Department Of Respiratory Diseases Research Articles

Bronchiectasis Exacerbations: Are We Doing Everything We Can?

At the European Respiratory Society (ERS) Congress 2024, two experts in bronchiectasis, Pieter Goeminne, Department of Respiratory Diseases, Vitaz Saint-Nicholas Hospitals, Belgium, and Michal Shteinberg, Pulmonology Institute and CF Center – Carmel Medical Center; Israel Institute of Technology; and The B. Rappaport Faculty of Medicine, Haifa, Israel, discussed bronchiectasis’ pathogenesis and exacerbations, along with unmet needs regarding diagnosis and treatment. Bronchiectasis is a chronic and progressive inflammatory disease with a rising prevalence. Commonly associated conditions/related comorbidities of bronchiectasis include post-infective diseases and other airway conditions (such as chronic obstructive pulmonary disease [COPD] and asthma), although the cause of bronchiectasis may remain unknown in over a third of patients. Development of bronchiectasis involves the intersection of four pathogenic components: chronic infections, airway ciliary dysfunction, chronic inflammation (mostly neutrophilic), and structural lung damage, commonly known as the ‘vicious vortex.’ In particular, bronchiectasis development, progression, and exacerbation also involve upregulated and dysregulated neutrophil function. Exacerbations in bronchiectasis are marked by symptoms of increased cough, sputum changes, decreased lung function, and fatigue, among others. Careful clinical examination and awareness of bronchiectasis symptoms are needed to properly diagnose and treat the initial condition and prevent exacerbations. Triggers for exacerbations can be endogenous, such as neutrophil or eosinophil increases, as well as exogenous, including the presence of infectious agents and pollution. Research regarding treatment for bronchiectasis is limited, but European guidelines recommend airway clearance techniques and antibiotics during exacerbations. To enable more targeted treatment for bronchiectasis from first occurrence, to limit exacerbations, and during an exacerbation, there are unmet needs for better identification of resistant genes, treatments for pathogens and inflammation, and biomarkers of exacerbation triggers.

Removal of airway foreign body using flexible bronchoscopy in children

BackgroundFlexible bronchoscopy is mainly used to diagnose airway foreign bodies (AFBs). Due to advances in pediatric anesthesia, many teams have considered the extraction of AFBs by flexible bronchoscopy. We aimed to assess the success of flexible bronchoscopy in AFB removal in children. Patients and methodsWe analyzed retrospectively the data of children admitted for AFB aspiration in the Pediatric Respiratory Diseases Department B of Abderrahmane Mami Hospital in Tunisia between January 2012 and December 2022. AFB removal was performed by flexible bronchoscopy through the use of a laryngeal mask airway (LMA) or intubation. ResultsOf the 105 children included, AFB was removed by flexible bronchoscopy in 99 children (94.3 %). The mean age of the children was 32 months (9–150 months) with a sex ratio of 2:3. The foreign body was organic in 67 % of cases. Overall, 37 children underwent rigid bronchoscopy first (35.2 %). Flexible bronchoscopy was performed through the LMA in 77 cases (73 %) and after intubation in the other cases. Thoracic surgery was needed in two cases (1.9 %). Four infants expectorated the AFB after the procedure (3.8 %). Only two children developed laryngeal edema with transient oxygen desaturation. ConclusionAFB removal using a flexible bronchoscope is an efficient and safe procedure when performed by an experienced team. The recent use of LMA has facilitated the use of a larger bronchofiberscope and the insertion of multiple tools that can reach distal airways.

COPD after “Tabouna” Exposure: A Distinct Phenotype in Tunisian Women?

