Tuberculosis survivors often face long-term physical, psychological, and social challenges that extend beyond microbiological cure. Post-tuberculosis complications include pulmonary damage, cardiovascular and neurological sequelae, as well as significant impacts on overall wellbeing and livelihoods. Despite increasing awareness, most care continues to focus primarily on lung disease, overlooking the multisystem and social needs of survivors. A holistic, people-centered framework that integrates medical, rehabilitative, and community-based strategies is essential for restoring health and facilitating societal participation among tuberculosis survivors.

Background: Cough is a prominent symptom of chronic respiratory diseases, including asthma, idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD), and bronchiectasis (BE). Some patients develop chronic cough (CC), defined as lasting more than 8 weeks, yet its characteristics remain poorly understood. This study aimed to characterize CC across various chronic respiratory diseases using validated cough assessment tools. Methods: The Cough Assessment in Chronic Respiratory Diseases (COASESS) study, a multicenter, prospective cross-sectional study, was conducted at 10 university hospitals. CC was evaluated in terms of intensity (numeric rating scale [NRS]), frequency (cough symptom score [CSS]), and quality of life (using the cough assessment test [COAT] and Leicester cough questionnaire [LCQ]). Cough hypersensitivity was assessed with the cough hypersensitivity questionnaire (CHQ). Data on age, sex, and smoking status were also collected. Results: Among the 303 enrolled patients, 266 with chronic respiratory diseases were included in the analysis. Patients with asthma were younger, predominantly female, and non-smokers, whereas those with COPD and IPF were older males who had previously smoked (p<0.001). Scores for COAT, LCQ, NRS, and CSS showed significant differences across the diseases, with asthma and IPF patients experiencing a greater symptom burden and lower quality of life compared to those with COPD or BE (p<0.001). Although CHQ total scores were similar across groups, asthma patients more frequently reported triggers such as talking and post-nasal drip. Conclusion This study revealed distinct characteristics of CC across different chronic respiratory diseases. Asthma and IPF were associated with a higher symptom burden, and cough hypersensitivity varied depending on the underlying condition. These findings highlight the necessity for disease-specific assessments and management strategies for CC.

Background: Asthma remission has recently emerged as an aspirational treatment goal, yet its definition remains inconsistent across studies and expert groups. The absence of a standardized framework hampers its application in clinical practice and research, particularly in Korea where biologics use is rapidly increasing. This study aimed to establish a consensus definition of clinical remission in severe asthma among Korean experts. Methods: A two-round modified Delphi survey, followed by a focused third round, was conducted among 28 board-certified pulmonologists from the Korean Academy of Tuberculosis and Respiratory Diseases (KATRD). The questionnaire consisted of six domains and 27 items. Responses were analyzed using agreement rates, interquartile ranges, and content validity ratios to determine consensus levels. Results: Consensus was reached on defining clinical remission as a composite of no exacerbations, no systemic corticosteroid use, sustained symptom control (Asthma Control Test ≥20 on at least three occasions over 12 months), and stabilization and optimization of pulmonary function while on maintenance treatment. Experts agreed that pulmonary function should be assessed based on clinical judgment rather than absolute thresholds. Complete remission was additionally defined as fulfilling all clinical remission criteria with normalization of type 2 inflammation (blood eosinophils <300/μL and fractional exhaled nitric oxide <25 ppb). Conclusion This Delphi consensus provides a regionally relevant and pragmatic framework for defining remission in severe asthma. These statements may help guide clinical practice, inform guideline development, and support future research on remission as a treatment goal.

Background: Bronchiectasis has a complex and heterogeneous pathogenesis, with various etiologies, the majority being idiopathic. This study aimed to examine the characteristics of patients with idiopathic bronchiectasis in comparison to those with post-infectious bronchiectasis. Methods: We analyzed data from patients with idiopathic and post-infectious bronchiectasis (including post-tuberculosis) from the Korean Multicenter Bronchiectasis Audit and Research Collaboration (KMBARC) registry, a prospective cohort study. Results: Among the 866 patients enrolled in the study, 346 (40.0%) were classified as having idiopathic bronchiectasis, while 363 (41.9%) had post-infectious bronchiectasis. The idiopathic group demonstrated a shorter disease duration, a higher body mass index (BMI), a lower prevalence of chronic obstructive pulmonary disease (COPD), a higher prevalence of rhinosinusitis, a predominance of lower lobe distribution, less frequent use of regular respiratory treatments, better pulmonary function, and a statistically lower bronchiectasis severity index compared to the post-infectious group. A multivariable logistic regression analysis was conducted, considering factors such as gender, age, BMI, history of asthma, COPD, rhinosinusitis, rheumatoid arthritis, gastroesophageal reflux disease, and smoking status. A higher BMI (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04 to 1.15) and a history of rhinosinusitis (OR, 3.10; 95% CI, 1.57 to 6.14) were associated with idiopathic bronchiectasis. In contrast, a history of COPD was linked to post-infectious bronchiectasis (OR, 0.57; 95% CI, 0.41 to 0.80). Conclusion Patients with idiopathic bronchiectasis are characterized by a higher BMI and a history of rhinosinusitis compared to those with post-infectious bronchiectasis. These findings may provide exploratory insights into underlying systemic or non-pulmonary factors. Further research is necessary to clarify the clinical significance of these associations.

