​Respirar is a free and open access electronic scientific journal. It is an official publication of the Asociación Latinoamericana de Tórax (ALAT). Its objective is to disseminate the scientific work carried out in Latin America in the area of respiratory pathology. This journal is aimed at health professionals. Quarterly: March, June, September and December. - - - - - - - - - - EDITORS IN CHIEF Dr. Francisco Arancibia (Instituto Nacional del Tórax, Santiago de Chile, Chile) https://orcid.org/0000-0001-5429-5420 Dr. Carlos Luna (Hospital de Clínicas, Ciudad Autónoma de Buenos Aires, Argentina) https://orcid.org/0000-0002-9288-096X ASSISTANT EDITORS Dra. Lorena Noriega- Aguirre (Universidad de Panamá, Facultad de Medicina; Ciudad de la salud de la Caja de Seguro Social; Investigadora Nacional I del SNI – SENACYT; Panamá, Panamá) https://orcid.org/0000-0003-1806-9797 Dr. Rogelio Pérez-Padilla (Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Ciudad de México, México) https://orcid.org/0000-0002-1132-5308 Dr. Carlos Arturo Torres-Duque (Centro Internacional de Investigación en Neumología y Salud Respiratoria (CINEUMO); Fundación Neumológica Colombiana; Universidad de La Sabana; Bogotá, Colombia) https://orcid.org/0000-0003-0004-8955 Dr. Gustavo Zabert (Universidad Nacional del Comahue, Facultad de Ciencias Médicas (FACIMED), Rio Negro, Argentina) https://orcid.org/0000-0001-9937-4464 Editorial Coordinator- Editorial Secretary: Lic. Mercedes Cavallero
Asociación Latinoamericana de Tórax (ALAT)
Respiratory Rehabilitation Consensus for Latin America
Copyright (c) 2026 Respirar https://creativecommons.org/licenses/by/4.0
Evidence-Based Consensus on Pulmonary Rehabilitation: Recommendations for Latin America
Introduction: Chronic respiratory diseases lead to complex disability associated with progressive physical inactivity, systemic effects, and emotional burden, ultimately deteriorating quality of life and increasing the use of health services. Pulmonary rehabilitation (PR) is an effective intervention that enhances functional capacity, reduces exacerbations, and improves quality of life. However, in Latin America, significant barriers persist, limiting access and resulting in uneven implementation across the region. Methods: A multidisciplinary team developed evidence-based recommendations for the implementation of PR programs. PICO questions were formulated, and a systematic review was conducted following the PRISMA guidelines. The quality of evidence was assessed using the GRADE approach. An external panel of experts performed an independent review to ensure the validity, methodological rigor, and clinical applicability of the recommendations. Results: Ten key recommendations were established, including patient education and self-management, appropriate oxygen use, respiratory physiotherapy, telerehabilitation, complementary therapies, psychological support, nutritional assessment, strategies for high-altitude populations, and inspiratory muscle training. These interventions contribute to improved quality of life and functional capacity, enhance treatment adherence, and reduce exacerbations. Conclusion: PR should be integrated as part of standard care at all levels of the health system through trained multidisciplinary teams. This consensus harmonizes regional criteria and supports the expansion of safe, effective, and sustainable PR programs tailored to the needs and realities of Latin America.
