We would like to thank J.A. Neder for his thoughtful correspondence and critical review of the updated ERS/ATS technical statement on pulmonary function test interpretation [1]. As the updated technical document focuses on physiological interpretation of pulmonary function tests, we welcome the discussion on how to incorporate these updated standards into clinical practice.

Each year, ~500 000 people worldwide suffer from rifampin-resistant tuberculosis (RR-TB) or multidrug-resistant tuberculosis (MDR-TB; resistance to both rifampin and isoniazid) [1]. Bedaquiline and delamanid are newly developed anti-TB drugs and their efficacies in the treatment of MDR/RR-TB have been well documented in both randomised controlled trials [2, 3] and cohort studies [4, 5]. As these new

Mucus abnormalities play important roles in the development and/or evolution of most, if not all, airway diseases. The airway mucus is both a crucial component of the airway's mechanical defence mechanisms against irritants and microorganisms, and a marker of airway injury: its composition is influenced by various pathophysiological mechanisms involved in acute and chronic airway diseases, including

Since the identification of SARS-CoV-2 at the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has affected more than 410 million people worldwide and killed almost 6 million [1, 2]. The predecessors of COVID-19, i.e. the SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) outbreaks, had been relatively self-limiting, preventing clinicians and researchers

It is a bumpy road, to develop a tuberculosis infection (TBI) test with the capability of predicting progression to active tuberculosis (TB). As a gold standard for TBI diagnosis with these characteristics is still missing, tuberculin skin tests (TSTs) and the interferon- (IFN-) release assays (IGRAs), including QuantiFERON-TB Gold Plus (QFT-plus) and T-SPOT.TB, remain the main tests used to identify

Pulmonary function tests (PFTs) remain of foremost relevance to the management of patients with respiratory diseases. The recently published European Respiratory Society (ERS)/American Thoracic Society (ATS) document on testing interpretation is therefore poised to influence the way pulmonologists teach, describe and quantify respiratory physiological impairment [1]. A careful appraisal of its main

The ERS living guideline document regarding the management of hospitalised adults with COVID-19 has been updated and republished.

Climate change represents a global challenge and nations are increasingly looking to decarbonise their economies by developing roadmaps for reducing greenhouse gas (GHG) emissions in accordance with international treaties, such as the Paris Agreement [1]. As the healthcare sector remains a key contributor to GHG emissions [2], an examination of the global carbon footprint of its operations and treatment

Background Screening for tuberculosis (TB) infection often includes QuantiFERON-TB Gold Plus (QFT) testing. Previous studies showed that two-thirds of patients with negative QFT results just below the cut-off, so-called borderline test results, nevertheless had other evidence of TB infection. This study aimed to identify a biomarker profile by which borderline QFT results due to TB infection can be

Introduction Higher flavonoid intakes are beneficially associated with pulmonary function parameters; however, their association with chronic obstructive pulmonary disease (COPD) is unknown. This study aimed to examine associations between intakes of 1) total flavonoids, 2) flavonoid subclasses and 3) major flavonoid compounds with incident COPD in participants from the Danish Diet, Cancer and Health

Background Our objective was to determine whether anti-interleukin (IL)-6 receptors improve outcomes of critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia. We report on two cohort-embedded, investigator-initiated, multicentre, open-label, Bayesian randomised controlled clinical trials. Methods Patients were randomly assigned to receive either usual care (UC) or UC+tocilizumab

In this review article we present the evidence to date supporting the role of the calcium-sensing receptor (CaSR) as a key, pluripotential molecular trigger for asthma and speculate on the likely benefits of topical therapy of asthma with negative allosteric modulators of the CaSR: calcilytics.

