Pulmonary & Respiratory Medicine

Background: Obstructive sleep apnea syndrome (OSA) and asthma are two common respiratory diseases. An overlap between the two diseases has been widely reported. It is established that OSA may affect control of asthma. This study aims to highlight OSA prevalence in patient with difficult to control asthma and to point out the feature of this overlap syndrome.

Methods: We conducted a prospective study including sixty patients with difficult control asthma who had symptoms suggestive of OSA (Epworth scale>10). Based on the findings of the respiratory polygraphy, a comparative analysis of clinical, biologic, lung function testing and therapeutic features was performed.

Results: OSA was confirmed in 63.3% of cases, and was severe, moderate and mild in 26%, 61% and 13% of them respectively. Comparison between the OSA and non-OSA arms showed no significant differences in the asthmatic disease features: date of onset, atopy, history of near fatal asthma and medication use. However, OSA patients were older than non OSA patients (54 vs. 45 years old; p=0.05). Furthermore there was a difference in the proportion of males between both arms (50% in OSA vs 23% in non OSA; p=0.05). Gastro-oesophageal reflux disease (GERD) was more common in the OSA group (57.9% vs. 21.7%; p=0.034). There was no significant difference between the two arms regarding obesity, allergic rhinitis and smoking.

Conclusion: This study shows that OSA is more prevalent in difficult to control asthma patients. The presence of overlap syndrome was correlated with age, male gender and GERD.

Objective: Wet cough is one of the most common pathologies in the world affecting nearly 12% of the world population. Being a multifactorial disease, involving initially viral infection, followed by bacterial secondary superinfection, damage to the throat mucosa, production of sticky mucus, and poor local immunity, there is currently no effective drug available. We conceived VB-Gy, an osmotically active filmogen solution, capable of cleaning the infected surface of all contaminants topically present, and of preparing a favorable ground for healing. The efficacy and safety of VB-Gy is assessed through a clinical trial, vs. saline solution as comparator product.

Methods: The study was a multi-centric, randomized, placebo-controlled, double-blind trial on patients suffering from wet cough. The study involved 39 in the test product group and 15 patients in the comparator group, each patient applying 3-4 sprays of investigational product 4-5 times per day, over a maximum period of 15 days. The effects on wet cough severity, frequency, chest discomfort, as well as on throat pain, irritation, requirement for antibiotics, and answers to Leicester cough questionnaire for quality of life, were evaluated.

Results: Although regular and frequent use of saline solution spray helped reduce wet cough symptoms noticeably, the test product induced very fast and nearly total regression of all clinical signs without any side effects, with statistically highly significant difference compared to placebo comparator and baseline data.

Conclusion: Treating wet cough requires a multi-target, cell-friendly, and safe approach to obtain not only symptomatic but also curative relief. VB-Gy is a completely new generation of nearly instant, safe, and multi-target therapeutic approach of treating various topical infections.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosing mediastinal and hilar lymphadenopathy. While bacteremia and serious infectious complications after EBUS-TBNA have been reported, the efficacy of antibiotic prophylaxis is unclear. This preliminary prospective study aimed to evaluate the efficacy of antibiotic prophylaxis after EBUS-TBNA.

Methods: Patients were randomly assigned to the antibiotic group (n = 43) or control group (n = 47). Ampicillin/ sulbactam was intravenously administered before the puncture, followed by oral amoxicillin/clavulanate. The primary outcome was body temperature (BT) within 5 days after EBUS-TBNA. The secondary outcomes were the change in the white blood cell count (WBC) and C-reactive protein (CRP) value before and after the examination, and the frequency of infectious complications that required antibiotics. We also assessed the clinical characteristics of patients with fever.

Results: BT after EBUS-TBNA did not significantly differ between the groups. Antibiotic prophylaxis had no effect on the changes in the WBC and CRP value. Neither group had infectious complications associated with EBUS-TBNA. The smoking pack-year was higher in the group with fever than without fever, although the WBC and CRP value at baseline were similar between the groups. The number of punctures, presence of low-density areas in the lymph nodes, and antibiotic treatment were unrelated to the development of fever following EBUS-TBNA.

Conclusion: Results of this study and the low frequency of infectious complications, which has been demonstrated in previous reports, suggest that antibiotic prophylaxis is not recommended for EBUS-TBNA (UMIN: 000008813).

Chronic obstructive pulmonary disease COPD is a systemic disease with predominant respiratory symptoms. Airflow obstruction has significant effects on cardiac function and gas exchange with systemic consequences. Various extra pulmonary effects include, Skeletal muscle wasting and cachexia, ischemic heart disease, heart failure including left sided heart failure, osteoporosis, Normocytic anemia, lung cancer, depression etc. Osteoporosis becomes more prevalent in COPD patients as the disease progresses. Present study is a case-control study that was conducted by department of Internal and pulmonary medicine. Patients diagnosed with COPD based on ATS guidelines and staged based on GOLD guidelines that were following as an outpatient in pulmonary clinic of SKIMS were selected for the study. Total of sixty patients of COPD were taken and were compared with one hundred twenty age and sex matched controls. In current study we found no significant correlation between osteoporosis and smoking, although smoking is clearly a risk factor for both osteoporosis and COPD.

