Background: Pulmonary infarction (PI) is the result of the occlusion of distal pulmonary arteries resulting in damage to downstream lung areas that become ischemic, hemorrhagic, or necrotic, and it is often a complication of an underlying condition such as pulmonary embolism (PE). Since in most of cases it is located peripherally, lung ultrasound (LUS) can be a good evaluation tool. The typical radiological features of PI are well-known; however, there are limited data on its sonographic characteristics and its evolution. Methods: The aim of this study is to evaluate, using LUS, a convenience sample of patients with acute PE with computed tomography (CT) consolidation findings consistent with PI. Patients’ clinical characteristics were collected and LUS findings at baseline and their short-term progression was assessed. LUS was performed within 72 h of PE diagnosis (T0) and repeated after one (T1) and four weeks (T2). Each procedure started with a focused examination of the areas of lesions based on CT findings, followed by an exploration of the other posterior and lateral lung fields. The convex probe was used for initial evaluation integrating LUS evaluation with the linear one was employed for smaller and more superficial lesions and when appropriate. Color Doppler mode was added to study vascularization. Results: From June to October 2023, 14 consecutive patients were enrolled at the Respiratory Unit of the University Hospital of Pisa. The main population characteristics included the absence of respiratory failure and prognostic high-risk PE (100%), the absence of significant comorbidities (79%), and the presence of typical symptoms, such as chest pain (57%) and dyspnea (50%). The average number of consolidations per patient was 1.4 ± 0.6. Follow-up LUS showed the disappearance of some consolidations and some morphological changes in the remaining lesions: the presence of hypoechoic consolidation with a central hyperechoic area (“bubbly consolidation”) was more typical at T1 while the presence of a small pleural effusion often persisted both at T1 and T2. A decrease in wedge/triangular-shaped consolidations was observed (82% at T0, 67% at T1, 24% at T2), as was an increase in elongated shapes, representing a residual pleural thickening over time (9% at T0, 13% at T1, 44% at T2). A reduction in size was also observed by comparing the mean diameter, long axis, and short axis measurements of each consolidation at the three different studied time points: the average of the short axes and the median of the mean diameters showed a statistically significant reduction after four weeks. Additionally, a correlation between lesion size and pleuritic pain was described, although it did not achieve statistical significance. Conclusions: Patients’ clinical characteristics and ultrasound features are consistent with previous studies studying PI at PE diagnosis. Most consolidations detected by LUS change over time regarding size and form, but a minority of them do not differ. LUS is a safe and non-invasive exam that could help to improve patients’ clinical approach in emergency rooms as well as medical and pulmonology settings, clinically contextualized for cases of chest pain and dyspnea. Future studies could expand the morphological study of PI.

Background:Drug-induced interstitial lung disease (DI-ILD) encompasses a heterogeneous spectrum of potentially severe pulmonary toxicities associated with various pharmacological agents. Diagnosis is often delayed due to nonspecific symptoms and imaging findings that can mimic other ILDs or infections, particularly in patients receiving oncological or immunomodulatory therapies. Novel approaches are needed to improve early recognition and management. Methods:We conducted a non-systematic, narrative literature review across major biomedical databases up to June 2025, aimed at describing current and emerging applications of artificial intelligence (AI) and radiomics in the early diagnosis, risk stratification, and personalised management of DI-ILD. Results:Radiomics applied to computed tomography and positron emission tomography/computed tomography enables extraction of high-dimensional quantitative features capturing subclinical alterations undetectable by visual assessment. In DI-ILD (particularly immune checkpoint inhibitor-related pneumonitis), radiomic models show potential diagnostic utility in distinguishing overlapping imaging patterns and predicting fibrotic progression. Integration with clinical, radiological and pharmacogenomic data has improved model performance in several studies. Additionally, AI approaches, including convolutional neural networks and ensemble learning methods, demonstrate promise in enhancing pattern recognition and risk stratification. Conclusions:Radiomics and AI are emerging complementary tools in multidisciplinary management of DI-ILD, offering objective imaging biomarkers and facilitating multimodal data integration to improve diagnostic precision and personalised therapeutic decisions. Nonetheless, reproducibility remains limited by variability in imaging protocols and lack of large-scale prospective multicentre validation. Clinical implementation requires standardised protocols to ensure consistency and reliability. The development of transparent, interpretable models seamlessly integrated into healthcare workflows is essential to fully leverage their real-world potential in proactive patient care.

