Background: Squamous cell carcinoma has a stronger association with tobacco smoking than other nonsmall cell lung cancers (NSCLC). A study was undertaken to determine whether chronic obstructive pulmonary disease (COPD) is a risk factor for the squamous cell carcinoma histological subtype in smokers with surgically resectable NSCLC. Methods: Using a case-control design, subjects with a surgically confirmed diagnosis of squamous cell carcinoma were enrolled from smokers undergoing lung resection for NSCLC in the District Hospital of Ferrara, Italy. Control subjects were smokers who underwent lung resection for NSCLC in the same hospital and had a surgically confirmed diagnosis of NSCLC of any histological type other than squamous cell. Results: Eighty six cases and 54 controls (mainly adenocarcinoma, n = 50) were enrolled. The presence of COPD was found to increase the risk for the squamous cell histological subtype by more than four times. Conversely, the presence of chronic bronchitis was found to decrease the risk for this histological subtype by more than four times. Among patients with chronic bronchitis (n = 77), those with COPD had a 3.5 times higher risk of having the squamous cell histological subtype. Conclusions: These data suggest that, among smokers with surgically resectable NSCLC, COPD is a risk factor for the squamous cell histological subtype and chronic bronchitis, particularly when not associated with COPD, is a risk factor for the adenocarcinoma histological subtype.

Haemoptysis, which is a challenging symptom accounting for 10-15% of all pulmonology consultations, may be associated with life-threatening medical conditions such as lung cancer [1-7]. Its aetiology and epidemiology vary widely among studies according to geographic locations and time of publication, epidemiological design, and diagnostic tests employed [2-8]. Bronchiectasis, malignancies, post-tuberculosis sequelae, and idiopathic bleedings have been recognised as the most frequent causes of haemoptysis in Europe over the last decade [3-7]. No guidelines exist suggesting an optimal work-up of symptoms, and data on the diagnostic yield of the most commonly prescribed examinations are limited [8]. The aim of this observational, prospective, multicentre study was to investigate the haemoptysis aetiology in association with its severity in an Italian population. We also evaluated the diagnostic yield of the prescribed diagnostic tests. The study was approved by the ethical committees of five Italian participating hospitals and registered at ClinicalTrials.gov (identifier: NCT02045394). Written informed consent was signed by the recruited patients, who were followed-up for 18 months. Herein, we report the findings of the baseline assessment. From July 2013 to September 2015, consecutive adult (i.e. ⩾18 years old) patients with haemoptysis were considered eligible. The following were considered as exclusion criteria: 1) aetiology of haemoptysis already detected (e.g. proven cancer-related and/or bronchiectasis-related haemoptysis); and 2) refusal to sign the informed consent. Patients were divided into three groups on the basis of the total amount of blood expectorated in 24 h [2, 3, 9]: mild (i.e. drops of blood to 20 mL in 24 h), moderate (i.e. 20-500 mL in 24 h), and severe (i.e. >500 mL in 24 h). All enrolled patients underwent physical examination and blood analysis. Subsequent tests deemed necessary for the diagnosis (i.e. sputum cultures, chest radiography, multi-detector chest computed tomography (CT), bronchoscopy, otorhinolaryngological evaluation, angiography) were chosen by the attending clinician on the basis of the clinical hypothesis and the symptom-driven diagnostic protocols of each hospital involved in the study. Final diagnosis was established in each centre, on the basis of the clinical and imaging evidence, by a multidisciplinary consensus that involved pulmonologists, radiologists, pathologists and otorhinolaryngologists. An electronic ad hoc form was created to collect demographic, epidemiological and clinical variables. Absolute and relative frequencies were used to summarise qualitative variables. Quantitative variables, for which the non-parametric distribution was assessed with the Shapiro-Wilk test, were summarised with medians and interquartile ranges (IQRs). 95% confidence intervals were computed to provide an interval estimation. The statistical software used for all the computations was Stata13.0 (StataCorp, College Station, TX, USA). During the study period, 606 patients (median age 67...

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In stable conditions patients with an NFA attack in the previous 5 years cannot be distinguished from patients with mild-to-moderate asthma, while they are different from severe asthmatics both in terms of lung function and of airway inflammation. The risk factor that characterizes this group of patients is reduced usage of prophylactic corticosteroids.

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Cytopathological analyses of bronchial washings (BWs) collected during fibre‐optic bronchoscopy are often inconclusive for lung cancer diagnosis. To address this issue, we assessed the suitability of conducting molecular analyses on BWs, with the aim to improve the diagnosis and outcome prediction of lung cancer. The methylation status of RASSF1A, CDH1, DLC1 and PRPH was analysed in BW samples from 91 lung cancer patients and 31 controls, using a novel two‐colour droplet digital methylation‐specific PCR (ddMSP) technique. Mutations in ALK, BRAF, EGFR, ERBB2, KRAS, MAP2K1, MET, NRAS, PIK3CA, ROS1 and TP53 and gene fusions of ALK, RET and ROS1 were also investigated, using next‐generation sequencing on 73 lung cancer patients and 14 tumour‐free individuals. Our four‐gene methylation panel had significant diagnostic power, with 97% sensitivity and 74% specificity (relative risk, 7.3; odds ratio, 6.1; 95% confidence interval, 12.7–127). In contrast, gene mutation analysis had a remarkable value for predictive, but not for diagnostic, purposes. Actionable mutations in EGFR, HER2 and ROS1 as well as in other cancer genes (KRAS, PIK3CA and TP53) were detected. Concordance with gene mutations uncovered in tumour biopsies was higher than 90%. In addition, bronchial‐washing analyses permitted complete patient coverage and the detection of additional actionable mutations. In conclusion, BWs are a useful material on which to perform molecular tests based on gene panels: aberrant gene methylation and mutation analyses could be performed as approaches accompanying current diagnostic and predictive assays during the initial workup phase. This study establishes the grounds for further prospective investigation.

We report here a case of primary pulmonary epithelioid hemangioendothelioma diagnosed in a 67-year-old Caucasian man, presenting with exertion dyspnoea, dry cough, and multiple bilateral pulmonary nodules revealed by computed tomography. At the 18F-fluorodeoxyglucose positron emission tomography, these nodules were negative. The histopathological diagnosis was made on a pulmonary wedge resection (performed during video-thoracoscopic surgery).

In our study, premedication with midazolam increased the patient-reported tolerance of the bronchoscopy. However, the absence of premedication did not affect the diagnostic yield of the procedure.