Background: COPD due to exposure to combustible biomass is an increasingly recognized phenotype, particularly among women who use traditional ovens, known as ‘Tabouna’, for baking bread. This paper aims to investigate the clinical and functional characteristics of COPD in Tunisian female patients attributed to the use of ‘Tabouna’. Methods: A retrospective single-center cohort study was conducted on patients recruited from the Department of Respiratory Disease at A. Mami Hospital, who were diagnosed with COPD between January 2014 and December 2022. The diagnosis of COPD adhered to the standards defined in GOLD 2022. Results: Out of the 95 women included in the study, 48 (50.5%) were exposed to tobacco smoke, while 47 (49.5%) were exposed to the ‘Tabouna’. The median age was 70.4 ± 11.5 years, ranging from 40 to 95 years. Patients exposed to biomass were notably older, with a median age of 75.4 compared to 64.6 (p = 0.04). A significant association was observed between COPD and biomass smoke exposure, both in women residing in rural and urban areas (p = 0.006). The frequency of patients exposed to biomass with comorbidities was higher than in the group exposed to tobacco, but only hypertension showed statistically significant results (p = 0.01). Tobacco smoke induced more impairment in lung function than biomass in the group with FEV1 ≤ 30% (p = 0.04). Long-acting muscarinic antagonists were more commonly prescribed to smokers (p = 0.04). Serious complications such as chronic respiratory failure and intensive care admissions were similar in both groups (p = 0.8 and 0.4). Conclusions: COPD in women after exposure to the ‘Tabouna’ was observed in older patients and characterized by delayed diagnosis. Despite these clinical differences, poor COPD outcomes were similar in both groups.

Allergy to Hymenopter Venins: About Two Cases

The prevalence of allergic diseases has increased significantly, Hymenoptera allergy is one of the most frequent causes of anaphylaxis. The most common species are Wasps and Bees. The fatal risk has been known since antiquity. We report the study of two observations of allergy to hymenoptera venom collected in the respiratory diseases department of the Ibn Rochd University Hospital of Casablanca. A man and a woman, victims of a hymenoptera sting, presented severe allergic reactions requiring treatment with allergenic immunotherapy. The clinical examination was unremarkable. The blood count showed hypereosinophilia. Skin tests were positive for bee venom. The specific IgE assay for bee venom was positive. The diagnosis chosen was that of allergy to bee venom. Our patients were classified as Mueller stage III. The bee venom desensitization protocol was started according to the Ultra Rush protocol with clinical monitoring of the desensitization sessions.

Pneumocystis in the Pulmonary Department: About 20 Cases

Pneumocystosis is an opportunistic infection responsible for severe infiltrative pneumonia and death in immunocompromised patients. However, few studies have been carried out to identify the epidemiological aspects of this pneumonia in our context. Its frequency at Morocco in not well known Our work is a descriptive, analytical and retrospective study of 20 cases collected from January 2008 to December 2021 in the respiratory diseases department of the IBN ROCHD in Casablanca. The goal is to give a better characterization of the specificities of this pathology in our context and thus to contribute to better management. We identified 12 men and 8 women, aged 28 to 45 with an average age of 37. Dyspnea (100%), hyperthermia (90%) and dry cough (30%) were the symptoms indicative of the infection. Pneumocystis jirovecii was isolated from bronchial aspiration fluid in 5 cases. The diagnosis was therefore radio-clinical in 75% of the cases. The LDH level was increased in 18 patients with an average value of 1379.3 UI/l. Curative treatment with the Triméthoprim-Sulfaméthoxazole combination has been initiated in all our patients. Fifty-five percent of patients adjuvant corticosteroid therapy and only 50% were on oxygen therapy. Prophylaxis remains the best treatment for combating this scourge.

Driver and actionable mutations in younger patients with lung cancer - are we searching properly?

The authors focused on a group of young lung cancer patients with the aim of better understanding the mechanisms of tumor pathogenesis in these patients and search for potential targetable mutations. We collected retrospective data on patients under 40 years diagnosed with lung cancer (NSCLC or small-cell lung cancer) from 2011-2020 at the Department of Respiratory Diseases, University Hospital Brno, Czech Republic. Tumor tissue of these patients was analysed by next-generation sequencing (NGS, a panel of 550 variants in 19 genes). Demographic characteristics, smoking history, histology, molecular-genetic results and clinical stage of the disesase were recorded in all eligible patients from accessible medical databases. Of 17 identified patients in only 8 cases was successful NGS carried out due to lack of sufficient good quality material in the other cases. The most frequently found molecular genetic changes were EGFR, RICTOR and HER2 amplification and MET and FGFR1 amplification. In addition, we found rare pathogenic variants in BRAF and PIK3CA genes. Actionable variants were detected in 75% patients. We detected very frequent driver and potentially actionable alterations in young patients with lung cancer. This suggests different mechanisms of carcinogenesis in these patients and indicates that they might benefit more from a specific approach than older lung cancer patients.

