INTRODUCTION:In-hospital cardiac arrest is associated with poor outcomes, yet peri-procedural code status discussions before bronchoscopy may be inconsistent, particularly in patients with elevated procedural risk. METHODS:We conducted an anonymous online survey of a convenience sample of hospital-based pulmonologists in Germany and Switzerland between April and July 2025. The survey assessed routine practices and attitudes regarding peri-procedural code status discussions, risk stratification, and management of patients with pre-existing No-CPR status. Owing to distribution through multiple channels and secondary forwarding, a precise response rate could not be calculated. RESULTS:A total of 148 pulmonologists participated (mean age 47.8 years; 94.6% board-certified). Discussions regarding CPR preferences were conducted almost always or most of the time before high-risk bronchoscopies by 67.6% of respondents, but were rarely or almost never performed before low-risk procedures by 72.0%. Respondents more frequently reported procedural risk than patient-related factors as a trigger for these discussions. Peri-procedural No-CPR status was considered controversial by 44.9%, and responsibility for these discussions varied among respondents. Only 25% reported formal institutional training. CONCLUSIONS:Substantial variability exists in peri-procedural code status practices before bronchoscopy. Clearer responsibilities and structured guidance are needed to better align care with patient preferences.
Background: Inadequate endotracheal tube (ETT) cuff sealing permits microaspiration of subglottic secretions, driving ventilator-associated pneumonia and perioperative respiratory complications. Standard cylindrical and tapered cuffs remain susceptible to microchannel formation and leakage. This pilot study evaluated a novel ETT with a 90-mm self-expanding viscoelastic cuff (V-Cuff®) operating at ambient pressure compared to standard and specialty ETTs in vitro. Methods: Five ETTs of each type—standard cylindrical (Ruschelit®), specialty tapered (Shiley Evac/TaperGuard®), and V-Cuff®—were tested at 37°C in a 3D-printed tracheal model with 5 cmH₂O positive end-expiratory pressure (PEEP). Evaluations included upper and lower pressure threshold assessments (UPTA and LPTA) and simulated swallowing (80 mmHg, 2s) and coughing (125 mmHg, 3s). Continuous and categorical outcomes were analyzed using Mann-Whitney U and Fisher's Exact tests, respectively. Results: Under 5 cmH₂O PEEP, the standard ETT leaked immediately at 0 mmHg on UPTA. Both specialty and V-Cuff® ETTs tolerated supracuff pressures >90 mmHg on UPTA (p<0.001 vs. standard). On LPTA, air leak occurred at a mean of 5 ± 0.71 mmHg (standard) and 12 ± 1.22 mmHg (specialty), whereas the V-Cuff® showed no leakage at pressures >90 mmHg (p=0.008 vs. standard and specialty). During simulated swallowing and coughing, all standard and specialty ETTs leaked (5/5), while the V-Cuff® maintained complete seal integrity without leakage (0/5; p=0.008). Conclusions: In this pilot in vitro study, the V-Cuff® ETT demonstrated superior airway sealing under all static and dynamic conditions compared to standard and tapered-cuff ETTs. These preliminary findings suggest the improved seal may reduce tracheal soiling, though prospective clinical validation is required to confirm reductions in aspiration-related complications.
Background: The overlap between asthma and obesity is becoming an increasing health concern, as overweight and obesity are linked to a higher risk of developing asthma and a greater disease burden. Objective: To assess the association between obesity and hospital-related complications, as well as early readmission rates, in asthmatic patients. Methods: This prospective observational cohort study was conducted at the Department of Chest Diseases, Ain Shams University Hospitals, between January 2024 and January 2026. A total of 75 adult patients were included and classified into three BMI groups: normal weight, overweight, and obese (n = 25 each). Clinical characteristics, pulmonary function tests, and in-hospital outcomes were assessed. Results: Asthma severity increased with BMI, with severe asthma present in 96.0% of obese patients compared with 20.0% of overweight patients and none of the normal-weight patients (p < 0.001). Obese patients had lower pre-FEV₁ % predicted (47.5 ± 21.1%) than both overweight (58.5 ± 12.4%) and normal weight patients (65.2 ± 13.5%) (p = 0.003). They also had lower oxygen saturation and longer hospital stay (p < 0.001). ICU admission occurred only in obese patients (40.0%), with 20.0 % requiring mechanical ventilation. BMI correlated with longer hospital stay and lower oxygen saturation (p < 0.001). Predictors of ICU admission included obesity, severe asthma, ventilatory support, lower oxygen saturation, and reduced FEV₁. Conclusion: Higher BMI was associated with increased asthma severity, poorer control, impaired lung function, and worse clinical outcomes, including longer hospital stay and greater need for intensive care. These findings highlight the value of weight management and comprehensive care in improving outcomes for obese patients with asthma.