Introduction Loss-of-function variants in both copies of the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause cystic fibrosis (CF); however, there is evidence that reduction in CFTR function due to the presence of one deleterious variant can have clinical consequences. Here, we hypothesise that CFTR variants in individuals with a history of smoking are associated with chronic obstructive

Cystic fibrosis (CF) is a life-long and life-shortening disease, best treated with early interventions to prevent complications across multiple organs and to extend the lifespan of this population. In the USA and Europe, the diagnosis of CF occurs primarily through newborn screening [1]. Newborns with two defective copies of the cystic fibrosis transmembrane conductance regulator (Cftr) gene have elevated

During the first meeting of the World Health Organization (WHO) in 1973, pulmonary hypertension (PH) was defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg measured by right heart catheterisation [1]. This criterion was chosen arbitrarily and was founded on the premise that mPAP at rest in a supine position does not exceed 15 mmHg 2]. In 2009, the landmark paper of Kovacs et al. [3] provided

The biological diagnosis of cystic fibrosis (CF) is based on a sweat chloride (Cl–) concentration (SCC) ≥60 mmol·L–1 and/or the identification of two allelic CF-causing variants [1]. Diagnosis of CF can be challenging in subjects with intermediate SCC between 30 and 59 mmol·L–1 and only one CF-causing variant detected.

Portopulmonary hypertension (PoPH) is a subtype of pulmonary arterial hypertension (PAH) complicating the course of portal hypertension [1, 2]. Similar to other causes of PAH, PoPH is characterised by a progressive structural and functional remodelling of small pulmonary arteries leading to pre-capillary pulmonary hypertension defined by a mean pulmonary artery pressure (mPAP) ≥25 mmHg, normal pulmonary

In patients with pulmonary arterial hypertension (PAH) presenting with progressive disease despite optimised medical therapy, lung transplantation remains an important treatment option [1–3]. Current guidelines recommend assessing the individual mortality risk regularly using a three-stratum model to determine whether patients are at low, intermediate or high risk of death [1, 2].

Background According to current guidelines, the diagnosis of pulmonary hypertension (PH) relies on echocardiographic probability followed by right heart catheterisation (RHC). How echocardiography predicts PH recently redefined by mean pulmonary arterial pressure (mPAP) >20 mmHg instead of ≥25 mmHg and pulmonary vascular disease defined by pulmonary vascular resistance (PVR) ≥3 or >2 WU has not been

Background Low-dose dexamethasone demonstrated clinical improvement in patients with coronavirus disease 2019 (COVID-19) needing oxygen therapy; however, evidence on the efficacy of high-dose dexamethasone is limited. Methods We performed a randomised, open-label, controlled trial involving hospitalised patients with confirmed COVID-19 pneumonia needing oxygen therapy. Patients were randomly assigned

Background Hepatopulmonary syndrome affects 10–30% of patients with cirrhosis and portal hypertension. We evaluated the serum angiogenic profile of hepatopulmonary syndrome and assessed the clinical impact of hepatopulmonary syndrome in patients evaluated for liver transplantation. Methods The Pulmonary Vascular Complications of Liver Disease 2 study was a multicentre, prospective cohort study of adults

Patients diagnosed with coronavirus disease 2019 (COVID-19) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection frequently experience symptom burden post-acute infection or post-hospitalisation. We aimed to identify optimal strategies for follow-up care that may positively impact the patient's quality of life (QoL). A European Respiratory Society (ERS) Task Force

Background Eosinophils are implicated as effector cells in asthma, but the functional implications of the precise location of eosinophils in the airway wall is poorly understood. We aimed to quantify eosinophils in the different compartments of the airway wall and associate these findings with clinical features of asthma and markers of airway inflammation. Methods In this cross-sectional study, we

Background Cardiorespiratory fitness is not limited by pulmonary mechanical reasons in the majority of adults. However, the degree to which lung function contributes to exercise response patterns among ostensibly healthy individuals remains unclear. Methods We examined 2314 Framingham Heart Study participants who underwent cardiopulmonary exercise testing (CPET) and pulmonary function testing. We investigated

Background Severe asthma is associated with multiple comorbidities, including gastro-oesophageal reflux disease (GORD), which can contribute to exacerbation frequency and poor quality of life. Since epithelial dysfunction is an important feature in asthma, we hypothesised that in severe asthma the bronchial epithelium is more susceptible to the effects of acid reflux. Methods We developed an in vitro

The transfer factor of the lung for carbon monoxide (TLCO) and spirometry are our two most valued tests in functional assessment. The understanding of the physiology underpinning TLCO (or DLCO) owes much to Robert Forster's research, including the formulation of the Roughton–Forster equation [1], the topic of this editorial. His other research involved oxygen and CO2 exchange, the role of carbonic

Lung function in adolescence is a powerful marker of overall health during adulthood and has been associated with the incidence of respiratory, cardiovascular and metabolic comorbidities in later life [1]. To improve early intervention, the identification of risk factors that may predispose children and adolescents towards poor lung function is urgently needed.

