Small airways are recognized as the main site of disease progression and airflow limitation in patients with chronic obstructive pulmonary disease (COPD). Whereas conventional lung function testing, e.g. spirometry, is non-specific to small airway disease (SAD), the advent and wider availability of techniques sensitive to SAD, such as oscillometry, has improved our understanding of the clinical importance of small airway dysfunction. Despite this progress, a gap between the recent advances in knowledge of SAD to its implementation in daily clinical practice remains. We aimed to answer key questions that would allow practitioners (e.g. family doctors, internists, pulmonologists) to introduce oscillometry in their clinical practice.

Lung cancer remains the leading cause of cancer-related deaths worldwide, with occupational carcinogen exposure contributing significantly to its etiology. However, the molecular mechanisms underlying this process remain largely unexplored.

Clinicians who care for patients with chronic respiratory failure are faced with complex medical decisions when initiating and managing home mechanical ventilation. The technological advances and complexities of home mechanical ventilators (HMVs) have outpaced the education and resources provided to clinicians who manage this unique patient population. Many clinicians are familiar with 1 brand and depend on medical equipment suppliers when prescribing and managing home ventilators. A recent national safety recall in the United States of one of the most commonly used HMVs has led to an increase in burden and challenges facing clinicians caring for patients with chronic respiratory failure. The recall has forced clinicians to address knowledge gaps in evolving home mechanical ventilation technology. Evidence supporting the use of advanced and proprietary algorithms is limited, and understanding how to initiate or transition between devices to achieve success using such modes requires education, awareness, and expertise on the risks and benefits of tailoring therapy appropriately. This review focuses on providing practical, real-world guidance to transitioning autotitrating algorithms between HMVs to optimize patient therapy.

Lung cancer screening (LCS) by low-dose computed tomography reduces lung cancer mortality and is covered by Medicare, yet adherence to screening for eligible Medicare beneficiaries is low. Medicare requires a shared decision making (SDM) visit prior to an initial LCS, with a stated goal of promoting adherence to annual screening, but it is unknown whether these visits improve adherence over time.

A 72-year old man, who formerly used tobacco with a 60 pack-year history, was referred to our interventional pulmonology unit for evaluation of a severe stenosis of right main stem bronchus. This stenosis was discovered in a recent hospital admission for respiratory failure associated with right lower lobe pneumonia, which was considered postobstructive. After discharge, the patient continued to experience chest tightness and a persistent cough, which allowed him to expel mucus plugs only with considerable effort. He denied experiencing fever or weight loss. Three years earlier, in 2020, the patient had undergone a right upper lobectomy followed by adjuvant platinum-based chemotherapy for pT1cN1 squamous cell carcinoma. However, during the COVID-19 pandemic, he spontaneously declined any follow-up tests. His medical history was also significant for COPD, obesity, type II diabetes, myelodysplastic syndrome, aortic valve replacement for endocarditis, and rectal resection for pT3N0 adenocarcinoma.

A 72-year-old man with progressive dyspnea was referred to our hospital for evaluation of diffuse lung disease. His medical history was unremarkable except for a 20-year history of smoking 20 cigarettes per day. Abnormal findings were first identified on a chest radiograph during a routine medical checkup 11 months earlier. Chest CT scan showed diffuse ground-glass opacities with basilar predominant distribution and some areas of alveolar consolidation predominantly in the lower lobes. Based on clinical and radiographic findings, the patient was initially diagnosed with interstitial lung disease and treated with IV methylprednisolone pulse followed by oral prednisolone, but his condition did not improve. To exclude the possibility of infectious lung disease, empirical antibiotics were administered; however, the patient showed no clinical improvement. Subsequent treatments, including additional methylprednisolone pulses and immunosuppressive agents such as tacrolimus and cyclophosphamide, also failed to yield any significant benefit. His dyspnea progressively worsened, and home oxygen therapy was initiated 4 months before referral. Because of his deteriorating condition despite maximal medical therapy, he was referred to our hospital for comprehensive evaluation.

Acute aortic dissection is a rare and life-threatening emergency, with fatal outcomes often resulting from delayed or missed diagnoses. Type A aortic dissection, which typically presents with acute chest pain radiating to the back, is the most common cause of death associated with aortic lesions and requires urgent surgical intervention. We present an unusual case of type A aortic dissection that manifested solely with sudden paralysis and tingling of the right lower limb, without chest or back pain. Despite timely diagnosis in the emergency department, emergency surgical intervention failed to save the patient's life.