Severe asthma is a subset of difficult-to-treat asthma that requires the verification of inhaler technique, the correction of modifiable risk factors, as well as diagnosis and comorbidity review. When severe asthma is suspected, patients should undergo proper phenotyping (T2-high or T2-low) and be referred to a specialized severe asthma clinic. The current biologics for severe asthma treatment include omalizumab (anti-IgE), mepolizumab and reslizumab (anti-IL-5), benralizumab (anti-IL-5 receptor), dupilumab (anti-IL-4/IL-13), and tezepelumab (anti-TSLP). The outcomes to evaluate are the reduction in systemic corticosteroid use, the reduction in exacerbations and healthcare use, and improvement in symptoms and lung function. Comorbidities should be carefully considered, and if possible, addressed with the same biologic. Dupilumab, mepolizumab, and omalizumab are also approved for chronic rhinosinusitis with nasal polyps (CRSwNP), the most common asthma comorbidity. There are currently several clinical trials on biologics for severe asthma. Depemokimab is an ultra-long-acting anti-IL-5 antibody with promising results in phase III trials as a twice-yearly biologic for T2-high asthma. Verekitug follows a similar dosing concept, targeting TSLP, but is still undergoing phase II trials. Itepekimab and astegolimab are two anti-IL-33 antibodies that could have a role in the future treatment of severe asthma. Tezepelumab is in a phase III clinical trial for CRSwNP. Besides new drugs, there is still a need for major research into biologics in severe asthma cases, namely with comparative studies, better biomarkers for predicting response, and the determination of optimal treatment duration.

Background: Chronic obstructive pulmonary disease (COPD) is frequently associated with exertional oxygen desaturation, which may be evaluated using the 6-minute walking test (6MWT). However, it is a time-consuming test. The 1-minute sit-to-stand test (1STST) is a simpler test, already used to evaluate the functional status. The aim of this study was to compare the 1STST to the 6MWT in the evaluation of exertional desaturation. Methods: This was a cross-sectional study including 30 stable COPD patients who performed the 6MWT and 1STST on the same day. Six-minute walking distance (6MWD), number of 1STST repetitions (1STSTr), and cardiorespiratory parameters were recorded. Results: A significant correlation was found between the 6MWD and the number of 1STSTr (r = 0.54; p = 0.002). The minimum oxygen saturation (SpO₂) in both tests showed a good agreement (intraclass correlation coefficient (ICC) 0.81) and correlated strongly (r = 0.84; p < 0.001). Regarding oxygen desaturation, the total agreement between the tests was 73.3% with a fair Cohen’s kappa (κ = 0.38; p = 0.018), and 93.33% of observations were within the limits of agreement for both tests in the Bland–Altman analysis. Conclusion: The 1STST seems to be a capable tool of detecting exercise-induced oxygen desaturation in COPD. Because it is a less time- and resources-consuming test, it may be applied during the outpatient clinic consultation to regularly evaluate the exercise capacity and exertional desaturation in COPD.

Non-tuberculous mycobacterial pulmonary disease may have different clinical manifestations. We report a case of a 64-year-old woman presenting with persistent respiratory complaints, fever and radiological findings. Initially, she was diagnosed with community-acquired pneumonia, but after being submitted to an extensive investigation, including CT-guided transthoracic lung biopsy, a diagnosis of organising pneumonia (OP) was established. The patient was treated with corticosteroids with no favourable response. Subsequently, Mycobacterium avium complex (MAC) was identified in bronchoalveolar lavage culture. The patient was diagnosed with OP secondary to MAC infection and specific antibiotic treatment was initiated. This case represents an infrequent association and illustrates how important it is to investigate primary causes of OP to obtain a satisfactory treatment response.

Introduction: Recently, the inclusion of comorbidities in GAP score has demonstrated a higher discriminative performance in predicting the risk of death comparing to GAP alone in IPF (TORVAN). We performed a mortality analysis in Chronic Hypersensitivity Pneumonitis (cHP) patients, accordingly to ILD-GAP and TORVAN model. Methods: Retrospective analysis of cHP patients, followed in an ILD outpatient department. Results: We included 49 patients, mainly female (32-65.3%) with a median age of 71 years (45-84). The most common comorbidities were systemic hypertension (36-73.5%) and diabetes mellitus (14-28.6%). With ILD-GAP, the patients were divided: 42.9% (n=21) - 0-1 category; 38.8% (n=19)-2-3 category; 16.3% (n=8)-4-5 category and 2.0% (n=1)->5 category Considering TORVAN, the patients (n=46) were divided: 19.6%(n=9) - I category; 19.6%(n=9) - II category; 39.1%(n=18) - III category and 21.7%(n=10) - IV category. Fourteen patients(28.6%) died during follow-up and the median survival time was 29.0 months(5-55). The majority of patients who died were included in stage III and IV(n=13) of TORVAN model. When grouping in binary variables, there was a statistically significant difference between the proportion of deaths in the different categories of TORVAN (stage I-II vs III-IV,p= 0.011) and ILD-GAP (index 1-3 vs >=4,p<0.001). For 1-year mortality, the ILD-GAP and TORVAN score had an AUC of 0.872 (95%CI 0.71-0.99;p=0.015) and 0.726 (95%CI 0.43-0.99;p=0.139), respectively. Conclusion: In our sample of cHP, the ILD-GAP and the TORVAN were associated with mortality, however, ILD-GAP seems to have a better predictive value than TORVAN. Larger studies are needed to evaluate the impact of these scores.

Background: After the FLAURA trial, it has been widely discussed which is the best treatment sequencing in EGFR+ NSCLC: start osimertinib as 1st line treatment versus initiate 1st/2nd generation tirosine-kinase inhibitor(1/2G TKI) and use osimertinib for the ones who progress with T790M+. Our aim was to identify the percentage of patients that initiated 1/2G TKI and had clinical conditions to search for the T790M mutation and to initiate osimertinib as 2nd line treatment. Methods: Retrospective study of NSCLC EGFR+ diagnosed between january/2017 and october/2019. Clinical, pathological and molecular data were analyzed. Results: Were identified 88 patients and 29 had initiated 1/2G TKI, which were mainly female (n=20-69.0%), with a median age of 70 years (40-92) and non-smoker (n=22-75.9%). From this group, 5 patients (17.2%) still maintained 1/2G TKI. Considering patients with progression (n=24), 5 patients (20.8%) did not performed the search for the T790M: best supportive care/death (n=4) and lost follow-up (n=1). The T790M was searched in nineteen patients (79.2%) (liquid biopsy and/or tumor): positive in 52.6%(n=10) and insufficient sample in 5.3%(n=1). Regarding the T790M+, 9 patients began osimertinib as 2nd line treatment. One patient had a functional status deterioration while waiting for T790M results. Conclusion: Most patients that progressed after 1/2G TKI presented clinical conditions to search for the T790M mutation. However, only 37,5% of patients had conditions/criteria to initiate osimertinib as 2nd line treatment. Therefore, these results reinforce the importance of finding predictors of T790M+, in order to identify those patients that will benefit from 1/2G TKI->T790M+>osimertinib strategy.