Diaphragmatic dysfunction is an uncommon and often overlooked cause of dyspnoea, particularly when symptoms progress insidiously. We present the case of a 50-year-old man with a history of a bicycle accident, without associated thoracic trauma. A routine chest X-ray revealed an elevated left hemidiaphragm (figure 1A,B), initially presumed to be trauma-related. Despite this finding, the patient remained

Recent years have seen an increase in recognition of women’s health and the importance of understanding how disease presentation, progression and management differ by sex and gender. Growing evidence has demonstrated the impact of hormone fluctuations, including puberty and menopause, on health-related outcomes.1 2 Organisations and policies including the European Medicines Agency, the National Institute

Background Prospective validation and comparison of the performance of nodule management protocols is limited. The aim of this study was to examine the performance of size and risk thresholds for assessing malignancy in solid nodules at baseline low-dose CT (LDCT) in a lung cancer screening (LCS) programme. Methods This was an observational study using data from the SUMMIT Study, a prospective longitudinal

Lung cancer screening (LCS) with low-dose CT has been proven to reduce lung cancer-specific mortality in high-risk individuals. However, there has been a lot of concern regarding false-positive scans requiring additional imaging follow-up or even biopsies. Reporting guidelines, such as those developed by the American College of Radiology (ACR Lung-RADS)1 or the British Thoracic Society (BTS),2 aim

Background Pulmonary hypertension (PH) is a progressive cardiopulmonary condition associated with increased morbidity and mortality. The extracellular matrix component hyaluronan (HA) is linked to vascular remodelling and interstitial fibrosis in PH. We hypothesised that inhibition of HA synthesis with hymecromone could serve as a reverse-remodelling therapy in PH. Methods We performed a proof-of-concept

In this issue of Thorax , Czepiel et al report the results of a double-blind randomised controlled trial of an oral agent, hymecromone, in patients with pulmonary hypertension (PH).1 The authors provide a sound biological rationale as to why hyaluronan, a constituent of the extracellular matrix, may have an important role in vascular biology. The agent subjected to study is hymecromone, an inhibitor

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When conventional cardiopulmonary resuscitation (CCPR) cannot restore spontaneous circulation, the initiation of venoarterial extracorporeal membrane oxygenation during refractory cardiac arrest—known as extracorporeal CPR (ECPR)—might restore circulation and adequate tissue oxygenation. ECPR could substantially improve survival with favourable functional recovery. However, the complexity and time-sensitive

Background The association between lower adult lung function and increased cardiovascular comorbidity has not been adequately explained. We investigated whether shared developmental signalling pathways, critical to lung development and repair, could partly explain it. Methods In UK Biobank (UKB), we performed pairwise colocalisation analysis of variants in 55 lung development genes associated with

Physical inactivity is a modifiable and widespread risk factor in chronic disease populations, including those with obstructive pulmonary disease and recipients of lung transplantation (LT). While LT restores respiratory function, full physical recovery remains elusive. Muscle weakness and reduced exercise tolerance are common and often worsened by immunosuppressive therapies, immobility and nutritional

Background Despite significant clinical improvements, there is evidence of persisting airway inflammation in people with cystic fibrosis (CF) established on elexacaftor/tezacaftor/ivacaftor (ETI) therapy. As CF is a multi-system disease, systemic immune profiles can reflect local inflammation within the lungs and other organs. Understanding systemic inflammation after ETI therapy may reveal important

Introduction In Hong Kong, tuberculin skin test (TST) with a 15 mm cut-off was used at 0 and 3 months for contact screening, but half of future tuberculosis cases might be missed. Follow-on interferon-gamma release assay (IGRA) was added for those with tuberculin reaction of 5–14 mm in a pilot programme. Methods This was a prospective cohort study. All household contacts of smear-positive tuberculosis

Introduction Most lung transplant (LTX) recipients do not meet physical activity (PA) guidelines. Interventions are needed as long-term inactivity is related to morbidity and mortality. We investigated the effect of a telecoaching programme on objectively measured PA in LTX recipients. Methods Inactive patients (<7500 steps/day, n=90) were randomised into a light or intensive version of a 1-year PA

In this issue of Thorax , the REMAP-CAP investigators publish the final results from the COVID-19 Immune Modulation Therapy Domain for COVID-19 of Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP).1 REMAP-CAP is an international, adaptive, platform trial focused on hospitalised patients with pneumonia. At the outset of the COVID-19 pandemic in

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Section snippets ContributorsWM and H-ML oversaw the project; MR and EM were involved with FAPI-PET/CT, including graphs; CPH was involved with CT-imaging, including graphs; WM, H-ML, AS, JHWD, and MP were responsible for clinical data interpretation; WM, MS, AS, H-ML, and MP cared for the patient; WM was responsible for data handling; WM and ANS wrote the manuscript; and all authors critically reviewed

