Pulmonary hypertension associated with chronic lung disease (PH_lung) is a frequent complication of chronic obstructive pulmonary disease, interstitial lung disease, and other parenchymal lung disorders, and is associated with impaired exercise capacity, reduced quality of life and poor survival. Despite increasing recognition of its clinical importance, major challenges remain regarding early diagnosis, hemodynamic classification, and optimal treatment. Following the 7th World Symposium on Pulmonary Hypertension, a panel of experts reviewed from Germany and International collaborators summarized recent evidence and discussed unresolved issues relevant to everyday clinical practice. This review summarizes current concepts of the diagnosis and management of PH_lung, with particular emphasis on multimodal screening strategies integrating pulmonary function testing, biomarkers, echocardiography, cardiopulmonary exercise testing, and thoracic imaging to improve patient selection for right heart catheterization. We discuss practical aspects of hemodynamic assessment, overlapping phenotypes, including connective tissue disease, sarcoidosis, and the emerging pulmonary vascular "lung phenotype", and current evidence supporting targeted therapies with emphasis on patients' pathways in real-world settings. While inhaled treprostinil has become the first approved treatment for pulmonary hypertension associated with interstitial lung disease in several countries, no pulmonary hypertension-specific therapy is currently recommended routinely for COPD-associated PH, highlighting the need for careful patient phenotyping and individualized management in expert centres. The review further addresses indications for lung transplantation and outlines future research priorities. Earlier recognition, multidisciplinary collaboration, and continued translational and clinical research are essential to improve outcomes in this highly vulnerable patient population.

Emerging respiratory infectious diseases increasingly arise at the human-animal-environment interface and challenge clinicians with rapidly evolving diagnostic, therapeutic, and infection-control decisions. This narrative review summarizes clinically relevant viral and bacterial pathogens that may present as severe respiratory disease, but are easily mistaken for common community-acquired infections during early illness. We focus on zoonotic influenza A viruses, including contemporary H5N1, Middle East respiratory syndrome coronavirus (MERS-CoV), hantaviruses, Nipah virus, and inhalational bacterial threats such as anthrax, pneumonic plague, tularemia, and melioidosis. These infections may progress from non-specific symptoms to severe pneumonia, acute respiratory distress syndrome, shock, neurological complications, disseminated infection, or death. Timely recognition depends on careful assessment of travel, occupational and recreational exposures, animal contact, outbreak signals, and pathogen-specific syndromic clues. Multiplex molecular diagnostics can support early triage and exclusion of common pathogens, but targeted PCR, culture, serology, sequencing, and reference laboratory confirmation remain essential. Management requires prompt supportive care, appropriate isolation, public health notification, and pathogen-directed antimicrobial, antiviral, antitoxin, or prophylactic strategies where available. By integrating clinical presentation, diagnostics, treatment, vaccines, and One Health considerations, this review aims to translate knowledge on emerging infections into practical bedside preparedness.

Mucus plugs represent a muco-obstructive endophenotype across the spectrum of chronic obstructive airway diseases. Beyond reflecting mucus hypersecretion alone, they constitute a structural and biological manifestation of altered mucus biophysics, impaired mucociliary clearance, epithelial dysfunction, and inflammatory signaling. Their presence contributes to regional airflow limitation, ventilation heterogeneity, hypoxemia, and adverse clinical outcomes, even when conventional pulmonary function tests underestimate their impact. Advances in imaging have enabled the transition of mucus plugs from a descriptive radiologic finding to a potentially actionable biomarker for risk stratification and therapeutic response assessment, particularly in severe asthma and chronic obstructive pulmonary disease, where muco-obstruction has been associated with increased exacerbation risk and mortality. This narrative review integrates current evidence on the mechanisms underlying plug formation and persistence, their clinical expression, imaging strategies, and therapeutic implications across asthma and chronic obstructive pulmonary disease.