Introduction Available endobronchial valves (EBVs) for lung volume reduction in severe emphysema are limited in variety and predominantly feature complex metal-silicone designs (e.g., Zephyr®). This study aimed to introduce a novel, all-silicone endobronchial valve (ESV) designed to simplify manufacturing and potentially improve biocompatibility. Methods A preclinical study implanted ESVs or Zephyr® EBVs (1:1) into unilateral caudal lobes of eight pigs, assessed using computed tomography (CT), bronchoscopy, and necropsy over 6 weeks. A first-in-human (FIH) trial enrolled three severe emphysema patients (male, aged 48-72 years, collateral ventilation-negative). ESVs were placed using bronchoscope under general anaesthesia. Outcomes included procedural success, safety, target lobar volume reduction, lung function, quality of life, and exercise capacity at baseline, 3 and 6 months. Results Preclinically, all valves (12 ESV, 12 Zephyr®) were successfully implanted and removed. Complete target lobe atelectasis occurred by 6 weeks in all animals, without major adverse events; localised granulation was observed. In the FIH trial, all ESVs were successfully deployed (procedure time: 5-20 min). Target lobar volume reductions occurred at 6 months in two of three cases (Case1:1.5L, Case2:0.4L). Emphysema volume was decreased at 3 and 6 months. Lung function, quality of life, and exercise capacity showed trends toward improvement. One patient experienced an acute exacerbation of chronic obstructive pulmonary disease; no pneumothorax, pneumonia, or haemoptysis occurred. Conclusion Overall, ESV was shown to have an initial feasibility for endobronchial lung volume reduction in humans. Further studies are needed to evaluate the sustained effects.

Loss of muscle mass and sarcopenia are associated with poor prognosis in chronic respiratory illnesses and are currently emerging as coexisting conditions that deserve attention in patients with idiopathic pulmonary fibrosis (IPF). However, the exact impact of muscle changes in this deadly disease is not entirely understood. Our study aimed to investigate the role of muscle loss/myosteatosis assessed by computed tomography (CT) in the short and long-term survival of patients with IPF treated with antifibrotics.

The sedation required for rigid medical thoracoscopy may be associated with hypoventilation and intermittent hypoxaemia. High flow oxygen administration has been shown to decrease hypoxaemia during sedation for flexible bronchoscopy, a procedure using similar sedation protocols to medical thoracoscopy.

Optimal initiation and management of long-term home non-invasive ventilation (LTH-NIV) therapy requires a personalised approach that may not be possible within some healthcare systems. This survey of Italian physicians determined current practices regarding LTH-NIV initiation and follow-up in patients with chronic hypercapnic chronic obstructive pulmonary disease (COPD), areas for process improvements, and use of telemonitoring.

Atrial fibrillation (AF) and obstructive sleep apnea syndrome (OSAS) manifest differently in men and women, which may influence treatment decisions and adherence. The aim of our study was to investigate clinical, polysomnographic, and biological characteristics of AF-OSAS patients and to compare gender differences in this specific population.

INTRODUCTION Talc pleurodesis is a widely used intervention for recurrent pneumothorax and pleural effusion, particularly in nonsurgical candidates. However, some patients experience immediate failure or recurrence and require additional intervention. The safety and effectiveness of repeated talc administration remain unclear. This study investigated repeat-dose talc pleurodesis to determine its safety and efficacy in the management of initial failures and recurrence. METHODS This retrospective study (January 2019-September 2024) analyzed hospitalized patients undergoing talc slurry pleurodesis. Data included demographics, comorbidities, indication, and number of talc doses for successful pleurodesis. The primary outcome was pleurodesis success after repeat dosing. Analyses used chi-square tests, Cox regression for recurrence risk, and Kaplan-Meier estimates for recurrence-free survival. RESULTS Among 103 patients who underwent bedside talc slurry pleurodesis for pneumothorax (n=70) or pleural effusion (n=33), 80 (77.7%) achieved successful pleurodesis with a single 4 g dose (pneumothorax = 56; effusion = 24). Of the 23 patients with immediate pleurodesis failure, 16 (69.6%) achieved success following repeat-dose pleurodesis (pneumothorax = 7; effusion = 9), while 7 required alternative interventions. Recurrence after discharge occurred in 17 (21.3%) of the single-dose group (pneumothorax = 11; effusion = 6) compared with 1 (6.3%) in the repeat-dose group. Among 18 recurrence cases overall, 9 underwent repeat pleurodesis, with 8 (88.9%) achieving success. CONCLUSION Repeat-dose talc pleurodesis may represent a reasonable management approach for patients experiencing immediate failure or recurrence after an initial successful pleurodesis with minimal complications. Further research is needed to optimize protocols and improve outcomes for patients undergoing pleurodesis.

