The study protocol describes a randomized controlled trial designed to evaluate the impact of a Multimodal Educational Program (MEP) based on the VARK model on asthma control, quality of life, and medication adherence among children aged 7-15 years diagnosed with asthma. Data will be collected at baseline, one month, and three months post-intervention with allocation concealment and blinded data collection to ensure rigor.

In a cohort of 323 children hospitalized for preschool wheeze, 35.6% developed persistent wheeze/asthma after age five. Median blood eosinophil counts (BEC) were significantly higher in children with later asthma (0.30 × 10³/μL) compared to those without (0.14 × 10³/μL; p < 0.001). BEC alone had modest predictive ability for later asthma (AUC 0.673) and improved prediction when combined with five clinical factors (AUC 0.789). A BEC threshold of 0.57 × 10³/μL provided high specificity (92.8%) but low sensitivity (30.4%) for identifying later asthma.

In a study of 134 children aged 2-15 years with prior spacer use presenting with acute wheezing or asthma exacerbations, 63.4% of participants had a high level of knowledge about spacer use. Caregivers performed better than autonomous children (77.7% vs 30%). Better knowledge was associated with younger age and pediatric pulmonology follow-up in children and inversely associated with age in caregivers. Despite generally favorable knowledge, technique errors were frequent, especially among autonomous children.

The study identified 39 candidate genes related to autophagy and inflammation in childhood asthma, from which 10 key genes were selected using machine learning to construct a diagnostic model achieving AUCs of 0.768, 0.751, and 0.710 in training, test, and validation datasets respectively. Functional analyses showed these genes are involved in signaling, metabolic, and immune-regulatory pathways and correlate with immune cell infiltration. Mendelian randomization suggested a potential causal relationship between STYXL1 gene expression and childhood asthma risk. qPCR validation in a small cohort of 5 patients and 5 controls showed consistent gene expression patterns with transcriptomic data.

An explainable SVM machine-learning model was developed to classify physician-diagnosed childhood asthma status using NHANES data from 6,437 children aged 2-14 years, achieving a mean PR-AUC of 0.294 during training and 0.312 (95% CI: 0.268-0.370) in the held-out test set; the model demonstrated moderate discrimination with sensitivity 0.672 and specificity 0.740 at the selected threshold.

A 14-year-old male with a rare restrictive cor triatriatum sinister was initially misdiagnosed with refractory asthma. He presented with palpitations and was found to have severe post-capillary pulmonary hypertension (estimated pulmonary artery pressure of 85 mmHg, catheterisation pressures: PA 50/30 mmHg, mean 39 mmHg; PCWP 28 mmHg) and right-sided heart changes. Surgical resection of a calcified membrane was successfully performed following confirmation of reversible pulmonary vascular resistance (PVR/SVR ratio 0.12).

Asthma prevalence is increasing among older adults globally, especially in developed regions and Asia, but underdiagnosis and undertreatment are widespread due to diagnostic challenges, patient-related barriers, and limited access to advanced therapies.

The 2026 GINA Strategy Report emphasizes personalized, evidence-based asthma care using the Assess-Adjust-Review cycle to improve symptom control and reduce future risks. It strongly recommends inhaled corticosteroid-containing treatments for all age groups and advises against SABA-only treatment. For adults and adolescents, low-dose ICS-formoterol as an anti-inflammatory reliever is preferred due to its significant reduction in severe exacerbations compared to SABA-based regimens. The report includes updated guidance on severe asthma phenotyping, biologic therapy selection, and acute exacerbation management.

In patients with asthma across varying severity (NAEPP steps 1-5), inhaled corticosteroid (ICS)-containing reliever therapies (ICS-formoterol or ICS+SABA) demonstrated improved outcomes compared to short-acting beta2-agonists (SABA) alone, with strong recommendations for their use as-needed in lower steps and as maintenance-and-reliever therapy in higher steps.

The guideline strongly recommends as-needed ICS-formoterol or ICS+SABA over SABA-only therapy in patients at NAEPP steps 1 and 2, and strongly recommends maintenance-and-reliever therapy (MART) with ICS-formoterol over scheduled ICS-LABA plus as-needed SABA in patients at NAEPP steps 3-5. Conditional recommendations favor as-needed ICS-SABA over scheduled ICS with as-needed SABA at steps 1 and 2, and ICS+SABA reliever over SABA reliever in those at steps 3-5 using scheduled maintenance ICS-LABA. These recommendations emphasize reducing severe exacerbations and minimizing corticosteroid exposure.

Asthma in middle-aged adults is associated with impaired sleep quality and increased insomnia symptoms, including difficulties initiating sleep, maintaining sleep, and early morning awakening. Allergic rhinitis, chronic rhinosinusitis, asthma symptoms, exacerbations, snoring, sleep apnea, and nocturnal gastroesophageal reflux were linked to worse sleep outcomes. The strongest associations with impaired sleep and insomnia symptoms were observed in individuals with uncontrolled asthma combined with chronic rhinosinusitis and nocturnal breathing disorders and reflux.

An 88-year-old woman with refractory wheezing and transient corticosteroid response was diagnosed with primary tracheal B-cell lymphoma causing airway stenosis, which was markedly improved by emergency radiotherapy.

Circulating immune cells from severe asthma patients exhibit reduced cytokine responses to RV-A16 infection ex vivo, showing decreased levels of IFNα, IFNγ, CCL5, TNFα, IL-1β, IL-6, and IL-8 compared to healthy subjects, with the exception of CCL2 which was not reduced.

The metabolic reprogramming of Th17 cells via the mitochondrial oxidative phosphorylation (OXPHOS) pathway sustains their survival under corticosteroid treatment and promotes the production of LIGHT, which drives airway remodeling in mixed granulocytic asthma (MGA). LIGHT activates the MMP9-dependent TGFβ pathway to induce remodeling, while OXPHOS regulates RORγt expression essential for Th17 differentiation and promotes osteopontin expression necessary for fibroblast activation. Dual blockade of LIGHT and OXPHOS reverses airway remodeling, inflammation, and restores Treg cell numbers in a murine model of MGA.

Parental strictness/supervision was negatively correlated with absolute measures of peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) in children with cystic fibrosis, and was independently associated with lower inspiratory muscle strength (MIP%) (β = -0.767, p = 0.003). Total perceived social support showed a positive association with exercise capacity as measured by the Modified Shuttle Walk Test percentage (MSWT%) (β = 0.439, p = 0.014), although the overall regression model was not statistically significant (p = 0.059). No independent associations were found with FEV1% for either parental attitudes or social support after adjustment.

