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Background Respiratory tract infections (RTIs) are a major global health burden due to their high morbidity and mortality. This retrospective study described the epidemiology of respiratory pathogens in adults over a 5-year period at an Australian tertiary healthcare network. Methods All multiplex reverse transcription polymerase chain reaction respiratory samples taken between the 1st of November 2014 and the 31st of October 2019 were included in this study. Overall prevalence and variations according to seasons, age groups and sex were analysed, as well as factors associated with prolonged hospital and intensive care length of stay. Results There were 12,453 pathogens detected amongst the 12,185 positive samples, with coinfection rates of 3.7%. Picornavirus (Rhinovirus ), Influenza A and respiratory syncytial virus were the most commonly detected pathogens. Mycoplasma pneumoniae was the most commonly detected atypical bacteria. Significant differences in the prevalence of Chlamydia pneumoniae and Human metapneumovirus infections were found between sexes. Longest median length of intensive care and hospital stay was for Legionella species. Seasonal variations were evident for certain pathogens. Conclusions The high rates of pathogen detection and hospitalisation in this real-world study highlights the significant burden of RTIs, and the urgent need for an improved understanding of the pathogenicity as well as preventative and treatment options of RTIs.

Bilateral simultaneous spontaneous pneumothorax is a rare occurrence that generally requires prompt intervention. We report a case of simultaneous bilateral spontaneous pneumothorax. As the patient had minimal symptoms and normal vital signs, he was conservatively managed. Follow‐up imaging showed resolution of the pneumothorax with no evidence of underlying lung abnormality or abnormal pleural communications. This rare case highlights the feasibility and safety of adopting a conservative approach in the management of bilateral spontaneous pneumothorax. Bilateral simultaneous spontaneous pneumothorax is a rare occurrence that generally requires prompt intervention. We report a case of simultaneous bilateral spontaneous pneumothorax that was conservatively managed.

Respiratory diseases are leading causes of death and disability in the world. While early diagnosis is key, this has proven difficult due to the lack of sensitive and non-invasive tools. Computed tomography is regarded as the gold standard for structural lung imaging but lacks functional information and involves significant radiation exposure. Lung magnetic resonance imaging (MRI) has historically been challenging due to its short T2 and low proton density. Hyperpolarised gas MRI is an emerging technique that is able to overcome these difficulties, permitting the functional and microstructural evaluation of the lung. Other novel imaging techniques such as fluorinated gas MRI, oxygen-enhanced MRI, Fourier decomposition MRI and phase-resolved functional lung imaging can also be used to interrogate lung function though they are currently at varying stages of development. This article provides a clinically focused review of these contrast and non-contrast MR imaging techniques and their current applications in lung disease.

Rationale Bronchial thermoplasty (BT) is a treatment option for patients with severe asthma. Despite demonstrated sustained symptomatic benefits, its mechanism of action remains unclear, with emerging evidence suggesting a reduction in ventilation heterogeneity. Objective This study aims to determine if BT reduces ventilation heterogeneity as measured by phase-resolved function lung magnetic resonance imaging (PREFUL MRI). Methods Twenty-one patients with severe asthma and 14 healthy volunteers (HV) were recruited. Patients were assessed at baseline and 6-months after BT. Data collected included asthma control questionnaire (ACQ-5), exacerbation frequency, and short-acting beta-agonist (SABA) and oral corticosteroid (OCS) use. Both HV and patients also underwent lung function tests and PREFUL MRI. Ventilation heterogeneity was assessed using ventilation defect percentage (VDP) of static regional ventilation (RVent) and dynamic flow-volume loop cross-correlation metric (FVL-CM), and interquartile distance (IQD) of the ventilation distribution. Results At baseline, patients had a significantly higher RVent VDP (20.0 ± 14.5 vs 3.8 ± 2.2%, p  < 0.001), FVL-CM VDP (23.7 ± 17.8 vs 2.4 ± 2.3%, p  < 0.001), and IQD (0.61 ± 0.27 vs 0.32 ± 0.05, p  < 0.001) than HV. Post BT, significant reductions in RVent VDP (15.5 ± 11.7 vs 20.0 ± 14.5%, p  < 0.001), FVL-CM VDP (18.7 ± 13.9 vs 23.7 ± 17.8%, p  < 0.001), and IQD (0.53 ± 0.22 vs 0.61 ± 0.27, p  < 0.001) were observed in patients, along with significant improvements in ACQ-5, exacerbation frequency, SABA and OCS use. No change in lung function was seen. Significant correlations were observed between ΔACQ and ΔRVent VDP (ρ = 0.50, p  = 0.02), ΔFVL-CM VDP (ρ = 0.51, p  = 0.02), and ΔIQD (ρ = 0.45, p  = 0.04). Conclusions Clinical benefits post BT are accompanied by a reduction in ventilation heterogeneity that are undetected by lung function test. These findings provide valuable insights into the mechanisms of action of BT and highlight the complementary role of functional lung imaging in the study of pulmonary diseases for which traditional lung function tests may be insensitive at detecting therapeutic response.

