Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder characterized by persistent airflow limitation and chronic respiratory symptoms. COPD is the second leading cause of death in India and the third leading cause of death worldwide. Osteoporosis, a significant and often overlooked comorbidity of COPD, presents a major challenge. The disease itself, combined with multiple risk factors, including the use of inhaled corticosteroids-a cornerstone of COPD treatment-contributes to a decline in bone mineral density (BMD). This cross-sectional study investigates the prevalence of osteopenia and osteoporosis among COPD patients at a tertiary care center in South India, with a particular focus on the impact of inhaled and systemic corticosteroids on BMD and other associated risk factors. One hundred COPD patients were assessed for their BMD. Our findings reveal a strikingly high prevalence (88%) of reduced BMD among COPD patients, with 69% diagnosed with osteoporosis and 19% with osteopenia. Most COPD patients are middle-aged smokers and frequently use steroid-containing inhalers, which contribute to decreased BMD and an increased risk of fractures. The study highlights a significant association between osteoporosis and factors such as smoking history, COPD severity (GOLD classification), and cumulative steroid exposure. These results highlight the urgent need for proactive, regular screening and early intervention to assess bone health in COPD care.

Primary ciliary dyskinesia (PCD) is a rare genetic heterogeneous disorder mainly characterized by impaired mucociliar clearance and chronic respiratory symptoms. Although DNAH5 is commonly implicated in PCD, several DNAH5 variants remain unclassified. The proband was studied by high-speed videomicroscopy, transmission electron microscopy, whole exome sequencing and immunofluorescence. Protein structural analysis was performed through structural models obtained by X-ray crystallography and cryo-electron microscopy. The family was studied by Sanger sequencing of the variants, high-speed videomicroscopy and immunofluorescence. The patient carry, in heterozygosity, the DNAH5 c.5290T > C p.(Ser1764Pro) missense variant of uncertain significance and the pathogenic truncated variant DNAH5 c.4237C > T p.(Gln1413*). He was clinically diagnosed in adulthood with PCD, confirmed following nasal nitric oxide measurement, high-speed videomicroscopy and transmission electron microscopy, all of which revealed hallmark PCD defects, with decreased nasal nitric oxide levels (30nl/min) and ciliary beating frequency (0.66Hz), a dyskinetic ciliary beating pattern (62.5% total immotility) and a class-1 ultrastructure. Immunofluorescence analysis demonstrated reduced DNAH5 expression, and protein structural models predicted that the variant of uncertain significance causes an unstable protein. Family analyses confirmed a trans-inheritance and uncovered a brother with a similar PCD phenotype, the same two variants and similar reduced DNAH5 expression. Results support a pathogenic role for the c.5290T > C p.(Ser1764Pro) variant and elucidate the effects of the other variant. These results underscore the importance of integrating clinical, ultrastructural, molecular and protein expression analyses to clarify and contribute to PCD diagnosis, besides now serving as potential markers for diagnostics and targeted therapies.