Incentive Breathing: Between Habit and Clinical Reasoning
Severe Asthma in a Middle-Income Country: Impact of the ASMAIRE REXPIRA Specialized Clinic
Introduction: The impact of specialized clinics for severe asthma on disease control in middle-income countries like Colombia is limited. Objective: To evaluate the impact of ASMAIRE REXPIRA on clinical outcomes in a cohort of patients with severe asthma. Methods: A real-world, retrospective, observational, before–after study was conducted in patients ≥18 years with severe asthma (high-dose ICS/LABA, GINA 2020 step 5) who were enrolled in 2022 and completed two years of follow-up. The year prior to enrollment was compared with the first and second years of follow-up. Outcomes included exacerbations requiring oral corticosteroids (OCS), emergency department visits or hospitalizations, symptoms (ACT and ACQ-5), pre- and post-bronchodilator (BD) FEV₁, and quality of life (miniAQLQ). Results: A total of 196 patients were included; 80.1% were women, with a mean age of 51.9 years and a BMI of 27.8. At the first year, the proportion of patients with controlled asthma increased from 49.7% to 64.1%, and further to 70.4% in the second year (p<0.001). Exacerbation rates requiring OCS, emergency care or hospitalization decreased by 67%, 69%, and 78%, respectively, in the first year and continued to decrease in the second year. Quality of life improved significantly at both time points (p<0.001). No significant changes were observed in FEV₁. Conclusions: Managing severe asthma with an interdisciplinary approach at clinics like ASMAIRE REXPIRA improves disease control. This care model may be cost-effective, pending economic evaluation, and could help reduce severe asthma burden if adopted more widely in Latin America.
Professional Profile and Areas of Opportunity for Teachers in Respiratory Medicine in Latin America
Expert Consensus: Clinical Recommendations for the Use of Glucocorticoids in Patients Diagnosed with Asthma
Introduction: The use of glucocorticoids is essential in the management of asthma; however, their overuse entails significant risks. Objective: Develop a multidisciplinary consensus to optimize their use in clinical practice in Colombia and Latin America. Methodology: The consensus is based on an expanded review of clinical practice guidelines, international consensus statements, and literature reviews. A total of 102 publications were analyzed, of which 24 were included for evidence extraction, recommendations, assessment of evidence quality, and strength of recommendations. These elements informed the drafting of recommendations that were subsequently submitted to voting during the consensus conference. Fourteen experts representing scientific societies, academia, professional associations, and a patient representative participated in validating the recommendations following a consensus conference methodology. Results: Resulting clinical recommendations addressed criteria for glucocorticoid use, management of asthma exacerbations, follow-up, and implementation strategies. Emphasis was placed on calculating cumulative doses, identifying alert thresholds, monitoring patients receiving glucocorticoids, and referral to specialists. This consensus provides recommendations for the rational use of glucocorticoids in patients with asthma, as well as the need for strict monitoring of glucocorticoid use and associated effects, with the goal of achieving asthma control through appropriate therapeutic regimens. It promotes continuous education processes and alignment with international guidelines. The consensus offers practical tools for clinical decision-making and risk management.
Z-Scores as a Strategy for Interpreting Oscillometry across Different Measurement Devices
Background: The use of oscillometry has increased significantly in recent years, promoting the development of portable devices for clinical application; however, the comparability of z-scores across different devices has not been well established. The objective of this study was to evaluate the agreement between results obtained with two different brands, in a healthy pediatric population. Methods: This was a prospective, cross-sectional study in healthy children aged 3–17 years. Oscillometry was performed using two different measurement devices in random order, following current technical recommendations. z-scores for R5, R5–R20, X5, AX, and Fres were analyzed according to the reference equations of Gochicoa et al. and Ducharme et al., depending on the device used. Comparisons between devices were performed using paired tests (t-test or Wilcoxon), and agreement was assessed using the concordance correlation coefficient, Bland–Altman analysis and the kappa coefficient. Results: A total of 43 children were included, 51% female, with a mean age of 8.7 ± 3.4 years. Comparisons showed significant differences in all variables when expressed as absolute values, but not when expressed as z-scores (except for z-R5 and z-Fres). Although concordance was low (CCC 0.1–0.3), when oscillometry was classified as normal/abnormal, the level of agreement was high (81–100%; κ = 0.62). Conclusions: Oscillometric measurements are not interchangeable between devices when expressed as absolute values; however, the use of z-scores with device-specific reference equations may facilitate clinical comparison in pediatric populations. Further studies are warranted.
Bullae in HIV Patient with Pneumocystis Jirovecii Pneumonia and Acute Respiratory Distress Syndrome
In patients infected with the human immunodeficiency virus (HIV) and Pneumocystis jirovecii (PJP) pneumonia, the prevalence of emphysematous lesions seen on imaging ranges from 10% to 34%. Their presence is associated with increased morbidity and mortality. The aim of this report is to present a clinical case of an HIV-positive patient with PJP pneumonia and acute respiratory distress syndrome (ARDS), which progressed to bullae.