Sex transition from female to male as a risk factor for sleep-disordered breathing

AimThe female-to-male (FtM) sex transition requires lifelong supplementation with male sex hormones, resulting in high prevalence of weight gain, fat redistribution and other metabolic changes. Although sleep-disordered breathing (SDB) data for this group of patients are very limited, increased prevalence is expected. We report a mini-series of six case reports of FtM transsexuals treated in our centre. Patients and methodsAll reported cases are consecutive patients referred to a department of respiratory diseases and tuberculosis of a university hospital from 2017 to 2022. The standard pulmonary examination was performed, followed by limited polysomnography. ResultsIn all FtM subjects, SDB was present and continuous positive airway pressure (CPAP) therapy was indicated. The sex transition process was completed in three individuals while the other three only took testosterone supplementation at the assessment time. The subjects’ age ranged from 21 to 38 years, the apnoea-hypopnea index ranged from 17.3 to 104.1, and the BMI was 33.48–43.41. The CPAP therapy was effective in five patients, with one requiring bi-level positive airway pressure therapy. One subject committed suicide before the first check-up, four patients had a good level of compliance at one-year follow-up, and one had insufficient CPAP adherence. ConclusionSDB decreases the quality of life and life expectancy of FtM individuals. Their prognosis is undoubtedly better with effective treatment. Hence, obese FtM subjects should be considered at risk and screened for SDB.

Clinical relevance of low bone density in cystic fibrosis adult patients: A pilot study

Survival improvement in cystic fibrosis (CF) is associated with more frequent long-term complications, including CF related bone disease (CFBD). Impact of CFBD on global health outcome remains poorly described. We aimed to assess the relationship between low bone mineral density (BMD) and spinal pain, disability, and quality of life in CF adult patients. This monocentric cross-sectional study with prospective data collection was conducted from November 2016 to December 2019 in the Department of Respiratory Diseases at the University Hospital of Reims (NCT02924818). BMD was assessed by X-ray absorptiometry (DXA). Disability was assessed by the Health Assessment Questionnaire (HAQ). Quality of life was assessed by both the St George's Respiratory Questionnaire and the Cystic Fibrosis Questionnaire for teenagers and adults (CFQ 14+). Forty patients were analyzed, 68% of men, with a median age of 25 years, a median body mass index of 21 kg/m² and a median FEV1% of 54%. Nine patients (23%) had spinal pain. Ten patients (25%) had a low BMD. Compared with patients with normal BMD, patients with low BMD had a significantly lower BMI (22 vs 19 kg/m²; P = .006) and less vitamin D supplementation (33% vs 0%; P = .035). Low BMD was not associated with spinal pain, disability and quality of life. Low BMD is frequent in CF, affecting 1-quarter of adult patients. No significant association was found between low BMD and spinal pain, disability or quality of life.

Clinical characteristics and etiology of children with bronchiolitis before and during the COVID-19 pandemic in Suzhou, China.

We sought to compare the clinical characteristics and etiology of children with bronchiolitis in Suzhou before the pandemic of coronavirus disease 2019 (COVID-19) with those during the pandemic. Children who were hospitalized with bronchiolitis in the Department of Respiratory Disease, Children's Hospital of Soochow University were retrospectively enrolled over 3 consecutive years (2019, 2020, and 2021) from February 1 to January 31. Medical records were reviewed for etiology, clinical manifestations, and laboratory examination results. The pathogen detection rate and the positive respiratory syncytial virus (RSV) detection rate were lowest in 2020 and highest in 2021. The rate of human rhinovirus detection in 2021 was higher than that in 2019 but similar to that in 2020. The RSV-positive rate differences among the 3 years varied by age group. Regarding the monthly distribution of RSV-positive cases over the 3-year study, all age groups showed a significant increase in the number of cases during the winter of 2021, and this increase started as early as October. With regard to clinical manifestations, the proportion of children presenting with stuffy nose rhinorrhea in 2021 [73.33% (165/225)] was greater than that in 2019 [48.61% (122/251)] and 2020 [57.06% (97/170)], while the proportion of children with gastrointestinal symptoms in 2021 [11.56% (26/225)] was smaller than that in 2019 [25.50% (64/251)] but similar to that in 2020 [17.06% (29/170)]. After the implementation of COVID-19 pandemic-related interventions, significantly lower pathogen detection and RSV-positive rates were observed in children with bronchiolitis in 2020. An upward trend in these rates was observed in 2021, coinciding with the relaxation of COVID-19 prevention measures. Strengthening infection control and surveillance systems is extremely important for future work.