An estimated 25 million people worldwide have one deleterious variant in the cystic fibrosis transmembrane conductance regulator ( CFTR ) gene. Chronic respiratory disease symptoms are at an increased prevalence in cystic fibrosis (CF) heterozygotes. Determine the level of CFTR function in CF heterozygotes compared to individuals without CF-causing variants. Establish whether CFTR function differs between asymptomatic and symptomatic CF heterozygotes. Individuals without respiratory symptoms or CF family history were recruited as controls. Heterozygotes were recruited from families with a CF individual harboring null alleles or c.1521_1523del (F508del) in CFTR . CFTR function was measured by short circuit current in primary human nasal epithelial cells (HNEs) from participants. Cell composition was assessed by single cell RNA sequencing. CFTR function was variable in cells from control and heterozygous individuals. Mean CFTR function in asymptomatic null (8.8±0.5µA/cm 2 (SEM); n=30) and F508del (8.7±1.0µA/cm 2 ; n=22) heterozygotes was similar and significantly lower at 54.6% and 53.9% than controls (16.1±1.1µA/cm 2 ; n=24; p<0.0001). Mean CFTR function in symptomatic heterozygotes (8.4±1.0µA/cm 2 ; n =15) was 52.1% of controls and did not differ from asymptomatic heterozygotes (p=0.7803). Cell identities and proportions were equivalent between control and heterozygous cultures. HNEs from CF heterozygotes showed variable response to CFTR modulators. CFTR function in primary airway cells exhibits substantial interindividual variability and overlaps between controls and CF heterozygotes. CF heterozygotes exhibit approximately 50% of CFTR function in controls, regardless of symptom status. These findings suggest that respiratory symptoms in CF heterozygotes are influenced by factors beyond CFTR dysfunction. Scientific Knowledge on the Subject: A growing body of evidence indicates that cystic fibrosis (CF) heterozygotes are at increased risk for a range of common and chronic respiratory diseases. Given that an estimated 10 million individuals in the United States are CF heterozygotes, this population may represent a substantial and underappreciated burden of CFTR-associated disease. However, CFTR function has not been well characterized in CF heterozygotes, and it remains uncertain whether observed clinical phenotypes reflect reduced CFTR activity. Resolving these issues will be essential for clarifying the pathobiology of common respiratory diseases and for evaluating the potential role of CFTR modulator therapy in symptomatic CF heterozygotes.What This Study Adds to the Field: Analysis of 24 controls and 67 CF heterozygotes revealed substantial interindividual variability in CFTR function, as measured ex vivo in differentiated nasal airway epithelial cells. Mean CFTR function in CF heterozygotes was approximately 50% of that observed in controls. CFTR function did not differ significantly between symptomatic and asymptomatic heterozygotes. These findings suggest that reduced CFTR activity may contribute to symptom susceptibility in CF heterozygotes, but additional factors beyond CFTR dysfunction are likely required for the development of CF-like features. Ethical approval and participant consent statement: All participants provided written consent to the research study under IRB00116966 and/or IRB00235883 and consented to have their anonymized data published. All research was conducted in a fair and ethical manner.

HighlightsWhat are the main findings?A male with respiratory dysfunction of the primary ciliary dyskinesia type presented a novel homozygotic DNAH5 variant, total cilia immotility, predominant absence of outer dynein arms, and concomitant markedly absent protein level. Family confirmed homozygosity and co-segregation with the phenotype.What is the implication of the main finding?Results enabled us to reclassify the variant as pathogenic, enabling its clinical actionability. As the patient also presented with oligoteratozoospermia, with markedly absent protein level but unaffected motility, results further support that this variant impacts differently in the respiratory and reproductive cells.Primary ciliary dyskinesia (PCD) is a rare genetic disorder mainly characterized by impaired mucociliary clearance and chronic respiratory symptoms. From a consanguineous family, a male patient, although with respiratory complaints since birth, was diagnosed with PCD only in adulthood. Whole-exome sequencing disclosed a novel homozygous intronic single-nucleotide deletion, NM_001369.3(DNAH5):c.13723+4del, initially classified as of uncertain clinical significance. Digital highspeed videomicroscopy (HSVM) evidenced a null ciliary beating frequency; transmission electron microscopy showed absence of outer dynein arms (class-1); and immunofluorescence (IF) demonstrated markedly absent DNAH5 protein level in the apical cilia region with delocalization to the transition and basal-body regions. Bioinformatic analysis predicted altered splicing at the donor splice site of exon 78, whereas mRNA sequencing revealed two splicing defects: the mainly expressed transcript corresponding to exon 78 skipping and a minor transcript originated from a cryptic splice site in exon 78. The patient was infertile and showed severe oligoteratozoospermia. Sperm IF analysis revealed absence of DNAH5 from the flagellum with accumulation at the neck region. The family study confirmed homozygosity. The present results support a pathogenic role for the c.13723+4del variant and underscore the importance of integrating clinical, ultrastructural, DNA, mRNA and protein analyses to clarify and contribute to PCD diagnosis.

