Search Results (2,602)

Background/Objectives: The coexistence of chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2D) poses significant clinical challenges due to overlapping mechanisms of systemic inflammation, oxidative stress, hypoxia, and metabolic dysregulation. Patients with both conditions face higher risks of exacerbations, prolonged hospitalizations, cardiovascular events, and reduced quality of life. This review aims to summarize current evidence on the pathophysiological interplay between COPD and T2D and to evaluate the impact of lifestyle and pharmacologic interventions. Methods: A narrative review of the literature was conducted to evaluate the pathophysiological links between COPD and T2D, assess the effects of pharmacologic and lifestyle interventions, and highlight key gaps and priorities for future research, with an emphasis on integrated, evidence-based management for this high-risk population. Results: Lifestyle interventions, including smoking cessation and structured physical activity, remain foundational to management. Emerging evidence indicates that antidiabetic therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter-2 inhibitors (SGLT-2is), may confer additional pulmonary, metabolic, and cardiovascular benefits. These agents modulate systemic inflammation, oxidative stress, endothelial function, and insulin sensitivity, potentially reducing COPD exacerbations, improving lung function, and enhancing survival. Safety concerns, including glucocorticoid-induced hyperglycaemia and hypoxia-related metabolic complications, underscore the need for careful monitoring and individualized therapy COPD patients. Conclusions: Optimal care requires a multidisciplinary, patient-centred approach integrating pulmonology, endocrinology, primary care, nutrition, and rehabilitation, alongside shared decision-making and patient education. Despite promising findings, critical knowledge gaps remain. Large, well-designed randomized controlled trials and standardized definitions are needed to guide personalized therapeutic strategies. Full article

Metabolomic studies in COPD reveal systemic metabolic perturbations, yet sex is often treated as a covariate rather than a biological driver. We aimed to identify plasma metabolites differentiating COPD from controls and to define sex-specific metabolic signatures in both groups. Methods: In this controlled observational study (BIOMEPOC cohort), untargeted plasma metabolomics was performed by LC-MS/MS. Differential abundance was tested across four contrasts (COPD vs. controls; men vs. women within controls; men vs. women within COPD; sex-by-disease interaction) with a false discovery rate (FDR) correction. Because smoking history differed between COPD and controls, a post hoc ever-smokers analysis was conducted. Results: COPD differed from controls in nine metabolites (all decreased): DL-stachydrine, 3-methyl-L-histidine, fructose, pipecolinic and nipecotic acids, 5-nitro-o-toluidine, conjugated linoleic acid, aminoadipate, and creatinine. This pattern is compatible with metabolic depletion, remodeling, and/or altered flux across multiple compartments rather than simple substrate deficiency, spanning muscle-related pools, amino acid handling, carbohydrate-associated metabolism, and exposome-linked inputs. In ever-smokers, results were directionally consistent, with five metabolites remaining nominally significant. Among controls, five metabolites were higher in men after FDR correction (PABA, cis-4-hydroxy-D-proline, N-acetylasparagine, deoxycarnitine, and creatinine), consistent with physiological sex dimorphism in energy pathways, connective-tissue remodeling, and diet/microbiome-related metabolism. Within COPD, six metabolites differed by sex after FDR correction, defining three axes: creatine energy buffering (men: higher GAA/creatinine, lower creatine), purine/urate handling (men: higher urate), and conjugated bile acids (men: higher GCDCA), implicating muscle bioenergetics, redox/inflammatory tone, and gut–liver crosstalk. Conclusions: Plasma metabolomics identifies a pattern compatible with systemic remodeling in COPD and sex-associated divergences in creatine, purine/urate, and bile-acid pathways, supporting a sex-influenced view of systemic COPD heterogeneity and highlighting targets for mechanistic validation. Full article

