The Apnea-Hypopnea Index (AHI), the standard measure of obstructive sleep apnea (OSA), has limitations in reflecting disease severity.

ACE inhibitors (ACEi) are widely used antihypertensive agents with proven cardioprotective effects. Previous mechanistic and clinical studies have suggested ACEi therapy may slow disease progression and reduce mortality in idiopathic pulmonary fibrosis (IPF).

Thoracoscopy guidelines recommend inducing artificial pneumothorax before medical thoracoscopy in patients with minimal or absent pleural effusion. Recent single-arm studies have demonstrated that non-artificial pneumothorax approaches reduce operative time and complication rates compared with artificial pneumothorax techniques in these patients. However, there is a lack of trials comparing the effectiveness and safety of performing artificial pneumothorax versus not performing it in these cases.

Chronic cough (CC) is one of the most common symptoms reported to primary care and to respiratory outpatient clinics. The Triggers and Sensations Provoking Coughing (TOPIC) questionnaire is a 15-item questionnaire designed to capture sensations and triggers associated with CC in a fashion that discriminates between refractory CC (RCC) and other causes of CC.

Development of persistent critical illness (PerCI) necessitating prolonged ICU stays varies across hospitals. Specialty palliative care consultation may mitigate PerCI development by influencing the transition to comfort-directed care when appropriate.

Long COVID or a post-COVID condition, defined as the persistence of symptoms at least 3 months after acute COVID-19 infection, is a novel condition in which a definitive diagnostic marker and treatment have yet to be found. This condition, which has been estimated to impact > 65 million individuals worldwide, manifests with multisystem involvement, most commonly presenting with fatigue, brain fog, dyspnea, cough, or a combination thereof. The burden of these symptoms can range from mild to severe, with many patients reporting an inability to return to usual activities. Herein, we present several hypothetical but clinically representative case reports to allow discussion around how we approach the diagnosis of respiratory symptoms of long COVID in those with and without chronic lung disease.

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.

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.

Low-tidal-volume ventilation (LTVV) improves outcomes in critically ill patients, but its impact in patients with acute brain injuries (ABIs) is less certain.

There is considerable variation in clinicians' approaches to decisions to withhold or withdraw life sustaining treatment (LST) across US hospitals. These differences are not explained by patient preferences alone and are likely influenced by other factors (eg, hospital policies, hospital culture, state laws, medical society guidelines).

Chronic beryllium disease (CBD) is considered a phenocopy of sarcoidosis, generally caused by occupational exposure to beryllium. Its diagnosis relies on the demonstration of beryllium sensitization by the beryllium lymphocyte proliferation test (BeLPT).

Light's criteria use pleural fluid protein and lactate dehydrogenase (LDH) to differentiate pleural effusions as exudative or transudative. In a subset of exudative pleural effusions, discordance occurs between LDH and protein (ie, protein high, LDH low, or vice versa).

In 2012, the Global Lung Function Initiative (GLI) collected a large international database of spirometry measurements in healthy people from which predicted spirometric values were derived based on sex, age, and height for people from 4 different geographic ancestral groups. In 2023, a single set of predicted spirometry values was developed for the entire dataset, designed to be independent of ancestry.

Lung cancer screening (LCS) has evolved over the past decade with research advances and clinical experience helping to define target populations for screening, to improve lung nodule detection and management, and to identify structural components of programs that improve the quality of screening delivery. The 2015 American College of Chest Physicians and American Thoracic Society Policy Statement, "Components Necessary for High-Quality Lung Cancer Screening," identified 9 essential components for high-quality LCS. Ten years later, optimizing the balance between the benefits and harms of LCS and ensuring equitable screening among all population groups remain fundamental objectives. In this 2025 update, we aimed to summarize new knowledge and highlight critical components that are needed for providing high-quality LCS. A multidisciplinary group of LCS experts was assembled to review evidence from the past 10 years. The original components were reviewed and updated to develop 8 refined components that should be considered essential structural elements of screening programs. Each component recommended by the authors is supported by an evidence update. Applying this framework will allow screening programs across the country to ensure implementation of high-quality, net-benefit LCS.

Current indications for long-term oxygen therapy (LTOT) primarily are based on thresholds of arterial oxygen saturation (SaO2) or PaO2 that ignore fundamental mechanisms of adaptation and intolerance to hypoxia. In individuals exposed to chronic hypoxic conditions, the accumulation of hypoxia-inducible factors (HIFs) in the cell nucleus upregulates target genes that favor tolerance to hypoxia. Adaptations include hyperventilation, systemic vascular bed development, increased erythropoiesis, and cellular metabolic adjustments. Excessive responses to hypoxia also may develop, leading to pulmonary vasculature remodeling and other end-organ dysfunctions. Biomarkers of hypoxia may complement the measurement of SaO2 or PaO2 in personalizing oxygen prescription before end-organ dysfunction becomes clinically apparent.

The precise impact of cardiovascular risk factors (CVRFs) on the right ventricle-pulmonary circulation unit remains unclear.

With the sudden onset of the COVID-19 pandemic, countries rushed to implement guidelines for triage. Some were unprepared. In Germany, academic discourse had focused on criteria for triage, while often neglecting their translation into clinically applicable protocols in ICUs.

A 54-year-old woman with a history of recurrent exertional dyspnea for 5 years was admitted for evaluation. Six months prior, she noted a worsening of her symptoms, with progressive physical activity limitation caused by exertional fatigue and dyspnea (climbing 2 to 3 flights of stairs). She also experienced palpitations, with an estimated heart rate that ranged from 120 to 150 beats per minute. The patient denied chest pain, hemoptysis, or other notable symptoms. Notably, the patient underwent surgical repair of an atrial septal defect more than 20 years earlier, with a good postoperative recovery. Regular postoperative echocardiograms revealed no residual shunt, no valvular abnormalities, and no pulmonary hypertension. The patient had no history of smoking, drug abuse, or alcohol consumption.

Identifying biomarkers is vital for interstitial lung disease (ILD) management and prognostication. Although anti-Ro52 antibodies frequently are detected in autoimmune diseases, their significance in ILD remains unclear.

The routine use of CT imaging and lung cancer screening has increased the incidence of peripheral pulmonary lesions (PPLs). Sampling may be needed for some nodules. Many new technologies are available to improve the diagnostic performance of bronchoscopy for the sampling of PPLs, but few comparative trials exist. The objective of this study was to compare the diagnostic performance of bronchoscopy with radial endobronchial ultrasound (rEBUS) using an ultrathin bronchoscope (BF-MP190F; Olympus) with a non-ultrathin bronchoscope and to compare the diagnostic performance of bronchoscopy with and without rapid on-site evaluation (ROSE).