Relationship between etiology and morphological classification of benign central airway stenosis and its prognosis

Objectives: To analyze the relationship between etiology and morphological classification of benign central airway stenosis and its prognosis. Methods: We performed a retrospective study of the medical records of 453 patients initially diagnosed with benign airway stenosis at Department of Respiratory Diseases in Beijing Tiantan Hospital affiliated to Capital Medical University from January 2003 to October 2019. Of 453 patients, 260 were male. The age of the study population was 12-86(44.0±24.5) years. Results: Among the 453 patients diagnosed with benign central airway stenosis, 161 case (35.5%, including 113 post-tracheostomy tracheal stenosis and 48 post-intubation tracheal stenosis) were iatrogenic; 88 cases were from benign tumors (19.4%), 77 cases from tracheal or bronchial tuberculosis (17.0%), 71 case from tracheal foreign bodies (15.7%). Disease causes varied among different gender or age groups. The main type of stenosis was structural stenosis, of which 241 cases (53.2%) were intra-luminal and 183 cases (40.4%) were scar contracture type. The site of stenosis showed a certain relationship with the causes of stenosis. The stenosis degree was mainly from grade 2 to grade 4 (76.4%), and the length was mainly within 3 cm (84.8%). Single factor analysis on the relationship between disease cause, morphological classification and prognosis of benign central airway stenosis showed statistically better prognosis in groups that were caused by benign tumor, intraductal stenosis or stenosis that were 3-4 in degree and 1-2 degree in length. Conclusion: The common causes of central airway stenosis included iatrogenic stenosis, benign tumor, tracheal or bronchial tuberculosis and tracheal foreign bodies. Benign airway stenosis with different disease causes and morphological classification had different prognosis after bronchoscopic interventional treatment. Clinicians should know the disease causes, morphological characterization and risk factors for benign airway stenosis for earlier diagnosis, treatment or prevention.

Direct and indirect impacts of the COVID-19 pandemic on patients with pulmonary and pleural malignancies – a retrospective analysis of patient outcomes treated at Department of Respiratory Diseases, University Hospital Brno, during the 2nd and 3rd coronavirus waves

The pandemic of COVID-19 has significantly influenced the dia-gnostics and treatment of patients with lung and pleural malignancies. This group of patients is the riskiest, compared to patients with other cancers, both in morbidity and mortality.The data of patients with lung/pleural malignancies and proved COVID-19 positivity were analyzed at the Department of Respiratory Diseases and Tuberculosis, University Hospital Brno, during the period from October 2020 to May 2021. Demographic data, information about the course of SARS-CoV-2 infection and oncological disease as well as mortality were monitored. Together with the data from the study population, three case reports are also presented.Fifty-three patients were found (79% males), mean age 69.4 years, mainly with adenocarcinoma histology. A total of 47.1% patients experienced mild course of SARS-CoV-2 infection, 56.6% needed hospitalization, 24.5% died. Active anticancer treatment was delayed in 62.4% cases due to SARS-CoV-2 infection; the mean time of the delay reached 14.5 days.Patients with lung and pleural malignancies have a high risk of severe course of SARS-CoV-2 infection and mortality. Moreover, the ongoing SARS-CoV-2 infection as well as postcovid changes can complicate the anticancer treatment itself.

Pulmonary Aspergilloma: About 167 Cases

Pulmonary aspergilloma is a serious deep mycosis, especially in countries with high tuberculosis endemicity, because of its bleeding complications, which are sometimes massive, and can be life threatening. Our work is a retrospective, descriptive and analytical study of 167 cases of pulmonary aspergilloma, collected from January 2003 to May 2021 in the department of respiratory diseases of the CHU IBN ROCHD of Casablanca, whose aim was to provide a better characterization of this pathology in our context in order to improve the management of these patients. We counted 111 (66.26%) men and 56 (33.53%) women, aged between 21 and 80 years, with an average age of 48.5 years. A history of tuberculosis was present in 150(89.8%) cases, as well as COPD in 25(15%) cases. Respiratory symptoms were dominated by hemoptysis in 151 (90.4%) cases, dyspnea in 83 (49.7%) cases and chest pain in 55 (33%) cases. 64 (38.32%) cases had a normal pleuropulmonary examination, while 79 (47.3%) cases had snoring. The diagnosis was made mainly on radio-clinical data. Aspergillus serology was positive in 98(59%) cases. On thoracic CT, the typical grelot image was present in 70 (42%) cases. The lesions were predominantly in the right upper lobe in 115(69%) cases. The CT scan also classified the lesions as simple aspergilloma (SCA) in 35(21%) cases and as chronic cavitary pulmonary aspergillosis (CCPA) in 132(79%) cases. The treatment was surgical in 108 (64,67%) cases. The postoperative course was simple in the majority of patients. However, we had 3 (2.77%) postoperative deaths. The average duration of follow-up of these patients was 3.5 years, during which an empyema was noted in 6 (6.81%) cases, a death in 5 (6%) cases and a recurrence in 2 (2.22%) cases. Medical treatment of PA with Itraconazole was indicated in 59 (35%) cases, for an average duration of 12 months with quarterly clinical, biological and radiological follow-up. The evolution was marked by clinical improvement in 15(25%) ....

