Industrial air pollution has been linked to respiratory diseases due to pulmonary function impairment, which are poorly documented in low-and middle-income countries. This study aimed to assess the pulmonary function of a community exposed to air pollution in an Industrial Area (IA) in Ouagadougou, Burkina Faso. Thus, a cross-sectional study was conducted among 146 residents of the IA and 146 residents of Nioko 2, constituting respectively, the target and control populations, from November to December 2023. A medical team collected data on respiratory symptoms experienced by the study population through a questionnaire followed by a clinical examination. Pulmonary function tests (PFTs) were then performed by spirometry according to ATS/ERS guidelines. The results showed that the study population suffered from both upper airway (87% IA, 70.50% Nioko 2) and lower airway (89% IA, 64.40% Nioko 2) symptoms whose prevalence was higher among the residents of the IA. The PFTs revealed a decrease in the predicted average percentage of FEV1% (p = 0.002) and FET % (p = 0.002) before bronchodilation among the residents of the IA compared to Nioko 2. These spirometric parameters still remained decreased among residents of the IA compared with Nioko 2 even after bronchodilation, but with only a significant difference for FET % (p = 0.011). Furthermore, the pulmonary impairment diagnosed among the residents of the IA before bronchodilation was restrictive defects (p = 0.035), with a strong representation of females (37.50% IA, 11.11% Nioko 2). Univariate logistic regression revealed that residence in the IA was significantly associated with restrictive ventilatory defects (OR, 1.697; p = 0.035). The restrictive defects diagnosed were the main pulmonary function impairment observed in the residents of the IA notably in women. The findings in this study highlight the impact of air pollution on the pulmonary function of the residents of the IA specifically on the lower respiratory tract.

The rapid advancement of artificial intelligence (AI) has highlighted its potential as a supportive tool in pulmonary function test (PFT) interpretation given the inherent biological variation, inter-rater variability, lack of confidence in result interpretation and restricted access within resource-constrained settings. This study aims to systematically review the published literature on the diagnostic accuracy of AI-based interpretation of PFTs and evaluate its implications for current and future clinical practice in healthcare. After screening, forty-seven publications met the inclusion criteria and were analysed to create a narrative summary. Four main over-arching themes were identified from the available literature. AI appears to consistently outperform non-specialists in diagnostic accuracy of PFTs and showed a synergistic effect when used as an adjunct in both specialist and non-specialist settings. Using AI software also had greater diagnostic accuracy than clinicians when presented with suboptimal or limited clinical information and investigations. It was also observed that the implementation of AI can address the issue of inter-rater variability by giving more consultant interpretations. Chronic obstructive pulmonary disease diagnosis saw the greatest accuracy with other conditions such as obstructive sleep apnoea showing limited evidence for the introduction of AI as a diagnostic tool. The evidence suggests that AI has the potential to play a significant role in the future of healthcare but should be used as an adjunctive tool as opposed to an independent diagnostic decision maker. One such way it could be utilised is as a triage/screening tool to help bridge the gap between primary and secondary care.

Shrinking lung syndrome (SLS) is a rare pulmonary manifestation of systemic lupus erythematosus (SLE). It is characterized by unexplained dyspnea, restrictive ventilatory defect, and diaphragmatic elevation without interstitial lung disease (ILD). A 32-year-old man with SLE presented with progressive dyspnea initially attributed to pleural and infectious processes. As systemic features evolved, SLE was confirmed. Pulmonary function tests (PFTs) showed severe restriction (forced vital capacity-FVC-28%, total lung capacity-TLC-37%), with elevated hemidiaphragm and no alternative pulmonary pathology, supporting the diagnosis of SLS. Treatment with highdose glucocorticoids, rituximab, and mycophenolate mofetil resulted in marked clinical improvement, substantial recovery of lung function (FVC 65%), and successful glucocorticoid withdrawal. A structured literature review (January 2021-March 2026) identified 19 studies reporting 37 SLS cases. Dyspnea was the predominant manifestation, frequently accompanied by pleuritic chest pain and dry cough. Restrictive ventilatory defects were consistently reported, with significantly reduced FVC, TLC, and transfer factor of the lung for carbon monoxide values. Imaging most commonly demonstrated elevated hemidiaphragm(s) and reduced lung volumes without ILD. Treatment predominantly involved glucocorticoids, often combined with steroid-sparing agents. Rituximab was frequently used as a steroid-sparing agent in severe/refractory cases and was generally associated with clinical and functional improvement. Based on the presented case and cases identified in literature, SLS remains a diagnostic challenge and should be considered in patients with SLE presenting with unexplained dyspnea and restrictive physiology. Early recognition and prompt immunosuppressive therapy may improve outcomes.

