Pulmonary & Respiratory Medicine

Objective: Temporary improvement in health status after available therapy or medication has been reported for interstitial lung disease. However, interstitial lung disease is progressive, and there is no study on the change in quality of life over time. Therefore, we examined the time course of the Chronic obstructive pulmonary disease Assessment Test (CAT) score in relation with pulmonary function and exercise capacity.
Methods: Out of 162 subjects with interstitial lung disease, 56 subjects evaluated more than twice by the CAT were assigned retrospectively to the study and divided into two groups according to the duration from disease onset. The percent of predicted forced vital capacity and diffusion capacity of the lung for carbon monoxide, and 6-min walk distance were also collected from the hospital records for analysis.
Results: The CAT score improved in 21 subjects with less than five years of disease (15 to 7, p=0.004), but declined in 35 subjects with five or more years (12 to 17, p=0.002). The intervals of evaluation were not different between the groups (21 and 20 months on average, p=0.80). Forced vital capacity and diffusion capacity of the lung for carbon monoxide at baseline were more impaired in the subjects with longer disease history (p=0.001 and p=0.006, respectively). The CAT score and diffusion capacity of the lung for carbon monoxide or 6-min walk distance were correlated in each group at the baseline. Pulmonary function declined on repeated evaluation even in subjects with less than five years of disease history.
Conclusion: Quality of life might be improved within five years of disease regardless of deterioration in pulmonary function; however, the improvement would become difficult afterward due to progressive change in pulmonary function or exercise capacity in interstitial lung disease.

This study offers a cheap and rapid method for the measuring of breath or measuring the size and capacity of the lung. In this innovative method, the respiration flowmeter than other conventional methods with high costs will be done very fast and accurate. In this device, the measurement accuracy and speed will increase dramatically, because of the high-frequency response than other methods. In this paper, the results of design and manufacturing the spirometry device using nanotechnology are discussed, which including synthesis of piezoelectric ceramics PMNPT and the amplifier circuit design.

The aim of this study was to compare physical performance in Italian adolescents with different habitual activity levels and to examine its relationship with peripheral muscle strength and quality of life.
At regular clinic visits in 5 cystic fibrosis (CF) Centres in Italy, 35 subjects performed spirometry, incremental shuttle walk test (ISWT), one-repetition maximum (1 RM) and completed the Habitual Activity Estimation Scale (HAES). Subjects were divided into two groups, based on activity levels derived from the HAES.
More active subjects achieved higher ISWT distance (ISWD) (1040.4 m vs.851.3 m, p=0.2) and described better body image perception (75.7% vs. 66.7% p=0.3) than subjects in the less active group, but these results did not reach a statistical significance. There was no correlation between ISWD, lung function and quality of life, but we observed a moderate correlation between ISWD and upper limb strength (r=0.46).
Our data showed that more active subjects did not differ from less- active ones. Further studies should choose alternative tools to assess physical activity levels in order to detect the real engagement in vigorous activities, making it easier to compare and combine results and promote educational intervention.

Background and objective: The British Thoracic Society (BTS) recommends that sedation for fiber-optic bronchoscopy (FOB) should be offered to all patients. This study evaluates the safety of FOB under sedation in patients with COPD.
Methods: Is a prospective observational study, with the approval of institutional review board. Sedation was administered by a board-certified anaesthetist. Patients were premedicated (IV) with metoclopramide 10 mg, fentanyl initial dose: 25 μg, midazolam initial dose 2-3 mg. After an initial 50 mg IV propofol, the dose was then carefully titrated according to the ASA physical status classification.
Results: The duration of the procedure was not different between the two groups (14.7 ± 3.551 vs. 14.9 ± 3.8 min p=0.695). Serious complications were very infrequent in both groups (2.1 vs. 0.07%, p=0.148). In the group of COPD patients there was no correlation between the lowest SaO2 during the procedure (r=0.03, p=0.518) or the SaO2 at the end of the procedure (r=-0.006, p=0.909) and the baseline FEV1. Neither the presence of a fall in the SaO2 greater than 4 points (HR 0.895, IC 0.452-1.773, p=0.750) nor a SaO2 lower than 90% during the procedure (HR 0.346, IC 0.060-1.918, p=0.233) or the general rate of complications (including desaturation) (HR: 0.627, CI: 0.257-1.529, p=0.305) were predicted by a baseline FEV1 lower than 50%.
Conclusions: We conclude that FOB under conscious sedation by a certified anesthesiologist is a safe procedure in patients with COPD with a low incidence of adverse effects.