Epidemiologic-clinical, biological and radiological features of pulmonary tuberculosis in patients with diabetes in Antananarivo, Madagascar

La tuberculose pulmonaire est fréquemment associée au diabète sucré, avec parfois des présentations atypiques. Notre objectif était d´identifier les particularités épidémiologiques, cliniques, biologiques et radiologiques de la tuberculose pulmonaire chez les diabétiques par rapport aux non diabétiques. Ceci afin d´améliorer leur prise en charge. l´étude a été réalisée dans les services d´Endocrinologie et de Pneumologie du Centre Hospitalier Universitaire Joseph Raseta Befelatanana et le Service de Maladies Respiratoires du Centre Hospitalier de Soavinandriana à Antananarivo, Madagascar. Elle a concerné les cas de tuberculose pulmonaire à bacilloscopie positive enregistrés de janvier 2018 à janvier 2020 (25 mois). C´est une étude rétrospective transversale descriptive et analytique. Dans notre étude, la prévalence du diabète chez les tuberculeux était de 20,31%. Un âge plus avancé, une évolution clinique à bas bruit, un syndrome inflammatoire biologique important, moins de cavernes mais plus d´opacités systématisées, des lésions radiologiques à localisation basale ou diffuses, plutôt unilatérales droites, ont été constatés plus fréquemment chez les diabétiques comparés aux non diabétiques. La connaissance des particularités de la présentation de la tuberculose pulmonaire chez les diabétiques aidera les personnels de santé à ne pas passer à côté du diagnostic même devant une présentation atypique. Par ailleurs, comme la majorité des tuberculoses pulmonaires survient chez les diabétiques déséquilibrés, un bon équilibre glycémique permettra certainement de diminuer son incidence.

Editorial introductions.

Current Opinion in Allergy and Clinical Immunology was launched in 2001. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of allergy and clinical immunology are divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS M. Teresa (Maite) de la MorenaM. Teresa (Maite) de la MorenaM. Teresa (Maite) de la Morena is Professor of Pediatrics in the Department of Pediatrics, Division of Immunology at University of Washington and Seattle Children's Hospital, USA. She graduated from medical school at Universidad Complutense de Madrid, Spain. This was followed by residency and fellowships training in pediatrics, allergy and immunology, and laboratory immunology at the University of South Florida, St. Petersburg, Florida, USA. Dr de La Morena has a clinical interest in allergy and immunology, clinical immunology with particular focus on the primary immunodeficiency diseases. Her research interests include long term clinical outcomes of patients with X-linked Hyper IgM syndrome, DiGeorge syndrome and microRNAs in primary immunodeficiency disorders, including their role in thymic development. Stephen JollesStephen JollesDr Jolles is a Consultant Clinical Immunologist and Honorary Professor at the University Hospital of Wales, UK. He is Clinical Lead in the Immunodeficiency Centre of Wales and Co-Director of the Hub Immunology Diagnostic Laboratory of Wales. Dr Jolles trained in immunology and allergy, and obtained his PhD on Langerhans cell migration at the National Institute for Medical Research, London. He has a particular interest in the clinical use of immunoglobulin and its mechanism of action and research interests include development of new therapeutic products, new screening strategies to improve the laboratory diagnosis of primary and secondary immunodeficiency and allergy, and better ways to monitor primary immunodeficiency disease and the impact of treatments. Giovanni PassalacquaGiovanni PassalacquaProf. Giovanni Passalacqua was born in Genoa in 1964, graduated in 1990 from the Genoa University Medical School, Italy, and was appointed by the specialty degrees in Allergy and Clinical Immunology and Respiratory Medicine in 1994 and 2002. He is the Co-Chairman of the Immunotherapy Scientific Committee of the WAO and member of the ARIA editorial board. Prof. Passalacqua serves as a section editor for Current Opinion in Allergy and Clinical Immunology, and also as a reviewer for Allergy, JACI, Clin Exp Allergy and ERJ. Prof. Passalacqua is the co-author of several international position papers, including ARIA guidelines, WAO Pos pap on SLIT, EAACI Pos Pap on local immunotherapy. His main fields of research are sublingual immunotherapy, mechanisms of allergic inflammation, antihistamines, corticosteroids, respiratory allergy, hymenoptera venom allergy. Under the chairmanship of Professor Canonica, he developed and investigated sublingual immunotherapy in the last 20 years. He has had 450 full articles published in peer reviewed journals indexed in MedLine plus 15 chapters in international handbooks. He currently heads the Allergy and Respiratory Diseases Department, and chairs the Specialty School in Respiratory Diseases, University of Genoa, Italy. Robert BushRobert BushDr Robert Bush received his MD degree from West Virginia University, USA. After completing his residency in internal medicine and fellowship in allergy and immunology at the University of Wisconsin – Madison, USA, he joined the faculty. He is currently Professor (Emeritus) of Medicine and was the former Chief of Allergy at the William S Middleton VA Hospital, Madison, Wisconsin, USA. His research interests include sublingual immunotherapy, allergen characterization, fungal allergy, food allergy, and occupational asthma.