Subglottic stenosis (SGS) is a chronic fibroinflammatory condition that causes pathological narrowing of the airway between the vocal cords and the trachea, with symptoms ranging from dyspnea to stridor and respiratory failure. The causes are heterogeneous: traumatic iatrogenic forms (such as prolonged intubation), autoimmune (e.g., granulomatosis with polyangiitis), post-viral (including COATS related to COVID-19), and idiopathic (iSGS), the latter affecting primarily adult Caucasian women with no obvious predisposing factors. All forms share a common pathogenetic core: epithelial damage, immune activation, chronic inflammation, and progressive fibrosis. Recent molecular studies, however, reveal that different variants of SGS exhibit distinct biological signatures, suggesting the existence of molecular subtypes with differentiated clinical courses. The emerging approach therefore aims for a biomarker-based classification for precision medicine. Future treatments may include targeted immunotherapies (e.g., IL-17A/IL-23 inhibitors), anti-fibrotic drugs, and epithelial regeneration strategies, alongside current surgical techniques to improve long-term prognosis.
BACKGROUND:Sedation has become an essential component of modern interventional pulmonology, accompanying the progressive expansion of bronchoscopic procedures from conventional diagnostic bronchoscopy to advanced diagnostic and therapeutic airway interventions. Despite its increasing relevance, sedation practices remain heterogeneous, and dedicated national recommendations specifically addressing interventional pulmonology are still lacking in many countries. METHODS:A national cross-sectional survey was conducted among physicians involved in interventional pulmonology practice through the Accademia di Ecografia Toracica (ADET) network. The questionnaire consisted of 29 structured items covering organizational models, pharmacological strategies, monitoring approaches, and safety-related aspects of procedural sedation. Responses were analyzed descriptively using proportions, medians, and interquartile ranges. Agreement was operationally defined as a Likert score of 4-5 in at least 70% of responses. RESULTS:Forty-one responses were included in the final analysis. Sedation was routinely integrated into procedural activity in most centers, although relevant variability emerged regarding sedation management, monitoring practices, and anesthesiology involvement. The strongest agreement concerned the need for national recommendations to standardize sedation practices (80.5% agreement), followed by recognition that anesthesiologist presence is required during high-risk interventional procedures (73.2%). Substantial agreement emerged regarding pulmonologist-led moderate sedation in selected settings (68.3%), while capnography did not reach clear consensus (44.7%). Limited anesthesia availability was considered a relevant organizational factor by 63.2% of respondents. CONCLUSIONS:Among participating clinicians, sedation was widely integrated into routine interventional pulmonology practice but remained organizationally heterogeneous. The survey identified broad agreement regarding the need for national harmonization and dedicated anesthesiology support for high-risk procedures. Given the network-based recruitment strategy and the absence of procedural volume data, these findings should be considered exploratory and hypothesis-generating rather than fully representative of national practice.
