Mycobacterium abscessus complex: A Review of Recent Developments in an Emerging Pathogen

What Is Chronic Lung Disease, The Condition Pope Francis Suffers From?

In just a matter of weeks, Pope Francis has faced several new challenges in his long-running battle with chronic lung disease. The spiritual leader's condition has been critical, with news of his well-being waxing and waning since Feb. 14 given his age and fragility.

Here's a breakdown of what 88-year-old Francis is facing:

What conditions does Pope Francis have?

As of Tuesday afternoon, Francis was in critical but stable condition at Rome's Gemelli hospital, where he had already spent nearly a dozen days in treatment. The Argentine pope was battling double pneumonia, as only his latest bout with lung infection.

He already suffered from preexisting chronic lung disease. As a young man, a portion of one of his lungs was ultimately removed after a severe respiratory infection.

ExplorePope Francis shows slight improvement and resumes some work, while still critical, Vatican says

Francis initially entered the hospital following a weeklong bout with chronic bronchitis. The double pneumonia diagnosis quickly followed. By the end of his first week of treatment, he was facing double pneumonia and chronic bronchitis, as well as bacterial, viral and fungal lung infections.

Credit: NYT

Credit: NYT

What is chronic lung disease?

According to the American Lung Association, chronic lung disease prevents the lungs and respiratory system from working correctly. It manifests in three ways: restrictive lung diseases, obstructive lung diseases and pulmonary vascular lung diseases.

Restrictive lung diseases include conditions that inflame or scar the lungs, including pulmonary fibrosis and sarcoidosis. Obstructive lung diseases include asthma and chronic bronchitis, diseases that often cause thick mucus buildup along the lungs' air sacs. Pulmonary vascular lung diseases, which include pulmonary hypertension and pulmonary embolism, concern the organ's blood vessels.

While there is no cure, there are ways to improve your symptoms and manage chronic lung disease. According to the ALA, people living with the disease should stay up to date on vaccinations that prevent respiratory infections like flu or pneumonia, eat healthy foods and continue to stay active.

What is bronchitis?

Stuffy nose, chest congestion, wheezing — bronchitis symptoms range from light fatigue to coughing up mucus. The ALA reported that the lung infection can often go away on its own after running its natural course for several weeks.

However, Francis is prone to bronchitis in winter because of his preexisting lung disease. As a viral infection, antibiotics are not an effective treatment so it's important to rest and drink plenty of water, which can help loosen chest congestion.

ExploreHow the extreme cold can affect your lungs

Chronic bronchitis is a more serious condition that develops over time. While symptoms may get better or worse, the ALA reports they will never completely go away.

What is double pneumonia?

According to the ALA, pneumonia can have mild, even unnoticeable, symptoms. Other times, however, the signs are severe. The lung disease sometimes causes coughs that produce mucus (sometimes blood), fever, sweating, shaking, rapid breathing, sharp chest pain, loss of appetite, nausea and confusion. Fevers can reach as high as 105 degrees.

When the disease affects both lungs, it is referred to as double (or bilateral) pneumonia. The lungs become infected, inflaming the air sacs within. The inflammation leads to a buildup of fluid, which makes breathing difficult.

According to the American Thoracic Society, adults who survive pneumonia sometimes still face long-term effects, including cognitive decline and an overall worsening quality of life for months to years.

From 1999 to 2019, an estimated 2.1% of all U.S. Deaths were caused by pneumonia. It remains the single largest infection-related cause of death among children worldwide, according to the World Health Organization.

When should you call a doctor about lung disease?

Different lung diseases come with different symptoms, but there are commonalities between them. According to the Yale School of Medicine, patients should consider making an appointment with a pulmonologist if they are experiencing shortness of breath, a persistent cough, recurring chest infections, loud snoring at night or excessive sleepiness during the day.

ALA advised patients to seek a pulmonologist in consultation with their primary care provider if their cough persists for more than three weeks or becomes severe.

"A simple cough associated with allergies or a cold shouldn't send you looking for a pulmonary specialist," according to the association's website. "Urgent care or your primary care doctor should be your first stop, and then on to an allergist or ear, nose and throat (ENT) specialist."

Some diseases come with extra caution signs, however. Because it can be deadly, especially to children, the ALA advises anyone who believes they have pneumonia to seek medical treatment before it gets worse.