Phenotypification and Response to Treatment of Allergic Patients with Severe Asthma: Real-World Experience in Argentina
Introduction: Evidence on the response to treatment with biologics in allergic patients with severe asthma in Latin America is scarce. Our objective was to compare the baseline phenotype and response to biologic therapy in allergic and non-allergic adult patients in the Argentine cohort of the International Severe Asthma Network (ISAN). Methods: We analyzed the data available at baseline and at 12 months of biologic treatment in allergic (positive skin test and/or radioallergosorbent test with associated symptoms) and non-allergic patients. Results: n=79: 51 allergic (64.56%) and 28 non-allergic (35.44%). Allergic patients were significantly younger and had a longer history of asthma at the start of treatment. The median number of asthma exacerbations was significantly reduced in both subgroups, with no differences in the magnitude of the effect. Hospitalizations were significantly reduced in allergic patients, and no hospitalizations were reported in non-allergic patients. The baseline percentage of allergic and non-allergic patients requiring maintenance oral corticosteroids was similar and decreased significantly, with no differences in the magnitude of the decrease. The median ACT (Asthma Control Test) score and FEV1% increased significantly in both subgroups, with no differences in the magnitude of effect. The percentages of clinical remission (4 domains) were similar (25.49% in allergic patients; 25% in non-allergic patients). Conclusions: Despite demographic phenotypic differences between allergic and non-allergic patients with severe asthma, the response and clinical remission rates with biological agents were comparable in both subgroups.
For a childhood and infancy free of tobacco and nicotine
Successful Management of Recurrent Post-Intubation Subglottic Stenosis after Surgical Resection: Endoscopic Dilation and Dumon Stent Placement with External Fixation. A Case Report
Post-intubation subglottic stenosis is an uncommon but potentially serious complication. We present the case of a 39-year-old man with a history of hypertension and psoriasis who developed grade IV subglottic stenosis after prolonged intubation for a left basal ganglia hemorrhage. After laryngotracheal resection with end-to-end anastomosis, he experienced a recurrence refractory to endoscopic dilations. The patient underwent bronchoscopic dilation and placement of a silicone Dumon stent with external fixation using a percutaneous suture. The patient had no recurrence or complications after 18 months of follow-up.
Pleuropulmonary Ultrasound: Relationship of Findings with Histological Types in Lung Cancer
Introduction: Thoracic ultrasound is an accessible tool for evaluating consolidations with suspected malignancy; however, the histologic classification of malignant tumors is not fully described. Objective: To evaluate ultrasonographic findings in lung cancer and correlate them with histological type. Methods: Prospective study of 26 patients with consolidations suspicious for malignancy at Dr. José Ignacio Baldó Hospital, January – August 2022. Two observers evaluated the ultrasonographic characteristics of consolidations in B-mode and Doppler, blinded to histologic results, which were obtained by the standard hematoxylin-eosin staining method. Chi – squared tests were used for associations and the Kappa coefficient for interobserver agreement. Results: The examined consolidations appeared heterogeneous with deep, fragmented borders and absence of air bronchograms. Adenocarcinoma was the prevalent histologic type (65,4%). Doppler uptake was observed in 96,2% of tumors, with monophasic spectra in 69,2% and low resistance in 61,5%. A significant association was found between squamous cell carcinoma and pleural thickening > 10 mm (p = 0.048), and interobserver agreement was excellent. Conclusions: Thoracic ultrasound is a reproducible tool for local characterization of lung cancer. Pleural thickening associated with squamous carcinoma and absence of air bronchogram may improve noninvasive diagnostic accuracy. Further studies are needed to validate these findings.