Chronic respiratory disease which majorly includes Asthma and Chronic Obstructive pulmonary disease that may account for an estimated burden of about 100 million individuals in India. There were only few studies from India on the field of epidemiology of Asthma and COPD. The prevalence rates for both disorders reported in different studies have widely varied. In phase-I of the observational study on epidemiology of Asthma and COPD was conducted at a chest clinic. Population prevalence of Asthma and COPD in all age groups was reported and analyzed. In phase-II of observational study a standardized and validated questionnaire was used employing auniform methodology in all patients. The main objective of this project is to find differences in the epidemiology of asthma and chronic obstructive pulmonary disease, including in the prevalence rates and other casual variables (age, gender, residence, occupation), if any, in different places in a Chest Clinic. And also to assess the influence of exposure to tobacco smoking, ETS (Environmental tobacco smoke) and other risk factors, on the prevalence of both Asthma and COPD.

Rationale: Substantial variation in the prevalences of obstructive lung disease exist between Hispanic/Latino heritage groups. Experimental studies have posited biological mechanisms linking serum lipids and lipid-lowering medications with obstructive lung disease. The aim of this study is to examine the associations of serum lipid levels with the prevalences of asthma and chronic obstructive pulmonary disease in the Hispanic Community Health Study/ Study of Latinos and how these associations vary by Hispanic/Latino heritage group.

Methods: The Hispanic Community Health Study/Study of Latinos is a population-based probability sample of 16,415 self-identified Hispanic/Latino persons aged 18-74 years recruited between 2008 and 2011 from randomly selected households in four US field centers. The baseline clinical examination included comprehensive biological testing (fasting serum lipid levels), behavioral and socio-demographic assessments, medication inventory including inhalers, and respiratory data including questionnaires for asthma and standardized spirometry with post-bronchodilator measures for identification of obstructive lung disease.

Measurements and main results: Hispanic/Latinos with current asthma had lower age- and statin-use-adjusted mean serum total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels than their non-asthmatic counterparts. In analysis adjusted for age plus gender, ethnicity, cigarette smoking, alcohol intake, body mass index, lipid/cholesterol-lowering medications, age at immigration, health insurance status, and use of oral corticosteroids, increasing serum levels of total cholesterol and low-density lipoprotein cholesterol were associated with lower odds of current asthma in the estimated population. Unlike asthma, Hispanic/Latinos with chronic obstructive pulmonary disease had lower mean high-density lipoprotein than their non- chronic obstructive pulmonary disease counterparts. In the fully adjusted analysis no significant associations were found between lipid levels and prevalent chronic obstructive pulmonary disease.

Conclusions: We showed a modest inverse relationship between serum lipid levels and current asthma. These results highlight some important differences in Hispanics/Latinos and certain serum lipids may be factors or markers of obstructive lung disease.

Congenital Pulmonary Airway Malformation (CPAM) is a rare hamartomatous lesion. There are five major clinicopathologic types, most of which are incompatible with life. We report a case of 75 year old man, who was relatively asymptomatic throughout his life till he was 74, and was diagnosed to have CPAM on investigations for chronic cough by open lung biopsy. A brief review of clinicopathologic features of various types of CPAM also done.

Granulomatosis with Polyangiitis (GPA), formerly known as Wegener’s Granulomatosis, is a rare multisystem autoimmune disease of unknown etiology. GPA is characterized by necrotizing granulomatous inflammation and pauciimmune vasculitis in small- and medium-sized blood vessels. Given its protean clinical manifestations, the diagnosis of GPA can be difficult to distinguish from infectious etiologies. Here we describe a case of GPA diagnosed based on a positive ANCA serology and endobronchial features which responded to treatment with only steroids.

Justification: The existence of important peripheral muscular dysfunction contributes at very substantial manner to reduce the tolerance to exercise in a patient with chronic obstructive pulmonary disease.

Methods: this was an exhaustive research on benefits of exercise training for a group of patients, thirteen studies were found (n=351), from these four were excluded studies. The analysis was done using the SPSS v 15.0, and Excel 2007, p<0.05 was considered the significance value.

Results: the moderating variables that were meta-analysis were present in more than two experimental investigations. In total eight variables were found from which six variables showed significant effects (oxygen consumption, volume minute, heart rate, breathing rate, fatigue, dyspnea, emotional condition, six walking test).

Two control groups were compared; heart rate and breathing rate had a significant effect in the group that did exercise. Another analysis assessed the type of training: muscle strength, aerobic resistance, or combination of both, including body part involved, no significant difference was found.

In both comparisons the training type and the body part involved gives a significant effect.

Conclusion: the types of training should be combined for upper and low limbs.