The use of bronchoscopy with endobronchial ultrasound (EBUS) to aid in lymph node and lung biopsy is relatively new. This review will summarize the literature surrounding the efficacy of bronchoscopy with EBUS. Safety of bronchoscopy with EBUS is not markedly different that procedure with EBUS and is impacted by patient features including co-morbidities as well as different sedation modalities. This paper reviews the impact on both safety and diagnostic yield. The yield from using EBUS guided biopsy varies with the diagnosis but is high with linear EBUS. Recent data incorporating other technologies (electromagnetic navigation, robotic assistance) with bronchoscopy has potential to increase diagnostic yields, appears to be equivalent to transthoracic needle biopsies performed by radiology. Different sedation modalities are utilized, including the use of dedicated anesthesia providers, for bronchoscopy with EBUS but do not appear to significantly affect the diagnostic yield. Bronchoscopy with EBUS (both linear and radial) is a safe procedure with acceptable yields. The type of sedation does not appear to affect the diagnostic yield or the safety of the procedure. Further research into incorporation of other technologies may provide for higher diagnostic yields.
Obstructive sleep apnea (OSA) is highly prevalent among patients with coronary artery disease (CAD) and has been implicated in adverse cardiovascular outcomes through multiple pathophysiological pathways. The Randomized Intervention with Continuous Positive Airway Pressure in Coronary Artery Disease and Sleep Apnea (RICCADSA) project was initiated to investigate the prevalence, clinical significance, and treatment implications of OSA in patients with revascularized CAD. This review summarizes the major scientific contributions of the RICCADSA project over the past two decades and discusses their impact on contemporary cardiovascular sleep medicine. RICCADSA demonstrated that OSA is highly prevalent among participants with CAD and provided important mechanistic insights linking OSA to systemic inflammation, myocardial dysfunction, autonomic dysregulation, endothelial and vascular biology, and adverse cardiovascular outcomes. Although the primary randomized trial did not demonstrate a significant reduction in cardiovascular events with routine continuous positive airway pressure (CPAP) treatment in nonsleepy participants, subsequent analyses identified treatment-responsive subgroups based on adherence, excessive daytime sleepiness, physiological traits, autonomic responses, hypoxic burden, and endothelial phenotypes. More recent investigations have highlighted the limitations of conventional severity metrics such as the apnea–hypopnea index and supported the emerging role of biological and physiological phenotyping in cardiovascular risk stratification. Over the past twenty years, the RICCADSA project has evolved from a randomized clinical trial into a comprehensive research platform that has helped shape current understanding of OSA and cardiovascular disease. Its findings have contributed to a transition from an AHI-centered approach toward precision sleep cardiology, emphasizing the biological heterogeneity of OSA and the need for individualized treatment strategies to optimize cardiovascular outcomes.
We summarized current evidence on occupational lung diseases (OLDs) in low- and middle-income countries (LMICs). Research on OLDs in LMICs remains limited and unevenly distributed. Of the 29 included studies (≈ 47,000 workers), most were from Africa and South Asia. Majority were cross-sectional (n = 25) and only two each of cohort and interventional studies; and were categorized into: manufacturing and industrial processing (n = 17), mining and extraction (n = 4), agriculture and farming (n = 5), and services and waste management (n = 4) sectors. We found a high prevalence of respiratory conditions across different settings. Important gaps include the scarcity of interventional research, lack of data from several LMIC regions, limited exposure assessment, and limited inclusion of women and informal-sector workers. Our review reveals a substantial gap in high-quality evidence on OLDs in LMICs. There is a need to strengthen surveillance, monitor exposure, and conduct interventional studies in LMICs.
Bronchiectasis management has traditionally followed a one-size-fits-all approach that overlooks the disease’s marked clinical and biological heterogeneity. This review examines how the treatable traits framework, originally developed for asthma and chronic obstructive pulmonary disease, applies to bronchiectasis, and asks how the recently updated European Respiratory Society Clinical Practice Guideline formalises this precision medicine approach in routine care. The updated guideline endorses systematic assessment across pulmonary, aetiological, extrapulmonary, and behavioural/lifestyle domains, emphasising aetiological work-up, exacerbation risk stratification, and individualised pharmacological and non-pharmacological therapy. A newly approved disease-modifying agent for non-cystic fibrosis bronchiectasis, targeting neutrophil serine protease activation, exemplifies this endotype-directed shift toward addressing neutrophilic airway inflammation directly. A structured treatable traits approach translates the guideline’s key messages into actionable, multidomain assessment and treatment. Wider adoption, supported by emerging biomarkers, digital monitoring tools, and an expanding therapeutic pipeline, offers a route to more personalised, outcome-focused care and should inform the design of future bronchiectasis trials.
This review examines the evolution of surgical strategies for pleural mesothelioma (PM) over the past decade, focusing on the paradigm shift from aggressive extrapleural pneumonectomy to lung-sparing approaches. We sought to evaluate how randomized trial evidence, contemporary databases, and advances in systemic therapy have reshaped surgical decision-making and patient selection algorithms. The MARS and MARS 2 randomized trials challenged traditional surgical approaches, with MARS 2 reporting worse outcomes with extended pleurectomy/decortication (EPD) compared to chemotherapy alone, though serious concerns about methodology, surgical quality assurance and analysis were persist. National database analyses consistently show lower mortality with lung-sparing procedures compared to extrapleural pneumonectomy. Histologic subtype has emerged as a critical selection criterion, with surgery showing benefit primarily in epithelioid disease. Biomarkers such as Ki67 expression and mesothelin provide additional prognostic stratification. The CheckMate 743 trial established immunotherapy combinations as suitable care for unresectable disease, prompting investigation of neoadjuvant immunotherapy approaches. Summary: Surgery for pleural mesothelioma has evolved from extrapleural pneumonectomy to selective, lung-preserving strategies within multimodality care. Patient selection emphasises epithelioid histology, favourable biomarker profiles, and treatment in high-volume specialist centers. The integration of immunotherapy and development of predictive biomarkers will likely further refine surgical candidacy, making personalised treatment algorithms the future standard of care.