Continuous Positive Airway Pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA), yet diagnostic and treatment models have historically overlooked sex-specific responses. This study aimed to examine sex differences in changes in sleep-related symptoms, cognitive functions and quality of life (QOL) following CPAP initiation in individuals with OSA.

Introduction Gender disparities in long-term health-related quality of life (HRQOL) after pulmonary embolism (PE) are only rarely investigated. The present study aimed to explore gender disparities in HRQOL of patients with PE up to four years after hospital discharge. Methods Data from the German 'Lungenembolie Augsburg (LEA)' cohort study were used. Baseline characteristics of adult hospitalized patients with PE were collected during their hospital stay. Participants completed postal questionnaires 3 and 6 months, and 1, 2, 3 and 4 years after their PE. The Pulmonary Embolism Quality of Life Questionnaire (PEmb-QoL) and the European Quality of Life Questionnaire (EQ-5D-5L) were used to measure HRQOL. Multivariable linear mixed models were applied to determine the association between gender and HRQOL. Interaction effects between gender and various covariables were examined. Results In 569 participants (45% women, mean age 62.9 ± 14.5 years), significant interaction effects of gender with other covariables were found in most subscales of the PEmb-QoL and the EQ-5D-5L. Among patients without chronic obstructive pulmonary disease, women scored significantly worse in the PEmb-QoL total score and the subscales "Limitations of activities of daily living" and "Work-related problems". Among patients with obesity, women had significantly more limitations of activities of daily living than men. Among patients younger than 64 years, women had significantly more social limitations and emotional complaints than men. The observed gender differences were restricted to the first six months after PE. Conclusion Gender disparities regarding HRQOL were observed in specific subgroups and mainly occurred in the first six months after PE.

Shape-sensing robotic-assisted bronchoscopy (ssRAB) was shown to be superior in diagnosing peripheral pulmonary nodules (PPNs) compared to conventional bronchoscopy. Although RAB is established in the USA since 2019, the ION™ Endoluminal System was not CE marked in Europe until 2023.

Pulmonary toxicity is a possible adverse event (AE) of all systemic treatments for lung cancer. Drug-induced parenchymal and interstitial lung disease (D-ILD) is a rare pulmonary AE but can be life-threatening. The presentation of D-ILD is variable and nonspecific, both from a clinical and radiologic point of view. Good management of D-ILD therefore requires a high level of suspicion, which should be established through education of both patients and clinicians. Upon suspicion, clinicians should promptly evaluate lung cancer patients with new respiratory complaints and/or new radiographic abnormalities for the presence of D-ILD. The differential diagnosis is, however, broad, encompassing infectious and non-infectious causes. Clinical, laboratory, microbial and imaging findings should be incorporated to adjudicate the possibility of D-ILD. In the absence of a conclusive diagnostic test, D-ILD is a challenging diagnosis of exclusion that benefits from a multidisciplinary approach. Pulmonologists play an active role in an integrated diagnostic work-up and management of D-ILD and they should therefore remain actively engaged in this clinically relevant subject. Incidence under current standard systemic treatments for lung cancer, risk factors, clinical and radiographic presentations, and management of D-ILD will be discussed in this review. In addition, a practical framework of differential diagnosis is provided.

Introduction Intrapleural fibrinolytic therapy, involving the sequential administration of DNase and tissue plasminogen activator (tPA), is a key component in the management of pleural infections. This approach has been shown to reduce hospital length of stay and the need for surgical intervention. However, it remains unclear whether these agents are pharmaceutically compatible for concurrent administration. This study investigates the compatibility of DNase and tPA when mixed together. Methods We prepared the following combinations of tPA (Actilyse, Boehringer Ingelheim B.V.) and DNase (Pulmozyme, Roche Nederland B.V.): undiluted (10 mg tPA + 5 mg DNase), diluted in 50 mL saline, and diluted in 500 mL saline. Control solutions containing only tPA, only DNase, or only saline were also prepared. Physical stability was assessed by visual inspection for particulate formation, haze, precipitation, color change, or gas evolution. Chemical stability was evaluated by measuring pH at baseline, 2 hours, and 4 hours post-preparation, at both room temperature and 40°C. Incompatibility was defined as a mean absolute pH change greater than 1 unit over time. Results All tested solutions remained physically and chemically stable across all time points, dilutions, and temperatures. Conclusion Our findings demonstrate that tPA and DNase are pharmaceutically compatible when mixed and diluted in normal saline. This supports the feasibility of concurrent intrapleural administration, which may reduce labor intensity, improve protocol adherence, and lower the risk of iatrogenic infections in patients with pleural infections.

It is not known if pulse oximetry oxygen saturation measurements (SpO2) are subject to even number bias and boundary effects which have been reported for other physiological measurements.

