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Objectives Infliximab, an anti-TNF agent, is used to treat sarcoidosis that does not respond to corticosteroids or second-line agents. The efficacy of other anti-TNF agents, non-TNF biologics and targeted synthetic therapies remains unclear. This study aims to evaluate the role of these therapies in the management of multisystem sarcoidosis. Methods We conducted a systematic literature search to identify

The data supporting the benefits of home non-invasive ventilation (NIV) in patients with severe chronic obstructive pulmonary disease (COPD) have been accumulating over the last decade. Historically, there was debate about the potential benefits of home NIV in this patient population, with early small-scale studies in specialist centres demonstrating physiological changes;1–3 however, these findings

Rationale Chronic obstructive pulmonary disease (COPD) is the most common indication for domiciliary non-invasive ventilation (NIV), but long-term outcomes data are limited. Objective This multistate model analysis estimated the impact of NIV therapy continuation versus cessation on transitions between three different disease states. Methods Model data came from the French national health insurance

Background Acute respiratory distress syndrome (ARDS) is a rapidly evolving condition. Dynamic assessments using patient trajectories may provide novel insights into disease heterogeneity. The primary objective of this study was to develop and validate dynamic oxygenation subgroups of ARDS based on longitudinal arterial oxygen tension/fractional inspired oxygen (PaO2/FiO2) ratios from the day of ARDS

In this issue, Bai et al present a novel approach to classifying acute respiratory distress syndrome (ARDS), analysing how oxygenation trajectories over the first days of ventilation relate to outcomes, rather than relying on a single static measurement.1 Using data from multiple databases, they applied group-based trajectory modelling to identify three distinct subgroups of patients based on the evolution

BACKGROUND Preclinical and preliminary clinical data suggest that Iloprost may improve tissue perfusion in septic shock. However, its effect on organ failure remains unclear. METHODS In this multicenter, double-blind, randomized controlled trial, adults with septic shock and persistent hypoperfusion (i.e. elevated capillary refill time and/or skin mottling) were randomized to receive a 48-hour intravenous

RATIONALE Despite advancements in emphysema treatment, high morbidity and mortality rates highlight the need for innovative therapies. A novel self-expanding nitinol airway scaffold was designed to alleviate lung hyperinflation by connecting emphysematous parenchyma with central bronchi, releasing trapped air. OBJECTIVES To assess the feasibility, safety, and initial outcomes of airway scaffolds in

BACKGROUND There is growing interest in identifying early stages of interstitial lung disease (ILD) to improve patient outcomes. This document reviews updated evidence on interstitial lung abnormalities (ILA), provides suggestions for screening, evaluation, and management, proposes criteria for distinguishing ILA from ILD, and identifies research priorities. METHODS A committee of clinical and methodology

RATIONALE Although clinical trials have documented the oral corticosteroid (OCS)-sparing effect of biologics in patients with severe asthma, little is known about whether this translates to a reduction of new-onset OCS-related adverse outcomes. OBJECTIVE To compare the risk of developing new-onset OCS-related adverse outcomes between biologic-initiators and non-initiators. METHODS This was a longitudinal

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BackgroundLung function is a key determinant of health, but current knowledge on lung function growth and decline over the life course is based on fragmented, potentially biased data. We aimed to empirically derive general population-based life course lung function trajectories, and to identify breakpoints and plateaus. MethodsWe created an accelerated cohort by pooling data from eight general population-based

RATIONALE Wood smoke exposure is increasing worldwide due to the rise in wildfire events. Various studies have associated exposure to wildfire-derived smoke with adverse respiratory conditions. However, the mechanism by which this occurs is unknown. Previous studies using wood smoke as a model of wildfire smoke have focused on the respiratory immune response and have reported increased neutrophil percentage

Right heart catheterization (RHC) is the gold standard for the diagnosis of pulmonary hypertension (PH). There are variations in practice and several pitfalls introducing errors in diagnosis that can significantly impact treatment. Errors in assessing the correct pulmonary artery wedge pressure (PAWP) can significantly affect accurate classification of patients with pulmonary hypertension, and lead

