In 2021, chronic obstructive pulmonary disease (COPD) caused about 3.5 million deaths globally, ranking as the fourth leading cause of death. Exposure to multiple environmental factors can lead to chronic inflammation and progressive lung damage, increasing the risk of COPD. Exposure to indoor and outdoor air pollution, environmental chemicals, occupational hazards, climate change and lifestyle and behavioural factors such as tobacco smoke might influence COPD risk, especially in vulnerable populations

A 68-year-old Asian woman was referred to our department because of an abnormal chest X-ray showing multiple patchy consolidative nodules and cavitary lesions, suggestive of a wide range of differential diagnoses, including infection, metastatic tumour, connective tissue disease and vasculitis. The patient had no relevant medical, medication or smoking histories. Chest CT revealed multiple diffuse, thick-walled, cavitary lung lesions with nodules and surrounding consolidation in both lung fields (figure 1, upper row). The laboratory findings revealed white blood cell, 8000/µL (Neu, 69.2%; Lym, 22.2%; Mono, 7.0%); C-reactive protein, 3.59 mg/dL; lactate dehydrogenase, 177 U/L; Beta-D-Glucan, <5 pg/mL; Aspergillus antigen, (−); perinuclear/cytoplasmic antineutrophil cytoplasmic antibody, (−); and interferon-gamma release assay for tuberculosis, (−). The only tumour marker significantly elevated was carbohydrate antigen 19–9 (CA19-9; 1072.7 U/mL; reference range: 0–37 U/mL). The bilateral

Background Sex discrepancies in the association between smoking and development and prognosis of chronic obstructive pulmonary disease (COPD) are controversial. We tested the hypothesis that females compared with males are more susceptible to the detrimental effects of smoking in relation to COPD. Methods We identified 47 231 males and 57 806 females from the Copenhagen General Population Study. Smoking amount was assessed with sex interaction against COPD-related outcomes, including the cross-sectional association with airway obstruction, chronic bronchitis and dyspnoea, assessed using logistic regression analyses, and longitudinal association with exacerbation and mortality, assessed using Cox proportional hazard regression adjusted for potential confounders. Results The increase in risk of airway obstruction (N=7367), chronic bronchitis (N=9206) and dyspnoea (N=8541) with higher smoking amount was greater in females compared with males. During 15 years’ follow-up (median 9.3 years),

Despite significant advances in the last decade, lung cancer remains the leading cause of cancer-related deaths, and early detection and diagnosis are paramount.1 Oftentimes, early lung cancer presents as a small nodule detected on a CT scan either incidentally or through lung cancer screening.2 3 Further evaluation of these nodules depends on radiographic characteristics, such as size, morphology and location, and individual risk factors, such as age and smoking history. Nodules at intermediate or high probability of malignancy are often referred for additional testing, including biopsy, which traditionally has been done via CT-guided transthoracic needle biopsy. Over the last decade, advanced diagnostic bronchoscopy has emerged as a reasonable alternative, with a recent randomised controlled trial suggesting comparable diagnostic yield.4 5 The study by Fernandez–Bussy and colleagues published in the journal is a two-centre retrospective study of 182 lung nodules biopsied using shape-

Primary spontaneous pneumothorax (PSP) traditionally refers to patients with no underlying lung disease; while those with established lung pathology are classified as secondary spontaneous pneumothorax (SSP). However, there is increasing recognition that patients with PSP do not have normal lungs.1 2 There are associations with familial conditions resulting from tumour suppressor genes and those with defects in the extracellular matrix.3 The classic condition related to tumour suppressor genes is Birt-Hogg-Dubé syndrome (BHD). BHD is an autosomal dominant condition caused by heterozygous mutations in FLCN, which encodes folliculin.4 Conditions with defects in the extracellular matrix include Marfan syndrome, Loeys-Dietz and vascular Ehlers-Danlos syndrome. Marfan syndrome is a condition caused by mutations in FBN1, which encodes fibrillin 1. Ehlers-Danlos syndrome (EDS) is a family of connective disorders mostly resulting from mutations in collagen pathways. Only the vascular subtype (

Background The diagnosis of interstitial lung disease (ILD) can pose a challenge as the pulmonary function test (PFT) is only minimally affected at the onset. To improve early diagnosis, this study aims to explore the potential of artificial intelligence (AI) software in assisting pulmonologists with PFT interpretation for ILD diagnosis. The software provides an automated description of PFT and disease probabilities computed from an AI model. Study methods In study phase 1, a cohort of 60 patients, 30 of whom had ILD, were retrospectively diagnosed by 25 pulmonologists (8 junior physicians and 17 experienced pneumologists) by evaluating a PFT (body plethysmography and diffusion capacity) and a short medical history. The experts screened the cohort twice, without and with the aid of AI (ArtiQ.PFT, V.1.4.0, ArtiQ, BE) software and provided a primary diagnosis and up to three differential diagnoses for each case. In study phase 2, 19 pulmonologists repeated the protocol after using ArtiQ.