Background: Mediastinal lymphadenopathy indicates an intrathoracic pathological process. Tuberculous mediastinal lymphadenopathy (TML) can be an early sign of tuberculosis infection, particularly in developing countries. Its incidence is often unclear due to underdiagnosis and limited access to diagnostic tools. Timely diagnosis is essential, as delayed treatment can result in severe complications. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a reliable method for obtaining samples and establishing a diagnosis, although its use is constrained by various factors. This study aims to clarify the role of EBUS features in assessing TML. Methods: This is a cross-sectional study that recruited ≥18 years old patients with suspected TML who underwent EBUS-TBNA. Mediastinal lymph nodes were systematically evaluated EBUS, with a focus on the largest nodes for further characteristic analysis. A TBNA was performed, and the retracted samples were assessed for pathology, acid-fast bacilli, Mycobacterium tuberculosis (MTB) culture, and Xpert Ultra examinations. Results: One hundred patients were recruited for the study. Fifty-three of these patients were ultimately diagnosed with TML. Significant associations were found between TML and several factors: short-axis size (p<0.001), oval-shaped lymph nodes (p=0.034), indistinct margins (p<0.001), central hilar presentation (p<0.001), internal echoes (p<0.049), thin layer echogenicity (p=0.033), and nodal matting (p<0.001). Among the diagnostic modalities, Xpert Ultra demonstrated the highest sensitivity for TML at 71.7%. Conclusion Endobronchial ultrasonographic features such as small size, round shape, indistinct margin, central hilar presentation, internal echo, thin layer echogenicity, and nodal matting are indicative of TML.

Non-pharmacological interventions are integral to the multidisciplinary management of fibrosing interstitial lung diseases (ILDs), complementing pharmacological therapies by addressing functional decline, symptom burden, and quality of life. Palliative care is fundamental, offering a structured approach to symptom control—particularly dyspnoea— and facilitating advance care planning. Oxygen therapy may provide symptomatic benefit in patients with resting, nocturnal, or exertional hypoxemia, though evidence remains limited and extrapolated mainly from idiopathic pulmonary fibrosis cohorts. Pulmonary rehabilitation, encompassing supervised exercise and patient education, has demonstrated short-term improvements in exercise tolerance; however, long-term effects on dyspnoea and health-related quality of life are inconsistent. Nutritional status is an emerging area of interest, with data linking low body mass index and unintentional weight loss, underscoring the potential value of dietary assessment and intervention. Psychological support is critical, as ILD patients frequently experience anxiety, depression, and psychological distress. Although peer-led interventions remain under-investigated, they appear to address significant unmet needs in patient education and emotional support. Occupational therapy provides tailored strategies to maintain functional independence and manage fatigue, thereby improving daily living. Immunization against influenza, pneumococcus, and severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) is essential, given the elevated risk of infection-related morbidity and mortality. For selected patients with progressive disease refractory to medical therapy, lung transplantation offers a potential survival advantage, necessitating timely referral and evaluation. Although results are promising, evidence is still limited for some interventions and further research is warranted to establish robust, evidence-based guidelines for non-pharmacological management in fibrosing ILD.

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow limitation and persistent respiratory symptoms. A key factor in the progression of COPD is small airway dysfunction (SAD), which originates in airways smaller than 2 mm in diameter. Chronic exposure to smoke and toxins leads to inflammatory remodeling and luminal obstruction, detectable through micro-computed tomography (CT) studies before spirometric airflow limitations become evident. SAD exacerbates COPD by increasing airway resistance and promoting dynamic airway collapse during exhalation. Clinically, SAD presents as gas trapping, hyperinflation, and exercise intolerance, which are associated with a rapid decline in lung function. Recent evidence indicates that SAD may be a modifiable and clinically significant trait in COPD, with management strategies including extrafine-particle inhalers, smoking cessation, pulmonary rehabilitation, and emerging biologic therapies. Various assessment methods, such as pulmonary function tests and CT imaging, are used to assess SAD. This review focuses on the role of SAD in the pathophysiology of COPD and the clinical implications of easily applicable measurements, including forced expiratory flow between 25% and 75% of forced vital capacity, impulse oscillometry, Pi10, and parametric response mapping, as well as potential treatment modalities for SAD in COPD.