"And see your doctor right away if you have difficulty breathing, develop a bluish color in your lips and fingertips, have chest pain, a high fever, or a cough with mucus that is severe or is getting worse," states the ALA website.

Adults older than 65, children 2 or younger and people with underlying medical conditions or weakened immune systems are considered high-risk groups.

Bronchitis, on the other hand, is something the ALA is only as concerned with when its chronic.

"On average, the symptoms of acute bronchitis last only a couple of weeks," the website said. "However, if you have a cough that won't go away, or if you get sick with bronchitis frequently, it may be the sign of a more serious disease and you should visit your doctor."

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Lung Cancer: Basic Info You Should Know

It's cancer that starts in your lungs and can spread to other parts of your body. Although it's the top cause of cancer deaths for U.S. Men and women, it's also one of the most preventable kinds, by not smoking and avoiding other people's secondhand smoke.

The disease almost always starts in the spongy, pinkish gray walls of the lungs' airways (called bronchi or bronchioles) or air sacs (called alveoli).

There are more than 20 kinds of lung cancer. The two main types are non-small-cell lung cancer and small-cell lung cancer.

Adenocarcinoma is the most common kind of NSCLC. It makes up 40% of lung cancer cases. It mainly happens in people who smoke or who used to. It's also the No. 1 type of lung cancer among nonsmokers.

More women get it than men. People with this type tend to be younger than those with other kinds.

Adenocarcinoma can spread to the lymph nodes, bones, or other organs such as the liver.

Squamous cell carcinoma usually starts in the lung's largest branches, which doctors call the central bronchi.

This type accounts for 30% of lung cancers, and it's more common in men and people who smoke. It may form a cavity within the tumor. It often involves the larger airways. It may make you cough up some blood.

Squamous cell carcinoma can also spread to the lymph nodes, bones, and other organs such as the liver.

Large-cell carcinomas are a group of cancers with large cells that tend to start along the lungs' outer edges. They're rarer than adenocarcinoma or squamous cell carcinoma, making up 10%-15% of lung cancers. This type of tumor can grow faster and often spreads to nearby lymph nodes and distant parts of the body.

This is the most aggressive form of the disease. It usually starts in the large, central bronchi. Almost all people who get it are smokers. It spreads quickly, often before symptoms appear. Many times, it spreads to the liver, bone, and brain. Small-cell lung cancer makes up 10%-15% of lung cancers.

The outlook for someone with lung cancer depends on a lot of things, including what type they have, their overall health, and how advanced the disease is when doctors find it.

Smoking is the biggest reason. It's responsible for about 85% of all cases.

Quitting cuts the risk. Former smokers are still slightly more likely to get it than nonsmokers.

There are also other reasons. Some genetic glitches may put some people at higher risk.

Secondhand tobacco smoke is also a cause. People who live with someone who smokes are 20% to 30% more likely to get lung cancer than those who live in a smoke-free home. People exposed to radiation therapy can also have a higher risk.

Some other chemicals are risky, too. People who work with asbestos or are exposed to uranium dust or the radioactive gas radon are more likely to get lung cancer, especially if they smoke.

Lung tissue that was scarred by a disease or infection, such as scleroderma or tuberculosis, becomes at risk for tumors in that tissue. Doctors call this a scar carcinoma. The risk is also higher in people that have pulmonary fibrosis or HIV infection.

Some researchers think that diet may also influence your risk. But that's not clear yet.

There often aren't any symptoms in the early stages. For other people, red flags that can be linked to lung cancer include:

Shortness of breath

Coughing that doesn't go away

Wheezing

Coughing up blood

Chest pain

Fever

Weight loss with or without loss of appetite

Hoarse voice

Shoulder or arm pain or weakness

Trouble swallowing

Unusual bone pain

Talk to your doctor if you have those lung cancer symptoms. There could be other explanations.

A type of CT scan, called spiral or helical low-dose CT scanning, has helped to find the disease early in smokers and former smokers when combined with other tests.

The U.S. Preventive Services Task Force recommends an annual low-dose CT scan for adults ages 50 - 80  with a 20-pack-year history of smoking who currently smoke or who have quit within the past 15 years.

Treatment depends on what type of lung cancer you have and how advanced it is.

Sometimes, doctors can do surgery to remove a tumor if the disease hasn't spread. You may also get radiation, chemotherapy, targeted therapy, or immunotherapy.

