Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Background: Pediatric bronchoscopy and bronchoalveolar lavage (BAL) are valuable procedures, used by pediatric pulmonologists in a wide variety of clinical scenarios. Reports of indications for BAL include investigations of infectious processes, for unusual or poorly responsive pneumonia, and non-infections reasons, including interstitial lung disease and aspiration syndromes. BAL in pediatric asthma is occasionally done in severe and uncontrolled asthma, to rule out co-morbid conditions or to investigate asthma phenotypes. We report here the results of BAL in young children with global pre-BAL diagnoses, with comprehensive analysis of the BAL cellularity and culture results, and with a post hoc review by an allergist. The results of BAL in children with enigmatic pulmonary processes were compared to the expected BAL cellularity in normal children, obtained by an expanded historical mini review. Methods: The initial objective was to perform a mini review of the collective published data for normal/control children with BAL differential cell counts with the purpose of using the results to compare normals to the information obtained on the symptomatic children with BAL results from pulmonologists in our combined allergy–pulmonary division. The exploratory study group was children 0–6 years of age who underwent a BAL from 2000 to 2024 at an academic pulmonary-allergy division. The children had presumptive diagnoses requiring investigation, including the most common diagnoses of asthma, chronic cough, aspiration, or refractory bronchitis, and in this post hoc protocol only the diagnoses provided on the pre- and/or post-operative summary by the divisional pulmonologist(s) performing the BAL were used in the post hoc analysis. Secondarily, the operative day pre- and/or post-lavage diagnoses were used to divide the children into groups (based on operative day diagnoses) to stratify their lavage results, based on eosinophils, neutrophils, culture positivity and lipid-laden macrophages. Normative data collected from the literature was used as the historically expected results for the BAL group(s) analysis. Results: A mini review of BAL cellularity across 25+ years of literature was performed to establish normative data for our subsequent analysis. Both eosinophils and neutrophils are low or absent in normal children based on the comprehensive literature review. As a part of a larger cohort of 500 children ages 0–20 years, 317 children ages 0–6 were selected for review. The protocol was approved by the University Institutional Review Board. Using the mini review as reference, we found that eosinophil counts of one or more were recovered in over 20% of all children, regardless of bronchoscopy indication. Neutrophilia >50% of cells and/or bacteria colony counts >100,000 organisms were also frequent findings (>50 percent of the children). As a separate observation, lipid-laden macrophages did not isolate to aspiration indications for the bronchoscopy and lavage. Conclusions: An updated mini review of the cellularity expected in control children provided a context to the findings in our studied exploratory sample population. There was a high recovery of neutrophils coupled with culture positivity found across all children undergoing BAL. Eosinophils > 1 were present in up to 25% with a pre-lavage asthmatic symptom indication, but almost an equal percentage in other children with non-asthma-like conditions was surprising. Lipid-laden macrophage data was unhelpful....
Background: Interstitial lung disease (ILD) is the most serious manifestation of antisynthetase syndrome (ASyS). Limited research has explored racial differences in the clinical presentation and outcomes of ASyS-ILD. This study compared clinical manifestations, pulmonary function, and outcomes between Black and White patients with ASyS-ILD. Methods: A retrospective analysis was conducted using electronic health records from 2010 to 2020. Patients diagnosed with ILD and positive antisynthetase antibodies were included (N = 66; 34 Black and 32 White). Demographics, comorbidities, clinical features, pulmonary function tests, chest imaging, and clinical outcomes were compared between races. Results: Black patients were younger at diagnosis (49.1 ± 10.8 vs. 55.1 ± 12.9 years, p = 0.043) and had reduced pulmonary function (p < 0.01). Black patients also had a higher prevalence of traction bronchiectasis (96.6% vs. 73.1%, p = 0.012) and obstructive sleep apnea (p = 0.025). There were no differences in the frequency of hospitalizations, intensive care unit admissions, or deaths between groups. Myositis was common in both groups, and the distribution of antisynthetase antibodies did not differ by race (p = 0.333). Conclusions: Black patients are younger at diagnosis, have reduced lung function, and have increased traction bronchiectasis compared to White patients with ASyS-ILD. There is a higher prevalence of obstructive sleep apnea amongst Black patients without differences in body mass index. There was no difference in mortality and the need for lung transplantation. This study highlights several key differences between Black and White patients with ASyS-ILD. Longitudinal prospective studies are crucial to rigorously investigate race-based differences in morbidity, mortality, and long-term outcomes among patients with ASyS-ILD....
Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive, unpredictable, fatal interstitial lung disease. Antifibrotic therapy with pirfenidone or nintedanib slows functional decline, yet comparative real-world evidence remains limited. Materials and Methods: This retrospective, single-center, comparative cohort study included 76 IPF patients treated at the Clinic for Pulmonology at the University Clinical Center of Serbia (February 2019–February 2025). Diagnosis of IPF was made according to the guidelines of the American Thoracic Society and the European Respiratory Society. Demographic features, comorbidities, forced vital capacity (FVC), diffusion capacity for carbon monoxide (DLCO), high-resolution computerized tomography (HRCT) patterns, 6-min walk test distance (6MWTD), echocardiography, and survival outcomes were analyzed. Disease progression was defined as a ≥10% decline in FVC and/or DLCO after 12 months. Results: Of the 76 patients, 31 received nintedanib and 45 pirfenidone. Baseline characteristics, comorbidities, and HRCT patterns were comparable between groups. Mean annual decline in FVC was −1.74% with pirfenidone and −2.38% with nintedanib, without a statistical difference. DLCO declined by −4.25% and −6.29%, respectively, with similar downward trends over time in both groups. Progression was recorded in 35 (46.1%) patients, of whom 18 (58.06%) were in the nintedanib group and 17 (37.77%) in the pirfenidone group, with no difference between therapies (p = 0.81). Definite and probable usual interstitial pneumonia (UIP) were evenly represented on HRCT, although progression correlated significantly with the probable UIP pattern (p = 0.006). 6MWTD decreased in both groups over 12 months, again without treatment-related differences (p = 0.566). During up to 6 years of follow-up, overall survival was 4.18 years, with no significant difference between the nintedanib (4.55 years) and pirfenidone (3.81 years) groups (p = 0.159). No association was found between disease stage (FVC or DLCO) and progression. Conclusions: This study demonstrates that pirfenidone and nintedanib are equally effective in the management of IPF in real-world settings. The absence of significant differences in functional decline, progression rates, and survival indicates that treatment choices should be guided by individual clinical profiles rather than efficacy alone, reinforcing antifibrotic therapy as the primary approach to alter the course of IPF. Importantly, disease progression was strongly associated with a probable UIP pattern on HRCT, supporting current guidelines suggesting that probable UIP has a natural history and prognosis similar to those of definite UIP....
Background/Objective: Little is known about the efficacy of biologics and in particular Dupilumab in patients with severe asthma associated with COPD (SA-COPD) features. The objective of this study was to determine whether Dupilumab has similar clinical/functional efficacy in individuals with SA-COPD and in those with pure severe asthma (SA). Methods: We retrospectively selected 11 consecutive patients with SA with COPD features (smoking history of at least 15 pack/years; emphysema on chest CT scan; FEV1 < 80%; RV and TLC > 130%; DLCO < 70; salbutamol reversibility test < 12%) treated with Dupilumab for at least 1 year. These subjects were compared with 33 consecutive patients with SA alone who were also treated with the same biologic for at least 12 months. Results: FEV1 and FEF25–75 changes after treatment were 10 ± 18.3% and 18.6 ± 26.5% in the SA group, whereas they were 4.8 ± 7.6% and 7.2 ± 6.8% in individuals with SA-COPD (p = 0.909 and p = 0.102 respectively). Similarly, ACT (5.3 ± 3.1 vs. 5.6 ± 3.7; p = 0.783) and exacerbation changes (−2.97 ± 1.3 vs. −4 ± 4.3; p = 0.960) after Dupilumab were similar in the two groups. No differences were also found in FeNO and BEC changes (−18 ± 22 vs. −21.3 ± 21.1 ppb and −63.6 ± 415 vs. −142 ± 299 cells/μL respectively; p = 0.984 and p = 0.481). The percentages of subjects that reduced and stopped OC therapy and those that stepped down the level of ICS dose after treatment were also similar in the two populations. After adjustment for multiple confounding factors, changes in all evaluated outcomes also remained comparable between patients with SA-COPD and those with SA. Conclusions: In our experience, Dupilumab is effective both in patients with SA alone and in those with asthma–COPD overlap. We must always consider T2 inflammation in the management of such patients in order to provide the most appropriate treatment....
In clinical practice, healthcare providers encounter a rising incidence of aspergillosis, which significantly affects morbidity and mortality in vulnerable patients. Over the past few decades, molds have increasingly affected patients with underlying pleuropulmonary, hematological, or oncological diseases undergoing cytotoxic treatment or immunosuppression, leading to impaired cell-mediated immunity and an increased risk of postoperative complications. Although the spectrum of Aspergillus infection is variable, ranging from allergic to chronic, invasive manifestation, pleural involvement is rarely reported. Pleural aspergillosis is an extrapulmonary manifestation of invasive aspergillosis, associated with thoracic surgical procedures and with a bronchopleural fistula, not necessarily combined with pulmonary aspergillosis. An elective or emergency thoracic surgery in immunocompromised patients increases the risk of postoperative infectious complications. Herein, we report a case of isolated postoperative pleural aspergillosis in a 28-year-old immunocompromised man with metastatic synovial sarcoma in the lungs, who underwent pleurodesis for pneumothorax, lobectomy for lung metastasis, and subsequently required decortication and thoracoplasty to achieve effective control of infection. To address this, the patient responded well to aggressive surgical debridement along with both systemic and intrapleural antifungal agent instillation. The essential in vitro diagnostics, including microscopy, microbiological culture and histopathological examination, both from necrotic pleural specimens, detected Aspergillus fumigatus, a global priority species of invasive aspergillosis. Postoperative aspergillosis with pleural involvement and bronchopleural fistula, in immunocompromised patients with sarcoma, is rarely reported, requiring a combination of surgical approach and optimized antifungal treatment regimens. The current knowledge on pleural aspergillosis management remains limited, and highlights the need for case reporting to refine expertise....
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