PD-L1 Expression in Patients with Idiopathic Pulmonary Fibrosis.

Background: Idiopathic pulmonary fibrosis (IPF) is the most common and severe form within the group of idiopathic interstitial pneumonias. It is characterized by repetitive alveolar injury in genetically susceptible individuals and abnormal wound healing, leading to dysregulated bronchiolar proliferation and excessive deposition of extracellular matrix, causing complete architectural distortion and fibrosis. Epithelial-to-mesenchymal transition is considered an important pathogenic event, a phenomenon also observed in various malignant neoplasms, in which tumor cells express programmed death-ligand one (PD-L1). The aim of this study was to assess the presence of PD-L1 in patients with IPF and other interstitial lung diseases (ILDs). Method: Patients with a clinically and radiologically suspected idiopathic interstitial pneumonia or other ILDs undergoing transbronchial cryobiopsy to confirm the diagnosis at the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, were included in this prospective observational study. Cellular membrane PD-L1 expression in epithelial cells was determined using the DAKO PD-L1 IHC 22C3 PharmDx Kit. Results: Membrane-bound PD-L1 (mPD-L1) was found in twelve (28%) of the forty-three patients with IPF and in five (9%) of the fifty-five patients with other ILDs (p = 0.015). When adjusting for age, gender and smoking status, the odds ratio of having IPF when expressing mPD-L1 in alveolar and/or bronchiolar epithelial cells was 4.3 (CI: 1.3–14.3). Conclusion: Expression of mPD-L1 in epithelial cells in the lung parenchymal zones was detected in a consistent subgroup of patients with IPF compared to other interstitial pneumonias. Larger studies are needed to explore the role of mPD-L1 in patients with IPF.

Exhaled Nitric Oxide as a Surrogate Marker for Obstructive Sleep Apnea Severity Grading: An In-Hospital Population Study.

PurposeOur study aimed to evaluate the relationship between exhaled nitric oxide (eNO) markers and obstructive sleep apnea (OSA) severity and verify the changes in eNO profiles among mild, moderate, and severe OSA subgroups.MethodsThis study was a cross-sectional and in-hospital population-based study. We investigated 123 OSA patients (17 mild, 23 moderate and, 83 severe OSA) in the department of respiratory diseases. Studied data included anthropometry, respiratory polygraphy, biological markers, spirometry, and multi-flow eNO measurements. Data analysis implied linear correlation, non-parametric ANOVA, and pair-wise comparison.ResultsNo significant difference could be found among 3 OSA severity subgroups for FENO at – four sampling flow rates (50–350 mL/s). The bronchial production rate of NO (J’awNO) was proportionally increased, with median values of 11.2, 33.9, and 36.2 in mild, moderate, and severe OSA, respectively (p=0.010). The alveolar concentration of NO (CANO) changed with a non-linear pattern; it was increased in moderate (6.49) vs mild (7.79) OSA but decreased in severe OSA (5.20, p = 0.015). The only correction that could be established between OSA severity and exhaled nitric oxide markers is through J’AWNO (rho=0.25, p=0.02) and CANO (rho= 0.18, p=0.04). There was no significant correlation between FENO measured at three different flow rates and the OSA severity. We also found a weak but significant correlation between FENO 100 and averaged SpO2 (rho = 0.07, p= 0.03).ConclusionThe present study showed that J’AWNO, which represents eNO derived from the central airway, is proportionally increased in more severe OSA, while eNO from alveolar space, indicated by CANO, was also associated with OSA severity and relatively lower in the most severe OSA patients. In contrast, stand-alone FENO metrics did not show a clear difference among the three severity subgroups.