Plastic Bronchitis Type 1 as a Respiratory Manifestation of a Lupus-Scleroderma-Type Connective Tissue Disease with Autoantibodies in an Indeterminate Range
Plastic bronchitis is a rare condition characterized by the formation of bronchial casts that cause airway obstruction and regional ventilatory impairment. The inflammatory or type 1 form has been primarily associated with infectious and allergic processes, with its coexistence with systemic autoimmune diseases being exceptional. We present the case of a 36-year-old woman with type 1 plastic bronchitis and systemic manifestations consistent with an incompletely classified autoimmune disorder, including mucocutaneous, esophageal, hepatic, and immunological involvement. The patient showed clinical, radiological, functional, and biochemical improvement after the initiation of immunosuppression with mycophenolate mofetil and prednisone. Allergic bronchopulmonary aspergillosis and other infectious causes were ruled out. This case highlights the importance of a comprehensive diagnostic approach in patients with inflammatory plastic bronchitis and coexisting systemic manifestations.
Corticosteroid Therapy: a Double-Edged Sword. An ALAT Position Statement
Background: For more than seven decades, systemic corticosteroids have been a cornerstone in the treatment of chronic inflammatory diseases, particularly bronchial asthma. However, their widespread and often indiscriminate use has raised growing concern because of their association with a broad spectrum of systemic adverse effects and their clinical and economic impact on healthcare systems. Objective: To critically analyze the current evidence on patterns of systemic corticosteroid use, their safety profile, and their clinical and economic impact, with particular emphasis on asthma management, and to provide recommendations for a safer and more rational use of these agents. Methods: This position paper was developed by the Asthma Department of the Latin American Thoracic Association (ALAT), based on a narrative review of the available literature and expert consensus. Results: Epidemiological data show a high global prevalence of use, particularly among patients with asthma and other chronic respiratory diseases. Even short courses or relatively low cumulative doses increase the risk of serious adverse events —infections, cardiovascular complications, osteoporosis, metabolic disorders, and hypothalamic–pituitary–adrenal axis suppression—, contributing to greater morbidity, mortality, and costs. In severe asthma, emerging evidence has driven a paradigm shift aimed at minimizing exposure through rational prescribing, optimization of maintenance therapy, and targeted biologic therapies. Conclusions: Although systemic corticosteroids remain essential, their excessive or inappropriate use imposes a substantial clinical and economic burden. Rational prescribing, active monitoring of adverse effects, and early adoption of steroid-sparing therapies are key approaches to improving treatment safety, particularly in severe asthma.
Impact of Overweight on the Clinical Course of Children Hospitalized with Bronchiolitis
Introduction: Bronchiolitis is a highly prevalent disease and leading cause of hospitalizations in children under 12 months. Cases of overweight and obesity are increasing worldwide in the pediatric population. This study aimed to determine the impact of overweight on the clinical course and complications of children hospitalized with bronchiolitis in a tertiary center. Methods: A retrospective observational study was conducted over 12 months (January–December 2019). Data were obtained from electronic medical records based on predefined inclusion and exclusion criteria. Analysis was performed using STATA version 14 and R 4.2. Results: Data from 200 patients were analyzed, with a median age of 5 months (range 0–23, SD 5.45); 47 patients (23.5%) were overweight. The most frequent symptoms were respiratory distress (94.5%) and tachypnea (89%). RSV was the most common pathogen (84.1%). Overweight patients had a longer hospital stay (+1 day) and increased oxygen requirements (+1 day). They also had higher odds of ventilatory failure at admission (OR 3.03, CI 1.13–7.85, p=0.009), high-flow nasal cannula use (OR 2.48, CI 1.18–5.15, p=0.007), and bronchodilator use (OR 2.13, CI 1.02–4.41, p=0.02). Multivariate analysis confirmed these associations. Conclusions: This is the first Latin American study to explore the association between overweight and bronchiolitis severity in hospitalized children. Our findings suggest that overweight may act as a risk factor, contributing to a more severe clinical course.
