Background: Reticulation, ground glass opacities and post-infection bronchiectasis are present three months following hospitalisation in patients recovering from SARS-CoV-2 infection and are associated with the severity of acute infection. However, scarce data exist on small airways impairment and lung hyperinflation in patients with long COVID-19. Aim: To evaluate small airways function and lung hyperinflation in previously hospitalised patients with long COVID-19 and their association with post-COVID-19 breathlessness. Methods: In total, 33 patients (mean ± SD, 53 ± 11 years) with long COVID-19 were recruited 149 ± 90 days following hospital discharge. Pulmonary function tests were performed and lung hyperinflation was defined as RV/TLC ≥ 40%. Small airways function was evaluated by measuring the closing volume (CV) and closing capacity (CC) using the single-breath nitrogen washout technique (SBN₂W). Results: CC was 115 ± 28% pred. and open capacity (OC) was 90 ± 19. CC was abnormal in 13 patients (39%), CV in 2 patients (6.1%) and OC in 9 patients (27%). Lung hyperinflation was present in 15 patients, whilst the mean mMRC score was 2.2 ± 1.0. Lung hyperinflation was associated with CC (r = 0.772, p = 0.001), OC (r = 0.895, p = 0.001) and mMRC (r = 0.444, p = 0.010). Conclusions: Long COVID-19 patients present with small airways dysfunction and lung hyperinflation, which is associated with persistent dyspnoea, following hospitalisation.

Background/Objectives: Cardiorespiratory complications are commonly reported among patients with long COVID-19 syndrome. However, their effects on exercise capacity remain inconclusive. We investigated the impact of long COVID-19 on exercise tolerance combining cardiopulmonary exercise testing (CPET) with resting echocardiographic data. Methods: Forty-two patients (55 ± 13 years), 149 ± 92 days post-hospital discharge, and ten healthy age-matched participants underwent resting echocardiography and an incremental CPET to the limit of tolerance. Left ventricular global longitudinal strain (LV-GLS) and the left ventricular ejection fraction (LVEF) were calculated to assess left ventricular systolic function. The E/e’ ratio was estimated as a surrogate of left ventricular end-diastolic filling pressures. Tricuspid annular systolic velocity (SRV) was used to assess right ventricular systolic performance. Through tricuspid regurgitation velocity and inferior vena cava diameter, end-respiratory variations in systolic pulmonary artery pressure (PASP) were estimated. Peak work rate (WRpeak) and peak oxygen uptake (VO₂peak) were measured via a ramp incremental symptom-limited CPET. Results: Compared to healthy participants, patients had a significantly (p < 0.05) lower LVEF (59 ± 4% versus 49 ± 5%) and greater left ventricular end-diastolic diameter (48 ± 2 versus 54 ± 5 cm). In patients, there was a significant association of E/e’ with WRpeak (r = −0.325) and VO₂peak (r = −0.341). SRV was significantly associated with WRpeak (r = 0.432) and VO₂peak (r = 0.556). LV-GLS and PASP were significantly correlated with VO₂peak (r = −0.358 and r = −0.345, respectively). Conclusions: In patients with long COVID-19 syndrome, exercise intolerance is associated with left ventricular diastolic performance, left ventricular end-diastolic pressure, PASP and SRV. These findings highlight the interrelationship of exercise intolerance with left and right ventricular performance in long COVID-19 syndrome.

