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.

A 27-month-old previously healthy girl presented with 3 months of cough and 1 day of fever and rhinorrhea. Her parents had immigrated from Africa, but our patient had been born in the United States and had no notable environmental exposures. An alarming chest radiograph suggested a broad differential diagnosis, and lung biopsy with pathology was ultimately required to confirm her rare diagnosis. Both her diagnosis and its significant implications are discussed.

Chronic cough remains a major unmet clinical need, particularly in patients with refractory or unexplained disease. This study aimed to develop a spray-dried dry powder inhaler formulation of lidocaine hydrochloride capable of targeting deposition to the upper and central airways, where cough receptors are mainly located, while minimizing deep lung delivery and systemic exposure. Lidocaine was incorporated into sodium hyaluronate, selected as a mucoadhesive and release-modifying excipient. The effects of polymer molecular weight, drug-to-polymer ratio, and spray-drying parameters on the key quality attributes of the formulation were investigated. Low-molecular-weight sodium hyaluronate at a 20:80 lidocaine-to-polymer ratio produced amorphous microparticles with appropriate solid-state characteristics and controlled dissolution behaviour. Optimization identified a lead formulation with a median particle size of 8.9 µm and a non-respirable fraction of about 85%, supporting preferential deposition in the tracheobronchial region. Aerodynamic performance assessed using a Next Generation Impactor and an anatomically realistic mouth-throat model confirmed efficient delivery with limited fine particle deposition. Compared with raw lidocaine, the optimized formulation showed slower in vitro release, consistent with drug incorporation within the polymer matrix. In a randomized, single-blind, crossover proof-of-concept study in healthy volunteers, inhalation of 8 mg lidocaine powder significantly increased cough threshold at 15 and 30 min versus placebo, without clinically relevant safety concerns, bronchoconstriction, or impairment of the gag reflex. These findings show that particle engineering can enable regional airway targeting of lidocaine by dry powder inhalation and support the potential of this approach as a rapid, on-demand antitussive strategy.

Bronchial atresia is a rare congenital anomaly characterized by focal interruption of a bronchus, typically associated with distal mucoid impaction and hyperinflation of the corresponding lung parenchyma. It is usually identified incidentally in children or young adults, whereas diagnosis in late adulthood is uncommon. We report the case of a 59-year-old man who presented with chronic cough and dyspnea. Chest computed tomography (CT), performed before and after intravenous contrast administration, revealed focal unilateral hyperlucency involving the posterior segment of the right upper lobe, associated with a moniliform bronchocele containing mucoid impaction and interruption of the proximal continuity of a dorsal subsegmental bronchus with the segmental bronchus and the central tracheobronchial tree. No enhancing endobronchial lesion, suspicious pulmonary mass, post-obstructive consolidation, or significant lymphadenopathy was identified. These findings were highly suggestive of congenital bronchial atresia. The patient was referred for pulmonology evaluation. In the absence of superinfection, significant functional impairment, or persistent diagnostic uncertainty, conservative management with clinical follow-up was recommended. The patient remained clinically stable during five months of follow-up, with no worsening of symptoms or recurrent respiratory infection. This case highlights the key role of CT in establishing the diagnosis of bronchial atresia in adulthood and in differentiating it from other causes of focal hyperlucency and bronchial obstruction.

Chronic cough, defined as a cough lasting 8 weeks or longer in adults, presents a significant diagnostic challenge due to the complexity of underlying causes. Unexplained chronic cough accompanied by shortness of breath that does not improve with chest tube placement administration may be suspected of esophago-pleural fistula. A 54-year-old woman experienced a 2-month chronic cough, shortness of breath, and chest and abdominal pain. Initially treated symptomatically, she was later diagnosed with right-sided pneumothorax. The patient underwent chest tube placement, fluid therapy, antibiotics, gastroprotective agents, and breathing exercises. A chest CT scan suggested an esophago-pleural fistula, although this diagnosis was suspected radiologically and not definitively confirmed by esophagography or endoscopy, and she was referred for thoracic surgical intervention. This case highlights the importance of a comprehensive diagnostic approach in chronic cough with systemic symptoms. Pneumothorax with esophago-pleural fistula is a rare but serious condition requiring early stabilization, empirical antibiotic therapy, and further imaging evaluation. Esophago-pleural fistula should be considered in cases of atypical pneumothorax with gastrointestinal symptoms. Early diagnosis, appropriate intervention, and multidisciplinary collaboration are key to successful treatment.

