Department Of Respiratory Medicine Research Articles

The correlation between rapid eye movement sleep and nocturnal hypertension in patients with obstructive sleep apnea: A retrospective study.

Obstructive sleep apnea (OSA) is a respiratory disease closely associated with hypertension and heart disease. This study aimed to evaluate the diagnostic value of rapid eye movement (REM) sleep during nocturnal hypertension in OSA patients. We selected 194 patients who underwent polysomnography (PSG) at the Respiratory and Critical Care Medicine Department of Jiading District Central Hospital in Shanghai between January 2021 and August 2023. All patients were assigned to the hypertension and normal blood pressure groups, and the differences between the 2 groups were compared. This study included 194 patients (137 with nocturnal hypertension and 57 with normal nocturnal blood pressure). The proportion of male sex, body mass index, apnea-hypopnea index (AHI), REM sleep duration, percentage of REM sleep duration to total sleep duration, REM-AHI, nonrapid eye movement-AHI, oxygen desaturation index (ODI), REM-ODI, nonrapid eye movement-ODI, and average nighttime heart rate during sleep were higher in the hypertension group than in the normal blood pressure group, and the lowest oxygen saturation was lower than that in the normal blood pressure group (P < .05). Logistic regression analysis showed that REM-AHI was an independent risk factor for nocturnal hypertension (adjusted odds ratio, 1.048; 95% confidence interval, 1.011-1.086; P = .01). Receiver operating characteristic curve analysis showed that the REM-AHI had an area under the curve of 0.721 (95% confidence interval, 0.641-0.801; P < .001) for diagnosing nocturnal hypertension in patients with OSA, with a maximum Youden index of 0.379. The optimal critical value of the REM-AHI was 23.6 times/h, with a sensitivity of 64.2% and specificity of 73.7%. REM sleep is closely related to nocturnal hypertension, and patients with OSA are more prone to cardiovascular events.

Respiratory endoscopy intervention in 12 patients with refractory persistent air leakage after pulmonary surgery: a preliminary study of case series

ObjectiveTo explore the value of our protocol of respiratory endoscopy intervention in the treatment of refractory persistent air leakage(PAL) after pulmonary surgery.MethodA retrospective study was conducted in 12 patients with PAL after pulmonary surgery who were successfully treated by our protocol of respiratory endoscopy intervention in the Department of Respiratory and Critical Care Medicine of the Fourth Hospital Affiliated to Soochow University and the First Hospital Affiliated to Soochow University from December 2019 to January 2024. 4 types of treatment were included in our protocol; A: chest tube drainage combined with negative pressure suction; B: medical thoracoscopy with chest tube as a path; C: stimulating bronchial mucosa hyperplasia under bronchoscopy; D: blocking of the fistula orifice with the relevant materials under the bronchoscope; And the specific treatment received by each patient was based on the condition of the patient.ResultsThe bronchopleural fistula was found in 7 patients; The fistula orifice was found in 5 patients and the diameter of fistula orifices were 4.0–12.0 mm, with an average of 7.2 ± 3.6 mm. Among the 7 patients with bronchopleural fistula, 1 patient received C + D, 1 patient received A + B + C, 1 patient received A + C + D, 4 patients received A + B + C + D; Among the 5 patients with fistula orifice, 2 patients received C + D, 2 patients received A + B + D, 1 patient received A + C + D. All the 12 patients were effectively treated, among which 9 patients who underwent chest tube drainage were successfully extubed. The median (interquartile distance) retention time of chest tubes before and after our protocol of respiratory endoscopy intervention were respectively 73.5(50.5,106.25) days and 29(22,38.75) days, p < 0.05.ConclusionsOur protocol of respiratory endoscopy intervention can significantly shorten the retention time of the patient’s chest tube and effectively treat refractory PAL after pulmonary surgery. However, it should be emphasized that individualized therapy should be provided according to the location and size of the fistula orifice.

