Exacerbations, impaired health-related quality of life (HRQoL) and reduced exercise capacity increase the risk of hospitalisations and death in chronic obstructive pulmonary disease (COPD). However, their monitoring relies on in-person assessments, potentially delaying early care. While smart sensing technologies can enable remote monitoring, their use in predicting disease worsening remains limited. The TOLIFE Clinical Study A (CSA) aims to develop an artificial intelligence (AI) model integrating clinical data with smart sensing devices data to predict exacerbation onset and changes in HRQoL, dyspnoea and exercise capacity in people with COPD.

One of the most prevalent and impactful symptoms in COPD is persistent dyspnea, occurring in the majority of patient with advanced COPD. Opioids, mostly morphine, have been investigated and suggested as treatment in palliative care guidelines. However, in recent years multiple trials on morphine for persistent dyspnea have shown no clinical benefit, and there are concerns regarding adverse events. Transdermal fentanyl has not yet been investigated for this indication.We performed a multicenter, cross-over, double-dummy RCT, investigating transdermal fentanyl (12 mcg·h-1), morphine (10 mg p.o. bid), and placebo, during three treatment periods of two weeks (including three days wash out). Patients with persistent dyspnea despite optimal therapy and mMRC score≥3 caused by COPD, FEV1<50%, and stable disease were included. The primary endpoint was change in mean daily dyspnea score on a numeric rating scale (NRS). Secondary outcomes were change in worst daily dyspnea (NRS), health status (CCQ), anxiety (HADS-A), hypercapnia (capillary bloodgas), mastery (CRQ-M), and sleep quality (NRS).Between April 2019 and November 2024, 59 randomisations were performed in 58 participants (69±7 years, 54% female, FEV1 33±10%), 37 participants completed the study. The main reasons for study discontinuation were exacerbations (n=13) and side effects (n=7). There were no significant differences between both fentanyl and morphine compared to placebo for mean and worst dyspnea, sleep, health status, mastery, anxiety, hypercapnia, or side effects (except for a possible difference in vomiting).This study demonstrated no positive effect of transdermal fentanyl nor oral morphine, compared to placebo in the treatment of persistent dyspnea in COPD.

Acid α-glucosidase (GAA) is the sole lysosomal enzyme responsible for degrading glycogen into glucose monomers. Deficiency of GAA leads to progressive lysosomal glycogen accumulation and cellular dysfunction, resulting in Pompe disease (PD), an autosomal recessive disorder. This case report described a 41-year-old woman who presented with progressive dyspnea and decreased exercise tolerance. The preliminary examination in the outpatient clinic showed that the patient suffered from pulmonary hypertension (PH). After the patient was admitted to the hospital and further relevant auxiliary examinations were completed, and finally a diagnosis of late-onset Pompe disease (LOPD) was confirmed. Protein structure prediction suggested that the double mutation might disrupt the hydrogen bond network, hydrophobic core, and aromatic interactions of the GAA enzyme, potentially reducing the stability of the protein (ΔΔG = -2.55 kcal/mol). Although these computational insights provide a theoretical basis for the clinical phenotype, they require further validation. This is a rare case of PD complicated with PH in the absence of childhood symptoms, suggesting that specific missense mutations may contribute to late-onset and milder phenotypes. This case underscores that clinicians should strengthen clinical discrimination when diagnosing respiratory failure and PH. Understanding the characteristics of infantile-onset Pompe disease (IOPD)-relatively mild enzymatic activity impairment and late onset-helps in the clinical management of genetic metabolic.

A 65-year-old male presented to the emergency department with acute dyspnea and critically low oxygen saturation (77%), which led to the discovery of an unusual pulmonary arteriovenous malformation (PAVM). Computed tomographic pulmonary angiography revealed a 2.5-cm vascular lesion connecting the right inferior pulmonary artery to the left cardiac atrium, resulting in significant right-to-left shunting. The patient's respiratory symptoms resolved completely after video-assisted thoracoscopic surgical resection, demonstrating the value of comprehensive imaging in diagnosing rare vascular anomalies. This case highlights the clinical significance of unexpected vascular malformations in older adults.

A retrospective analysis was conducted of the clinical data of 22 patients with refractory bronchopleural fistula admitted to the Department of Respiratory and Critical Care Medicine, Emergency General Hospital, from January 2024 to January 2025.All patients underwent bronchoscopic airway stent placement combined with petroleum jelly gauze packing. Of these, 18 cases (81.8%) had central-type fistulas (mean diameter:5.22±1.96 mm), and 4 cases (18.2%) had peripheral-type fistulas (mean diameter:1.38±0.75 mm).Twenty patients had a single fistula, and two had multiple fistulas; 14 patients (63.6%) had concomitant empyema. Dyspnea and Karnofsky Performance Status (KPS) scores were compared before and after treatment, and time to residual cavity closure, time to chest tube removal, and complications were recorded. During 6 to 12-month follow-up, 20 patients achieved residual cavity closure, with a median closure time of 2.5 months; the median time to chest tube removal was 3 months. Both dyspnea and KPS scores showed improved significantly compared to pre-treatment values. Treatment failed in two patients::one was converted to open-window drainage, and one died of an unrelated illness 9 months postoperatively. One patient developed severe granulation tissue hyperplasia postoperatively, which improved after stent removal. These preliminary findings suggest that bronchoscopic airway stent placement combined with Vaseline gauze packing is an effective and safe minimally invasive interventional treatment for refractory bronchopleural fistula.