Background: Mild asthma is often characterized by normal spirometric values and a negative bronchodilation test (BDT), which makes accurate diagnosis challenging. The aim of our study was to evaluate the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) in mild asthma. Methods: In adults with symptoms suggestive of asthma and normal spirometry values, BDT, FeNO, BPT and skin prick testing were performed. Patients with positive BPT started inhaled corticosteroid (ICS) therapy. Those with positive response to ICS were considered asthmatics. Results: There were 142 asthmatics and 140 non-asthmatics. No significant difference was found in BDT between the groups, p = 0.233. Median FeNO levels were significantly higher in the asthma group (49.5 ppb) than in the non-asthma group (23 ppb), p < 0.001. BPT was positive in 145 (51.42%) and negative in 137 (48.58%) patients. Positive response to ICS treatment was recorded in 142/145 (97.9%) patients. In diagnosing asthma, FeNO ≥ 25 ppb had a sensitivity of 75.4% and specificity of 47.9%. Conclusions: FeNO has insufficient sensitivity and specificity in mild asthma and the application of BPT is often necessary to establish an accurate diagnosis.

Introduction: Lung cancer is one of the most diagnosed malignancies with increasing incidence worldwide. Immunotherapy is the main oncological treatment for advanced non-small cell lung cancer (NSCLC), for which the discovery of new efficient biomarkers is crucial. Scientific evidence points to the importance of the Lung Immune Prognostic Index (LIPI), but its predictive significance is unclear. Aim: The aim of this study was to investigate the clinical significance and predictive role of LIPI in patients with advanced NSCLC and PD-L1 mutation who are eligible for immunotherapy in combination with chemotherapy. In addition, to our knowledge, this is the first time that the association between COVID-19 infection and the course and outcome of oncologic treatment of NSCLC has been investigated. Patients and Methods: Patients were divided into four study groups according to strictly defined clinical parameters, therapeutic approach, and COVID-19 infection. LIPI was determined and its predictive power was evaluated in all studied groups, as well as overall survival (OS), progression-free survival (PFS), and disease control rate (DCR). Results: This study confirmed the understudied and uncertain predictive power and clinical relevance of LIPI as a biomarker in patients with advanced NSCLC. Patients infected with COVID-19 had a higher survival rate than uninfected patients despite the therapeutic approach, which may be attributed to their hospitalization and intensive medical management during the pandemic. Conclusions: Findings obtained in this study may help to determine treatment options according to the clinical condition of the patient by using LIPI values as a non-invasive, readily available and economically acceptable predictive biomarker in lung oncology.

Introduction: Chronic obstructive pulmonary disease (COPD) is a known risk factor for nontuberculous mycobacterial pulmonary disease (NTM-PD), and inhaled corticosteroid (ICS) therapy has also been associated with an increased incidence of NTM-PD. However, there is limited information on the yield of NTM screening in COPD patients. Aim: The aim of our study was to determine the frequency and relevance of NTM isolates in patients with COPD exacerbations at the University Hospital Centre Zagreb. Methods: a retrospective analysis of mycobacterial cultures obtained from COPD patients during exacerbations between January 1st, 2021 and December 31st, 2022. Both sputum and bronchoscopy obtained samples were included in the analysis. Results: Our cohort encompassed 175 COPD patients (GOLD I 3.4%, GOLD II 19.4%, GOLD III 32.1%, GOLD IV 29.7%, unknown 15.4%; frequent exacerbators 50.28%, unknown 1.7%; ICS therapy in 63.4%). NTM were isolated from 5/175 (2.86%) of patients: 4 M. avium and 1 M. xenopi. The NTM group didn’t differ from the non-NTM group in average age (66.3 vs. 69.85), average smoking pack-years (57 vs. 53), or mean BMI (25.14 vs. 25.32 kg/m²). However, all patients with NTM isolate were frequent exacerbators and used ICS but, interestingly, had only moderate severity of obstruction in spirometry. Only two out of five patients had NTM-PD, both caused by M. avium. Conclusion: In our setting, the yield of NTM screening in COPD exacerbations is low and might be recommended only in COPD patients with a phenotype of frequent exacerbator and ICS therapy, regardless of the obstruction severity.

Background: The cough variant asthma (CVA) is characterized by non-specific symptoms and normal spirometric values, which makes diagnosis challenging. To diagnose CVA it is necessary to document airway hyperreactivity (AHR). The aim of our study was to evaluate the diagnostic value of body plethysmography in the assessment of AHR by methacholine challenge test (MCT). Methods: In CVA-suspected patients, a bronchodilation test (BDT), MCT with spirometry, and body plethysmography were performed. MCT was considered positive if there was a 20% decrease in forced expiratory volume in 1 second from the baseline value (PC20FEV1) or a 40% reduction in specific conductance (PC40sGaw) after inhaling methacholine concentration < 8 mg/mL. Sensitivity and specificity were generated for different cut off points of sGaw (PC40sGaw, PC45sGaw, PC50sGaw). Anti-asthma treatment was started for those with proven AHR. The diagnosis of asthma was made after one year of follow-up based on response to treatment. Results: AHR was diagnosed in 83.5% (91/109) of patients by either BDT, PC20FEV1, or PC40sGaw. After one year of follow-up asthma was confirmed in 76 patients. The sensitivity of BDT, PC20FEV1, and PC40sGaw was 25%, 64%, and 97%, respectively. The specificity of BDT, PC20FEV1 and PC40sGaw was 94%, 88%, and 67%, respectively. The sensitivity for PC45sGaw and PC50sGaw was 88% and 63%, and the specificity was 82% and 91%, respectively. Conclusions: Body plethysmography is a valuable tool in the assessment of AHR in CVA, with the best sensitivity-to-specificity ratio for PC45sGaw.

Background/Objectives: Cough variant asthma (CVA) is characterized by nonspecific symptoms and normal spirometric values, which makes diagnosis challenging. To diagnose CVA it is necessary to document airway hyperreactivity (AHR). The aim of our study was to evaluate the diagnostic value of body plethysmography in the assessment of AHR using the methacholine challenge test (MCT). Methods: In CVA-suspected patients, a bronchodilation test (BDT), an MCT with spirometry, and body plethysmography were performed. The MCT was considered positive if there was a 20% decrease in forced expiratory volume in 1 s from the baseline value (PC₂₀FEV₁) or a 40% reduction in specific conductance (PC₄₀sGaw) after inhaling methacholine of concentration < 8 mg/mL. Sensitivity and specificity were generated for different cut off points of sGaw (PC₄₀sGaw, PC₄₅sGaw, PC₅₀sGaw). Anti-asthma treatment was started for those with proven AHR. The diagnosis of asthma was made after one year of follow-up based on the response to treatment. Results: AHR was diagnosed in 83.5% (91/109) of patients by either a BDT, PC₂₀FEV₁, or PC₄₀sGaw. After one year of follow-up, asthma was confirmed in 76 patients. The sensitivities of the BDT, PC₂₀FEV₁, and PC₄₀sGaw were 25%, 64%, and 97%, respectively. The specificities of the BDT, PC₂₀FEV₁ and PC₄₀sGaw were 94%, 88%, and 67%, respectively. The sensitivities for a PC₄₅sGaw and PC₅₀sGaw were 88% and 63%, and the specificities were 82% and 91%, respectively. Conclusions: Body plethysmography is a valuable tool in the assessment of AHR in CVA, with the best sensitivity-to-specificity ratio found at a PC₄₅sGaw.