Amiodarone-induced pulmonary toxicity (AIPT) is one of the most serious adverse effects of amiodarone and is one of the leading causes of death associated with its use. The onset of AIPT depends on dosage, patient's age, and pre-existing pulmonary pathologies; typically, the adverse effects stop progressing when a cumulative dose higher than 150 mg is reached. The risk of developing amiodarone-induced pulmonary fibrosis is directly related to the dosage and duration of administration. In this case report, the effect of a prolonged overdose of amiodarone taken at doses of 200 mg/day for two years is reported, with symptoms and instrumental evidence of respiratory pathology induced by amiodarone drug toxicity. Comorbidities, oxygen therapy, invasive procedures, and surgical interventions can trigger pulmonary symptoms. Despite significant advances in understanding AIPT, its etiology and pathogenesis remain poorly understood. The role of steroids in the treatment of AIPT is still under debate as most reports of improvement after amiodarone withdrawal differ little from those in which concomitant steroid therapy was used. In clinical practice, therapeutic doses of corticosteroids may be indicated for patients with AIPT; usually, a starting dose of prednisone from 40 to 60 mg daily, which is then gradually reduced, is prescribed. The pharmacodynamics of amiodarone determines a treatment period of four to 12 months.The patient with AIPT in this case report, who markedly improved after treatment with prednisone at a starting dose of 50 mg/day, which was then gradually tapered. At the end of the therapy, the computed tomography (CT) scan revealed the disappearance of most of the scattered ground-glass opacities and of the thickening indicating bi-apical pulmonary fibrosis.The case report is unique because: 1) Bronchoalveolar lavage (BAL)/transbronchial biopsy was not used for diagnosis.2) The case was framed based on the patient's laboratory and clinical data.3) The pathology is normally prevalent in men rather than women.

Physicians use auscultation as a standard method of thoracic examination: it is simple, reliable, non-invasive, and widely accepted. Artificial intelligence (AI) is the new frontier of thoracic examination as it makes it possible to integrate all available data (clinical, instrumental, laboratory, functional), allowing for objective assessments, precise diagnoses, and even the phenotypical characterization of lung diseases. Increasing the sensitivity and specificity of examinations helps provide tailored diagnostic and therapeutic indications, which also take into account the patient's clinical history and comorbidities. Several clinical studies, mainly conducted in children, have shown a good concordance between traditional and AI-assisted auscultation in detecting fibrotic diseases. On the other hand, the use of AI for the diagnosis of obstructive pulmonary disease is still debated as it gave inconsistent results when detecting certain types of lung noises, such as wet and dry crackles. Therefore, the application of AI in clinical practice needs further investigation. In particular, the pilot case report aims to address the use of this technology in restrictive lung disease, which in this specific case is pulmonary sarcoidosis. In the case we present, data integration allowed us to make the right diagnosis, avoid invasive procedures, and reduce the costs for the national health system; we show that integrating technologies can improve the diagnosis of restrictive lung disease. Randomized controlled trials will be needed to confirm the conclusions of this preliminary work.

This case report describes the combination of pulmonary fibrosis and emphysema (CPFE) as a possible new addition to the growing list of smoking-related lung diseases, which are characterised by the coexistence of usual interstitial pneumonia (UIP) or non-specific interstitial pneumonia (NSIP) with emphysema in tobacco smokers.

Reflux asthma is an entity characterised by typical symptoms and in some cases is 'silent' and is more dangerous when associated with obesity and sleep apnoea syndrome. Its prevalence in the general population is high, as demonstrated by numerous studies listed below, and it is particularly a problem in the paediatric population; where, despite treatment by medical specialists, asthma symptoms are poorly controlled with a high risk of acute exacerbations. The aim of this clinical study is to show how the addition of a particular type of alginate (Deflux plus sachets) containing hyaluronic acid and melatonin at low doses administered over a prolonged period of six months, causes a reduction in vagal reflex stimulation of the oesophagus and pulmonary microaspiration reflexes by regulating lower oesophageal sphincter (LES) motility in asthmatic patients; improving the ACT score (asthma control test score). In the reported statistical analysis, ROC curves were performed for sensitivity and specificity for the analysed parameters, including the ACT score with statistically significant data p<0.0001. We conclude that the combination of conventional therapy for reflux asthma associated with alginates may improve the risk of acute asthma exacerbation and dynamic lung volumes.

SARS-CoV-2 infection impairs functional outcomes and quality of life, even in its mild-to-moderate form. It is therefore appropriate to draw attention to the role played by respiratory rehabilitation and physiotherapists in the pulmonary rehabilitation process that post-SARS-CoV-2 patients must undergo. We enrolled 80 patients in a prospective case-control study; 40 cases (mild-to-moderate post-SARS-CoV-2 infection patients) and 38 control subjects (i.e. patients affected by other respiratory diseases) completed a full pulmonary rehabilitation cycle. 6 Minute Walking Distance, Borg CR10 Scale, modified Medical Research Council (mMRC) Dyspnoea scale, EuroQoL EQ-5D-3L questionnaire, Barthel scale, arterial blood gas test and peripheral oxygen saturation (SpO2) were compared for all patients before and after rehabilitation. All patients experienced significant improvements in all parameters analyzed, except for arterial blood gas test. Results were similar for both groups, in particular both groups experienced improvements in mMRC scale, EuroQoL questionnaire, Barthel scale and 6-minute walking distance. Pulmonary rehabilitation appears to improve exercise tolerance, dyspnea and quality of life in patients recovering from mild-to-moderate SARS-CoV-2 infection. Further studies are needed on larger sample size population to validate these results.