Background/Objectives: This study aimed to assess the safety and efficacy of lung surgery for the treatment of early-stage non-small cell lung cancer (NSCLC) in octogenarians, with a specific focus on the Uniportal-VATS approach, evaluating surgical outcomes and short-term oncological results within a precision medicine perspective. Methods: This retrospective, single-center study included octogenarian patients who underwent surgical treatment for early-stage NSCLC between January 2018 and March 2024. Among 1329 patients treated during the study period, 136 octogenarians were carefully evaluated by a multidisciplinary board and selected for surgical management. Results: The mean age was 82.41 ± 2.72 years, with a prevalence of men (63.2%). In 107 (78.7%) cases, lung resection was performed using the Uniportal-video-assisted thoracic surgery (U-VATS) approach. Overall, 71 lobectomies (52.2%) and 65 segmentectomies or wedge resections (47.8%) were performed, balancing oncological radicality with comorbidities. Only minor complications occurred, such as atelectasis (2.9%), atrial fibrillation (4.4%), pneumonia (1.5%), or air-leakage (2.2%). Factors significantly associated with postoperative complications included open approach (p = 0.014), lobectomy as the extent of resection (p = 0.008), and chronic obstructive pulmonary disease (COPD) (p = 0.010). On multivariable analysis, lobectomy remained the only independent predictor for postoperative complications (OR: 5.95, 95% CI [1.24–28.62], p = 0.026). In-hospital and 90-day mortality were null. The median length of hospital stay in octogenarians was 6 days and was significantly shorter in the Uniportal-VATS group compared with the open surgery one (p < 0.001). All patients were discharged home independently. One- and three-year overall survival rates were 88% and 71%, respectively. No risk factor was associated with mortality in our series. Conclusions: Lung surgery, particularly the Uniportal-VATS approach, appears to be a safe and effective treatment option for octogenarian patients with early-stage NSCLC, provided that patient selection is carefully based on individual clinical characteristics within a multidisciplinary framework based on individualized risk stratification. When feasible, sublobar resection should be preferred in order to minimize postoperative complications. Full article

Chronic obstructive pulmonary disease (COPD) is a major contributor to global respiratory morbidity and exhibits substantial sex- and gender-related differences in incidence, phenotype, pathophysiology, and outcomes across the life course. Historically regarded as a predominantly male disease due to higher smoking rates, COPD is now increasingly recognized among women, reflecting changing exposure patterns and enhanced diagnostic attention. Moreover, evidence indicates that women may be more biologically susceptible to the harmful effects of tobacco smoke and often develop COPD at younger ages. Clinical manifestations also differ, with women more frequently reporting dyspnea, anxiety, and depression, whereas men may exhibit more cough and sputum production. Imaging studies suggest that airway-predominant disease is more common in women, while men are more likely to demonstrate emphysema-predominant patterns. Furthermore, women face an increased risk of exacerbation, yet they are more likely to experience underdiagnosis or misdiagnosis. Treatment responses and comorbidity patterns also show sex- and gender-related variations. Despite these differences, most clinical guidelines and therapeutic strategies do not differentiate by sex and gender, highlighting a gap in personalized COPD management. Overall, growing evidence underscores the importance of incorporating sex and gender as biological and sociocultural variables in COPD research, diagnosis, and treatment. Recognizing sex/gender-specific risk profiles, symptom patterns, and disease phenotypes may improve early detection and enable more targeted, effective interventions. This narrative synthesis, derived from a meticulous search in PubMed and the critical selection of 74 articles from the 448 identified originally, integrates evidence from guideline statements, registry studies, mechanistic and preclinical research, imaging and physiology investigations, systematic reviews, and randomized controlled trials that report sex- and gender-disaggregated data. Full article

Alterations in glutathione and its metabolism contribute to oxidative stress in COPD, but the role of S-glutathionylation (PSSG) and its major regulator glutaredoxin 1 (Grx1) remains unclear. This study investigated the Grx1/PSSG axis in sputum of COPD patients and its associations with lung function and inflammation, as well as Grx1 secretion in mouse models and in cell culture. In patients with an acute exacerbation, PSSG levels were significantly decreased in sputum, while Grx1 protein and total Grx activity were increased compared to stable COPD. No differences were observed between healthy smokers and stable patients. PSSG levels correlated negatively with sputum neutrophils, IL-8 and IL-1β, but positively with lung function parameters, whereas Grx1 showed the opposite pattern. Enhanced Grx1 levels were also detected in bronchoalveolar lavage fluid from mice exposed to cigarette smoke or chronic pulmonary inflammation. Moreover, epithelial cells and macrophages secreted Grx1 in response to pro-inflammatory mediators, and Grx1 modulated expression of MMPs by macrophages in vitro and in vivo. In conclusion, this study identifies the Grx1/PSSG redox axis as a potential important factor in COPD pathogenesis, especially during exacerbations. Further research should examine in more detail the intricate relation of extracellular Grx1 with lung function and inflammation. Full article

