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)

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

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

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

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

A 22-year-old woman presented with intermittent blood-tinged sputum for about 3 years. She reported experiencing exertional dyspnoea and had no history of chronic disease, family history or smoking. On physical examination, mild coarse breathing sounds and wheezing on the upper sternum were auscultated. Lab results were non-specific. Chest CT scan (figure 1A,B) revealed a heterogeneous enhancing endotracheal

Background Idiopathic pulmonary fibrosis (IPF) is a disease of progressive lung scarring. There is a known association between diabetes mellitus (DM) and IPF, but it is unclear whether a causal relationship exists between these traits. Objectives The objectives of this study are to examine causal relationships among DM, diabetes-associated traits and IPF using a Mendelian randomisation approach. Methods

Background Bronchoalveolar lavage (BAL) is essential in determining the efficacy of novel therapies in alpha-1 antitrypsin deficiency (AATD). These require initial proof-of-concept demonstration that treatment administration increases alpha-1 antitrypsin (AAT) levels and/or anti-neutrophil elastase inhibitory capacity (ANEC) in the lung. Early-phase studies often encounter high interindividual variability

Measurements on biological fluids form the mainstay of routine clinical investigations. Samples of blood, urine, etc are, generally, easily obtainable and measurements can be interpreted directly. On the other hand, alveolar epithelial lining fluid (ELF) is relatively inaccessible but offers valuable insight into pathogenesis and pharmacokinetics relating to diseases affecting the alveolus. The lung

Background The evidence base on montelukast-associated adverse outcomes is inconclusive in children and young persons (CYP) with asthma. We aimed to investigate 1-year incidence of neuropsychiatric diagnoses after initiation of montelukast as an adjunct therapy to inhaled corticosteroids (ICSs) in CYP aged 3–17 years with asthma. Methods This propensity score matched cohort study was conducted using

Since 1998, montelukast has been licensed for the treatment of seasonal allergic rhinitis and asthma in people aged over 6 months. In children in particular, montelukast was welcomed as a steroid-sparing alternative to traditional asthma-preventer drugs, which could be taken just once daily, and which did not require the use of an inhaler. Although recent systematic reviews have shown regular inhaled

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

Background Pulmonary microvasculature alterations are implicated in emphysema pathogenesis, but the association between pulmonary microvascular blood volume (PMBV) and emphysema has not been directly assessed at scale, and prior studies have used non-specific measures of emphysema. Methods The Multi-Ethnic Study of Atherosclerosis Lung Study invited participants recruited from the community without

An alarmingly high prevalence of tuberculosis (TB) was reported among the Saharia tribe in Madhya Pradesh, India. A community-based intervention study was undertaken to improve TB case finding during 2018–2021. The interventions mainly comprised active case detection through village TB volunteers using advocacy, communication and social mobilisation activities. A preintervention and postintervention

A 38-year-old woman was admitted for uterine fibroid surgery. A routine preoperative CT chest scan identified bilateral patchy, high-density shadows, with unclear boundaries, more evident in the upper lobes (figure 1A). She had no respiratory symptoms, such as coughing or expectoration, and was an office worker with allergies to seafood and mango. She denied having comorbidities including diabetes

Worldwide inequalities in care significantly impact respiratory health outcomes.1 2 Despite this, there are few studies examining how wheeze and asthma outcomes, including healthcare use and treatment decisions, vary with socioeconomic status and ethnicity in young children. Therefore, it is highly relevant to acknowledge the paper by D Lo et al , ‘Association between socioeconomic deprivation, ethnicity

Industry uses market segmentation of products to attract and retain consumers from a variety of groups based on demographics, interests, behavioural factors and common needs. This approach is used across many commercial sectors selling a diverse range of commodities including cleaning, beauty, food, automobile and electronic products. Consumers may be attracted to goods based on a number of characteristics

Interstitial lung disease (ILD) is a heterogeneous parenchymal disorder.1 2 Patients with ILD often present with non-specific symptoms such as a non-productive cough and exertional dyspnoea. The differential diagnosis for ILD is broad and includes conditions such as connective tissue disease (CTD), hypersensitivity pneumonitis, drug-associated ILD and granulomatous diseases. Furthermore, the initial

In sarcoidosis, any organ may be affected, and the majority of cases have pulmonary involvement. The disease course in pulmonary sarcoidosis varies considerably, from complete resolution to chronic disease and/or pulmonary fibrosis. The heterogeneity of sarcoidosis is a major challenge in treatment decision-making, and the hope is that subgrouping patients into phenotypes may help to provide the right

Objective People with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral. We conducted a Delphi study of international experts to identify consensus referral criteria for specialist outpatient palliative care for people with COPD. Methods Clinicians in the fields

Background Clinical studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RA) can have beneficial effects on cardiopulmonary function. We conducted this longitudinal cohort study to compare the risk of cardiopulmonary outcomes and mortality between GLP-1 RA use and no use in patients with type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD). Methods The study identified

Background Lung function testing remains a cornerstone in the assessment and management of interstitial lung disease (ILD) patients. The clinical implications of the Global Lung function Initiative (GLI) reference equations and the updated interpretation strategies remain uncertain. Methods Adult patients with ILD with baseline forced vital capacity (FVC) were included from the Australasian ILD registry

Introduction Given the heterogeneity of sarcoidosis, predicting disease course of patients remains a challenge. Our aim was to determine whether the 3-year change in pulmonary function differed between pulmonary function phenotypes and whether there were differential longitudinal changes by race and sex. Methods We identified individuals seen between 2005 and 2015 with a confirmed diagnosis of sarcoidosis