BACKGROUND Limited real-world data exist on the health impacts of the Philips Respironics recall for positive airway pressure (PAP) devices. RESEARCH QUESTION What is the relationship between PAP device manufacturer and obstructive lung disease (OLD) development and progression? STUDY DESIGN AND METHODS We conducted a retrospective longitudinal study using Ontario health administrative databases (Canada)

BACKGROUND Low spirometry testing rate for screening of chronic obstructive pulmonary disease (COPD) is partly attributed to complex procedures, stringent quality control requirements, and long examination times. Simplifying the spirometry protocol may increase the feasibility of COPD screening in community settings. RESEARCH QUESTION Does the simplified spirometry protocol have high diagnostic accuracy

Introduction Combination of the noradrenergic atomoxetine with either the antimuscarinic aroxybutynin or trazodone has been shown to improve obstructive sleep apnoea (OSA) severity. However, atomoxetine may contribute to apnoea-cycling and reduced drug tolerability due to wake-promoting, especially in a subgroup (poor cytochrome 2D6 metabolisers leading to higher blood concentration of medication)

Background Early warning systems (EWS) used across the world typically assign a fixed number of points to patients receiving supplemental oxygen, regardless of amount. This ordinal binary approach may fail to recognise deteriorating patients who have an increasing oxygen requirement with otherwise stable observations. It is unclear whether weighting oxygen beyond binary scoring improves recognition

Introduction Tocilizumab improves outcomes in critically ill patients with COVID-19. Whether other immune-modulator strategies are equally effective or better is unknown. Methods We investigated treatment with tocilizumab, sarilumab, anakinra and no immune modulator in these patients. In this ongoing, adaptive platform trial in 133 sites in 9 countries, we randomly assigned patients with allocation

Severe community-acquired pneumonia (sCAP) is a major global health challenge, with high morbidity and mortality, especially among patients requiring intensive care. Despite advancements in antimicrobial therapies and supportive care, sCAP remains a significant threat, particularly for those needing invasive mechanical ventilation or vasopressor support. Recent progress in diagnostics, therapeutics

The 13-valent conjugate pneumococcal vaccine (13vPCV) replaced the 7vPCV in the Australian Immunisation Program in 2011 as a 3+0 schedule, updated to 2+1 schedule in 2018. We analysed national surveillance data to investigate the change in the incidence of pneumococcal serotype 3 (ST3) invasive pneumococcal disease (IPD) in preschool children. During 2009–2023 the incidence/100 000 children of ST3

The BTS/SIGN/NICE have recently published updated guidance for the treatment of asthma.1 The guideline advises that inhaler choice should be based on the lowest environmental impact among suitable devices and provides a hyperlink to a decision aid informing patients about the relative carbon footprint of dry powder versus metered dose aerosol inhalers. The advice is consistent with much of the published

Inhaled corticosteroids (ICSs) benefit patients with chronic obstructive pulmonary disease at high risk of exacerbations with raised blood eosinophil count (BEC). Emerging evidence suggests current smokers show a reduced response to ICS. This post-hoc analysis of the FLAME trial explored the impact of smoking status on the efficacy of long-acting beta-2 agonist (LABA)+ICS versus LABA+long-acting muscarinic

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BackgroundEvidence from randomised clinical trials (RCTs) of Janus kinase (JAK) inhibitors—compared with usual care or placebo—in adults treated in hospital for COVID-19 is conflicting. We aimed to evaluate the benefits and harms of JAK inhibitors compared with placebo or usual care and whether treatment effects differed between prespecified participant subgroups. MethodsFor this systematic review

BACKGROUND Despite the significant health and economic burden associated with obstructive sleep apnea (OSA) among civilians, little is known about this burden among active-duty military personnel. RESEARCH QUESTION What is the health and utilization burden of OSA among active-duty service members in the United States? STUDY DESIGN AND METHODS Data were derived from the Military Data Repository (2016-2021)

BACKGROUND The high incidence of bronchopulmonary dysplasia (BPD) continues to be a problem among extremely low-gestational-age neonates (ELGANs). Recent improvements in next-generation proteomics have provided opportunities to obtain new perspectives on the early detection of BPD. In this study, our main objectives were to study the proteomes of patients by collecting nasopharyngeal aspirate (NPA)

