Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease with few treatment options. The poor success in developing anti-IPF strategies have impelled researchers to reconsider the importance of choice for animal model and assessment methodologies. Currently, it is still not settled whether the bleomycin-induced lung fibrosis mouse model finally returns to resolution.This study aimed to follow the

BACKGROUND To gain a global perspective on short-acting β2-agonist (SABA) prescriptions and associated asthma-related clinical outcomes in patients with asthma, we assessed primary health data across 24 countries in 5 continents. METHODS SABINA III was a cross-sectional study that employed electronic case report forms at a study visit (in primary or specialist care) to record prescribed medication(s)

Elevated counts of alveolar macrophages and attenuated phagocytic capacity are associated with COPD. Factors governing macrophage phagocytosis are poorly understood. In this study we aimed to compare the influence of airway epithelial cell secretions from COPD and nonCOPD subjects on macrophage phagocytic activity, and the role of antimicrobial peptides (AMPs).Supernatants from nonCOPD and COPD small

BACKGROUND Understanding why patients with severe asthma do not follow healthcare provider (HCP) advice to adjust treatment is critical to achieving personalised disease management. METHODS We reviewed patient choice to follow HCP advice to adjust asthma treatment in a randomised, controlled, single-blind (study participant), multi-centre, parallel group 48-week clinical study comparing biomarker directed

Immune cells contain a specialised type of proteasome, i.e. the immunoproteasome, which is required for intracellular protein degradation. Immunoproteasomes are key regulators of immune cell differentiation, inflammatory activation and autoimmunity. Immunoproteasome function in peripheral immune cells might be altered by smoking and in COPD thereby affecting immune cell responses.We here analysed the

Biomarkers of disease progression and treatment response are urgently needed for patients with lymphangioleiomyomatosis (LAM). Activity-based nanosensors, an emerging biosensor class, detect dysregulated proteases in vivo and release a reporter to provide a urinary readout of disease. Because proteases are dysregulated in LAM and may directly contribute to lung function decline, activity-based nanosensors

Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and aging is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that

Mycoplasma pneumoniae is the most common bacterial cause of pneumonia in children hospitalised for community-acquired pneumonia. Prevention of infection by vaccines may be an important strategy in the presence of emerging macrolide resistant M. pneumoniae. However, knowledge of immune responses to M. pneumoniae is limited, complicating vaccine design. We therefore studied the antibody response during

This issue of the European Respiratory Journal presents an elegant study describing the neurobiological basis of a respiratory nocebo effect [1]. The nocebo effect is the dark side of the placebo effect. Both terms designate a gap between an observed effect and what would be predicted on the basis of the known physiological properties of the corresponding intervention. In other words, the placebo effect

Asthma and COPD are two common chronic airway diseases associated with high morbidity and mortality [1, 2]. It is estimated that approximately 20% of asthma and COPD have diagnosis or features of both [3]. There is growing appreciation of the need to tease out phenotypes and endotypes across the spectrum of chronic airway diseases [4, 5], to evolve towards precision medicine [6, 7]. While there have

Acute decompensated pulmonary arterial hypertension (PAH) is characterised by rapid worsening of clinical signs of right heart failure (RHF) with subsequent congestion and systemic circulatory insufficiency that can lead to multisystem organ failure [1–3]. Short-term outcomes of acute decompensated RHF are very poor and it remains the primary cause of mortality in PAH [4, 5]. Intensive care of acute

Blood eosinophil count is a readily available biomarker in COPD that can assist identification of patients most likely to benefit from inhaled corticosteroids (ICS) [1]. Recent evidence has demonstrated a link between blood eosinophil count as a continuous variable and magnitude of response to ICS in terms of exacerbation rate reduction [2, 3]. The current Global Initiative for Chronic Obstructive

Pulmonary arterial hypertension (PAH) is a progressive disease predominantly targeting pre-capillary blood vessels. Adverse structural remodelling and increased pulmonary vascular resistance result in cardiac hypertrophy and ultimately failure of the right ventricle. Recent whole-genome and whole-exome sequencing studies have identified SOX17 as a novel risk gene in PAH, with a dominant mode of inheritance

Background Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this

Cues such as odours that do not per se evoke bronchoconstriction can become triggers of asthma exacerbations. Despite its clinical significance, the neural basis of this respiratory nocebo effect is unknown. We investigated this effect in a functional magnetic resonance imaging (fMRI) study involving 36 healthy volunteers. The experiment consisted of an experience phase in which volunteers experienced

Background Prenatal vitamin D3 supplementation has been linked to reduced risk of early-life asthma/recurrent wheeze. This protective effect appears to be influenced by variations in the 17q21 functional single nucleotide polymorphism rs12936231 of the child, which regulates the expression of ORMDL3 (ORM1-like 3) and for which the high-risk CC genotype is associated with early-onset asthma. However