Asthma biologics and bronchial thermoplasty (BT) are both effective therapies for severe asthma but there are no direct comparisons between the two treatments. The aims of this study are to described the outcomes of patients with severe asthma managed at a tertiary centre severe asthma clinic with either biologics, BT, or both, and to compare the effectiveness of BT with currently available biologics. Data was retrospectively collected at pre-specified timepoints-baseline, prior to BT (for patients undergoing BT), and at a follow-up clinic visit in July 2025. Data collected included demographics, serum biomarkers, lung function, asthma control questionnaire (ACQ), frequency of oral corticosteroid (OCS) requiring exacerbations, maintenance OCS dose, initial treatment prescribed and treatment changes over time. One hundred and fifteen consecutive patients' data were reviewed. Significant improvements in ACQ (3.4 (3-4.2) vs 1.8 (0.8-2.6), P<0.001) and number of OCS-requiring exacerbations (2 (1-4) vs 1 (0-1), P<0.001) were noted at follow-up compared to baseline. Sixty percent of patients who were on OCS at baseline were able to be successfully weaned off and 50% of the remaining patients were able to reduce their dose. Patients who underwent BT were either ineligible for (27%), or failed to respond to biologic therapy (73%). Despite this, significant reductions in ACQ (2.9 (2.2-3.5) vs 1.8 (1.2-2.5), P<0.001), OCS-requiring exacerbations (3.5 (2-6) vs 0 (0-1.3), P<0.001), and maintenance OCS dose were observed post BT. No significant difference was noted in the magnitude of change in key clinical outcomes between patients treated with biologics and those who underwent BT. In this retrospective real-world study, patients treated with BT had comparable clinical outcomes to those treated with asthma biologics. This included a subset of patients who were ineligible for, or failed to respond to biologic therapy. These results support the ongoing role of BT in the era of biologic therapy.

Ventilation heterogeneity is a hallmark of asthma. This study examines the feasibility of phase‐resolved functional lung magnetic resonance imaging (PREFUL MRI) in the evaluation of ventilation heterogeneity in severe asthma, its response to bronchodilator, and correlation with spirometry. Twenty‐three patients with severe asthma and seven healthy volunteers completed PREFUL MRI and spirometry pre and post‐bronchodilator. Ventilation heterogeneity was assessed using ventilation defect percentages (VDP) for regional ventilation (RVent) and flow‐volume loop cross‐correlation (FVL), interquartile distance (IQD), and inhomogeneity index (IHI). Patients exhibited a significantly higher pre‐bronchodilator VDPRVent (19.9 ± 14.0 vs. 1.9 ± 1.9%, p < 0.001), VDPFVL (21.6 ± 15.9 vs. 1.7 ± 2.1%, p < 0.001), IQD (0.60 ± 0.25 vs. 0.30 ± 0.06, p < 0.001), and IHI (0.34 ± 0.12 vs. 0.18 ± 0.04, p < 0.001) compared to healthy volunteers. Post‐bronchodilator, VDPRVent (14.7 ± 12.5 vs. 19.9 ± 14.0%, p = 0.02), IQD (0.51 ± 0.20 vs. 0.60 ± 0.25, p = 0.02), and IHI (0.30 ± 0.11 vs. 0.34 ± 0.12, p = 0.02) decreased significantly in patients but remained significantly higher than in healthy volunteers. Significant correlations were observed between pre‐bronchodilator FEV1 and VDPRVent (ρ = −0.61, p < 0.001), VDPFVL (ρ = −0.73, p < 0.001), IQD (ρ = −0.57, p = <0.001), and IHI (ρ = −0.60, p < 0.001). PREFUL MRI derived markers of ventilation heterogeneity are worse in patients with asthma, improve post‐bronchodilator, and correlate with the severity of airflow obstruction. These findings support the role of PREFUL MRI in assessing ventilation heterogeneity in asthma. Graphical showing some of the PREFUL‐derived ventilation biomarkers used in this study (left panel) and their response to bronchodilator therapy (top right panel) as well as correlations with FEV1 (bottom right panel). FEV1, forced expiratory volume in 1 s; HV, healthy volunteer; IQD, interquartile distance; PostBD, post‐bronchodilator; PreBD, pre‐bronchodilator; PT, patients with severe asthma; ρ, Spearman rho; VDPRVent, regional ventilation defect percentage; VDPFVL, flow volume loop cross‐correlation ventilation defect percentage.