Refractory or unexplained chronic cough (RUCC) is a cough lasting more than 8 weeks that persists despite guidelines-based evaluation and treatment, either because no cause is identified or because the cough continues after appropriate treatment of identified conditions. It can significantly impair functioning, sleep, and quality of life. Guideline-supported options remain limited. We report on a case of RUCC that was very effectively treated with low-dose sublingual buprenorphine. This partial μ-opioid agonist can offer greater safety and lower misuse liability compared to full opioid agonists or tramadol. Further study of this treatment option is warranted.

BACKGROUNDIn European countries, including France, the incidence and costs of whooping cough in people with chronic conditions remains understudied.AIMWe aimed to estimate cumulative incidence and costs of whooping cough hospitalisations in children, adolescents and adults with chronic conditions in France.METHODSWe extracted data from patients hospitalised with whooping cough with or without underlying chronic conditions, asthma, chronic obstructive pulmonary disease (COPD), diabetes and immunocompromising conditions between 2008 and 2020 using the Système National des Données de Santé (SNDS).RESULTSAmong the 10,893 patients hospitalised with whooping cough in 2008-2020, asthma and/or COPD were the most common chronic conditions. Of the 7,212 children and adolescents hospitalised, 1,263 (17.5%) had asthma and 68 (0.9%) had an immunocompromising condition. Of the 3,681 adults, 2,297 (62.4%) had asthma and/or COPD, 594 (16.1%) had an immunocompromising condition and 454 (12.3%) had diabetes. In children and adolescents, the highest cumulative incidence ratio (CIR) was among patients with an immunocompromising condition (adjusted CIR = 3.6; 95% confidence interval (CI): 2.8-4.6) whereas in adults, patients with asthma and/or COPD had the highest adjusted CIR (18.6; 95% CI: 17.4-19.9). Median hospitalisation costs were the highest for patients with an immunocompromising condition (EUR 4,401). No significant changes in healthcare resource utilisation were observed before and after whooping cough hospitalisation in adults.CONCLUSIONChronic conditions are associated with higher cumulative incidence of whooping cough-related hospitalisation in France. This highlights the importance of reducing whooping cough circulation, through strengthening vaccination programmes, particularly for those with chronic conditions.

Pituitary neuroendocrine tumours (PitNETs) commonly present with symptoms related to mass effect or hormonal dysfunction, including headache, visual disturbances, and endocrine abnormalities. However, atypical presentations without neurological or hormonal "red flag" symptoms may delay diagnosis, particularly in primary care settings where benign upper respiratory conditions are more frequently encountered. We report the case of a 56-year-old postmenopausal woman who presented with a five-month history of persistent postnasal drip, chronic non-productive cough and a sensation of nasal congestion characterised by fullness in the nasal and retro-orbital region. Despite conservative medical management, persistent symptoms prompted a computed tomography (CT) of the brain and paranasal sinuses, which unexpectedly revealed a sellar mass extending into the left sphenoid sinus. Subsequent magnetic resonance imaging (MRI) confirmed a 3.4cm pituitary macroadenoma with left cavernous and sphenoid sinus invasion, left internal carotid artery encasement, optic nerve involvement, and imaging features of pituitary apoplexy. Hormonal evaluation showed hyperprolactinaemia, and histopathology following endoscopic endonasal resection confirmed a lactotroph PitNET. This case highlights the importance of diagnostic reassessment in patients with persistent symptoms and demonstrates that clinically significant PitNETs can masquerade behind common benign upper respiratory conditions.

Gastroesophageal reflux disease (GERD) is implicated as a potential cause of chronic laryngopharyngeal symptoms, including laryngitis, cough, dysphonia, and throat clearing, often grouped under laryngopharyngeal reflux (LPR). This study aimed to assess the predictive value of clinical and demographic factors for GERD in patients with LPR symptoms using multichannel intraluminal impedance-pH monitoring. Analytical cross-sectional study of 2688 adults with upper airway symptoms and suspected LPR undergoing pH-impedance monitoring between January 2019 and December 2022. Pathological GERD was defined as acid exposure time (AET) >6%, or AET 4%-6% with abnormal reflux parameters (total reflux events >80 and/or positive symptom association). Proximal reflux episodes were recorded but not used diagnostically. Multivariable logistic regression analyses identified independent predictors. Among 2688 patients (73.6% female; mean age 54.5 years), only 8.4% had pathological GERD. Independent predictors included higher body mass index, male sex, older age, heartburn, and hiatal hernia. The final model demonstrated moderate discrimination area under the curve (AUC) 0.676. Only a small proportion of patients with suspected LPR have objective GERD. Pathological reflux is better predicted by traditional GERD-related factors than by isolated laryngopharyngeal symptoms, supporting a more cautious interpretation of LPR and consideration of alternative diagnoses.