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Background: Severe community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and while European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP., Materials and Methodology: The European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Latin American Thoracic Association (ALAT) launched a task force to develop the first international guidelines for sCAP. The panel comprised a total of 18 European and four non-European experts, as well as two methodologists. Eight clinical questions for sCAP diagnosis and treatment were chosen to be addressed. Systematic literature searches were performed in several databases. Meta-analyses were performed for evidence synthesis, whenever possible. The quality of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Evidence to Decision frameworks were used to decide on the direction and strength of recommendations., Results: Recommendations issued were related to diagnosis, antibiotics, organ support, biomarkers and co-adjuvant therapy. After considering the confidence in effect estimates, the importance of outcomes studied, desirable and undesirable consequences of treatment, cost, feasibility, acceptability of the intervention and implications to health equity, recommendations were made for or against specific treatment interventions., Conclusions: In these international guidelines, ERS, ESICM, ESCMID and ALAT provide evidence-based clinical practice recommendations for diagnosis, empirical treatment and antibiotic therapy for sCAP, following the GRADE approach. Furthermore, current knowledge gaps have been highlighted and recommendations for future research have been made., Competing Interests: Conflict of interest: I. Martin-Loeches reports grants from GE, consulting fees from Gilead and MSD, lecture honoraria from MSD, Gilead and Mundipharma, and advisory board and lectures for Pfizer, MSD and Menarini, outside the submitted work. A. Torres reports consulting fees and lecture honoraria from Pfizer, Poliphor, MSD, Jansen and OM Pharma, and advisory board and lectures for Pfizer, MSD, Atriva, Jansen and Menarini, outside the submitted work. B. Nagavci serves as the ERS methodologist. S. Aliberti reports grants from Insmed Incorporated, Chiesi, and Fisher & Paykel, royalties from McGraw Hill, consulting fees from Insmed Incorporated, Insmed Italy, Insmed Ireland Ltd, Zambon, AstraZeneca UK Limited, CSL Behring GmbH, Grifols, Fondazione Charta, Boehringer Ingelheim, Chiesi, Zcube Srl, Menarini and MSD Italia Srl, lecture honoraria from GlaxoSmithKline Spa, and advisory board participation with Insmed Incorporated, Insmed Italy, AstraZeneca UK Limited and MSD Italia Srl, outside the submitted work. M. Antonelli reports grants from GE, consulting fees from Gilead, lecture honoraria from MSD, Chiesi, Fisher & Pickel, and Orphan, and a leadership role at ESICM, outside the submitted work. M. Bassetti reports research grants and/or advisor/consultant and/or speaker/chairman for Bayer, Biomerieux, Cidara, Cipla, Gilead, Menarini, MSD, Pfizer, Shionogi and ThermoFisher, outside the submitted work. L. Bos reports grants from the Dutch Lung Foundation (young investigator grant), the Dutch Lung Foundation and Health Holland (public–private partnership grant), Dutch Lung Foundation (Dirkje Postma Award), IMI COVID19 initiative and Amsterdam UMC fellowship, outside the submitted work. J. Chalmers reports research grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Grifols, Novartis and Insmed, and received consultancy or speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis, Pfizer and Zambon, outside the submitted work, and is chief editor of the ERJ. L. Derde reports grants from European Union's FP7 grant PREPARE (602525); EU FP7-HEALTH-2013-INNOVATION-1, grant number 602525, H2020 RECOVER grant agreement number 101003589, ZonMw grant ANAkinra voor de behandeling van CORonavirus infectious disease 2019 op de Intensive Care (ANACOR-IC) project number 10150062010003, lecture honoraria from Netherlands International Sepsis Symposium, travel support from ESICM, ISICEM, Weimar sepsis Update, European Respiratory Society, Critical Care Reviews, UPMC Pittsburgh, International Sepsis Forum and ANZICS/ACCCN ASM, and advisory board participation with Sepsis Canada International; REMAP-CAP has received drugs as part of the trial interventions; and the following leadership positions: chair, international trial steering committee, REMAP-CAP (2021–present), coordinating committee member, ECRAID (2021–present), member expert panel on COVID-19 therapeutics, European Commission (2021–present), member “Pandemic Preparedness Plan” committee, KNAW (2021–present), chair elect Education and Training Committee (2019–2021), chair Clinical Training Committee, ESICM (2019–2021), task force infectious threats, NVIC (chair 2019–2021), outside the submitted work. J. de Waele reports grants from Flanders Research Foundation and consulting fees from Pfizer and MSD, outside the submitted work. M. Kollef reports consulting fees from Merck, Pfizer and Shionogi, outside the submitted work. C. Luna reports grants as principal investigator in clinical trials, has participated on adjudication committee for diagnosis in clinical trials, has received honoraria for lectures on pulmonary infections, has received economical support for attending to the ERS and ATS meetings, and has participated on an advisory board for pneumococcal vaccines, outside the submitted work. R. Menendez reports lecture honoraria from, and participated on advisory boards for Pfizer, Advanz Pharma, Gilead Sciences and GSK, and travel support from Pfizer, Gilead and Advanz Pharma, outside the submitted work. M. Niederman reports grants from Shionogi, Merck and Bayer, consulting fees from Pfizer, Merck, Shionogi, Bayer, Nabriva and Thermo-Fisher, and participation on an advisory board for Fab'entec, outside the submitted work. D. Rigau formerly served as ERS methodologist. M. Schultz received grants from Zonmw (Netherlands Organisation For Health Research And Development) and financial support from Hamilton Medical AG, Switzerland, outside of this project. E. Weiss reports speaker and travel fees from MSD, Akcea Therapeutics and LFB, outside the submitted work. T. Welte reports grants from German Ministry of Research and Education, lecture honoraria from Advanz, Biotest, Thermo Fischer, MSD, Pfizer and Shionogi, outside the submitted work. R. Wunderink reports consultancy and lectures for bioMerieux, and consultancy for MSD, Shionogi, LaJolla, Venatorx, Vir and Microbiotx, and has acted as chairman, clinical evaluation committee for Pfizer, and as DSMB member for Vir, outside the submitted work. All other authors have nothing to disclose., (The content of this work is not subject to copyright. Design and branding are copyright ©ERS 2023. For reproduction rights and permissions contact permissions@ersnet.org.)