Background/Objectives: Thoraco-abdominal asynchrony (TAA) is a key mechanical consequence of severe chronic obstructive pulmonary disease (COPD), particularly during acute exacerbations (AECOPD), when dynamic hyperinflation and diaphragmatic dysfunction impair the coordination between rib cage and abdominal motion. Continuous, non-invasive monitoring of respiratory mechanics may provide valuable information on clinical evolution during hospitalization. This study aimed to evaluate Global Phase Delay (GPD) as a longitudinal marker of TAA in hospitalized AECOPD patients and to explore its ability to reflect disease severity and short-term clinical evolution using repeated measurements obtained with thoracic and abdominal respiratory belts using respiratory inductance plethysmography (RIP). Methods: We conducted an observational longitudinal study in hospitalized adults with AECOPD. Respiratory inductance plethysmography signals were recorded daily over four consecutive days using thoracic and abdominal RIP belts. Five-breath sequences were analyzed to derive GPD, phase angle, and loop rotation direction through automated MATLAB processing. Clinical data included demographics, lung function, blood gases, dyspnea severity, and need for intermediate respiratory care unit (IRCU) admission. Temporal changes in TAA indices and subgroup differences (FEV₁ < 35%, IRCU admission) were assessed using repeated-measures ANOVA. Results: Twenty-one patients were included. On admission, mean absolute GPD was 49 ± 58°, with larger delays observed in patients with more severe airflow limitation and in those requiring IRCU support. During hospitalization, GPD showed a significant reduction over time (p < 0.05), particularly in these subgroups, indicating progressive improvement in thoraco-abdominal synchrony. Directional analysis of GPD revealed heterogeneous patterns consistent with different underlying mechanical behaviors. Conclusions: Serial assessment of TAA using respiratory bands and GPD provides clinically meaningful information on the evolution of respiratory mechanics during AECOPD hospitalization. This approach may support bedside monitoring and help track patient response to treatment, offering potential value for individualized respiratory management. Full article

Background: Patients with coexisting lung cancer and COPD are highly susceptible to unplanned readmissions. This study aimed to develop and internally validate a robust predictive nomogram based on the “inflammation-nutrition-tumor” framework to quantify this risk. Methods: A retrospective cohort of 207 clinical episodes from male patients with lung cancer and COPD was analyzed. Participants were categorized into Planned Readmission (PR, n = 165) and Unplanned Readmission (UR, n = 42) groups. Independent risk factors were identified via univariate and multivariable analyses using Generalized Estimating Equations (GEE). A nomogram was subsequently constructed, and its performance was rigorously evaluated using the Area Under the Curve (AUC), calibration plots, and Decision Curve Analysis (DCA). Results: Multivariable GEE analysis demonstrated that the Systemic Immune-Inflammation Index (SII) was a highly significant independent risk factor (OR for a 500-unit increase = 1.490, 95% CI: 1.234–1.798, p < 0.001). Advanced cancer stage (III–IV) was also a significant predictor (OR = 3.590, 95% CI: 1.301–9.909, p = 0.014), while prealbumin (OR = 0.950, 95% CI: 0.896–1.007, p = 0.087) was identified as a key nutritional predictor. The integrated four-variable nomogram (age, cancer stage, SII, prealbumin) demonstrated good discriminative ability with an AUC of 0.809 (95% CI: 0.733–0.885). The calibration plot indicated excellent agreement, and DCA confirmed a substantial clinical net benefit. Conclusions: This SII-based nomogram provides a reliable and practical tool for individualized risk stratification, facilitating targeted clinical interventions to mitigate unplanned readmission rates in this vulnerable population. Full article