BACKGROUND:Chronic thromboembolic pulmonary disease (CTEPD) and its hemodynamic counterpart chronic thromboembolic pulmonary hypertension (CTEPH) are long-term sequelae of acute pulmonary embolism (PE), often underdiagnosed. Often, patients with CTEPD without PH may, however, develop exercise-induced PH (ExPH), a clinical condition detectable only under stress conditions. OBJECTIVE:This narrative review aims at evaluating current evidence on the role of stress testing in the early diagnosis, screening and clinical management of CTEPD and CTEPH, with a particular focus on exercise-induced hemodynamic abnormalities. METHODS:A literature search was conducted using PubMed, including observational studies, clinical trials and international guidelines published from 1998 to 2025 Studies investigating the use of cardiopulmonary exercise testing (CPET), exercise stress echocardiography (ESE), stress cardiac magnetic resonance imaging (MRI), the 6-min walk test (6MWT) and exercise right heart catheterization (exRHC) in both CTEPD and CTEPH were selected. RESULTS:Non-invasive stress tests such as CPET and ESE demonstrated high sensitivity and negative predictive value in detecting ExPH, particularly in oligosymptomatic patients with persistent symptoms after PE. ExRHC remains the gold standard for confirming ExPH, defined by a mPAP/CO slope >3 mmHg/L/min with normal pulmonary arterial wedge pressure (PAWP) and elevated pulmonary vascular resistance (PVR) during exercise. Nevertheless, due to its invasive nature and limited availability, ExRHC is not suitable for first-line screening. For early evaluation, non-invasive tests such as CPET and ESE may be preferred, as they provide a broader, safer and more accessible functional assessment. CONCLUSION:Stress testing is a valuable tool in the functional assessment of CTEPD without PH and should be systematically integrated into post-PE screening protocols. Early use of CPET and ESE allows detection of subclinical pulmonary vascular dysfunction, guiding appropriate referral and treatment, while exercise RHC should be reserved for selected cases with inconclusive findings or complex physiology.

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 AND AIM:The role of exercise testing in the follow up of patients with persistent dyspnea after pulmonary embolism (PE) is currently limited, with cardiopulmonary exercise test (CPET) mainly recommended in patients with a low probability of pulmonary hypertension (PH) at rest. METHODS:We conducted a comprehensive systematic review of studies retrieved from EMBASE and MEDLINE. When appropriate, meta-analysis was conducted. RESULTS:Twenty-eight studies were included. At CPET, pooled VE/VCO₂ slope was lower in CTEPD without PH compared to chronic thromboembolic pulmonary hypertension (CTEPH) (mean difference = 12.34, 95% CI =17.19 to 7.48, I² =76%). CPET parameters indicated more severe cardiopulmonary impairment in CTEPH than in pulmonary arterial hypertension (PAH), with a lower pooled Peak VO₂ (mean difference=-0.57 mL·kg⁻¹·min⁻¹, 95% CI=-0.94 to -0.20, I²=0%), higher VE/VCO₂ slope (mean difference=8.44, 95% CI=3.31 to 13.57, I²=19%), lower peak PETCO₂ (mean difference=-3.55 mmHg, 95% CI=-4.75 to -2.34 mmHg, I²=0%), and lower PETCO₂ at anaerobic threshold (mean difference=-3.55 mmHg, 95% CI=-4.75 to -2.34 mmHg, I²=0%). In CTEPH, peak VO2 correlated with mPAP and survival: in two studies, different VO2 thresholds were associated with survival differences of 30% and 35%, respectively. The prevalence of exercise-induced PH, assessed by exercise right heart catheterization (exRHC), was reported as 50% and 45% in two studies. DISCUSSION:CTEPH is associated with worse CPET profile compared with both CTEPD without PH and PAH. Peak VO₂ and ventilatory efficiency may have prognostic value in CTEPH, while evidence in CTEPD without PH remains largely exploratory and hypothesis-generating.

Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive respiratory rare disease characterized by an irreversible loss of lung function, with unknown etiology and poor prognosis. A population registry-based study was conducted to provide estimates of prevalence, incidence and survival of IPF. The study included all cases diagnosed with IPF in the years 2000–2022 and residing in Tuscany, Italy. Prevalence as of December 31, 2022, was calculated by sex and age class. Incidence was calculated across the period 2018–2022. Survival at 1, 5 and 10 years from diagnosis with 95

Background: Pleural effusion (PE) is a common condition where accurate detection is essential for management. Thoracic ultrasound (TUS) is the first-line modality owing to safety, portability, and high sensitivity, but accuracy is operator-dependent. Artificial intelligence (AI)-based automated analysis has been explored as an adjunct, with early evidence suggesting potential to reduce variability and standardise interpretation. This review evaluates the diagnostic accuracy of AI-assisted TUS for PE detection. Methods: This review was registered with PROSPERO (CRD420251128416) and followed PRISMA guidelines. MEDLINE, Scopus, Google Scholar, IEEE Xplore, Cochrane CENTRAL, and ClinicalTrials.gov were searched through 20 August 2025 for studies assessing AI-based TUS analysis for PE. Eligible studies required recognised reference standards (expert interpretation or chest CT). Risk of bias was assessed with QUADAS-2, and certainty with GRADE. Owing to heterogeneity, structured narrative synthesis was performed instead of meta-analysis. Results: Five studies (7565 patients) published between 2021–2025 were included. All used convolutional neural networks with varied architectures (ResNet, EfficientNet, U-net). Sensitivity ranged 70.6–100%, specificity 67–100%, and AUC 0.77–0.99. Performance was reduced for small, trace, or complex effusions and in critically ill patients. External validation showed attenuation compared with internal testing. All studies had high risk of bias in patient selection and index test conduct, reflecting retrospective designs and inadequate dataset separation. Conclusions: AI-assisted TUS shows promising diagnostic performance for PE detection in curated datasets; however, evidence is inconsistent and limited by key methodological weaknesses. Overall certainty is low-to-moderate, constrained by retrospective designs, limited dataset separation, and scarce external validation. Current evidence is insufficient to support routine clinical use. Robust prospective multicentre studies with rigorous independent validation and evaluation of clinically meaningful outcomes are essential before clinical implementation can be considered.

Background: The incidence of cancer-associated thromboembolism has been extensively investigated, but mostly in heterogeneous cancer populations. Prognostic risk assessment is crucial in pulmonary embolism, but the accuracy of the commonly used tools remains uncertain in patients with cancer. Methods: We retrospectively included outpatients with consecutive lung cancer attending the Pulmonary Unit in Pisa from July 2019 to June 2021. The study population was the subgroup of patients who developed at least one episode of pulmonary embolism. For all patients, clinical data within 72 h of pulmonary embolism diagnosis, Khorana Risk Score, and overall survival time were collected. Results: A total of 512 patients with lung cancer attended the clinic; 40 patients developed pulmonary embolism (cumulative incidence of 7.81%). Eight patients (20%) died within a month, and twenty-two patients (55%) died within 6 months. Troponin, N-terminal pro-brain-type natriuretic peptide and shock index were significantly different between survivors and non-survivors (p < 0.05). Pulmonary artery diameter and the right to left ventricle index were not significantly different between survivors and non-survivors. Patients' survival significantly decreased with the increase in Khorana Risk Score. Conclusions: Compared to previous studies, a higher incidence of pulmonary embolism in lung cancer was detected by our study. The prognosis of patients with lung cancer with pulmonary embolism seemed to be influenced more by the natural history of cancer than by the severity of pulmonary embolism. Khorana Risk Score might be considered as a prognostic tool in patients with lung cancer and may be used in the prognostic work-up for lung cancer-associated thromboembolism after a prospective validation.

