Background/Objectives: Idiopathic pulmonary fibrosis (IPF) registries are established to enhance understanding of its natural history. Methods: Serbia (RS) participated in the EMPIRE (European Multi-Partner IPF Registry) from June 2015 to October 2022, involving four centers. The registry included patients over 18 diagnosed with IPF based on the 2011 international criteria. We aimed to gather key clinical, functional, and survival data, along with treatment information for IPF patients in RS, using a centralized electronic case report for consistency. Results: 188 RS patients participated (median age at diagnosis 65, 63.8% male, 51% smoking history, 56% radiological usual interstitial pneumonia (UIP) pattern). At the diagnosis, median forced vital capacity (FVC) was 73.7% and diffusion capacity for carbon monoxide (DL_CO) was 38%. At initiation of antifibrotic therapy, median FVC was 73.2% (71.5% for deceased, 75.8% for survivors (p = 0.455), and DL_CO was 33.8% (19.9% for deceased, and 35.6% for survivors (p = 0.046)). The median long-term survival from diagnosis was 29.4 months (95% CI: 22.6–36.2 months), and 9.4 months (95% CI: 5.9–12.9 months) from the initiation of therapy, with no difference in the duration of antifibrotic treatment between survivors and deceased (p = 0.598). Conclusions: The RS EMPIRE cohort represents a younger, less comorbid population with fewer smokers and more probable UIP, factors linked to a favorable prognosis. Nevertheless, survival was poorer than expected, mainly due to advanced disease severity at the time of antifibrotic initiation, as indicated by lower DL_CO. These findings highlight the importance of earlier diagnosis and treatment before significant physiological decline to improve outcomes.

Background/Objectives: Discharging patients after hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (COPD) is a critical transition in care associated with a high risk of early readmission. This survey aimed to describe physician-reported discharge practices following COPD exacerbations, identify perceived gaps and organizational barriers, explore attitudes toward structured COPD discharge summaries, and use a SWOT analysis as an interpretative framework. Methods: In this cross-sectional observational survey, 100 physicians involved in COPD care were recruited from the official mailing list of the Respiratory Society of Serbia, which represents approximately 71% of the Society’s members. The survey assessed discharge procedures, multidisciplinary practices, patient education, comorbidity management, perceived causes of readmission, and barriers to structured discharge summaries. Data were analyzed descriptively and complemented with a structured SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis. Results: Most respondents worked in tertiary care settings and were involved in managing patients hospitalized for COPD exacerbations. Although 24% of physicians routinely used structured discharge summaries, 45% reported never using them. The most frequently perceived contributors to 30-day readmissions were active smoking (90%), poor treatment adherence (81%), comorbidities (77%), and incorrect inhaler technique (72%). Major barriers to implementing structured discharge summaries included the lack of standardized templates, time constraints, poor coordination across healthcare levels, and technical limitations. Willingness to implement structured discharge tools was high (mean score 8.86/10). SWOT analysis identified strong professional support for discharge standardization alongside organizational and system-level barriers to implementation. Conclusions: This exploratory survey identified important gaps between recommended and routine COPD discharge practices and highlighted organizational barriers to implementation. The findings may inform future evaluation and development of structured discharge tools in this healthcare setting.

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive, unpredictable, fatal interstitial lung disease. Antifibrotic therapy with pirfenidone or nintedanib slows functional decline, yet comparative real-world evidence remains limited. Materials and Methods: This retrospective, single-center, comparative cohort study included 76 IPF patients treated at the Clinic for Pulmonology at the University Clinical Center of Serbia (February 2019–February 2025). Diagnosis of IPF was made according to the guidelines of the American Thoracic Society and the European Respiratory Society. Demographic features, comorbidities, forced vital capacity (FVC), diffusion capacity for carbon monoxide (DLCO), high-resolution computerized tomography (HRCT) patterns, 6-min walk test distance (6MWTD), echocardiography, and survival outcomes were analyzed. Disease progression was defined as a ≥10% decline in FVC and/or DLCO after 12 months. Results: Of the 76 patients, 31 received nintedanib and 45 pirfenidone. Baseline characteristics, comorbidities, and HRCT patterns were comparable between groups. Mean annual decline in FVC was −1.74% with pirfenidone and −2.38% with nintedanib, without a statistical difference. DLCO declined by −4.25% and −6.29%, respectively, with similar downward trends over time in both groups. Progression was recorded in 35 (46.1%) patients, of whom 18 (58.06%) were in the nintedanib group and 17 (37.77%) in the pirfenidone group, with no difference between therapies (p = 0.81). Definite and probable usual interstitial pneumonia (UIP) were evenly represented on HRCT, although progression correlated significantly with the probable UIP pattern (p = 0.006). 6MWTD decreased in both groups over 12 months, again without treatment-related differences (p = 0.566). During up to 6 years of follow-up, overall survival was 4.18 years, with no significant difference between the nintedanib (4.55 years) and pirfenidone (3.81 years) groups (p = 0.159). No association was found between disease stage (FVC or DLCO) and progression. Conclusions: This study demonstrates that pirfenidone and nintedanib are equally effective in the management of IPF in real-world settings. The absence of significant differences in functional decline, progression rates, and survival indicates that treatment choices should be guided by individual clinical profiles rather than efficacy alone, reinforcing antifibrotic therapy as the primary approach to alter the course of IPF. Importantly, disease progression was strongly associated with a probable UIP pattern on HRCT, supporting current guidelines suggesting that probable UIP has a natural history and prognosis similar to those of definite UIP.

