There is a fine balance in maintaining healthy microbiota composition, and its alterations due to genetic, lifestyle, and environmental factors can lead to the onset of respiratory dysfunctions such as chronic obstructive pulmonary disease (COPD). The relationship between lung microbiota and COPD is currently under study. Little is known about the role of the microbiota in patients with stable or exacerbated COPD. Inflammation in COPD disorders appears to be characterised by dysbiosis, reduced lung activity, and an imbalance between the innate and adaptive immune systems. Lung microbiota intervention could ameliorate these disorders. The microbiota’s anti-inflammatory action could be decisive in the onset of pathologies. In this review, we highlight the feedback loop between microbiota dysfunction, immune response, inflammation, and lung damage in relation to COPD status in order to encourage the development of innovative therapeutic goals for the prevention and management of this disease.

Perinuclear Anti Neutrophil Cytoplasmic Antibody (p-ANCA) is a serological marker of Microscopic Polyangiitis (MPA), a vasculitis associated with lung involvement potentially mimicking Idiopathic Pulmonary Fibrosis (IPF). In this study, we evaluated the role of p-ANCA in predicting clinical evolution and prognosis in a cohort of IPF patients. In this observational, retrospective, case–control study, we compared 18 patients with an IPF diagnosis and p-ANCA positivity with 36 patients with seronegative IPF, matched for age and sex. IPF patients with and without p-ANCA showed similar lung function decline during the follow-up, but IPF p-ANCA+ showed better survival. Half of IPF p-ANCA+ patients were classified as MPA for the development of renal involvement (55%) or skin signs (45%). The progression towards MPA was associated with high levels of Rheumatoid Factor (RF) at baseline. In conclusion, p-ANCA, mainly when associated with RF, could predict the evolution of Usual Interstitial Pneumonia (UIP) towards a definite vasculitis in patients, with a better prognosis compared with IPF. In this view, ANCA testing should be included in the diagnostic workup of UIP patients.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) represents the gold standard technique for the diagnosis and staging of lung carcinoma. However, its diagnostic yield may be limited for granulomatous pathologies or rare tumors requiring comprehensive histological and molecular analysis. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) is an emerging technique that allows for the acquisition of larger histological samples with preserved tissue architecture. The primary objective of this prospective multicenter study was to evaluate the potential increase in diagnostic yield afforded by the addition of EBUS-TMC to EBUS-TBNA in patients selected by pre-test clinical–radiological criteria presenting with hilar–mediastinal lymphadenopathies without an obvious primary neoplastic lung lesion. Methods: The study prospectively enrolled 91 patients across two Italian interventional pulmonology units. Patients were selected based on a pre-defined clinical–radiological criterion aimed at excluding primary lung cancer suspects. For each patient, both EBUS-TBNA and EBUS-TMC were performed. Results: The overall diagnostic yield for the combined procedure was 84.6% (77/91 patients). EBUS-TMC achieved a diagnostic yield of 78.0%, which was significantly higher than EBUS-TBNA alone of 60.4%. The addition of EBUS-TMC resulted in a statistically significant increase in diagnostic yield of 17.6%. This increase was particularly pronounced for lymphoproliferative diseases. The safety profile of EBUS-TMC was favorable without major complications. The clinical–radiological criterion used to select patients for EBUS-TMC in addition to the standard of care of EBUS-TBNA, aiming at excluding primary lung cancer, was correct in 89.0% of the study population (81 out of 91 patients). Conclusions: EBUS-TMC is a safe and feasible technique that significantly enhances the diagnostic yield (17.6% absolute increase in diagnostic yield) in patients with hilar–mediastinal lymphadenopathies. The clinical–radiological criterion employed proved effective in pre-selecting patients who benefit most from cryobiopsy, thereby enabling a more rational allocation of healthcare resources.

Background and Objectives: Lower respiratory tract infections are particularly frequent in hematological patients; their early diagnosis and the timely start of targeted therapy are essential. Bronchoalveolar lavage (BAL) can provide a microbiological sample from the lower airways in a minimally invasive way. This study aimed to determine the diagnostic yield of BAL in hematological patients for microbiological purposes and its influence on modifying the therapeutic strategy. Material and Methods: This multicenter, retrospective, observational study included data from 193 consecutive patients from two centers from January 2020 to October 2022. The patients underwent a bronchoscopy with BAL in cases of pulmonary infiltrates suspicious of pulmonary infection. The demographic data, presenting symptoms, level of immunosuppression, chest CT changes, BAL sampling results, and antimicrobiological drug administration were analyzed. Results: Of the 193 procedures, 143 (74.1%) were performed on hospitalized patients, while 50 were performed on outpatients. In 53.9% of the cases, the BAL isolated at least one germ; in particular, if the procedure was carried out within 72 h of presenting symptoms, the probability of isolating the germ increased significantly (74.3%, p = 0.04). Among the isolated germs, 59.4% were viruses, 28.6% were bacteria, and 12% were fungi. The patients with higher immunosuppression and the febrile ones underwent BAL earlier than the patients with mild immunosuppression (p = 0.01) and those with other presenting symptoms (p = 0.0001). BAL positivity led to a change in empirical antimicrobial therapy in 79 out of 104 cases (77% vs. 36.3%; p < 0.001); these data were also confirmed among the hospitalized patients (81% vs. 44%; p < 0.001). The isolation of a pathogen through BAL and the degree of patient immunosuppression negatively influenced patient survival (p < 0.05 and p < 0.01, respectively). Conclusions: BAL is confirmed as a valid approach for evaluating pulmonary infiltrates in hematological patients, given the excellent clinical impact and high diagnostic yield, mainly if performed early after symptom presentation. However, ongoing antimicrobial treatments at the time of BAL may have potentially affected the diagnostic yield of the procedure.