In cystic fibrosis (CF) mice, reduced femur length and lower serum IGF-1 levels compared to wild-type were observed at 4 weeks under specific pathogen free (SPF) conditions but not under germ-free (GF) conditions, indicating that gut microbiota contribute to early postnatal skeletal growth impairment. By 14 weeks, femur lengths and IGF-1 levels were similar regardless of microbiota presence, and CF mice showed slower growth only during 1 to 4 weeks under SPF conditions. Additionally, CF mice displayed greater gut dysbiosis at 4 weeks compared to 14 weeks.

In a case series of eight pregnant women at risk of having a fetus with cystic fibrosis, two women took the CFTR modulator elexacaftor/tezacaftor/ivacaftor (ETI) during pregnancy. In one infant homozygous for the F508del variant with fetal signs of worsening bowel obstruction, ETI initiation at 27 weeks gestation was followed by birth without meconium ileus. In a second case with mixed CFTR variants, prenatal ETI was associated with improvement in ultrasound signs of bowel obstruction and absence of meconium ileus at birth. A third fetus with concerning prenatal imaging but no prenatal ETI exposure was born without meconium ileus and classified as having CFTR-related metabolic syndrome or inconclusive CF diagnosis. Other pregnancies were managed variously, including termination and negative diagnoses.

The median survival age of people with cystic fibrosis has increased significantly following the introduction of CFTR modulator therapies such as elexacaftor/tezacaftor/ivacaftor in 2019. However, as patients live longer, they face challenges related to residual CFTR dysfunction, chronic inflammation, comorbidities, disease management complexities, and psychosocial burdens. Lifestyle factors including stress, nutrition, physical activity, sleep, and treatment adherence influence health outcomes and represent potential targets for behavioral interventions to improve healthy aging and quality of life in adults with cystic fibrosis.

From 2017 to 2024, nontuberculous mycobacteria (NTM) positivity among people with cystic fibrosis (pwCF) initially declined around 2020-2021 but increased by 2024. Respiratory culture surveillance decreased significantly during this period, yet adjusted models showed an annual increase in odds of NTM positivity by 4.2% nationally and 11.4% at National Jewish Health (NJH) from 2020 to 2024.

Home spirometry measurements of percent predicted FEV1 (ppFEV1) were slightly lower than office spirometry when measured cross-sectionally, with home-coached ppFEV1 being 1.46% lower and home-uncoached ppFEV1 being 3.31% lower. However, the 3-month change in ppFEV1 from baseline did not significantly differ between home and office spirometry.

Single-cell and spatial profiling of the pancreas from cystic fibrosis (CF) donors revealed a high-mucin ductal subtype with preserved abundance but altered localization, inflammatory and fibrotic pathway changes driven by immune and pro-fibrotic cell interactions, and beta cells exhibiting increased stress responses and compensatory secretion distinct from type 1 and type 2 diabetes. Islets near adipose tissue and collagen had reduced beta cells linked to signaling from multiple cell types.

The study identified 683 direct FOXJ1 target genes in human airway epithelial cells, with 89 multiciliated cell (MCC)-enriched genes, especially those encoding axonemal proteins like microtubule-inner proteins and dynein arm docking components, being downregulated in FOXJ1-deficient cells. FOXJ1 expression persists in well-differentiated human airway epithelial cells, indicating functions beyond cilia initiation, and it likely functions cooperatively with RFX transcription factors within a transcriptional complex.

International collaboration has significantly advanced the study of Primary Ciliary Dyskinesia by creating a unified global research infrastructure that includes patient advocacy groups, coordinated clinical research projects, registries, and multinational trials, leading to harmonized diagnostic guidelines and improved research platforms.

The scoping review identified 11 studies involving 373 children treated with auto-adjusting positive airway pressure (APAP) for obstructive sleep apnea (OSA). Most evidence was observational with only one randomized trial. APAP was frequently started empirically without prior titration polysomnography (PSG). Studies mainly assessed adherence and use, with fewer evaluating physiologic sleep outcomes, pressure concordance, safety, or patient-centered clinical outcomes. Reporting on device details and initiation procedures was inconsistent.

In a study of 261 neonates including those with repaired myelomeningocele and NICU recovery infants, apnea-hypopnea index (AHI) values were similar between supine and nonsupine sleep positions in most groups, except in the fetoscopic myelomeningocele group where AHI was significantly lower when supine (7.94, 95% CI 4.95-12.75) compared to nonsupine (22.1, 95% CI 14.02-35.01; p < 0.001).

Children with Down syndrome who received early diagnosis and treatment for obstructive sleep apnea showed long-term neurocognitive benefits at 60 months of age, particularly in daily functioning and socialization, compared to those receiving standard care with later diagnosis.

In children with non-syndromic cleft lip and palate, obstructive sleep apnea (OSA) was identified in 71.1% of participants with valid polysomnographic recordings, mostly mild cases. The Sleep Disturbance Scale for Children (SDSC) total and subscale scores showed no significant correlation with polysomnographic parameters. Specifically, the Sleep Breathing Disorders (SBD) subscale had a sensitivity of 38.5% and specificity of 72.7%, while the Excessive Daytime Sleepiness (EDS) subscale had a sensitivity of 23.1% and specificity of 54.5% for identifying OSA.

Neuromuscular electrical stimulation (NMES) treatment resulted in significant improvements in patient-reported outcomes including sleep disturbance (mean change -6.1), sleep-related impairment (mean change -10.0), and depression (mean change -3.5) with posterior probabilities of improvement ranging from 99.8% to 100%. The probability of clinically meaningful improvement for mood, sleep disturbance, and sleep-related impairment ranged from 86% to 91%. Change in functioning showed a lower probability of improvement at 60.9%. These effects persisted after controlling for age, gender, treatment adherence, and stimulation intensity variables.

In psychiatric inpatients at risk for obstructive sleep apnea (OSA), commonly used screening questionnaires showed significantly reduced diagnostic accuracy in patients aged 65 years and older, with area under the curve (AUC) values decreasing by 0.12 to 0.36 compared to younger patients. Older patients had higher median apnea-hypopnea index (AHI) values (7.7 vs. 1.8 events/h; p=0.007) and higher prevalence of OSA (73.2% vs. 47.2%; p=0.003). The reduction in accuracy was mainly due to lower specificity in older patients. Chronological age alone had moderate discrimination with an AUC of 0.70 (95% CI, 0.61-0.80), while other factors like BMI, neck circumference, and symptoms performed poorly.