BACKGROUND:Severe asthma affects approximately 3-5% of the pediatric asthmatic population and is associated with substantial clinical, economic, and psychosocial burdens. Despite major advances in biological therapies, standardized guidance for their optimal use in children and adolescents remains limited. OBJECTIVE:To establish experts' consensus on the management of severe pediatric asthma through a Delphi process promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP), with particular focus on biological therapy selection, monitoring, and response assessment. METHODS:A modified Delphi process involving 50 pediatric asthma experts was conducted. Twenty-seven statements addressing epidemiology, pathophysiology, biomarkers, biological therapies, monitoring strategies, and response definitions were developed through iterative rounds. Consensus was defined as ≥80% agreement (scores 4-5 on a 5-point Likert scale). RESULTS:All 27 statements achieved consensus (agreement range: 82-100%; mean scores: 4.1-4.9). Complete consensus was reached on key issues, including the need for endotype-based therapy selection, the predominance of type 2 inflammation in severe pediatric asthma, the role of currently available biological therapies (omalizumab, mepolizumab, dupilumab, tezepelumab), multidimensional response assessment (clinical, functional, and biological), and the importance of patient and family engagement. Strong consensus also supported the use of Core Outcome Measures for Severe Asthma (COMSA) for monitoring, classification of responders/super-responders /non-responders, and the predictive value of selected biomarkers, including blood eosinophil counts (≥300 cells/µL), FeNO, and baseline oral corticosteroid dose. CONCLUSIONS:This Delphi Consensus provides expert-endorsed, evidence-based recommendations for the management of severe pediatric asthma, emphasizing personalized selection of biological therapy guided by biomarkers and systematic response monitoring using standardized outcome measures.
BACKGROUND:Rhinitis is a common medical condition characterized by different phenotypes. Allergic (AR) and non-allergic (NAR) rhinitis share common type 2 inflammation. The present Italian educational activity investigated the clinical characteristics and treatments of patients with rhinitis managed by Italian otorhinolaryngologists. METHODS:Globally 117 well-matched otorhinolaryngologists attended this educational activity. This initiative consisted of a preliminary questionnaire to participants, one educational webinar, a field training session, and one in-person meeting. Demographic and clinical parameters, and treatments (previous and current) were collected. RESULTS:The otorhinolaryngologists collected data of 1238 patients with rhinitis (814 with AR and 424 with NAR). Nasal obstruction was the most common symptom, present in 88% of patients. Quality of life was impaired in about 80% of patients. Concomitant presence of nasal obstruction and impaired quality of life was associated with more severe symptoms. Intranasal corticosteroids (INCS) were the preferred treatment for participants. This educational initiative changed participants' attitudes and increased the percentage of INCS prescriptions, mainly for budesonide, and the use of INCS cycles. CONCLUSIONS:The present iterative educational initiative yielded practical insights into the clinical characteristics of patients with type 2 rhinitis. Nasal obstruction and impaired quality of life are common clinical characteristics among patients visited. A close link between inflammation and associated symptoms justifies the frequent use of INCS. In this context, budesonide was perceived as a valuable option in managing AR and NAR patients.
BACKGROUND:Electronic cigarettes are widely used, and healthcare providers play an important role in advising patients about their safety and possible use in smoking cessation. However, differences in knowledge, attitudes, and confidence may affect the consistency and quality of counseling. AIM:This systematic review examined evidence on knowledge, attitudes, confidence, and information sources related to electronic cigarettes among healthcare providers and medical students. METHODS:A search of PubMed and Scopus was conducted for English-language studies published within the past 10 years. Quantitative, qualitative, and mixed-methods observational studies were included, and findings were synthesized narratively due to methodological differences across studies. RESULTS:Fourteen studies met the inclusion criteria. Although awareness was generally high (up to 79.3%), detailed knowledge was often limited. In Europe, about half of physicians rated their understanding as moderate, and 96.5% of Polish physicians considered e-cigarettes harmful, with only 11.5% supporting their use for smoking cessation. In the Middle East, fewer than 15% viewed them as safer than conventional cigarettes. Among students, 30-36% selected "don't know" when asked about safety. CONCLUSION:Confidence in counseling varied and was typically lower among students. Media and social networks were the most common sources of information. Despite high awareness, important knowledge gaps remain, highlighting the need for structured education and clearer clinical guidance.