Low-dose computed tomography (LDCT) screening can reduce lung cancer (LC)-related mortality, but questions remain about the duration of this effect and differences by sex and tumor histology. Extended follow-up data from the ITALUNG and LUSI trials were pooled to examine screening-related tumor stage-shifts and to estimate relative hazards for LC-related mortality, by sex and histology. Findings were compared to, and additionally combined with, those from the US National Lung Screening Trial (NLST). In ITALUNG-LUSI, screening yielded a 30% reduction of overall LC mortality up to 8 years after final screening (dilution-adjusted HR=0.70[0.51-0.96]). This reduction, however, was more pronounced for women (HR=0.49[0.25-0.96]) than men (HR=0.78[0.54-1.11]), which was confirmed in combined data of ITALUNG-LUSI plus NLST (6 years post-screening, women: HR=0.74[0.61-0.90], men: HR=0.93[0.80-1.06]; pheterogeneity=0.06). Analyses of stage-shifts and relative mortality hazards suggested that screening reduced mortality by non-small cell and non-squamous tumors in both sexes. In women (18-20%), more than among men (5-9%), screening also resulted in frequent detection of adenocarcinomas with lepidic growth. Finally, in both ITALUNG-LUSI and NLST, LDCT screening reduced the incidence and mortality for small-cell lung cancer (SCLC) among women (HR=0.63[0.43-0.94], all trials combined) but not among men (pheterogeneity=0.04). LC-related mortality reduction by LDCT screening may last until 8 or more years after cessation, and appears to be stronger for women than men, due to reduced incidence and mortality of SCLC in women only. The latter might be caused by removal of (likely EGFR-mutated, and slowly growing) adenomatous precursor lesions that over time would transform into SCLC (lineage plasticity). These findings may have major implications for the optimization of screening programs in terms of eligibility criteria and screening intervals Rudolf Kaaks, Francisco O. Cortès-Ibañez, Stefan Delorme, Erna Motsch, Verena Katzke, Claus-Peter Heussel, Hans-Ulrich Kauczor, Giulia Picozzi, Giuseppe Gorini, Francesca Maria Carozzi, Laura Carrozzi, Eugenio Paci, Donella Puliti, Mario Mascalchi. Effectiveness of lung cancer screening by sex and tumor histology: Extended, pooled analysis of the ITALUNG and LUSI trials, with comparison to findings in the NLST [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7409.

RATIONALE: Pleural fluid (PF) pH is highly specific and sensitive for identifying patients at risk of complicated parapneumonic effusion (CPPE). As PF pH and pleural fluid glucose (PFG) are strongly correlated, PFG can act as a surrogate when immediate pH measurement is unfeasible. In an appropriate clinical context, low PFG suggests a higher probability of CPPE, supporting chest drain insertion. To our knowledge, this is the first study to assess PFG measurement accuracy using point-of-care (POC) arterial blood gas analyzer (ABGA) compared to delayed standard laboratory analysis (LAB-PFG). METHODS: We enrolled adult outpatients with pleural effusion undergoing diagnostic thoracentesis at Pisa University Hospital's Pulmonology Unit. Exclusion criteria included inability to obtain informed consent or PF during thoracentesis. Glucose and pH were measured simultaneously using a GEM Premier 5000® ABGA (Werfen). PF samples were then sent to the laboratory for biochemical analysis, cytology, and microbiology. The primary outcome was to compare the accuracy of POC ABGA with standard laboratory methods for measuring PFG. Statistical analysis included Pearson correlation coefficient and Bland-Altman plot. RESULTS: A total of 31 patients were included, with a mean age of 73 ± 15 years. Pleural effusions were classified as follows: 53.6% malignant, 17.9% cardiogenic, 10.7% parapneumonic, 7.1% of other origins, and 10.7% with an indefinite diagnosis. The Pearson correlation coefficient demonstrated a strong correlation between Lab-PFG and ABGA-PFG (r = 0.99, 95% CI 0.97-0.99; P < 0.001). Mean PFG concentrations were 116.3 ± 30.1 mg/dL in the laboratory, and 111.5 ± 37.7 mg/dL with the ABGA. The Bland-Altman analysis showed a mean bias of 4.58 mg/dL between ABGA-PFG and Lab-PFG (95% LoA: -5.15 to 14.31 mg/dL). CONCLUSIONS: This study is the first to demonstrate a significant correlation between POC ABGA and laboratory-based PFG measurements. The utilization of POC ABGA for PFG assessment offers several advantages. It enables a comprehensive evaluation by simultaneously measuring PFG, pH, and hematocrit, thereby enhancing diagnostic accuracy. The rapid turnaround time, eliminating the need for laboratory sample processing, is crucial in emergencies, for critically ill patients, facilitating timely clinical decision-making. Additionally, PFG measurements are less susceptible to inaccuracies stemming from collection methods or contamination by substances such as air, lidocaine, or heparin compared to conventional pH measurements. Despite limitations, our findings suggest that POC ABGA for PFG evaluation may be both accurate and reliable. Comprehensive multicenter studies utilizing diverse ABGA devices are necessary to validate these findings and assess broader clinical utility.