Application of Case-based Learning in Respiratory Medicine Nursing Education

Objective: To explore the application effects of case-based learning in respiratory medicine nursing education. Methods: 60 nursing interns in the respiratory medicine department of our hospital from January 2023 to December 2023 were selected and randomly divided into a control group and an observation group, with 30 students in each group. The control group adopted traditional teaching methods, while the observation group adopted case-based learning based on traditional teaching methods. The differences in theoretical knowledge, operational skills, clinical thinking ability, and learning interest between the two groups were compared. Results: The scores of theoretical knowledge, operational skills, clinical thinking ability, and learning interest of the observation group were significantly higher than those of the control group, and the differences were statistically significant (P &lt; 0.05). The satisfaction score of the observation group was significantly higher than that of the control group, with a significant difference (P &lt; 0.05). Conclusion: Case-based learning can effectively improve the teaching effect of respiratory medicine nursing, cultivate students’ comprehensive abilities, and is worthy of promotion and application.

A Study on the Correlation Between Sarcopenia and Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a disease that affects the entire body. Sarcopenia, one of the adverse manifestations of the whole body, can lead to a variety of adverse outcomes. The worldwide studies have shown that sarcopenia was associated with COPD. This article aims to further enrich this research direction by focusing on the relationship between sarcopenia and COPD in Chinese inpatients. The subjects of this study were patients hospitalized in the Department of Respiratory and Critical Care Medicine of Rongchang People&amp;apos;s Hospital of Chongqing from July 2022 to May 2024. After bioelectrical impedance analysis (BIA), test of 6 m walking speed, and tests for upper grip strength were accomplished, the sarcopenia can be diagnosed. According to the presence of chronic airflow limitation, which assessed by post-bronchodilator spirometry, we diagnosed COPD. COPD and sarcopenia as two variables, simple correlation analysis was adopted for them. The subjects were classified into sarcopenia group and non-sarcopenia group. And then, the correlation between sarcopenia and COPD was assessed with binary logistic regression analysis. Finally we get the results. Spearman&amp;apos;s correlation coefficient for sarcopenia and COPD was 0.166 (p&amp;lt;0.05). While, COPD was not an independent risk factor to sarcopenia in the binary logistic regression analysis. Therefore, this study draws conclusions that COPD and sarcopenia is associated, but not linked independently.

Characteristics of different pathogenic bacterial infections and their effects on prognosis in adult patients with bronchiectasis.

The present study aimed to analyse the types of pathogens infecting adults with bronchiectasis and the effects of different pathogens on the number of acute exacerbations and the length of hospitalization for 1 year in patients with severe bronchiectasis. A total of 522 patients with bronchiectasis admitted to the Department of Respiratory and Critical Care Medicine at the Second Hospital of Jiaxing (Zhejiang, China) between January 2019 and December 2022 were retrospectively analysed. The patients were divided into a mild to moderate group and a severe group according to the bronchiectasis severity index criteria. The basic and clinical information of all the patients was collected. The patients were followed up for 1 year after the day when the sputum or alveolar lavage fluid samples tested positive for pathogens. The follow-up information included the exacerbation of cough symptoms, the number of hospitalizations and the number of days of antibiotic use in patients with bronchiectasis. A total of 522 patients with bronchiectasis were positive for pathogens, including 192 patients with Pseudomonas aeruginosa (P. aeruginosa; 36.8%), 60 patients with Klebsiella pneumoniae (K. pneumoniae; 11.5%), 48 patients with mixed pathogens (≥2 pathogens at the same time; 9.2%), 36 patients with Staphylococcus aureus (6.9%), 33 patients with Aspergillus fumigatus (6.3%), 30 patients with Haemophilus influenzae (5.7%), 15 patients with Acinetobacter baumannii (A. baumannii; 2.9%) and 108 patients with other pathogens (20.7%). Compared with patients with mild to moderate bronchiectasis, patients with severe bronchiectasis were more likely to have P. aeruginosa but less likely to have K. pneumoniae and other pathogens. The length of hospitalization and duration of antibiotic use in the severe group of patients with bronchiectasis caused by P. aeruginosa, A. fumigatus, or A. baumannii were significantly longer than those in the mild to moderate group. During the 1-year follow-up, the number of acute exacerbations and hospitalizations of patients with severe bronchiectasis caused by A. baumannii and P. aeruginosa were significantly greater than those of patients with severe bronchiectasis caused by other pathogens. According to logistic regression analysis, A. baumannii and P. aeruginosa were independent risk factors for acute exacerbation of severe bronchiectasis in the following year. In patients with severe bronchiectasis, the pathogens A. baumannii, P. aeruginosa and A. fumigatus were independent risk factors for future acute exacerbations and increased risk of hospitalization.

