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Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 30 April 2025 | Viewed by 10631

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Dr. Daniele Sola

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Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
Interests: rare immunological diseases; vasculitis; immunodeficiencies; connective tissue disease; leukocyte biology
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Dear Colleagues,

At present, some common and rare lung diseases are well-defined, and others are almost unknown. The scientific community updates the guidelines, such as GINA or GOLD guidelines, almost every year to help clinicians in everyday practice. New evidence is emerging about the effectiveness of innovative treatments involving combinations of traditional drugs or small molecules, monoclonal antibodies, and bronchial electrotherapies; even nutraceuticals are used for long-term care. With this Special Issue, we aim to collect information to help clinicians care for their patients. Reviews and articles are welcome. We will collect crucial clinical observations on a single patient or small or large population data. We wish to collate scientific research on adult lung diseases regarding symptoms, objective manifestations, haematochemical and instrumental data, follow-ups, common and rare lung disease therapies, and possibly descriptions of new diseases or unusual signs/symptoms.

Dr. Daniele Sola
Guest Editor

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Keywords

cough
dyspnea
tachypnea-bradypnea
bronchospasm
hemophthous
respiratory insufficiency
pulmonary fibrosis
hypoxia-hypercapnia
biological therapy
non-invasive ventilation
bronchoscopy-broncholavage

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Published Papers (8 papers)

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Research

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20 pages, 2756 KiB

Open AccessArticle

Vitamin C and Tuberculosis: Examining the Relationship Between Antioxidant Defense and Disease Severity—Preliminary Findings from a Southwestern Romanian Study

by Ramona Cioboata, Dragos Nicolosu, Andrei-Theodor Balasoiu, Mara Amalia Balteanu, Ovidiu Mircea Zlatian, Andrei Osman, Viorel Biciusca, Eugen-Nicolae Tieranu, Gabriel Florin Razvan Mogos and Alice Elena Ghenea

J. Clin. Med. 2024, 13(22), 6715; https://doi.org/10.3390/jcm13226715 - 8 Nov 2024

Cited by 2 | Viewed by 1261

Abstract

Background/Objectives: This study explored the relationship between serum vitamin C levels, antioxidant defense mechanisms, and the severity of pulmonary tuberculosis (TB) among Romanian patients. Methods: This study enrolled 53 patients with bacteriologically confirmed pulmonary tuberculosis at Victor Babes University Hospital in Craiova between January 2023 and August 2024. Participants were stratified into two groups based on their serum vitamin C levels: 26 patients with normal levels and 27 patients with low levels. Clinical, demographic, and biological parameters, including inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were assessed at baseline and after 60 days of TB treatment. Serum vitamin C levels were measured using ELISA. The persistence of Mycobacterium tuberculosis (MTB) was evaluated using sputum smear microscopy and culture at baseline and after 2 months of treatment. Results: The results showed that patients with low vitamin C levels had significantly higher baseline ESR (92.63 ± 27.69 mm/h) and CRP (43.89 ± 12.00 mg/L) levels compared to those with normal levels (ESR: 65.11 ± 13.27 mm/h, CRP: 31.19 ± 9.76 mg/L). After 60 days, 66.67% of patients with low vitamin C levels remained culture-positive compared to 26.92% in the normal vitamin C group (p = 0.004). Multivariate analysis indicated that vitamin C deficiency was significantly associated with a higher TB culture load. Conclusions: These findings suggest that vitamin C deficiency may contribute to the persistence of MTB and highlight the potential role of vitamin C supplementation as an adjunct to standard TB treatment, particularly in the context of global efforts to eradicate the disease by 2035. Full article

(This article belongs to the Special Issue Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment)

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11 pages, 621 KiB

Open AccessArticle

Clinical Impacts of Pseudomonas aeruginosa Isolation in Patients with Bronchiectasis: Findings from KMBARC Registry

