Background/Objectives: Small airway disease/dysfunction (SAD) is crucial in obstructive airway diseases but is less investigated in interstitial lung disease (ILD). There are only a few physiological studies investigating SAD in the context of pulmonary fibrosis. Oscillometry is a simple technique that assesses SAD with minimal patient effort. In this study, we investigated the role of oscillometry in patients with mild pulmonary fibrosis without evident obstructive disorder, focusing on small airways. Methods: Oscillometry and pulmonary function test (PFT) data of consecutive patients newly diagnosed with pulmonary fibrosis of unknown etiology in a university hospital ILD clinic were collected and analyzed. Results: Data from 34 patients with mild pulmonary fibrosis were collected in 6 months. Disease severity, as evaluated by FVC, presented strong correlations with the oscillometry parameters: resistance (R5: r = −0.588, p < 0.001), reactance (X5: r = 0.671, p < 0.001), resonant frequency (Fres: r = −0.562, p = 0.001), and the area of reactance (AX: r = −0.515, p = 0.002). The oscillometry parameter R5-19-expressing was abnormal in 27% of patients, correlated with FEF25-75% (r = −0.370, p = 0.021) and was a predictor of a FEF25-75% < 60% pred. with AUC 0.738 (95%Cl 0.519–0.956). R5-19 correlated with FVC (r = −0.481, p = 0.004) and was the only SAD parameter that correlated with the composite physiologic index (CPI, r = 0.338, p = 0.04), while FEF 25-75% and RV/TLC% did not. Conclusions: Oscillometry is an easy to perform technique that may reveal early mechanical alterations caused by pulmonary fibrosis. Peripheral resistance, as expressed by R5-19, which identifies small airway dysfunction as a marker of peripheral lung pathology, may be complementary to pulmonary function testing and may also have prognostic implications for ILD patients.

Background: A link between inflammation and venous thromboembolism (VTE) in COVID-19 disease has been suggested pathophysiologically and clinically. The aim of this study was to investigate the association between inflammation and disease outcomes in adult hospitalized COVID-19 patients with VTE. Methods: This was a retrospective observational study, including quantitative and qualitative data collected from COVID-19 patients hospitalized at the Infectious Diseases Unit (IDU) of the University Hospital of Ioannina, from 1 March 2020 to 31 May 2022. Venous thromboembolism was defined as a diagnosis of pulmonary embolism (PE) and/or vascular tree-in-bud in the lungs. The burden of disease, assessed by computed tomography of the lungs (CTBoD), was quantified as the percentage (%) of the affected lung parenchyma. The study outcomes were defined as death, intubation, and length of hospital stay (LoS). A chi-squared test and univariate logistic regression analyses were performed in IBM SPSS 28.0. Results: After propensity score matching, the final study cohort included 532 patients. VTE was found in 11.2% of the total population. In patients with VTE, we found that lymphocytopenia and a high neutrophil/lymphocyte ratio were associated with an increased risk of intubation and death, respectively. Similarly, CTBoD > 50% was associated with a higher risk of intubation and death in this group of patients. The triglyceride–glucose (TyG) index was also linked to worse outcomes. Conclusions: Inflammatory indices were associated with VTE. Lymphocytopenia and an increased neutrophil-to-lymphocyte ratio negatively impacted the disease’s prognosis and outcomes. Whether these indices unfavorably affect outcomes in COVID-19-associated VTE must be further evaluated.

Rationale: A common symptom of worsening respiratory disease is an increase in cough. Patients currently self-report changes in cough as part of routine follow-up. However, self-reports are inaccurate. This project evaluated an automated process for quantifying cough during sleep. Methods: A proprietary deep learning model was developed to detect “cough-events” from audio collected with a smartphone. The model was trained using data from 169 subjects from publicly available sources and the University of Ioannina, Greece. Data consisted of coughs from healthy controls and patients with asthma and COPD. The trained model was evaluated in a quiet ‘nighttime like’ environment at the University of Ioannina, Greece with a new cohort of 40 subjects (15 male, age 54.6±12.2, 21 healthy controls, 5 asthmatics, 11 COPD and 3 other respiratory diseases). A total of 5 coughs were recorded from each subject at intervals of 30 seconds. Recordings were annotated by a respiratory physician and analyzed offline using the trained model. Results: In total 218 events were counted by the physician and 221 detected by the model. The model showed good agreement with the physician annotations, with a true positive rate (precision) of 84% and recall rate of 85%. On average, there was a 1.1±1.45 difference between physician counted events and the model. Comparing healthy and unhealthy subjects there was an average difference between annotator and system of 1.28±1.7 for healthy patients, and 0.95±1.2 for unhealthy patients Conclusion: The model shows good agreement with annotations from a respiratory physician. The recall and precision of the model was sufficiently high to give an accurate measurement of a patient’s nocturnal cough trend.