Path analysis of illness perception, medication beliefs, family support on inhaler adherence in elderly COPD patients: Based on triadic reciprocal determinism

ObjectiveThis study aimed to explore the pathways through which personal factors (demographic characteristics, illness perception, medication beliefs) and environmental factors (family support) influence adherence to inhaler therapy among Chinese elderly patients with chronic obstructive pulmonary disease (COPD) based on the triadic reciprocal determinism. MethodsA cross-sectional survey was conducted from June 2022 to December 2023 using the Test of Adherence to Inhalers (TAI), the Beliefs about Medicines Questionnaire (BMQ), the Brief Illness Perception Questionnaire (B-IPQ) and the Family Support Scale to investigate 305 elderly COPD patients (mean age 70.96 years, 213 males) from the Department of Respiratory Medicine of a comprehensive hospital in Anhui, China mainland. Path analysis was performed using AMOS 22.0. ResultsPath analysis showed that illness perception, necessity beliefs, concerns beliefs and family support all had direct effects on inhaler adherence, while age had an indirect effect on adherence. Additionally, necessity beliefs and concerns beliefs exhibited significant mediating effects between illness perception and inhaler adherence. Family support respectively mediated the relationships between necessity beliefs, concerns beliefs and inhaler adherence. ConclusionA multidimensional approach targeting cognitive, belief and family factors holds promise for substantially improving inhaler adherence among elderly COPD populations. Practice ImplicationsThis study provided new perspectives for improving inhaler adherence in COPD patients. Healthcare providers should emphasize improving patients' illness perception and medication beliefs, considering the important impact of family support on inhaler adherence.

Role of Immunotherapy in Non-Small Cell Lung Cancer (NSCLC)

Background: Non-small cell lung cancer accounts for approximately 85% of all lung cancers and presents a serious public health challenge due to an increasing incidence and poor prognosis, with only a 5-year survival rate of 5-10% in advanced disease stages. Objective: The aim of this work is an overview of the clinical efficacy and safety profile of ICIs in NSCLC patients, mainly focusing on the predictive role played by PD-L1 expression and tumor mutational burden as predictive biomarkers of treatment response. Methods: A total of 63 NSCLC patients treated with ICIs at a Department of Respiratory Medicine, Dhaka National Medical Institute Hospital, Dhaka, Bangladesh and National Institute of Diseases of the Chest and Hospital (NIDCH), and National Institute of Cancer Research &amp; Hospital (NICRH), Mohakhali, Dhaka, Bangladesh from July 2023 to December 2023, were retrospectively analyzed. Demographical information, treatment regimens, and clinical outcomes were collected and analyzed. Treatment responses were evaluated based on Response Evaluation Criteria in Solid Tumors, and safety was assessed through monitoring adverse events. Results: The median age of the cohort was 62 years, with presentation in advanced stages, III and IV in 70%. An objective response rate of 42% was observed; median PFS was 8.5 months. Of note, patients with high PD-L1 expression of ≥ 50% had a response rate of 60%, whereas those with lower expression had a rate of 30%. It was observed in TMB analysis that high mutational burden is associated with a median PFS of 10 months versus 5 months in the case of low TMB. About 15% of patients developed adverse events, mostly immune-mediated. Conclusion: This study has exemplified the promising efficacy of ICIs in the improvement of treatment outcomes for patients with NSCLC and underlined critical roles that PD-L1 expression and TMB have played in guiding personalized treatment strategies. Although encouraging, these findings are retrospective and ..