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BACKGROUND PRISm is regarded as a COPD precursor, but whether this varies by smoking status remains unclear. RESEARCH QUESTION Are annual lung function decline and the risk of developing airflow limitation different among PRISm subtypes by smoking status? STUDY DESIGN AND METHODS 2850 participants from a 15-year population-based prospective cohort were included in this analysis. Participants were categorized

INTRODUCTION Patients with pulmonary hypertension are classified according to clinical criteria to inform treatment decisions. Knowledge of the molecular drivers of pulmonary hypertension might better inform treatment choice. METHODS Between 2013 and 2021, 470 patients with pulmonary hypertension, 136 disease controls and 59 healthy controls were enrolled as a discovery cohort. Plasma levels of 7288

RATIONALE We hypothesized that the disproportionate impact of social determinants of health (SDoH) captured in survey data could help explain a larger proportion of racial gaps in lung function than previously reported. METHODS We defined a series of nested, increasingly healthy reference populations using data from NHANES 2007-2012. Starting with non-smokers without respiratory symptoms or diagnoses

From screening to treatment, the continuum of lung cancer care suffers from unequal access and delivery, with more vulnerable patients less able to receive high-quality care. Despite great advances in lung cancer care (e.g., screening and nodule programs to identify early-stage disease and immune-mediated and targeted therapies for advanced-stage disease), disparities persist both in the United States

BACKGROUND Limited data exists to inform and appropriately counsel female lung transplant (LuT) recipients regarding post-transplant pregnancy. QUESTION What are the modifiable factors that impact pregnancy outcomes in female LuT recipients? STUDY DESIGN AND METHODS Retrospective observational analysis was performed on female LuT recipients who reported post-transplant pregnancies to the Transplant

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Introduction Tuberculosis (TB) remains a critical global public health challenge, and there is an urgent need to improve the diagnosis and management of post-TB lung disease (PTLD). We aimed to compare end of treatment prevalence of PTLD among participants with and without drug-resistant TB and to evaluate the association between plasma cytokines and matrix metalloproteinases with lung damage. Methods

A crisis is a time of intense difficulty, a turning point when an important change needs to take place. Here, we argue that the UK is approaching a critical point in clinical research capacity, following years of decline in medically trained research staff.1 The British Thoracic Society (BTS) respiratory consultant and trainee surveys (2024) highlighted the problems facing respiratory research. The

Over the past three decades, several drugs have been developed to target three major dysfunctional pathways in PAH, including the prostacyclin, endothelin, and nitric oxide pathways. Despite these advances, PAH remains incurable, necessitating further drug discovery efforts. New therapies focus on previously untargeted pathways, especially the bone morphogenetic protein (BMP)/transforming growth factor-beta

BACKGROUND Obstructive sleep apnoea (OSA) carries an increased risk of motor vehicle accidents (MVA), which resulted in the European Commission introducing a legal directive (2014/85/EU) restricting driving in patients with moderate/severe OSA and sleepiness, unless effectively treated. We assessed the implementation of the directive in European Union (EU) member and non-member states. METHODS National

BACKGROUND Patients with interstitial lung disease (ILD) often receive care from general pulmonologists, as geographic and financial barriers limit access to specialized care centers. However, graduating pulmonary fellows lack confidence in managing patients with ILD. Refining ILD education in pulmonary fellowship could address this gap, but what trainees must learn is not currently defined. RESEARCH

BACKGROUND With growing interest in a centralized approach to lung cancer screening (LCS), pooling current evidence to estimate its impact on annual adherence is essential for aligning practice with guideline recommendations. RESEARCH QUESTION Is participation in a centralized screening program associated with higher adherence rates compared to decentralized programs among individuals with negative

Despite substantial advancements in the management of cardiogenic shock, mortality rates remain greater than 40%. Trials have shown that increasing survival rates in cardiogenic shock is challenging. Even the most successful trials show 5–15% reductions in mortality, and gains have been restricted to acute myocardial infarction cardiogenic shock, representing approximately 5% of the population with

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