Integration of cryobiopsies for interstitial lung disease diagnosis is a valid and safe diagnostic strategy-experiences based on 250 biopsy procedures.

BackgroundTransbronchial cryobiopsies has become increasingly used in the diagnostic workup in patients suspected of having interstitial lung disease. The procedure is associated with less complications, morbidity and mortality compared to surgical lung biopsies although with a diagnostic yield that is not as high, but close to that of surgical lung biopsies. The aim of the present study was to describe the complications and diagnostic yield and their prognostic factors.MethodsAll patients undergoing transbronchial cryobiopsies at the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, were included in this prospective observational cohort study.ResultsA total of 250 patients were included [61% male, mean age 66 years (range, 22–81 years)]. Pneumothorax was detected in 70 (28%) of the patients, moderate hemorrhage in 53 (21%) and severe hemorrhage in 2 (1%) of the patients. Hemorrhage was associated with central biopsies, but not with anticoagulant therapy. None of the complications were related to lung function, exercise capacity, biopsy or probe size. Only one patient experienced an acute exacerbation. Three-month mortality was 0.4% (1 patient), caused by cancer and unrelated to the procedure. Cryobiopsies contributed to the final diagnosis in 72% of the patients and after multidisciplinary team discussion, a consensus diagnosis was obtained in 82% of the patients. The gender, the total sum of biopsy sizes, number of biopsies and presence of more than 50% alveolar tissue in biopsies increased the diagnostic yield.ConclusionsOur study confirms that using cryobiopsies in the diagnostic setup for interstitial lung diseases is safe with a limited risk of acute exacerbations and mortality. Cryobiopsies contribute to the diagnosis in the majority of patients.

A prospective multi-center clinical investigation of HIV-negative pulmonary cryptococcosis in China

Objective: To investigate the current status of the diagnosis and treatment of pulmonary cryptococcosis in respiratory medicine and improve the understanding of the clinical characteristics of HIV-negative pulmonary cryptococcosis in China. Methods: A prospective multi-center open cohort study was designed to screen for pulmonary cryptococcosis in the general wards and intensive care units of the Department of Respiratory Diseases in 22 hospitals. The HIV-negative patients with positive cryptococcal etiological diagnosis based on smear culture, antigen detection and histopathology were enrolled in the study. The clinical data of enrolled patients were collected and analyzed. Results: A total of 457 cases of pulmonary cryptococcosis were enrolled, among which 3.28% (15/457) were disseminated infections. The case fatality rate was 0.88% (4/457). The majority of the cases were diagnosed by histopathological examinations (74.40%, 340/457) and cryptococcus antigen detection (37.64%, 172/457). Patients with pulmonary cryptococcosis accounted for 2.04‰ (457/223 748) of the total hospitalized patients in the Department of Respiratory Diseases during the same period, and the ratio was the highest in south and east China. Meanwhile, 70.24% (321/457) of the patients had no underlying diseases, while 87.75% (401/457) were found to have immunocompetent status. Cough and expectoration were the most common clinical symptoms in patients with pulmonary cryptococcosis. However, 25.16% (115/457) of the patients had no clinical symptom or physical signs. In terms of imaging features on pulmonary CT, multiple pulmonary lesions were more common than isolated lesions, and there were more subpleural lesions than perihilar or medial lesions. Morphologically, most of the lesions were middle-sized nodules (1-5 cm) or small-sized nodules (3 mm to 1 cm). The sensitivity of serum cryptococcus antigen test was 71.99% (203/282). Moreover, antigen-positive patients differed from antigen-negative patients in terms of basic immune status, clinical symptoms, imaging features and infection types. Meanwhile, immunocompromised patients differed from immunocompetent patients in terms of clinical symptoms, physical signs, infection-related inflammation indicator levels, imaging features, serum cryptococcus antigen positive rate and prognosis. Conclusions: The majority of cases of HIV-negative pulmonary cryptococcosis in China had no underlying disease or immunocompromised status, and the overrall prognosis was favorable. However, early diagnosis of HIV-negative pulmonary cryptococcosis remains challenging due to the complicated manifestations of the disease.

