A 36-year-old non-smoking immunocompetent female patient was admitted due to cough, weight loss, and general malaise. A CT scan revealed a tumor in the left upper lobe with pathological mediastinal lymph nodes. Bronchoscopic biopsy of the tumor and EBUS lymph nodes 11L, 7, and 4R were performed. Histological examination revealed granulomatous inflammation with necrosis and rare tuberculouse bacilli (Figure 1). Cultures remained negative, but Xpert MTB/RIF assay was positive for tuberculosis and negative for antibiotic resistance. The patient received standard six-month tuberculosis therapy, but the lymph nodes and the lesion itself slightly increased on the follow-up CT after six months, and new endobronchial lesions appeared, corresponding to the puncture sites. Upon repeat bronchoscopy, tumor-like growth were found at all three sites previously sampled with EBUS-TBNA, which were completely excised (Figure 2). Histological examination showed granulomas with necrosis but without the presence of bacteria, fungi, or TB bacilli. Xpert MTB/RIF was still marginally positive (Figure 3). The patient, who clinically improved, was not reintroduced to therapy but was kept under careful observation for one year. During this time, the changes on CT regressed, and sputum cultures remained negative. In this presented case, we describe iatrogenic fistulas that developed at the sites of puncture tracts created by previous EBUS-TBNA, through which tuberculosis spread into the airway lumen. Endobronchial seeding after EBUS-TBNA has been likely underreported in the literature (1-2). Similar fistulas could also form in the esophagus in the case of EUS-B, although they have not been reported so far. However, we believe it is important to highlight and recognize the tendency of tuberculosis to form fistulas when considering invasive diagnostics of mediastinal lymph nodes in suspected tuberculosis cases.

Asthma is a heterogeneous chronic inflammatory disease involving different underling pathogenetic mechanisms. We aimed to investigate the characteristics of patients with the diagnosis of asthma and primary antibody immunodeficiency (PAD) and the impact of immunoglobulin therapy (IVIg).

ROSE entails immediate pathological evaluation of diagnostic specimens in the procedure room, facilitating real-time feedback to operator on specimen adequacy and diagnosis. There is ongoing debate about its role in the field of Endobronchial Ultrasound Transbronchial Needle Aspiration (EBUS-TBNA).

Pulmonary hypertension (PH) complicating interstitial lung diseases (ILDs) is critical for symptom burden and prognosis. The prevalence of PH varies according to ILDs subgroups and severities. Establishing the diagnosis of PH associated with ILDs (PH-ILDs) is complex due to overlapping symptoms, late clinical signs and poor diagnostic performance of routine non-invasive diagnostic methods. Treatment options for PH-ILDs are limited and target mainly the underlying parenchymal lung disease. For decades, clinical trials of PH-ILDs treatment using pulmonary vasodilators have failed showing no benefits or even harm. Thus, most PH specific therapies are contra-indicated in PH-ILDs. Recently, the landmark INCREASE trial showed that inhaled treprostinil improved exercise capacity (6-minute walking distance) and NT-proBNP, stabilized forced vital capacity and reduced clinical worsening. Inhaled treprostinil was approved by the FDA in 2021, while approval in Europe and Switzerland is pending. After its approval in Europe and Switzerland, the optimal use of inhaled treprostinil will require a careful patient selection with comprehensive assessments (including right heart catheterization) by highly specialized expert centers treating both patients with PH and ILDs.

Bronchial Dieulafoy's disease (BDD) comprises rare vascular malformations. This study analyzes a series of BDD patients diagnosed through combined bronchial computed tomography arteriography (CTA) and bronchoscopy, addressing critical gaps in diagnostic standardization and therapeutic decision-making.

Lung cancer screening has increased the detection of peripheral pulmonary lesions (PPLs). Accurate diagnosis for therapy and prognosis is crucial but challenging. Our study compares the safety and efficacy of transbronchial cryobiopsy with two probe diameters and forceps biopsy.

