Objectives: To compare positive airway pressure (PAP) adherence between patients with or without excessive daytime sleepiness (EDS) in mild, moderate and severe obstructive sleep apnea (OSA). Methods: Patients >18 years diagnosed with OSA in 2018 and 2019, without previous history of PAP usage and with adherence registration in the first medical consultation after treatment initiation, were included. EDS was defined as a score of >10 on the Epworth Scale. Patients were divided into two groups according to the adherence to PAP: "Adherent" if using the device for >4 h for >70% of the nights and "Nonadherent" otherwise. Simple and multiple logistic regression models for adherence were determined.Results: 321 patients were included, most male (64.2%), with mean age 56.56 years. Most patients had severe OSA (n = 159; 49.5%), and median AHI was 29.3/h [16.8; 47.5]. Being older or having a severe OSA resulted in an increased adherence (OR = 1.020, CI95% = [1.002; 1.039] and OR = 2.299, CI95% = [1.273; 4.191], respectively). In patients without EDS a statistically significant difference was found in adherence between those with severe OSA and both mild and moderate OSA categories (OR = 0.285, p = 0.023 and OR = 0.387, p = 0.026, respectively), with patients with severe OSA being adherent. There was no sta-tistical difference in adherence between patients with or without EDS (OR 1.083; p = 0.876), nor in the different degrees of severity in those with EDS.Conclusion: In our study there were no differences in PAP therapy adherence between patients with or without excessive daytime sleepiness. Older age and higher OSA severity resulted in higher adherence rates.& COPY; 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The most accessible and widely used Pulmonary Function Test (PFT) is spirometry, however it is unable to measure static lung volumes, essentials to support the diagnosis of hyperinflation or lung restriction. This study aimed to fill this gap by using Machine Learning (ML) models to predict these values and to make an automatic classification of patient's ventilatory pattern. This is a retrospective study with 8140 anonymized PFTs containing biological, anthropometric, spirometric and whole-body plethysmography's data, in which we applied seven ML models for classifying the ventilatory pattern and three to infer the values of Residual Volume (RV), Total Lung Capacity (TLC) and RV/TLC. The model with the best performance for classification was the Extreme Gradient Boosting (XGboost), with an area under the curve ROC (AUC) of 0.881 for air trapping (identification of presence/absence of elevated RV/TLC) and an AUC of 0.874 for the ventilatory pattern (identification as normal static lung volumes, large lungs, hyperinflation, air trapping, simple restriction or complex restriction). In terms of regression, the algorithm with the best performance was the Linear Regression (LR), with a R2 of 0.539 to predict the value of RV, for the prediction of TLC, LR had an R2 of 0.856, for the RV/TLC the R2 was 0.752 and for the RV/TLC's z score had an R2 of 0.442. This research demonstrates the viability of incorporating ML into spirometry to provide a more comprehensive analysis of lung function. By incorporating these techniques, we can gain deeper insight into patient's lung health, supporting more accurate diagnosis and treatment plans.

Background: Chronic Obstructive Pulmonary Disease (COPD) results of the interaction between genetic and environmental factors. The influence of the gender is still controverse. Aim: Assess gender differences regarding proportion and predicted factors for COPD diagnosis. Methods: We included individuals aged ≥40 years with smoking habits ≥10 pack year (PY), who performed spirometry in a Lung Function Laboratory of Hospital da Luz Lisbon for 4 months. Individuals with respiratory disease, under bronchodilator and respiratory symptoms (RS) unknown were excluded. Standardized and non-standardized coefficients logistic regression models for COPD diagnosis for both genders were determined using as predictors age, body mass index (BMI), smoking status, PY and presence of RS. A global logistic regression model was also obtained. Results: We included 241 individuals, 134 were male. The COPD diagnosis was 20.9% within male group and 13.1% within female group, without differences (p=0.156). Age was a risk factor for COPD (male:OR 1.052; CI95% 1.002-1.109.female: OR 1.108; CI95% 1.021-1.216) as well as the presence of RS (male:OR 4.990; CI95% 1.863-14.544.female: OR 3.818; CI95% 1.014-17.662). Current smoker status had a significantly greater risk among female (OR 7.5834; CI95% 1.545–62.870 vs OR 0.9317; CI95% 0.316-2.728). The presence of RS had the highest absolute coefficient for the male and the current smoker status for the female model. Interaction between gender and current smoker status was statistically significant (p=0.048). Conclusion: We did not find differences in COPD prevalence between gender. Different factors could be related with different risk for COPD according the gender. Current smoker seems to have higher risk among female.