This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available., Competing Interests: Conflict of interest: T.G. Blum reports an unrestricted grant from Stiftung Oskar-Helene-Heim (Berlin, Germany), through which staff support for the work of the current Task Force was provided. R.L. Morgan declares no competing interests. V. Durieux declares no competing interests. J. Chorostowska-Wynimko declares grants to the National Institute of Tuberculosis and Lung Diseases from Pfizer and to the Polish Respiratory Society from AstraZeneca; consulting fees from AstraZeneca, Pfizer, Amgen, Takeda, Merck Sharp & Dohme, Roche and Roche Diagnostica; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca, Pfizer, CelonPharma, Amgen, Takeda, Novartis, Bristol Myers Squibb, Merck Sharp & Dohme, Roche, Roche Diagnostica and Amoy; support for attending meetings and/or travel from Bristol Myers Squibb, AstraZeneca, Merck Sharp & Dohme, Pfizer and Amgen; participation on a data safety monitoring board or advisory board for AstraZeneca, Pfizer, Takeda, Merck Sharp & Dohme, Roche and Roche Diagnostica, all in the 36 months prior to manuscript submission; and is Secretary General of the European Respiratory Society and a member of the Executive Committees of the Polish Respiratory Society and the Polish Coalition for Personalized Medicine. D.R. Baldwin declares payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Bristol Myers Squibb, AstraZeneca, Roche and Merck Sharp & Dohme, all in the 36 months prior to manuscript submission. J. Boyd is an employee of the European Lung Foundation. C. Faivre-Finn reports research grants from AstraZeneca and Elekta; payment or honoraria for presentations from AstraZeneca; support for attending meetings and/or travel from Elekta and AstraZeneca; and participation on a data safety monitoring board or advisory board for AstraZeneca and Merck Sharp & Dohme, all in the 36 months prior to manuscript submission. F. Galateau-Salle declares no competing interests. F. Gamarra declares no competing interests. B. Grigoriu declares support for attending meetings and/or travel from Roche and AstraZeneca; and participation on a data safety monitoring board or advisory board for AstraZeneca, all in the 36 months prior to manuscript submission. G. Hardavella declares no competing interests. M. Hauptmann declares no competing interests. E. Jakobsen declares no competing interests. D. Jovanovic declares payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Merck Sharp & Dohme, Roche, Boehringer Ingelheim, WCBIP 2020 and AstraZeneca; payment for expert testimony relating to the health effects of air pollution from SO2 released by Serbia Zijin Copper mining and smelting complex and the two biggest Serbian power plants, all in the 36 months prior to manuscript submission; and is a member of the editorial boards of the Journal of Thoracic Disease and the AME Surgical Journal, and a committee member of the National Ecological Association (NEA), Serbia. P. Knaut declares no competing interests. G. Massard declares a speaker's fee from Pneumo Update Europe, in the 36 months prior to manuscript submission. J. McPhelim declares advisory board payments from AstraZeneca, Janssen-Cilag and Bristol Myers Squibb, all in the 36 months prior to manuscript submission. A-P. Meert declares no competing interests. R. Milroy declares no competing interests. R. Muhr declares no competing interests. L. Mutti declares no competing interests. M. Paesmans declares no competing interests. P. Powell is an employee of the European Lung Foundation. P.M. Putora declares research grants to their institution from AstraZeneca, Takeda and Bayer; and a speaker's fee from Janssen-Cilag, all in the 36 months prior to manuscript submission. J. Rawlinson declares travel/accommodation support from the BTOG to attend the annual meeting in Dublin as patient advocate/steering committee member; travel/accommodation support from the European Respiratory Society to attend a screening meeting in Barcelona (patient representative) and European Lung Foundation patient event at the European Respiratory Society Congress Madrid 2019; travel/accommodation support from the NCRI to attend a conference in Glasgow (consumer member); travel/accommodation support from the EORTC to attend the Patient Days event as a speaker and patient panel member; and has been a Non-Executive Director (lay member) at Sandwell and West Birmingham Clinical Commissioning Group, UK. A.L. Rich declares no competing interests. D. Rigau is a methodologist for the European Respiratory Society. D. de Ruysscher declares grants to their institution from AstraZeneca and BeiGene; payment to their institution for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca; and payment to their institution for participation on an advisory board from AstraZeneca, all in the 36 months prior to manuscript submission. J-P. Sculier declares no competing interests. A. Schepereel declares a research grant to their institution from Bristol Myers Squibb; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca, Bristol Myers Squibb and Leo Pharma; support for attending meetings and/or travel from AstraZeneca, Bristol Myers Squibb, Merck Sharp & Dohme and Roche; and payment for participation on a data safety monitoring board or advisory board from AstraZeneca, Bristol Myers Squibb and Merck Sharp & Dohme, all in the 36 months prior to manuscript submission. D. Subotic declares no competing interests. P. Van Schil declares consulting fees paid to their institution by AstraZeneca and Merck Sharp & Dohme; payment to their institution for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca; and travel expenses related to participation in data safety monitoring or advisory boards for the LungART Trial and the Pearls Trial, all in the 36 months prior to manuscript submission; and is the President-elect of the International Association for the Study of Lung Cancer and the Treasurer of the Belgian Association for Cardio-Thoracic Surgery. T. Tonia is a methodologist for the European Respiratory Society. C. Williams is an employee of the European Lung Foundation. T. Berghmans declares consulting fees from InhaTarget; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Janssen; and participation on a data safety monitoring board or advisory board for Janssen and Roche, all in the 36 months prior to manuscript submission., (Copyright ©The authors 2023. For reproduction rights and permissions contact permissions@ersnet.org.)

