulmonary unit and definition of right heart failure proposed in the 2018 World Symposium on Pulmonary Hypertension have proven useful constructs in subsequent years. Here, we review updated knowledge of basic mechanisms that

Chronic thromboembolic pulmonary hypertension is a complication of pulmonary embolism and a treatable cause of pulmonary hypertension. The pathology is a unique combination of mechanical obstruction due to failure of clot resolution, and a variable degree of microvascular disease, that both contribute to pulmonary vascular resistance. Accordingly, multiple treatments have been developed to target the

Extract The World Health Organization (WHO) hosted an expert committee on chronic cor pulmonale in Geneva, Switzerland, from 10 to 15 October 1960. In the introduction of the report [1], the authors underscored that the attention of the Director General of the WHO had been drawn to the fact that, while the lung diseases causing pulmonary heart disease (corresponding to the exact translation of the

Clinical trials in pulmonary arterial hypertension (PAH) have led to the approval of several effective treatments that improve symptoms, exercise capacity and clinical outcomes. In phase 3 clinical trials, primary end-points must reflect how a patient "feels, functions or survives". In a rare disease like PAH, with an ever-growing number of treatment options and numerous candidate therapies being studied

Pulmonary hypertension (PH) associated with chronic lung disease (CLD) is both common and underrecognised. The presence of PH in the setting of lung disease has been consistently shown to be associated with worse outcomes. Recent epidemiological studies have advanced understanding of the heterogeneity of this patient population and shown that defining both the specific type of CLD as well as the severity

Despite the progress made in medical therapies for treating pulmonary hypertension (PH), a subset of patients remain susceptible to developing a maladaptive right ventricular phenotype. The effective management of end-stage PH presents substantial challenges, necessitating a multidisciplinary approach and early identification of patients prone to acute decompensation. Identifying potential transplant

Care of pulmonary hypertension (PH) patients in special situations requires insightful knowledge of the pathophysiology of the cardiopulmonary system and close interaction with different specialists, depending on the situation. The role of this task force was to gather knowledge about five conditions that PH patients may be faced with. These conditions are 1) perioperative care; 2) management of pregnancy;

The global impacts of pulmonary hypertension (PH) were formally recognised in 1973 at the 1st World Health Organization meeting dedicated to primary pulmonary hypertension, held in Geneva. Investigations into disease pathogenesis and classification led to the development of numerous therapies over the ensuing decades. While the impacts of the disease have been lessened due to treatments, the symptoms

Pulmonary hypertension (PH) remains a challenging condition to diagnose, classify and treat. Current approaches to the assessment of PH include echocardiography, ventilation/perfusion scintigraphy, cross-sectional imaging using computed tomography and magnetic resonance imaging, and right heart catheterisation. However, these approaches only provide an indirect readout of the primary pathology of the

In recent years, major advances have been made in the understanding of the cellular and molecular mechanisms driving pulmonary vascular remodelling in various forms of pulmonary hypertension, including pulmonary arterial hypertension, pulmonary hypertension associated with left heart disease, pulmonary hypertension associated with chronic lung disease and hypoxia, and chronic thromboembolic pulmonary

Extract Progressive pulmonary fibrosis (PPF), also known as progressive fibrosing interstitial lung disease (ILD), is a term used to describe progressive lung fibrosis in a patient with an ILD other than idiopathic pulmonary fibrosis (IPF) [1]. Patients with PPF often experience burdensome symptoms such as cough and dyspnoea and impairment in their quality of life [2]. Several studies have reported

As part of the October issue, the European Respiratory Journal presents the latest in its series of podcasts. Deputy Chief Editor Don Sin interviews associate editor Marius Hoeper and Kelly Chin (UT Southwestern Medical Center, Dallas, TX, USA) about articles published from the World Symposium on Pulmonary Hypertension.