Severe asthma is defined as either refractory to traditional therapies or controlled only with therapies that have intolerable side effects. Biological agents are known to offer treatment alternatives to patients with type 2 inflammation severe asthma. We describe the case of a woman with a long history of type 2 inflammation severe asthma, with uncontrolled symptoms and need of systemic corticosteroid therapy as prevailing features, and with respiratory failure that differentiated her from other patients with severe asthma.

Introduction: Lung function testing are a crucial test in pneumology and are safe and well-integrated in clinical practice. Despite that, lung function testing might be uncomfortable to some patients and there’s a risk of incidents occurring. Checklists are cognitive tools that help the execution of some tasks and are an essential tool on risk management and injury prevention. Objective: Improvement patient safety during lung function testing through the implementation of a safety checklist. Methods: A safety checklist was created and implemented to apply before lung function testing. Worksheets were the tool used to collet information before and after the checklist implementation. Simple descriptive statistics and Fisher’s exact test were used with an α = 0,05. Results: The worksheet fulfilment was completed in 83% and there were no statistic significant differences in the studied variables. Despite that, the number of contraindications detected doubled after the checklist implementation. Conclusion: A safety checklist implementation before lung function testing improved the detection of contraindication to lung function testing. We suggest the application of this list in lung function setting to improve patient safety. Continuous improvement and education of health professionals is essential in understanding and applying this kind of risk management tools.

Background: Early (EOA) and late-onset asthma (LOA) are widely used as phenotypic classifications. Several clusters have been described. This study’s goal is to compare major aspects of these two phenotypes. Methods: A retrospective study of adult patients with asthma diagnosis observed in our Asthma clinic between 2012 and 2016. Patients were divided into EOA (onset < 18 years old) and LOA (onset > 18 years old) groups and their data was statistically analysed. Results: 606 patients were included, 351 had EOA and 233 LOA. In the EOA group, 71.2% were women (N=250), 47.3% (N=116) had smoking history and 27.1% (N=95) were obese. Rhinitis was found in 298 patients (84.9%), gastroesophageal reflux disease (GERD) in 71 (20.2%), anxiety or depression in 30 (8.5%), cardiac disease in 29 (8.2%). Atopy was found in 50.1% (N=176) of patients in which tests were performed. Mean FEV1 was 81.4% (sd 20.2). Mean exacerbation number during follow up period was 1.1 (sd 2.0). In the LOA group, 70.8% (N=165) were women, 33.9% (N=79) had smoking history and 31.3% (N=73) were obese. Rhinitis was found in 197 patients (84.5%), followed by GERD in 82 (35.1%), anxiety or depression in 35 (15.0%), cardiac disease in 30 (12.8%). Atopy was found in 45.5% (N=106) of cases in which tests were made. Mean FEV1 was 86.7% (sd 20.6). Mean exacerbation number during follow up period was 0.9 (sd 1.6). Statistically significant differences regarding atopy (p-value < 0.001) and mean FEV1 (p-value 0.015) were identified. Conclusion: Patients with EOA had more atopy and more severe airway obstruction. Although they exacerbated more often, this was not statistically significant. The lack of other statistically significant differences may be due to small sample size.

Background: OHS and COPD are both common respiratory conditions that can lead to chronic hypercapnic respiratory failure with the need for domiciliary NIV. Variability of NIV practice is a known issue. The aim of this study was to investigate differences regarding baseline characteristics and adherence between both conditions. Method: A retrospective analysis of patients observed in our chronic respiratory failure clinic between 2016 and 2018 was performed. Patients with OHS and COPD were selected and compared regarding baseline characteristics and adherence at the first evaluation after NIV setup. Adherence to treatment was evaluated by the mean use hours per night. Results: 94 patients were included. 57 were OHS and 37 were COPD patients. Baseline characteristics according to each group are summarised in table 1. There were statistically significant differences between gender, prevalence of heart failure, BMI, EPAP and pCO2 value. A tendency to poor adherence in COPD patients was observed. Conclusion: The tendency to poor compliance to NIV of COPD patients may justify the higher pCO2 values found and contribute to the difficulty of demonstrating NIV benefits in these patients in several studies. New strategies to improve adherence should be researched.