Introduction: Coronary artery calcifications (CAC) and emphysema are common findings detected during low-dose computed tomography (LDCT) lung cancer screening. This study investigated the association between CAC and pulmonary function parameters among individuals with CT-detected emphysema. Materials and Methods: This cross-sectional study included 323 participants with radiographically detected emphysema identified through a lung cancer screening program. All participants underwent pre-bronchodilator spirometry. We evaluated associations among CAC, pre-bronchodilator airflow limitation, and pulmonary function parameters. We used multivariable logistic regression to identify factors independently associated with CAC. Results: Coronary artery calcifications were present in 216 participants (66.9%). Participants with CAC were significantly older than those without CAC (68.2 ± 6.7 vs. 61.1 ± 7.1 years, p < 0.001) and were more frequently male (59.3% vs. 32.7%, p < 0.001). Pre-bronchodilator airflow limitation was significantly more common among participants with CAC (50.0% vs. 35.5%; p = 0.014). No significant differences were observed in FEV1 or FVC values. In multivariable logistic regression analysis, age and male sex were independently associated with CAC, whereas pre-bronchodilator airflow limitation was not independently associated with CAC after adjustment. Conclusion: Among individuals with CT-detected emphysema, coronary artery calcifications were associated with a higher prevalence of pre-bronchodilator airflow limitation. However, age and male sex were the strongest independent predictors of CAC, suggesting that shared demographic and cardiovascular risk factors may account for much of the observed overlap between pulmonary and cardiovascular abnormalities. These findings support the value of integrated cardiopulmonary assessment within lung cancer screening programs.

Background: Low-dose computed tomography (LDCT) lung cancer screening (LCS) frequently identifies emphysema in high-risk smokers. However, the extent to which CT-detected emphysema reflects underlying physiological impairment remains uncertain. We evaluated whether spirometry can detect functional abnormalities in this population beyond structural imaging findings. Methods: This cross-sectional study included 323 individuals with LDCT- detected emphysema and no lung cancer or prior chronic respiratory diseases within a screening cohort (n = 3076). Participants underwent pre-bronchodilator spirometry and symptom assessments (COPD Assessment test (CAT) and Modified Medical Research Council (mMRC) Dyspnea Scale). Pre-bronchodilator airflow limitation was defined as forced expiratory volume in one second to forced vital capacity ratio (FEV₁/FVC) < 0.70. Small airways dysfunction was defined by ≥2 reduced mid-expiratory flow parameters (<60% predicted). Flow–volume curve morphology was assessed qualitatively. Results: Pre-bronchodilator airflow limitation was observed in 45.2% of participants, predominantly mild. Small-airway dysfunction was present in 52%, and an abnormal flow–volume curve morphology in 67.5%. Notably, functional abnormalities were frequently observed despite preserved FEV₁. Symptom burden was low, with only 7.7% of participants reporting clinically significant symptoms. Functional impairments often overlapped and were common in minimally symptomatic individuals. Conclusions: In a lung cancer screening (LCS) cohort with CT-detected emphysema, functional abnormalities are frequently observed, including in individuals with preserved FEV₁ and minimal symptoms. Spirometry provides additional physiological insight beyond structural imaging; however, these findings are descriptive and should not be interpreted as diagnostic of COPD. Further studies are needed to determine their clinical relevance.

Single-inhaler triple therapy (SITT) combines an inhaled corticosteroid (ICS; for example, fluticasone furoate, budesonide, or beclometasone dipropionate), a long-acting β2-agonist (LABA; for example, vilanterol or formoterol fumarate), and a long-acting muscarinic antagonist (LAMA; for example, umeclidinium or glycopyrronium bromide) in one device. Triple pharmacological therapy reduces exacerbations in selected patients with chronic obstructive pulmonary disease (COPD), but its effects on mortality and cardiovascular outcomes remain uncertain. This structured narrative review summarizes randomized trials, observational comparative-effectiveness studies, target trial emulations, systematic reviews, and health technology assessments published between 2015 and 2026. We grouped the evidence by comparator: LABA/LAMA, ICS/LABA, multiple-inhaler triple therapy (MITT), and ICS continuation versus withdrawal, because each comparison addresses a different clinical question. Pivotal trials and evidence syntheses consistently showed fewer moderate-to-severe exacerbations with triple therapy, with reported rate ratios of approximately 0.69–0.93. Mortality signals from IMPACT and ETHOS are clinically important, but previous ICS use and ICS withdrawal among participants assigned to ICS-free comparators make these findings difficult to interpret. Observational cardiovascular findings are also uncertain because residual confounding, treatment selection, exposure misclassification, outcome misclassification, and differences in baseline disease severity limit causal interpretation. Compared with MITT, the main advantages of SITT are simpler treatment and possible improvements in adherence and persistence, not greater pharmacological potency. Treatment decisions should consider exacerbation history, repeated blood eosinophil counts, pneumonia risk, cardiovascular disease, previous ICS exposure and response, inhaler technique, device suitability, and patient preference. Trials in patients with documented absence of previous ICS use and well-designed target trial emulations are needed to determine whether the observed mortality and cardiovascular associations are causal.