Introduction Well-selected patients with advanced emphysema and hyperinflation benefit from lung volume reduction (LVR), including bronchoscopic LVR with endobronchial valves (EBV) and lung volume reduction surgery (LVRS). As bilateral EBV placement may not be advisable, an alternative approach is required. This prospective case series evaluates hybrid LVR, where contralateral LVRS is performed for patients with functional decline despite persistent atelectasis post-EBV. Case presentation Six patients underwent hybrid LVR with a median baseline pre-EBV FEV1 of 750 ml (range, 430-880), RV of 226% (187-293) and 6MWD of 342 meters (245-378). Baseline SGRQ was 70 points (47-86). Time between EBV and LVRS was 698.5 days (403-1027), and all had persistent atelectasis at the time of contralateral LVRS. Post-LVRS hospital stay was 5.5 days (2-44), with complications in two patients (chest tube replacement, arrhythmia requiring upgrade to intensive care unit). There was no 90-day mortality. Compared to pre-EBV, six months post-LVRS, FEV1 improved by 80 ml (-20-410), RV decreased by 1000 ml (740-1870), 6MWD increased by 59.5 meters (-65-123), and SGRQ dropped by 11.5 points (-33-19). Conclusion This case series on hybrid LVR demonstrates its potential to improve lung function and quality of life in selected patients who experience a deterioration in lung function following successful EBV placement.

Bronchoscopy is a valuable tool for the diagnosis and treatment of lung diseases. However, traditional bronchoscopy techniques face challenges such as incomplete examination coverage, unstable image quality, high lesion leakage rate, and high operator dependency, which are particularly prominent in the context of uneven distribution of healthcare resources. In recent years, the rapid development of deep learning technology has provided a new path for the innovation of bronchial image quality control and diagnosis. This study systematically analyses the technology migration potential of AI in the field of medical endoscopy and explores its application prospects in bronchoscopic image analysis. At the same time, this paper also summarizes the shortcomings of bronchial image analysis in the current study, and in the future, it is necessary to further optimize the model generalization ability through multi-center clinical validation and explore the clinical application of real-time decision support system, so as to comprehensively improve the standardization and diagnostic efficiency of bronchial images.

Introduction Small airways dysfunction (SAD) is increasingly recognized as an early marker of respiratory disease. Recent cohort studies have reported wide variability in SAD prevalence across countries, suggesting a possible role of air pollution as a contributing factor. This study aimed to assess SAD prevalence in a general population from rural Switzerland, compare it to existing cohorts, and identify associated factors. Methods We analysed data from the Swiss Longitudinal Cohort Study (SWICOS), conducted in two neighbouring rural villages in Southern Switzerland (Cama and Lostallo). All participants underwent spirometry, with SAD defined as a maximal mid-expiratory flow below the lower limit of normal. Air pollution data were obtained from official monitoring stations located within 10 km of the study site. Results The study included 423 participants (mean age 50.4 ± 16.3 years; 43.7% male). SAD prevalence was 2.60% (95% CI: 1.46-4.60), significantly associated with active smoking, but not with age, BMI, or respiratory symptoms. Exposure to particulate matter was lower than in other international cohorts. Conclusion In this rural Swiss population study, SAD prevalence was slightly lower than in the Swiss urban cohort and markedly lower than in other recent studies, which involved populations exposed to higher levels of air pollution. These findings support growing evidence that air pollution exposure may contribute to early small airways impairment.

Prolonged weaning from invasive mechanical ventilation remains a major clinical challenge. While outcomes from certified weaning centers are increasingly documented, data on long-term survival and post-discharge trajectories are limited. This study evaluates both in-hospital weaning outcomes and long-term survival in patients treated at two specialized weaning centers in Germany.

Pneumocystis jirovecii pneumonia (PJP) is a significant cause of morbidity and mortality in children with advanced HIV disease (AHD) and other immunosuppressive conditions. Acquired tracheal stenosis in children living with HIV (CLHIV) has not been described.

Iriscope, a novel ultra-thin video probe designed to be inserted through the bronchoscope working channel enables direct visualization of peripheral lung lesions. However, its diagnostic value in comparison or in combination with established bronchoscopic guidance techniques remains unclear. This study aims to evaluate the added benefit of combining Iriscope with radial endobronchial ultrasonography (R-EBUS) compared to R-EBUS alone for the diagnosis of peripheral lung lesions sized 20-50 mm.

COPD is the third cause of death in Spain. The ETHOS (NCT02465567) and IMPACT (NCT02164513) RCTs showed reduced exacerbations and all-cause mortality for single-inhaler triple therapy (SITT), but no studies have evaluated the potential impact on COPD outcomes of higher SITT adoption in Spain.

Drug-induced interstitial lung disease (DILD) involves different pathogenic mechanisms, and it is difficult for clinicians to identify the culprit drug. There is currently no systematic research that allows us to understand the comprehensive situation of potential risk drugs and culprit drugs for DILD.