Haemothorax is an accumulation of blood in the pleural space. Retained haemothorax refers to blood that cannot be drained from the pleural cavity and is associated with an increased risk of empyema and fibrothorax often necessitating surgical evacuation. We describe our experience of using intrapleural fibrinolytic therapy in three patients with different bleeding risk and acute non‐traumatic retained haemothorax. The first was a 41‐year‐old female with disseminated Candida guilliermondii sepsis and an iatrogenic haemothorax, second was a 48‐year‐old female with transfusion‐dependent acute myeloid leukaemia and spontaneous haemothorax, and the third was a 72‐year‐old female with spontaneous haemothorax from newly diagnosed lung cancer. All patients received one to two doses of intrapleural alteplase without any bleeding complications and resolution of retained haemothorax. This case series demonstrates the successful application and safety of this approach as an alternative to surgery in a well‐resourced environment with close monitoring and ready access to blood transfusion. We describe our experience of using intrapleural fibrinolytic therapy in three patients with different bleeding risk and acute non‐traumatic retained haemothorax.

Retained haemothorax is a common sequela of traumatic haemothorax and refers to blood that cannot be drained from the pleural cavity. We report a case of trapped lung secondary to retained haemothorax in a patient who sustained a penetrating chest injury. Initial chest computed tomography (CT) showed a large haemothorax that was managed with an intercostal drain insertion (ICD). Repeat chest CT and thoracic ultrasonography performed after ICD removal showed an organized pleural space resembling haematoma. ICD was reinserted with administration of intrapleural fibrinolytic therapy (IPFT). Subsequent chest CT showed the development of a pleural rind and trapped lung. A second ICD was inserted, and further IPFT were administered together with aggressive negative pressure suction. Haemoglobin remained stable. The patient made a full recovery and imaging performed two weeks later showed minor blunting of the costophrenic angle. This case highlights the feasibility and safety of IPFT in the management of trapped lung associated with traumatic retained haemothorax as an alternative to surgery.

The role of eosinophilic inflammation in exacerbations of chronic obstructive pulmonary disease (COPD) is increasingly recognised. Eosinophilic exacerbations have previously been associated with shorter hospital length of stay and lower inpatient mortality. The objective of this study was to examine clinical characteristics of hospitalised COPD exacerbations stratified by admission eosinophil count. We performed a retrospective cohort study of exacerbations of COPD at an Australian tertiary health service between 1 October 2019 and 30 September 2020 that were identified using ICD-10 discharge codes. Patients were excluded if they received any systemic corticosteroids prior to hospitalisation. Admissions were stratified according to blood eosinophil count as high eosinophil (HE, ≥2% total white blood cell count), or low eosinophil (LE, <2%). Four hundred and six patients were analysed. HE patients were younger (74.7 vs 77.7 years, p=0.001) and had fewer co-morbidities (1 [1-2] vs 2 [1-3], p=0.044). Patients with HE were less likely to be taking inhaled corticosteroids (59% vs 71%, p=0.017). HE exacerbations had a higher blood eosinophil count (0.31 vs 0.06 × 10 /L, p<0.0001), lower total white cell count (8.45 vs 10.6, p<0.001), lower CRP (10.4 vs 26.7, p<0.001), fewer infections (29.5% vs 52.1%, p<0.001) and less oxygen requirement (35.2% vs 46.8%, p=0.036). HE exacerbations had a shorter length of stay (3.56 vs 4.40 days, p=0.047) but similar inpatient mortality. Eosinophilic exacerbations of COPD were phenotypically different, affect a younger, less co-morbid population and were associated with shorter length of stay. This may be useful to help prognosticate clinical outcomes and guide clinical management.

ObjectiveThis study aimed to examine the environmental and operational factors that disrupt sleep in the acute, non-ICU hospital setting.Design, setting and participantsThis was a prospective study of adult patients admitted to an acute tertiary hospital ward (shared versus single room) and sleep laboratory (single room conducive to sleep).Main outcome measuresThis study measured ambient light (lux) and sound (dB), number of operational interruptions, and questionnaires assessing sleep and mental health.ResultsSixty patients were enrolled, 20 in a double bedroom located close to the nursing station (‘shared ward’), 20 in a single bedroom located distant to the nursing station (‘single ward’) and 20 attending the sleep laboratory for overnight polysomnography (‘sleep laboratory’). Sleep was disturbed in 45% of patients in the shared and single ward groups (Pittsburgh Sleep Quality Index > 5). Light levels were appropriately low across all 3 locations. Sound levels (significant effect of room F(1.38) = 6.452, p = 0.015) and operational interruptions (shared ward 5.6 ± 2.5, single ward 6.2 ± 2.9, sleep laboratory 2.7 ± 2.1 per night, p < 0.05 wards compared to sleep laboratory) were higher in the shared and single ward group compared to the sleep laboratory but not compared to each other. Noise was rated as the greatest environmental disturbance by 70% of ward patients compared to 10% in the sleep laboratory.ConclusionHigher noise levels and frequent operational interruptions are potential barriers to sleep and recovery on an acute medical ward which are not ameliorated by being in a single bedroom located distant to the nursing station