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 Data Base (ESADA)

BACKGROUND Limited studies have investigated the influence of body mass index (BMI) trajectories on lung function covering the entire growth period. METHODS We conducted a prospective study utilizing data from the Swedish BAMSE birth cohort. Latent class mixture modelling was employed to examine the diversity in BMI z-scores from birth to 24 years of age. Participants with four or more BMI z-scores

BACKGROUND Several major risk factors for chronic obstructive pulmonary disease (COPD), such as population aging, smoking rates, and air pollution levels are rapidly changing, causing inevitable changes in the population burden of COPD. We determined the excess direct costs of COPD and their trend from 2001 to 2020. METHODS Using administrative health data from British Columbia, Canada, we created

Persistent neutrophilic inflammation is a central feature in both the pathogenesis and progression of bronchiectasis (BE). Neutrophils release neutrophil serine proteases (NSPs), such as neutrophil elastase, cathepsin G and proteinase 3. When chronically high levels of free NSP activity exceed those of protective antiproteases, structural lung destruction, mucosal-related defects, further susceptibility

BACKGROUND COPD has high mortality, compounded by comorbid cardiovascular disease. We investigated two electrocardiogram (ECG) markers, Cardiac Infarction Injury Score (CIIS) and P pulmonale, as prognostic tools for adverse cardiopulmonary events in COPD. METHODS Post hoc analysis of the IMPACT trial. Outcomes included odds (odds ratio [95% confidence intervals]) of adverse cardiopulmonary events stratified

Extract Primary ciliary dyskinesia (PCD), the second most common genetic muco-obstructive lung disease, is caused by mutations in over 50 different genes that encode proteins that are critical for the structure and/or function of motile cilia expressed at the apical membrane of ciliated airway epithelial cells [1–5]. These PCD genes include genes encoding proteins of the axonemal structure, regulatory

Extract We read with interest the recent paper by Grynblat et al. [1] reporting the onset of proteasome inhibitor (PI)-induced pulmonary arterial hypertension (PAH) in 11 patients with multiple myeloma, median 6.5 (range 0.4–46.9) months after PI treatment initiation with carfilzomib or bortezomib. All patients had elevated natriuretic peptide levels at diagnosis, when measured. At follow-up after

Background Primary ciliary dyskinesia is a genetic disorder caused by aberrant motile cilia function that results in defective ciliary airway clearance and subsequently leads to recurrent airway infections and bronchiectasis. We aimed to determine: how many functional multiciliated airway cells are sufficient to maintain ciliary airway clearance? Methods To answer this question we exploited the molecular

RATIONALE Lung quantitative computed tomographic (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. METHODS We used consensus clustering on qCT measurements of airway and lung CT scans

RESEARCH QUESTION We previously reported that Deep Brain Stimulation (DBS) of motor thalamus (MT), in a patient with post-stroke tremor, relieved breathlessness associated with chronic obstructive pulmonary disease. This raised the question of whether MT DBS mitigates the ascending dyspnoea signal. We therefore sought to conduct a fully powered cohort study of experimentally induced air hunger (AH)

RATIONALE Ansa cervicalis stimulation (ACS) of the infrahyoid muscles has been proposed as a neurostimulation therapy for obstructive sleep apnea (OSA). ACS stabilizes the pharynx by pulling it caudally, but its specific effects on flow limitation caused by palatal, oropharyngeal lateral wall, tongue base, or epiglottis collapse remains unclear. OBJECTIVES To quantify the effect of ACS on collapsibility

BACKGROUND Little is known about the underlying relationship between mosaic loss of chromosome Y (mLOY), the most common chromosomal alterations in older men, and the risk of age-related lung diseases. METHODS We included 217 780 participants from the UK Biobank and 42 859 participants from the China Kadoorie Biobank. The mLOY events were detected using the Mosaic Chromosomal Alterations pipeline.

BACKGROUND Fibrosis is often associated with aberrant repair mechanisms that ultimately lead to organ failure. In the lung, idiopathic pulmonary fibrosis (IPF) is a fatal form of interstitial lung disease (ILD) to which there is currently no curative therapy. From the cell biology point of view, the cell of origin and eventual fate of activated myofibroblasts (aMYFs) have taken center stage as these

BACKGROUND In patients with chronic respiratory failure, home non-invasive ventilation (NIV) is delivered through nasal or oronasal masks. Masks are a cornerstone for NIV success but can be associated with side effects. However, the type, the frequency and the consequences of these side effects are unknown. Here, we aimed to study the prevalence, nature, and impact of mask-related adverse events in

Patients with severe eosinophilic asthma, characterised by a high disease burden, benefit from mepolizumab, which improves symptoms and reduces exacerbations, potentially leading to clinical remission in a subgroup. This study aimed to identify treatment response trajectories to mepolizumab for severe eosinophilic asthma and to assess the achievement of clinical remission.Data from the Australian Mepolizumab

Extract We thank D. Beinart and co-workers for their insightful comments and important question regarding the PIPE Study of oral prednisone as adjunctive therapy for pulmonary exacerbations in people with cystic fibrosis (CF) [1].