Objectives To examine the accuracy and impact of artificial intelligence (AI) software assistance in lung cancer screening using CT. Methods A systematic review of CE-marked, AI-based software for automated detection and analysis of nodules in CT lung cancer screening was conducted. Multiple databases including Medline, Embase and Cochrane CENTRAL were searched from 2012 to March 2023. Primary research

Background Preschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds. Methods Retrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. We reported number

Introduction Cigarette smoking leads to altered DNA methylation at the aryl-hydrocarbon receptor repressor (AHRR) gene. However, it remains unknown whether pipe or cigar smoking is associated with AHRR methylation. We evaluated associations of non-cigarette tobacco use with AHRR methylation and determined if AHRR methylation was associated with smoking-related health outcomes. Methods Data were pooled

Objective Primary ciliary dyskinesia (PCD) severity has been related to genotype and levels of nasal nitric oxide (nNO). The most common TAS2R38 haplotypes (PAV/PAV, PAV/AVI, AVI/AVI) encoding the bitter taste receptor can affect nNO levels and thus could play a role in the susceptibility to respiratory infections. We assessed the impact of these polymorphisms on nNO production and Pseudomonas aeruginosa

Background and aims The recurrence of obstructive sleep apnoea (OSA) after positive airway pressure (PAP) therapy termination has physiological consequences that may increase cardiovascular (CV) risk. We aimed to determine whether PAP termination is associated with an increased incidence of major adverse CV events (MACE) compared with adherent PAP continuation. Methods Data from the Pays de la Loire

Mesenchymal stem cells (MSC) have immune regulatory properties that may ameliorate pathophysiological processes in sepsis. We determined the effect of allogeneic adipose-derived MSCs (Cx611) on the host response during sepsis due to community-acquired bacterial pneumonia (CABP) by measuring 29 plasma biomarkers and blood transcriptomes at six time points in 82 patients randomised to two intravenous

A 19-year-old female presented with a 6-month history of progressive shortness of breath. She reported a new onset of palpitations preceding her shortness of breath, which progressed progressively into dull chest pain and trepopnea, and she experienced dyspnoea while lying on her right side. With wheezing and rhinorrhoea, the symptoms became more prominent. She had no previous history of haemoptysis

A 73-year-old woman was found to have a pulmonary mass on a CT scan of the chest 10 years ago, but did not receive any treatment. Approximately 2 years ago, she started experiencing chest tightness and bloating, without other discomfort. These symptoms worsened half a month ago and were accompanied by dyspnoea. A CT scan (figure 1A,D) revealed a spherical mass in the left upper lobe lingular segment

A 47-year-old male presented with chronic cough, which has worsened over the last 5–6 months. Dyspnoea, fever and significant weight loss were denied. The patient had no history of smoking or vaping. The patient worked as an automotive technician in a car manufacturing plant specialised in aluminium-based vehicle bodies with frequent exposure to metallic fumes during polishing and welding of aluminium/beryllium

An elderly female, lifelong non-smoker, with rheumatoid arthritis treated with methotrexate and prednisone for 10 years was referred for evaluation of incidentally detected, randomly distributed pulmonary nodules on a CT performed for pleuritic chest pain and dyspnoea (figure 1A). Subsequent [18F]fluoro-d-glucose (FDG)-positron emission tomography (PET) showed the nodules had increased in size and

Background In adults and children with intellectual disability (ID), sleep -disordered breathing (SDB) is thought to be common. However, large epidemiological studies are lacking, and there are few studies on optimal methods of investigation and even fewer randomised, controlled intervention trials of treatment. Method Peer-reviewed publications from various databases were examined in line with search

The ACCESS trial ( Lancet Respir Med 2024;12(4):294–304) provides new evidence supporting the use of macrolides in community-acquired pneumonia (CAP). In this prospective, double-blind study, Giamarellos-Bourboulis and colleagues randomised patients admitted with CAP and receiving intravenous antibiotics to addition of either oral clarithromycin or placebo for 7 days. Participants from 18 Greek hospitals

Introduction Fluoroquinolones can cause severe collagen-associated adverse effects, potentially impacting the pulmonary connective tissue. We investigated the association between fluoroquinolones and spontaneous pneumothorax. Methods A case–time–control study was performed using the nationwide French reimbursement healthcare system database (SNDS). Cases were adults ≥18 years admitted for spontaneous

Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations

Silicosis is the most ancient form of occupational lung disease, being known to have caused disability and the premature death of workers for many millennia.1 Despite this, silicosis continues to be a global health problem,2 accounting for almost 13 000 deaths worldwide in 2019.3 Those at risk of this disease commonly work in industries that involve either cutting through silica-containing material

In 2019, a record 4.5 billion passengers travelled by air.1 This fell markedly during the COVID-19 pandemic, but in 2023, the industry’s measure of overall airline ‘traffic’, revenue passenger kilometres, was back to 94% of the 2019 figures, with predictions that 2024 will see new record passenger numbers (see figure 1).2 This highlights how common air travel is and reinforces the idea that it is highly

Over the last few decades, women’s health has slowly shifted closer to the forefront of research.1 There have been multiple major campaigns at academic, charity and government level, for the improvement of women’s health globally. In 2021, the UK government implemented the Women’s Health Strategy to improve the health of women in the UK over 10 years and Asthma and Lung UK published their report on