Airway manifestations of Granulomatosis with Polyangitis (GPA) can be varied ranging from simple mucosal inflammation to critical tracheobronchial stenosis. Management of critical airway stenosis secondary to GPA is challenging. Significant airway compromise might require immediate evaluation and endoscopic or surgical intervention. Endoscopic interventions either in the form of balloon dilatation, electrosurgery, laser therapy, intralesional corticosteroid injection, topical application of mitomycin C, endoluminal spray cryotherapy or stent placement, remain the mainstay of treatment especially in patients who are deemed high risk and not a candidate for reconstructive surgery. We describe a case of tracheobronchial stenosis secondary to GPA, presenting with respiratory insufficiency requiring mechanical ventilator assistance on tracheostomy, successfully managed by endoscopic intervention combining bronchoscopic balloon dilatation and airway stent placement.

Background/objectives: Research on chronic non-communicable respiratory conditions is limited. This study assessed the impact of UK medical research on other European countries development of clinical practice guidelines (CPGs), to evaluate the UK contribution to the evidence-base of European CPGs on chronic non-communicable respiratory conditions.
Method: The UK contribution was determined on a fractional count basis to clinical guidelines’ citations: (1) from each of five selected (target) Member States (MS), namely France, Germany, The Netherlands, Sweden and Switzerland; and (2) from the other 25 countries (the other 23 EU MS, plus Iceland and Norway).
Results: There were 6,087 cited references on 52 clinical practice guidelines published from 21 European countries. The UK contribution varied between 11% and 17% for the five target EU MSs countries for all respiratory conditions clinical guidelines. There was more foreign collaboration research on Chronic Obstructive Pulmonary Disease (COPD) (33%) than asthma (25%) with results being statistically significant.
Conclusions: The study showed the importance of UK medical research contribution to the evidence-base of respiratory clinical guidelines in other European MS. Notable differences between asthma and COPD, can inform research priorities and medical progression on respiratory conditions’ clinical management.

Although a number of studies have reported elevated levels of eicosanoids in acute lung injury with sepsis, the possibility that eicosanoids may act as risk and prognostic factors for sepsis patients who develop acute respiratory distress syndrome (ARDS) remains poorly studied. To clarify this aspect, we measured the levels of eicosanoids and used logistic regression analysis and receiver operating characteristic (ROC) curves to investigate whether eicosanoids could act as risk and prognostic factors for sepsis patients who develop ARDS. We conducted a casecontrol study comparing 13 sepsis patients with ARDS and 23 sepsis patients without ARDS. The plasma levels of leukotriene B4 (LTB4), 6-keto-prostaglandin F1α (6-keto-PGF1α) and thromboxane B2 (TXB2) were measured by radioimmunoassays as substitutes for the plasma levels of PGI2 and TXA2, which are unstable. The levels of eicosanoids in sepsis patients with ARDS were significantly higher than those in sepsis patients without ARDS. Logistic regression analysis revealed that LTB4 was the only risk factor for sepsis patients with ARDS (odds ratio, 1.10; P=0.02). The area under the ROC curve values for all eicosanoids were significantly greater than 0.5 (P<0.001), and the likelihood value for the TXB2 levels was higher than those of the other eicosanoids. We conclude that LTB4 may be an important risk factor for sepsis patients with ARDS, while TXA2 may be an important prognostic factor for sepsis patients with ARDS.

Aim: To evaluate the proportion of pulmonary TB among patients hospitalized with suspected communityacquired pneumonia (CAP).
Methods: Consecutive patients diagnosed with community acquired pneumonia (CAP) admitted to a tertiary care centre over a 2 year period was studied prospectively. Systematic investigation of samples of sputum and blood cultures was performed. A subset of patients had urine antigen tests and serum serology.
Results: We enrolled 104 CAP suspected patients in the study group according to the BTS guidelines for CAP. Among these patient’s sputum AFB smear positivity was observed in 21 cases (20.19%). 18 (17.30%) patients turned out to be sputum gram stain positive, but their respective cultures didn’t show any growth. 65 (62.50%) of them turned out to be gram stain and culture positive for bacteriological aetiology. The Commonest cause for CAP among sputum and blood culture positive cases was Streptococcus pneumoniae (19/65) followed by, Klebsiella pneumoniae (17/65), Staphylococcus aureus (13/65), Pseudomonas aeruginosa (8/65), Escherichia coli (4/65), Acinetobactor spp. (3/65).
Conclusion: Tuberculosis is one of the leading causes of CAP in TB-prevalent areas. Our diagnostic index may help clinicians identify pulmonary TB cases immediately from CAP and initiate appropriate isolation and optimal treatment.

