Purpose of review: In this review, we present the latest findings on the cause, pathogenesis and management of patients with chronic obstructive pulmonary disease (COPD) and an infective phenotype. Recent findings: More than half of COPD exacerbations are infective. Bacteria are isolated in 70% of them, but viruses also play an important role, both alone and in combination with bacteria. Furthermore, in many cases, viral infection can be followed by bacterial infection in patients with COPD but not in individuals with normal lung function. Viral infection may produce changes in the lung microbiome that may precipitate subsequent bacterial infection. Research on the lung microbiome is providing new insight into the pathogenesis of infection in healthy and diseased lungs. Summary: COPD patients have alterations in their lung microbiome that may result in chronic infection with potentially pathogenic microorganisms (PPMs) even in periods of clinical stability and associated with a higher frequency of bacterial exacerbations. Patients with this infective phenotype may require a personalized approach to therapy with the use of short-term or long-term antibiotic treatment in addition to the usual treatment for COPD.

Over recent years, investigators have experienced a growing appreciation for small airways disease as an occupational lung disease. Small airways disease includes a range of diagnoses such as hypersensitivity pneumonitis, mineral dust airways disease, and constrictive bronchiolitis. Novel exposures or, in certain cases, novel settings for well-established respiratory toxicants continue to be reported. Given recent reports among military personnel serving in the Middle East as well as diacetyl exposed workers employed in microwave popcorn manufacturing plants, constrictive bronchiolitis as an occupational lung disease has gained particular notoriety. The diagnosis of constrictive bronchiolitis remains challenging as plain chest radiographs may appear normal and physiologic testing may revea...

Abnormal opacities detected at chest radiography must be localized as parenchymal or extraparenchymal to facilitate differential diagnosis. Extraparenchymal opacities may arise from the chest wall soft tissues, osseous structures, or pleura. Regarding the latter, pleural effusion and fibrothorax are commonly recognized patterns of pleural disease encountered at thoracic imaging. Less commonly, nodules or masses arising from the pleura may be seen, and usually this imaging pattern reflects the presence of pleural malignancy. However, there are rare conditions that may affect the pleura and simulate malignant pleural disease, particularly thoracic splenosis. Splenosis represents autotransplantation of functional splenic tissue into ectopic sites, most frequently within the abdomen, and rarel...

Synopsis: The longer patients go receiving >6 mL/kg tidal volumes for acute respiratory distress syndrome (ARDS), the higher their mortality. Source: Needham DM, Yang T, Dinglas VD, et al. Timing of low tidal volume ventilation and intensive care unit mortality in ARDS. Am J Respir Crit Care Med. 2015; 191:177-185. (Source: Clinical Pulmonary Medicine)