ALAT-SEPAR Consensus on Asthma Exacerbations: the Answer to an Unmet Need
Latin American Registry of Patients with Post-Tuberculosis Lung Disease: Analysis of Clinical Conditions, Pulmonary Function, Quality of Life, and Rehabilitation. Multicenter Study
Introduction: Tuberculosis (TB) is a communicable disease included in the Pan American Health Organization’s Initiative for the Elimination of Diseases in the Americas. In Latin America, unlike other regions, the World Health Organization has reported a sustained increase in TB incidence in recent years. In parallel, Post-Tuberculosis Pulmonary Disease (PTPD) has emerged as a relevant clinical entity, associated with respiratory, functional, and psychosocial sequelae that negatively impact quality of life and generate substantial catastrophic health costs. However, the burden and clinical characteristics of PTPD in Latin America remain poorly defined. Objective: To describe the demographic, clinical, functional, radiological, and quality-of-life characteristics of patients with PTPD in Latin America through a standardized registry, in order to generate evidence to support recommendations for timely diagnosis and management in the region. Methods: A multicenter registry was developed using a standardized shared medical record model available on the REDCap (Research Electronic Data Capture) platform of the Latin American Thoracic Association (ALAT). Relevant clinical data, pulmonary function tests, radiological imaging, quality-of-life assessments, and the use and impact of pulmonary rehabilitation will be collected from patients with PTPD across participating Latin American countries. Conclusions: This registry will allow estimation of the burden of PTPD in Latin America and provide a comprehensive characterization of affected patients. The generated data will support strategies aimed at improving diagnosis, treatment, and rehabilitation, promoting an integrated approach to reduce disability and catastrophic health costs associated with this condition.
Copyright (c) 2025 Respirar https://creativecommons.org/licenses/by/4.0
Agenesis of the Right Pulmonary Artery: a Diagnostic Challenge in Acute Pulmonary Edema
Introduction: Right pulmonary artery agenesis and right pulmonary hypoplasia are considered rare conditions identified in early life. Approximately five cases have been reported in adulthood, two of which presented with complications such as pulmonary hypertension and acute pulmonary edema. Case report: We present the case of a 34-year-old woman in the immediate postpartum period with clinical presentations suggestive of acute pulmonary thromboembolism. Chest CT angiography revealed a congenital vascular malformation: agenesis of the right pulmonary artery branch, unilateral pulmonary edema, and indirect evidence of pulmonary hypertension. Conclusion: This case highlights the importance of considering vascular malformations as a cause of unilateral acute pulmonary edema with underlying pulmonary hypertension, which carries a high risk of mortality, particularly during pregnancy and the postpartum period. Its timely identification allows for targeted management and specialized follow-up.
Humanization in Primary Care for Patients with Tuberculosis
Introduction: The humanization provided by health personnel in primary health care to patients with tuberculosis is crucial for their satisfactory evolution. Objective: To explore the opinions of the staff of the basic health teams in the health areas of the municipality of Habana Vieja on the humanization of patients treated for tuberculosis. A descriptive, exploratory study was conducted using a Likert scale for a comprehensive sample of 23 healthcare personnel who care for patients in treatment, from December 2023 to June 2024. Sociodemographic variables, frequencies and percentages were used. Opinions were explored using seven statements. A position index was calculated for each item (-totally disagree, -disagree, -no idea about it, -agree and -totally agree) with a 95% confidence interval. Results: 21/23 respondents were under 65 years of age and 65.22% were female. 19/23 had been in the program for more than 10 years. The majority of respondents agreed with the first three statements, regarding population stigma and lack of knowledge (PI = 0.674, 0.543, and 0.750), respectively. From the fourth to the seventh statement about the gaps in humanized care, they were between strongly disagree and disagree, with (IP= 0.272; 0.467; 0.370 and 0.489), respectively. Conclusion: The opinions of health professionals in the municipality of Habana Vieja showed that there is an adequate performance for the humanized care of TB patients. However, educational activities should be increased for professionals, patients and civil society regarding knowledge of the disease.
