The aim of the study was to characterise gastro-oesophageal reflux (GOR) in idiopathic pulmonary fibrosis (IPF).40 consecutive IPF patients underwent pulmonary high-resolution computed tomography (HRCT) scan and impedance-pH monitoring while off antisecretory therapy. The presence of pulmonary fibrosis was assessed using validated HRCT scores. Reflux features included distal oesophageal acid exposure, number of acid/weakly acidic reflux episodes and their proximal migration. 40 consecutive patients with interstitial lung disease other than IPF (non-IPF patients) and 50 healthy volunteers were also enrolled.IPF patients had significantly higher (p<0.01) oesophageal acid exposure (median (interquartile range (IQR)) 9.25 (4.7–15.4)%versus3.3 (1.4–7.4)%versus0.7 (0.2–4.2)%, number of acid (median (IQR) 45 (23–55)versus32 (19–44)versus18 (10–31)), weakly acidic (median (IQR) 34 (19–43)versus21 (11–33)versus18 (15–28)) and proximal reflux (median (IQR) 51 (26.5–65.5)versus20 (9.5–34.5)versus9 (5–20)) events compared to non-IPF patients and healthy volunteers, respectively. Pulmonary fibrosis HRCT scores correlated well with reflux episodes in both the distal (r²=0.567) and proximal (r²=0.6323) oesophagus. Patients with IPF had more bile acids and pepsin (p<0.03) in bronchoalveolar lavage fluid (BALF) (62% and 67%, respectively) and saliva (61% and 68%, respectively) than non-IPF patients (25% and 25% in BALF, and 33% and 36%, respectively, in saliva) and controls (0% and 0% in BALF and saliva, respectively).Acid GOR is common in IPF, but weakly acidic GOR may also occur. Patients with IPF had a risk of pulmonary aspiration of gastric contents. Outcome studies with intense antireflux therapy are needed.

Background: The aim of this study was to evaluate the activity and toxicity of pemetrexed and carboplatin combination as first-line chemotherapy in malignant pleural mesothelioma (MPM). Patients and methods: Patients with measurable advanced MPM and a zero to two Eastern Cooperative Oncology Group (ECOG) performance status (PS) were enrolled. The schedule was pemetrexed 500 mg/m² in combination with carboplatin area under the curve 5, every 21 days. In all, 76 patients were treated. Median age was 65 years; median ECOG PS was zero. Results: Grade 3 hematological toxicity according to World Health Organization criteria was seen in 36 (47.3%) patients; grade 4 hematological toxicity in 5 (6.5%) patients. There were 16 (21%) partial responses and 3 (4%) complete responses, for an overall response rate of 19 (25%) [95% confidence interval (CI) 15.3–34.7]. In all, 29 (39%) (95% CI 28–48) patients reported stable disease. The median survival was estimated at 14 months. Conclusion: This combination of carboplatin and pemetrexed is moderately active and the toxicity is acceptable.

Acute and chronic eosinophilic pneumonia (AEP and CEP) include a group of rare interstitial lung diseases characterized by peripheral blood eosinophilia, increased eosinophils in bronchoalveolar lavage fluid, or eosinophilic infiltration of lung parenchyma. AEP is characterized by rapid onset, fast response to steroid treatment, and no relapse. CEP is characterized by marked tissue and peripheral blood eosinophilia, rapid response to steroid therapy, and tendency to disease recurrence. In addition, we briefly describe other eosinophilic lung diseases that must be considered in differential diagnosis of AEP and CEP. Eosinophilic pneumonias may be idiopathic or due to known causes such as medications or environmental exposure. At variance with previous reviews on this topic, a particular look in this overview was directed at pathological findings and radiological patterns.

Current epidemiological data on interstitial lung disease (ILD) are still poor. The principal cause of the discordant data is associated with a heterogeneous group of respiratory diseases that includes a large number, about 200 families, with low frequency, distinct and sometimes unknown etiology, and different progression. In fact, some conditions spontaneously resolve, whereas others, such as IPF and most non-IPF ILDs, progress to respiratory failure and death despite treatment. Furthermore, epidemiological data are limited. The scope of the narrative review is to report ILD incidence and prevalence in registries from different countries in the last three decades. We identified 20 ILD registries (17 prospective and 3 retrospective) from major countries in Europe (n = 10), Asia (n = 7), North America (n = 2), and Oceania (n = 1). Significant discrepancies in ILD and ILD subtype prevalence and incidence among countries are reported in registries. These discrepancies could be determined by different ethnicities and socioeconomic conditions as well as by updates in disease diagnosis and classification. ILD epidemiological registries are progressively ameliorating through better adherence to updated guidelines and classification codes. An accurate and definite diagnosis and compilation of ILD epidemiological registries will be useful for a more precise monitoring of disease progression and treatment. Future research to identify the populations with the highest risk factors, including genetic and molecular studies, and implementation of disease progression scores are needed to improve ILD clinical assessment.