Fungal sensitization is an increasingly recognized endophenotype in chronic respiratory disease; however, its role in bronchiectasis remains poorly defined. This study aimed to provide the most comprehensive evaluation to date of fungal sensitization and its clinical relevance in bronchiectasis using an expanded panel of crude and recombinant fungal allergens.

Although lung cancer screening programs aimed at high-risk adults who smoke have effectively reduced mortality rates, the risk factors for lung cancer in people who have never smoked (LCINS) remain poorly understood.

An 18-year-old man with no prior medical history presented to the tertiary care center with a 6-month history of progressively worsening bone pain. The pain was localized to the right posterior ribs, mid-thoracic spine, and right iliac bone and was described as deep, throbbing, and exacerbated by physical activity, which significantly limited his mobility. Concurrently, he reported recurrent episodes of dyspnea and chest tightness, particularly in the supine position. Physical examination revealed reduced tactile fremitus and diminished breath sounds over the bilateral lower lung fields, with dullness to percussion. Bilateral pitting edema extended from the ankles to the knees (grade 1+), with no signs of joint swelling, skin rash, or lymphadenopathy. Vital signs were notable for low-grade fever (38.2 °C) and tachycardia (heart rate: 92 beats/min).

A 55-year-old woman presented to the emergency department with fever, cough, and progressive dyspnea for 3 days. Chest CT scan showed diffuse pulmonary lesions, and arterial blood gas analysis showed a Pao2 of 56 mm Hg on room air. Consequently, she was transferred to the respiratory ICU because of rapidly progressing respiratory failure. Her medical history indicated a 20-year history of psoriasis. She initiated treatment with ixekizumab (an interleukin-17 inhibitor) 3 months ago. A chest radiograph before ixekizumab treatment showed no abnormalities. After administration of ixekizumab therapy, her skin lesions demonstrated significant improvement. She denied any history of tobacco use or chronic lung disease.

An 81-year-old woman was referred to our Cardiomyopathy Clinic for unexplained asymmetric left ventricular hypertrophy. She was asymptomatic, with no family history of cardiac disease nor of sudden cardiac death. The patient's medical history included a hepatitis C virus infection, successfully eradicated with antiviral therapy, and a hysterectomy for multiple uterine leiomyomas at the age of 36. Moreover, she underwent thoracoscopic right upper and right lower wedge resection for multiple pulmonary masses, consistent with metastatic benign leiomyomas, at the age of 63. Three years before the current evaluation, a recurrence of pulmonary leiomyomas, not affecting respiratory dynamics, nor causing any symptom, was diagnosed but not treated with surgery. Follow-up evaluations by CT scan showed slow progression of pulmonary lesions over the years in the absence of clinical manifestations.

Flow-controlled ventilation (FCV) is characterized by a bidirectional linearized gas flow translating into a constant flow. We report the prolonged use of FCV in a 30-year-old patient with major trauma, including severe traumatic brain injury and posttraumatic ARDS, because the patient sustained other severe injuries such as those to the spine and pelvis. Conventional mechanical ventilation failed to attain normoxia and normocapnia, leading to hemodynamic compromise and refractory intracranial hypertension. FCV was used as an off-label rescue therapy because prone positioning and extracorporeal membrane oxygenation were contraindicated. Within a few hours, ventilation improved despite lower minute volumes. This was paralleled by a reduction in norepinephrine requirements and normalization of intracranial pressure. FCV was continued for 96 hours. This case report underlines the potential benefits of FCV as a novel ventilation mode in patients with ARDS and justifies future studies evaluating the outcome effects of FCV in this complex population.

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.

Systemic lupus erythematosus (SLE)-associated pulmonary arterial hypertension (PAH) exhibits marked clinical heterogeneity. Although pathogenic variants in the BMPR2 gene and other PAH-related genes drive pulmonary vascular remodeling in idiopathic or familial PAH, their role in SLE-associated PAH remains unclear.

Large language models (LLMs) are demonstrating increasing promise across clinical applications, but their domain-specific knowledge in asthma has not been thoroughly explored. Additionally, state-of-the-art models released in 2025 (ChatGPT-5, ChatGPT-o3, Claude-3.7, DeepSeek-V3, and Grok-3) have yet to be studied in asthma.

Current evidence supports risk-based treatment for pulmonary arterial hypertension (PAH) with an endothelin receptor antagonist and phosphodiesterase type 5 inhibitor as initial therapy for patients with low- and intermediate-risk PAH, and triple therapy with the addition of a parenteral prostacyclin for patients with high-risk PAH.

Although quantitative CT imaging offers objective evaluation of radiologic progression in non-idiopathic pulmonary fibrosis (IPF) fibrosing interstitial lung disease (ILD), clinically meaningful thresholds for defining progressive pulmonary fibrosis (PPF) remain unclear.

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.

IL-5 is a key mediator of severe eosinophilic asthma (SEA) and also may contribute to airway remodeling.

Pulmonary hypertension (PH) is characterized by a high mean pulmonary artery pressure and an impaired health-related quality of life. The Pulmonary Hypertension Functional Class Self-Report (PH-FC-SR), a patient-reported version of the World Health Organization Functional Classification (WHO-FC), was developed to assess PH functional class from the patient perspective.

In July 2021, the Veterans Health Administration (VHA) implemented a nationwide inhaler formulary change affecting approximately 260,000 veterans with COPD and asthma. Clinician perceptions regarding this formulary change are unknown.

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.

Targeting hypercapnia during invasive mechanical ventilation with subsequent respiratory acidosis may impair right ventricular (RV) function and cause RV failure. RV dysfunction is common after cardiac arrest and may be associated with poor outcomes.

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.

Interstitial lung diseases (ILDs) are a heterogeneous group of entities characterized by similar clinical, pathologic, and radiologic features. High-resolution CT scan is the first-line imaging modality; however, the use of ionizing radiation in patients requiring several follow-ups, the limitation in distinguishing active inflammation from fibrosis, as well as its poor tissular characterization properties have opened a scenario in which MRI may have a role in patients with ILD. The high prevalence of lung cancer in ILD and the frequently unrecognized ILD-related pulmonary hypertension (PH) have raised interest in the potential application of MRI in these patients.

Follow-up of incidental lung nodules in real-world clinical practice is often inconsistent and suboptimal. Improving these follow-up processes presents a complex challenge, particularly for institutions without existing infrastructure. Although advanced tools such as natural language processing and artificial intelligence hold promise, many successful programs have relied on low-cost, manual approaches tailored to local workflows and resource availability. This article outlines a practical, experience-based framework for enhancing incidental lung nodule follow-up across diverse health care settings-including those with limited resources-by proposing scalable, feasible strategies that help bridge the gap between evidence-based guidelines and routine clinical practice.