Three subtypes of achalasia have been defined using esophageal manometry. Several studies have reported that symptoms are experienced differently among men and women, regardless of subtype. All subtypes could have some impact on the appearance of respiratory symptoms and lung complications due to compression of the trachea or aspiration of undigested food. The aim of this research was to analyze the differences in respiratory symptoms and radiographic presentation of lung pathology depending on the diameter and achalasia types. One or more respiratory symptoms were reported in 48% of 114 patients, and all of them had two or more gastrointestinal symptoms. The symptom score (SS) is statistically significant for the prediction of subtype 1 (area under the curve = 0.318; p < 0.001, cut-off score of 6.5 had 95.2% sensitivity) and subtype 2 (area under the curve = 0.626; p = 0.020, cut-off score of 7.5 had 93.1% sensitivity). The most common type was subtype 2 (50.8%), and although only 14 patients had subtype 3, they had the largest esophageal diameter (mean 5.8 cm). The difference in esophageal diameter was significant between subtype 1 and 3 (p = 0.011), subtype 2 and subtype 3 (p = 0.011). Nine patients (6%) had mega-esophagus (four patients in type 1, three in type 2 and two in type 3). More than half of all patients (51.7%) had at least one parenchymal lung change on CT scan. Recurrent micro-aspirations led to changes in the structure of the airways and lung parenchyma such as ground glass (GGO) and nodular changes (12%) and fibrosis (14.5%), and they had higher esophageal diameters (p < 0.001). Patients with chronic lung CT changes had significantly higher esophageal diameter than with acute changes (p < 0.001). Awareness of the association of achalasia and lung disorders is important in early diagnosis and treatment. More than half (57.5%) of patients with achalasia had some clinical and/or structural pulmonary abnormalities. All three subtypes had similar respiratory symptoms, meaning they cannot be used to predict the subtype of achalasia; on the contrary, SS can predict the first two subtypes. A higher diameter of the esophagus is associated with chronic structural lung changes. Although unexpected, the pathological radiological findings and diameter were significantly different in subtype 3 patients, but those parameters cannot lead us to a specified subtype.

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.

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.

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive condition and a leading cause of morbidity and mortality worldwide. The rate of forced expiratory volume in one second (FEV1) decline is a key prognostic marker. This study aimed to evaluate the impact of demographic, clinical, and therapeutic factors, including respiratory muscle strength and inhaled corticosteroid (ICS) use, on FEV1 decline.Methods: A prospective study was conducted in 2019 at the Clinic for Pulmonology, Clinical Center of Serbia. Fifty patients with stable COPD underwent spirometry, body plethysmography, respiratory muscle strength testing, and laboratory analyses. Demo-graphic and clinical data were collected via questionnaire. All assessments were repeated after six months of regular inhalation therapy.Results: Significant reductions were observed in FEV1, FVC, TLC, PImax, and PEmax. Lower baseline respiratory muscle strength predicted a faster FEV1 decline. Patients in GOLD stage 2 and those with greater hyperinflation exhibited accelerated functional deterioration. Therapy type affected selected parameters: LABA/ICS and LAMA/LABA/ICS regimens significantly reduced residual volume, but not the rate of FEV1 decline. Higher eosinophil counts were associated with a slower reduction in FEV1, suggesting a potential protective effect of ICS.Conclusion: Respiratory muscle strength, hyperinflation, and eosinophil count represent important predictors of COPD progression. Incorporating these parameters into diagnostic and therapeutic algorithms may improve early risk stratification and support indi-vidualized treatment strategies.

This paper examines the relationship between air pollution (SO2, NO2, PM2.5, and PM10) and hospitalization of patients with COPD (chronic obstructive pulmonary disease) and asthma. Our research was conducted in the area of Belgrade during 2019. It was found that SO2, NO2, PM2.5 and PM10 contribute to the worsening of COPD and asthma. Our results indicate that the highest monthly and daily values for NO2, SO2 and PM2.5 were recorded mainly throughout autumn and winter months. During these two seasons, the number of hospitalizations of COPD patients with acute exacerbations, as well as patients with non-allergic asthma, significantly increased. Higher concentrations of suspended PM10 particles were also recorded in the winter months. Targeted intervention measures-including expansion of the air quality monitoring network, increased urban green areas, reduction of sulfur concentrations in fuels, and the adoption of cleaner energy technologies- should be implemented in Belgrade to mitigate air pollution and reduce the associated healthcare burden among patients with COPD and asthma. Our future work will examine the role of specific meteorological conditions on air pollution and asthma/COPD hospitalization.

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.