Postpneumonectomy-like syndrome is a rare condition resulting from unilateral lung disease with severe lung volume loss leading to excessive mediastinal shift and herniation of the healthy lung into the contralateral hemithorax, mimicking the mediastinal shift observed in postpneumonectomy syndrome after pneumonectomy. We report a unique case of postpneumonectomy-like syndrome caused by an atypical bronchial carcinoid completely occluding the left main bronchus. A 25-year-old woman presented with symptoms of chronic exertional dyspnea and productive cough. Imaging studies showed complete left lung atelectasis due to a mass occluding the left main bronchus, as well as extreme mediastinal deviation and substantial herniation of the right lung into the left hemithorax. Bronchoscopic biopsy of the tumor and subsequent left pneumonectomy with concurrent lymph node dissection revealed an atypical carcinoid. Sixteen months after surgery the patient has been asymptomatic with repeat imaging studies showing no change in mediastinal shifting. Bronchial carcinoids are notorious for causing bronchial obstruction. The present case represents an extreme complication of centrally located bronchial carcinoid, resulting in postpneumonectomy-like syndrome with severe mediastinal shift and herniation of the healthy lung into the diseased hemithorax.

Background: Depression and anxiety represent significant comorbidities in idiopathic pulmonary fibrosis (IPF) patients, affecting their quality of life. The COVID-19 pandemic has had an uneven impact on global mental health. The Hospital Anxiety and Depression Scale (HADS) constitutes a validated tool to identify anxiety disorders and depression. The aim of this multicentre study was to evaluate the effect of COVID-19 vaccination on depression and anxiety in IPF patients. Methods: Consecutive IPF patients (median 73.5 years) who are regularly followed-up with were included in the study. Demographics, functional, and clinical were recorded. The HADS score was calculated before and one month after vaccination against COVID-19 in all participants. A Wilcoxon signed ranks test was conducted. Results: A total of 180 IPF patients (median 73.5 years) were included in the study. Among them, 145 patients (81%) received antifibrotic treatment. A significant reduction in HADS, both in anxiety and depression scales, was observed one month after vaccination against SARS-COV-2), independent of age, smoking, lung function impairment, and prior history of depression (p < 0.01). Conclusions: A higher Hospital Anxiety and Depression Scale score was detected before vaccination against COVID-19. It seems that vaccination also offered a beneficial effect on depression and anxiety in IPF patients, independent of age, smoking, lung function impairment, and prior history of depression.

Introduction: Hemoptysis is a common clinical problem in emergency departments with a broad differential diagnosis that includes life-threatening causes, hence the patient should be thoroughly assessed. Aim: The aim of this study was to evaluate the epidemiological profile of patients admitted for hemoptysis in a Respiratory medicine department and assess the role of imaging modalities in the diagnostic approach. Methods: We analyzed the medical records of 161 patients admitted with hemoptysis in the Respiratory medicine department of the University Hospital of Ioannina, between July 2020 - December 2022. Results: The mean age was 68±19.2 years, the majority (79%) were men and 80% had a smoking history. Infections and malignancy were the most frequent causes of hemoptysis (24%), followed by drug-related hemoptysis (21%) and bronchiectasis (13%). Pulmonary embolism and tuberculosis were identified in 6% and 3% of the cases, while definite diagnosis was not established in 11% of the cases. In terms of imaging, abnormal findings were reported in 60% and 86% of Xrays and CT scans, respectively. The main findings were indicative of infection or carcinoma (mass, lymphadenopathy). Massive hemoptysis was present in 5% of the cases and was attributed either to carcinoma or infection with the concurrent use of anticoagulants. Conclusions: Infections and carcinoma were the primary causes of hemoptysis in our analysis, which is in accordance with the literature. Drug-related hemoptysis, seems to be an emerging cause of hemoptysis, which could be attributed to the increasing use of anticoagulants (40% in our dataset). The diagnostic yield of CT scan was verified, while we are assessing the contribution of bronchoscopy.