In a large cohort of 67,397 patients, a demographics-only model using age, gender, BMI, and race achieved AUROC values of 0.749, 0.718, and 0.726 for detecting apnea-hypopnea index (AHI) thresholds of ≥5, ≥15, and ≥30 events/h respectively, retaining 86–94% of the accuracy compared to a model using all questionnaire and demographic features. The questionnaire-only model performed worse, with AUROCs between 0.674 and 0.699. Age, BMI, and gender were the most important predictors, while adding questionnaire data improved AUROC by at most 0.038. Classification into four severity categories showed poor accuracy (≤0.45).

In a cohort of 12,715 adults, 25.8% had co-occurring obstructive sleep apnoea (OSA) and insomnia symptoms. This group showed strong associations with nocturnal dyspnoea (adjusted odds ratio [aOR] 3.94), morning headache (aOR 3.31), and depressed mood (aOR 3.01) compared to those without OSA or insomnia symptoms. Polysomnography revealed respiratory disturbances combined with prolonged sleep latency and a higher arousal index in participants with both conditions.

Obstructive sleep apnea was not associated with significant changes in choroidal thickness or vascularity index as measured by optical coherence tomography.

A wide range of inflammatory biomarkers, both established (e.g., TNF-α, CRP, interleukins) and novel (e.g., IFN-γ, fractalkine, SAA, MCP-1, TLR, YKL-40, S100 proteins, NLR, PLR, galectin-3, neopterin, PTX3), have been linked to obstructive sleep apnea (OSA) severity and cardiovascular risk, although results are sometimes inconsistent. Continuous positive airway pressure (CPAP) treatment can reduce some of these inflammatory markers.

Small physiological and imaging studies, mainly in hemodialysis patients, associate fluid overload and regional fluid measures with sleep apnea severity, but responses to fluid removal are heterogeneous and some studies include both obstructive and central events. There is no reproducible volume-sensitive OSA phenotype established.

Participants with lower-limb lymphedema (LLL) had significantly higher risks of obstructive sleep apnea (OSA) and daytime sleepiness, as indicated by higher STOP-BANG Questionnaire and Epworth Sleepiness Scale scores, compared to those with upper-limb lymphedema (ULL). LLL patients also demonstrated poorer physical and mental health-related quality of life. Although sleep quality measured by the Pittsburgh Sleep Quality Index was higher in the LLL group, this difference was not statistically significant. There was a significant association between lymphedema severity and sleep quality within the LLL group.

The study developed and proposed a set of schemas for polysomnography (PSG) harmonization that integrate heterogeneous biosignals, sleep parameters, and demographic features across eight publicly available PSG datasets, enabling consistent attribute selection and uniform preprocessing.

Among 944 systemic sclerosis patients undergoing first right heart catheterisation, 53% were diagnosed with precapillary pulmonary hypertension. Bosentan exposure ('ever') was associated with a lower likelihood of detecting precapillary PH (OR 0.594, 95% CI 0.362 to 0.975), with a stronger association for ongoing bosentan use in patients with current digital ulcers (OR 0.230, 95% CI 0.081 to 0.652). Endothelin receptor antagonists in general showed a trend toward reduced detection of precapillary PH in patients with current digital ulcers, while other vasoactive-vasodilating drug classes did not show such effects.

Measuring esophageal pressure (Pes) can provide a more accurate estimate of transmural pressure in patients with elevated intrathoracic pressure, such as those with obesity, and this correction can reduce overestimation of postcapillary pulmonary hypertension (PH) diagnosed using traditional pulmonary artery pressure measurements.

A 38-year-old woman with IgD-λ POEMS syndrome presented with edema, pulmonary hypertension, renal impairment, and multiple systemic symptoms. Routine serum and urine protein studies were negative, but extended immunofixation electrophoresis detected a trace monoclonal IgD component. Elevated serum VEGF and bone marrow findings confirmed the diagnosis. Renal biopsy showed POEMS-associated glomerular microangiopathy-like lesions. Treatment with dexamethasone, lenalidomide, and autologous stem-cell transplantation led to resolution of edema, improvement in pulmonary hypertension, normalization of serum creatinine to 60 μmol/L, and VEGF normalization by three months after transplantation.

The femoral venous stasis index (FVSI) significantly improves 1-year risk classification in patients with pulmonary hypertension beyond the ESC/ERS 2022 model, with a global Net Reclassification Index (NRI) of 0.736. Among intermediate-risk patients, 1-year event rates increased significantly across FVSI categories (16.7%, 43.5%, 66.7%; p = 0.027), and survival differed significantly across FVSI-based subgroups (p < 0.001).

Atorvastatin directly targets TLR4, inhibits the NF-κB/NLRP3/IL-1β signaling pathway, and reduces pulmonary arterial smooth muscle cell (PASMC) proliferation, resulting in alleviation of pulmonary hypertension (PH) in a rat model. Specifically, atorvastatin reduced right ventricular systolic pressure, right ventricular hypertrophy, and pulmonary artery thickening, and suppressed PDGF-BB-induced PASMC proliferation by downregulating TLR4/NF-κB/NLRP3/IL-1β proteins. Knockdown of NLRP3 also reduced PASMC proliferation, confirming its central role.

CircNtrk3 expression is decreased in PASMC from pulmonary hypertension rats, and its knockdown promotes PASMC proliferation and migration by increasing Ca2+ influx and metabolic reprogramming. Overexpression of circNtrk3 reduces right ventricular pressure, pulmonary vascular remodeling, and right ventricular hypertrophy. Hnrnpk stabilizes circNtrk3, which suppresses miR-17-5p and regulates Ca2+ influx and metabolic changes via the Bmpr2/Trpc4 pathway.

In the Sugen/hypoxia rat model of severe pulmonary hypertension, right heart remodeling is characterized predominantly by cardiomyocyte hypertrophy and extracellular matrix remodeling, accompanied by increased right heart pressures, prolonged action potentials in the right atrium and ventricle, and proteomic alterations including upregulation of sarcomeric and fibrillar proteins and downregulation of oxidative energy production proteins.