Association between serum albumin and disease severity of non-cystic fibrosis bronchiectasis

Background Bronchiectasis is a chronic debilitating but neglected pulmonary disease. It is associated with substantial health related burden and health care costs. However, the biochemical parameters related to disease severity have not been sufficiently assessed. Objective: Aim of the present study to find out any association between serum albumin and disease severity of non-cystic fibrosis bronchiectasis. Methods This was a cross-sectional observational study of 33 subjects with non-cystic fibrosis bronchiectasis at department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital (NIDCH) from December 2019 to March 2021. After taking informed written consent BSI score be calculated and blood was taken for to measure serum albumin. Data was collected through questionnaire. After completion of the data collection, analysis was done with the help of Statistical Package for Social Science (SPSS) version 22. Results Mean age of the study subjects was 43.36 ± 15.65 years with a range of 21 -76 years and more likely to be men (60.6%). History of previous pulmonary tuberculosis found in 48.5% subjects as associated conditions and pseudomonas aeruginosa (21.2%) was the most common organisms in sputum culture. 87.9% of the study subjects had history of exacerbation within last 12 months and 60.6% were hospitalized within last 2 years. More than half (54.6%) of the study subjects had severe, 33.3% had moderate and 12.1% had mild bronchiectasis with the mean BSI score of 9.00 ± 3.05. Mean serum albumin was 3.22 ± 0.84 g/dl. Albumin had a significant negative correlation with BSI score (r = -0.457 and p = 0.008). Conclusion The serum albumin had moderate correlation with disease severity of non-cystic fibrosis bronchiectasis. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1104-1111

Analysis of Mycoplasma pneumoniae pneumonia and viral coinfection in southern Guangzhou after the COVID-19 pandemic.

Mycoplasma pneumoniae (MP) has recently become an important pathogen of respiratory infection in both children and adults. The objective of this study was to investigate the detection rate of MP and clinical features of viral coinfection in Mycoplasma pneumoniae pneumonia (MPP) after the coronavirus disease 2019 (COVID-19) pandemic in southern Guangzhou. We reviewed 3,094 patients with respiratory infection who visited the respiratory medicine and pediatrics department from October 2023 to January 2024. Patients underwent polymerase chain reaction (PCR) or immunoglobulin M (IgM) serology for MP, influenza virus (IFV), respiratory syncytial virus (RSV), adenovirus (ADV) and enterovirus (EV). We further compared the clinical, laboratory, and imaging findings of the MPP patients with and without viral coinfection. In order to identify the significant association with viral coinfection in MPP, multivariable logistic regression analysis was performed. MP infection was identified in 746 (36.69%) children and 140 (13.20%) adults, and there were 308 (41.29%) children and 76 (54.29%) adults with MPP. Eighty-four (27.27%) children and 7 (5.0%) adults with MPP had viral coinfection. Viral coinfection including MPP-RSV (4.22%), MPP-ADV (4.22%), MPP-EV (7.14%) and MPP-IFV (11.68%) was identified in children. These patients had a higher frequency of fever, higher white blood cell, higher concentration of C-reactive protein and procalcitonin, and higher proportion of lactate dehydrogenase (LDH) at greater than 250 U/L. Imaging feature of consolidation and air bronchogram sign was observed in both MPP and viral coinfection. Multivariable analysis showed fever (adjusted odds ratio, 3.46; 95% confidence interval, 1.02-11.74; P=0.047) and elevated procalcitonin of greater than 5 ng/mL (adjusted odds ratio, 3.17; 95% confidence interval: 1.50-6.72; P=0.003) as the factors associated with the viral coinfection, suggesting that viral infections could aggravate the primary MP infection or predispose patients to secondary bacterial infection. Viral coinfection in MPP was common after the COVID-19 pandemic in southern Guangzhou. Increase in procalcitonin should be considered as a possibility of viral coinfection in children with MPP. This finding suggests the need for viral test in children with elevated procalcitonin in MPP, which could help clinicians identify viral coinfection at an early stage and provide timely antiviral intervention.