Background: Diabetic foot infections (DFIs) are a major cause of hospitalization, limb loss, and mortality among patients with diabetic foot ulcers (DFUs). This study evaluated the risk of developing DFIs among patients with newly diagnosed DFUs across insurance categories. Methods: Adults ≥18 years with a new DFU diagnosis were identified in the PearlDiver insurance claims database (2010–2020) using validated ICD-9/10 codes. Insurance status at the index DFU was categorized as Medicaid, Medicare, commercial, or self-pay. Propensity score matching (1:3) based on age, sex, Charlson Comorbidity Index, and major comorbidities was used to compare Medicaid vs. non-Medicaid patients. Results: Among 258,122 patients with new DFUs, 20,638 (8.0%) were Medicaid beneficiaries. Medicaid patients were younger (50.1 ± 10.2 vs. 60.6 ± 12.1 years, p < 0.001) but had similar comorbidity burden compared with commercially insured and Medicare patients. In matched analysis post-matching, Medicaid insurance was independently associated with higher odds of DFI-related hospitalization within 12 months (aOR 1.18, 95% CI 1.14–1.24) and major amputation at 3 years (aOR 1.72, 95% CI 1.39–2.13). Higher CCI, chronic kidney disease, congestive heart failure, COPD, and peripheral vascular disease also predicted adverse outcomes. Conclusions: Medicaid insurance was independently associated with increased risks of DFI and major amputation among patients with newly diagnosed DFUs. These findings highlight infection as a potentially modifiable pathway driving limb loss and emphasize the need to improve early ulcer evaluation and infection management for Medicaid beneficiaries. Full article

Background: The use of HFNC (High Flow Nasal Cannula) in the management of acute respiratory failure has been fully established in clinical practice. Conversely, less data is available supporting its use in chronic hypoxemic–hypercapnic respiratory failure. The aim of the present study is to evaluate the efficacy of HFNC in chronic hypercapnic respiratory failure associated with stable COPD. Methods: In this retrospective single-center longitudinal observational study, 40 patients treated with HFNC at home followed at the COPD Clinic of Respiratory Diseases (University of Campania L. Vanvitelli Monaldi Hospital, Naples) were included. All patients are re-assessed at our clinic at T0, T3, T6 and T12 months through functional respiratory tests and blood gas analysis. Results: After 12 months, significant reductions in pCO₂ (arterial partial pressure of carbon dioxide) (from 58.5 to 48.0 mmHg) and lactates (from 1.60 to 0.90 mmol/L) were observed, and MIP and MEP improved significantly. Patients receiving HFNC flows ≥50 L/min experienced greater reductions in pCO₂ and fewer exacerbations. Multivariate analysis identified HFNC flow rate (p = 0.0046), hours of use/day (p = 0.0157), lactate levels (p = 0.0301), and FEV₁ (forced expiratory volume in 1 s) (p = 0.0491) as independent predictors of reduction in PaCO₂. Higher BMI and greater airway obstruction were associated with a reduced response. Conclusions: Treatment with HFNC represents a reasonable therapeutic choice to reduce AEs-COPD and reduce PaCO₂ and lactates in stable COPD patients. Full article

The aim of this study was to examine the factors associated with COVID-19-related fear in older adults from Kazakhstan, and to explore its associations with sociodemographic characteristics, health status and multiple domains of quality of life in a regional context. A total of 445 individuals aged 60 and above from both urban and rural locations in Kazakhstan participated in this cross-sectional study. To assess the quality of life among older people we used the OPQoL (Older People’s Quality of Life) Scale. Further variables were evaluated: sociodemographic (age, gender, education level, marital status, and place of residence); health-related (self-reported overall health, hypertension, diabetes, cerebrovascular disease, cardiovascular disease, and chronic obstructive pulmonary disease (COPD); and COVID-19-related fear variable. Female gender (OR = 2.344; p = 0.001), present hypertension (OR = 2.106; p = 0.008), the specialized secondary educational level (OR = 2.321; p = 0.012) and at the border of significance university educational level (OR = 1.832; p = 0.051) were variables significantly associated with the COVID-19-related fear in older adults. For individuals with reported COVID-19-related fear, advanced age was significantly negatively associated with leisure and activities domain (B = −0.747; p = 0.020) of OPQoL; better self-reported overall health was significantly positively associated with life overall domain (B = 0.691; p < 0.001), health domain (B = 1.320; p < 0.001), psychological and emotional well-being domain (B = 0.395; p = 0.001), home and neighborhood domain (B = 0.249; p = 0.036), independence, control over life and freedom domain (B = 1.082; p < 0.001), financial circumstances domain (B = 1.132; p < 0.001), and leisure and activities domain (B = 0.556; p = 0.026) of OPQoL; present hypertension was significantly negatively associated with health domain (B = −0.888; p = 0.004) of OPQoL; present cardiovascular disease was significantly negatively associated with life overall domain (B = −0.588; p = 0.027), health domain (B = −0.967; p = 0.009), and independence, control over life and freedom domain (B = −0.542; p = 0.039) of OPQoL; being single was significantly negatively associated with life overall domain (B = −0.481; p = 0.033), social relations domain (B = −0.671; p = 0.014) and financial circumstances domain (B = −0.694; p = 0.036) of OPQoL; and urban place of residency was significantly positively associated with health domain (B = 0.735; p = 0.011) and psychological and emotional well-being domain (B = 0.483; p = 0.010) of OPQoL. Our findings pointed that numerous variables were associated with the COVID-19-related fear and quality of life domains regarding COVID-19-related fear in older adults from Kazakhstan during pandemics. Full article