Introduction: Obstructive sleep apnea (OSA) is characterized by excessive narrowing or complete obstruction of supraglottic airway during sleep. Variations in subglottic airway function may also influence supraglottic airway. Previous studies have suggested a protective role of increased air trapping in OSA severity but data are limited. Objective: To determine whether there is a relationship between pulmonary function and OSA severity. Methods: A retrospective analysis of patients who performed a cardiorespiratory polygraphy (CRP) in our hospital in 2015 and 2016 was conducted. Adults diagnosed with OSA who performed pulmonary function tests (PFT) were selected and characterized regarding demographics and pulmonary function. Results: 834 CRP were performed and 374 patients were included with a mean age of 61.7±13.3 years. 61% were male. Mean BMI was 34±6.9 kg/m2. OSA was mild (apnea–hypopnea index [AHI] 5-15) in 42%, severe (AHI > 30) in 35% and moderate (AHI 15-30) in 23%. PFT demonstrated an obstructive pattern in 18.2%, restrictive in 11.8%, nonspecific in 5% and were normal in 65%. Mean FEV1 was 88.1±21.7% of predicted and mean RV was 116.2±27.8% of predicted. FEV1 was negatively correlated with AHI. FEV1 < 100% of predicted had an odds ratio of 1.7 for AHI > 30. FEV1 < 60% of predicted had an odds ratio of 0.4 for AHI > 30. RV > 180% of predicted had an odds ratio of 0.3 for AHI > 15. Conclusion: In our population, a decrease in FEV1 (even among normal values) was associated with an increased risk of severe OSA but this was not true for FEV1 < 60% of predicted. This degree of FEV1 reduction was a protective factor along with RV > 180% of predicted. This points to a possible protective role of air trapping in OSA severity.

Introduction: Lung cancer is a major cause of morbidity and mortality. Lung cancer patients have more visits to the emergency room compared to patients with other types of cancer that results in increased number of admissions and high in-hospital mortality. Aim: Identification of major causes of hospitalization and mortality concerning patients with lung cancer. Materials and Methods: Review of clinical files of patients admitted in the Pulmonology ward of our hospital from January 2016 to December 2017 with lung cancer, according to demographic characteristic, comorbidities, pathology, clinical stage, diagnosis at discharge and outcome. Results: We analysed 104 patients (153 admissions), 80% were male, with average age of 65.4±10.2 years (min42, max85). 85% had active or past smoking habits. Chronic obstructive pulmonary disease was seen in 21%. 9 patients had a previous diagnosis of inactive cancer from another location. 50% of the patients had adenocarcinoma. At admission most of the patients had advanced stage disease (83%). The most frequent diagnosis at the time of discharge was respiratory infection (29%), followed by disease progression (17%). As for outcome, there were 34 deaths (22%), 94% had advanced disease. The main diagnoses of the deceased group were respiratory infection (10) and disease progression (10). Conclusion: Respiratory infection was the major cause of admission. We found that smoking habits (OR:8.85, p value:0.038); advanced stage disease at admission (OR:3.88, p value:0.076), disease progression as cause of admission (OR:2.27, p value:0.081) and previous diagnosis of cancer from another location (OR:2.88, p value:0.089) had a statistically significant association with mortality.

A solitary pulmonary nodule (SPN) is a common and increasing clinical problem. Differential diagnosis is broad and often challenging, mainly in patients with previous cancer. Aim: Analyze patients with SPN and previous cancer and compare metastatic and primary lung cancer (PLC) lesions. Patients with SPN on computerized tomography scan and history of cancer (except basal cell carcinoma) who underwent surgical resections between January 2015 and December 2017 at Hospital da Luz–Lisboa were included. All cases were evaluated at a multidisciplinary lung cancer tumor board team meeting. We analyzed histology, demographic and radiological features. p-values ≤0.05 were considered significant. There were included 29 patients with history of cancer: 12 colorectal, 8 breast, 4 genitourinary, 4 lung and 1 sarcoma. PLC was diagnosed in 15 (51.7%), metastasis in 11(37.9%)- 8 colorectal, 1 genitorectal, 1 atypical lung carcinoid and 1 sarcoma - and benign lesions in 3. Surgery was the diagnosis procedure in 24(82.8%)–17 with frozen section. There were no significant differences between primary and metastatic neoplastic lesions in gender, age and smoking history (p>0.05). All subsolid nodules (n=5) were PLC. In solid neoplastic SPN, 10 PLC and 11 metastasis, there was no difference in diameters. Irregular edge was associated with PLC lesions (p=0.008) and smooth margin with metastasis (p=0.001). Lobulated margins did not seem differentiate neoplastic lesions (p=1.0). PLC is an important diagnosis in the differential diagnosis of NPS, including in patients with a history of cancer. Radiological features can help to discern primary to metastatic SPN in this group.

