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Diagnostics
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Diagnosis and Management of Lung Diseases
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Diagnosis and Management of Lung Diseases

A Special Issue of Diagnostics (ISSN 2075-4418) belonging to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 30 November 2026 | Viewed by 2640

Editors

Dr. Fu-Zong Wu

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Guest Editor
1. Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
2. Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
3. School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
Interests: lung cancer; diagnosis; prognosis; radiomics; texture analysis
Special Issues, Collections and Topics in MDPI journals
Dr. Nevenka Piskac Zivkovic

E-Mail Website
Guest Editor
1. Department of Internal Medicine, Division of Pulmonology, University Hospital Dubrava, Zagreb, Croatia
2. Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
Interests: lung cancer; endobronchial ultrasound; thoracic ultrasound; navigational bronchoscopy; cryobiopsy

Special Issue Information

Dear Colleagues,

Contemporary pulmonary diagnostics encompasses a variety of modalities, including advanced bronchoscopy procedures such as endobronchial ultrasound, navigational and robotic bronchoscopy, cryobiopsy of lymph nodes, peripheral pulmonary nodules, and lung parenchyma. The primary goal is to obtain tissue suitable for molecular and advanced genetic analysis. It is a cornerstone for the treatment of lung cancer and interstitial pulmonary diseases.

The rapid development of new technologies, such as artificial intelligence and the widespread use of so-called “-OMICS” approaches, enables the generation of big data and opens new horizons in the exploration of potential diagnostic approaches for lung disease. Large efforts are being made to establish new biomarkers for various respiratory conditions, sampled non-invasively (or minimally invasively) from biological fluids such as blood plasma or induced sputum, aiming to minimize potentially more harmful procedures such as bronchoscopy and radiation exposure from transthoracic biopsy guided by a CT scan.

Tobacco smoking significantly contributes to the burden of pulmonary diseases. It is well recognized that cigarette smoking is a major risk factor for the development of lung cancer and chronic obstructive lung disease, namely emphysematous tissue destruction. Additionally, cigarette smoking has been associated with idiopathic pulmonary fibrosis. A distinct mechanism and molecular pathways of cigarette smoking-related lung conditions, particularly lung cancer, emphysema, and fibrosis, are permanently in focus for respiratory specialists and researchers.

COPD, as one of the world’s leading causes of death, poses a major health risk on a global scale. COPD is a disease with many faces, and it is currently not clear which COPD patients will develop underlying emphysema. Namely, COPD patients with emphysema have lower exercise capacity, worse lung function, and higher disease mortality. Additionally, COPD patients with emphysema (emphysema-predominant phenotype or concurrent emphysema and chronic bronchitis) have higher cardiovascular risk than COPD patients without emphysema. It is, therefore, crucial to accurately phenotype COPD patients, develop novel diagnostic approaches to identify emphysema, and identify distinct molecular pathways that may be altered in this specific phenotype.

Dr. Fu-Zong Wu
Dr. Nevenka Piskac Zivkovic
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • endobronchial ultrasound
  • navigational bronchoscopy
  • robotic bronchoscopy
  • cryobiopsy
  • lung cancer
  • interstitial lung diseases
  • OMICS approaches
  • proteomics
  • emphysema
  • chronic obstructive pulmonary disease

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Published Papers (3 papers)

