IgG4-related disease (IgG4-RD) is a recently recognized disorder characterized by elevated serum IgG4 levels and infiltration of IgG4 positive blood cells in the affected organs. However, other conditions like malignancy as well as connective tissue diseases, may show similar findings. A 56-year-old male patient visited Second Xiangya Hospital, Central South University for recurrent fever and chest pain for more than 1 month. Preliminary tests diagnosed as IgG4-related lung disease (IgG4-RLD). However, the improvement of symptoms was absent after the treatment with methylprednisolone. The patient underwent the second biopsy and the result eventually demonstrated lung adenocarcinoma. The role of IgG4 in the pathogenesis or prognosis for lung adenocarcinoma remains unclear. Therefore, a thorough evaluation of symptoms, test of specific serum markers and eventually pathological confirmation are required to avoid misdiagnosis.

Both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSA) are common respiratory diseases. Both can exist at the same time, which is referred to as the " overlap syndrome (OS)". Epidemiological studies showed poorer outcomes with increased comorbidities and mortality, which indicated complicated interactions between COPD and OSA. Even though the underlying mechanisms of overlap syndrome have not yet well understood, the airway and systemic inflammation as well as oxidative stress induced by hypoxia played an essential role in the disease interactions and pathogeneses of comorbidities, mainly cardiovascular diseases. One other question is that how to treat the overlap syndrome. This paper summarizes the current research progress of the overlapping interaction and treatment.

Asthma and chronic obstructive pulmonary disease overlap (ACO) is a hot topic in recent years. Although the precise definition of ACO is still controversial, scholars have found that the patients with overlapping features of asthma and COPD have a worse prognosis and increased medical cost than those with asthma or COPD alone. Thus, there is a big challenge to have a better understanding and to manage these patients in clinical practice. To strengthen awareness of this type of patients, the Global initiative for Chronic Obstructive Lung Disease (GOLD) and Global initiative for asthma (GINA) in 2014 named them as " Asthma Chronic Obstructive Lung Overlap Syndrome" (ACOS), which was further revised to the Asthma Chronic Obstructive Lung Overlap (ACO) in the follow-up GINA guidelines (2017). In the updated version, it emphasized that ACO was not a separate disease. However, although the research on ACO has increased significantly in recent years, there are still many controversies, which includes the definition, diagnostic criteria and treatment therapies. In this review, we provide the recent advances in the diagnosis and an overview of available treatment for of ACO.

Primary enteric adenocarcinoma is a rare variant of primary pulmonary adenocarcinoma. This disease lacks a distinctive manifestation and often requires pathological examination to make a definite diagnosis. A male patient visited the Second Xiangya Hospital, Central South University for consistent cough and sputum production for about 1 year. Anti-infection therapy was given but it showed ineffectiveness. Enteric adenocarcinoma was diagnosed after percutaneous lung biopsy according to pathological findings. Combining this case with relevant literature, we summarized the characteristics to raise physicians' awareness for this rare subtype.
Adenocarcinoma/surgery* ; Adenocarcinoma of Lung ; Humans ; Lung ; Lung Neoplasms ; Male

BACKGROUND: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 proposed a new classification that reclassified many chronic obstructive pulmonary disease (COPD) patients from group D to B. However, there is a paucity of data related to the comparison between reclassified and non-reclassified COPD patients in terms of long-term prognosis. This study aimed to investigate long-term outcomes of them and determine whether the GOLD 2017 revision improved the assessment of COPD patients. METHODS: This observational, multicenter, prospective study recruited outpatients at 12 tertiary hospitals in China from November 2016 to February 2018 and followed them up until February 2022. All enrolled patients were classified into groups A to D based on GOLD 2017, and the subjects in group B included patients reclassified from group D to B (group DB) and those remaining in group B (group BB). Incidence rates and hazard ratios (HRs) were calculated for the exacerbation of COPD and hospitalization in each group. RESULTS: We included and followed up 845 patients. During the first year of follow-up, the GOLD 2017 classification had a better discrimination ability for different risks of COPD exacerbation and hospitalization than GOLD 2013. Group DB was associated with a higher risk of moderate-to-severe exacerbation (HR = 1.88, 95% confidence interval [CI] = 1.37-2.59, P  <0.001) and hospitalization for COPD exacerbation (HR = 2.23, 95% CI = 1.29-3.85, P  = 0.004) than group BB. However, during the last year of follow-up, the differences in the risks of frequent exacerbations and hospitalizations between group DB and BB were not statistically significant (frequent exacerbations: HR = 1.02, 95% CI = 0.51-2.03, P  = 0.955; frequent hospitalizations: HR = 1.66, 95% CI = 0.58-4.78, P  = 0.348). The mortality rates of the two groups were both approximately 9.0% during the entire follow-up period. CONCLUSIONS The long-term prognosis of patients reclassified into group B and of those remaining in group B was similar, although patients reclassified from group D to group B had worse short-term outcomes. The GOLD 2017 revision could improve the assessment of Chinese COPD patients in terms of long-term prognosis.
Humans ; Prospective Studies ; East Asian People ; Disease Progression ; Severity of Illness Index ; Pulmonary Disease, Chronic Obstructive/epidemiology*

OBJECTIVES: Pulmonary alveolar proteinosis (PAP) is a rare disease with non-specific and various clinical manifestations, often leading to misdiagnosis. This study aims to raise the awareness of this disease via summarizing the clinical characteristics, diagnosis, and therapy of PAP. METHODS: We retrospectively analyzed clinical data of 25 hospitalized cases of PAP during 2008 and 2019 in the Department of Respiratory and Critical Care Medicine of the Second Xiangya Hospital of Central South University. RESULTS: Cough with unkown reason and dyspnea were common clinical manifastations of PAP. Five patients had a history of occupational inhalational exposure. Sixteen patients had typical image features including ground-glass opacification of alveolar spaces and thickening of the interlobular and intralobular septa, in typical shapes called crazy-paving and geographic pattern. Fourteen patients underwent pulmonary function tests, revealing a reduction in the diffusing capacity for carbon monoxide. The positive rate of transbronchial biopsy was 95%. Five patients received the whole lung lavage and the symptoms and imaging fcauters significantly relieved after five-years follow-up. CONCLUSIONS PAP is characterized by radiographic pattern and pathology. Transbronchial lung biopsy is effective to make diagnosis of PAP. The whole lung lavage remains a efficient therapy.
Biopsy ; Bronchoalveolar Lavage ; Cough ; Dyspnea ; Humans ; Pulmonary Alveolar Proteinosis/therapy* ; Retrospective Studies