Although asthma is very common, affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world, which results in both over- and under-diagnosis. A taskforce was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendations for clinical practice.The taskforce defined eight Population, Index, Comparator and Outcome questions that were assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. The taskforce utilised the outcomes to develop an evidence-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences.The taskforce supports the initial use of spirometry followed by bronchodilator reversibility testing (if airway obstruction is present). If initial spirometry fails to show obstruction, further tests should be performed in the following order: exhaled nitric oxide fraction, peak expiratory flow variability, or, in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms.The taskforce reinforces spirometry as a priority and recognises the value of measuring blood eosinophils and serum immunoglobulin E to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved forced expiratory volume in 1 s/forced vital capacity ratio deserves further attention. The taskforce draws attention to the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids; the comorbidities that may obscure diagnosis; the importance of phenotyping; and the necessity of considering the patient experience in the diagnostic process., Competing Interests: Conflict of interest: R. Louis reports grants and personal fees from GSK, AZ, Chiesi and Novartis, personal fees from Sanofi, outside the submitted work. Conflict of interest: I. Satia reports grants and personal fees from GSK and Merck, personal fees from AstraZeneca, grants from ERS Respire 3 Marie Curie Fellowship and E.J. Moran Campbell Early Career Award, outside the submitted work. Conflict of interest: I. Ojanguren reports grants and personal fees from AstraZeneca, Sanofi and GSK, personal fees and non-financial support from Boehringer Ingelheim and Chiesi, grants, personal fees and non-financial support from Novartis, personal fees from MSD, Puretech, Bial and TEVA, outside the submitted work. Conflict of interest: F. Schleich reports grants and personal fees for national board participation and presentations from GSK and AstraZeneca, personal fees for board participation and lectures from Chiesi, outside the submitted work. Conflict of interest: M. Bonini has nothing to disclose. Conflict of interest: T. Tonia reports acting as ERS Methodologist. Conflict of interest: D. Rigau worked as ERS methodologist until February 2020. Conflict of interest: A. ten Brinke reports institutional fees for research advisory board work from GSK, Sanofi, TEVA, AstraZeneca and Boehringer Ingelheim, institutional fees for lectures from AstraZeneca, GSK,TEVA and SanofiGenzyme, grants from AstraZeneca, GSK and TEVA, outside the submitted work. Conflict of interest: R. Buhl reports personal fees from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Novartis, Sanofi, Roche and Teva, and grants to Mainz University Hospital from Boehringer Ingelheim, GlaxoSmithKline, Novartis and Roche, all outside the submitted work. Conflict of interest: S. Loukides has nothing to disclose. Conflict of interest: J.W.H. Kocks reports grants, institutional fees and non-financial support from AstraZeneca and Boehringer Ingelheim, grants and institutional fees from Chiesi Pharmaceuticals, GSK, Novartis and TEVA, institutional fees from MSD and COVIS, outside the submitted work; and holds 72.5% of shares in the General Practitioners Research Institute. Conflict of interest: L-P. Boulet reports grants from Amgen, AstraZeneca, GlaxoSmithKline, Merck, Novartis and Sanofi-Regeneron, personal fees for consultancy and advisory board work from AstraZeneca, Novartis, GlaxoSmithKline, Merck and Sanofi-Regeneron, personal fees for lectures from AstraZeneca, Covis, GlaxoSmithKline, Novartis, Merck and Sanofi, grants and non-financial support from AstraZeneca, Covis, GlaxoSmithKline, Merck and Novartis, and is Chair of Global Initiative for Asthma (GINA) Board of Directors, President of the Global Asthma Organisation (Interasma) and Member of the Canadian Thoracic Society Respiratory Guidelines Committee. Conflict of interest: A. Bourdin reports grants, personal fees, non-financial support and other (investigator in clinical trials) from GSK, AstraZeneca, Boeringher Ingelheim and Actelion/Jansen, personal fees, non-financial support and other (investigator in clinical trials) from Novartis, Chiesi Farma, Sanofi Regeneron and Roche, non-financial support and other (investigator in clinical trials) from Teva, other (investigator in clinical trials) from United Therapeutics and Pulsar, outside the submitted work. Conflict of interest: C. Coleman is an employee of European Lung Foundation. Conflict of interest: K. Needham has nothing to disclose. Conflict of interest: M. Thomas reports personal fees from GSK, Boehringer Ingelheim and Chiesi, outside the submitted work. Conflict of interest: M. Idzko has nothing to disclose. Conflict of interest: A. Papi reports board membership, consultancy, payment for lectures, grants for research and travel expenses reimbursement from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici and TEVA, board membership, consultancy, payment for lectures and travel expenses reimbursement from Mundipharma, Zambon, Novartis and Sanofi/Regeneron, grants for research, payment for lectures and travel expenses reimbursement from Menarini, board membership, consultancy and travel expenses reimbursement from Roche, grants from Fondazione Maugeri and Fondazione Chiesi, personal fees for consultancy from Edmondpharma, outside the submitted work. Conflict of interest: C. Porsbjerg reports grants and personal fees from Astra Zeneca, GSK, Novartis, TEVA, Sanofi and Chiesi, grants from Pharmaxis, outside the submitted work. Conflict of interest: D. Schuermans reports non-financial support from Free University of Brussels, outside the submitted work. Conflict of interest: J.B. Soriano has nothing to disclose. Conflict of interest: O.S. Usmani reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi and GlaxoSmithKline, grants from Edmond Pharma, personal fees from Napp, Mundipharma, Sandoz, Takeda, Cipla, Covis, Novartis, Mereo Biopharma, Orion, Menarini, Ucb, Trudell Medical, Deva and Kamada, outside the submitted work., (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)