Introduction: Silicosis is a well-recognised occupational lung disease caused by inhalation of crystalline silica dust; however, extrapulmonary involvement, particularly splenic silicosis, remains rare and underreported in the literature. Case presentation: A 46-year-old female sand sifting machine operator presented with six years of occupational silica exposure at a sand classification and packing factory. In 2005, she developed respiratory symptoms, and chest radiography revealed diffuse nodular opacities, although silicosis was not diagnosed at that time. In October 2024, approximately 19 years after initial presentation, computed tomography demonstrated multiple calcified pulmonary nodules, progressive massive fibrosis, eggshell calcification of mediastinal lymph nodes, and multiple calcified micronodules throughout the splenic parenchyma. Based on these characteristic radiological findings and her occupational exposure history, a diagnosis of complicated silicosis with extrapulmonary splenic involvement was established. Despite a latency period shorter than the traditionally reported 10-30 years for chronic silicosis, the clinical course was indolent across the interval between the two assessments (2005 and 2024), which may lie near the boundary between chronic and accelerated forms. Conclusions: Splenic silicosis should be considered in patients with occupational silica exposure who present with splenic calcifications. Although sand sifting operations have received limited attention as a potential source of silica exposure, the occurrence of multiple cases at the same facility suggests potentially high exposure intensity. These findings emphasise the importance of comprehensive prevention strategies and raise the question of whether earlier initiation of health surveillance may benefit workers in sand processing industries.
Recupera e Respira, a pilot project launched in the Friuli Venezia Giulia region in Italy in 2022, addresses the environmental impact of improper disposal of respiratory inhalers. When these medical devices are disposed of as regular household waste without segregation, they contribute to pollution with aluminum and plastic, and emission of residual hydrofluoroalkane (HFA). In collaboration with Federfarma, the national association representing over 19,000 private pharmacies affiliated with Italy's National Health Service, and with the support of Assinde, a company specializing in pharmaceutical returns management and the safe disposal of expired or unused medicines, Chiesi Italy suggested and implemented an institutionally approved collection and disposal system for empty inhalers. This initiative achieved a recovery rate of 24.6% over 3 years (calculated from IQVIA sell-out data referring to the Friuli Venezia Giulia region for September 2022 to June 2025), collecting over 111,000 inhalers from regional pharmacies. Proper disposal occurred at certified facilities capable of neutralizing hazardous components at high temperatures. The project highlights the role of pharmacies in educating patients and facilitating sustainable healthcare practices. An increase in recovery rates from 22.6% to 27.3% was observed in the first 2 years of project, with a sightly decrease over the third year. Overall, this study demonstrates the model's potential scalability, aligning with Chiesi's net zero goals by 2035. The study highlights how innovative waste management systems can effectively reduce the environmental burden of inhalers and foster public engagement in sustainability.
BACKGROUND:Tobacco-related small-airway dysfunction (SAD) may precede spirometric obstruction. The single-breath nitrogen washout (SBW N₂) captures ventilation heterogeneity and may detect early peripheral airway involvement through the phase III slope (ΔN₂/L) and closing volume (CV). AIM:To describe SBW N₂ indices in smokers with preserved spirometry, examine their relationship with cumulative smoking exposure, and contextualise results against published reference (healthy predicted) values. METHODS:Cross-sectional study of current smokers (n=90) with preserved spirometry (pre-bronchodilator FEV1/FVC ≥0.70). Spirometry followed SEPAR criteria and SBW N₂ followed ERS/ATS recommendations. Associations with pack-years were assessed by Pearson correlations and linear regression. In the absence of a concurrently recruited healthy control group, SBW N₂ outcomes were also expressed as percent-predicted using published reference equations (ΔN₂/L and CV/VC in males aged 30-70 years). To explore sex-related differences in ventilation heterogeneity, we compared key characteristics and size-independent functional indices between men and women (spirometry as % predicted and ratios) and fitted a multivariable OLS model for ΔN₂/L adjusting for pack-years, age and BMI. RESULTS:Mean age was 42 (11) years and mean smoking exposure 29.01 (16.95) pack-years. Mean ΔN₂/L was 2.674 (1.424) %N2•L⁻¹ and correlated significantly with pack-years (r=0.452, p<0.0001), as did CV/VC (r=0.389, p=0.00015). In external-reference comparisons, ΔN₂/L in males aged 30-70 years (n=42) was markedly elevated (327.1 (165.7)% predicted; p<0.0001), with 83.3% exceeding the proposed ULN (180% predicted). In multivariable regression adjusting for pack-years, age and BMI, male sex remained independently associated with higher ΔN₂/L (β=+0.946 %N2•L⁻¹; 95% CI 0.400 to 1.492; p<0.001). CONCLUSIONS:SBW N₂ indices-particularly ΔN₂/L-show a dose-response relationship with smoking burden and are markedly abnormal relative to healthy predicted values, even in smokers with preserved spirometry. These findings support SBW N₂ as a sensitive tool for detecting early peripheral SAD before spirometric obstruction becomes apparent. Sex-related differences in ΔN₂/L persisted after adjustment for smoking exposure and anthropometrics, suggesting that sex should be considered when extrapolating male-based reference contextualisation to women.