We thank S. Verbanck and co-workers for their insightful response to the recent official European Respiratory Society technical standards for Global Lung Function Initiative (GLI) reference lung volumes [1]. The data presented highlight the real-world impact of using published equations and how equipment or protocol offsets can impact clinical interpretation. We generally agree with S. Verbanck and

We have read with interest the official European Respiratory Society technical standards for Global Lung Function Initiative (GLI) reference lung volumes [1], and we welcome the user-friendly online computation module that facilitates translation of spirometry, transfer factor and lung volume variables into % predicted and z-scores [2]. The latter allows lung function researchers to stay up-to-date

Pneumothorax is an important complication of coronavirus disease 2019 (COVID-19) [1, 2]. Based on a series of 60 individuals, we previously estimated that 0.91% of people admitted to hospital with COVID-19 develop pneumothorax [1]. Males accounted for three quarters of those affected, and patients requiring noninvasive or invasive ventilatory support appeared at elevated risk. In a separate series

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are a major public health threat because of reduced treatment options and poor patient outcomes. New antimicrobials and regimens have been developed in recent years, but their effectiveness has been hampered by the rise and spread of drug-resistant strains. Whole genome sequencing (WGS) has emerged as a tool able to revolutionise

Automated analysis of medical images is not new [1–3]. Researchers in the respiratory sciences and, particularly, the field of interstitial lung diseases, have long enthused about the potential for computers to analyse medical images thereby revealing "signals" hitherto invisible to the human eye: an enthusiasm only enhanced by recent developments in machine learning and artificial intelligence [4–6]

During the COVID-19 pandemic, the use of protective masks has been essential to reduce contagions. However, public opinion is that there is an associated subjective shortness of breath. We evaluated cardiorespiratory parameters at rest and during maximal exertion to highlight any differences with the use of protective masks. 12 healthy subjects performed three identical cardiopulmonary exercise tests

Introduction Evidence suggests that vascular inflammation and thrombosis may be important drivers of poor clinical outcomes in patients with COVID-19. We hypothesised that a significant decrease in the percentage of blood volume in vessels with a cross-sectional area between 1.25 and 5 mm2 relative to the total pulmonary blood volume (BV5%) on chest computed tomography (CT) in COVID-19 patients is

Background Coronavirus disease 2019 (COVID-19) has spread worldwide, having a dramatic impact on healthcare systems. The aim of this study is to evaluate mid-term clinical impact of COVID-19 on respiratory function. Methods 379 patients were evaluated 4 months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Patients were divided in two groups based on the presence of pneumonia

BACKGROUND Cardiac sarcoidosis (CS) is a life-threatening condition in which clear recommendations are lacking. We aimed to review systematically the literature on cardiac sarcoidosis treated by corticosteroids and/or immunosuppressive agents in order to update the management of CS. METHODS Using Pubmed, Embase and Cochrane Library databases, we found original articles on corticosteroid and/or standard

We thank T. Yasuma and co-workers for their valuable comments on our paper describing the association between individual-level long-term concentrations of air pollutants at the residential addresses of patients with idiopathic pulmonary fibrosis (IPF) and mortality among them [1]. We agree that the release of nitrogen dioxide (NO2) or particulate matter in cigarette smoke is one of the considerations

We read with great interest the work reported by Yoon et al. [1]. The authors found that a high concentration of nitrogen dioxide at an individual's residential address is significantly associated with increased mortality in idiopathic pulmonary fibrosis (IPF) patients when all confounders are included in the health analysis model. However, an important question that remains unclear in the study is

Acute respiratory distress syndrome (ARDS) is an inflammatory disorder of the lungs, with sepsis as the predominant aetiology. Despite advances in ventilation strategies, mortality for moderate to severe ARDS remains at 40–46% [1]. ARDS is associated with neutrophil influx into alveoli. Persistently high neutrophil and low alveolar macrophage (AM) numbers in bronchoalveolar lavage (BAL) fluid are associated

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing the current coronavirus disease (COVID-19) pandemic [1]. Over recent months, a plethora of novel research articles has been published, dealing with multiple aspects and manifestations of the disease. Increasing evidence points to a central role of endothelial cells in SARS-CoV-2 infection [2–5]. Early studies have already indicated

Forced oscillation technique (FOT) is a measure of respiratory impedance first described by DuBois more than 60 years ago [1]. Respiratory impedance (Zrs) can be calculated by superimposing sound waves on normal tidal breathing without special breathing manoeuvres.