Bronchopulmonary dysplasia (BPD) originates in utero and involves microRNA (miRNA) dysregulation across the fetal-neonatal continuum, linking antenatal factors such as placental dysfunction, fetal growth restriction, inflammation, and oxidative stress to altered lung development and increased susceptibility to BPD. MiRNAs regulate key processes including pulmonary angiogenesis, VEGF signaling, and antioxidant responses, and are detectable in multiple biological compartments, providing insight into disease mechanisms and potential biomarker and therapeutic targets.

A 5-month-old male infant with intestinal tuberculosis presented with fever, abdominal distension, intestinal obstruction, and multiple perforations. Conventional TB tests were negative, but metagenomic next-generation sequencing (mNGS) detected Mycobacterium tuberculosis complex with 2,868,520 sequence reads. Surgical intervention and a standard four-drug anti-TB regimen combined with additional antibiotics led to substantial clinical improvement, including weight gain and developmental progress.

Increasing age, male gender, lower body weight, known HIV and diabetes comorbidities, tobacco and alcohol consumption, and unknown status for behavioural risks and comorbidity were significantly associated with higher odds of unfavourable treatment outcomes and mortality among adult drug-sensitive TB patients in Maharashtra during 2021-2022.

Among adults treated for drug-sensitive pulmonary tuberculosis, lower baseline BMI was significantly associated with higher odds of post-treatment ventilatory defects, particularly restrictive spirometry, with BMI below 16 kg/m² carrying a five-fold increased risk compared to BMI ≥18.5 kg/m². Undernourished participants exhibited higher baseline IL-6, which mediated a substantial portion (32% for FEV1 and 49% for FVC) of the impaired lung function observed.

The Indian Society of Organ Transplantation developed 36 consensus statements regarding latent tuberculosis management in kidney transplantation, endorsing routine pre-transplant screening primarily with interferon-gamma release assays due to BCG vaccination confounding tuberculin skin tests. Isoniazid-based regimens are preferred for treatment, with considerations for resistance, hepatotoxicity, and hepatitis C co-infection affecting therapy choice.

A total of 5,848 NTM-positive samples were identified from 1986 to 2021, with a significant change-point in the temporal trend occurring around mid-2017, after which the annual percent increase in NTM isolations was 21.7% (95% CI 18.6-24.8). The Mycobacterium avium complex remained the most common species, while M. kansasii and M. xenopi declined. Patient demographics shifted over time, with patients in 2014-2021 being older (mean age 60 vs. 56 years, p<0.001) and having a higher proportion of females (41.9% vs. 28.3%, p<0.001). Respiratory samples made up 70.9% of isolations. The increase in NTM isolations was accompanied by changes in species distribution and patient characteristics.

RSV vaccination recommendations for adults, especially those aged ≥60 years and immunocompromised individuals, are supported by guidelines from over 24 countries and more than 50 medical societies. However, there is significant variation in age thresholds, risk-based eligibility criteria, and implementation strategies across different regions and countries.

Eight ion homeostasis-related candidate diagnostic genes for tuberculosis were identified (CCL28, CCR2, CCR6, CD52, FAM20A, KEL, SLC24A2, and XCL1). A multivariable logistic regression model based on these genes achieved high discriminatory performance with an AUC of 0.997 in the training set, a nested cross-validation AUC of 0.862, and an AUC of 0.986 in an external validation cohort. SLC24A2 was consistently upregulated across datasets and associated with immune-related gene sets and pathways, with molecular docking suggesting a potential interaction between Calcitriol and SLC24A2.

The biomimetic DNA tetrahedral phototherapy system (TDN + AIE@MM) achieved dual spatiotemporal targeting of granulomas and lymph nodes, enabling effective delivery to immunosuppressive sites. Under 808 nm laser irradiation, it accomplished over 99% killing of intracellular and extracellular Mycobacterium tuberculosis H37Ra, induced pro-inflammatory M1 macrophage polarization, enhanced T-cell proliferation, and antigen-specific immune responses. In vivo studies showed increased activation of antigen-presenting cells and CD4+ T-cells, reduced lung bacterial load, and a higher proportion (21.8%) of tissue-resident memory CD8+ T cells on day 42, approximately double that achieved by rifampicin. In a relapse model, the 84-day relapse rate was 16.7% compared to 66.7% for rifampicin, with increased memory B cells and effector memory T cells, demonstrating durable protective immunity.

Immune cell-based therapies for tuberculosis, especially when combined with genetic engineering and nanotechnology, show promise in addressing the challenges of TB treatment, including drug resistance and complex treatment needs. Recent clinical trials are encouraging, highlighting the potential of these therapies to improve treatment outcomes.

Long non-coding RNAs (lncRNAs) play a regulatory role in tuberculosis (TB) pathogenesis by coordinating inflammatory signaling and cellular energy metabolism, showing potential as diagnostic biomarkers that in some cases outperform conventional tests in initial studies.

Mycobacterium marinum causes significant cutaneous and invasive infections with clinical management hindered by reliance on anti-tuberculous regimens that show variable efficacy, require prolonged treatment, and lack dedicated randomized controlled trials. Preclinical drug screening using M. marinum as a tuberculosis surrogate has increased, but clinical translation of candidates remains slow. Major challenges include intrinsic and acquired drug resistance, absence of predictive animal models, poorly defined drug targets, and limited drug resistance surveillance.

Anterior lumbar spinal surgery has significantly evolved since its early 20th-century inception for treating spinal tuberculosis. The development of the 'Hong Kong operation' in the 1950s was a response to a tuberculosis epidemic and contributed to advancements in treatment principles, fusion techniques, and surgical access corridors. More recently, alternative access methods, minimally invasive techniques, and biocompatible implants have been developed, many inspired by the challenges of spinal infections.

Long-acting nanomedicine has the potential to improve tuberculosis treatment by reducing adherence-related vulnerability and enhancing drug delivery through sustained active exposure, targeted pulmonary and intralesional delivery, intracellular drug release, multidrug synchronization, and controlled host-directed therapy. Various delivery platforms such as injectable depots, inhalable systems, cellular targeting, and polymeric platforms are evaluated for their biological relevance and translational feasibility.

In a study of 57 tuberculosis patients with mutation-positive tNGS reports, 180 unique patient-variant events involving nine genes and 56 standardized variants were identified. The most common gene mutations were in rpoB (84.2%) and katG (64.9%), with katG p.Ser315Thr, rpsL p.Lys43Arg, and rpoB p.Ser450Leu being the leading variants. Seven of eight possible resistance combinations to rifampicin (RIF), isoniazid (INH), and fluoroquinolones (FQ) were observed, with the RIF+/INH+/FQ- combination being the most frequent. The RIF+/INH+/FQ+ group exhibited the greatest variant complexity. Some variant events had reported frequencies below 100%, mainly involving pncA and gyrA. The reconstruction method successfully integrated variant data across drugs, highlighting multigene co-occurrence patterns and variant frequency distributions.