Background: The major reasons to treat sarcoidosis are to lower the morbidity and mortality risk or to improve quality of life (QoL). The indication for treatment varies depending on which manifestation is the cause of symptoms: lungs, heart, brain, skin or other manifestations. While glucocorticoids remain the first choice for initial treatment of symptomatic disease, prolonged use is associated with significant toxicity. Glucocorticoid-sparing alternatives are available. The presented treatment guidelines aim to provide guidance to physicians treating the very heterogenous sarcoidosis manifestations., Methods: A European Respiratory Society Task Force committee composed of clinicians, methodologists and patients with experience in sarcoidosis developed recommendations based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology. The committee developed eight PICO (Patients, Intervention, Comparison, Outcomes) questions and these were used to make specific evidence-based recommendations., Results: The Task Force committee delivered 12 recommendations for seven PICOs. These included treatment of pulmonary, cutaneous, cardiac and neurologic disease as well as fatigue. One PICO question regarding small-fibre neuropathy had insufficient evidence to support a recommendation. In addition to the recommendations, the committee provided information on how they use alternative treatments, when there was insufficient evidence to support a recommendation., Conclusions: There are many treatments available to treat sarcoidosis. Given the diverse nature of the disease, treatment decisions require an assessment of organ involvement, risk for significant morbidity, and impact on QoL of the disease and treatment., Competing Interests: Conflict of interest: R.P. Baughman reports grants from Gilead, Genentech, Bayer, aTyr and Bellephron, grants and personal fees for consultancy from Novartis, personal fees for consultancy from Methial, grants and personal fees for consultancy and lectures from Mallinckrodt, grants and personal fees for lectures from Boehringer Ingelheim, outside the submitted work. Conflict of interest: D. Valeyre reports personal fees for advisory board work from Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: P. Korsten reports grants and personal fees from GlaxoSmithKline, personal fees from AbbVie, Pfizer, Chugai, Novartis Pharma, Sanofi-Aventis, Lilly and Gilead, outside the submitted work. Conflict of interest: A.G. Mathioudakis reports grants from Boehringer Ingelheim, outside the submitted work. Conflict of interest: W.A. Wuyts has nothing to disclose. Conflict of interest: A. Wells reports personal fees for lectures and advisory board work from Boehringer Ingelheim and Roche, during the conduct of the study. Conflict of interest: P. Rottoli has nothing to disclose. Conflict of interest: H. Nunes has nothing to disclose. Conflict of interest: E.E. Lower reports grants from Gilead, Genentech, Bayer and aTYR, grants and personal fees for consultancy from Novartis, outside the submitted work. Conflict of interest: M.A. Judson received grant support for his institution from Mallickrodt. Conflict of interest: D. Israël-Biet has nothing to disclose. Conflict of interest: J.C. Grutters has nothing to disclose. Conflict of interest: M. Drent has nothing to disclose. Conflict of interest: D.A. Culver reports grants and personal fees from aTyr, Mallinckrodt, Boehringer Ingelheim and Foundation for Sarcoidosis Research, personal fees from Roche, outside the submitted work. Conflict of interest: F. Bonella reports personal fees and non-financial support from Boehringer Ingelheim, Roche, Galapagos, BMS and Savara Pharma, outside the submitted work. Conflict of interest: K. Antoniou has nothing to disclose. Conflict of interest: F. Martone has nothing to disclose. Conflict of interest: B. Quadder has nothing to disclose. Conflict of interest: G. Spitzer has nothing to disclose. Conflict of interest: B. Nagavci acts as an ERS methodologist. Conflict of interest: T. Tonia acts as an ERS methodologist. Conflict of interest: D. Rigau acts as an ERS methodologist. Conflict of interest: D.R. Oullette reports grants from PCORI (Patient-Centred Outcomes Research Institute, US Federal) and Sanofi, outside the submitted work; and has provided expert witness work for venous thromboembolic disease., (Copyright ©The authors 2021. For reproduction rights and permissions contact permissions@ersnet.org.)

Background: Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children., Methods: A task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach., Results: The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework., Conclusion: Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future., Competing Interests: Conflict of interest: E.A. Gaillard reports consultancy work for Boehringer Ingelheim with money paid to the University of Leicester; investigator led research grants from Circassia, Gilead and Chiesi Ltd; research collaboration with Medimmune. Conflict of interest: C.E. Kuehni has nothing to disclose. Conflict of interest: S. Turner has nothing to disclose. Conflict of interest: M. Goutaki has nothing to disclose. Conflict of interest: K.A. Holden has nothing to disclose. Conflict of interest: C.C.M. de Jong has nothing to disclose. Conflict of interest: C. Lex reports other (lecture fee paid to institution) from Novartis, outside the submitted work. Conflict of interest: D.K.H. Lo has nothing to disclose. Conflict of interest: J.S. Lucas reports grants and non-financial support (provision of equipment) from Circassia, outside the submitted work. Conflict of interest: F. Midulla has nothing to disclose. Conflict of interest: R. Mozun has nothing to disclose. Conflict of interest: G. Piacentini has nothing to disclose. Conflict of interest: D. Rigau acts as ERS methodologist. Conflict of interest: B. Rottier has nothing to disclose. Conflict of interest: M. Thomas reports personal fees from GSK, Boehringer Ingelheim and Chiesi, outside the submitted work. Conflict of interest: T. Tonia acts as ERS Methodologist. Conflict of interest: J. Usemann reports personal fees from Vertex, outside the submitted work. Conflict of interest: O. Yilmaz reports non-financial support for meeting attendance from Abdi Ibrahim, other (lecture fees) from Novartis, outside the submitted work. Conflict of interest: A. Zacharasiewicz has nothing to disclose. Conflict of interest: A. Moeller has nothing to disclose., (Copyright ©The authors 2021. For reproduction rights and permissions contact permissions@ersnet.org.)