Maintenance treatment patterns in chronic obstructive pulmonary disease (COPD) may reflect disease severity beyond the usual indicators used in emergency departments (EDs). The objective of this study was to evaluate whether treatment complexity predicts 30-day clinical deterioration. We conducted a prospective multicenter cohort study including patients aged $ 40 years presenting to 14 EDs with acute exacerbation of COPD confirmed by spirometry (post-bronchodilator FEV1/FVC < 0.7) or clinically suspected COPD (sCOPD: $ 10 pack-years with chronic respiratory symptoms). Treatment intensity was categorized as none, monotherapy, dual therapy, triple therapy, or multiple therapy ($ 4 drugs). The primary endpoint was a 30- day composite of therapeutic intensification, ED revisit, hospitalization, or death. Multivariable mixed-effects logistic regression was performed, adjusting for age, sex, comorbidity (Charlson Comorbidity Index), functional status (Barthel Index), and exacerbation severity, with a random intercept for hospital. The median age was 75 years (IQR, 67-81). The composite endpoint occurred in 381 of the 1179 patients included (32.3%). After adjustment for age, sex, comorbidity, functional status, exacerbation severity, and hospital center, triple therapy (adjusted odds ratio [aOR], 2.20; 95% CI, 1.24-4.08; P = .009) and multiple therapy (aOR, 2.34; 95% CI, 1.32-4.34; P = .005) were associated with an increased risk of deterioration. The multivariable model showed adequate discriminative ability (C statistic = 0.71; 95% CI, 0.67-0.75). Treatment complexity predicted 30-day deterioration, likely reflecting underlying disease severity not captured by conventional measures rather than a causal effect of treatment.

The forced expiratory volume in 3 seconds (FEV3) to forced expiratory volume in 6 seconds (FEV6) ratio is a novel spirometry measure that identifies early airflow abnormalities, but its long-term prognosis value in the general population remains unclear. We aimed to evaluate the long-term all-cause mortality risk among participants with a reduced FEV3/FEV6. Data were obtained from the National Health and Nutrition Examination Survey cycles 1988–1994 and 2007–2012. Reduced FEV3/FEV6 was defined as an FEV3/FEV6 less than the lower limit of normal. Multivariable logistic regression was used to assess the relationship of reduced FEV3/FEV6 with comorbidities and chronic respiratory symptoms. The relationship between reduced FEV3/FEV6 and all-cause mortality was evaluated using Cox regression models. The nonlinear relationship between FEV3/FEV6 and all-cause mortality was assessed using restricted cubic splines. Subgroup analyses were conducted to validate the robustness of the relationship. Overall, 25,159 participants were enrolled in the 308-month median follow-up analysis, of whom 8.8% (2225/25,159) had reduced FEV3/FEV6. Participants with reduced FEV3/FEV6 exhibited increased risks of congestive heart failure, asthma, chronic bronchitis, emphysema, respiratory symptoms, and all-cause mortality risk (adjusted hazard ratio=1.23, 95% confidence interval: 1.13–1.34, P<0.001). The findings remained consistent across subgroups. A nonlinear U-shaped association was observed between FEV3/FEV6 and all-cause mortality, with the turning point at 1.04. Participants with reduced FEV3/FEV6 had worse respiratory health outcomes, suggesting that FEV3/FEV6 can be used as a prognostic spirometry indicator.

Rheumatological diseases may cause interstitial lung damage. This study aimed to investigate the association between pediatric body composition parameters and interstitial lung disease in patients with rheumatological conditions. In this cross-sectional study, all patients aged 8-18 years with rheumatological diseases and chronic respiratory symptoms were evaluated for interstitial lung disease using spirometry, thorax computed tomography, and carbon monoxide diffusion tests. Nutritional status and body composition were assessed using bioelectrical impedance analysis, body mass index, and fat-free mass index. Patients were categorized into three groups, group I (normal fat-free mass index and body mass index), group II (sarcopenia-low fat-free mass index but normal body mass index), and group III (malnutrition with both low fat-free mass index and body mass index). A total of 26 patients were included, and the median age was 169.03 (94-216) months. The median body mass index was 21.9 (14.4-33.8) kg/m2. Sixteen (62%) patients had normal body mass index and normal fat-free mass index (group I), four (15%) patients had normal body mass index and low fat-free mass index (group II), and six (23%) patients had low body mass index and low fat-free mass index (group III). Among the pulmonary function tests, the median (interquartile range) carbon monoxide diffusion tests​​​​​​ z-score was -2.3 (-4.9 to 0.06). A positive correlation was found between carbon monoxide diffusion tests z-scores and fat-free mass index (r=0.589, p=0.002). Fat-free mass index was significantly lower in the group with carbon monoxide diffusion tests z-scores of <-1.64. Nutritional status may be associated with pulmonary function test results in children with interstitial lung disease-related rheumatological diseases.