Antimicrobial Treatment in Hospitalized Adults With Community-Acquired Pneumonia: Compliance and Factors Impacting Duration

To assess compliance with national and international guidelines for the initial empirical selection of antimicrobials, the duration of antimicrobial treatment in hospitalized patients with mild-to-moderate community-acquired pneumonia (CAP), and to analyze potential factors that could influence the duration of antimicrobials use. A retrospective study was conducted to collect medical records of patients admitted to the Department of Respiratory and Critical Care Medicine of Beijing Tongren Hospital with mild-to-moderate CAP from January 1, 2020 to November 30, 2022. The rationality of antimicrobial therapy was evaluated by comparing national and international guidelines, and the factors influencing the duration of antimicrobial therapy were analyzed by logistic regression. A total of 177 patients were enrolled. The age of patients was mainly distributed between 46 and 65 years old (38.42%). There were 82.49% of patients with basic diseases. In compliance with national, US, and European guidelines for the initial empirical antimicrobial selection in 177 CAP patients was 87.01%, 77.97%, and 78.53%. The mean duration of antibiotic treatment was 11.77±4.30 days, and patients switched from intravenous antimicrobial therapy to oral therapy within 2-10 days (5.15±2.84). Logistic regression analysis showed that the C-reactive protein (CRP) level at admission was an independent factor affecting the duration of antimicrobial use in hospitalized patients with mild-to-moderate CAP (OR=0.963, 95%CI: 0.947~0.979, p &lt; 0.05). The results of this study indicated that the patients with a CRP level of 43.89mg/L on admission to the hospital were more likely to require antimicrobial therapy for longer than 7 days.

Peak expiratory flow rate monitoring can predict asthma exacerbation better as compared to monitoring by symptoms, prospective cohort study

Background: Global initiative for asthma (GINA) guidelines suggest to use peak expiratory flow rate (PEFR) monitoring to assess response to treatment, to identify triggers for exacerbation and to have a baseline value for action plan (especially for the poor perceivers). In comparison to adults, there are less evidence in support of the routine use of PEFR recording for the diagnosis and monitoring level of control of asthma in children. This study was conducted with objective to assess the effect of PEFR monitoring on numbers of exacerbations in comparison to monitoring by symptoms in asthma. Methods: This was a prospective cohort study done for a in department of pediatrics and respiratory medicine, of a tertiary care hospital, North India. Prior to recruitment ethical approval and informed consent/assent was taken. Study subjects were children with partial and uncontrolled asthma aged 5-12 years of age. Patients were divided into two groups on their first visit by using random allocation number. In group “A” monitoring was done with symptoms only, while in group “B” monitoring was done by symptoms and PEFR. Number of exacerbations during study period was noted. At baseline and follow up, CACT score was calculated. Spirometry was done at the end of 3 months. Results: Group B had statistically significant lesser exacerbation during study period as compared to group A (OR=0.23; 95% CI=0.06-0.81; p=0.020). Conclusions: PEFR based monitoring can be used as a potential tool for aborting or decreasing the severity of episodes of exacerbations of asthma especially in resource limited areas.

A Comparative Study of Pigtail Catheter and Malecots Chest Tube Thoracostomy in the Management of Empyema Thoracis at a Tertiary Care Center in North India

Background: The study aimed to compare the effectiveness of pigtail catheter vs. malecot chest tube thoracostomy in the management of empyema thoracis and pyopneumothorax. Methods : This prospective randomised interventional study was conducted in the Department of Respiratory Medicine at a tertiary care centre in north India between September 2020 and August 2021. One hundred patients, qualified as per inclusion criteria, were included in the study, and randomization was done using the random number table method. After allocation concealment and randomization, the intervention was done in the sense that Group A (51 cases) received a pigtail catheter (14F) and Group B (49 cases) received a malecot chest tube (28F) (a total of 100 cases). After the intervention, both groups were observed for 14 days. On the 14th day, the data for the primary observations (radiological clearance on day 1, day 7, day 14th, and mean duration of hospital stay) and secondary observations (postoperative pain score, post-procedure complications) were noted, and statistical analysis was done. Results: Radiological clearance in the malecot chest tube group (28F) is better on days 1 (0.55±0.13) and 7 (0.75±0.08) than in the pigtail catheter group on day 1 (0.52±0.18) and day 7 (0.72±0.11). But, radiological clearance on day 14 in the malecot chest tube group (0.91±0.06) and the pigtail catheter group (0.91±0.08) is comparatively equal (p&lt;0.05). The mean duration of hospital stay and pain scores were better in the pigtail catheter group than in the malecot chest tube group. Conclusions: Our study suggests pigtail catheters are a safe and effective method and should be considered in the management of empyema thoracis and pyopneumothorax