The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A ( p16 ) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pre-therapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres., Competing Interests: Conflict of interest: A. Scherpereel reports personal fees for advisory board work from AstraZeneca, BMS, MSD, Roche and Janssen, non-financial support for meeting attendance from BMS, MSD and Roche, institutional support for clinical trial participation from Astra-Zeneca/MedImmune, BMS, Verastem and Bayer, grants from BMS, outside the submitted work. Conflict of interest: I. Opitz has nothing to disclose. Conflict of interest: T. Berghmans has nothing to disclose. Conflict of interest: I. Psallidas works as a Medical Science Director for AstraZeneca, outside the submitted work; membership of the task force was resigned when this position became effective. Conflict of interest: M. Glatzer has nothing to disclose. Conflict of interest: D. Rigau works as methodologist for the European Respiratory Society. Conflict of interest: P. Astoul has nothing to disclose. Conflict of interest: S. Bölükbas has nothing to disclose. Conflict of interest: J. Boyd is an employee of the European Respiratory Society. Conflict of interest: J. Coolen has nothing to disclose. Conflict of interest: C. De Bondt has nothing to disclose. Conflict of interest: D. De Ruysscher reports grants from Bristol-Myers-Squibb AstraZeneca, Celgene, Roche/Genentech and Merck/ Pfizer, outside the submitted work. Conflict of interest: V. Durieux has nothing to disclose. Conflict of interest: C. Faivre-Finn has nothing to disclose. Conflict of interest: D. Fennell reports personal fees and non-financial support from BMS and MSD, non-financial support from Eli Lilly, Clovis, Bergen Bio and Pierre Fabre, grants, personal fees and non-financial support from Roche-Genentech, personal fees from Aldeyra, during the conduct of the study. Conflict of interest: F. Galateau-Salle has nothing to disclose. Conflict of interest: L. Greillier reports grants, personal fees and non-financial support from Roche and Novartis, personal fees and non-financial support from Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, AstraZeneca, Abbvie and MSD, outside the submitted work. Conflict of interest: M.A. Hoda has nothing to disclose. Conflict of interest: W. Klepetko has nothing to disclose. Conflict of interest: A. Lacourt has nothing to disclose. Conflict of interest: P. McElnay was employed by GlaxoSmithKline, outside the submitted work. Conflict of interest: N.A. Maskell has nothing to disclose. Conflict of interest: L. Mutti has nothing to disclose. Conflict of interest: J-C. Pairon reports grants from Santé Publique France Agency and French National Health Insurance (CNAM-TS), outside the submitted work. Conflict of interest: P. Van Schil has nothing to disclose. Conflict of interest: J.P. van Meerbeeck has nothing to disclose. Conflict of interest: D. Waller has nothing to disclose. Conflict of interest: W. Weder reports personal fees from AstraZeneca for advisory board work and lectures, grants and personal fees for lectures from Covidien. Conflict of interest: G. Cardillo has nothing to disclose. Conflict of interest: P.M. Putora reports grants from AstraZeneca and Celgene, outside the submitted work., (The article has been co-published with permission in the European Respiratory Journal and the European Journal of Cardio-Thoracic Surgery. All rights reserved in respect of European Respiratory Journal, © European Respiratory Society 2020 and European Journal of Cardio-Thoracic Surgery, © European Association for Cardio-Thoracic Surgery 2020. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.)

Inhaled corticosteroids (ICS) combined with bronchodilators can reduce the frequency of exacerbations in some patients with chronic obstructive pulmonary disease (COPD). There is evidence, however, that ICS are frequently used in patients where their benefit has not been established. Therefore, there is a need for a personalised approach to the use of ICS in COPD and to consider withdrawal of ICS in patients without a clear indication. This document reports European Respiratory Society recommendations regarding ICS withdrawal in patients with COPD.Comprehensive evidence synthesis was performed to summarise all available evidence relevant to the question: should ICS be withdrawn in patients with COPD? The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence synthesis was discussed and recommendations formulated by a committee with expertise in COPD and guideline methodology.After considering the balance of desirable and undesirable consequences, quality of evidence, and feasibility and acceptability of interventions, the guideline panel made: 1) conditional recommendation for the withdrawal of ICS in patients with COPD without a history of frequent exacerbations, 2) strong recommendation not to withdraw ICS in patients with blood eosinophil counts ≥300 eosinophils·µL -1 and 3) strong recommendation to treat with one or two long-acting bronchodilators if ICS are withdrawn.A conditional recommendation indicates that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention., Competing Interests: Conflict of interest: J.D. Chalmers has received speaker fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Insmed; consultancy fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Grifols, Insmed and Zambon; and holds research grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences Grifols and Novartis. Conflict of interest: I.F. Laska has nothing to disclose. Conflict of interest: F.M.E. Franssen reports research grants from AstraZeneca and Novartis and fees for consultancy from Boehringer Ingelheim, Chiesi, GSK and Teva. Conflict of interest: W. Janssens reports grants, speakers’ and consultancy fees from Chiesi, AstraZeneca, Boehringer and GSK, outside the submitted work. Conflict of interest: I. Pavord reports fees for consultancy from AstraZeneca, Boehringer Ingelheim, Aerocrine, Almirall, Novartis, GSK, Genentech, Regeneron, Teva, Chiesi, Sanofi, Cricassia, and Knopp, grants from the National Institute for Health Research. Conflict of interest: D. Rigau is methodologist of the European Respiratory Society. Conflict of interest: M.J. McDonnell reports personal fees from Boehringer Ingelheim and Menarini, grants from Health Research Board Ireland, outside the submitted work. Conflict of interest: N. Roche reports grants and personal fees from Boehringer Ingelheim, Novartis and Pfizer, and personal fees from Teva, GSK, AstraZeneca, Chiesi, Mundipharma, Cipla, Sanofi, Sandoz, 3M, Trudell and Zambon. Conflict of interest: D.D. Sin has received research funding from AstraZeneca and Merck, has received honoraria for speaking engagements from Novartis, Boehringer Ingelheim and AstraZeneca, and fees for advisory board work from Sanofi-Aventis and Regeneron. Conflict of interest: D. Stolz reports research grants from AstraZeneca, Curetis and Boston Scientific, and fees for consultancy from AstraZeneca, Novartis, GSK, Roche, Zambon, Pfizer and Schwabe Pharma. Conflict of interest: S. Suissa reports grants and personal fees from Novartis and Boehringer Ingelheim, and personal fees from AstraZeneca, outside the submitted work. Conflict of interest: J. Wedzicha has received research grants from GlaxoSmithKline, Boehringer Ingelheim, Novartis, AstraZeneca, Chiesi and Johnson & Johnson. D. Stolz reports research grants from AstraZeneca, Curetis and Boston Scientific, and fees for consultancy from AstraZeneca, Novartis, GSK, Roche, Zambon, Pfizer and Schwabe Pharma. Conflict of interest: M. Miravitlles has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, Sandoz, Zambon, CSL Behring, Grifols and Novartis, consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, Kamada, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, Teva, pH Pharma, Novartis, Sanofi and Grifols, and research grants from GlaxoSmithKline and Grifols., (Copyright ©ERS 2020.)