Lophomonas blattarum (L. blattarum) is an emerging protozoan increasingly reported in respiratory specimens. This study aimed to characterize the clinical and radiological features of adult patients with L. blattarum detected in bronchial lavage samples. This retrospective observational study included adult patients diagnosed at a tertiary care center between January 1, 2024 and January 1, 2026. Demographic data, comorbidities, clinical presentation, laboratory findings, radiological features, treatment approaches, and outcomes were analyzed descriptively. Fifty-one patients were included (mean age 59.0 ± 14.8 years; 51.0% male). Symptoms were predominantly chronic, with 73.3% reporting duration > 8 weeks. The most common symptoms were cough (73.3%), sputum (46.7%), and dyspnea (45.7%); fever was uncommon (6.5%). Frequent comorbidities included diabetes mellitus (31.9%), hypertension (29.8%), cardiovascular disease (23.4%), prior tuberculosis (25.0%), malignancy (26.0%), and immunosuppression (21.3%). More than half were never-smokers (52.2%). The mean leukocyte count was 9.02 ± 3.39 × 10⁹/L, and the median C-reactive protein level was 12.70mg/L (IQR: 3.38-42.88). Chest CT findings were heterogeneous. Nodules were most frequent (38.3%), followed by ground-glass opacities (29.8%) and small airway signs (27.7%). Consolidation was observed in 16.3% and mediastinal or hilar lymphadenopathy was present in 48.9%. Metronidazole was administered to 54.9% of patients; radiological improvement was observed in 21.7%. Microscopy-based detection of L. blattarum-like organisms in bronchial lavage was mainly observed in patients with chronic respiratory symptoms, heterogeneous and non-specific CT findings, and substantial comorbidity burden. Further prospective controlled studies with molecular confirmation are needed to clarify its clinical significance.

ABSTRACTPulmonary inflammatory myofibroblastic tumour (IMT) is a rare mesenchymal neoplasm with variable biological behaviour, ranging from benign inflammatory lesions to locally aggressive tumours. Its association with autoimmune phenomena remains unclear. We report a woman in her twenties with a prior diagnosis of lung IMT who re‐presented with chronic respiratory symptoms, systemic features and radiological progression. Repeat evaluation revealed bilateral bronchocentric consolidation, positive antinuclear antibodies and histopathological findings consistent with fibro‐inflammatory disease, without ALK expression or significant IgG4 infiltration. Concomitant erythema nodosum supported an autoimmune process. Repeat biopsy did not fully reproduce the original IMT morphology, and follow‐up remains limited. She had significant clinical, functional and radiological improvement following immunosuppressive therapy. This case emphasizes the diagnostic complexity of lung masses in young patients and emphasizes the importance of considering autoimmune‐associated IMT as a potentially reversible condition.

This study aimed to investigate the prevalence, awareness, treatment and control rates of chronic obstructive pulmonary disease (COPD) and their influencing factors among adults in regional China. In 2023, 6403 community-dwelling residents aged 40 years and older were randomly chosen from Nanjing municipality of China. COPD was determined as self-reported physician-diagnosed patients or post-bronchodilator FEV1/FVC < 0.70, and without other lung function impaired diseases. Multivariate logistic regression models were introduced to identify influencing factors for each rate. Totally, 5605 participants were analyzed. The spirometry-based COPD prevalence, awareness, treatment and control rates were 15.4%, 4.4%, 2.4% and 56.8%, separately, while the corresponding age- and sex-standardized rates were 15.5%, 4.6%, 2.4% and 56.5%, respectively. Age, marital status, education, physical activity and body weight status significantly correlated with COPD prevalence. Among COPD patients, these with higher educational level, chronic respiratory symptoms, or family history, and former smokers were more likely to be aware of COPD. Those smoking formerly, aged 60-79 years, with chronic respiratory symptoms, family history of COPD, higher educational level, or physical inactivity were more likely to receive treatment. Additionally, patients living in urban areas tended to have the disease under control. The prevalence of COPD among adults aged 40 years and older was high, but awareness, treatment and control rates remained limited in regional China. For the purpose to reduce COPD burden, it shall be a priority for policy-makers to initiate/provide effective and accessible education and lung function screening programs of COPD for adults in China.