Refractory dyspnoea is a common symptom of chronic respiratory disease, often poorly recognized by healthcare professionals. Pharmacological treatments are of limited effectiveness. A multidisciplinary intervention carried out by a specialized palliative care team has demonstrated its effectiveness in helping patients improve their quality of life.

Introduction Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease that subverts the normal structure of the lungs and finally causes respiratory failure. High flow nasal therapy (HFNT) is currently used in the acute setting for IPF with acute respiratory failure (ARF). Also, acute exacerbation of IPF (AE-IPF) and end-stage disease are common indications. Chronic cough is often an unmet need in IPF because it is partially responsive to common pharmacological treatment. Moreover, opioids have known adverse events. The aim of this paper is to investigate the effects and safety of chronic HFNT on lung function and symptoms of IPF. Methods This is a single center case-control study including patients affected by IPF. We included 35 adult patients with a consistent radiological diagnosis of IPF, clinical history of lung function decline and high prevalence of symptoms. All patients received the standard of treatment, particularly including antifibrotic drugs and conventional oxygen therapy (COT). 18 subjects were assigned to additional treatment with HFNT for 12 months. Results No significant differences were observed after the follow up with HFNT in terms of lung function. Results are showed in Figure 1. The mean FVC was 1.89 ± 0.73 L with HFNT and 2.43 ± 0.87 without HFNT (p=0.09). The mean FVC % of predicted is shown in Fig.1A; the mean FVC decline per year was 190 with HFNT vs 200 ml with standard of care. The mean DLCO % of predicted was 28.86 ± 14.51 % of predicted with HFNT and 36.03 ± 19.18 with COT (p=0.276), as shown in Fig.1B. No significant impact was observed on dyspnea, the mean borg scale value was 6.72 ± 2.22 after HFNT and 7.14 with COT (p=0.56) (Fig.1C). The score for cough significantly improved after treatment with a mean score in the HFNT group being 46.67 ± 10.85 vs 73.8 ± 18.43 (p<0.0001) with standard of care. Conclusions Long-term HFNT significantly reduces chronic cough in patients affected by IPF compared to COT. Lung function including FVC and DLCO is not significatively influenced.

Cystic fibrosis (CF) is a genetic disorder caused by mutations in the CFTR gene. A minority of people with CF carry two heterozygous CFTR mutations other than the common Phe508del, complicating diagnosis and treatment.

Currently, scholars have applied machine learning to the clinical prediction of acute asthma exacerbations. However, given the heterogeneity of inflammatory phenotypes in asthma, it is imperative to develop machine learning models tailored to specific asthma inflammatory phenotypes.

Chronic respiratory diseases, including asthma, chronic obstructive pulmonary disease, and bronchiectasis, are significant global health concerns associated with recurrent exacerbations, hospitalization, and increased mortality. Preventive strategies, particularly vaccination, play a crucial role in managing these diseases by reducing infection-related exacerbations and stabilizing lung function. This review summarizes the recommendations provided by four major Italian scientific societies on vaccination against key respiratory pathogens, including respiratory syncytial virus, influenza, SARS-CoV-2, Streptococcus pneumoniae, and varicella-zoster virus (VZR), which pose serious risks to individuals with chronic respiratory conditions. Evidence supporting the role of vaccines in minimizing exacerbations and improving patient outcomes in asthma, chronic obstructive pulmonary disease, and bronchiectasis is highlighted, alongside recent advancements in vaccine technology and recommendations for high-risk populations. This expert-led, multidisciplinary approach underlines the necessity of targeted immunization strategies to mitigate complications, lower healthcare costs, and enhance the quality of life for patients with respiratory diseases. By collecting the latest evidence-based recommendations, this article aims to guide healthcare providers in adopting optimal vaccination strategies for respiratory disease management and contribute to the broader public health effort to reduce the burden of respiratory infections.