New Era in the Management of Early-Stage Lung Adenocarcinoma: a 3-Year Observational Follow-Up Study
Background: Lung cancer is frequently diagnosed in advanced stages and is currently the leading cause of cancer-related mortality worldwide. A multidisciplinary approach is crucial to optimize diagnosis, treatment and improve patient survival. Methods: A retrospective cohort analytical study over two time periods, including patients over 18 years old with early-stage lung adenocarcinoma treated at a high-complexity oncology center in Colombia. The exposure group (2021-2023) received multidisciplinary care, while the non-exposure group (2018-2020) was managed conventionally by individual specialists. The study aimed to compare clinical outcomes and treatment times between both groups. Statistical analysis was based on the distribution of variables. Results: A total of 34 patients were included. The multidisciplinary approach enabled earlier diagnosis of lung adenocarcinoma, increasing early-stage identification from 30% to 61% between 2018 and 2022. Additionally, the multidisciplinary group had a higher proportion of asymptomatic cases (54% vs. 32%) and a lower relapse rate (7% vs. 52%) compared to conventional management. Treatment initiation times were significantly reduced from 3.2 to 2.2 months (p < 0.05), and the time from pathology to treatment decreased to 30 days in the multidisciplinary group versus 85 days in the conventional group. Conclusions: The multidisciplinary approach reduced waiting times for the initiation of cancer treatment, increased treatment adherence and improved clinical outcomes.
Demographic Characterization of Patients with Pulmonary Arterial Hypertension Group 1 and Group 4 at Fundación Santa Fe de Bogotá from 2017 to 2024: Our Real Life Experience
Introduction: Pulmonary hypertension is a potentially fatal condition; it is considered a public health concern due to its clinical impact. Therapeutic options are available in our setting, however, the lack of diagnostic standardization is undeniable. Objective: To determine the clinical and demographic characteristics of patients diagnosed with pulmonary arterial hypertension in group 1 or group 4. Methods: This is an observational, cross-sectional study. Patients over 18 years of age diagnosed with pulmonary arterial hypertension in group 1 or associated with chronic thromboembolic pulmonary hypertension, confirmed by right heart catheterization, and treated at Fundación Santa Fe de Bogotá between January 2017 and April 2024 were included. Descriptive statistics were applied to characterize and describe the variables. Results: A total of 42 patients were included, with 81% belonging to group 1 and 19% to group 4. 90.4% were women, with a mean age of 62 years. Nearly 70% of the patients were receiving some type of specific vasodilator therapy, either as monotherapy (48%) or in combination therapy (22%). In the differentiation by etiological group, there were statistically significant differences in LVEF (62 ± 0.09% in group 1 vs. 66 ± 0.16% in group 4) (p = 0.02), as well as in terms of SvO2 (64 ± 0.19% vs. 79 ± 0.26%, respectively) (p = 0.003). Conclusions: In patients with pulmonary arterial hypertension, the distribution by sex, age, clinical characteristics, hemodynamic profile, and treatment status was comparable to that reported in international registries outside of Latin America.
Correlation of Cardiac Output by Blood Gas Analysis and Echocardiography in Critical Care Medicine at very High Altitude
Introduction: Cardiac output (CO) is a marker to determine the global hemodynamic state. Its determination by Fick's principle has been used by invasive and non-invasive methods such as simple blood gas analysis (GA), the latter has been displaced by more modern methods. Transthoracic echocardiography (TTE) is a validated and reliable method to determine CO. The objective of this study is to determine if there is a linear relationship between the CO by GA through theoretical formulas and the GC obtained by TEE. Material and Methods: Observational, descriptive, cross-sectional and single-center study. Patients admitted to the Adult Intensive Care Unit of the Hospital del Norte in the city of El Alto at 4,150 meters above sea level were included. The data was tabulated in Excel. Normality tests, Bravais-Pearson correlation, Bland-Altman test were performed with the SPSS Statistics v 29 program; the White test for heteroskedasticity was performed in XLSTAT. The Hospital Bioethics committee approved the study protocol. Results: The Bravais-Pearson r coefficient was 0.60 (95% CI: 0.18 to 0.82; p value 0.007). This relationship increased when we used the formula proposed by this study with r 0.64 (95% CI: 0.23 to 0.84; p value 0.003). We found a linear relationship between stroke volume (SV) and arterial O2 concentration (CaO2) with r 0.8 (95% CI: 0.5 to 0.9; p 0.001). Conclusion: There was a linear correlation of CO by both methods in patients.