HighlightsPublic health relevance—How does this work relate to a public health issue?Persistent allergic rhinitis significantly impacts daily productivity and quality of life, necessitating accessible and scalable management strategies.This study addresses the need for non-pharmacological adjuncts to manage chronic respiratory symptoms and airway inflammation in the adult population.Public health significance—Why is this work of significance to public health?An eight-week moderate-intensity aerobic exercise program substantially improves both subjective symptom severity and objective physiological markers, including Peak Nasal Inspiratory Flow (PNIF) and lung function (FEV1, FVC).The intervention demonstrates a significant reduction in eosinophilic airway inflammation (FeNO), supporting the “one airway, one disease” framework in public health management.Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?Structured aerobic exercise is a safe, low-cost, and feasible “physical activity prescription” that can be integrated into community-based care and routine clinical practice.These findings empower patients toward self-management and provide an evidence-based approach to mitigate the socioeconomic burden of chronic allergic conditions.Allergic Rhinitis (AR) is an IgE-mediated inflammatory disorder that impairs quality of life and systemic function. Following the ‘one airway, one disease’ paradigm, AR-related inflammation often extends to the lower respiratory tract. This randomized controlled trial investigated the effects of an 8-week moderate-intensity aerobic exercise (MOA) program on clinical symptoms, nasal airflow, airway inflammation, pulmonary function, and cardiorespiratory parameters in young adults with physician-confirmed persistent AR. To isolate the exercise effects, all participants discontinued antihistamines, corticosteroids, and leukotriene antagonists before and during the study period. Eighteen participants were allocated to either the MOA group (n = 9), which performed treadmill walking or jogging at 50–60% heart rate reserve three times per week for eight weeks, or a control group (CON, n = 9) that maintained usual daily activities. Clinical symptoms, peak nasal inspiratory flow, fractional exhaled nitric oxide, pulmonary function, heart rate, blood pressure, aerobic fitness, and perceived exertion were assessed at baseline, week 4, and week 8 using standardized procedures. Compared with baseline and the CON group, the exercise intervention resulted in significant reductions in nasal congestion, itching, sneezing, and rhinorrhea, accompanied by increased nasal airflow and reduced airway inflammation. Pulmonary function indices and cardiorespiratory parameters also improved following training. These findings suggest that moderate-intensity aerobic exercise may offer a valuable non-pharmacological approach to support conventional care, potentially enhancing respiratory and physiological outcomes in young adults with persistent AR.

Post-tuberculosis lung disease (PTLD) is a major cause of chronic respiratory impairment globally, yet it remains a critically neglected complication in high-burden, low-resource settings. This narrative review synthesizes evidence on PTLD, with a specific focus on Ethiopia, to analyze the health system gaps and propose actionable solutions. We conducted a narrative review of published and grey literature on the clinical burden, socioeconomic impact, and health system challenges of PTLD, with a particular emphasis on Ethiopia. Evidence was selected for relevance to PTLD phenotypes, diagnosis, management, and health system integration. PTLD, encompassing conditions like bronchiectasis, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis, affects a substantial proportion of tuberculosis (TB) survivors, leading to chronic respiratory symptoms, lung function disability, and socioeconomic impact. In Ethiopia, despite its inclusion as a priority lung disease in the national strategic plan, critical gaps persist. These include a profound lack of clinical and patient awareness, severely limited diagnostic capacity (spirometry, imaging), absent treatment and rehabilitation pathways, a scarcity of local epidemiological and implementation research, and unaddressed policy system barriers that impact infectious and chronic disease care. Ethiopia's policy recognition of PTLD is a pivotal first step. An urgent, coordinated effort is required to translate this into functional, equitable care. Success depends on concurrent action by researchers to generate local evidence, public health institutes to integrate surveillance and develop guidelines, clinicians to pioneer service delivery models, and policymakers to mandate and fund integration. Bridging the PTLD care gap is essential to safeguard the long-term health of TB survivors and strengthen the health system's capacity to manage chronic disease.

