The term "Broncholithiasis" is defined as a presence of calcified or ossified materials within the tracheobronchial tree. The report of the condition dates backs to year 300 BC when Aristotle first described a symptom of "spitting of stones." The process of calcification usually starts within either the mediastinal, hilar, or peribronchial lymph nodes. The impetus is typically initiated by a granulomatous process such as Tuberculosis or histoplasmosis, however it can also been seen following exposure to other fungal, or occupational elements. The exact mechanism of the calcified material [broncholith] entering the endobronchial tree remains unknown. It is however hypothesized that the calcified tissues gradually erodes and/ or breaks loose in the airways, as a result of repetitive movements of respiration or cardiac pulsations. However, often the broncholiths are found in the airways without any signs of erosion. The most common symptoms of broncholithiasis include cough, hemoptysis, and wheezing as a result of irritation of the airways and the surrounding tissues. The diagnosis is typically suspected on a chest radiographs and confirmed by bronchoscopy. Depending on the severity of the disease, management options vary from a simple observation to a surgical resection. Despite the potential for a major complications, the overall disease prognosis is good if timely and appropriate management is provided.

To determine the utility of apoptosis inhibitor of macrophage (AIM)/CD5L as a potentially novel biomarker of morbidity and mortality in critically ill patients with sepsis.

Chronic obstructive pulmonary disease (COPD), asthma, and cystic fibrosis (CF) are obstructive lung diseases with distinct pathophysiologies and clinical phenotypes. In this review article we highlight recent advances in our understanding of relationships between clinical phenotypes, host inflammatory response, and lung microbiota in these diseases. Although COPD, asthma, and CF largely have distinct lung microbiota and inflammatory profiles, certain commonalities exist. In all three of these lung diseases, and in healthy persons, anaerobic taxa that are typically associated with oral microbiota (e.g. Prevotella and Veillonella) are present in the airways and associated with increased host inflammatory response. Similarly, across all three diseases, members of the Proteobacteria phylum are associated with more advanced disease. Finally, we highlight challenges in translating these findings into advances in clinical care, including continued knowledge gaps regarding the causal relationships between host inflammatory response, lung microbiota, medication effects, and clinical phenotypes.

The Genetic Epidemiology of COPD (COPDGene) is a non-interventional, multicenter, longitudinal study of over 10,000 subjects including smokers with a >10 pack year history with and without COPD, and healthy never smokers to characterize disease-related phenotypes and explore associations to susceptibility genes. The subjects were extensively phenotyped with comprehensive symptom and comorbidity questionnaires, spirometry, computed tomography (CT) of the chest, and genetic and biomarker profiling. The objective of this review is to summarize the major advances in the clinical epidemiology of COPD from the first 10 years of the COPDGene study. We highlight the influence of age, gender, and race on the natural history of COPD, and the impact of comorbid conditions, chronic bronchitis, exacerbations, and asthma - COPD overlap (ACO).

Postnasal Drip (PND) is a common symptom associated with upper respiratory tract disorders. It occurs without other symptoms or combined with chronic rhinosinusitis (CRS). However, the pathophysiology of PND is debated to this day and an objective definition of PND has not been established. Therefore we aimed to elucidate whether the viscosity and volume of nasal secretions as well as the mucociliary clearance and sensitivity of the nasopharynx, or atopy could play a role in the pathophysiology of PND.

Chronic obstructive pulmonary disease (COPD) has a substantial burden seen in both patient quality of life and healthcare costs. One method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs bring the best available evidence to a range of healthcare professionals by adapting guidelines to a local context and detailing essential steps in care.

COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms.

Common variable immunodeficiency (CVID) disorders refer to a relatively common primary immune deficiency group of diseases that present with infectious and inflammatory complications secondary to defects in antibody production and sometimes in cellular immunity. The disorder often presents in middle age or later with recurrent sinopulmonary infections, bronchiectasis or a plethora of noninfectious complications such as autoimmune disorders, granulomatous interstitial lung disease (GLILD), gastrointestinal diseases, malignancies (including lymphoma), and multisystem granulomatous disease resembling sarcoidosis. Infusion of immunoglobulin by intravenous (IVIG) or subcutaneous (SCIG) is the mainstay of therapy. Management of complications is often difficult as immune suppression may be necessary in these conditions, and entails the use of medications and biologicals which may further increase the risk for infections. Specifically, bronchiectasis, granulomatous lymphocytic interstitial lung disease, repeated sinopulmonary infections and malignancies are sequelae of antibody deficiency that may present to the pulmonologist. This review will provide an updated understanding of the molecular aspects, differential diagnosis, presentations and the management of CVID disorders.

Dyspnea is prevalent among hospitalized patients but little is known about the experience of dyspnea among inpatients. We sought to characterize the multiple sensations and associated emotions of dyspnea in patients admitted with dyspnea to a tertiary care hospital.

The relationship between OSA and glucose metabolism remains controversial. This retrospective study investigated the relationship between OSA and incident type 2 diabetes (T2D) in a clinic cohort of Chinese adults in Hong Kong, and the effect of long-term continuous positive airway pressure (CPAP) treatment.

Evidence regarding the association between sarcopenia (skeletal muscle depletion) and outcomes in patients with lung cancer varies across studies. We aimed to systematically review the prognostic value of sarcopenia in lung cancer.

Abundant epidemiological evidence supports an association between Idiopathic Pulmonary Fibrosis (IPF) and lung cancer. Lung tumors in patients with IPF develop preferentially in the periphery immediately adjacent to fibrotic areas, with different histologic distribution and immunohistochemical features compared to non IPF-associated lung tumors. In this context, evidence indicates that IPF and lung cancer share many pathogenetic similarities including genetic and epigenetic marks. It has been suggested that specific germline mutations predispose for both IPF and lung cancer, leading to imbalance between oncogenes and tumor suppressor genes and ultimately carcinogenesis within fibrotic lungs. Aberrant epigenetic regulation due to methylation, histone modifications and mainly deregulation of common non-coding RNAs represent a possible pathogenetic link between the two disease paradigms. Genetic and epigenetic alterations lead to abnormal activation of common transduction pathways, including Wnt-β catenin and PI3/AKT, mediating metaplasia and hyperproliferation in alveolar type II epithelial cells. Cellular transformations in the mesenchymal phenotype represent a common link between lung fibrosis and carcinogenesis. In this review we summarize current data on common cellular and molecular pathogenetic mechanisms between IPF and lung cancer and highlight promising therapeutic targets for this dreadful combination.

Exercise stress testing of the pulmonary circulation may uncover decreased pulmonary vascular (PV) distensibility as a cause of impaired aerobic exercise capacity and right ventriculo (RV)-pulmonary arterial (PA) uncoupling. As such, it may help to the differential diagnosis of unexplained dyspnea, including pulmonary hypertension (PH) and/or heart failure with preserved ejection fraction (HFpEF).

Whether four direct oral anticoagulants (DOACs) are superior to warfarin in Asians with nonvalvular atrial fibrillation (NVAF) remains unclear.

Historically, chronic obstructive pulmonary disease (COPD) has been considered to affect mostly older men with a history of smoking; however, in recent times, its prevalence and mortality rates have steadily increased among women.

Right ventricular (RV) dysfunction is associated with shortened life expectancy in heart failure with preserved ejection fraction (HFpEF). The contribution of pulmonary vascular dysfunction to RV dysfunction in HFpEF is not well understood.