Continuing data on racial bias in pulse oximeters and artificial intelligence have sparked calls for health systems to drive innovation against racial bias in health care device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions.

The management of incidental pulmonary nodules is guided by recommendations set forth by the Fleischner Society. Although most pulmonary nodules are benign, timely and evidence-based follow-up can reduce morbidity and mortality. There are known socioeconomic disparities for engagement with recommended cancer screenings; however, it is unclear whether disparities exist for follow-up of incidentally detected pulmonary lesions.

Coccidioidomycosis, caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii, is recognized as an increasing threat both nationally and worldwide. This is in large part secondary to the expanding range of Coccidioides species and increased international travel to endemic regions. Most individuals exposed to airborne Coccidioides organisms do not need medical attention, but approximately 30% will demonstrate primary pulmonary coccidioidomycosis with signs and symptoms that mimic community-acquired pneumonia or other respiratory illnesses. Further, 5% of those with a diagnosis of pulmonary coccidioidomycosis will demonstrate serious and even life-threatening manifestations, including extrapulmonary or disseminated coccidioidomycosis. Of those who demonstrate pulmonary coccidioidomycosis, past evidence suggests that approximately 5% to 15% will experience long-term pulmonary sequelae in the form of nodules, abscesses, or cavitary lesions. These lesions may not be easily distinguished from malignancy or other infections, such as TB, and they add a substantial burden to both patients and the health care system. Despite the long-term consequences of cavitary coccidioidomycosis in some individuals, the current literature review and practice guidelines demonstrate a paucity of clear management strategies to treat these patients. In this report, we focus on cavitary lesions in coccidioidomycosis with the goal of presenting a description of the evaluation and management of their various forms, manifestations, and complications. These recommendations are derived from a multidisciplinary group of experts.

The screening strategy for interstitial lung disease (ILD) in patients with rheumatoid arthritis is currently debated. Although high-resolution CT (HRCT) imaging is the gold standard for diagnosing ILD, its systematic use as a screening tool is not yet recommended. The role of lung ultrasound (LUS) in assessing ILD has been previously explored.

Low-dose morphine may be prescribed to reduce chronic breathlessness in COPD. Subjective findings suggest morphine may influence breathlessness through sleep-related mechanisms. However, concerns exist regarding opioid safety in COPD. The effects of morphine during sleep in COPD have not been objectively investigated. This study aimed to objectively determine the effects of low-dose morphine on sleep in COPD.

Annual lung cancer screening using low-dose CT (LDCT) imaging effectively reduces mortality from lung cancer and is recommended for people who are at high risk of developing the disease. The utilization of lung cancer screening, however, has remained low. Due to significantly higher cigarette smoking rates, patients with behavioral health disorders (those living with mental illness and/or substance use disorders) are more likely to be diagnosed with and die of lung cancer; at the same time, they are less likely to undergo cancer screenings. There is an urgent need for targeted efforts to improve access to lung cancer screening among this population disproportionately affected by the disease. In this commentary, we propose integrating lung cancer screening facilitation into services provided by behavioral health professionals who are uniquely positioned to reach these patients and deliver interventions to increase uptake of cancer screenings. We suggest several measures that could improve lung health outcomes of patients with behavioral health disorders: (1) training behavioral health professionals in lung cancer screening eligibility assessment; (2) providing patients with educational materials; (3) integrating shared decision-making counseling for lung cancer screening into behavioral health care settings; (4) providing the practical support needed to access screening; and (5) establishing effective partnerships with community organizations. Regardless of the level of engagement, possibly ranging from brief training to the implementation of comprehensive programs, any involvement will benefit patients. This integrated approach will contribute to reducing lung cancer mortality among patients with behavioral health disorders who have long experienced systemic health inequities.

Asthma is a common, multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes and endotypes and the availability of targeted biologic treatment options, the disease remains uncontrolled in a substantial proportion of patients with risk of exacerbations, requiring systemic corticosteroids, and with progressive disease. Current international guidelines advocate for a personalized management approach to patients with uncontrolled severe asthma. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) asthma expert panel was convened to discuss strategies to optimize asthma care and to prevent systemic corticosteroid overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current one-size-fits-most concept, which focuses on a symptom-driven treatment strategy, and shift toward a phenotype- and endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life. Herein, we provide a consensus view on asthma care that advocates a holistic approach and highlight some unmet needs to be addressed in future clinical trials and population studies.

A 68-year-old woman presented with worsening dyspnea. She had presented to her local community hospital 10 days earlier with similar symptoms. She was diagnosed with a right-sided pleural effusion, which was attributed to pneumonia and treated with antibiotics. She underwent two thoracenteses within a week, with relief of dyspnea after each procedure. Two days after hospital discharge, she developed recurrence of dyspnea and presented to our hospital. She denied any cough, fever, chills, or night sweats. She denied leg swelling, orthopnea, or paroxysmal nocturnal dyspnea. She did not have any recent surgeries or trauma. She had a medical history notable for Hodgkin lymphoma treated with radiation 40 years ago, renal cancer treated with nephrectomy, COPD on chronic 2 L oxygen nasal cannula, and pulmonary embolism on chronic anticoagulation. She also had a chronic left-sided chest port, which had been placed for a long-standing history of difficult IV access.

An 80-year-old man with no history of substance addiction presented with complaints of cough and breathlessness for 4 months. His cough was nonproductive, waxing and waning in nature with high symptom load during daytime, but not associated with chest pain or wheezing. He gives no history of nasal or sinus symptoms, aspiration, or reflux symptoms. Breathlessness was nonparoxysmal, independent of cough and progressing from modified medical research council Grade-I to Grade II. It was not accompanied by wheezing or stridor. He denied specific triggers and seasonal, diurnal, or postural variation of symptoms. His medical history was largely unremarkable, apart from hypertension diagnosed 2 decades earlier. Despite 6 months of treatment with dual antihypertensive medications, his BP remained uncontrolled. He did not receive angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for the treatment of hypertension as per his old medical records. He denies history of atopy, occupational or environmental dust exposure. He refused history of fever, significant loss of weight or appetite. He had been treated for asthma with a combination of a long-acting beta-2 agonist and an inhaled corticosteroid inhaler, which provided no relief.