Abstract Introduction Tracheobronchomegaly, also known as Mounier-Kuhn Syndrome, is a rare disorder characterized by marked dilation of the trachea and bronchi resulting from atrophy of the elastic fibers and muscularis propria in the airway wall. Patients typically exhibit nonspecific chronic respiratory symptoms, which often contribute to a delay in diagnosis. In this report, we describe a case presenting with hemoptysis and recurrent lower respiratory tract infections. The diagnosis of Mounier-Kuhn syndrome was established based on findings from high-resolution computed tomography (HRCT). Case presentation A 74-year-old male, a retired worker, was transferred to our hospital following episodes of hemoptysis and recurrent lower respiratory tract infections. He reported a previous smoking history of 5 years, with a consumption of approximately 10 cigarettes per day, but currently denies tobacco use. The laboratory data were as follows: white blood cell count 13.3 × 109/l, neutrophils 11.34 × 109/l, C-reactive protein 176.4 mg/L, and positive procalcitonin (PCT, 1.53 ng/mL). High-resolution computed tomography (HRCT) was performed, and coronal reconstruction demonstrated marked dilation of the trachea and main bronchi, with diameters measuring 30.2 mm in the trachea, 26.3 mm in the right main bronchus, and 23.7 mm in the left main bronchus (Figure 1 A). On the sagittal view, the tracheal diameter reached 33.32 mm (Figure 1 B). Three-dimensional reconstruction further revealed extensive tracheobronchial dilatation accompanied by multiple diverticula (indicated by arrows, Figure 1 C). Subsequent fibrobronchoscopy confirmed the presence of tracheomalacia with dynamic partial collapse during expiration (Figure 1D.E.F). Finally, he was diagnosed as Mounier-Kuhn syndrome. Discussion Tracheobronchomegaly (Mounier-Kuhn Syndrome) is a rare disorder that has been underdiagnosed since its first description in 1932. Computed tomography (CT) serves as the cornerstone for establishing the diagnosis and guiding comprehensive evaluation. The characteristic hallmarks—marked airway dilation, tracheobronchial diverticulosis, and related complications—should be recognized to facilitate accurate diagnosis, inform appropriate management, and avoid unnecessary interventions. In the management of Mounier-Kuhn syndrome, a symptom-driven approach is recommended. No specific treatment is indicated for asymptomatic patients, whereas tobacco cessation constitutes a cornerstone of care. For symptomatic individuals, the mainstay of management includes routine respiratory physiotherapy and the use of antibiotics to manage acute infectious exacerbations. This report aims to enhance awareness of the common complications and associated pulmonary conditions in these patients. This abstract is funded by: None

The therapeutic dilemma triangle in rheumatoid arthritis-related respiratory disease.

BACKGROUND Vascular rings are rare congenital anomalies of the aortic arch system that encircle and compress the trachea and esophagus, leading to respiratory and feeding symptoms that may mimic more common pediatric conditions. Delayed diagnosis remains a challenge, particularly in patients presenting beyond the neonatal period. AIM To describe the clinical presentation, diagnostic approach, anatomical characteristics, surgical management, and postoperative outcomes of pediatric patients diagnosed with complete and incomplete vascular rings at a tertiary referral center. METHODS We conducted a retrospective study of patients diagnosed with vascular rings at the Children’s Heart Center of the American University of Beirut Medical Center between January 2010 and December 2025. All patients underwent transthoracic echocardiography and computed tomography angiography for diagnostic confirmation and surgical planning. RESULTS Eight patients were identified, of whom three (37.5%) were male. The mean age at time of procedure was 17.5 months (range: 8 days to 38 months). Feeding difficulties and chronic respiratory symptoms were the most common presenting features (both 75%). Three patients (37.5%) had associated intracardiac anomalies. Double aortic arch was the most frequent anatomical subtype (50%), followed by right aortic arch with aberrant left subclavian artery (37.5%). All patients underwent surgical repair, with cardiopulmonary bypass required in two cases. There were no operative or in-hospital deaths. Two neonates developed postoperative tracheomalacia. During a mean follow-up of 32 months, complete symptom resolution was observed in 50% of patients, while the remainder demonstrated significant clinical improvement. CONCLUSION Vascular rings remain an important but often underrecognized cause of airway and esophageal compression in infants and young children. Delayed presentation was common in this cohort, underscoring the need for heightened clinical suspicion in patients with persistent respiratory or feeding symptoms. Multimodal imaging and timely surgical intervention result in excellent survival and favorable clinical outcomes, although residual symptoms may persist, particularly in patients with severe preoperative airway compromise.