Background Chronic obstructive pulmonary disease (COPD) is a common and severely incapacitating respiratory illness that is characterized by ongoing, non-reversible airflow restrictions. Various medical treatment options include bronchodilators, anti-cholinergic drugs, and steroids. This study aimed to evaluate the effectiveness of oral roflumilast in addition to standard therapy among COPD patients to prevent exacerbations and improve pulmonary function tests (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)). Methodology This quasi-experimental study enrolled 80 moderate-to-severe COPD patients through non-probability sampling. They were divided into two groups. In Group A, participants received standard treatment as per the operational definition for six months. In Group B, participants received once-daily roflumilast, 500 µg, while maintaining background medications of COPD as per the operational definition for six months. Quantitative variables, including age, post-bronchodilator FEV1, and FVC, were expressed as mean ± SD. An independent-sample t-test was used to compare the outcome variables (FEV1 and FVC) between the two groups. The number of COPD exacerbations was analyzed using an appropriate statistical test, such as the Mann-Whitney U test. All the data were analyzed using SPSS version 28.0. Results Both groups showed a significant increment in mean FEV1 and FVC from day zero to six months; however, mean FEV1 and FVC were significantly higher for Group B patients from the fourth to sixth months. A decreasing trend was observed in the frequency of exacerbations in both groups. At the fifth and sixth months of treatment, Group B patients showed significantly lower frequency of exacerbations compared to Group A patients. Conclusions Oral roflumilast as an adjunct to standard COPD therapy improved clinical outcomes by enhancing pulmonary function (particularly FEV1) and reducing exacerbation frequency. Reduction in recurrent exacerbations may contribute to better symptom control, improved quality of life, and decreased healthcare burden. Therefore, roflumilast 500 µg once daily may be considered a useful add-on option in selected COPD patients, although larger studies with longer follow-up are warranted to establish long-term benefits.

Background: Post-COVID-19 syndrome (PCS) is defined as the persistence or development of new symptoms 3 months after the initial infection with the SARS-CoV-2 virus, these clinical aspects being most often associated with functional respiratory changes, as well as imagistic modifications. This study aimed to evaluate longitudinal changes in pulmonary function among patients with PCS, in relation to the severity of the acute COVID-19 episode and the time elapsed since infection. Methods: A retrospective, observational study was conducted at the Clinical Hospital of Pulmonary Diseases Iași, Romania, between January 2021 and December 2022, including 97 adult patients with confirmed PCS. Demographic, clinical, and functional data were collected from medical records. Pulmonary function tests (PFTs) were performed according to ATS/ERS standards, assessing Forced Vital Capacity (FVC), Forced Expiratory Volume in the First Second (FEV1), FEV1/FVC ratio (Tiffeneau Index), Maximal Expiratory Flow at 50% and 25% of FVC (MEF50, MEF25), Diffusing Capacity of the Lung for Carbon Monoxide (adjusted for haemoglobin) (DLCO), Carbon Monoxide Transfer Coefficient (KCO), Alveolar Volume (AV), Total Lung Capacity (TLC) and Residual Volume (RV). Patients were grouped by time elapsed since infection (1-3, 4-7, 9-12, and up to 22 months). Statistical analyses included the Mann-Whitney U test, Spearman's correlation, ROC curve analysis, and Principal Component Analysis (PCA). Results: A progressive improvement in FVC was observed up to 9-18 months post-infection (p < 0.05), while FEV1 remained stable, suggesting a predominantly restrictive ventilatory pattern. Patients with moderate acute COVID-19 presented significantly lower FVC%, FEV1%, DLCO%, and KCO% values compared with those with mild disease (p < 0.05). Diffusion abnormalities (DLCO and KCO) persisted beyond 12 months, indicating lasting alveolar-capillary impairment. ROC analysis identified TLC (AUC = 0.857), AV (AUC = 0.855), and KCO (AUC = 0.805) as the most discriminative parameters for residual dysfunction. PCA revealed three major functional domains-airflow limitation, diffusion capacity, and lung volume-explaining up to 70% of total variance. Conclusions: We are facing the emergence of a new phenomenon, namely a secondary post-COVID-19 pandemic of patients confronting with persistent post-COVID-19 symptoms who present with functional respiratory changes and who require careful monitoring in dynamics, personalized treatments and a multidisciplinary approach.