BACKGROUND:Coexistence of interstitial lung disease (ILD), particularly idiopathic pulmonary fibrosis (IPF), and lung cancer poses major diagnostic and therapeutic challenges, yet clinical management remains heterogeneous. The project aims to describe current Italian practices for integrated management of ILD with concomitant lung cancer. Methods: ICARO (Interstiziopatia e Cancro del polmone: AppRoccio al management clinico integratO) is a national cross-sectional clinician survey conducted in Italy on behalf of the Italian Respiratory Society from November 2024 to March 2025. A 12-item multiple-choice questionnaire assessed diagnostic strategies, treatment preferences, and perceived toxicity risks. Invitations were sent to X physicians, among which 38 ansewered (35 specialists and senior 3 registrars (age range: 28-68 years). Results: An ILD multidisciplinary team was available in 26/38 (71.1%) centres. Diagnostic procedures for lung cancer in ILD patients were reported as performed "always/often" by 14/38 (36.8%), with the main concern being ILD progression after procedures (31/38 - 81.6%). Most respondents continued antifibrotic therapy during systemic cancer treatment (28/38- 73.7%). Combined chemotherapy plus immune checkpoint inhibitors was perceived as the highest-risk regimen by 19/38 physicians (50%), and 20/38 (52.6%) were hesitant to offer neoadjuvant immunotherapy in stage II-IIIa NSCLC. Severe toxicity from radiotherapy was reported as frequent by 8/38 (21.1%). Conclusions: Italian clinicians report substantial variability in diagnostic and therapeutic strategies for lung cancer in ILDs, driven mainly by concern for ILD progression and treatment-related pulmonary toxicity. Although limited, this study unveils an urgent need for further prospective studies to better define the safety and efficacy of combined therapeutic approaches and to establish evidence-based guidelines to support clinical decision-making.
BACKGROUND:Many transcription factors may be involved in the pathogenesis of pulmonary fibrosis (PF). One such factor is PPARG. The PPARG agonist, pioglitazone (PG), has demonstrated general lung protective activity in animal models and is considered a promising therapeutic agent for fibrotic intervention. This study aimed to investigate the effect of PG on the expression of connective tissue remodeling genes in the lungs using bleomycin (BLM)-induced lung fibrosis (BIF). METHODS:The study was conducted on male BALB/c mice. PF was induced by pretreatment with bleomycin sulfate and cyclophosphamide. The mice were randomly divided into 3 groups: the first group was administered BLM at a dose of 0.15 U/kg in 50 µl of sterile saline (0.9% NaCl), and the second group was administered 50 µl of saline. The third group was not induced with pulmonary fibrosis and served as a control group. On the 4th day of the experiment, animals from the first and second groups were randomly divided into animals that received PG orally at a dose of 20 mg/kg or saline (40 µl) for 14 days. 4-hydroxyproline was determined in right lung tissue samples. Gene expression was determined using real-time PCR. RESULTS:PG administration to BIF mice resulted in a significant reduction and normalization of the total number of BAL cells, fibrosis score, mRNA expression of genes associated with connective tissue - Col1a1 (P=0.0466), Col3a1 (P=0.0053), Mmp2 (P=0.0006), Tgfb2 (P=0.0459), and Tgfb3 (P=0.0017), as well as mRNA of genes regulating lung connective tissue inflammation and fibrosis - Mrc1 (P=0.0263), Edn1 (P=0.0012), Pparg (P=0.0044), Nr1d1 (P=0.0053) and Fn1 (P=0.0125). CONCLUSIONS:PPARG activation by PG alleviates BIF by decreasing collagen deposition, Col1a1 and Col3a1 mRNA expression, remodeling of lung tissue (decreasing Mmp2, Edn1, and Fn1 mRNA), and M2-specific profibrotic macrophage Mrc1 mRNA.