Background: COPD is a multifactorial chronic lung disease driven by an abnormal inflammatory reaction. It is well recognized that genetic factors play a role in susceptibility to COPD. Hence, polymorphism in pro-inflammatory cytokines, including interleukin-1 (IL-1), may confer a risk for the development of COPD. Methods: We genotyped 163 patients with COPD and 174 control individuals using a TaqMan genotyping assay for IL1B -511 C>T SNP and a PCR-RFLP-based method for IL1B +3953 C>T SNP and VNTR polymorphism in IL1RN in order to elucidate their possible role as candidate risk factors of COPD in a Bulgarian population. Results: The genotypes containing at least one variant T allele of IL1B -511 C>T SNP demonstrated a 2.1-fold higher risk for COPD after adjustment for age, sex, and smoking status (p = 0.011). The genotype with at least one T allele of IL1B +3953 C>T appeared to be protective, with a 2.21-fold lower risk for COPD after adjustment for sex, age, and smoking status (p = 0.007). The IL1B T_C haplotype showed a 1.70-fold higher risk of COPD (p = 0.018) in comparison to the C_T haplotype. Carriers of the VNTR IL1RN 1*3 genotype develop COPD earlier compared to 1*1 (p = 0.099). Patients with the 2*2 genotype had slightly higher FEV1/FVC (%) in comparison to 1*2 carriers (p = 0.09). Conclusions: To our knowledge, this study is the first to provide exploratory evidence on the T_C haplotype of IL1B -511 C>T; +3953 C>T that may be a predisposing factor for COPD in Bulgarian population. We suggest that the VNTR polymorphism of the IL1RN gene does not affect the risk for COPD but may lead to early disease development. Full article

Background: Coronary artery disease (CAD) commonly coexists with chronic obstructive pulmonary disease (COPD), but may be under-recognised, since symptoms such as dyspnoea and chest discomfort are often attributed to lung disease. We hypothesised that coronary artery disease is highly prevalent in patients with COPD, even in the absence of typical angina symptoms. Methods: This study aimed to detect CAD in patients with COPD. We conducted a single-centre observational study, including 76 patients with no known previous cardiovascular events. To detect ischaemic heart disease, three methods were used, according to standard clinical indications: coronary angiography, coronary CT, and calcium score analysis on chest CT. The findings were categorised according to lesion severity and vessel involvement. Results: A substantial proportion of patients with COPD harboured previously undiagnosed atherosclerotic coronary disease (78%). However, most detected disease was non-obstructive atherosclerosis (56%), whereas severe stenosis was present in approximately one-third of patients (32%). Single-vessel disease accounted for 37% of cases, while the remaining patients exhibited multi-vessel involvement. Nevertheless, only a small proportion of patients had typical angina symptoms (11.8%), and the most frequent complaint was effort dyspnoea (50%). Patients not receiving inhaled corticosteroid therapy were more likely to have extensive coronary artery disease (χ² (6)= 14.228, p = 0.027). Conclusions: These findings support our hypothesis that atherosclerotic coronary disease is often under-recognised in patients with COPD. ICS-containing therapy appeared to be associated with less extensive coronary artery involvement; however, this observation should be interpreted cautiously. Full article