Introduction: Individuals with respiratory disease are at risk of hypoxaemia during air travel. Several methods have been used, however, the hypoxic challenge testing (HCT) is nowadays the preferred method to predict it. The relation between air travel hypoxaemia, baseline lung function tests (LFT) and arterial oxygenation has been studied with discrepant data. Aim: Assess the correlation between PaO2 on HCT and LFT, resting sea level PaO2 and SpO2. Methods: Included all respiratory patients who performed LFT and HCT between January 2016 and December 2017 at Hospital da Luz Lisboa (private hospital). HCT was performed and analyzed according to British Thoracic Society recommendations (2011). Median (me) was shown. Pearson correlation (r) was used. P value ≤0.05 was considered significant. Results: Fifteen respiratory patients were included: 5 chronic obstructive pulmonary disease, 2 asthma, 2 pneumectomy, 2 obstructive sleep apnea and 4 other respiratory diseases. Seven patients (46.7%) had a positive HCT. Correlation between PaO2 on HCT (mmHg) (me=55.0) and FEV1 (%) (me=76.5; r=0.390, p=0.150), FEV1 (mL) (me=1485.0; r=0.503, p=0.096), FVC (%) (me=97.7; r=0.407, p=0.148), FVC (mL) (me=2465.0; r=0.559, p=0.059), DLCO (%) (me=66.9; r=0.444, p=0.097) and resting sea level PaO2 (mmHg) (me=69.0; r=0.562, p=0.072) was not significant. A positive correlation was observed between PaO2 on HCT and sea level SpO2 (%) (me=95.0; r=0.674, p=0.006). Conclusions: In this sample of respiratory patients, there is a moderate correlation between baseline SpO2 and PaO2 on HTC. LFT did not predict PaO2 on HTC. HTC remains an essential tool to evaluate if respiratory patients need in-flight oxygen.

Background: Obstructive sleep apnea (OSA) is a disease with a high impact on quality of life, morbidity and mortality. The relationship between obesity and OSA is well established. Aim: In our study we analyzed the effect of bariatric surgery (BC) on an OSA population of obese patients and at what weight loss a control sleep study should be scheduled. Methods: A total of 51 obese (BMIu003e 30Kg/m2) patients proposed for BC with an apneia/hipopneia index (AHI) u003e 5/h were included between 2015 and 2017. All performed a level 3 home sleep recording (HSR) before and after BC. The test statistics software used was SPSS 19.0 (t test for pared samples and multiple linear regression, significant level α = 0.05). Results: From the 51 patients evaluated 62.7% (32) were female, with a mean age of 49.61±11.88 years old. The average of weight lost that results in an improvement of IAH in this study population is 24 kg [age (p = 0.014); AHI (p = 0.05); R = 0.504 (p = 0.001)]. Conclusion: We concluded that BC can be an effective treatment for obese OSA patients with a significant impact in AHI, BMI, P90 as well as in OSA severity. Also, the ideal time to access therapy success by performing an HSR, based on a regression model for this study population, is after a loss of ≈ 24 kg after surgery.