Respiratory Function Tests in Alveolar Hypoventilationand Ventilatory Support
The ventilatory pump is responsible for alveolar ventilation (respiratory centers, nerve conduction pathways, neuromuscular joint, respiratory muscles and rib cage). A drop in alveolar minute ventilation is inversely related to arterial values of CO2, so hypoventilation is the cause of hypercapnia. Failure of the ventilatory pump determines hypoventilation and the need for mechanical respiratory assistance (invasive or non-invasive). The use of respiratory functional tests facilitates the correct interpretation of alveolar hypoventilation and making therapeutic decisions. Respiratory function allows prediction of the need for ventilatory support before obvious hypercapnia appears. Likewise, properly interpreted information can offer the clinician bedside keys to making differential diagnoses and may allow a prognostic prediction. This review contributes to understand the respiratory functional disorders linked to hypoventilation, focusing on the interrelation between the indicators of respiratory functional examination tests and the treatment modalities using ventilatory support.
Pulmonary Adenomyosis in a Post-Menopausal Woman: a Rare Variant of Pulmonary Endometriosis. Case Presentation
We present the case of a 48-year-old woman with the incidental finding of pulmonary nodules during preoperative evaluation. She reported a history of hysterectomy for uterine fibroids without oophorectomy at age 30 and resection of breast nodules for fibroadenomas. A chest computed tomography scan confirmed multiple nodules in both lungs. Lung biopsy revealed endometrial glands surrounded by stroma and smooth muscle without atypia, with immunohistochemistry positive for smooth muscle actin, calponin, CD10, estrogen receptors, and cytokeratins AE1/AE3. The histopathological diagnosis was consistent with pulmonary adenomyosis, an uncommon form of Thoracic Endometriosis Syndrome (TES). Given the patient's asymptomatic nature and the nodular presentation of the lesions without evidence of adjacent complications, a conservative management approach was chosen, including periodic clinical and radiological follow-up, prioritizing close monitoring for any morphological or symptomatic changes that might warrant more active intervention. This case highlights the importance of considering benign entities such as pulmonary adenomyosis in the differential diagnosis of pulmonary nodules.
Recurrent Respiratory Papillomatosis with Transformation to Squamous Cell Carcinoma: Case Report
Laryngeal papillomatosis is a common benign neoplasm in childhood and rare in adults. It represents the initial manifestation of recurrent respiratory papillomatosis, a laryngeal tumor caused by the human papillomavirus (HPV) acquired during childbirth from an infected mother. HPV types 6 and 11 are the most common, characterized by the development of exophytic, verrucous lesions in the upper airways. These lesions tend to recur after treatment, retaining their potential for dissemination and malignant transformation. Oral sex and HPV type 16 have been associated with squamous cell carcinoma of the oropharynx. We present the case of a 53-year-old woman with a history of vocal cord paresis following resection of laryngeal papillomas four years prior. She currently presents with grade 2 to 3 dyspnea, diaphoresis, dysphonia, weight loss, coughing fits, and mucopurulent sputum. Physical examination revealed an oxygen saturation of 80% with inspiratory wheezing and laryngeal stridor. Flexible nasobronchoscopy showed friable, clustered granulomatous lesions of an exophytic, vegetative type obstructing the upper airway in more than 95% of cases, as well as irregular papillomatous vegetative lesions extending into the trachea. Histopathological analysis revealed moderately differentiated squamous cell carcinoma. This case highlights the high probability of malignant association, estimated between 1% and 4%, demonstrating the need for multimodal treatments applied both in patients with unresectable cancers and those undergoing systemic oncological therapies.