Background/Objectives: An increasing proportion of patients with Type 2 diabetes mellitus (T2DM) are classified as high risk, often presenting with multimorbidity, functional vulnerability, and complex treatments. This study compared the sociodemographic, functional, clinical, therapeutic, and healthcare utilization profiles of high-risk chronic patients with and without T2DM in primary health care. Methods: A cross-sectional study included adults classified as high-risk chronic patients in primary health care electronic health records in the Madrid Region (30 April 2021). Sociodemographic, functional, clinical, lifestyle, pharmacological variables, and primary health care services utilization were analyzed. Multivariate logistic regression identified factors independently associated with T2DM. Results: Among 163,188 high-risk chronic patients, 41.5% had T2DM. Patients with T2DM were older, more often male, and had a comparable deprivation index values to non-diabetic patients. They showed higher functional dependency and greater need for informal caregiving. Clinically, patients with T2DM had a higher burden of chronic conditions and a predominance of cardiometabolic, hematological and renal comorbidities, whereas non-diabetic patients exhibited more neuropsychiatric, chronic infectious, oncological and respiratory profiles. Polypharmacy was more frequent in T2DM patients, who also showed lower medication adherence. In the explanatory model, older age (OR 1.02/year), cardiometabolic comorbidities (ORs ~1.2–1.6), highest quartile of morbidity complexity (OR 1.27), polypharmacy (OR 1.34), and concern about medications (OR 1.08) were associated with T2DM, while female sex (OR 0.660), depression (OR 0.888), COPD (0.704), neoplasms (0.688), and higher medication adherence (OR 0.53) were associated with not having T2DM. Conclusions: High-risk chronic patients with T2DM exhibit distinct sociodemographic, functional, and clinical profiles compared with those without T2DM, characterized by greater complexity, cardiometabolic burden, therapeutic intensity and use of healthcare services, supporting the need for tailored, integrated primary health care strategies. Full article

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide, yet only a fraction of smokers develops the disease, suggesting protective mechanisms in resilient individuals. Identifying airway-localized molecular signatures may improve our understanding of disease pathomechanisms and support hypothesis generation for biomarker research. In this pilot study, induced sputum from smokers with COPD (n = 28) and smokers without COPD (n = 16; Global Initiative for Chronic Obstructive Lung Disease (GOLD)-defined pre-COPD) was analyzed by untargeted proteomics, metabolomics, and lipidomics. After quality control, 1180 proteins, 187 metabolites, and 1234 lipids were retained. Analyses included univariate models with false discovery rate adjustment and multivariate analyses (PCA, PLS-DA), followed by pathway enrichment and protein interaction network analysis. While few features remained significant after FDR correction, consistent cross-omics patterns were observed. COPD was characterized by ↑ glutathione, creatine, and L-arginine; ↓ CCDC88A and ↑ STAT3 and SYDE2; and broad lipid remodeling involving phosphatidylcholines, sphingolipids, and eicosanoids. Network analysis highlighted STAT3 as a highly connected node linking COPD-related genes. These findings suggest that the multi-omic profiling of induced sputum can capture coherent airway-localized molecular signatures such as oxidative stress, cytoskeletal remodeling, and Rho-family GTPase signaling. However, the results should be interpreted as exploratory and require validation in functional studies. Full article

Lung diseases are among the leading causes of death worldwide. Nowadays, to detect lung diseases, a specialist uses auscultation to make a diagnosis. Newer auscultation devices based on stethoscopes allow these sounds to be recorded for later analysis. However, the diagnosis process is time-consuming and relies on medical expertise to generate an accurate diagnosis. For these reasons, automated and objective diagnostic systems are crucial for the early detection of lung diseases and preventing them from worsening. In this study, a computer-aided diagnostic system that integrates the Radial Short-Time Fourier Transform (RSTFT) with a Convolutional Neural Network (CNN) enhanced by attention mechanisms is presented. The RSTFT is employed to convert lung sound recordings from a public dataset into angular frequency representations, which are used as input to the CNN. The network automatically extracts discriminative features and classifies the recordings into five categories: Chronic Obstructive Pulmonary Disease (COPD), bronchiectasis, pneumonia, asthma, and healthy lungs. Experimental results demonstrate that the proposed method outperforms several state-of-the-art approaches in terms of accuracy, precision, recall, and F1-score. These findings indicate that the proposed RSTFT–CNN framework provides an effective and reliable solution for the automated diagnosis of lung diseases, offering valuable support for clinical decision-making and early intervention. Full article