Background: The length of hospital stay (LoS) among COVID-19 patients is influenced by multiple factors. This study aimed to identify factors associated with LoS among deceased Cambodian patients with confirmed SARS-CoV-2 infection. Methods: We analyzed a total of 106 deceased patients with confirmed SARS-CoV-2 infection reported between March 11 and May 1, 2021, and publicly shared on the Ministry of Health's Facebook page. A zero-inflated Poisson regression model was used to identify factors associated with LoS. Maximum likelihood estimates, and incidence rate ratios (IRRs) were calculated, and model goodness of fit was assessed. Results: The mean LoS to death was 4.39 days (standard deviation, SD = 5.17). Factors associated with a shorter LoS included critical respiratory symptoms (p = .011), being dead on arrival (p < .0001), advanced age (p = .003), residence in a province (p = .004), presence of multiple chronic conditions (p = .0006), and receiving care at a non-designated COVID-19 treatment facility (p = .005). In contrast, each additional day between SARS-CoV-2 diagnosis and hospital admission was associated with an approximately 9% increase in LoS (95% CI 1.07, 1.10). Conclusions: Despite substantial efforts by the Cambodian government to control the pandemic, many COVID-19 patients died shortly after hospital admission. The findings highlight important patient characteristics and underscore the need for improved patient education, strengthened healthcare infrastructure, and enhanced public preparedness for future pandemics.
Introduction: Clinical reasoning in medicine is a complex cognitive process that integrates sensory perception, interpretation, and abductive inference to develop diagnostic hypotheses. Despite the rise of artificial intelligence, the patient-clinician encounter remains rooted in semiotics and a probabilistic approach driven by Bayesian updating. In this context, medical knowledge is viewed as context-dependent and subject to continuous revision based on new clinical signs. Main body: This paper identifies bedside ultrasonography as a transformative "epistemic mediator" that enhances traditional semiotics by uncovering subtle clinical signs often missed by conventional inspection, palpation, percussion, and auscultation. In managing respiratory diseases, ultrasound provides direct, contextualized data that refines the interpretation of findings such as dullness, altered fremitus, and crackles by linking them to specific anatomical correlates. Based on these principles, the AdET-CHEPHEUS initiative proposes a new paradigm for chest physical examination centered on three pillars: 1) Visual inspection; 2) Auscultation integrated with ultrasound; 3) Palpatory ultrasound evaluation Conclusion: By replacing traditional percussion with more informative and reproducible ultrasound-based methods, this model aligns modern technology with classical clinical epistemology. The integration of ultrasound into bedside reasoning represents a vital evolution in chest semiotics, preserving the human element of the diagnostic process while increasing accuracy.