Home-based pulmonary rehabilitation (HBPR) in adults with interstitial lung disease (ILD) improves exercise capacity and health-related quality of life (HRQoL), with randomized controlled trials showing a mean improvement of 20.88 meters in the 6-minute walk test and a 5.84-point improvement in the St. George’s Respiratory Questionnaire compared to usual care. Pre-post studies also demonstrated significant improvements in exercise capacity and HRQoL, along with reductions in anxiety, depression, and fatigue. Longer intervention durations, structured supervision such as telerehabilitation, and adherence of 70% or greater were associated with greater benefits.

Lung ultrasound (LUS) is effective compared to high-resolution computed tomography (HRCT) as a screening tool for interstitial lung disease in rheumatoid arthritis patients, with several diagnostic and severity scores developed and tested.

In a cohort of 104 patients with progressive pulmonary fibrosis (PPF) primarily caused by connective tissue disease–associated interstitial lung disease, lung function declined over 12 months, with forced vital capacity decreasing from 67.7% to 62.4% and DLCO from 56.3% to 49.8%. Antifibrotic therapy, received by 55.8% of patients (mostly nintedanib), significantly reduced patients experiencing ≥ 2 exacerbations per year from 71.2% to 29.3% and hospitalizations ≥ 2 per year from 59.6% to 10.6% (P < 0.001). During follow-up, 26.9% of patients died. Low baseline oxygen saturation, a 6-minute walk distance under 300 metres, and ≥ 2 exacerbations at baseline predicted poor outcomes.

In a Danish cohort of 197 patients with fibrotic interstitial lung disease (F-ILD), 57% developed progressive pulmonary fibrosis (PPF) within a median follow-up of 13 months over 4 years. Patients with PPF showed significantly greater annual declines in forced vital capacity (-140 mL/year) and diffusing capacity of the lung for carbon monoxide (-2.97 percentage points/year) than those without PPF. However, survival rates at 3, 5, and 7 years were 73%, 58%, and 48% respectively for PPF patients, with no significant survival difference between PPF and non-PPF groups. A higher baseline ILD-gender-age-physiology (ILD-GAP) index stage was independently associated with worse survival (hazard ratio 2.64).

Among 1382 lung cancer patients undergoing systemic treatment, 118 (8.54%) developed interstitial lung disease (ILD). Smoking history, immunotherapy exposure, and inflammatory abnormalities were independently associated with increased risk of ILD, with adjusted odds ratios of 3.37, 3.77, and 2.25 respectively. Comorbidity had a borderline association (aOR 1.66). A four-factor risk score based on smoking, any comorbidity, immunotherapy exposure, and inflammatory abnormality achieved an area under the curve (AUC) of 0.771 in the development cohort and 0.756 in external validation cohorts. ILD incidence in high-risk groups identified by this score reached approximately 25-29%.

A 53-year-old woman with EGFR-mutant NSCLC developed grade 3 interstitial lung disease (ILD) after gefitinib treatment, which resolved with corticosteroids. Following multiple lines of chemotherapy and tumor progression, she was successfully rechallenged with almonertinib (a third-generation EGFR-TKI) and corticosteroids, resulting in measurable tumor shrinkage, sustained tumor control, no recurrence of pulmonary toxicity, and approximately 8 months of progression-free survival.

In idiopathic pulmonary fibrosis, both ≥5% annual weight loss and ≥10 percentage point annual decline in forced vital capacity (FVC) independently predict worse transplant-free survival, with higher Composite Physiologic Index (CPI) scores also associated with increased risk. Patients experiencing both significant weight loss and FVC decline had over a fourfold increased risk of death or transplant, and these factors provide additive prognostic information consistently over time.

Large language models (LLMs) outperformed 20 published claims-based algorithms in identifying interstitial lung disease (ILD) across three input types: claims alone, electronic health record (EHR) notes alone, and combined claims and notes. For example, with claims alone, Qwen3-8B achieved 89.8% positive predictive value (PPV) at 15.9% yield versus 86.7% PPV at 4.9% yield for the best algorithm. With combined claims and notes, Qwen3-14B reached 100.0% PPV at 24.3% yield. In a simulated drug-safety scenario assuming a true odds ratio of 3.0, the observed odds ratio was 2.67 using combined inputs from LLMs versus 1.07 with the best existing algorithm, reducing the estimated sample size needed for 80% power from 27,200 to 591 patients.

A decrease in peripheral oxygen saturation (SpO2) of 6 percentage points or more during the 6-minute walk test (6MWT) independently predicts a decline in forced vital capacity (FVC) of 5 percentage points or greater in patients with idiopathic pulmonary fibrosis (IPF) and other fibrotic interstitial lung diseases (ILDs). This SpO2 change is associated with FVC decline over up to 5 years and identifies patients with differing transplant-free survival outcomes when combined with baseline FVC and 6-minute walk distance.

A 70-year-old patient with interstitial lung disease had a rare endobronchial lipoma causing obstruction of the right middle lobe bronchus, leading to recurrent infections and atelectasis. Lung-sparing bronchoscopy with snare electrocautery and argon plasma coagulation successfully restored airway patency, with drainage of purulent secretions and antimicrobial treatment resolving infection.

Alterations in microRNA (miRNA) maturation processes—including disruption of the Drosha/DGCR8 complex, altered Dicer-dependent processing, post-transcriptional modifications, ADAR-mediated RNA editing, and mechanotransduction pathway interference—contribute to miRNA dysregulation in idiopathic pulmonary fibrosis (IPF), affecting antifibrotic miRNAs like miR-29 and promoting extracellular matrix accumulation and profibrotic signaling.

Anti-MDA5 antibody-positive dermatomyositis can present with distinctive skin manifestations and rapidly progressive interstitial lung disease despite normal muscle strength and creatine kinase levels. In the reported case, the patient exhibited typical skin findings and respiratory symptoms with elevated inflammatory markers but deteriorated rapidly despite treatment with glucocorticoids and intravenous immunoglobulin, ultimately leading to death.