Impulse oscillometry system (IOS) is an effort-independent pulmonary function testing technique that assesses respiratory system mechanics during tidal breathing and has gained increasing interest as a complementary modality to traditional pulmonary function tests (PFTs), while its physiological relevance and clinical role alongside conventional tests remain incompletely defined. This narrative literature review synthesises evidence on the correlations between IOS parameters and traditional PFT indices, summarises clinical applications across major chronic respiratory diseases, and discusses emerging developments including artificial intelligence-based approaches; the review is based on studies published since 2010 that compare IOS with spirometry, body plethysmography, and diffusing capacity of the lung for carbon monoxide (DLCO) in chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD). Correlation studies indicate that IOS resistance-related parameters are more closely associated with obstructive ventilatory impairment, particularly in COPD and asthma, whereas reactance-related parameters show stronger associations with restrictive ventilatory abnormalities, lung volumes, and diffusion impairment, especially in ILD. Across disease entities, R5-20 and resonant frequency consistently demonstrate higher sensitivity for detecting small airway dysfunction. Clinically, IOS provides value in assessing bronchodilator responsiveness, evaluating asthma control, detecting small airway involvement when spirometry is preserved, and monitoring exposure-related airway effects. Artificial intelligence-based models integrating multidimensional IOS data further highlight its potential in disease screening and classification. Overall, IOS provides complementary physiological and clinical information beyond traditional PFTs, and further large-scale, multicentre studies and methodological standardisation are needed to support its broader clinical implementation.

Sarcoidosis is a systemic disease of unknown etiology, characterized by granulomatous inflammation in various organs. Elevated serum Immunoglobulin G4 (IgG4) levels are typically associated with IgG4-related disease (IgG4-RD), characterized by plasma cell infiltration and fibrosis, but their role in sarcoidosis remains unclear. Given the fibro-inflammatory nature of both conditions, this study aimed to describe a cohort of sarcoidosis patients with elevated IgG4 levels and explore the potential clinical relevance of this finding. We retrospectively analyzed biopsy-confirmed sarcoidosis cases with measured serum IgG4 levels. Clinical data were gathered, including demographics, organ involvement, pulmonary function tests (PFTs), sarcoidosis-associated pulmonary hypertension (SAPH), and markers of autoimmunity. The study cohort included ten patients with a mean age of 50 ± 15 years, comprising six males and seven Black individuals. Two patients reported a family history of sarcoidosis; the mean body mass index (BMI) was 28.5 ± 5.7. Five patients were never smokers, and four were former smokers. Eight patients had lung involvement, two with advanced Scadding stage 4, four with airflow obstruction, and two with restriction physiology on PFT. Out of seven patients with echocardiography, five had SAPH. Other organ manifestation included ocular disease in three patients, joint involvement in two, liver disease in two, and heart disease in one. Autoimmune markers were present in five patients. These findings suggest a potential overlap between IgG4-RD and sarcoidosis. Further research is needed to clarify IgG4's role in sarcoidosis and whether elevated serum IgG4 identifies a subset of patients who may benefit from B-cell depletion therapies.