by Jinhwa Song, Sooim Sin, Hye-Rin Kang, Yeon-Mok Oh and Ina Jeong

J. Clin. Med. 2024, 13(17), 5011; https://doi.org/10.3390/jcm13175011 - 24 Aug 2024

Cited by 1 | Viewed by 1120

Abstract

Background: Pseudomonas aeruginosa isolation in bronchiectasis is associated with a poor prognosis, including increased hospital admissions, exacerbation, and mortality. In this study, we aimed to evaluate the clinical characteristics and outcomes of P. aeruginosa isolation from patients with bronchiectasis in South Korea. Methods: This multicenter prospective cohort study analyzed 936 patients with bronchiectasis. We examined the prevalence of P. aeruginosa isolates and other microbiological characteristics. Additionally, the clinical characteristics related to disease severity and 1-year prognosis were compared between patients with and without P. aeruginosa isolation. Propensity score matching was used to mitigate confounding biases. Results: Of the 936 patients with bronchiectasis, P. aeruginosa was isolated from 89. A total of 445 matched patients—356 patients without (non-Pseudomonas group) and 89 with (Pseudomonas group) P. aeruginosa isolation—were analyzed. The Pseudomonas group showed poorer lung function, greater involvement of radiographic bronchiectasis, and a higher proportion of cystic bronchiectasis than the non-Pseudomonas group. After one year, more patients in the Pseudomonas group were admitted for bronchiectasis than in the non-Pseudomonas group. Moreover, the Bronchiectasis Health Questionnaire scores were significantly lower in the Pseudomonas group than in the non-Pseudomonas group. Conclusions: The isolation of P. aeruginosa was independently associated with increased disease severity and poor clinical outcomes in Korean patients with bronchiectasis. Full article

(This article belongs to the Special Issue Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment)

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17 pages, 744 KiB

Open AccessArticle

Clinical Features and Outcomes of Patients with Idiopathic Inflammatory Myositis-Associated Interstitial Lung Disease in Rural Appalachia: A Cross-Sectional Study

by Vishal Deepak, Bhanusowmya Buragamadagu, Fnu Rida Ul Jannat, Rachel Salyer, Ty Landis, Sayanika Kaur and Bathmapriya Balakrishnan

J. Clin. Med. 2024, 13(5), 1294; https://doi.org/10.3390/jcm13051294 - 25 Feb 2024

Viewed by 1472

Abstract

Background: Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune disorders often complicated by interstitial lung disease (ILD). The clinical characteristics and outcomes of IIM-associated ILD have been reported variably, but the literature on rural populations is scarce. Methods: A retrospective cross-sectional study was conducted at a rural tertiary academic medical center. Twenty-nine patients met the final inclusion criteria. The primary outcome was to assess the disease state and immunological and radiographic features of IIM-associated ILD. Secondary outcomes included disease progression, ILD exacerbation, mortality rate, and factors associated with poor outcome. Results: Dermatomyositis (n = 15, 51.72%) followed by polymyositis (n = 8, 27.58%) were predominant myopathies. The most common autoantibodies were anti-Jo1 antibodies (n = 11, 37.93%). Indeterminate usual interstitial pneumonitis (41.30%, n = 12) was the most common radiographic pattern followed by non-specific interstitial pneumonia (n = 5, 17.24%). ILD exacerbation (n = 14, 66.66%) and mortality rate (n = 6, 20.69%) were high. Albumin levels were significantly lower in patients who died. Conclusions: The clinical characteristics of patients with IIM-associated ILD in rural Appalachia exhibit notable distinctions, and outcomes are worse compared to other populations. Larger studies are needed to investigate other prognostics factors and longitudinal trends of clinical characteristics and outcomes of IIM-associated ILD in rural populations. Full article

(This article belongs to the Special Issue Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment)

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14 pages, 1330 KiB

Open AccessArticle

The National Early Warning Score 2 with Age and Body Mass Index (NEWS2 Plus) to Determine Patients with Severe COVID-19 Pneumonia

by Konlawij Trongtrakul, Pattraporn Tajarernmuang, Atikun Limsukon, Theerakorn Theerakittikul, Nutchanok Niyatiwatchanchai, Karjbundid Surasit, Pimpimok Glunriangsang, Chalerm Liwsrisakun, Chaiwat Bumroongkit, Chaicharn Pothirat, Juthamas Inchai, Warawut Chaiwong, Panida Chanayat and Athavudh Deesomchok