Immune checkpoints, including PD-1/PD-L1, CTLA-4, TIM-3, VISTA, TIGIT, LAG-3, ICOS, TREM-2, and the SIRPα/CD47 axis, play a role in the regulation of idiopathic pulmonary fibrosis development.

In patients with idiopathic pulmonary fibrosis treated with pirfenidone for 1 year, greater preservation of normal lung on CT was associated with a lower risk of death or lung transplantation (adjusted HR per 5% increase: 0.90; 95% CI: 0.85-0.96; p < 0.001), while increases in fibrosis extent predicted higher risk (adjusted HR per 5% increase: 1.16; 95% CI: 1.06-1.27; p = 0.002). For lung function decline (≥10% absolute FVC decline), only change in fibrosis extent was a significant predictor (adjusted HR per 5% increase: 1.26; 95% CI: 1.09-1.45; p = 0.001).

Preclinical studies indicate that incretin-based therapies may influence pathways involved in pulmonary fibrosis, including transforming growth factor-β signaling, fibroblast activation, extracellular matrix deposition, mesenchymal transition, inflammation, oxidative stress, and metabolic mechanisms. These therapies also affect body weight and composition, primarily reducing adipose tissue but with variable effects on lean mass. However, current evidence of antifibrotic efficacy in patients with fibrotic interstitial lung disease is lacking.

In a retrospective cohort study of 510 IPF patients, 25.7% died during an 18-month follow-up. Those who died had higher ESR levels and worse pulmonary function. ESR was identified as an independent risk factor for mortality, with an odds ratio of 1.024 (95% CI: 1.002-1.048). ESR predicted all-cause mortality with an AUC of 0.645 (95% CI: 0.591-0.700), and an optimal cut-off value of 21.5 mm/h. Patients with ESR ≥ 21.5 mm/h had a significantly increased mortality risk (hazard ratio 5.406, 95% CI: 1.177-24.825).

Conventional prognostic models for acute exacerbation of interstitial lung disease (AE-ILD) allow for rapid risk stratification but lack the ability to integrate diverse data and manage clinical complexity. While artificial intelligence (AI) methods have been preliminarily applied to clinical and imaging data for prognostication in AE-ILD, there is limited direct evidence for AE-ILD, and it is unclear if AI models offer improved prognostic value over traditional approaches.

Fatty acid-derived dicarboxylic acid modification of trastuzumab reduces Fcγ receptor engagement and macrophage-associated pulmonary uptake, leading to decreased interstitial lung disease (ILD) incidence in antibody-drug conjugate (ADC) treatment without compromising HER2-positive tumor targeting or cytotoxicity. Specifically, C18-DA modification abolished FcγRIII binding and decreased macrophage uptake by up to approximately 42%, while in vivo C12-DA and C18-DA modifications reduced lung inflammation and ILD-like lesions, with C18-DA lowering lesion incidence from 100% to 41.7%. Modified ADCs also showed increased systemic exposure and reduced clearance.

In a multicenter retrospective cohort study of 65 adults undergoing transbronchial lung cryobiopsy for suspected diffuse parenchymal lung disease, robotic-assisted bronchoscopy (RAB) with a 1.1-mm cryoprobe achieved a significantly higher specific histopathologic diagnostic yield (95.0%) compared to flexible bronchoscopy (FB) with a 1.1-mm cryoprobe (61.5%) and FB with a 1.7-mm cryoprobe (73.7%) (P = 0.032). After adjusting for radiographic fibrosis and biopsy size, RAB-TBLC was associated with higher diagnostic yield than FB-TBLC with the 1.1-mm cryoprobe (adjusted OR 11.15; 95% CI 1.76–219.95). Complication rates were lower in the RAB group (10.0%) compared to FB groups (34.6% and 42.1%), but this did not reach statistical significance (P = 0.065).

Shape-sensing robotic-assisted bronchoscopy (ssRAB) demonstrated a strict diagnostic yield of 70.2% and an intermediate diagnostic yield of 77.4% for peripheral pulmonary nodules measuring 8 mm or smaller. Malignancy was identified in 53.3% of lesions. The median procedure time was 59 minutes. Pneumothorax occurred in 3.3% of patients, with 1.1% requiring chest tube placement.

In a propensity-matched cohort of children receiving noninvasive respiratory support postextubation, there was no significant difference in postextubation failure rates between CPAP (7.6%) and HFNC (8.1%) users (rate ratio 0.93, 95% CI 0.72-1.25). However, CPAP was associated with a longer median duration of respiratory support (72.0 hours vs. 30.5 hours; median difference 41.5 hours, 95% CI 37.7-45.2 hours) and longer PICU length of stay (10.2 days vs. 7.1 days; median difference 2.2 days, 95% CI 1.6-2.8 days) compared to HFNC. No association was found between type of respiratory support and in-hospital mortality.

This narrative review highlights substantial age-specific differences in respiratory mechanics, airway anatomy, pulmonary vascular physiology, and disease etiology that affect ARDS management. Adult ARDS management is supported by evidence favoring low-tidal-volume ventilation, prolonged prone positioning for severe cases, selective use of higher positive end-expiratory pressure, and early extracorporeal membrane oxygenation for refractory disease. Pediatric recommendations largely rely on consensus or observational data, while neonatal ARDS treatment is mainly extrapolated from neonatal respiratory disorders, considering factors like gestational age, surfactant biology, and pulmonary hypertension.

In ALS patients undergoing non-invasive ventilation (NIV), the timing of NIV initiation influences the decline in forced vital capacity (FVC) and survival. Patients who started NIV earlier (at T0 or T2) showed less decline in FVC (22.5% to 26%) and longer survival times (51.3 months) compared to those initiating NIV later (T3-T6), who experienced a greater FVC decline (34%) and shorter survival (15.7 months).

The study identified four key themes affecting the transition of young people using home mechanical ventilation (HMV) from pediatric to adult care: lack of formal transition frameworks leading to unclear expectations; disrupted care continuity and coordination; inadequate patient preparation for adult care responsibilities; and systemic barriers such as insufficient resources and reliance on individual providers. These challenges were consistently reported by patients, caregivers, and healthcare providers.