Chronic obstructive pulmonary disease (COPD) is among the leading causes of death worldwide and is characterized by chronic respiratory symptoms, persistent airflow limitation, and exacerbations. Diagnosis is confirmed by post-bronchodilator spirometry. Effective long-term management requires astructured assessment of relevant exposures, symptom burden, exacerbation history, and comorbidities. Key goals of treatment include reducing both symptom and disease burden and preventing future exacerbations, which are often associated with increased lung function decline. This article summarizes practical concepts for diagnostic work-up and therapeutic decision-making at the time of diagnosis, during follow-up, in acute exacerbations, and in the context of palliative care. It highlights individualized inhaled therapy, guided by symptoms, exacerbations, and blood eosinophil counts, as well as evidence-based non-pharmacological interventions such as smoking cessation, pulmonary rehabilitation, long-term oxygen therapy/non-invasive ventilation, and lung volume reduction strategies.

Background It is unknown whether subclinical emphysema-like changes, quantified at chest CT, are associated with loss of bone mineral density (BMD) in individuals without clinical chronic obstructive pulmonary disease (COPD). Purpose To identify early imaging markers of lung and bone health using deep learning-based imaging analysis in a large multiethnic cohort. Materials and Methods Chest CT scans obtained using the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) protocol during examination 5 and 6 of the prospective Multi-Ethnic Study of Atherosclerosis (MESA) were secondarily analyzed (April 2010-March 2018). Percentage emphysema was quantified at examination, and thoracic vertebral BMD was assessed at both examinations using a validated deep learning-based segmentation model. Participants with clinical COPD as determined on the basis of spirometry or self-reports were excluded. Linear mixed-effects models were constructed and adjusted for demographic characteristics and covariates, including smoking status, physical activity, and scanner type, and the interaction effect of sex was analyzed. Results The cross-sectional analysis included 2312 participants (median age, 67 years [IQR, 61-75 years]; 1285 female participants), and the longitudinal study included 1109 participants (median age, 65 years [IQR, 60-72 years]; 614 female participants) with available follow-up CT data. A greater percentage of emphysema-like changes was associated with lower BMD (β = -1.14 mg/cm3 [95% CI: -1.76, -0.53]) cross-sectionally and with greater annual BMD loss (β = -0.07 mg/cm3 per year [95% CI: -0.13, -0.01]) longitudinally. Interaction effects were identified for sex (P < .001) and race or ethnicity (P = .049). In stratified models, the associations were significant for men (β = -0.38 mg/cm3 per year [95% CI: -0.48, -0.28]) and Black/African American participants (β = -0.24 mg/cm3 per year [95% CI: -0.39, -0.09]). The Johnson-Neyman method revealed more than 2.7% emphysema as a threshold for a decrease in BMD among men, which corresponded to 39% of the male participants. The results remained robust after adjustment for pulmonary function and chronic respiratory symptoms. Conclusion In individuals without COPD, a greater percentage of emphysema-like changes was independently associated with faster vertebral bone loss, particularly in men, suggesting that subclinical emphysema may be a novel imaging marker of systemic skeletal decline. Clinical trial registration no. NCT0000548 © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Fukuda in this issue.