Background: Alpha-1 antitrypsin deficiency is an autosomal, codominant disorder caused by mutations of the SERPINA1 gene. Several mutations have been described associated with the development of pulmonary and/or chronic liver diseases. We report a novel mutation Mangera, identified for the first time in an Italian patient originating from the city of Angera (Varese), Italy. Case presentation: This case report describes a 64-year-old Italian male, a lifelong non-smoker, diagnosed with severe alpha-1 antitrypsin deficiency (AATD) as composed heterozygous with S allele and a novel mutation named Mangera. The patient presented with exertional dyspnea and had reduced serum AAT levels (0.54 g/L). Pulmonary function tests indicated mild airway obstruction with preserved diffusion capacity, and chest CT scans revealed early centrilobular emphysema and fibrotic changes. Genetic analysis was performed, finding a previously unreported mutation. Despite the severe AAT deficiency, the patient exhibited no significant clinical, radiological, or functional deterioration. Given the absence of disease progression, augmentation therapy was deferred in favor of ongoing annual monitoring. Conclusions:This case report highlights the necessity of referring patients to specialized centers equipped with the expertise and tools required for precise diagnosis. Furthermore, the identification of the Mangera mutation expands the spectrum of known SERPINA1 variants associated with severe AATD, emphasizing the ongoing need for vigilance and thorough investigation in cases of suspected deficiency.
The Italian National Congress of Imaging in Pulmonology, held in Milan on November 21st, provided a unique educational platform exploring the evolving role of thoracic imaging in respiratory medicine. Organized by the Italian Respiratory Society (SIP-IRS) Imaging Study Group, the congress brought together over 160 participants, including pulmonologists, radiologists, interventional specialists, and early-career professionals, reflecting the essential role of multidisciplinary collaboration in modern respiratory care. Topics included functional imaging approaches to small airway disease in COPD and asthma, multimodal imaging in lung transplantation, the role of CT angiography for haemoptysis management, and radiomics applications for quantifying emphysema patterns and fibrotic changes. The role of imaging in guiding inhaled and biological therapies was explored, alongside a lively debate on thoracic ultrasound for interstitial lung disease screening. Advanced sessions covered medical thoracoscopy techniques, quantitative ultrasound and artificial intelligence in pleural diseases, shape-sensing robotic-assisted bronchoscopy for peripheral nodules, expanding cryobiopsy applications, and imaging's role in monitoring progressive pulmonary fibrosis therapeutics. A distinctive feature was the first "Images in Pulmonology" contest, won by a remarkable case simultaneously depicting lung cancer and new life. This meeting report summarizes key congress highlights and underscores the importance of fostering multidisciplinary collaboration and structured imaging education to bridge the gap between technological capabilities and clinical expertise in respiratory medicine.
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, with significant burden in Italy. Prevalence estimates vary by data source: Health Search data indicate a prevalence of 2.7% among adults, whereas population-based analyses report higher estimates of approximately 5.6%. Triple therapy combining a long-acting muscarinic antagonist (LAMA), a long-acting beta2-agonist (LABA), and an inhaled corticosteroid (ICS) has been shown to improve lung function, reduce exacerbations, and potentially decrease mortality in moderate-to-severe COPD. Fixed-dose Single-Inhaler Triple Therapy (SITT) provides practical advantages over Multiple-Inhaler Triple Therapy (MITT), including improved treatment adherence, fewer inhaler technique errors, and comparable safety. This expert opinion review summarizes evidence from randomized controlled trials and real-world studies supporting the clinical, practical, and economic benefits of SITT. While access to SITT in Italy is influenced by regulatory frameworks, optimizing prescription practices and aligning treatment strategies with clinical evidence could enhance continuity of care and patient outcomes. The paper highlights strategies to improve COPD management, reduce treatment discontinuation, and ensure equitable access to effective therapies.
In recent decades lung ultrasound (LUS) has emerged as an invaluable bedside imaging tool for the evaluation of respiratory conditions such as pneumonia, bronchiolitis, pneumothorax, and pleural effusion in pediatric age, thanks to the thin chest wall and absence of rib ossification. Despite its growing application, optimizing technique and interpretation remains crucial for reliable diagnostic performance. the present educational paper provides practical tips and tricks to enhance the accuracy, efficiency, and clinical value of LUS in pediatric patients, focusing on probe selection, patient positioning, scanning technique, common artifacts, and interpretation pitfalls.