Introduction: An increased risk for lung cancer (LC) in interstitial lung disease (ILD) patients, mostly idiopathic pulmonary fibrosis, has been described. Data regarding LC development and clinical features in connective tissue disease (CTD)-related ILD are scarce. Objective: Access the incidence of LC in CTD-ILD patients and its clinical significance. Methods: Patients observed in our ILD clinic between 2012 and 2017 were reviewed. Those with CTD-ILD were selected and characterized regarding demographics, smoking habits, functional and radiologic findings and LC histology, stage and treatment. Results: Among 223 ILD patients, 8.5% (n=19) had CTD-ILD. 63% were female. Mean age at diagnosis was 69.3±11.8 years. 58% were never smokers, 32% previous and 10% current smokers. 42% had rheumatoid arthritis (RA), 16% sjögren syndrome (SjS), 10.5% systemic sclerosis, 10.5% dermatomyositis, 10.5% antisynthetase syndrome and 10.5% systemic lupus erythematosus. Mean follow up since ILD diagnosis was 35.7±23.8 months. During this period, LC incidence was 10.5% (n=2). Both patients were male, above 65 years and former smokers. One had RA-related UIP with GAP index 3 and was on prednisolone. He was diagnosed with squamous cell carcinoma (SCC) stage IB and treated with stereotactic body radiation therapy. 16 months later, disease progressed and he died in 1 month (21.6 months after LC diagnosis). The other was diagnosed with SjS-related NSIP (GAP index 2) and SCC stage IIIB, began chemotherapy and died in 1 month. Both deaths were cancer related. Conclusion: LC in CTD-ILD patients is an important comorbidity with an incidence of 10.5% in our population. ILD limited LC treatment and LC adversely affected overall survival.

Introduction: Dynamic hyperinflation (DH) presents itself as a pathophysiological consequence of exercise. It has been broadly described in obstructive ventilatory patterns, such as chronic obstructive pulmonary disease (COPD) and asthma, as the responsible entity for exercise intolerance. However, expiratory flow limitation during exercise has been described in individuals without obstructive lung disease, such as athletes, obese and elderly. Objective: Identify DH phenomenon during exercise in individuals with exercise intolerance not explained by their lung function at rest. Methods: Cardiopulmonary exercise testing (CPET) was performed in a private hospital, between January 2017 and January 2018, to evaluate exercise intolerance. Metabolic, cardiovascular and ventilatory responses to incremental load exercise were analyzed. In order to evaluate DH, flow-volume loops with inspiratory capacity evaluation were performed during rest and exercise. Patient’s demographics and smoking habits were also recorded. Results: 22 out of a total 49 CPET were performed with flow- volume loops at rest and during exercise. All of the 22 patients presented normal spirometry at rest and complained of exercise intolerance. DH was detected in 11 (50%) patients, with peak oxygen uptake and peak work rate higher than predicted. Mean age was 54.82±18.32 years old, 3 were women, 4 were never smokers, 5 were previous and 2 were current smokers. The mean BMI was 29,61±8,34 kg/m2. Conclusion: CPET is the gold standard test for evaluation of exercise intolerance. The analysis of flow–volume loop may seem useful to identify ventilatory constraint, but its clinical utility requires further study.

Introduction: Dyspnea is a very common symptom in clinical practice. Its etiological investigation is fundamental to guarantee appropriate treatment and symptomatic relief. When evaluation at rest is inconclusive, cardiopulmonary exercise testing (CPET) may represent a useful tool in identifying exercise limiting factors. One possible diagnosis is disproportionate hyperventilation (DHV) which represents a greater than expected ventilatory adaptation to incremental exercise, in the absence of any pathological cardiopulmonary limitation. It is fundamental to identify these cases since respiratory education and physiotherapy strategies may minimize this symptom. Objective: Identify DHV as a cause of dyspnea and exercise intolerance. Methods: A retrospective analysis of CPET performed between May 2012 and August 2016 in patients with exercise intolerance was done. A cycle ergometer and an incremental protocol until maximal exercise tolerated by the patient or ending by medical order were used. Results: 364 CPET were included and DHV was diagnosed in 9 female patients, nonsmokers, with mean age of 46.3±21.8 years. In these patients, the following mean values were identified: maximum work load 85.1±20.6 watts (88.0±23.6%), peak oxygen consumption 24.1±7.0 mL/kg/min (87.4±13.0%), anaerobic threshold (AT) 17.3±5.4 mL/kg/min (60.4±13.2%), respiratory reserve 45.0±20.0%, cardiac reserve 18.9±12.6 beats per minute, mean oxygen pulse 98.8±12.9%, VE/VCO2 at AT 35.0±6.7, VE/VO2 at peak oxygen consumption 42.6±9.7, VE/VO2 at AT 35.7±6.4 and maximal RER 1.4±0.2. Conclusion: Identifying DHV as an exercise limiting factor may lead to the appropriate treatment, reducing dyspnea and exercise intolerance.