Natural history of chronic obstructive pulmonary disease (COPD) is characterized by a progressive decline in pulmonary function and recurrent exacerbations, requiring frequent hospital admissions to medical wards. Great heterogeneity still exists between studies hindering our understanding of the true, global burden of AECOPD on healthcare systems over COVID-19 pandemic. We aimed to describe the AECOPD in the southern Italian region from 2017 to 2022 and to detail the location of admission, rate and characteristics of deaths, and use of noninvasive respiratory supports.

Hematological and oncological diseases collectively affect a substantial number of patients. Pulmonary hypertension (PH) is recognized as a potential rare complication associated with these conditions, manifesting in various forms of PH and presenting with a range of symptoms. This review aimed to summarize recent research findings and enhance the understanding of the complex interactions between PH and hemato-oncological diseases.

This study aimed to evaluate both the clinical efficacy and safety of airway stent placement in the treatment of patients with esophageal cancer-associated airway esophageal fistula (AEF). The focus is on evaluating improvements in patient survival and quality of life.

Acute respiratory disorders and bronchopulmonary dysplasia (BPD) are frequent and serious complications in very preterm infants (VPI). These conditions are influenced by several factors, including fluid imbalances and abnormal postnatal changes in body water composition (BWC). We aimed to investigate the association between BWC and the severity of respiratory disease in VPI using bioelectrical impedance analysis (BIA).

Bronchoscopic spray cryotherapy (SCT) is a novel treatment showing promise for chronic bronchitis (CB), characterized by excessive mucus secretion and productive cough. A large animal model for preclinical research of SCT is lacking, and its treatment's efficacy and mechanisms for CB are not well understood.

Advances in neonatal and pediatric intensive care have improved patient survival rates, emphasizing the need for respiratory support in cases of chronic respiratory failure, resulting in the establishment of the Turkish National Pediatric Patients Receiving Home Mechanical Ventilation (HMV) Support Registration System in 2023. This study aims to present the initial findings of the registry.

Bronchiolitis is a heterogeneous group of disorders, each with its own clinical and radiographic presentation, treatment options, and prognosis. Until now, classifications were based on pathology and radiology.

Malignant pleural effusion (MPE) is common in advanced malignancy. Data are needed on healthcare utilization and costs.

Elexacaftor/tezacaftor/ivacaftor (ETI) has shown significant improvements in pulmonary and nutritional status in persons with cystic fibrosis (pwCF). Less is known about the extrapulmonary impact of ETI and effects on airway microbiology, lung clearance index (LCI), and fraction of exhaled nitric oxide (FeNO).

German recommendations for the diagnosis of hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, were last published in 2007. The current S2k Guideline for the Diagnosis and Treatment of Hypersensitivity Pneumonitis replaces these diagnostic recommendations. They were supplemented by the aspect of chronic, and in particular of the chronic fibrotic phenotype of HP, and also, as the first HP guideline, include treatment recommendations. Based on current scientific evidence and on expert opinion, 12 consensus recommendations were developed. They include important statements summarizing the diagnostic process, the treatment indication and therapeutic strategies for patients with HP. Particular emphasis was placed on the different clinical courses (acute and chronic) and their characteristics (inflammatory and/or fibrotic pattern), which present differential diagnostic challenges and ultimately result in different treatment approaches. In addition to general information (diagnosis, classification, clinical disease course, epidemiology, pathogenesis, risk factors, prognosis, and special aspects associated with occupational disease), the guideline will present the various clinical disease entities of HP, some in detail, others in tabular form. A major focus is on the various diagnostic steps and the different treatment approaches. The background information serves to provide a deeper understanding and inform the implementation of the recommendations. In particular, other current international guidelines for the diagnosis of HP as well as German guidelines for the diagnosis of interstitial lung diseases (ILDs) (Leitlinien zur Diagnostik interstitieller Lungenerkrankungen) in general and for the pharmacotherapy of fibrotic ILDs were integrated and considered in this guideline.