J. Clin. Med. 2024, 13(1), 298; https://doi.org/10.3390/jcm13010298 - 4 Jan 2024

Cited by 6 | Viewed by 2339

Abstract

(1) Background: Early identification of severe coronavirus disease 2019 (COVID-19) pneumonia at the initial phase of hospitalization is very crucial. To address this, we validated and updated the National Early Warning Score 2 (NEWS2) for this purpose. (2) Methods: We conducted a study on adult patients with COVID-19 infection in Chiang Mai, Thailand, between May 2021 and October 2021. (3) Results: From a total of 725 COVID-19 adult patients, 350 (48.3%) patients suffered severe COVID-19 pneumonia. In determining severe COVID-19 pneumonia, NEWS2 and NEWS2 + Age + BMI (NEWS2 Plus) showed the C-statistic values of 0.798 (95% CI, 0.767–0.830) and 0.821 (95% CI, 0.791–0.850), respectively. The C-statistic values of NEWS2 Plus were significantly improved compared to those of NEWS2 alone (p = 0.012). Utilizing a cut-off point of five, NEWS2 Plus exhibited better sensitivity and negative predictive value than the traditional NEWS2, with values of 99.7% vs. 83.7% and 98.9% vs. 80.7%, respectively. (4) Conclusions: The incorporation of age and BMI into the traditional NEWS2 score enhanced the efficacy of determining severe COVID-19 pneumonia. Physicians can rely on NEWS2 Plus (NEWS2 + Age + BMI) as a more effective decision-making tool for triaging COVID-19 patients during early hospitalization. Full article

(This article belongs to the Special Issue Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment)

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15 pages, 7392 KiB

Open AccessArticle

Mapping the Most Common Founder Variant in RSPH9 That Causes Primary Ciliary Dyskinesia in Multiple Consanguineous Families of Bedouin Arabs

by Dalal A. Al-Mutairi, Basel H. Alsabah, Petra Pennekamp and Heymut Omran

J. Clin. Med. 2023, 12(20), 6505; https://doi.org/10.3390/jcm12206505 - 13 Oct 2023

Cited by 2 | Viewed by 1438

Abstract

Introduction: Primary ciliary dyskinesia (PCD) is a congenital thoracic disorder caused by dysfunction of motile cilia, resulting in insufficient mucociliary clearance of the lungs. The overall aim of this study is to identify causative defective genes in PCD-affected individuals in the Kuwaiti population. Methods: A cohort of multiple consanguineous PCD families was identified from Kuwaiti patients and genomic DNA from the family members was isolated using standard procedures. The DNA samples from all affected individuals were analyzed by whole exome sequencing (WES). Transmission electron microscopy (TEM) and immunofluorescent analysis (IF) were performed on samples obtained by nasal brushings to identify specific structural abnormalities within ciliated cells. Results: Here, we present six multiplex families with 11 patients who all presented with typical PCD symptoms. Ten out of eleven patients inherited a 3 bp homozygous deletion of GAA in RSPH9, whereas the eleventh patients inherited this variant in trans with a frameshift deletion in RSPH9. Genetic results were confirmed by segregation analysis. The in-frame deletion of GAA in RSPH9 has previously been published as pathogenic in both annotated RSPH9 transcript variants (1 and 2). In contrast, the previously unpublished RSPH9 frameshift deletion identified in KU-15.IV2 impacts only RSPH9 transcript variant two. Regarding all 11 PCD individuals analyzed, IF results demonstrated absence of RSPH9 protein and TEM analysis showed the typical findings in RSPH9 mutant individuals. Conclusions: We present the largest cohort of PCD individuals affected by the founder in-frame deletion GAA in RSPH9. This founder variant is the most common PCD-causing variant in Bedouin Arabs in Kuwait. Full article

(This article belongs to the Special Issue Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment)

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Review

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22 pages, 1358 KiB

Open AccessReview

Coinfections in Tuberculosis in Low- and Middle-Income Countries: Epidemiology, Clinical Implications, Diagnostic Challenges, and Management Strategies—A Narrative Review

by Ramona Cioboata, Mara Amalia Balteanu, Andrei Osman, Silviu Gabriel Vlasceanu, Ovidiu Mircea Zlatian, Denisa Maria Mitroi, Oana Maria Catana, Adriana Socaci and Eugen-Nicolae Tieranu

J. Clin. Med. 2025, 14(7), 2154; https://doi.org/10.3390/jcm14072154 - 21 Mar 2025

Viewed by 121

Abstract

Tuberculosis (TB) continues to be a major public health challenge in low- and middle-income countries (LMICs), where high burdens of coinfections exacerbate the disease’s impact. In 2023, an estimated 8.2 million people were newly diagnosed with tuberculosis worldwide, reflecting an increase from 7.5 million in 2022 and 7.1 million in 2019. In LMICs, limited access to healthcare, inadequate nutrition, and poor living conditions contribute to higher coinfection rates among TB patients, leading to delayed diagnosis and treatment, which in turn exacerbates disease severity and facilitates transmission. This narrative review synthesizes the epidemiology, clinical implications, diagnostic challenges, and management strategies related to TB coinfections with viral pathogens including HIV, SARS-CoV-2, and influenza, bacteria such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa, fungi such as Aspergillus and Candida species, and parasites. This review highlights that overlapping symptoms, immune system compromise, and socioeconomic barriers in LMICs lead to delayed diagnoses and suboptimal treatment outcomes, while also addressing the challenges of managing drug interactions particularly in HIV–TB coinfections and underscoring the need for integrated diagnostic approaches, improved treatment regimens, and strengthened healthcare systems, thereby consolidating current evidence to inform future research priorities and policy interventions aimed at reducing the overall burden of TB and its coinfections in resource-limited settings. Full article

