Physical examination is pivotal for getting a clue about the disease and making a provisional diagnosis. The respiratory examination is considered to be one of the toughest systemic examinations by undergraduate and postgraduate residents. No well-defined literature is available regarding the ideal method and interpretation of respiratory examination findings. There are many questions asked by experts that are hardly found in the literature. This review included a total of 30 important questions and the best possible answers, including expert questions from top institutes that are important for respiratory examination and would help all students (MBBS/MD/DNB/DM) to excel in their practical examination.

Tuberculosis (TB) is a global health concern caused by Mycobacterium tuberculosis, primarily affecting the lungs. In addition to TB, chronic respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD) and asthma are becoming more prevalent globally. Inhaled corticosteroids (ICS) are commonly used for COPD and bronchial asthma management, but some recent studies suggest a potential association between ICS usage and an increased risk of TB, raising concerns that they may lower lung immunity and enhance tuberculosis infection.

This research study was performed with an aim to investigate whether there is a link between inhaled corticosteroids (ICS) use and the risk of developing tuberculosis (TB) in COPD patients. The primary objective is to study whether the use of inhaled corticosteroids increases the risk of tuberculosis infection. The secondary objective is to compare the risk of TB in vulnerable populations with underlying comorbidities using inhaled corticosteroids.

This is an observational, analytical study conducted over 2 months in patients with COPD who have been receiving inhaled corticosteroids for more than 2 years.

A total of 97 COPD patients on ICS were recruited and categorized into TB (n = 4) and non-TB (n = 93) groups based on final outcomes. The mean ICS duration for the non-TB and TB groups was 24.8 and 48.0 months, respectively.

Despite being on ICS for more than 2 years, there was no significant correlation between ICS usage and TB infection. However, the study highlighted the significance of a prior TB history as a risk factor for increased reactivation (p < 0.001). Additionally, anemia was observed in reactivated TB cases, suggesting potential implications for identifying underlying chronic diseases in COPD patients.

The morbidity and mortality burden of the COVID-19 pandemic was high in socioeconomically deprived areas. Identifying the factors associated with in-hospital mortality in such settings will help physicians prioritize the scarce resources for the more needy individuals.

To study the demographic, clinical, and biochemical factors associated with in-hospital mortality in COVID-19 patients in Wayanad, Kerala, India. We also report the incidence of post-COVID symptoms and the mortality rate in the survivors of COVID-19 pneumonia.

The study design was a record-based retrospective cohort, and the study participants were 402 patients admitted with moderate to severe COVID-19 at the secondary care hospital of Wayanad, Kerala, India, during late 2020 and early 2021. In-hospital mortality was the major outcome variable, and we expressed the mortality risk in terms of relative risks (RRs). Factors associated with the same were assessed using Chi-square, Fisher's exact tests, and t-tests depending upon the type of exposure variable. Dose-response relationships were assessed using Chi-square for trend. A subgroup of consented survivors (n = 156) was followed to study the post-COVID symptoms and mortality rate outside the hospital. We constructed binary logistic models to find out the independent predictors of mortality.

The patient group (n = 402) was composed of individuals aged 18-95 years, and two-thirds (n = 258) were men. The in-hospital mortality rate was 17.7%. The risk of mortality increased with age, multimorbidity, and extent of hypoxia, peripheral oxygen saturation/fraction of inspired oxygen [SpO₂/FiO₂ (SF)] ratio, D-dimer, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), serum creatinine, and blood urea. The case fatality rate (CFR) had a dose-response relationship with the number of comorbidities. Out of the individual comorbidities analyzed, systemic arterial hypertension [RR = 1.5 (1.16-1.83)], cancer [RR = 4.7 (1.38-15.6)], and neurological disorders [RR = 5.8 (1.6-21.16)] were significantly associated with mortality in the hospital. According to the binary logistic regression analysis, age, hypoxia at the time of admission, intensive care unit (ICU) admission, serum creatinine, and SF ratio were the significant predictors of mortality. Most of the patients (73%) complained of some symptoms during follow-up. Easy fatigability and tiredness were the most common post-COVID symptoms, followed by exertional breathlessness, myalgia, decreased sleep, weight loss, and cough.

The physician should prioritize patients with multimorbidity and markers of organ involvement to save lives in resource-poor settings during pandemics and large infectious disease outbreaks affecting the community. The early diagnosis and management of comorbidities should be included in pandemic or outbreak preparedness to reduce morbidity and mortality.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) together is known as overlap syndrome. This study evaluated whether overlap syndrome is associated with worse inpatient outcomes after total hip arthroplasty (THA) compared with COPD alone.

