Access to polysomnography, the recommended standard for the diagnosis of obstructive sleep apnea (OSA) in children, is limited in many jurisdictions. Many children undergo treatment for OSA without confirmatory testing, are denied treatment in the absence of testing, or have a delay in treatment of other sleep disorders until OSA can be ruled out.

Pulmonary aspergilloma are characterized by a fungal ball that forms in a pre-existing lung cavity. While many patients remain asymptomatic, others may develop progressive symptoms including cough, hemoptysis, weight loss, fever, and, in severe cases, death. Management is often complex and highly patient-centered, ranging from routine surveillance in stable patients to invasive procedural or surgical approaches in those with more severe disease. Systemic antifungal therapy is generally not indicated for stable, asymptomatic simple aspergilloma, but may be considered in select scenarios such as symptomatic or progressive disease in non-surgical candidates, peri-procedural/perioperative settings or when overlapping CPA phenotypes (e.g., CCPA) are suspected. However, despite the significant morbidity and mortality associated with pulmonary mycetoma, there is a paucity in our understanding of their natural course, optimal treatment modalities and duration, appropriate follow-up plan and prognostication. Consequently, clinical decision-making is frequently based on clinician experience or institutional protocols. In this article, we provide a comprehensive review of pulmonary aspergilloma and its management, with the goal of presenting a practical and evidence-based framework to support clinicians in the evaluation and treatment of this chronic fungal disease.

Methamphetamine is a potent central nervous system stimulant that is highly addictive. Although methamphetamine use has historically been localized to the Western United States Census region, its reach has been growing, and methamphetamine use is now expanding throughout the United States and the world. Methamphetamine is now considered a definite cause of pulmonary arterial hypertension. Despite being one of the fastest growing causes of pulmonary arterial hypertension, recommendations to guide the care of patients with methamphetamine-associated pulmonary arterial hypertension have not been published. This review focuses on the care of patients with methamphetamine-associated pulmonary arterial hypertension. It provides a practical approach to care which incorporates pharmacologic therapy in conjunction with harm reduction strategies as well as support from ancillary services such as addiction medicine and social work.

To provide an expert consensus framework for standardizing lung ultrasound training for neonatologists.

As awareness of sleep's role in health grows, consumer sleep technologies (CSTs) have gained wide use among both researchers and the public. These devices offer continuous, noninvasive sleep tracking in real-world environments. However, understanding their accuracy compared with that of polysomnography (PSG), the gold standard in sleep measurement, remains limited, particularly in free-living settings and clinical populations. Assessing CST performance and usability in these contexts is essential for guiding future adoption.

The historic National Lung Screening Trial (NLST) reported lung cancer-specific and all-cause mortality reductions associated with low-dose CT (LDCT) imaging, and nearly all relevant authoritative organizations established guidelines and policies supporting implementation and insurance coverage for individuals who meet eligibility criteria. The immediate challenge became translating results into community settings. Early translation showed substantial challenges to delivery of quality lung cancer screening (LCS). The Kentucky LEADS (Lung Cancer Education Awareness Detection Survivorship) Collaborative developed a comprehensive system to evaluate and support LCS delivery in community contexts with an emphasis on supporting rural and low-resource settings. The QUILS System 1.0 (Quality Implementation of Lung Cancer Screening) featured 4 key components: (1) the QUILS Index 1.0, a quantitatively driven evaluation system assessing quality across 6 essential LCS implementation domains; (2) the QUILS Audit and Feedback Process 1.0, a strategy for providing feedback and guidance to bridge the QUILS Index and the QUILS Resource Portal; (3) the QUILS Resource Portal 1.0, online tools and trainings that are directly tied to components within the QUILS Index 1.0; and (4) the QUILS Technical Assistance and Coaching 1.0, providing additional problem-solving and support upon request. The 6 essential domains included: (1) Screening Eligibility; (2) Radiology Operations; (3) Team Operations; (4) Prevention Efforts; (5) Patient Education; and (6) Community Outreach. To collect initial feedback and evaluate the QUILS System 1.0, the investigative team planned and conducted a rigorous evaluation of this initial framework across 10 sites in Kentucky over an 18-month period.

Patients with neuromuscular disease and other thoracic restrictive disorders are at increased risk of hypoxia during high-altitude travel due to an ineffective hypoxic ventilatory response. Efforts to identify clinical parameters that successfully predict the need for hypoxic challenge testing, a tool used to assess the risk of hypobaric hypoxia, and its outcomes in this population have been inconsistent and limited mainly to small, retrospective studies. Consequently, recommendations regarding the evaluation and management of these patients prior to high-altitude travel have been uncertain and differ across medical societies. We provide a clinical management algorithm for this patient population that draws on the available data.

