As the world transitions from the acute phase of the COVID-19 pandemic, a novel concern has arisen—interstitial lung disease (ILD) as a consequence of SARS-CoV-2 infection. This review discusses what we have learned about its epidemiology, radiological, and pulmonary function findings, risk factors, and possible management strategies. Notably, the prevailing radiological pattern observed is organising pneumonia, with ground-glass opacities and reticulation frequently reported. Longitudinal studies reveal a complex trajectory, with some demonstrating improvement in lung function and radiographic abnormalities over time, whereas others show more static fibrotic changes. Age, disease severity, and male sex are emerging as risk factors for residual lung abnormalities. The intricate relationship between post-COVID ILD and idiopathic pulmonary fibrosis (IPF) genetics underscores the need for further research and elucidation of shared pathways. As this new disease entity unfolds, continued research is vital to guide clinical decision making and improve outcomes for patients with post-COVID ILD.

Introduction: The INBUILD trial found that patients with fibrosing interstitial lung diseases treated Nintedanib demonstrated a slower rate of progression than with placebo (Flaherty KR, et al. N Engl J Med. 2019;381:1718-1727). This study aims to analyse key clinical and survivability characteristics of a PFILD cohort treated with Nintedanib at a specialist centre in the UK. Methods: Retrospective data was collected from 138 patients from our centre over a 3-year period (November 2019-2022) from a Named Individual Patient Supply and a service evaluation. All 138 patients were diagnosed with PFILD after MDT consensus according to criteria from the INBUILD trial. Statistical analysis was performed on variables between surviving and deceased patients. Results: Of the 138 PFILD patients, 31 (22%) had passed away by December 2022. 98 PFILD patients (71%) started Nintedanib before December 2022. There was no statistically significant difference when considering age at diagnosis, sex, underlying fibrotic lung disease nor concomitant immunosuppression. Severity of disease progression (≥10% decline in FVC at diagnosis) was found to have a statistically significant impact on survival; 35.5% of deceased patients meeting this criterion. Lower baseline FVC (notably <70%) also demonstrated a statistically significant difference. Our data showed a trend towards an indeterminate usual interstitial pneumonia (UIP) pattern as predictor of mortality; however, further studies are necessary to confirm this. Conclusion: From our PFILD cohort lower baseline FVC and an indeterminate UIP pattern on CT-scan were all associated with an increased mortality risk.

Introduction: Stage III/N2 Non-small cell lung cancer (NSCLC) is a complex disease with multi-modality therapeutic options. UK practice emphasizes the presence of single station N2 (ssN2) vs multi-station N2 disease (msN2) to determine treatment. A pilot study in Manchester, found 34% of patients with pre-operative ssN2 disease (based on CT, PET-CT and EBUS) were upstaged at pathological sampling (Craig, C. et al. Lung cancer, v156, S23). This study aims to investigate this correlation across multiple centres. Methods: We conducted a retrospective analysis across 6 UK sites over a 5-year period (01/01/2016-31/12/2020). Data was collected from patients with T1-4N2M0 NSCLC, who had pre-operative staging (CT, PET and EBUS-TBNA) and an MDT diagnosis of ssN2, who underwent surgical resection. Clinical and pathological staging was compared to describe the diagnostic accuracy of pre-operative staging. Statistical analysis was performed on variables between the 2 groups. Results: 59 patients were recruited, 19 (32%) had pathological staging of msN2. 37% of these patients had no evidence of N2 nodes on CT but 89% had a PET stage of ssN2. In the false ssN2: 58% had nodes not sampled due to EBUS characteristics and size, 4 were due to negative EBUS sampling and 4 due to inaccessible nodes. There was no statistically significant difference in tumour sub-typing, location, size or PET-SUV between the 2 groups. Median time from EBUS to surgery was 33 days. Conclusion: In stage III-N2 disease, pre-operative staging is unreliable at distinguishing between ssN2 and msN2 when compared to pathological stage. This should provide caution for centres which rely on this distinction to define treatment.