The cardiopulmonary exercise test (CPET) provides an objective assessment of ventilatory limitation, related to the exercise minute ventilation (V_E) coupled to carbon dioxide output (V_CO2) (V_E/V_CO2); high values of V_E/V_{CO2 slope} define an exercise ventilatory inefficiency (EVin). In subjects recovered from hospitalised COVID-19, we explored the methodology of CPET in order to evaluate the presence of cardiopulmonary alterations. Our prospective study (RESPICOVID) has been proposed to evaluate pulmonary damage’s clinical impact in post-COVID subjects. In a subgroup of subjects (RESPICOVID2) without baseline confounders, we performed the CPET. According to the V_E/V_{CO2 slope}, subjects were divided into having EVin and exercise ventilatory efficiency (EVef). Data concerning general variables, hospitalisation, lung function, and gas-analysis were also collected. The RESPICOVID2 enrolled 28 subjects, of whom 8 (29%) had EVin. As compared to subjects with EVef, subjects with EVin showed a reduction in heart rate (HR) recovery. V_E/V_{CO2 slope} was inversely correlated with HR recovery; this correlation was confirmed in a subgroup of older, non-smoking male subjects, regardless of the presence of arterial hypertension. More than one-fourth of subjects recovered from hospitalised COVID-19 have EVin. The relationship between EVin and HR recovery may represent a novel hallmark of post-COVID cardiopulmonary alterations.

Peripheral pulmonary lesions (PPLs) are frequent incidental findings in subjects when performing chest radiographs or chest computed tomography (CT) scans. When a PPL is identified, it is necessary to proceed with a risk stratification based on the patient profile and the characteristics found on chest CT. In order to proceed with a diagnostic procedure, the first-line examination is often a bronchoscopy with tissue sampling. Many guidance technologies have recently been developed to facilitate PPLs sampling. Through bronchoscopy, it is currently possible to ascertain the PPL’s benign or malignant nature, delaying the therapy’s second phase with radical, supportive, or palliative intent. In this review, we describe all the new tools available: from the innovation of bronchoscopic instrumentation (e.g., ultrathin bronchoscopy and robotic bronchoscopy) to the advances in navigation technology (e.g., radial-probe endobronchial ultrasound, virtual navigation, electromagnetic navigation, shape-sensing navigation, cone-beam computed tomography). In addition, we summarize all the PPLs ablation techniques currently under experimentation. Interventional pulmonology may be a discipline aiming at adopting increasingly innovative and disruptive technologies.

COPD is one of the leading causes of death worldwide, so it represents a significant public health challenge. Over the years, new effective therapies have been proposed. However, the burden of COPD is still conditioned by frequent acute events defined as exacerbations (exacerbation of COPD-ECOPD), which have a significant impact not only on the patient’s quality of life but also on the progression of the disease, morbidity, and mortality. Related to the severity of the condition, ECOPD may require hospital admission and often repeatedly more admissions (readmission). The phenomenon of readmissions is a significant problem, contributing substantially to the utilisation of healthcare resources and the economic burden of COPD. Related contributing factors are still poorly understood, and managing the patients readmitted to the hospital with ECOPD may be challenging. Hospital readmissions should be optimally managed, including supporting and preventive strategies. Although early readmissions (30 days from discharge) are a marker of the quality of the patient’s care, we need to consider COPD patients globally. It is not sufficient to address just the acute events, so multidimensional management is necessary, able to follow the patient over time to identify, by a personalised approach, the correct treatment during and post hospitalisation and intercept any factor affecting the natural history of the disease, comprising the risk of hospital readmissions. In the context of the literature concerning respiratory medicine, particularly COPD patients, our narrative review analyses recent evidence regarding the current management of COPD hospital readmissions, aiming to propose preventive strategies helpful in clinical practice. The proposed strategies can potentially improve clinical outcomes and reduce healthcare costs when effectively implemented in practice.

Patients who have recovered from COVID-19 show persistent symptoms and lung function alterations with a restrictive ventilatory pattern. Few data are available evaluating an extended period of COVID-19 clinical progression. The RESPICOVID study has been designed to evaluate patients’ pulmonary damage previously hospitalised for interstitial pneumonia due to COVID-19. We focused on the arterial blood gas (ABG) analysis variables due to the initial observation that some patients had hypocapnia (arterial partial carbon dioxide pressure-PaCO₂ ≤ 35 mmHg). Therefore, we aimed to characterise patients with hypocapnia compared to patients with normocapnia (PaCO₂ > 35 mmHg). Data concerning demographic and anthropometric variables, clinical symptoms, hospitalisation, lung function and gas-analysis were collected. Our study comprised 81 patients, of whom 19 (24%) had hypocapnia as compared to the remaining (n = 62, 76%), and defined by lower levels of PaCO₂, serum bicarbonate (HCO³⁻), carbon monoxide diffusion capacity (DL_CO), and carbon monoxide transfer coefficient (K_CO) with an increased level of pH and arterial partial oxygen pressure (PaO₂). K_CO was directly correlated with PaCO₂ and inversely with pH. In our preliminary report, hypocapnia is associated with a residual lung function impairment in diffusing capacity. We focus on ABG analysis’s informativeness in the follow-up of post-COVID patients.

Endobronchial ultrasound has gained widespread popularity in the last decade, becoming the primary technique for minimally invasive evaluation of the mediastinum and staging of lung cancer. Several tertiary and quaternary care institutes use this method, performed by trained and accredited specialists. Its main indications are (I) diagnosis and staging of lung cancer, (II) mediastinal lymphadenopathy diagnosis (III) sampling peripheral pulmonary lesions. this manuscript aims to describe the operational potential of both convex endobronchial ultrasound probe and radial endobronchial ultrasound probe technology, focusing on lung cancer. This narrative review is complemented with by the description of peculiar clinical cases in which endobronchial ultrasound played a pivotal role in reaching the diagnosis.

Background: Initial evidence supports the hypothesis that patients with non-cystic fibrosis bronchiectasis (NCFB) have a higher risk of lung cancer. We systematically reviewed the available literature to define the characteristics of lung malignancies in patients with bronchiectasis and the characteristics of patients who develop bronchiectasis-associated lung cancer. Method: This study was performed based on the PRISMA guidelines. The review protocol was registered in PROSPERO. Results: The frequency rates of lung cancer in patients with NCFB ranged from 0.93% to 8.0%. The incidence rate was 3.96. Cancer more frequently occurred in the elderly and males. Three studies found an overall higher risk of developing lung cancer in the NCFB population compared to the non-bronchiectasis one, and adenocarcinoma was the most frequently reported histological type. The effect of the co-existence of NCFB and COPD was unclear. Conclusions: NCFB is associated with a higher risk of developing lung cancer than individuals without NCFB. This risk is higher for males, the elderly, and smokers, whereas concomitant COPD’s effect is unclear.