ABSTRACTBackgroundChronic pulmonary aspergillosis (CPA) is a significant, yet often overlooked, sequela of pulmonary tuberculosis (TB), particularly in resource‐limited settings. Data on the seroprevalence of Aspergillus infection in Senegal is absent, and diagnostic capacity is limited. This study aimed to determine the seroprevalence of Aspergillus‐specific antibodies among patients with a history of TB in Senegal and to evaluate the performance of a Rapid Diagnostic Test (RDT) against an Enzyme‐Linked Immunosorbent Assay (ELISA).MethodsA cross‐sectional study was conducted between April 30 to August 31, 2025 at two health centers in Senegal: Wakhinane and Yeumbeul among patients presenting with chronic respiratory symptoms. After obtaining informed consent from adult participants or from parents/guardians for minors, a blood sample was collected from each participant and tested for Aspergillus antibodies using both a rapid diagnostic test (RDT) and an ELISA. Results were classified as positive, negative, invalid, or not tested. Prevalence and agreement between the two assays were calculated using valid results only. Demographic data were collected, and descriptive statistics with test performance analyses were conducted.ResultsThe overall seroprevalence was significantly higher by ELISA (11.9%; 38/320) than by RDT (5.5%; 11/201). Site‐specific analysis revealed disparities: Wakhinane showed higher RDT positivity (4.5% vs. 1.0%), while Yeumbeul had higher ELISA positivity (13.5% vs. 11.2%). The cohort was predominantly male (66.0%) with a median age of 30 years. ROC analysis of the ELISA identified an optimal threshold that balanced sensitivity (78%) and specificity (89%).ConclusionThis study provided the first serological evidence of substantial Aspergillus antibody prevalence among post‐TB patients in Senegal, suggesting a significant burden of undiagnosed CPA. The higher sensitivity of ELISA makes it essential for surveillance and confirmation, while the RDT's practicality offers a viable option for initial screening in peripheral clinics. These findings underscored the urgent need to integrate CPA diagnosis into routine post‐TB care and to strengthen fungal diagnostic capacity in West Africa.

BackgroundApproximately 3–23% of people have airflow limitation according to the fixed ratio (FR) criterion (0.70), but not the lower limit of normal (LLN) criterion (FR+LLN−). People with FR+LLN− have a worse prognosis than FR−. However, whether people with FR+LLN− have a higher all-cause mortality risk than those with FR− remains unclear, and we explore it in this study.MethodsParticipants were enrolled from the National Health and Nutrition Examination Survey (NHANES) (1988–1994 and 2007–2012 cycles). Participants aged 20–79 years; with reliable spirometry data; not pregnant; without missing on demographic data; and with follow-up data were included in the analysis. Multivariable logistic regression was used to identify differences in chronic respiratory symptoms and comorbidities between the groups. The multivariable Cox proportional hazards model was used to analyze between-group differences in all-cause mortality.ResultsThe final sample consisted of 24,691 participants, including 21,421 (87%) in the FR− group, 1,035 (4%) in the FR+LLN− group, and 2,235 (9%) in the FR+LLN+ group. The FR+LLN− group had more chronic respiratory symptoms and comorbidities than the FR− group. The FR+LLN− group exhibited higher all-cause mortality than the FR− group [adjusted hazard ratio (HR) 1.15, 95% confidence interval (CI): 1.04–1.26, P=0.006] and similar all-cause mortality to the FR+LLN+ group (adjusted HR 1.34, 95% CI: 1.24–1.45, P<0.001).ConclusionsParticipants with FR+LLN− had a poorer health status and a higher risk of all-cause mortality than participants with FR−, indicating that people with FR+LLN− require necessary interventions to improve respiratory prognosis.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by persistent airflow limitation and chronic respiratory symptoms such as dyspnea and excessive sputum production. Ineffective airway clearance is one of the most common nursing problems in COPD patients due to mucus retention. Postural drainage and effective coughing techniques are non- pharmacological interventions aimed at facilitating sputum removal and improving ventilation. This descriptive case study aimed to describe nursing care through the implementation of postural drainage and effective coughing techniques in a COPD patient with ineffective airway clearance at Kenanga Ward, TK II Dustira Hospital Cimahi. The intervention was carried out twice daily for three consecutive days, with a duration of 20 minutes per session. The evaluation results showed improvement in airway clearance, characterized by decreased adventitious breath sounds (rhonchi and wheezing), reduced respiratory rate, and easier sputum expectoration. It can be concluded that postural drainage and effective coughing techniques can improve airway clearance in COPD patients. These interventions are expected to be applied independently by nurses and families to prevent respiratory complications.