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Research

17 pages, 691 KB  
Article
Chronic Hypercapnic Respiratory Failure in COPD in Lithuania: National Registry Trends and Prehospital Emergency-Care Professionals’ Knowledge of Hypercapnia and Oxygen Therapy
by Rasa Gauronskaitė, Anrenas Karvelis, Edvardas Danila and Rolandas Zablockis
Diagnostics 2026, 16(17), 2782; https://doi.org/10.3390/diagnostics16172782 - 29 Aug 2026
Viewed by 229
Abstract
Background/Objectives: Hypercapnic respiratory failure (HRF) is a serious complication of chronic obstructive pulmonary disease (COPD) and is associated with increased morbidity, mortality, and healthcare utilisation. National HRF trends among patients with COPD remain poorly characterised in Lithuania, and the knowledge of prehospital [...] Read more.
Background/Objectives: Hypercapnic respiratory failure (HRF) is a serious complication of chronic obstructive pulmonary disease (COPD) and is associated with increased morbidity, mortality, and healthcare utilisation. National HRF trends among patients with COPD remain poorly characterised in Lithuania, and the knowledge of prehospital emergency-care professionals regarding oxygen therapy and hypercapnia has not been evaluated. Methods: This study comprised two components. First, a cross-sectional online survey assessed knowledge of COPD, hypercapnia, and oxygen therapy among prehospital emergency-care professionals (EMS physicians, emergency nurses, EMS paramedics, and paramedics); three questionnaire items whose designated correct answers could not be unambiguously supported were excluded from the knowledge score, and the original 10-item score was retained as a sensitivity analysis. Second, nationwide electronic health record data from the Lithuanian national health record system (ESPBI IS, 2020–2023) were analysed retrospectively: patients with COPD and concomitant chronic HRF were identified using ICD-10-AM diagnostic codes, and the number of patients with a recorded J96.11 diagnosis irrespective of underlying disease was obtained as a national denominator. Proportions are reported with 95% confidence intervals and temporal trends as absolute changes in percentage points; multivariable logistic regression was used to estimate odds ratios adjusted for age group and sex. Between-year differences were tested using the χ2 test with Holm-adjusted pairwise comparisons, and the association between sex and chronic HRF was expressed as an odds ratio. All tests were two-sided, and p < 0.05 was considered significant. Results: Among the 65 prehospital emergency-care professionals surveyed, knowledge of hypercapnia was relatively high: 78.5% (95% CI 67.0–86.7) correctly defined it and 72.3% (95% CI 60.4–81.7) identified its symptoms, whereas 58.5% (95% CI 46.3–69.6) identified the recommended SpO2 target range of 88–92%. Respondents answered a median of 5 of the 7 scored knowledge items correctly (IQR 4–6). Total knowledge scores differed by professional role (p = 0.034) but not by years of experience, sex, or frequency of COPD contact; the sensitivity analysis using the original 10-item score gave the same pattern (p = 0.006). In the national electronic health record data, the COPD population increased from 27,239 to 32,446 (+19.1%) between 2020 and 2023, while the number of COPD patients with a recorded chronic HRF diagnosis rose from 160 to 291 (+81.9%). The proportion rose from 0.59% (95% CI 0.50–0.69) to 0.90% (95% CI 0.80–1.01), an absolute increase of 0.31 percentage points (95% CI 0.17–0.45; risk ratio 1.53, 95% CI 1.26–1.85). Men had higher odds than women after adjustment for age (adjusted OR 1.55, 95% CI 1.28–1.88), and adjusted odds were lowest in patients aged 80 years or older. Across the four annual cross-sections, COPD accounted for 41.5% of patient-year observations with a recorded J96.11 diagnosis nationally. Conclusions: Knowledge of COPD, hypercapnia, and oxygen therapy varied among the prehospital emergency-care professionals surveyed, with one of the lowest proportions of correct responses observed for the recommended target oxygen saturation range. National electronic health record data showed an increase in the proportion of patients with COPD who had a recorded diagnosis of chronic HRF between 2020 and 2023. These components were analysed independently, and no relationship between professional knowledge and temporal trends in recorded diagnoses was assessed. The electronic health record findings support continued monitoring and recognition of chronic HRF in COPD, whereas the survey findings support further evaluation of targeted education on oxygen therapy in the prehospital setting. Full article
(This article belongs to the Special Issue Diagnosis and Management of Lung Diseases)
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12 pages, 825 KB  
Article
Baseline Chronic Obstructive Pulmonary Disease Identifies a High-Risk Cardiopulmonary Phenotype in Patients with Heart Failure Undergoing SGLT2 Inhibitor Therapy
by Ivana Jurin, Marin Pavlov, Marin Viđak, Filip Doder, Antonio Patrk, Iva Vidaković and Nevenka Piskač Živković
Diagnostics 2026, 16(11), 1606; https://doi.org/10.3390/diagnostics16111606 - 25 May 2026
Cited by 1 | Viewed by 725
Abstract
Background/Objectives: Chronic obstructive pulmonary disease (COPD) often coexists with heart failure (HF) and can complicate the interpretation of symptoms, biomarker profiles, and clinical deterioration. Its prognostic significance at the time of sodium-glucose cotransporter 2 inhibitor (SGLT2i) initiation remains incompletely defined. We therefore evaluated [...] Read more.