Pattern of co-morbidities in patients of chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD), a disease of the elderly population is continuously increasing across the globe. COPD can be associated with the comorbidities, which in turn affect the course or severity of the disease. Objectives: To study the pattern of comorbidities in stable patients of COPD, and their comparison with apparently healthy attendant of the age of ≥35 years. Materials and Methods: A total of 121 COPD patients and 130 healthy attendants of patients coming to the respiratory disease department were enrolled in the study. All participants were evaluated for detailed clinical history, physical examinations, laboratory investigations, Hamilton depression rating scale, polysomnography, echocardiography, and ophthalmological tests to get the different variables. Results: Comorbidities in the case group having COPD were found more prevalent. Prevalence of hypertension (cases [n = 32], control [n = 12], odds ratio = 3.53, P = 0.004), depression (cases [n = 38], control [n = 18], odds ratio = 2.85, P = 0.0013), bronchiectasis (cases [n = 14], control [n = 3], odds ratio = 5.54, P = 0.0046), tuberculosis (cases [n = 20], control [n = 9], odds ratio = 2.66, P = 0.0187), ischemic heart diseases (cases [n = 19], control [n = 9], odds ratio = 2.5, P = 0.043), and musculoskeletal disorder including arthritis, peri-arthritis, and osteoporosis (cases [n = 28], control [n = 13], odds ratio = 2.70, P = 0.0060) found statistically significant in COPD patients in comparison to healthy controls. Other comorbidities such as diabetes, cataract, dyslipidemia, and uterine prolapsed were more common in COPD patients but these differences were not statistically significant. Also, 85.98% of COPD patients had at least one comorbidity. Conclusion: Our data showed that comorbidities viz hypertension, depression, bronchiectasis, tuberculosis, ischemic heart diseases, and musculoskeletal disorders are prevalent in COPD patients compared to healthy individuals.

Role of TLR4/NF-κB Signalling Pathway in Pulmonary Arterial Hypertension in Patients with Chronic Obstructive Pulmonary Disease.

To determine the role of toll-like receptor 4 (TLR4)/ nuclear factor kappa B (NF-κB) signalling pathway in pulmonary arterial hypertension (PAH) in patients with chronic obstructive pulmonary disease (COPD). An experimental study. Department of Respiratory Disease, The Hospital Affiliated to Jiangnan University, Wuxi, Jiangsu, China, from June 2018 to December 2019. Subjects included 98 COPD patients and 22 healthy individuals (control group). COPD patients were divided into two groups as PAH group (PAH group, n=57) and normal pulmonary arterial pressure group (nPAP group, n=41). TLR4 and NF-κB in peripheral bloodmononuclearcells (PBMC)were measured by real-time polymerase chain reaction (RT-PCR); and inflammatory cytokine of IL-6 and TNF-α were estimated by enzyme-linked immunosorbent assay (ELISA) of three groups. The levels of TLR4, NF-κB and inflammatory cytokine of IL-6 and TNF-α of PAH group were higher than those in nPAP group and controls (all p<0.05); and controls had a lower levels of TLR4, NF-κB and TNF-α than those n PAP group patients (all p<0.05) except for PAP and IL-6 (p=0.121 andp=0.304, respectively). The expression levels of TLR4 and NF-κB in PBMC were positively related to that PAP and inflammatory cytokine of IL-6 and TNF-α in PAH patients with COPD (all p<0.05), but the positive correlation betweenIL-6 and TNF-α expression level was not established (p=0.170). All parameters in the nPAP group had no significant correlation to each other, it is the same in control (all p>0.05). Inflammatory mechanisms play an important role in the development of PAH in patients with COPD. TLR4/NF-κB signal transduction pathway is involved in the pathogenesis of PAH, and the expression levels of TLR4/NF-κB may reflect the severity of PAH in patients with COPD. Key Words: Toll-like receptor 4, Nuclear factor kappa B, Pulmonary arterial hypertension, Chronic obstructive pulmonary disease, Inflammatory cytokine.