Clinical characteristics and predictive factors for plastic bronchitis in children with severe Mycoplasma pneumoniae pneumonia

Objective: To explore the clinical characteristics and predictive factors for plastic bronchitis (PB) in children with severe Mycoplasma pneumoniae pneumonia (SMPP). Methods: A retrospective cohort enrolled children with a clinical diagnosis of SMPP who were treated at the Department of Respiratory Medicine of Tianjin Children's Hospital Machang District from January 1, 2018, to October 31, 2023. According to the bronchoscopy and pathological examination results, the patients were divided into 142 cases in the PB group and 274 cases in the non-PB group. The clinical manifestations, laboratory data, imaging findings, and treatments were analyzed.Mann-Whitney U test and Chi-square test were used to analyze the differences between the two groups, and multivariate Logistic regression was used to analyze the risk factors. The receiver operating characteristic (ROC) curve was used to explore the predictive value of PB in SMPP. Results: Among 416 SMPP children, there were 197 males and 219 females; PB group 142 cases, non-PB group 274 cases, the age of disease onset was (6.9±2.9) years and (6.6±2.8) years in the PB group and the non-PB group respectively. The incidence of wheezing symptoms, hypoxemia, heat peak >40 ℃, the duration of fever, neutrophil-lymphocyte ratio, mean platelet volume, C-reactive protein, procalcitonin, interleukin-6, alanine transaminase, aspartate aminotransferase and ferritin were higher in the PB group (16 cases (11.3%) vs. 15 cases (5.5%), 14 cases (9.9%) vs. 12 cases (4.4%), 57 cases (40.1%) vs. 67 cases (24.5%), 10 (8, 12) vs. 9 (8, 12) d, 6.1 (4.1, 13.1)×109 vs. 5.0 (3.7, 6.8)×109/L, 10.2 (9.6, 10.8) vs. 9.4 (8.9, 10.1) fl, 33.4 (16.0, 67.5) vs. 23.0 (10.4, 56.1) mg/L, 0.24 (0.12, 0.48) vs. 0.16 (0.09, 0.31) μg/L, 39.9 (25.1, 81.4) vs. 31.3 (18.3, 59.3) ng/L, 16.0 (12.0, 29.0) vs. 14.0 (10.0, 24.3) U/L, 38.5 (28.0, 52.5) vs. 33.0 (25.0, 44.0) U/L, 233 (136, 488) vs. 156 (110, 293) μg/L, χ2=4.55, 4.79, 11.00, Z=2.25, 4.00, 6.64, 2.76, 2.98, 3.09, 2.22, 2.62, 4.18, all P<0.05). Multivariate Logistic regression analysis showed that the dyspnea (OR=2.97, 95%CI 1.35-6.55, P=0.007), the diminution of respiration (OR=2.40, 95%CI 1.27-4.52, P=0.006), neutrophil-lymphocyte ratio (NLR) (OR=2.07, 95%CI 1.71-2.51, P<0.001), lactate dehydrogenase (LDH) (OR=1.01, 95%CI 1.00-1.01, P<0.001), mean platelet volume/platelet count (MPV/PLT) (OR=1.39, 95%CI 1.13-1.71, P=0.002), pleural effusion (OR=2.23, 95%CI 1.21-4.13, P=0.011),≥2/3 lobe consolidation (OR=1.84, 95%CI 1.04-3.00, P=0.039) and atelectasis (OR=1.98, 95%CI 1.02-3.48, P=0.044) were independent predictors of PB in children with SMPP. ROC curve analysis showed that the cut-off values for NLR, LDH and MPV/PLT in the diagnosis of PB were 2.79 (sensitivity 0.89, specificity 0.69, area under the curve (AUC)=0.86, P<0.001), 474 U/L (sensitivity 0.63, specificity 0.65, AUC=0.70, P=0.003) and 0.04 (sensitivity 0.75, specificity 0.53, AUC=0.68, P=0.005) respectively. Children in the PB group had longer hospital stays and corticosteroid treatment course than those in the non-PB group, the proportion of children in the PB group who received bronchoscopy treatment twice or more was higher (9 (8, 12) vs. 8 (6, 10) d, 7 (5, 8) vs. 6 (5, 7) d, 128 cases (90.1%) vs. 218 cases (79.6%), 106 cases (74.7%) vs. 54 cases (19.7%), Z=6.70, 5.06, χ2=7.48, 119.27, all P<0.05). Conclusions: The dyspnea, respiration diminution, NLR level elevation (>2.79) and pleural effusion were predictive factors for PB in children with SMPP. This provides a basis for the early identification of PB in children with SMPP.