Background/Objectives: Chronic obstructive pulmonary disease (COPD) often coexists with heart failure (HF) and can complicate the interpretation of symptoms, biomarker profiles, and clinical deterioration. Its prognostic significance at the time of sodium-glucose cotransporter 2 inhibitor (SGLT2i) initiation remains incompletely defined. We therefore evaluated whether baseline COPD was associated with a greater biomarker burden and worse 12-month outcomes in a real-world HF cohort at the time of SGLT2i initiation. Methods: This prospective single-centre observational cohort included patients with HF enrolled in a tertiary registry between May 2022 and November 2024 in whom SGLT2i therapy was initiated. HF was diagnosed according to contemporary European Society of Cardiology (ESC) criteria on the basis of compatible symptoms and/or signs, objective structural or functional cardiac abnormalities on echocardiography, and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP). COPD status was defined by a documented pre-existing diagnosis at baseline. The primary endpoint was the 12-month time-to-first composite of all-cause death or unplanned hospitalization for acute decompensated HF. Results: Among 996 patients, 122 (12.2%) had COPD. Compared with patients without COPD, those with COPD more often had a smoking history, a higher comorbidity burden, a worse New York Heart Association (NYHA) class, higher baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) levels, and a lower estimated glomerular filtration rate (eGFR), whereas baseline HF pharmacotherapy was broadly similar. NT-proBNP remained higher at 6 and 12 months, whereas CRP remained higher at 6 months but not at 12 months. In multivariable Cox analysis adjusting for age, sex, major comorbidities, left ventricular ejection fraction (LVEF), renal function, high-density lipoprotein cholesterol (HDL-C), glycated haemoglobin (HbA1c), CRP, and log NT-proBNP, COPD remained independently associated with the primary endpoint (hazard ratio [HR] 2.610, 95% confidence interval [CI] 1.707–3.991; p < 0.001) and all-cause death (HR 2.097, 95% CI 1.246–3.532; p = 0.005). Conclusions: Among patients with HF starting SGLT2i therapy, baseline COPD identified a higher-risk cardiopulmonary phenotype characterized by a greater comorbidity burden, higher inflammatory and natriuretic biomarker levels, and worse 1-year outcomes. These observational findings support closer integrated cardiology–pulmonology follow-up. Full article
(This article belongs to the Special Issue Diagnosis and Management of Lung Diseases)
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20 pages, 1203 KB  
Article
Proteomics-Based Study of Potential Emphysema Biomarkers Reveals Systemic Redox System and Extracellular Matrix Component Dysregulation
by Grgur Salai, Ruđer Novak, Stela Hrkač, Václav Pustka, David Potěšil, Zbyněk Zdráhal, Divo Ljubicic and Lovorka Grgurević
Diagnostics 2026, 16(6), 931; https://doi.org/10.3390/diagnostics16060931 - 21 Mar 2026
Cited by 2 | Viewed by 1004
Abstract
Objective: Emphysema is an important chronic obstructive pulmonary disease (COPD) phenotype characterized by the destruction of air spaces distal to the terminal bronchiole. Aiming to detect potential emphysema biomarkers and to assess the systemic effects of emphysema in blood plasma, we conducted a [...] Read more.
Objective: Emphysema is an important chronic obstructive pulmonary disease (COPD) phenotype characterized by the destruction of air spaces distal to the terminal bronchiole. Aiming to detect potential emphysema biomarkers and to assess the systemic effects of emphysema in blood plasma, we conducted a small cross-sectional shotgun proteomics study. Methods: This study included N = 40 participants divided into four subgroups (N = 10 per group): patients with emphysema and COPD (CE), patients with COPD but without emphysema (CN), healthy smokers (HS) and healthy never-smokers (HN). The participants were sampled non-probabilistically to be similar in terms of age, sex and comorbidities. Participants’ blood plasma was analyzed using liquid chromatography–mass spectrometry. Bioinformatic analysis included detection of differentially expressed proteins (DEPs) and overrepresentation analysis (ORA). Results: Across all groups, a total of 994 proteins were identified, with NADP-dependent malic enzyme (NADP-ME; encoded by ME1) being the only DEP in the CE vs. CN contrast. Proteins such as BMP1, ADAMTSL-2, -4 and IGFBP4, -5, 6 were identified to be upregulated in CE vs. HN. Fibulin-1, -3 and several immunoglobulin components were identified to be downregulated in the CE vs. HN contrast. ORA revealed several enriched processes, including serine-type endopeptidase activity, insulin-like growth factor I and II binding, and signaling receptor binding. Conclusion: We propose NADP-ME, an important enzyme of intermediary metabolism and redox homeostasis, as a potential biomarker candidate of emphysema. Notably, NADP-ME is also implicated in anoikis resistance. Additionally, changes in the expression levels of BMP1, ADAMTSL-2 and -4, and fibulin suggest potential major systemic effects of extracellular matrix perturbation. As all data was derived from LC-MS analysis, these findings need to be further evaluated with complementary methods. Full article
(This article belongs to the Special Issue Diagnosis and Management of Lung Diseases)
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