Purpose of review: The last decade has seen a real drive to develop novel bronchoscopic tools for diagnosis and therapy in a number of disease areas, in particular in cancer diagnosis and the treatment of airways disease. Nowhere has this been more evident than in the field of chronic obstructive pulmonary disease/emphysema. Recent findings: The clinical trials with randomized endobronchial valves (EBVs) have demonstrated significant improvements in pulmonary function, quality of life and exercise capacity providing patients with heterogeneous disease with absence of collateral ventilation are selected. The responder rates are improved by valve adjustment or replacement where necessary. The results for endobronchial coils have been mixed with clinically meaningful results for pulmonary function and quality of life but at 1 year, the benefits in walk tests have been marginal. Vapour therapy appears promising and has the capacity for more targeted and staged therapy. Other therapies such as sealants which induce focal fibrosis, targeted vagal nerve ablation and cryoablation of bronchitis mucosa are also under development. Summary: Patients with severe heterogenous emphysema, evidence of hyperinflation and intact lobar fissures confirmed to have absent collateral ventilation may be considered for EBVs. Those with collateral ventilation or homogenous distribution of emphysema may be considered for endobronchial coils.

Purpose of review: Patients with lung cancer often develop endobronchial disease, endobronchial tumor extension or airway compression. Various nonmalignant diseases can also lead to severe central airway obstruction. Since the early 1980s, technical advances of interventional bronchoscopic techniques have improved symptom-free survival and quality of life for patients with lung cancer. Apart from other techniques, various airway stents have been developed. Although interventional procedures are not definitive therapies, they often relieve the strangling sensation produced by airway occlusion. There have been various new developments and the authors review the available current literature on endobronchial stents Recent findings: For patients with respiratory symptoms because of malignant airway obstruction, stent placement provides symptom palliation and improved quality of life. Summary: Various options for central airway obstruction are in development and will change our daily work. In particular, coated stents have a large potential in minimizing stent complications.

Purpose of review: Identification of patients with multidrug-resistant (MDR) pathogens at initial diagnosis is essential for the appropriate selection of empiric treatment of patients with pneumonia coming from the community. The term Healthcare-Associated Pneumonia (HCAP) is controversial for this purpose. Our goal is to summarize and interpret the data addressing the association of MDR pathogens and community-onset pneumonia. Recent findings: Most recent clinical studies conclude that HCAP risk factor does not accurately identify resistant pathogens. Several risk factors related to MDR pathogens, including new ones that were not included in the original HCAP definition, have been described and different risk scores have been proposed. The present review focuses on the most recent literature assessing the importance of different risk factors for MDR pathogens in patients with pneumonia coming from the community. These included generally MDR risk factors, specific risk factors related to methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa and clinical scoring systems develop to assess the MDR risk factors and its application in clinical practice. Summary: Different MDR risk factors and prediction scores have been recently developed. However, further research is needed in order to help clinicians in distinguishing between different MDR pathogens causing pneumonia.

Purpose of review: Antimicrobial-resistant respiratory tract infections (AMR-RTIs) are increasing, presenting important management challenges worldwide. Current management of AMR-RTI patients focuses on pathogen-directed antimicrobial treatment. Overt lung inflammation, parenchymal damage, and ineffective immune activation perpetrate increased patient morbidity and mortality. Immunomodulatory and tissue-regenerative host-directed therapies (HDT) may improve treatment outcomes. HDTs under investigation for improving AMR-RTI treatment outcomes are reviewed. Recent findings: Various HDTs are being developed or evaluated for adjunctive AMR-RTI treatment. α-1 antitrypsin was shown to reduce Pseudomonas aeruginosa burden in the airways of cystic fibrosis patients. Cellular therapy by reinfusing autologous bone marrow-derived MSCs into MDR/XDR-TB patients shows promise, whereas adjunctive T cell-based therapies are considered. Cytotoxic therapy using etoposide, a topoisomerase II-inhibiting anticancer drug extends survival of patients with severe influenza H1N1 infection-induced hemophagocytic lymphohistiocytosis. Two other novel HDT candidates, DAS181 and resveratrol show antiinfluenza effects. Novel kinase inhibitors SB203580 (MAPK-2 antagonist) and LY294002 (phosphoinositide-3 kinases antagonist) exhibit promising anti-MERS-CoV activity. Palivizumab, an anti-RSV monoclonal antibody, effectively prevents RSV infection in high-risk paediatric populations. T-cell therapy is currently considered for adjunctive HDT of azole-resistant pulmonary aspergillosis. Summary: Novel HDTs may revolutionize future treatment regimens for AMR-RTIs. Well designed multisite clinical trials are now necessary to accelerate progress.