Acute exacerbations of asthma are an important and unmet asthma need [1], responsible for considerable morbidity and economic cost, across all age groups [2]. The most common triggers are acute viral infections and seasonal allergen exposure [1, 3]. This close epidemiological relationship is demonstrated by the fact that the prevalence of endemic rhinovirus is the commonest predictor of acute asthma

Background Asthma is characterised by an aggravated immune response to respiratory viral infections. This phenomenon is a clinically well-recognised driver of acute exacerbations, but how different phenotypes of asthma respond immunologically to viruses is unclear. Objectives To describe the association between different phenotypes and severity of asthma and bronchial epithelial immune responses to

Airway ciliary function analysis underpins PCD diagnostics and ex vivo / in vitro mucociliary clearance studies. It is an important measure of airway culture model integrity in health and after microbial/viral infections or airway drug therapies.

Background Exposure to ambient fine particulate matter with an aerodynamic diameter <2.5 μg·m–3 (PM2.5) is a risk factor for pulmonary and systemic autoimmune diseases; however, evidence on which PM2.5 chemical components are more harmful is still scant. Our goal is to investigate potential associations between major PM2.5 components and interstitial lung disease (ILD) onset in rheumatoid arthritis

Background Rapid and reliable diagnostic work-up of tuberculosis (TB) remains a major healthcare goal. In particular, discrimination of TB infection from TB disease with currently available diagnostic tools is challenging and time consuming. This study aimed at establishing a standardised blood-based assay that rapidly and reliably discriminates TB infection from TB disease based on multiparameter

RATIONALE Transbronchial lung cryobiopsy is an emerging technique for diagnosing pulmonary rejection. However, no prospective studies of critically ill lung transplant recipients who require mechanical ventilation in the intensive care unit have been performed. OBJECTIVES AND METHODS From March 2017 to January 2020, we performed a prospective, randomised, comparative study to assess the diagnostic

Oral corticosteroid dependence among patients with severe eosinophilic asthma can cause adverse outcomes, including adrenal insufficiency. PONENTE's oral corticosteroid-reduction phase showed that, following benralizumab initiation, 91.5% of patients eliminated corticosteroids or achieved a final dosage ≤5 mg·day-1 (median, 0.0 mg [range, 0.0-40.0]).The maintenance phase assessed the durability of

BACKGROUND COVID-19 social distancing measures led to a dramatic decline in non-COVID respiratory virus (RV) infections, providing a unique opportunity to study their impact on annual FEV1 decline, episodes of temporary drop in lung function (TDLF) suggestive of infection and chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTR). METHODS All FEV1 values of LTR transplanted between

INTRODUCTION Imatinib reduced 90-day mortality in hospitalised COVID-19 patients in a recent clinical trial, but the biological effects that cause improved clinical outcomes are unknown. We aimed to determine the biological changes elicited by imatinib in patients with COVID-19, and what baseline biological profile moderates the effect of imatinib. METHODS Secondary analysis of a randomised, double-blind

Exposure to natural environments may affect respiratory health. This study examined the association of the exposure to green and blue spaces with lung function in children, and assessed the mediation effect of air pollution and physical activity.The study used data from the Generation XXI, a population-based birth cohort from the Porto Metropolitan Area (Portugal). Residential Normalised Difference

INTRODUCTION/AIM Physical inactivity is common in asthma and is recognised as an important modifiable risk for poor clinical outcomes such as impaired asthma control and health-related quality of life (HRQoL). Despite evidence supporting the role of physical activity (PA) in reducing the risk of these outcomes, little is known about optimal interventions for increasing PA in those with severe disease

BACKGROUND COPD is a major comorbidity in lung cancer screening (LCS) cohorts, with a high prevalence of undiagnosed COPD. Combining symptom assessment with spirometry in this setting may enable earlier diagnosis of clinically significant COPD and facilitate increased understanding of lung cancer risk in COPD. In this study, we wished to understand the prevalence, severity, clinical phenotype and lung