There is no consensus for identifying ideal candidates for extracorporeal membrane oxygenation (ECMO), a life-sustaining technology that can supply oxygenated blood to a patient whose heart and/or lungs are not properly functioning. Without clear and standardized guidelines, the decision about who to cannulate often falls upon one or several clinicians who weigh the procedure's risks and benefits. Limited data, and therefore substantial clinical judgment, guides ECMO candidacy determination, rendering the process particularly susceptible to heuristic-based decision-making and cognitive biases resulting from mental shortcuts. This can lead to candidates being inappropriately accepted or declined for ECMO and suboptimal allocation of a limited resource. This article presents a hypothetical case based on real clinical scenarios highlighting the impact that cognitive biases may play in ECMO candidacy and discussing their potential harms. We argue that ECMO candidacy determination is especially vulnerable to cognitive biases and offer several ways to mitigate their influence on candidacy selection. Our aim was to stimulate the recognition and mitigation of cognitive bias in ECMO deliberations as one step toward the standardization of ECMO candidacy determinations, with the goal of achieving more equitable and effective care for patients who would most benefit from this technology.

Rhabdomyolysis is the clinical syndrome resulting from the release of skeletal muscle cellular contents into the bloodstream, typically manifesting as limb weakness, myalgias, swelling, myoglobinuria, electrolyte abnormalities, and, critically, acute kidney injury (AKI). Recognition of this complex of clinical and biochemical features is necessary for accurate diagnosis and subsequent management.

Pulmonary fungal infections, which have traditionally been associated with patients who are immunocompromised, are now increasingly recognized among immunocompetent individuals. This trend is attributable to multiple factors including altered environmental conditions linked to climate change, postviral syndromes, and advances in ICU practices. Immunocompetent hosts typically generate effective responses to pulmonary fungal infection; however, severe disease may develop in the presence of abnormal lung structure or function, transient immune dysfunction, or antigenic hypersensitivity.

Chronic respiratory diseases (CRDs) remain one of the leading causes of preventable morbidity and disability worldwide, affecting up to one-third of the total Western population in 2025. Recognizing the substantial burden of inflammatory airway diseases such as asthma, COPD, chronic rhinosinusitis, and respiratory allergy, the European Forum for Research and Education in Allergy and Airway diseases (EUFOREA) organized the symposium "Shaping the Future of Respiratory Care" in April 2025 in Brussels, Belgium, at the occasion of the 10-year jubilee. Featuring keynote speakers from the World Health Organization and EUFOREA, this initiative had the following aims: (1) promoting dialogue on translating innovations into daily clinical practice; (2) encouraging collaboration between the different stakeholders in the respiratory field; and (3) defining strategic priorities to transform respiratory care and arrest the CRD epidemic over the next decade. The symposium highlighted the importance of moving toward predictive, preventive, and patient-centered medicine, while supporting value-based health care systems to improve long-term patient outcomes. This report summarizes the main insights and strategic directions discussed at the meeting.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary hypertension characterized by unresolved thromboemboli and subsequent fibrotic obstructions of the pulmonary arteries. Pulmonary thromboendarterectomy (PTE) is the treatment of choice if feasible. Multidisciplinary evaluation by an experienced CTEPH team is essential to ensure proper patient selection, operability assessment, and appropriate perioperative management of patients with high-risk hemodynamics and right ventricular failure. In the early postoperative period, close monitoring in the ICU is necessary. These patients are at risk for profound oxygenation and hemodynamic derangements after PTE surgery. Inotropic support, diuresis, mechanical ventilation with adequately large tidal volumes, and supportive care for potential complications such as reperfusion lung injury or airway hemorrhage are at the core of ICU management. Anticoagulation is a key cornerstone of CTEPH treatment and must be started as soon as possible, while carefully weighing the risks of bleeding complications vs rethrombosis. Follow-up evaluation after pulmonary endarterectomy is essential to evaluate for residual pulmonary hypertension and identify patients who may benefit from additional treatments. Ultimately, optimal outcomes depend on an experienced multidisciplinary CTEPH team with an approach to care that spans the preoperative, early postoperative, and after discharge phases. This review aims to provide clinicians with practical guidance for the perioperative management of patients with CTEPH undergoing PTE surgery.

Invasive candidiasis (IC) is a common complication in patients in ICUs. IC can be divided into bloodstream infections (candidemia) and deep-seated infections. Candida infections are associated with high mortality and longer hospital stays. Moreover, the emergence of Candida auris and other species prone to cause ICU outbreaks highlights the importance of this pathogen.