Hemorrhagic complications during pleural interventions—such as thoracentesis and chest tube insertion—remain a significant clinical concern, primarily due to inadvertent injury of the intercostal artery (ICA). The highly variable ICA anatomy is frequently not visualized on conventional imaging, limiting the reliability of landmark-based techniques. Color Doppler thoracic ultrasound (CDUS) has emerged as a non-invasive, real-time modality capable of identifying ICAs and their anatomical variants prior to pleural access. This narrative review synthesizes current evidence on CDUS-guided ICA screening, focusing on its technical principles, diagnostic performance, and clinical applicability. While feasibility and utility are supported by multiple observational studies, robust evidence demonstrating a reduction in bleeding complications is still lacking. Barriers to widespread implementation include heterogeneous scanning protocols, operator dependency, and the absence of standardized training. We discuss the anatomical rationale for pre-procedural vascular mapping and highlight emerging protocols aimed at standardizing ICA visualization. Although not yet incorporated into major clinical guidelines, CDUS represents a promising tool to enhance procedural safety. Emerging AI applications may further improve vessel detection by reducing operator dependency and enhancing reproducibility. High-quality prospective studies are essential to validate potential clinical benefits, optimize implementation strategies, and support integration into routine pleural practice.

BACKGROUND:The long-term evolution of COVID-19 in patients hospitalized during the pandemic's first wave remains largely unexplored. This study aimed to identify COVID-19 pulmonary phenotypes and their longitudinal patterns over a 12-month follow-up. METHODS:COVID-19 patients discharged from Pisa University Hospital (Italy) between March-September 2020, were evaluated at T3, T12, and T24 months post-discharge. Assessments included spirometry, lung volumes, DLCO, and chest CT for those with persistent pneumonia signs (PS). Latent transition analysis (LTA) identified COVID-19 phenotypes and longitudinal patterns based on PS and lung function (PFTs). Risk factors for these patterns were evaluated using multinomial logistic regression. RESULTS:Of 307 discharged patients, 175, 136, and 33 were followed-up at T3, T12, and T24, respectively. At T12, 21.6 % had impaired DLCO, 4.4 % a restrictive ventilatory pattern, and 31,6 % still had PS, persisting until T24. LTA identified three cross-sectional phenotypes at both T3 and T12 (no PS with normal PFTs; PS with normal PFTs; PS with impaired PFTs), and four longitudinal patterns from T3 to T12: persistence of no PS with normal PFTs (47.9 %); resolution of both PS and PFTs (15.4 %); persistent PS (36.7 %), either with (11 %) or without (25.7 %) impaired PFTs. The last two patterns correlated significantly with longer hospitalization, more comorbidities, and severe COVID-19. CONCLUSIONS:In our cohort of COVID-19 patients hospitalized during the pandemic's first wave, we observed distinct pulmonary phenotypes and longitudinal recovery patterns. More comorbidities and severe acute disease correlated with worse progression up to 24 months, suggesting long-term monitoring for such patients.