If your lung cancer is advanced -- for instance, if it has spread to distant parts of your body -- there are still treatments that can control the disease and prevent further symptoms. You might get radiation and chemotherapy to shrink tumors and help control symptoms.

Pain management is also key. At any point in your treatment, tell your doctor if you're in pain.

If your doctor mentions "palliative care," that includes helping you feel comfortable, managing pain, and improving your life as much as possible. It's not the same as hospice care, which focuses on preparing for the end of life.

Pay attention to your emotions, too. Dealing with cancer is hard. It's normal to feel a lot of strong emotions, including fear, anger, and sadness. It can help to talk with a counselor or join a support group to help you work through those feelings and face the many challenges that come with a cancer diagnosis.

Before recommending which treatment or combination of treatments is right for you, your doctor will determine how advanced your lung cancer is, a process called staging. This usually involves getting a CT scan of the chest and abdomen, and possibly a PET scan. You may also get a bone scan, a CT or MRI scan of the brain, and other tests.

Recurrence-free Survival Estimates After Surgery Higher In Less Advanced Lung Cancer

February 27, 2025

2 min read

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The recurrence-free survival estimate at 5 years was 34% in stage III non-small cell lung cancer.

Significant links between several patient factors and a reduced likelihood for recurrence-free survival emerged.

Among patients with non-small cell lung cancer treated with resection surgery, those classified as stage I vs. Stage III had higher recurrence-free survival estimates 5 years after the procedure, according to results published in CHEST.

"Our systematic literature review and meta-analysis presents a contemporary and thorough assessment of [recurrence-free survival] and recurrence outcomes from the published clinical literature, providing estimates at multiple time points after surgery by stage and geographic region," Ravi Rajaram, MD, MSc, FACS, assistant professor in the department of thoracic and cardiovascular surgery at The University of Texas MD Anderson Cancer Center, and colleagues wrote.

Data were derived from Rajaram R, et al. CHEST. 2023;doi:10.1016/j.Chest.2023.11.042.

After searching through three databases from January 2011 up to June 2021, Rajaram and colleagues examined 471 studies (87% retrospective; 75% single-center; 70% in Asia) of patients with stage I to III non-small cell lung cancer (NSCLC) who underwent surgical resection to determine how many patients achieve recurrence-free survival at yearly time points following surgery, as well as the characteristics that are linked to this type of survival.

Using staging criteria from either the seventh or eighth edition of the AJCC Cancer Staging Manual (n = 60,695; 85 studies), researchers observed high effect estimates of recurrence-free survival in patients with stage I NSCLC at 1 year (96%), 3 years (87%) and 5 years (81%) after surgery.

In the set of patients with stage II cancer, lower recurrence-free survival estimates were found (3 years, 58%; 5 years, 50%), and these estimates further decreased among patients with stage III NSCLC at the 1-year (68%), 3-year (38%) and 5-year (34%) mark, according to the study.

"As expected, we observed a steep decline in [recurrence-free survival] between stage I and stage III disease at all time points of interest," Rajaram and colleagues wrote.

When switching to use of only staging criteria from the eighth edition, the effect estimate of recurrence-free survival in patients with stage I NSCLC rose marginally above those found when using staging criteria from both editions at 3 years (89%) and 5 years (84%). This was also true for patients with stage III NSCLC, with an effect estimate of 48% at 3 years and 37% at 5 years.

Researchers found significant links between several patient characteristics and a reduced likelihood for recurrence-free survival:

rise in age by 1 year (3-year recurrence-free survival, OR = 0.94; 5-year recurrence-free survival, OR = 0.95);

stage II and III vs. I NSCLC (3-year, OR = 0.41);

larger average tumor size by 1 cm (3-year, OR = 0.6; 5-year, OR = 0.46);

increase in proportion of men by 1% (3-year, OR = 0.19);

North America vs. Asia geographic region (3-year, OR = 0.46; 5-year, OR = 0.38) and;

Europe vs. Asia geographic region (5-year, OR = 0.41).

In contrast, a significantly higher likelihood for recurrence-free survival was found among those who received mixed treatment approaches rather than lobectomy (5-year, OR = 1.5), according to the study.

"These findings can inform treatment decisions, clinical trial design and future research to improve outcomes among patients with NSCLC," Rajaram and colleagues wrote.

Sources/DisclosuresCollapse Disclosures: Johnson & Johnson funded this study. Rajaram reports being a consultant for Johnson & Johnson. Please see the study for all authors' relevant financial disclosures.

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