Pulmonary hypertension (PH) was present in over 95% of patients with silicosis-associated progressive massive fibrosis (PMF) undergoing lung transplantation, showing a hemodynamic profile similar to pulmonary arterial hypertension (PAH). Explant histology revealed confluent silicotic nodules, extensive fibrosis and hyalinization, obscuration or obliteration of vascular structures, and perivascular fibrohistiocytic infiltrates causing extrinsic narrowing, with classic PAH-type arteriolar muscular hypertrophy and plexiform arteriopathy being uncommon. Patients who developed primary graft dysfunction (PGD) more frequently exhibited pretransplant right ventricular dysfunction (71% vs 21%) and had a lower median TAPSE/RVSP ratio (0.27 vs 0.39) compared to those without PGD.

Among 191 childhood cancer survivors studied a median of 7 years postdiagnosis, 7% showed abnormal nitrogen multiple breath washout (N2MBW) lung clearance index (LCI) values, with abnormalities mainly in allogeneic hematopoietic stem cell transplantation (HSCT) survivors, who had a mean LCI of 7.18 and 33% abnormal values. Mean spirometry and diffusion capacity z-scores were mildly impaired overall, more so in high-risk survivors. Isolated LCI impairment without spirometry or diffusion abnormalities was rare (3%). Only allogeneic HSCT was significantly associated with higher LCI and acinar inhomogeneity (SACIN).

Recent evidence supports a symptom-guided, conservative approach for primary spontaneous pneumothorax, moving away from size-based interventions. Advances in imaging and genetics have identified structural, genetic, and hormonal causes of spontaneous pneumothorax that require early diagnosis due to important extrapulmonary implications. Management of persistent air leak in secondary spontaneous pneumothorax remains difficult, especially for nonsurgical candidates, with limited high-quality evidence supporting current treatment options such as autologous blood patch therapy, pleurodesis, and endobronchial valves.

This protocol describes the design of the EU PAL-COPD stepped wedge cluster randomised controlled trial to evaluate the ICLEAR-EU intervention, an integrated non-pharmacological palliative care service for hospitalised patients with advanced COPD, aiming to reduce respiratory-related hospital readmissions within 90 days and improve quality of life. The study plans to enrol 1224 patients across 18 hospitals in six European countries, with the primary endpoint being the percentage of patients readmitted within 90 days. Secondary measures include patient and caregiver quality of life, well-being, healthcare utilisation, and cost-effectiveness, analyzed using mixed-effects models accounting for clustering, time, and country.

The review found scarce direct evidence on treatment burden in adults with COPD and comorbidities, with only one study using a validated patient-reported instrument and one qualitative study. Greater comorbidity was generally linked to more complex medication regimens and poorer clinical control. The single study measuring treatment burden directly reported that comorbidity and regimen complexity were associated with higher treatment burden, while social support and self-efficacy were linked to lower burden. Additionally, higher regimen complexity was associated with lower medication discontinuation but increased re-exacerbations and readmissions.

The multicomponent digital therapeutic program significantly improved electronically monitored inhaled medication adherence over 24 weeks in patients with COPD, with adherence rates of 59.5% in the intervention group versus 33.1% in the control group (P = .009). Adherence declined over time in both groups but remained consistently higher in the intervention group.

Thirty months after removing prior authorization for LAMA and restricting ICS/LABA coverage in BC, LAMA use increased by 0.8%, mean LAMA canisters dispensed increased by 9.8 per 1,000 patients, LAMA proportion of days covered increased by 1.5%, and initiation of LAMA as first maintenance therapy increased by 34.8%. ICS/LABA use decreased by 1.3%, with no significant changes in the number of ICS/LABA canisters dispensed, proportion of days covered, or discontinuation rates. Combined drug costs remained unchanged.

Following the removal of prior authorization for LAMA and restriction for ICS/LABA coverage in British Columbia, there was a 0.8% increase in LAMA use and a 1.3% decrease in ICS/LABA use over 30 months. Mean LAMA canisters dispensed increased by 9.8 per 1,000 patients, and proportion of days covered (PDC) for LAMA increased by 1.5%. Additionally, (re)initiation of LAMA or starting LAMA as first maintenance therapy increased by 0.2% and 34.8%, respectively, while no significant changes were observed in ICS/LABA canisters dispensed, PDC, or discontinuation rates. Total combined drug costs remained unchanged.

The AMICO trial is a phase III, multicenter, randomized, double-blind, placebo-controlled study designed to evaluate the effects of metformin (850 mg twice daily) versus placebo over 36 months in 212 patients with clinically stable COPD characterized by centrilobular emphysema, FEV1 between 40%-70% predicted, and accelerated FEV1 decline (>40 mL·year-1). The primary outcome is the annual rate of FEV1 decline. Secondary outcomes include emphysema progression, changes in diffusing capacity, health status, exercise capacity, muscle strength, comorbidities, and aging-related biomarkers. Numerical results are not reported in the abstract.

Patients with COPD frequently experience disturbed sleep characterized by altered sleep architecture including increased light sleep, decreased slow-wave and REM sleep, frequent arousals, reduced sleep efficiency, and shorter total sleep duration. Subjectively, 40-70% of patients report poor sleep quality with issues initiating or maintaining sleep and increased daytime sleepiness. Nocturnal respiratory symptoms and common sleep disorders like insomnia, OSA, and RLS are more prevalent in this population and may exacerbate sleep disruption. Sleep disturbances are linked to anxiety, depression, fatigue, and reduced quality of life, potentially impacting COPD outcomes through systemic inflammation, decreased physical activity, and reduced treatment adherence.

At 5 years, high-risk children who received twice-daily whole-body emollient application for the first 8 weeks of life had a lower point prevalence of atopic dermatitis (12.3% vs. 24.0%; RR 0.52, 95% CI 0.26-1.02; p = .048) and reduced disease severity (median SCORAD 12.0 vs. 19.6; p = .034) compared to controls. Multiple imputation analyses showed a similar but less certain effect.

Circadian rhythms significantly influence emotional reactivity and regulation. Evening chronotypes are more vulnerable to negative affect, emotion regulation difficulties, and psychiatric symptoms compared to morning types. Social jet lag, especially common in adolescence, is linked to mood disturbances, anxiety, and impaired emotional regulation. Shift work causes circadian misalignment that disrupts executive functions necessary for emotion regulation, increasing stress, irritability, and risk of long-term mental health issues.

People with HIV are at increased risk for a wide range of pulmonary diseases driven by complex mechanisms such as persistent immune dysregulation, oxidative stress, accelerated aging, and microbiome alterations. Despite increased understanding of these mechanisms, significant gaps remain in clinical care, including limited HIV-specific trials and underrepresentation of people with HIV in lung disease studies, especially in sub-Saharan Africa and younger populations.