Extract We thank Y. Liu and co-workers for their thoughtful comments on our study of oral prednisone as adjunctive therapy for pulmonary exacerbations in people with cystic fibrosis (CF): the PIPE Study [1].

Extract Selexipag, an orally available prostacyclin receptor agonist, is globally approved for the treatment of pulmonary arterial hypertension (PAH) and has also been investigated in patients with chronic thromboembolic pulmonary hypertension (CTEPH). In 2022, the European Respiratory Journal published the results of a randomised, double-blind, placebo-controlled trial involving 78 Japanese patients

Extract Respiratory tract infections (RTIs) are often common and recurrent illnesses. A birth cohort study identified that the mean cumulative number of common colds within the first 12 years of life was 21.9 [1]. This study also suggested the normal range for RTIs: up to 11 per year in infancy, 8 per year at pre-school age, and 4 per year at school age [1], which is used for the definition of recurrent

Extract Asthma is a common disease affecting around 300 million people worldwide [1]. It is associated with airway remodelling, smooth muscle hypercontractility and increased mucus production, all of which can cause reduced lung function, reversible airway obstruction and characteristic wheeze.

Extract Mutations in the bone morphogenetic protein receptor type 2 (BMPR2) gene remain the most common genetic cause in both heritable and sporadic cases of pulmonary arterial hypertension (PAH). Presence of a BMPR2 mutation results in a lifetime risk of development of PAH of about 20% [1]. However, only one prospective study underpins the screening recommendations for asymptomatic BMPR2 mutation

Extract There is increasing recognition of the harm caused by steroid over-prescribing and need for corticosteroid stewardship in respiratory medicine. We read, with interest, the recently published results of the PIPE Study. Waters et al. [1] published the results of a randomised, double-blind, placebo-controlled trial comparing prednisone 1 mg·kg–1 twice daily with placebo in pulmonary exacerbations

Extract Pulmonary exacerbations remain the most important cause of morbidity, loss of lung function, and reduced quality of life in patients with cystic fibrosis (CF), and are characterised by chronic bacterial airway infection and persistent neutrophilic inflammation [1]. Historically, treatments for CF have predominantly concentrated on combating infections, and anti-inflammatory therapy has been

Extract The current Global Initiative for Chronic Obstructive Lung Disease (GOLD) document defines a COPD patient at risk of an exacerbation as one who has had two or more moderate exacerbations (requiring systemic steroids or antibiotics) or at least one severe exacerbation (requiring hospitalisation) in the previous year [1]. This definition is based on the predictive risk of previous exacerbations

Extract P2X3 receptors are found on sensory nerves and are activated by ATP. The recent discovery that P2X3 antagonism is effective in treating patients with refractory chronic cough has prompted recent studies into the effects of inhaled ATP [1–4], but few data exist pertaining to its safety and tolerability. We recently studied inhaled ATP in healthy volunteers, identifying adverse effects not previously

Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is often diagnosed late in acute pulmonary embolism survivors: more efficient testing to expedite diagnosis may considerably improve patient outcomes. The InShape II algorithm safely rules out CTEPH (failure rate 0.29%) while requiring echocardiography in only 19% of patients but may be improved by adding detailed reading of the computed

Introduction Pathogenic variants in the gene encoding for BMPR2 are a major genetic risk factor for heritable pulmonary arterial hypertension. Owing to incomplete penetrance, deep phenotyping of unaffected carriers of a pathogenic BMPR2 variant through multimodality screening may aid in early diagnosis and identify susceptibility traits for future development of pulmonary arterial hypertension. Methods