Background: Chronic respiratory diseases constitute a considerable part in the practice of pulmonologists and primary care physicians; spirometry is integral for the diagnosis and monitoring of these diseases, yet remains underutilized. The Air Next spirometer (NuvoAir, Sweden) is a novel ultra-portable device that performs spirometric measurements connected to a smartphone or tablet via Bluetooth®. Methods: The objective of this study was to assess the accuracy and validity of these measurements by comparing them with the ones obtained with a conventional desktop spirometer. Two hundred subjects were enrolled in the study with various spirometric patterns (50 patients with asthma, 50 with chronic obstructive pulmonary disease and 50 with interstitial lung disease) as well as 50 healthy individuals. Results: For the key spirometric parameters in the interpretation of spirometry, i.e. FEV₁, FVC, FEV₁/FVC and FEF_25–75%, Pearson correlation and Interclass Correlation Coefficient were greater than 0.94, exhibiting perfect concordance between the two spirometers. Similar results were observed in an exploratory analysis of the subgroups of patients. Using Bland-Altman plots we have shown good reproducibility in the measurements between the two devices, with small mean differences for the evaluated spirometric parameters and the majority of measurements being well within the limits of agreement. Conclusions: Our results support the use of Air Next as a reliable spirometer for the screening and diagnosis of various spirometric patterns in clinical practice.

Background: Coronavirus disease 2019 (COVID-19) has been a pandemic since 2020, and depending on the SARS-CoV-2 mutation, different pandemic waves have been observed. The aim of this study was to compare the baseline characteristics of patients in two phases of the pandemic and evaluate possible predictors of mortality. Methods: This is a retrospective multicenter observational study that included patients with COVID-19 in 4 different centers in Greece. Patients were divided into two groups depending on the period during which they were infected during the Delta and Omicron variant predominance. Results: A total of 979 patients (433 Delta, 546 Omicron) were included in the study (median age 67 years (54, 81); 452 [46.2%] female). Compared to the Omicron period, the patients during the Delta period were younger (median age [IQR] 65 [51, 77] vs. 70 [55, 83] years, p < 0.001) and required a longer duration of hospitalization (8 [6, 13] vs. 7 [5, 12] days, p = 0.001), had higher procalcitonin levels (ng/mL): 0.08 [0.05, 0.17] vs. 0.06 [0.02, 0.16], p = 0.005, ferritin levels (ng/mL): 301 [159, 644] vs. 239 [128, 473], p = 0.002, C- reactive protein levels (mg/L): 40.4 [16.7, 98.5] vs. 31.8 [11.9, 81.7], p = 0.003, and lactate dehydrogenase levels (U/L): 277 [221, 375] vs. 255 [205, 329], p < 0.001. The Charlson Comorbidity Index was lower (3 [0, 5] vs. 4 [1, 6], p < 0.001), and the extent of disease on computed tomography (CT) was greater during the Delta wave (p < 0.001). No evidence of a difference in risk of death or admission to the intensive care unit was found between the two groups. Age, cardiovascular events, acute kidney injury during hospitalization, extent of disease on chest CT, D-dimer, and neutrophil/lymphocyte ratio values were identified as independent predictors of mortality for patients in the Delta period. Cardiovascular events and acute liver injury during hospitalization and the PaO₂/FiO₂ ratio on admission were identified as independent predictors of mortality for patients in the Omicron period. Conclusions: In the Omicron wave, patients were older with a higher number of comorbidities, but patients with the Delta variant had more severe disease and a longer duration of hospitalization.

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.

Smoking has been accounted for numerous adverse effects. We report a direct effect of smoking in a 73-year-old patient, a heavy smoker who presented to the emergency department with a 48-h history of productive cough and fever. Chest x-ray and chest CT revealed right lung infiltrates; however, they were not suggestive of the diagnosis, which was established through flexible bronchoscopy. The specific procedure concurrently contributed to the treatment of the patient.

Introduction: There is evidence for the presence of endothelial dysfunction in patients with COPD. Objectives: We sought to examine potential associations of two important markers of endothelial dysfunction, MAB as well as serum vWf:Ag and vWf:Ac, in patients with COPD. Methods: 103 outpatients with stable COPD and 42 smokers of more than 10-pack-years without airway obstruction (control group) were included. Results: Cardiovascular risk, assessed by HEART score, was not different between the two groups (P=0.061).The presence of MAB was greater in patients with COPD than in the control group: 29% vs. 12% P=0.032.Patients with COPD had significantly higher levels of MAB than controls (mean±SD): 42.17±67.16 vs. 14.17±15.80 mg/g, P=0.001. In the COPD group, the presence of MAB was different among GOLD 2020 ABCD groups (P=0.006), being highest (47%) in group D. Presence of microalbuminuria was greater in patients with CAT score ≥10 (P=0.017) and in patients with FEV1 <55% (P=0.036).vWf:Ag and vWf:Ac were significantly higher in the COPD group compared to the control group (Mean±SD): 147.08±61.93% vs 111.52±28.75%, P<0.001 and 137.15±46.10 vs 106.83±31.62%, P<0.001, respectively.In COPD patients, vWf:Ag and vWf:Ac were different among ABCD groups (P<0.001 for both) being highest in group D. vWf:Ag and vWf:Ac were higher in the group of patients with FEV1<55% compared to those with FEV1≥55%: 154.91±77.70 vs. 126.34±36.54%,P=0.007 and 140.77±53.52 vs. 113.59±36.81%,P=0.002, respectively. Conclusions: The present study has found significant associations of MAB, vWf:Ag and vWf:Ac with the new version of ABCD grading system and with COPD patients who have reduced lung function.