Interstitial lung diseases (ILDs) comprise a large and heterogeneous group of disorders of known and unknown aetiology characterised by diffuse damage of the lung parenchyma. In recent years it has become evident that patients with different types of ILD are at risk of developing progressive pulmonary fibrosis, known as progressive fibrosing ILD (PF-ILD). This is a phenotype that behaves similar to

Background Lung ultrasound is feasible for assessing lung injury caused by coronavirus disease 2019 (COVID-19). However, the prognostic meaning and time-line changes of lung injury assessed by lung ultrasound in COVID-19 hospitalised patients are unknown. Methods Prospective cohort study designed to analyse prognostic value of lung ultrasound in COVID-19 patients by using a quantitative scale (lung

Introduction For the management of patients referred to respiratory triage during the early stages of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, either chest radiography or computed tomography (CT) were used as first-line diagnostic tools. The aim of this study was to compare the impact on the triage, diagnosis and prognosis of patients with suspected COVID-19 when

Background Observational studies suggest an association between reduced lung function and risk of coronary artery disease and ischaemic stroke, independent of shared cardiovascular risk factors such as cigarette smoking. We use the latest genetic epidemiological methods to determine whether impaired lung function is causally associated with an increased risk of cardiovascular disease. Methods and findings

RATIONALE Severe fetal malnutrition has been related to an increased risk of respiratory diseases later in life, but evidence for the association of a suboptimal diet during pregnancy with respiratory outcomes in childhood is conflicting. We aimed to examine whether a pro-inflammatory or low-quality maternal diet during pregnancy was associated with child's respiratory health. METHODS We performed

INTRODUCTION Pulmonary alveolar proteinosis related to mutations in the methionine tRNA synthetase (MARS1) gene is a severe, early-onset disease that results in death before the age of 2 years in one-third of patients. It is associated with a liver disease, growth failure and systemic inflammation. As methionine supplementation in yeast models restored normal enzymatic activity of the synthetase, we

BACKGROUND Navafenterol (AZD8871) belongs to a new class of bronchodilator, the single-molecule muscarinic antagonist and beta agonist (MABA), being developed for the treatment of chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the efficacy, pharmacokinetics and safety of navafenterol versus placebo and an active comparator treatment for moderate-to-severe COPD. METHODS This

Whether a combination of glucocorticoid and antifungal triazole is superior to glucocorticoid alone, in reducing exacerbations, in patients with allergic bronchopulmonary aspergillosis (ABPA) remains unknown. We aimed to compare the efficacy and safety of prednisolone-itraconazole combination versus prednisolone monotherapy in ABPA.We randomised subjects with treatment-naïve acute-stage ABPA complicating

RATIONALE Bedaquiline has been classified as a Group A drug for the treatment of multidrug-resistant tuberculosis (MDR-TB) by the World Health Organization, however globally emerging resistance threatens the effectivity of novel MDR-TB treatment regimens. OBJECTIVES We analysed pre-existing and emerging bedaquiline resistance in bedaquiline-based MDR-TB therapies, and risk factors associated with treatment

Asthma is the most common chronic illness diagnosed in children. Despite the relatively steady trends in incidence observed in developed countries over the past 10 years [1], asthma remains one of the most frequent causes of hospital admissions in children, representing a major societal and public health concern [2]. The extensive body of epidemiological evidence examining the causes of asthma shows

Lately, protective face masks have become part of everyday life and many patients and healthcare workers complain of reduced well-being and performance due to the permanent wearing of such masks. Reportedly, the main symptoms are headaches and difficult breathing, especially in combination with stress and physical exertion [1–3]. It is suspected that protective masks impede oxygen supply to the lungs

Dyspnoea, namely a patient's complaint of difficult, disturbing or distressing breathing, is a symptom that prompts physicians to undertake diagnostic and therapeutic procedures in order to identify and correct causative pathophysiological abnormalities. Dyspnoea can become self-perpetuating (a syndrome) when it persists despite mechanistic treatments. It then justifies symptomatic management to alleviate

Rifampicin drives the efficacy of the current first-line treatment regimen for tuberculosis (TB) [1]. Mutations in the rpoB gene cause rifampicin resistance (RR) of varying levels. Common mutations typically confer high-level, "high-confidence" resistance, providing a selective advantage to Mycobacterium tuberculosis during treatment at low fitness cost [2]. Growth-based phenotypic drug-susceptibility

We appreciate the interest shown by J.F.M. van Boven and co-workers in our study. PACT [1] was first and foremost designed as a pragmatic randomised controlled trial (RCT) reflecting current UK primary care practice. While addition of controller treatment for those in the personalised care group with poor control was guided by the study algorithm, the decisions with respect to monotherapy versus combination

We read the study of Ruffles et al. [1] with great interest. The authors undertook one of the first randomised controlled trials (RCTs) assessing the potential benefit of personalised prescription of bronchodilators according to Arg16Gly beta-2 genotype in adolescent patients with asthma. Following a 1-month run-in with inhaled corticosteroid (ICS) monotherapy, the intervention group received a bronchodilator

Conflicting evidence is currently available concerning the impact on asthma exacerbation of triple inhaled corticosteroid (ICS)/long-acting β2-adrenoceptor agonist (LABA)/long-acting muscarinic receptor antagonist (LAMA) fixed-dose combination (FDC). Since meta-analyses allow settling controversies of apparently inconsistent results, we performed a network meta-analysis of phase III randomised controlled