BACKGROUND There is little data to accurate interpretation of spirometry data in South Asia, a major global region with high reported burden for chronic respiratory disease. METHOD We measured lung function in 7,453 healthy men and women aged over 18 years, from Bangladesh, North India, South India, Pakistan and Sri Lanka, as part of the South Asia Biobank study. We first assessed the accuracy of existing

We thank S. Couillard for his interesting comments related to our publication on the effects of interleukin (IL)-5 deficiency on the transcriptome of residual eosinophils of Il5-deficient mice and mepolizumab-treated patients [1]. We indeed document stronger upregulation of the expression of the SOCS3 gene following stimulation with IL-33 ex vivo that is conserved between eosinophils from mepolizumab-treated

Congratulations to Van Hulst et al. [1] regarding their article on the influence of interleukin (IL)-5 blockade on blood eosinophils in severe asthma. In their discussion, the authors state that it is unclear whether increased stimulation-induced expression of suppressor of cytokine signalling-3 (SOCS3) in eosinophils in IL-5-depleted conditions is of clinical consequence. However, their data can be

Chest tubes are frequently indicated for removing accumulated air or fluid from the pleural space due to a variety of conditions, such as pneumothorax, empyema, haemothorax or malignant pleural effusions for which a bedside pleurodesis procedure is planned [1]. Small-bore chest tubes (SBCT), defined as those having an outer diameter of 14 Fr or less, are recommended as a first-line approach in most

From the 1990s, five national programmes were carried out in Finland to respond to respiratory health challenges [1–6]. Previous experience from tuberculosis facilitated the launch of other initiatives. The programmes were implemented in the national public healthcare. Importantly, professional associations, non-governmental patient organisations (NGOs) and pharmacies contributed to the change of clinical

Transplant recipients are at risk for poor outcomes from coronavirus disease 2019 (COVID-19) due to frequent medical comorbidities and presence of immunosuppression. Observational cohort studies suggest that patients after lung transplantation (LTx) with COVID-19 may have higher mortality in comparison to other solid organ transplant recipients. In a US retrospective analysis in the beginning of 2020

We read with interest the paper by Sofianopoulou et al. [1]. The authors have significantly contributed to highlighting the potential link between air pollution and health outcomes among pulmonary arterial hypertension (PAH) patients, by showing that exposure to particulate matter with an aerodynamic diameter smaller than 2.5 µm (PM2.5) was significantly associated with transplant-free survival, and

When selecting the best inhaler and drug combination for a patient with respiratory disease, a number of factors should be considered. While efficacy and safety of medical treatments are always a priority, in recent years the environmental impacts of all aspects of life have become an increasingly necessary consideration and inhaled therapies are no exception. The carbon footprint of an item, individual

Background Chest drain displacement is a common clinical problem that occurs in 9–42% of cases and results in treatment failure or additional pleural procedures conferring unnecessary risk. A novel chest drain with an integrated intrapleural balloon may reduce the risk of displacement. Methods A prospective randomised controlled trial comparing the balloon drain to standard care (12 F chest drain with

Background Chronic lung allograft dysfunction (CLAD) is the principal cause of graft failure in lung transplant recipients and prognosis depends on CLAD phenotype. We used a machine learning computed tomography (CT) lung texture analysis tool at CLAD diagnosis for phenotyping and prognostication compared with radiologist scoring. Methods This retrospective study included all adult first double lung

Background Mechanical stretch of cancer cells can alter their invasiveness. During mechanical ventilation, lungs may be exposed to an increased amount of stretch, but the consequences on lung tumours have not been explored. Methods To characterise the influence of mechanical ventilation on the behaviour of lung tumours, invasiveness assays and transcriptomic analyses were performed in cancer cell lines

In a recent issue of the European Respiratory Journal, Bay et al. [1] reported 15 patients with anti-melanoma differentiation-associated protein 5 (anti-MDA5+) rapidly progressive interstitial lung disease (RP-ILD) requiring extracorporeal life support (ECLS). In five patients, ECLS implementation allowing a bridge to emergency lung transplantation within a median delay of 8 days led to survival whereas