Background: Haemoptysis is a frequently occurring life threatening situation which can occur in various pulmonary conditions. Managing a case of haemoptysis is often difficult due to a large spectrum of causative factors. The effective control of haemoptysis depends upon identification of the etiology and localization of the site of bleeding.
Method: This was a two year cross sectional study of 102 patients who presented with active haemoptysis. Data from these patients was collected for the analyzing the underlying cause, diagnostic modality, treatment approach used and outcome of it in patients suffering from life-threatening haemoptysis.
Results: Old Pulmonary tuberculosis, (34.31%), bronchiectasis (25.49%), lung cancer (11.76%), aspergilloma (10.78%) accounted for the most common etiologies of haemoptysis. 12 patients (11.76%), out of 102 had mild haemoptysis, 26 patients (25.49%) had moderate haemoptysis and 64 patients (62.74%) had massive/severe haemoptysis. CT chest was the most sensitive diagnostic test when employed alone, with positive yield of 93.14%. Among study population 61 patients (59.80%) were treated conservatively, 39 patients (38.23%) were treated by bronchial artery embolisation (BAE) and 2 patients underwent surgery for management of recurrent haemoptysis. Most of the patients were treated conservatively, but in case of significant haemoptysis, Bronchial artery embolization was performed than the conservative treatment. Success rate of conservative treatment group on a long term basis was 72.13%, BAE group 89.47%, surgical treatment group was 100%, without any significant statistical significance (p value=0.090). The duration of hospitalization among conservative treatment group was 4.37 days and BAE group was 10.51 days (P-value<0.001).
Conclusion: The most common causes of haemoptysis were old pulmonary tuberculosis and bronchiectasis. Emergency bronchial artery embolisation is a better option than medical treatment for immediate cessation of haemoptysis. The successful treatment of haemoptysis requires thorough diagnostic evaluation and close interdisciplinary collaboration among pulmonologists, radiologists, and thoracic surgeons.

The evaluation of cardiopulmonary parameters is an essential factor for ascertaining of functional operability prior to anatomical lung resection. A predictive formulae for estimating of functional operability based on analysis of cardiorespiratory parameters have not yet been described. In marginal cases, a precise assessment is an important decisive factor under fear of postoperative complication regarding more radical parenchymal resection.
The functional tests such as spirometry, spiroergometry, stair climbing exercise, 6-Minute walk test, echocardiography, stress echocardiography and lung perfusion scintigram under consideration of general health situation could provide predictive postoperative information for ascertaining of functional operability.
We describe in this review the meaningful cardiorespiratory tests for estimating of the outcome prior to anatomical lung resection.

Rationale: Inspiratory muscle endurance as expressed by the tension-time index of the diaphragm [TTI=(Pdi/ Pdimax) × (Ti/Ttot)] in normal subjects and cardiorespiratory disorders requires the use of esophageal and gastric balloons. A noninvasive technique can be used in which the ratio of tidal volume to vital capacity (Vt/VC) is substituted for Pdi/Pdimax, with the resulting relationship [(Ti/Ttot) × (Vt/FVC)] called the breathing intolerance index (BIT). The response to medical management of BIT in patients with cardiomyopathy with chronic heartfailure has not been assessed before and after medical management.
Objectives: To compare control of ventilation and BIT in patients with stable dilated cardiomyopathy at rest and exercise, and to analyze BIT, oxygen uptake and carbon dioxide elimination at baseline and approximately one year after initiating medical management.
Methods: Control of ventilation and BIT were assessed in 24 patients (mean age 55.5 years; 17 males) at rest and at peak exercise during bicycle ergometry, at baseline and approximately 14 months later.
Results: Median peak VO2 was 12.9 mL/kg/min and 14.3 mL/kg/min at baseline and followup, respectively (p<0.036, adjusted for age, gender and BMI). It increased 4.3 times from rest to peak exercise at baseline and 4.7 times at followup (NS). Peak V’O2 increased by 10.5% between baseline and followup (p=0.036 after adjusting for age, sex and BMI). BIT did not change significantly. Peak V’O2/BIT increased significantly from baseline to follow-up (p=0.008, adjusted for age, sex and BMI). No patients died or experienced acute heart failure during the study.
Conclusions: Peak V’O2 in relation to non-invasively measured peak tension-time index of the respiratory muscles (BIT) increases significantly after one year of medical management, indicating increased efficient oxygen utilization as cardiac function improves. BIT is useful for noninvasively assessing inspiratory muscle endurance and relating oxygen uptake to ventilation in patients with dilated cardiomyopathy and chronic congestive heart failure