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Although these conditions are rare, a proportion of patients with interstitial lung diseases (ILDs) may develop a progressive-fibrosing phenotype. Progressive fibrosis is associated with worsening respiratory symptoms, lung function decline, limited response to immunomodulatory therapies, decreased quality of life and, potentially, early death. Idiopathic pulmonary fibrosis may be regarded as a model for other progressive-fibrosing ILDs. Here we focus on other ILDs that may present a progressive-fibrosing phenotype, namely idiopathic nonspecific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, connective tissue disease-associated ILDs ( e.g. rheumatoid arthritis-related ILD), fibrotic chronic hypersensitivity pneumonitis, fibrotic chronic sarcoidosis and ILDs related to other occupational exposures. Differential diagnosis of these ILDs can be challenging, and requires detailed consideration of clinical, radiological and histopathological features. Accurate and early diagnosis is crucial to ensure that patients are treated optimally., Competing Interests: Conflict of interest: V. Cottin reports receiving the following, outside the submitted work: personal fees from Actelion for consultancy, lectures and travel to medical meetings; personal fees from Boehringer Ingelheim for the development of educational presentations, consultancy, lectures and travel to medical meetings; personal fees from Bayer for consultancy; personal fees from Gilead for acting as a member of an adjudication committee; personal fees from GSK for consultancy; personal fees from MSD for consultancy and travel to medical meetings; personal fees from Novartis for consultancy and lectures; personal fees from Roche for consultancy, lecture fees and travel to medical meetings; personal fees from Sanofi for consultancy and lectures; a grant to his institution from Boehringer Ingelheim; a grant to his institution from Roche; personal fees from Promedior for acting as Chair of the DSMB; personal fees from Celgene for the DSMB; and personal fees from Galapagos for consultancy and for acting as Chair of the DSMB. Conflict of interest: N.A. Hirani has nothing to disclose. Conflict of interest: D.L. Hotchkin has nothing to disclose. Conflict of interest: A.M. Nambiar reports receiving the following, outside the submitted work: grants, personal fees, non-financial support and other support from Boehringer Ingelheim; and grants from Genentech-Roche. Conflict of interest: T. Ogura reports receiving the following, outside the submitted work: grants and personal fees from Boehringer Ingelheim, Japan; grants from the Ministry of Health, Labour and Welfare, Japan; personal fees from Astellas Pharma Inc., Shionogi & Co. Ltd, Toray Industries Inc., AstraZeneca K.K. and Kyorin Inc. Conflict of interest: M. Otaola has nothing to disclose. Conflict of interest: D. Skowasch reports receiving the following, outside the submitted work: personal fees/honoraria for consulting and speaking from Boehringer Ingelheim and Roche. Conflict of interest: J.S. Park has nothing to disclose. Conflict of interest: H.K. Poonyagariyagorn has nothing to disclose. Conflict of interest: W. Wuyts reports receiving the following, outside the submitted work: grants paid to his university from Boehringer Ingelheim and Hoffmann La Roche; and travel fees from Galapagos. Conflict of interest: A.U. Wells reports receiving the following, outside the submitted work: personal fees for speaking and for acting on advisory boards from Boehringer Ingelheim, Roche and Bayer., (Copyright ©ERS 2018.)

Objective: To evaluate the utility of measuring lung radiodensity from chest X-ray for the diagnosis of foreign body aspiration., Methods: Records of 59 children with foreign body aspiration were retrospectively reviewed. Lung radiodensity and radiodensity ratio (right/left lung radio density) before and after foreign body removal were measured. Radiodensity was calculated as the relative score compared with the tenth thoracic vertebra body (100 points) and the background (0 point). The change of radiodensity ratio (difference in radiodensity ratio of the second X-ray from that of first X-ray) was compared between 22 patients (foreign body group) and 22 normal subjects (control group)., Results: In the group of foreign body in the left bronchus, the mean (SD) radiodensity of the left lung [53.5 (12.8)] was lower than that of the right lung [60.8 (7.7), P<0.01] and it increased after foreign body removal [60.0 (6.9), P=0.02]. The radiodensity ratio decreased from 1.20 (0.30) to 0.96 (0.09) (P<0.01) after foreign body removal. In the group with a foreign body in the right bronchus, the radiodensity of the right lung [51.8 (12.8)] was lower than that of left lung [62.0 (11.7), P=0.03], and it also increased after foreign body removal [58.4 (9.6), P=0.03]. The change of radiodensity ratio in the foreign body group [15.7 (17.8)%] was higher than the control group [5.4 (4.3) %, P=0.01] and the cutoff value was 7.5%., Conclusions: Radiodensity from chest X-ray could be a useful tool for diagnosing foreign body aspiration in children.