This European Respiratory Society/Thoracic Society of Australia and New Zealand statement outlines a review of the literature and expert opinion concerning the management of reproduction and pregnancy in women with airways diseases: asthma, cystic fibrosis (CF) and non-CF bronchiectasis. Many women with these diseases are now living into reproductive age, with some developing moderate-to-severe impairment of lung function in early adulthood. The statement covers aspects of fertility, management during pregnancy, effects of drugs, issues during delivery and the post-partum period, and patients' views about family planning, pregnancy and parenthood. The statement summarises current knowledge and proposes topics for future research, but does not make specific clinical recommendations., Competing Interests: Conflict of interest: P.G. Middleton has nothing to disclose. Conflict of interest: E.J. Gade has nothing to disclose. Conflict of interest: C. Aguilera has nothing to disclose. Conflict of interest: L. Mackillop reports grants from NIHR Oxford Biomedical Research Centre, personal fees from Sensyne Health plc, outside the submitted work; and was a member of the UK's NICE guideline committee for Intrapartum Care for High Risk Women which included a section on women with asthma. Conflict of interest: B.M. Button has nothing to disclose. Conflict of interest: C. Coleman is an employee of the European Lung Foundation. Conflict of interest: B. Johnson is an employee of the European Lung Foundation. Conflict of interest: C. Albrechtsen has nothing to disclose. Conflict of interest: F. Edenborough has nothing to disclose. Conflict of interest: D. Rigau acts a European Respiratory Society methodologist. Conflict of interest: P.G. Gibson reports grants and personal fees from AstraZeneca, GlaxoSmithKline, Novartis and Sanofi, outside the submitted work. Conflict of interest: V. Backer has nothing to disclose., (Copyright ©ERS 2020.)

This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point ≥150 μL -1 to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest considering specific eosinophil (≥260 μL -1 ) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; 4) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4-5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available., Competing Interests: Conflict of interest: F. Holguin has nothing to disclose. Conflict of interest: J.C. Cardet has nothing to disclose. Conflict of interest: K.F. Chung has received honoraria for participating in advisory board meetings of GlaxoSmithKline, AstraZeneca, Novartis, Merck, Boehringer Ingelheim, 4D Pharma, Pieris and Teva regarding treatments for asthma, cough and chronic obstructive pulmonary disease and has also been remunerated for speaking engagements. Conflict of interest: S. Diver has nothing to disclose. Conflict of interest: D.S. Ferreira reports fellowship MTF 2015-02 from the European Respiratory Society, during the conduct of the study. Conflict of interest: A. Fitzpatrick has nothing to disclose. Conflict of interest: M. Gaga reports grants and personal fees from AstraZeneca and Chiesi, grants from Novartis, Menarini and Elpen, personal fees from MSD and BMS, outside the submitted work. Conflict of interest: L. Kellermeyer has nothing to disclose. Conflict of interest: S. Khurana reports grants from GlaxoSmithKline and Sanofi, outside the submitted work. Conflict of interest: S. Knight has nothing to disclose. Conflict of interest: V.M. McDonald reports grants from GlaxoSmithKline, grants and personal fees for lectures from AstraZeneca, personal fees for educational steering committee work from Menarini, outside the submitted work. Conflict of interest: R.L. Morgan has nothing to disclose. Conflict of interest: V.E. Ortega has nothing to disclose. Conflict of interest: D. Rigau acts as a European Respiratory Society methodologist. Conflict of interest: P. Subbarao has nothing to disclose. Conflict of interest: T. Tonia acts as a European Respiratory Society methodologist. Conflict of interest: I.M. Adcock has nothing to disclose. Conflict of interest: E.R. Bleecker undertaken clinical trials through his employer, Wake Forest School of Medicine and University of Arizona, for AstraZeneca, MedImmune, Boehringer Ingelheim, Genentech, Johnson and Johnson (Janssen), Novartis, Regeneron and Sanofi Genzyme, and has also served as a paid consultant for AstraZeneca, MedImmune, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Regeneron and Sanofi Genzyme, outside the submitted work. Conflict of interest: C. Brightling reports grants and personal fees from GlaxoSmithKline, Novartis, Genentech/Roche, Chiesi, 4D Pharma, Glenmark, Boehringer Ingelheim, Mologic, Gossamer and AstraZeneca/MedImmune, personal fees from Sanofi/Regeneron and Teva, outside the submitted work. Conflict of interest: L-P. Boulet reports research grants for participation in multicentre studies from AstraZeneca, Boston Scientific, GlaxoSmithKline, Hoffman La Roche, Novartis, Ono Pharma, Sanofi and Takeda; support for research projects submitted by the investigator from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck and Takeda; consulting and advisory board work for AstraZeneca, GlaxoSmithKline, Novartis and Methapharm; nonprofit grants for production of educational materials from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck Frosst and Novartis; conference fees from AstraZeneca, GlaxoSmithKline, Merck and Novartis; support for participation in conferences and meetings from Novartis and Takeda. Conflict of interest: M. Cabana reports personal fees for consultancy from Genentech and Novartis, outside the submitted work. Conflict of interest: M. Castro receives university grant funding from NIH, American Lung Association and PCORI; receives pharmaceutical grant funding from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Sanofi-Aventis; is a consultant for Aviragen, Boston Scientific, Genentech, Nuvaira, Neutronic, Therabron, Theravance, Vectura, 4D Pharma, VIDA, Mallinckrodt, Teva and Sanofi-Aventis; is a speaker for AstraZeneca, Boehringer Ingelheim, Boston Scientific, Genentech, Regeneron, Sanofi and Teva; and receives royalties from Elsevier. Conflict of interest: P. Chanez has undertaken consultancy services for Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, Novartis, Teva, Chiesi, Sanofi and SNCF, served on advisory boards for Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, Novartis, Teva, Chiesi and Sanofi, received lecture fees from GlaxoSmithKline, AstraZeneca, Novartis, Teva, Chiesi, Boston Scientific and ALK, and received industry-sponsored grants from AstraZeneca, ALK and Novartis. Conflict of interest: A. Custovic reports personal fees for consultancy from Novartis, Regeneron/Sanofi, Boehringer Ingelheim and Philips, personal fees for lectures from Thermo Fisher Scientific and Novartis, outside the submitted work. Conflict of interest: R. Djukanovic reports receiving fees for lectures at symposia organised by Novartis, AstraZeneca and Teva, consultation for Teva and Novartis as member of advisory boards, and participation in a scientific discussion about asthma organised by GlaxoSmithKline; and is a co-founder of and current consultant for, and has shares in, Synairgen, a University of Southampton spin-out company. Conflict of interest: U. Frey reports personal fees for meeting attendance from GlaxoSmithKline Scientific Advisory Board, outside the submitted work. Conflict of interest: B. Frankemölle has nothing to disclose. Conflict of interest: P. Gibson reports grants and personal fees for educational activities from GlaxoSmithKline, grants and personal fees for lectures and educational activities from AstraZeneca, personal fees for educational steering committee work from Novartis and Sanofi, outside the submitted work. Conflict of interest: D. Hamerlijnck is independent European Federation of Allergy and Airways (EFA) patient advisor to Novartis on patient involvement; patient co-chair of the ERS Severe Heterogeneous Asthma Registry, Patient-centred CRC; member of the scientific advisory board of the Veelbelovende Zorg for ZIN and ZonMw; member of the scientific advisory board of the BENEFIT (ZonMw–KBC Dutch Belgian collaboration); member of the IMI PARADIGM patient advisory group for EPF; member of the scientific advisory board for ERA-NET NEURON Biomarkers; patient reviewer for the Dutch Patient Federation and several ZonMw scientific committees. Conflict of interest: N. Jarjour reports the following, outside the submitted work: a grant from National Institutes of Health; personal fees for consultation from AstraZeneca and Boehringer Ingelheim. Conflict of interest: S. Konno reports grants from AstraZeneca, Kyorin Pharmaceutical, Japan Allergy Foundation, Novartis and Ministry of Education, Culture, Sports, Science and Technology of Japan, during the conduct of the study. Conflict of interest: H. Shen has nothing to disclose. Conflict of interest: C. Vitari has nothing to disclose. Conflict of interest: A. Bush has nothing to disclose., (Copyright ©ERS 2020.)