Adult patients (≥18 years) with COPD undergoing elective THA were identified from the National Inpatient Sample database. Propensity-score matching (PSM) balanced baseline differences between patients with COPD-OSA overlap syndrome and those with COPD alone. Regression analyses evaluated in-hospital mortality, length of hospital stay, unfavorable discharge, and postoperative complications.

After PSM, 25,926 patients were included. Compared with COPD alone, patients with COPD-OSA overlap had higher rates of unfavorable discharge (36.0% vs 29.7%), respiratory failure (3.6% vs 1.7%), and acute kidney injury (AKI) (6.3% vs 3.8%). In adjusted analyses, COPD-OSA overlap was significantly associated with higher risks of unfavorable discharge (aOR = 1.10, 95% CI: 1.03, 1.18), respiratory failure (aOR = 1.65, 95% CI: 1.37, 1.99), and AKI (aOR = 1.18, 95% CI: 1.03, 1.35). Age-stratified analyses demonstrated increased respiratory risk in patients ≥70 years, whereas younger patients had higher risks of both respiratory failure and AKI.

Among patients undergoing elective THA, COPD-OSA overlap syndrome is associated with increased adverse inpatient outcomes.

Human bone marrow-derived mesenchymal stromal cells (hBM-MSCs) are known to exert immunomodulatory and pro-reparative effects in vivo. This makes hBM-MSCs an enticing therapeutic candidate for inflammatory diseases, such as acute respiratory distress syndrome (ARDS). The ARDS microenvironment is complex and contains an abundance of free fatty acids (FFAs), which are known to differentially impact MSC functionality. PPARβ/δ is a ubiquitously expressed nuclear receptor that is activated in response to FFA-binding. PPARβ/δ has been shown to impact the therapeutic efficacy of mouse MSCs. This study sought to investigate the impact of PPARβ/δ-modulation on human MSC functionality in vitro and in vivo. hBM-MSCs were exposed to a synthetic PPARβ/δ agonist/antagonist in the presence or absence of ARDS patient serum and the immunomodulatory and pro-reparative capacity of the MSC secretome was investigated using in vitro assays and a pre-clinical model of LPS-induced acute lung inflammation (ALI). Our results highlighted enhanced pro-reparative capacity of PPARβ/δ-agonized hBM-MSCs secretome in CALU-3 lung epithelial cells, mediated by MSC derived angiopoietin-like 4 (ANGPTL4). PPARβ/δ-induced ANGPTL4-high MSC secretome facilitated enhanced endothelial barrier integrity in the lungs of ALI mice. Therapeutic effects of PPARβ/δ-agonized hBM-MSCs secretome were further enhanced by licensing MSCs with human ARDS patient serum. ARDS-licensed PPARβ/δ-induced ANGPTL4-high MSC secretome had reduced clinical score and weight loss. The role ANGPL4 in these protective effects was confirmed using an anti-ANGPTL4 antibody. These findings conclude that the MSC secretome therapeutic effects can be enhanced both in vitro and in vivo through licensing strategies that upregulate the angiogenic factor ANGPTL4.

We present the case of a 43-year-old man who developed painless jaundice following a respiratory infection. Diagnostic workup revealed severe immune hemolytic anemia, specifically cold agglutinin syndrome (CAS), characterized by a positive direct antiglobulin test (DAT) for complement C3d and IgM antibodies. The patient's clinical course was complicated by significant hemolysis, requiring supportive care and multiple blood transfusions. Further microbiological investigation identified Mycoplasma pneumoniae as the underlying trigger for this secondary CAS.

A 7-year-old, spayed female, Afghan Hound presented for evaluation of fever, lethargy, and cough. Initial thoracic radiographs revealed increased soft tissue opacity of the left cranial lung lobe, mild pneumopericardium, and mild pleural effusion. Subsequent computed tomography (CT) of the thorax demonstrated multiple bronchopericardial fistulas, measuring up to 6.0 mm in diameter, originating from a secondary bronchus of the caudal subsegment of the left cranial lung lobe. The pericardial sac was markedly dilated, containing both fluid and gas. Associated findings included pulmonary atelectasis of the left cranial and caudal lung lobes, regional lymphadenopathy, and minimal left caudal pleural effusion. The dog recovered uneventfully following left cranial and partial left caudal lung lobectomies with subtotal pericardiectomy, with resolution of clinical signs and no effusion on 2-week follow-up ultrasound. On the basis of the reviewed literature, this is the first case report describing CT findings of bronchopericardial fistulas in a dog.