In a 10-year retrospective review of 220 children undergoing posterior pharyngeal flap surgery using the horizontal split technique, 95% showed improved resonance and 89% achieved mild or no hypernasality post-operatively. Median nasalance scores decreased significantly from 42 pre-operatively to 18 post-operatively. Among 137 patients assessed for sleep apnea, 18 had an apnea-hypopnea index (AHI) ≥5, with 2 requiring flap takedown. Ten patients required revisional surgery, with those having 22q11.2 deletion syndrome or non-cleft VPD demonstrating higher risk for residual hypernasality and need for additional surgery.

A 9-year-old girl with a right upper lobe CPAM underwent lobectomy and subsequently developed right middle lobe bronchial obstruction caused by superior displacement and kinking of the middle lobe bronchus, a rare postoperative complication confirmed by imaging and bronchoscopy.

Climate-sensitive exposures related to climate change, such as heat, air pollution, wildfire smoke, aeroallergens, and indoor dampness, negatively impact paediatric lung-function trajectories through three main developmental pathways: early developmental disruption during gestation, sustained exposure impairing postnatal lung growth, and exacerbation-related step-down events in conditions like asthma and cystic fibrosis. These exposures may lower the lung-function starting point, reduce lung growth and peak function, and cause incomplete recovery after exacerbations.

In a retrospective cohort of 96 preterm infants treated with standardized hydrocortisone, 33.3% met treatment failure criteria by day 21, with treatment failure linked to higher oxygen requirements and a greater prevalence of severe bronchopulmonary dysplasia at 36 weeks. Starting hydrocortisone during non-invasive respiratory support was associated with a reduced likelihood of treatment failure, but this association was not statistically significant after excluding infants who died.

Gestational age at birth is associated with lower airway and parenchymal lung function in preterm infants, and longer duration of non-invasive ventilation (NIV) is linked to lower airway function but not to parenchymal function. Maternal characteristics showed no association with infant lung function.

Healthy late-preterm neonates at term-equivalent age have modestly lower tPTEF/tE (27.4 ± 7.0%) compared to term neonates (31.2 ± 6.9%; adjusted p = 0.028) and lower VPTEF/VE [28.6% (25.1-31.0) vs. 32.1% (27.3-35.5); adjusted p = 0.028]. Respiratory rate was higher in late-preterm neonates but not statistically significant after adjustment. Each additional week of gestational age was associated with a 1.18 percentage point increase in tPTEF/tE after adjusting for sex, body weight, and length (p < 0.001).

Mucus plugging is prevalent across chronic respiratory diseases, with prevalence rates of 63% in asthma, 47% in COPD, and 63% in cystic fibrosis. It is associated with distinct clinical characteristics such as higher eosinophil counts, increased FeNO, and reduced lung function (FEV₁% and FEV₁/FVC) in asthma, as well as older age, lower BMI, and reduced lung function in COPD. Mucus plugging is linked to worse clinical outcomes including higher risk of acute exacerbations, mortality, longer hospital stays, and increased hospitalization costs in COPD.

In a prospective cohort study of 67 operations on pulmonary hydatid cysts, video-assisted thoracoscopic surgery (VATS) resulted in significantly shorter postoperative hospital stays (6.1 ± 2.3 vs. 8.1 ± 4.6 days) and chest tube durations (5.5 ± 2.1 vs. 7.3 ± 4.0 days) compared to thoracotomy after adjusting for age and cyst location. Short-term complication rates were similar, and at 10-year follow-up with 29 patients, no recurrence was observed. Additionally, none of the VATS patients reported surgical site pain, whereas three thoracotomy patients did.

Oscillometry detected significant bronchodilator response in an additional 11% of asthma patients not identified by spirometry, although spirometry identified more overall responders. Different bronchodilator response groups showed distinct characteristics in airway obstruction, inflammation, gene expression related to mitochondrial stress and cell adhesion, and CT imaging features such as luminal area and gas trapping.

In patients with lung cancer, smoking is associated with significant alterations in bronchoalveolar lavage fluid (BALF) microbiota composition and metabolomic profiles. Smokers showed enrichment of specific microbial taxa such as Bacteroidota, Actinomycetota, Prevotella, Schaalia, and Mobiluncus, while never-smokers had higher levels of Pseudomonadota, Finegoldia, Peptoniphilus, and Paracoccus. Metabolomic analysis identified 23 differential metabolites between smokers and never-smokers, with 18 upregulated and 5 downregulated in smokers, involving pathways such as glutathione metabolism, amino acid metabolism, bile secretion, and coenzyme biosynthesis. Microbe-metabolite correlations included positive association between Mobiluncus and nicotine N-oxide and negative association between Finegoldia and dihydrothymine. ROC analysis indicated several metabolites have potential discriminatory value with AUCs ranging from 0.706 to 0.776.

Inhaled nanomedicines provide localized, sustained, and targeted therapy for various lung diseases by overcoming anatomical and biological barriers, utilizing diverse nanocarriers such as liposomes, lipid nanoparticles, polymeric systems, and biomimetic carriers, with emerging approaches including mRNA delivery, gene silencing, and CRISPR-based editing for conditions like pulmonary fibrosis, lung cancer, COPD, infections, and acute lung injury.

The airway microbiome plays a critical role in airway health, characterized by microbial diversity, ecological stability, and balanced host immune interactions. Dysbiosis, marked by reduced commensal diversity and increased pathogens, is associated with inflammation and progression of asthma and COPD. Environmental changes such as air pollution, climate change, and urbanization disrupt this microbial balance by decreasing diversity and increasing pathogen load through mechanisms including epithelial damage and immune alterations.

In a prospective case series of four patients with advanced emphysema and pre-capillary pulmonary hypertension undergoing endobronchial valve therapy, real-time invasive hemodynamic monitoring showed decreases in mean pulmonary artery pressure (mPAP) by 10% to 61% under general anesthesia and by 33% to 58% when awake, with post-extubation mPAP falling below 20 mmHg in three patients. Estimated pulmonary vascular resistance decreased in most patients, and pulmonary arterial compliance increased in all four.

A 54-year-old woman with ABPA treated with dupilumab showed improvement in ABPA, sinonasal disease, and lung function. Fourteen months after starting dupilumab, she developed a secondary Pasteurella multocida infection in a bronchiectatic lesion, which was successfully treated with antibiotics while continuing dupilumab and discontinuing corticosteroids without infection recurrence.