This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90-95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available., Competing Interests: Conflict of interest: L. Duijts has nothing to disclose. Conflict of interest: E.R. van Meel has nothing to disclose. Conflict of interest: L. Moschino has nothing to disclose. Conflict of interest: E. Baraldi has nothing to disclose. Conflict of interest: M. Barnhoorn has nothing to disclose. Conflict of interest: W.M. Bramer has nothing to disclose. Conflict of interest: C.E. Bolton has nothing to disclose. Conflict of interest: J. Boyd is an employee of the European Lung Foundation. Conflict of interest: F. Buchvald has nothing to disclose. Conflict of interest: M.J. del Cerro has nothing to disclose. Conflict of interest: A.A. Colin has nothing to disclose. Conflict of interest: R. Ersu has nothing to disclose. Conflict of interest: A. Greenough reports grants and honoraria for lectures from MedImmune/Abbott, outside the submitted work. Conflict of interest: C. Gremmen has nothing to disclose. Conflict of interest: T. Halvorsen has nothing to disclose. Conflict of interest: J. Kamphuis has nothing to disclose. Conflict of interest: S. Kotecha has nothing to disclose. Conflict of interest: K. Rooney-Otero has nothing to disclose. Conflict of interest: S. Schulzke has nothing to disclose. Conflict of interest: A. Wilson has nothing to disclose. Conflict of interest: D. Rigau acts as ERS methodologist. Conflict of interest: R.L. Morgan has nothing to disclose. Conflict of interest: T. Tonia acts as ERS methodologist. Conflict of interest: C.C. Roehr has nothing to disclose. Conflict of interest: M.W. Pijnenburg has nothing to disclose., (Copyright ©ERS 2020.)

Chest imaging in patients with acute respiratory failure plays an important role in diagnosing, monitoring and assessing the underlying disease. The available modalities range from plain chest X-ray to computed tomography, lung ultrasound, electrical impedance tomography and positron emission tomography. Surprisingly, there are presently no clear-cut recommendations for critical care physicians regarding indications for and limitations of these different techniques.The purpose of the present European Respiratory Society (ERS) statement is to provide physicians with a comprehensive clinical review of chest imaging techniques for the assessment of patients with acute respiratory failure, based on the scientific evidence as identified by systematic searches. For each of these imaging techniques, the panel evaluated the following items: possible indications, technical aspects, qualitative and quantitative analysis of lung morphology and the potential interplay with mechanical ventilation. A systematic search of the literature was performed from inception to September 2018. A first search provided 1833 references. After evaluating the full text and discussion among the committee, 135 references were used to prepare the current statement.These chest imaging techniques allow a better assessment and understanding of the pathogenesis and pathophysiology of patients with acute respiratory failure, but have different indications and can provide additional information to each other., Competing Interests: Conflict of interest: D. Chiumello has nothing to disclose. Conflict of interest: G.F. Sferrazza Papa has nothing to disclose. Conflict of interest: A. Artigas reports grants from Grifols, Fisher & Paykel, Fundacion Areces and Instituto Carlos III, outside the submitted work. Conflict of interest: B. Bouhemad has nothing to disclose. Conflict of interest: A. Grgic reports personal fees from MSD, Boehringer Ingelheim, Roche and Bayer Vital, outside the submitted work. Conflict of interest: L. Heunks reports personal fees for travel and lecturing from Maquet critical care, and grants from Ventfree and Orionpharma, outside the submitted work. Conflict of interest: K. Markstaller has nothing to disclose. Conflict of interest: G.M. Pellegrino has nothing to disclose. Conflict of interest: L. Pisani has nothing to disclose. Conflict of interest: D. Rigau works as a methodologist for the ERS. Conflict of interest: M.J. Schultz has nothing to disclose. Conflict of interest: G. Sotgiu has nothing to disclose. Conflict of interest: P. Spieth has nothing to disclose. Conflict of interest: M. Zompatori has nothing to disclose. Conflict of interest: P. Navalesi has nothing to disclose., (Copyright ©ERS 2019.)