Artificial intelligence (AI) is a branch of computer science developed in the 1950s to imitate the human ability for solving complex problems. Currently, it is widely applied in various fields of medicine for diagnostic support, assistance with medical practice and drug discovery. After entering respiratory medicine two decades ago, AI has been used in this field to support in making diagnoses and

Background Numerous lung cancer risk prediction models have been developed and validated worldwide. It is imperative to offer a comprehensive overview and comparative analysis of their performances. Methods We conducted an extensive literature search to identify studies developing and/or validating lung cancer risk prediction models. Then we summarised and compared the external performance of these

Background Critical care medicine has historically relied on syndromic diagnoses such as sepsis, acute respiratory distress syndrome (ARDS) and acute kidney injury to guide research and treatment. While this approach has advanced clinical practice, the growing recognition of patient heterogeneity presents significant challenges for treatment optimisation and trial interpretation. Understanding heterogeneous

Rationale Airways dysanapsis is defined by CT or spirometry as a mismatch between the size of the airways and lung volume and is associated with increased risk of developing chronic obstructive pulmonary disease (COPD). Lung disease in participants with dysanapsis and a label of asthma and/or COPD remains poorly understood. Methods In participants with asthma and/or COPD, we used 129Xe-MRI to assess

Background Idiopathic pulmonary fibrosis (IPF) is a progressive disease of lung parenchymal scarring that is triggered by repeated microinjury to a vulnerable alveolar epithelium. It is increasingly recognised that cellular ageing, whether physiological or accelerated due to telomere dysfunction, renders the epithelium less able to cope with injury and triggers changes in epithelial behaviour that

Chronic obstructive pulmonary disease (COPD) is mainly treated with bronchodilators (long-acting beta-agonists (LABA) and/or long-acting muscarinic antagonists (LAMA)) to reduce symptoms and exacerbations. Inhaled corticosteroids (ICS) are also frequently used, more recently in the form of single inhaler triple therapy (SITT).1–3 There are numerous established adverse effects of ICS (pneumonia, mycobacterial

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BACKGROUND The routine use of computed tomography 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

BACKGROUND Functional status and frailty are important considerations in lung transplant (LT) candidacy due to the potential impact on post LT outcomes. Once listed, waitlist duration can be unpredictable, and preservation of functional capacity is thus critical to prevent deterioration in conditioning. Pulmonary rehabilitation (PR) has been deemed to be a cornerstone of management of chronic lung

BACKGROUND Becoming a clinician requires not only the accumulation of medical knowledge but also the development of a professional identity. The humanities may illuminate how professional and personal experiences shape identity, support meaning-making, and foster resilience through reflection and creative expression. RESEARCH QUESTION What transformative experiences disrupt the professional identity

Challenges facing health care professionals (HCPs) in selecting an inhaled medication-delivery system for patients with chronic obstructive pulmonary disease (COPD) include: 1. numerous maintenance medications and combinations; 2. at least 22 different handheld inhaler devices; 3. management recommendations focusing mainly on classes of medications; 4. lack of knowledge about available medications/combinations

Inhaled aerosols, the cornerstone in the everyday therapeutic management of patients with asthma, target drug directly to their pathophysiological site of action within the lungs. Asthma is a disease of the whole airway tree1; that is, the central and peripheral airways, where the peripheral airways are considered a treatable trait.2 However, the complex architecture of the lungs with varied morphologic

BACKGROUND Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) cause right ventricular dysfunction with extrapulmonary sequalae including renal dysfunction. We sought to characterize renal dysfunction in PAH and CTEPH and to assess the effect of pulmonary hypertension treatment on renal function. METHODS We performed an individual participant data meta-analysis

RATIONALE Bronchiolitis obliterans syndrome (BOS) limits long-term survival after lung transplantation (LuTx) and may be triggered by infections. As immunoglobulin (Ig)A is crucial to ensure adequate mucosal immunity, we explored whether IgA-related mucosal immunity is impaired in BOS. METHODS Sixty LuTx recipients from the COLT cohort were retrospectively included. All participants were in stable

BACKGROUND The EMBARC registry shows considerable variation in culturable microbes in sputum between different European countries. The additive role of next generation metagenomic sequencing remains unexplored and association with antimicrobial resistomes unknown. METHODS We prospectively assessed sputum from N=349 individuals recruited into the EMBARC-BRIDGE study with next-generation shotgun metagenomic