Despite its prevalence—affecting up to 10% of adults worldwide—objective measurement of the cough—one of the most common yet least quantifiable respiratory symptoms—remains challenging. Conventional descriptors, such as ‘frequent’ or ‘severe,’ are inherently subjective and poorly reproducible, limiting clinical interpretation and standardization. Over the past five decades, technological advances have transformed cough assessment from manual counting and provocation testing to automated acoustic monitoring and neurophysiologic imaging. Modern validated systems, such as the Leicester cough monitor and VitaloJAK Cough monitoring system, provide reproducible measures of cough frequency, now accepted as regulatory trial endpoints. In contrast, cough intensity remains difficult to capture objectively. While physiologic tools that include peak cough flow, esophageal manometry, and electromyography provide mechanistic insights, they are invasive, and impractical for real-world use. Acoustic amplitude serves as a promising noninvasive surrogate, but suffers from ambient noise interference and lack of cross-device calibration. Functional magnetic resonance imaging and experimental brain positron emission tomography have further revealed cortical and subcortical dysregulation underlying cough hypersensitivity, reframing the chronic cough as a disorder of aberrant sensory processing. However, these approaches remain research tools, constrained by cost, accessibility, and limited validation. The future of cough assessment lies in integrated, multimodal systems that combine physioclassilogic, acoustic, and neuroimaging signals through AI-based analytics. Such approaches could transform the cough into a measurable digital biomarker—an objective ‘fifth vital sign.’ Realizing this vision will require collaborative efforts among clinicians, engineers, and policymakers to ensure validation, standardization, and clinical applicability.

Background: Impulse oscillometry (IOS) provides an effort-independent assessment of respiratory mechanics and is particularly sensitive to small airway dysfunction. Although IOS has been shown to complement spirometry in asthma, its association with exacerbation risk and its relationship with type 2 inflammatory biomarkers remain incompletely understood. Methods: In this retrospective cross-sectional study, 128 adult patients with physician-diagnosed asthma who underwent both spirometry and IOS at a tertiary hospital between January 2023 and July 2024 were analyzed. Exacerbation events during 1-year follow-up were identified from medical records. IOS parameters included resistance at 5 and 20 Hz (R5 and R20), reactance at 5 Hz (X5), resonant frequency (Fres), area under the reactance curve (AX), and frequency dependence of resistance between R5 and R20 (R5–R20). Correlations between spirometric indices and IOS parameters were assessed. Diagnostic performance for exacerbation events was evaluated using receiver operating characteristic (ROC) analysis. Exploratory analyses examined associations between IOS indices, fractional exhaled nitric oxide (FeNO), and blood eosinophil counts. Results: Thirty-three patients (25.8%) experienced exacerbations. AX showed the strongest correlations with forced expiratory volume in 1 second (FEV₁)% predicted (r=−0.51, p<0.001) and FEF25–75% predicted (r=−0.42, p<0.001). Patients with exacerbations exhibited significantly higher R5, Fres, AX, and R5–R20 compared with those without exacerbations, with AX demonstrating the largest effect size (Cohen’s d=0.91). In ROC analysis, AX showed the highest discriminative ability for exacerbation events (area under the curve=0.673). FeNO and blood eosinophil counts were not significantly correlated with IOS parameters and showed limited predictive performance when used alone; however, inclusion of AX significantly improved model discrimination. Conclusion IOS parameters, particularly AX, are significantly associated with asthma exacerbations and capture mechanical aspects of small airway dysfunction that are not fully reflected by spirometry or type 2 inflammatory biomarkers. IOS may provide clinically meaningful complementary information for risk stratification in asthma.

Background: Research on the relationship between the progression of interstitial lung abnormalities (ILA) and serum biomarkers, including white blood cell differential counts and Krebs von den Lungen-6 (KL-6), is limited. This study aimed to examine the clinical characteristics of patients with ILA and evaluate the association between disease progression and serum biomarkers. Methods: This retrospective cohort study analyzed data from 159 patients (63 with ILA and 74 with interstitial lung diseases) between October 2021 and September 2022. Data collected included clinical characteristics, pulmonary function tests, chest computed tomography (CT), complete blood cell counts, and KL-6 levels. In 52 of these patients who had previously undergone chest CT, the utility of serum biomarkers in reflecting radiologic progression was assessed using receiver operating characteristic curve analysis. Results: Patients with ILA exhibited clinical characteristics similar to those with idiopathic pulmonary fibrosis. Serum KL-6 levels did not correlate with forced vital capacity or diffusing capacity of the lung for carbon monoxide in patients with ILA. Among the 52 patients with ILA, 13 demonstrated radiologic progression. Serum KL-6 displayed moderate predictive performance, with area under the curves ranging from 0.57 to 0.89 (p=0.014) for radiologic progression. Levels of KL-6 greater than 400 U/mL were more frequently observed in patients with radiologic progression (61.5% vs. 20.5%, p=0.006). In multivariate analysis, age and KL-6 were independently associated with radiologic progression in patients with ILA. Conclusion Serum KL-6 levels may serve as a potential indicator of ILA progression in asymptomatic patients. Those with KL-6 levels exceeding 400 U/mL should be closely monitored for radiologic progression.