Chronic obstructive pulmonary disease (COPD) remains a leading cause of global morbidity and mortality. Despite advances in therapy, its complex pathogenesis involves mechanisms beyond the traditional paradigms of inflammation and protease-antiprotease imbalance. Emerging evidence indicates that COPD is also shaped by important mechanobiological processes, in which altered airway mechanics, parenchymal destruction, and respiratory muscle dysfunction create a pathological physical environment. In this narrative review, we synthesize current knowledge on how abnormal mechanical forces are sensed by key mechanosensors-including integrins, Piezo channels, and YAP/TAZ-and transduced into biochemical signals that drive chronic inflammation, fibrosis, and defective repair. We further discuss how these mechanotransduction feedback loops perpetuate structural injury and may help explain the clinical heterogeneity observed across airflow obstruction, emphysema, and exacerbation-prone phenotypes. Furthermore, we discuss therapeutic strategies, positioning pulmonary rehabilitation, lung volume reduction, and ventilation as interventions that restore mechanical homeostasis. Finally, we highlight the emerging possibility of targeting mechanosensitive pathways (e.g. ROCK and YAP/TAZ inhibitors) and utilizing mechanobiology-informed regenerative medicine. By integrating biomechanics with clinical management, this review provides a conceptual framework that may inform future efforts to move beyond symptomatic palliation toward more mechanism-based and potentially disease-modifying strategies in COPD.

This retrospective cohort study compares the risk and severity of acute respiratory failure (ARF) among adults hospitalized with different respiratory viruses.

We included 4927 adults admitted to Akershus University Hospital, Norway, from 2012 to 2021 with polymerase chain reaction-confirmed viral infection with influenza A/B, respiratory syncytial virus (RSV), parainfluenza virus (PIV), human metapneumovirus, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). ARF was defined as the use of high-flow oxygen, noninvasive ventilation, or mechanical ventilation during the hospital admission. Logistic regression models estimated adjusted probabilities of respiratory failure and ventilatory support, using influenza A/B as the reference, with adjustment for age, sex, National Early Warning Score 2 (NEWS2), weighted Charlson Comorbidity Index, and other covariates.

Overall, 11.8% of patients (n = 583) met the criteria for ARF. Compared with influenza A/B, all other virus groups except human metapneumovirus were associated with a higher adjusted probability of ARF. SARS-CoV-2 showed the highest risk, followed by PIV and RSV (all P < .01). A similar pattern was seen for noninvasive or mechanical ventilation. Sensitivity analyses using alternative comorbidity adjustments or analyzing patients before and after the coronavirus disease 2019 pandemic separately produced consistent relative rankings across virus groups.

SARS-CoV-2, PIV, and RSV were associated with increased risk of ARF in hospitalized adults compared with influenza A/B. SARS-CoV-2 strains circulating during the early pandemic showed the greatest risk, while RSV and PIV also conferred a substantial excess ARF risk. These findings underscore the need for clinical vigilance and preventive strategies in patients admitted with viral respiratory tract infections.

Paediatric severe pneumonia is a major cause of Paediatric Intensive Care Unit admissions. This review evaluates the extent that integrated nursing care, a comprehensive strategy that combines family-centred, psychosocial and routine interventions, benefits children with severe pneumonia. Integrated nursing care may enhance recovery by reducing fever, cough and hospital stay while improving lung function and quality of life.

To evaluate the effectiveness of integrated nursing interventions in improving rehabilitation outcomes in paediatric severe pneumonia patients admitted to paediatric intensive care units.

Systematic searches of PubMed, Scopus and Web of Science were used to find relevant research studies, which were then evaluated based on predetermined inclusion criteria. Then, meta-analysis assessing nursing interventions for paediatric severe pneumonia was conducted. Key outcomes included fever reduction, cough alleviation, shorter hospital stays and improvements in lung function and quality of life. The impact of interdisciplinary collaboration and family-centred care was also examined.

Six studies involving paediatric patients with severe pneumonia were included. With a pooled mean difference of -1.764 (95% CI: -2.126 to -1.402; p < 0.001), a meta-analysis revealed that integrated nursing care significantly improved clinical outcomes and expedited symptom resolution. When compared to standard care, integrated nursing interventions considerably reduced hospital stays, cough relief times and fever duration.

Integrated nursing care improves recovery in paediatric severe pneumonia patients in PICUs. However, further research is needed to standardise nursing intervention protocols and optimise implementation across diverse healthcare settings.

This review highlights the importance of structured nursing interventions, interdisciplinary teamwork and family-centred care in paediatric severe pneumonia management. Continuous nursing education is crucial for sustaining high-quality care and improving patient outcomes.