Systemic-to-pulmonary artery shunt (SPS) may present pseudo pulmonary artery filling defects (PAFDs) on computed tomography pulmonary angiography (CTPA), which can mimic pulmonary embolism (PE) and thus potentially cause misdiagnosis and inappropriate treatment.

[This corrects the article DOI: 10.1183/20734735.0001-2026.].

Bronchiectasis and pulmonary tuberculosis (TB) remain common causes of chronic respiratory morbidity worldwide, despite major advances in antimicrobial therapy and structured airway clearance strategies. In a subset of patients, medical treatment alone is insufficient, and surgical intervention may be required when disease is anatomically localised or when serious complications develop. From a surgical perspective, resection of non-functional, chronically infected lung segments in bronchiectasis can lead to sustained symptom improvement, fewer exacerbations, and effective control of haemoptysis when patients are appropriately selected. In pulmonary TB, surgery continues to serve both diagnostic and therapeutic purposes. Operative intervention may be necessary when noninvasive investigations fail to establish a diagnosis, or when persistent cavitary disease, drug-resistant infection, or structural complications such as destroyed lung, chronic empyema, or bronchopleural fistula are present. Current respiratory guidelines emphasise careful medical optimisation and multidisciplinary assessment before surgical referral, highlighting the importance of appropriate patient selection. This narrative educational review focuses on practical principles that guide surgical decision-making in bronchiectasis and pulmonary TB. Indications for surgery, contraindications to operative intervention, and criteria for referral for lung transplantation are discussed, with the aim of supporting clinicians involved in the care of patients with complex structural lung disease.

Aspergillus spp are common airborne fungi, and the commonest fungal pathogen of human lungs. In patients with chronic obstructive pulmonary disease (COPD), the usual defences against disease are impaired to various degrees, leading to persistent airway infection, especially with bronchiectasis; allergy (or sensitisation) and probable additional airways resistance; and chronic pulmonary aspergillosis or invasive aspergillosis. Recurrent COPD exacerbations are more common in those with Aspergillus found in the airways, opening up an unassessed therapeutic opportunity to reduce hospital admissions and deaths. External factors worsening the effect of this negative interaction include damp and/or mould in homes, higher air pollution indices. and respiratory viral infections that abrogate key immune defences. Corticosteroid therapy, both systemic and oral, further impairs airway and lung defences. Both local and general immune responses are affected. Aspergillus infection in patients with COPD is markedly under-recognised, primarily because the sensitivity of culture of Aspergillus from sputum is poor, bronchoscopy can be harmful in patients with chronic respiratory impariment, induced sputum is only used in research studies, and the role of serum Aspergillus IgG and antigen testing is not appreciated. In hospitalised patients and those at higher risk, high-volume fungal culture and PCR for Aspergillus on sputum would enable many more diagnoses. With approximately 60 million patients with COPD hospitalised with exacerbations globally, and high mortality rates in both invasive and chronic pulmonary aspergillosis in those with COPD, many opportunities for prevention, earlier diagnosis, and therapeutic interventions are untested. Reducing corticosteroid exposure in patients with COPD could greatly reduce the impact of Aspergillus in patients with COPD.

Bacterial quantification assays targeting rRNA for the detection of H. influenzae, S. aureus, S. pneumoniae and M. catarrhalis in bronchiectasis samples showed >90% sensitivity and consistently detected additional positives missed by the other methods https://bit.ly/3PF437y.

Kartagener syndrome (KS) is a rare autosomal recessive motile ciliopathy and a well-recognized subtype of primary ciliary dyskinesia, classically defined by the triad of situs inversus totalis, chronic sinusitis, and bronchiectasis, with frequent accompanying infertility. Because of its non-specific clinical manifestations overlapping with common respiratory disorders and limited availability of gold-standard diagnostic tools in primary care settings, KS is frequently misdiagnosed or diagnosed late. This study retrospectively analyzed the clinical data, diagnostic trajectories, and treatment outcomes of three adult patients with clinically diagnosed complete KS admitted to our institution between May 2021 and December 2022. All patients presented with long-standing recurrent cough and expectoration; two presented with hemoptysis and one with type II respiratory failure. Initial misdiagnoses included bronchiectasis, non-tuberculous mycobacterial infection, and chronic obstructive pulmonary disease. Clinical diagnosis of complete KS was established based on the classic triad on imaging combined with core clinical features, as confirmatory genetic or ultrastructural testing was not available. Pathogen testing detected Acinetobacter baumannii in one patient, while another patient had a coinfection of Pseudomonas aeruginosa and Enterobacter cloacae. One more patient received empirical antimicrobial therapy because their family declined bronchoscopy. After individualized treatment, clinical improvement was observed in all patients, with symptom resolution, normalized inflammatory markers, and stable disease during 6-12 months of follow-up. These findings underscore that the combined features of "situs inversus totalis + bronchiectasis + chronic sinusitis + childlessness/infertility (when formally confirmed)" are key diagnostic clues for KS in primary care. Primary care clinicians should strengthen awareness of this rare entity and use a multisystem diagnostic approach to prevent misdiagnosis and underdiagnosis. Prompt targeted antimicrobial therapy and sustained comprehensive long-term management were associated with favorable clinical outcomes in this small case series.

Primary ciliary dyskinesia (PCD) is a rare, hereditary disorder characterized by impaired motile ciliary function, resulting in abnormal mucociliary clearance (MCC). This leads to persistent infection and inflammation, progressive airway damage, and bronchiectasis. Physiotherapy, particularly airway clearance therapy (ACT), is considered a cornerstone of PCD management to compensate for the mechanical MCC deficit, aiming to reduce infection risk, prevent disease progression, and improve quality of life (QOL). However, evidence supporting specific physiotherapy regimens in PCD remains limited. Current practice varies widely across centers and countries, with no standardized guidelines. Common ACT methods include positive expiratory pressure (PEP) with or without oscillation, autogenic and postural drainage, active cycle of breathing technique (ACBT), intrapulmonary percussive ventilation (IPV), and high-frequency chest wall oscillation (HFCWO). Comparative studies show no clear superiority among techniques. Evidence for mucolytic therapy, such as hypertonic saline or rhDNAse, is weak or controversial. Scarce data demonstrate potential benefits of exercise interventions in improving ventilatory capacity and QOL. Age-specific considerations are crucial: ACT should be started early, be adapted to developmental stages, and be combined with strategies to enhance adherence. Despite physiotherapy being standard care, randomized controlled trials are challenging due to ethical constraints, potentially reducing a therapy that is already believed to be helpful. Future priorities include developing international guidelines and conducting high-quality studies to optimize treatment strategies. In conclusion, physiotherapy plays a crucial role in PCD management, but current recommendations rely largely on expert opinion and extrapolation from related conditions like cystic fibrosis (CF) and non-CF bronchiectasis (BRECT), underscoring the need for robust evidence.