Circadian rhythms are often severely disrupted in critically ill patients in the ICU. The ICU environment, characterized by irregular light-dark signals, continuous nutrition, and round-the-clock interventions, contributes to this disruption by providing weak and conflicting timing cues to the circadian system. Extensive scientific research has demonstrated that circadian rhythms play a vital role in regulating physiology and maintaining overall health. Therefore, integrating circadian principles into critical care may represent a promising strategy to improve patient outcomes in the ICU.

The Bronchiectasis & NTM Association established a network of specialized care centers with unique skills in the diagnosis and management of patients with bronchiectasis (BE) and/or infection with nontuberculous mycobacteria (NTM). The mission of the network is to reduce the time to diagnosis and support high-quality care for patients affected by these conditions. This was intended to address the rising incidence and prevalence of people with BE and/or NTM infection. As part of this care center network, there is development of standards of care based upon consensus agreement of experts. This position paper addresses the structure of a care center, including the members of a multidisciplinary core team, essential partners for more common complications of disease, and the necessary supportive staff to provide comprehensive care for patients with BE and/or NTM infection. Through review of the literature and expert consensus, this is intended to guide the development and improvement of care centers.

Interstitial lung disease (ILD) affects 40% to 60% of patients with systemic sclerosis (SSc) and represents the leading cause of death. Although treatment options for SSc with ILD remain limited, randomized controlled trials have demonstrated the safety and efficacy of approved and unapproved therapies. However, numerous unanswered questions remain regarding management of SSc with ILD, and 3 recently published clinical practice guidelines highlight the complexity of treating this condition. These guidelines offer distinct and sometimes contrasting views on treatment of SSc with ILD, creating unique challenges for clinicians. The present review aimed to synthesize evidence regarding the management of SSc with ILD with a focus on how to apply the recent guidelines into practice, beginning with screening for disease and extending to the intricate decision-making surrounding treatment.

Sarcoidosis is a systemic disease characterized by marked clinical equipoise regarding optimal methods for disease diagnosis, monitoring, and treatment. As a result of these challenges, patients with sarcoidosis face substantial delays in care and have reported psychological distress from the uncertainty they face throughout their care journeys. In complex diseases with multisystemic involvement, multidisciplinary care models can help provide diagnostic clarity and streamline care. Although experts and guidelines in the field advocate for multidisciplinary care to improve clinical management of sarcoidosis, limited primary literature describes implementation of these care models in sarcoidosis. In this review, we outline best practices and common challenges associated with establishing a multidisciplinary care team for sarcoidosis. We describe the development of the Johns Hopkins Sarcoidosis Center (JHSC) multidisciplinary team as well as the formation of the Johns Hopkins Sarcoidosis patient advisory board, which helps inform the team's goals and initiatives. Finally, we review the broader literature on multidisciplinary care models in sarcoidosis and interstitial lung disease, identifying areas for further study.

Subclinical interstitial lung disease (ILD) is common in patients with rheumatoid arthritis (RA). Some patients with subclinical rheumatoid arthritis-associated interstitial lung disease (RA-ILD) will progress to clinical ILD, which is associated with increased morbidity and mortality. Recently, the American College of Rheumatology and American College of Chest Physicians (CHEST) have published guidelines addressing screening for ILD in patients with RA; however, much is unknown about risk of progression or optimal treatment strategies after recognition of subclinical RA-ILD.

Determining the cause of a pleural effusion remains clinically challenging. Pleural fluid analysis (PFA) is an essential component of the diagnostic approach that we have reviewed in detail in a companion paper. However, despite the importance of PFA in establishing the cause of a pleural effusion, pathognomonic pleural fluid findings are rare. The true diagnostic value of PFA lies in its integration with the broader clinical picture. This diagnostic approach requires a systematic evaluation combining PFA with medical history, physical examination, laboratory data, and radiographic studies. In this manuscript, we review clinical features beyond PFA that are important in determining the cause of a pleural effusion. A detailed medical history may reveal important comorbidities, exposures, and previous surgical procedures that have diagnostic relevance. Radiographic findings, including the anatomic locations of pleural fluid, radiographic features, and the chronicity of the effusion, also may be diagnostically important. Blood tests may supply additional diagnostic information. Underpinning this diagnostic approach is that the clinician requires a deep understanding of the breadth of pleural diseases and their associated clinical presentations.

Mitral valve disease has a significant impact on the respiratory system. Present-day pulmonologists must be aware of its myriad presentations and evolving treatment landscape.