The amount of walking that people with chronic obstructive pulmonary disease (COPD) do is reduced. However, data on their manner of walking (i.e., gait) is still lacking. We characterised real-world gait in COPD by assessing levels and distributions of gait parameters, and comparing them across COPD severity, and with healthy peers.549 people with COPD from seven European sites and 19 healthy older

RATIONALE : Prolonged exposure to airborne particulate matter (PM) is associated with emphysema and chronic obstructive pulmonary disease (COPD); however, the precise underlying mechanism remains unclear. OBJECTIVES In a previous high-throughput screen, we identified inter-alpha-trypsin inhibitor heavy chain 4 (ITIH4) as a biomarker of long-term PM exposure. We hypothesized that ITIH4 is implicated

Sepsis is a life-threatening, dysregulated host response to infection. Immunosuppression is a risk factor for infections and sepsis. However, the specific immune derangements elevating the risk for infections and sepsis remain unclear in the individual patient, raising the question of whether a general state of immunosuppression exists. In this Review, we explore the relationship between immunosuppression

Bronchiectasis, a clinical syndrome of recurrent cough and sputum production, can be diagnosed when high-resolution CT (HRCT) scans show pathological airway enlargement. Obstructive airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), are diagnosed by the presence of obstructive spirometry with a ratio of forced expiratory volume in 1 s (FEV1) over forced vital capacity

On a rather cold summer afternoon 45 years ago, I found myself, a humble research fellow, in a committee room in the University of Birmingham UK surrounded by famous professors and investigators of hypoxaemic lung disease. My chief, the late Professor David Flenley, had been asked by the British Council to lecture in China and had sent me to deputise for him on the writing committee of the Medical

Background Inhaled short-acting β2-agonists (SABA) is recognised as an effective treatment in adults and older children with asthma, but the effect in young children and infants is still up for debate. We examine the efficacy of inhaled SABA for preschool-aged children presenting with acute wheeze/asthma in this systematic review and meta-analysis. Methods PubMed and Embase were searched through August

Introduction Current bronchiectasis guidelines advise against the use of inhaled corticosteroids (ICS) except in patients with associated asthma, allergic bronchopulmonary aspergillosis (ABPA) and/or chronic obstructive pulmonary disease (COPD). This study aimed to describe the use of ICS in patients with bronchiectasis across Europe. Methods Patients with bronchiectasis were enrolled into the European

Background The impact of deep vein thrombosis (DVT) location on acute pulmonary embolism (PE) prognosis remains uncertain. Methods Using the Registro Informatizado de Enfermedad TromboEmbólica registry, we assessed 30-day and 90-day outcomes in patients with acute symptomatic PE and concomitant upper-extremity (UEDVT) versus lower-extremity DVT (LEDVT). Cox regression was employed for analysis, and

Background Long-term oxygen therapy (LTOT) improves survival in patients with chronic severe resting hypoxaemia, but effects on hospitalisation are unknown. This study evaluated the potential impact of starting LTOT on acute exacerbation and hospital burden in patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and pulmonary hypertension (PH). Methods Longitudinal

Objective Asthma and type 2 diabetes are two important causes of morbidity globally. We examined both the association of type 2 diabetes with asthma in Swedish adults and the familial co-aggregation of the diseases. Methods We conducted a cross-sectional study of all adults aged 25–85 in Sweden between 2009 and 2013. Asthma and type 2 diabetes status were ascertained from the health registers. Models

A decreasing trend in asthma hospitalisations among Finnish and Swedish children has been reported. However, possible changes in asthma hospitalisations among adults are incompletely characterised. We aimed to investigate the incidence of adult asthma hospitalisations in Finland and Sweden from 2006 to 2022 using Finland’s National Hospital Discharge Register and Sweden’s National Patient Register

We investigated the association between time of day and season of testing on the level of bronchodilator responsiveness in a hospital-based population. We found that per 1-hour increment in the working day, the odds of a positive bronchodilator response decreased by 8%. A similar effect was seen when time of day was dichotomised into morning and afternoon time periods. When stratifying by referral

A 12-year-old boy presented with a 1 month history of cough and exertional dyspnoea. Physical examination revealed a heart rate of 106 beats/min, a respiratory rate of 28 breaths/min and an O2 saturation of 90–95%. Bilateral breath sounds were coarse with audible rhonchi. Contrast-enhanced chest CT revealed a large mass in the mediastinum and left lung. The mass encased mediastinal structures and protruded

A female aged 69 year never smoker presented with 4 months of non-resolving productive cough and shortness of breath on exertion following mild COVID-19 infection. Her background history was significant for tuberculosis infection in 1996, for which she completed a full course of treatment. An initial CT scan of the chest found bulky left hilar and mediastinal lymphadenopathy with heterogeneous calcification