Chronic obstructive pulmonary disease (COPD) exacerbations are important events in the natural history of the disease with debilitating consequences which include more rapid lung function decline, quality of life deterioration and increased risk of cardiovascular events and mortality. Inflammation in COPD is complex and is intrinsically less responsive to corticosteroids compared to asthma. Biologics could possibly reduce the burden of inflammation in selected patients. In this single center retrospective study, we evaluated the eligibility of COPD patients hospitalized during the last 6 years in the respiratory department of a tertiary hospital for a severe COPD exacerbation, to receive either dupilumab or mepolizumab according to the inclusion criteria of their respective randomized controlled trials and GOLD 2026 recommendations. 496 patients were included in the study, 83 (16.7 %) patients were eligible for treatment with mepolizumab and 29 (5.8 %) for treatment with dupilumab, while 413 (83.3 %) were not eligible for any of the biologics currently approved for COPD treatment. Patients who were eligible for biologics had lower FEV₁/FVC ratio and had experienced more COPD exacerbations and more hospitalizations for COPD exacerbations in the previous year compared to those characterized as non-eligible. The main factor missing from non-eligible patients was treatment with triple inhaled medication, prior to hospitalization. Only a minority of patients hospitalized due to severe COPD exacerbation would have been eligible to receive biologic therapy. Optimization of medical treatment including inhaled medication in addition to disease phenotyping are pivotal for the recognition of the patients which will benefit from the use of biologics.

Background/Objectives: Supervised pulmonary rehabilitation (PR) is effective in improving cardiorespiratory fitness in non-hospitalised individuals with long COVID. However, there is limited evidence regarding PR-induced improvements in cardiorespiratory parameters in previously hospitalised COVID-19 survivors. This study aimed to investigate the effect of a hybrid PR programme (outpatient followed by a digital intervention) on exercise tolerance, cardiorespiratory adaptations, functional capacity and quality of life outcomes in previously hospitalised COVID-19 survivors. Methods: Forty-two patients (age (mean ± SD): 57 ± 12 yrs) with excessive fatigue due to long COVID (FACIT score (26 ± 10) were allocated to PR (n = 27) or usual care (UC) (n = 15) 140 ± 75 days from hospital discharge. PR consisted of 8 outpatient sessions (twice weekly for 4 weeks) followed by 24 home-based sessions (3 times/week for 8 weeks). Patients in the UC group were instructed to be physically active. Exercise tolerance was assessed by cardiopulmonary cycling testing to the limit of tolerance. Results: Following the completion of the hybrid PR programme, peak work rate (WRpeak) and peak oxygen uptake (VO₂peak) were, respectively, improved in the PR group by 19 ± 10 Watt (p = 0.001) and by 2.4 ± 3.0 mL/kg/min (p = 0.001). Furthermore, in the PR group, the 6 min walk distance was increased by 72 ± 69 metres (p = 0.001). FACIT and mMRC scores were also improved in the PR group by 15 ± 10 (p = 0.001) and by 1.4 ± 1.0 (p = 0.001), respectively. In the UC group, only the mMRC score was improved by 0.7 ± 1.0 (p = 0.008). Conclusions: The application of a hybrid PR programme was beneficial in improving cardiorespiratory exercise fitness, functional capacity and quality of life in previously hospitalised COVID-19 survivors.

Background: COPD remains a leading cause of global morbidity and mortality, with acute exacerbations driving disease progression and healthcare utilisation. Artificial intelligence (AI) offers new opportunities to predict exacerbation risk by integrating multimodal data such as electronic health records (EHRs), spirometry and wearable sensor inputs. Methods: This systematic review, conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251165476), evaluated AI-based models developed for COPD exacerbation prediction using combined data modalities. Results: Comprehensive searches of PubMed, Embase and Google Scholar identified 859 records, of which five studies published between 2021 and 2025 met inclusion criteria. Study designs ranged from prospective monitoring cohorts to EHR-based and hybrid datasets. Models applied diverse approaches including random forests, gradient boosting, convolutional neural networks and ensemble learning frameworks. Reported discriminative performance was moderate to high, with area under the curve values between 0.73 and 0.92 and accuracies up to 0.92. Most of these performance metrics were derived from internal validation, with limited external testing, which restricts assumptions about generalisability. Sensitivity reached 0.94 in wearable-driven models, while only one study reported formal calibration assessment. Conclusions: Despite encouraging performance, methodological heterogeneity, limited external validation and incomplete reporting of preprocessing and explainability methods restrict clinical translation. Current evidence supports the potential of multimodal AI to enhance early detection of COPD exacerbations, but future research must prioritise transparent reporting, external validation and integration into real-world care pathways.