Frequency of Pleural Mesothelioma in Mexican Women. Case Study
Introduction: Pleural mesothelioma is a rare and aggressive tumor, which is uncommon in women and requires further clinical characterization. Methods: A retrospective study was conducted at the National Institute of Respiratory Diseases (January-December 2024), which included 21 women with a histological diagnosis. Results: The mean age was 63.5 years, and 38% reported domestic exposure to asbestos. All patients presented with pleural effusion, 57% with hypoxemia, and more than half required emergency care. The diagnosis was obtained mainly through VATS, with a diagnostic yield of 100% in all modalities. The predominant histological subtype was epithelioid in 90% of cases, and all were classified as stage IV. Conclusions: Pleural mesothelioma in women continues to be a late-diagnosed entity, with high clinical severity and frequently unrecognized exposure to asbestos. The constant presence of pleural effusion and the high proportion of stage IV patients highlight the priority of reinforcing diagnostic suspicion and timely access to highly cost-effective invasive methods, especially in contexts where domestic exposure may go unnoticed.
Redefining the Severity of Asthma Exacerbations: Implications and Limitations of the ALAT-SEPAR Consensus
Knowledge, Attitudes and Practices Regarding Sleep-Related Breathing Disorders: a Cross-Sectional Study among General Public
Introduction: Sleep-related breathing disorders (SRBD) are common underdiagnosed conditions with significant health consequences, including cardiovascular complications and impaired quality of life. Globally, disorders such as obstructive sleep apnea affect a substantial proportion of adults and are expected to rise with increasing risk factors like obesity, while remaining largely unrecognized. Objective: To evaluate knowledge, attitudes, and practices (KAP) regarding SRBD among the general population. Methods: A cross-sectional study was conducted over four months (June–September 2024) at Bangalore Medical College and Research Institute, including 250 participants aged ≥18 years. Data were collected using a validated 30-item semi-structured questionnaire assessing KAP domains and analyzed using IBM SPSS Statistics (Version 29.0). Results: Among participants, 56.4% had heard of SRBD, yet 58% did not consider it serious and only 42% recognized its health impact. Knowledge gaps were evident, with 52.4% unaware of diagnostic methods and 48.4% unaware of treatment options. Regarding attitudes, 47.2% would seek medical care and 41.2% were open to treatment, but only 17.6% were willing to undergo polysomnography. In practice, 55.2% avoided risk factors, while 73.2% had never discussed sleep concerns with a healthcare provider. Mean KAP scores showed moderate knowledge, mildly positive attitudes, and poor practices. Conclusion: Significant gaps persist in awareness and health-seeking behaviour related to SRBD. Targeted education, improved screening, and primary care training are essential to enhance early diagnosis and management.
Pleuroscopy as a Diagnostic Method in Patients with Previous Closed Pleural Biopsy without Conclusive Results
Introduction: Pleuroscopy is a minimally invasive technique that explores the pleural cavity and allows taking targeted biopsies of the parietal pleura. It is a highly cost-effective diagnostic method for unexplained exudative pleural effusion (PE). There is little evidence on its use in our region. Material and Methods: This is a retrospective, descriptive study conducted between June 1, 2024, and January 31, 2025. Adult patients hospitalized for pleural effusion with negative cytochemical and cytological studies, and non diagnostic closed pleural biopsy with an Abrams needle were included. Analysis included patients’ demographic data, type of tube used, time until tube removal, and post-procedure discharge, histopathological results, and complications. Results: Fifteen pleuroscopies were performed. A specific histopathological diagnosis was established in 86% (13/15) of the patients in the study, 77.7% (7/9) of the patients with forceps biopsy, and 100% (6/6) of the patients with cryoprobe biopsy. The histopathological diagnoses were malignant neoplasia (8/15), inflammatory/infectious (5/15), and undiagnosed (2/15). One patient with chest wall seroma and one patient with post-procedural respiratory failure were recorded as complications. Conclusions: Pleuroscopy allows taking parietal pleural biopsies under direct vision through a trocar, using forceps and cryoprobes. In this study, we demonstrated that it is a cost-effective and safe diagnostic alternative in patients whose previous fluid analysis and closed pleural biopsy were inconclusive.