(This article belongs to the Special Issue Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment)

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20 pages, 2146 KiB

Open AccessReview

Hypercoagulability in Tuberculosis: Pathophysiological Mechanisms, Associated Risks, and Advances in Management—A Narrative Review

by Denisa Maria Mitroi, Mara Amalia Balteanu, Ramona Cioboata, Silviu Gabriel Vlasceanu, Ovidiu Mircea Zlatian, Oana Maria Catana, Adina Andreea Mirea, Gabriel Florin Razvan Mogos, Ionela Rotaru and Viorel Biciusca

J. Clin. Med. 2025, 14(3), 762; https://doi.org/10.3390/jcm14030762 - 24 Jan 2025

Viewed by 687

Abstract

Tuberculosis (TB) induces a hypercoagulable state characterized by systemic inflammation, endothelial dysfunction, and alterations in the coagulation and fibrinolytic pathways. This review explores the pathophysiological mechanisms underlying hypercoagulability in TB, including increased pro-inflammatory cytokine release, endothelial damage, platelet activation, and reduced anticoagulant and fibrinolytic activity. These factors contribute to an elevated risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), which complicate TB prognosis and treatment. The potential role of adjunctive anti-inflammatory therapies, such as vitamin D, NSAIDs, corticosteroids, and anti-platelet agents, is highlighted as a strategy to mitigate systemic inflammation and reduce thrombotic risks in patients with TB. The challenges of anticoagulation therapy, particularly in managing the interactions between anti-TB medications and traditional anticoagulants, are discussed, along with the potential of novel oral anticoagulants (NOAs) as alternatives. We also address therapy of hypercoagulability in TB within resource-limited settings which requires low-cost diagnostics, accessible anticoagulation options, adjunctive therapies, and preventive strategies integrated into existing healthcare systems. Effective risk stratification and individualized management strategies are vital for reducing the morbidity and mortality associated with thrombotic complications in TB. Full article

(This article belongs to the Special Issue Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment)

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27 pages, 1340 KiB

Open AccessReview

Chronic Sarcoidosis: Diagnostic Difficulties and Search for New Criteria of Inflammatory Activity (A Case Report and Literature Review)

by Anna Starshinova, Elizaveta Berg, Artem Rubinstein, Anastasia Kulpina, Igor Kudryavtsev and Dmitry Kudlay

J. Clin. Med. 2024, 13(22), 6974; https://doi.org/10.3390/jcm13226974 - 19 Nov 2024

Viewed by 1322

Abstract

Sarcoidosis is a systemic inflammatory disease with an unknown etiology and a wide range of clinical manifestations. The incidence of sarcoidosis ranges from approximately 1 to 15 cases per 100,000 individuals per year worldwide. The significant variability in clinical presentations and target organs, as well as concomitant diseases, greatly complicates diagnosis. We analyzed articles in PubMed, Scopus, Cochrane Library, and Embase, where databases were searched using the keywords “chronic sarcoidosis”, “diagnosis of sarcoidosis”, “course of sarcoidosis”, “pulmonary sarcoidosis”, “cardiac sarcoidosis”, “skin sarcoidosis”, “neurosarcoidosis”, “ocular sarcoidosis”, and “autoimmune inflammation”. Studies on the course and diagnosis of sarcoidosis with a deep search of ten years were included. In this review, we present an analysis of publications on the course and diagnosis of chronic sarcoidosis, as well as a clinical case. We have noted that the diagnosis of chronic sarcoidosis is particularly difficult due to the lack of specific biomarkers or their combination. The development and introduction of new diagnostic criteria for this disease will contribute to increasing the level of efficiency, not only of the diagnostic complex, but also the prognosis of the development and course of the pathological process. Conclusion: For the most accurate diagnosis and determination of prognosis, the existence of a single immunological or imaging marker with sufficient sensitivity and specificity is necessary. Full article

(This article belongs to the Special Issue Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment)

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