A summary of the evidence and recommendations made in the ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia http://ow.ly/S3zA30iZfLa., Competing Interests: Conflict of interest: A. Torres reports grants from MedImmune, Cubist, Bayer, Theravance, and from Poliphor; personal fees from Bayer (Advisory Board), Roche (Advisory Board), The Medicines CO (Advisory Board), and from Curetis (rapid molecular tests) (Advisory Board); grants as the Principal Investigator of a Phase III study of Cefatzidime/Avibactam for HAP/VAP, during the conduct of the study. He has received personal fees from GSK (Educational symposium: Siglo XXI), Pfizer (speaker at sponsored vaccine symposia), Astra Zeneca (speaker at symposia on ceftaroline), and from Biotest Advisory Board (Enriched IgM for severe CAP), outside the submitted work. Conflict of interest: M.S. Niederman reports grants and personal fees from Bayer (inhaled amikacin research grant and consulting) and Merck (nosocomial pneumonia consulting and grant), personal fees from Thermo-Fisher (procalcitonin lectures), Theravance (consulting on telavancin), and Pfizer (consulting on linezolid), during the conduct of the study. Conflict of interest: J. Chastre reports personal fees from Medimmune/AstraZeneca (honoraria for consulting), Bayer (honoraria for consulting), Pfizer (honoraria for lecture), Cubist/Merck (honoraria for data safety committee participation), Aridis (honoraria for consulting and data safety participation), and Astellas (honoraria for consulting), outside the submitted work. Conflict of interest: G. Li Bassi reports grants from Medimmune, Cubist, Covidien, Theravance, Cardeas Pharma, Ciel Medical, Biovo Technologies, and Toray, during the conduct of the study. Conflict of interest: C. Luna reports grants and personal fees from Pfizer, and personal fees from Merck Sharp and Dohne, outside the submitted work. Conflict of interest: D. Rigau is a European Respiratory Society methodologist. Conflict of interest: T. Welte reports personal fees (for lectures/advisory board) from AstraZeneca, Basilea, Bayer, Grifols, Infectopharm, Novartis and Pfizer, research grants from Bayer, Grifols, Novartis and Pfizer, research grants from the EU, German Research Council and German Ministry of Research and Education, during the conduct of the study. He has received personal fees (for lectures/advisory board) from Boehringer, Berlin Chemie, Mundipharma and Insmed, outside the submitted work. Conflict of interest: R. Wunderink reports personal fees from Arsanis, Accelerate Diagnostics, Bayer, Cepheid, GenMark, The Medicines Company, Merck, Nabriva, Polyphor and Shionogi, during the conduct of the study. Conflict of interest: M. Kollef reports personal fees from Accelerate (consultant), Merck (consultant, speaker's bureau), Paratek (consultant) and Allergan (speaker's bureau), outside the submitted work. Conflict of interest: J.F. Timsit reports research grants from Merck and 3M, a research grant to his hospital from Astelas, and educational grants from Gilead; and personal fees (for advisory boards) from Pfizer, Paratek, Merck, Bayer, 3M and Abbott, all outside the submitted work.

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention., Competing Interests: Conflict of interest: D. Rigau acts as a methodologist for the European Respiratory Society. All other disclosures can be found alongside this article at erj.ersjournals.com, (Copyright ©ERS 2017.)

This document provides clinical recommendations for the prevention of chronic obstructive pulmonary disease (COPD) exacerbations. It represents a collaborative effort between the European Respiratory Society and the American Thoracic Society.Comprehensive evidence syntheses were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable (benefits) and undesirable consequences (burden in the form of adverse effects and cost), quality of evidence, feasibility, and acceptability of various interventions, the Task Force made recommendations for mucolytic, long-acting muscarinic antagonist, phosphodiesterase-4 inhibitor (roflumilast) and macrolide therapy, as well as a conditional recommendation against fluoroquinolone therapy. All of the recommendations were conditional, except for a strong recommendation for the use of a long-acting antimuscarinic agent versus a long-acting β 2 -adrenergic, indicating that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention.The guideline summarises the evidence and provides recommendations for pharmacological therapy for the prevention of COPD exacerbations., Competing Interests: Conflict of interest: D. Rigau and T. Tonia act as methodologists for the European Respiratory Society. All other disclosures can be found alongside this article at erj.ersjournals.com, (Copyright ©ERS 2017.)

Bronchiectasis in adults is a chronic disorder associated with poor quality of life and frequent exacerbations in many patients. There have been no previous international guidelines.The European Respiratory Society guidelines for the management of adult bronchiectasis describe the appropriate investigation and treatment strategies determined by a systematic review of the literature.A multidisciplinary group representing respiratory medicine, microbiology, physiotherapy, thoracic surgery, primary care, methodology and patients considered the most relevant clinical questions (for both clinicians and patients) related to management of bronchiectasis. Nine key clinical questions were generated and a systematic review was conducted to identify published systematic reviews, randomised clinical trials and observational studies that answered these questions. We used the GRADE approach to define the quality of the evidence and the level of recommendations. The resulting guideline addresses the investigation of underlying causes of bronchiectasis, treatment of exacerbations, pathogen eradication, long term antibiotic treatment, anti-inflammatories, mucoactive drugs, bronchodilators, surgical treatment and respiratory physiotherapy.These recommendations can be used to benchmark quality of care for people with bronchiectasis across Europe and to improve outcomes., Competing Interests: Conflict of interest: D. Rigau and T. Tonia act as methodologists for the European Respiratory Society. All other disclosures can be found alongside this article at erj.ersjournals.com, (Copyright ©ERS 2017.)

This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available., (Copyright ©ERS 2017.)

The diagnosis of primary ciliary dyskinesia is often confirmed with standard, albeit complex and expensive, tests. In many cases, however, the diagnosis remains difficult despite the array of sophisticated diagnostic tests. There is no "gold standard" reference test. Hence, a Task Force supported by the European Respiratory Society has developed this guideline to provide evidence-based recommendations on diagnostic testing, especially in light of new developments in such tests, and the need for robust diagnoses of patients who might enter randomised controlled trials of treatments. The guideline is based on pre-defined questions relevant for clinical care, a systematic review of the literature, and assessment of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. It focuses on clinical presentation, nasal nitric oxide, analysis of ciliary beat frequency and pattern by high-speed video-microscopy analysis, transmission electron microscopy, genotyping and immunofluorescence. It then used a modified Delphi survey to develop an algorithm for the use of diagnostic tests to definitively confirm and exclude the diagnosis of primary ciliary dyskinesia; and to provide advice when the diagnosis was not conclusive. Finally, this guideline proposes a set of quality criteria for future research on the validity of diagnostic methods for primary ciliary dyskinesia., (Copyright ©ERS 2017.)