The role of body weight in the diagnosis of obstructive sleep apnea (OSA) is well known although the mechanisms through which this occurs remain a subject of discussion. Our hospital employs routine screening for OSA in bariatric surgery candidates regardless of sleep complaints. Our aim was to compare morbidly obese patients (body mass index (BMI) ≥ 40kg/m2) with and without OSA regarding age, sleepiness (using the Epworth scale and considered positive if >12/24), smoking habits, snoring and medical comorbidities. Patients were screened with a type III cardio-respiratory polygraphy. Out of a total of 264 screened patients, 37 (14%) had a negative polygraphy, all women. We retrospectively compared this group with 38 women with moderate to severe sleep apnea. Significant differences between apnea and non apnea patients were respectively seen in age (p The fact that only women had negative studies confirms that there are significant gender related differences in the upper airway, fat distribution and respiratory stability in OSA. This gender difference decreases as age increases which might explain the difference in age between both groups. Metabolic syndrome was more prevalent in patients with OSA even though all were morbidly obese. Both groups had similar complaints of sleepiness evaluated by the Epworth scale. Metabolic syndrome in this group of women seems to play a role in OSA that is independent of BMI and those patients should be carefully screened for cormobidities and OSA independently of having symptoms. In morbidly obese women sleepiness was not related with the presence of OSA.

Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep disorder and is prevalence increases in the overweight population. The STOP-BANG questionnaire is a validated diagnostic tool, in which a score ≥3 has a high sensitivity in OSAS detection but a relatively low specificity. The objective of this study is verify if the association between sodium bicarbonate and the STOP-BANG questionnaire increases the specificity, with minimal effect in sensitivity. Subjects included were overweight patients referred for a polygraphic sleep study, which had also an arterial blood gas analysis in the same time period. Anthropometric data, as well as the results of the STOP-BANG were collected. Of the 141 patients studied, the mean age was 51 years, 35.5% were male, with an average BMI of 39.7 kg/m 2 . According to the polysomnographic study, 60% of patients had OSAS and the mean AHI was 17.3/h. The analysis of STOP-BANG showed a 85% sensitivity and 43% specificity for an AHIu003e5/h, with an increased sensitivity to 90% for moderate/severe OSAS and 97% for severe OSAS. When adding the HCO3 − values to the analysis, the specificity was increased (98%), but with markedly decreased sensitivity (15%). With the two steps method analysis the results showed a sensitivity of 44% and a specificity of 91%. In assessing the ROC curves, it shows that the STOP-BANG has an area of 0.738. In association with HCO3 − values has an area of 0.772 and using the two steps method the area is 0.811. In conclusion, STOP-BANG questionnaire has an important value in the screening of OSAS. However, for a more effective ranking, the addiction of HCO3 − values in overweight patients who have intermediate degrees of the questionnaire is essential

Introduction: Lisbon has an intermediate incidence of tuberculosis (TB). Flexible bronchoscopy can assist in diagnosing TB in patients with a negative smear microscopy. Earlier diagnosis by means of faster laboratory tests such as nucleic acid amplification tests (NAAT) is essential in controlling disease transmission. Objectives: Analyze the yield of bronchoscopy in diagnosing pulmonary TB and compare smear microscopy, culture and NAAT using GenoType MTBDRplus ver2.0. Methods: A retrospective analysis of TB patients hospitalized in the Infectious Disease’s ward between January 2013 and April 2016 was performed. Patients subjected to flexible bronchoscopy were selected and characterized regarding demographics and microbiological exams. Results: Fifty-eight patients were included with a mean age of 44±19 years and 71% were males. Diagnosis was confirmed by bronchoscopy in 41 (71%). Smear microscopy sensitivity was similar in bronchial wash (BW) and bronchoalveolar lavage (BAL): 39% vs 31%, p value 0.43. Culture sensitivity was also similar in BW and BAL: 70% vs 62%, p value 0.42. Culture sensitivity was superior to smear microscopy in both BW and BAL (BW: 70% vs 39%, p value <0.05; BAL: 62% vs 31%, p value <0.05). NAAT was performed in 25 BAL samples and was positive in 16 (64%). Its sensitivity was superior to smear microscopy (64% vs 24%, p value <0.05) and similar to culture (64% vs 60%, p value 0.77). Conclusion: Bronchoscopy led to diagnosis confirmation in 71% proving its importance in diagnosing pulmonary TB. NAAT sensitivity was similar to culture. NAAT is a faster diagnostic test allowing earlier treatment initiation and contributing to better control disease transmission.