Background: Idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) are chronic conditions often accompanied by a prothrombotic state. Antifibrotic therapies, including nintedanib and pirfenidone, have demonstrated efficacy in slowing disease progression. Despite the known interactions between coagulation pathways and fibrotic processes, there is a lack of data in the literature on the safety of the concomitant use of anticoagulants and antifibrotics. Objectives: This study aimed to evaluate the safety and clinical impact of combining antifibrotics and anticoagulants in patients with IPF or PPF. A single-center, retrospective study was conducted on 137 patients diagnosed with IPF or PPF, 25 of whom were on concurrent anticoagulant therapy (AC+). Baseline demographics, pulmonary function tests (PFTs), bleeding risk scores (HAS-BLED, RIETE), and clinical outcomes were analyzed over a 12-month follow-up period. Methods: Statistical analyses included t-tests, χ2 tests, Kaplan–Meier survival analysis, and multivariate logistic regression. Results: Two clinically relevant bleeding events were observed, with one in the AC+ group. No major bleeding episodes occurred in either group. Baseline forced vital capacity (FVC) was lower in the AC+ group (73.4 ± 16.9% vs. 83.0 ± 21.9%; p = 0.04), but no significant differences were observed in FVC, forced expiratory volume (FEV1), or diffusing capacity for carbon monoxide (DLCO) at 6 and 12 months. Survival rates and radiological progression were comparable between groups. Multivariate analysis revealed that DLCO was an independent predictor of mortality (HR 0.84; p = 0.005), while anticoagulant use was not. Conclusions: The concomitant use of antifibrotics and anticoagulants appears safe, with no significant increase in bleeding risk or adverse effects on disease progression. Future prospective studies are required to confirm these findings and explore the long-term impact of this therapeutic combination.

BACKGROUND: Emphysema Severity Index (ESI) is a novel parameter that describes, through a mathematical biomechanics model of the airways, the curvilinear shape of the expiratory portion of the flow/volume curve to evaluate the emphysema contribution to the obstruction detected by spirometry. It has been successfully applied in COPD patients and in adult and geriatric populations. AIM: to assess the usefulness of ESI in a general population sample with low prevalence of chronic respiratory diseases. METHODS: A general adult population sample of Pisa (Central Italy) participated in an epidemiological survey through standardized questionnaire and spirometry, within EU-funded project “Indicators of Monitoring COPD an Asthma II” (2009-11). 685 had valid lung function data with hospital admissions up to 2017. The input variables for the ESI computing algorythm are Peak Expiratory Flow, Forced Vital Capacity (FVC) and the Forced Expiratory Flows at 25%, 50% and,75% of FVC. Input variables are in absolute value, independent from percent reference data. ESI is a numerical value ranging from 0 (no emphysema) to 10 (very severe emphysema). Statistics included descriptive analyses, Kruskas-Willis non parametric test and logistic regression models (significance level p≤0.05). RESULTS: the sample main characteristics were: 52.7% females, 53.5+16.6 yr age, 55.5% ever smokers, 50.7% with occupational exposure, 61.6% exposed to vehicle traffic, 15% with lifetime respiratory hospital admissions. The value of ESI in the Pisa general population sample was: 1.16±0.78 (mean±SD), 0.98-0.39 (median-IQR). ESI had significantly higher values in males, ex-smokers, elderly, in subjects reporting family history of respiratory disease, rhinitis, phlegm, diagnoses of asthma, chronic bronchitis, emphysema, COPD and in those with limited daily activities, higher numbers of doctor visits and hospital admission for respiratory disease. For each ESI unit increment, there were increased 12-month emergency department visits (OR 1.61, 95%CI 1.13-2.29), medical visits (OR 1.67, 1.29-2.17), daily activity limitations (OR 1.33, 1.02-1.73) and respiratory hospital admissions (OR 2.26, 1.38-3.70). DISCUSSION: ESI is associated with environmental risk factors, symptoms and diagnosis of chronic respiratory disease in a general population sample living in a middle town in Italy. ESI may be a useful indicator for the early identification of subjects most likely to use health services.REFERENCES: 1) Occhipinti M, et al. Validation of a method to assess emphysema severity by spirometry in the COPDGene study. Respir Res. 2020;21(1):103. 2) Luoto J, et al. Emphysema severity index (ESI) associated with respiratory death in a large Swedish general population. Respir Med. 2022;200:106899.