Assessment of Knowledge and Attitude of Asthmatic Patients and Their Caregivers Regarding the Disease Using an Asthma Knowledge Questionnaire in a Tertiary Care Hospital in Chennai.

Introduction Asthma, a significant non-communicable disease impacting all age groups, leads to productivity loss, particularly affecting children and causing disruption within families. This study aims to evaluate the knowledge and attitudes of asthmatic patients and caregivers through questionnaires, focusing on available treatment options. Aims and objectives The study aimed to assess the knowledge and attitudes of asthmatic patients and caregivers at a tertiary care hospital in Chennai, Tamil Nadu, India. Objectives included evaluating asthma knowledge using a questionnaire and assessing attitudes towards the disease and available treatment options. Materials and methods This cross-sectional study, conducted at the Department of Respiratory Medicine, Sree Balaji Medical College & Hospital, Chennai, focused on bronchial asthma patients and their caregivers in the Outpatient Department (OPD) from May 2021 to November 2022. The study included 150 participants selected randomly based on sample size calculations. Data, collected through a proforma, included demographic variables. Participants' knowledge and attitudes toward asthma were assessed using the Asthma Knowledge and Asthma Attitude questionnaires. Exclusion criteria comprised patients with a history of tuberculosis, chronic obstructive pulmonary disease, interstitial lung disease, recent hemoptysis, or evidence of infective exacerbation. Results and discussion Among 150 participants, 44% were females and 56% were males. Asthma knowledge was present in 62.1% of females and 79.8% of males, while 37.9% of females and 20.2% of males lacked understanding. High prevalence rates of breathlessness (89.4% females, 90.5% males), wheezing (92.4% females, 81% males), and cough (77.3% females, 75% males) were noted. The knowledge questionnaire revealed a mean score of 4 out of 8, indicating a moderate understanding with significant gaps. Many lacked knowledge about affected sites, harbored misconceptions about pet contact, and dust exposure, and were uninformed about triggers, symptoms, and treatment. Lack of awareness regarding weather-related exacerbations, smoking effects, and medication purposes was evident. Reluctance towards long-term inhaler use underscored the necessity for comprehensive asthma education among patients and caregivers. Attitude questionnaire scores varied: 17 scored 16, 37 scored 18, 24 scored 19, 35 scored 21, 20 scored 24, and 17 scored 26, averaging 20.6, reflecting generally positive attitudes. The attitude questionnaire, with six questions, highlighted attitudes toward asthma. However, stigma around asthma affecting normal lives (77.3%), fear of lifelong medication use (84%), and embarrassment over public inhaler use (74%) highlighted areas for attitude improvement to enhance therapy compliance and patient outcomes. Conclusion Our study highlights concerns among asthma patients and caregivers, particularly those with limited education, regarding treatment side effects. Issues include apprehensions about inhaler therapy's addictive potential, insufficient awareness of asthma triggers, improper inhaler techniques, reluctance towards long-term inhaler use, and embarrassment over public use of inhalers contributing to the study's complexities.

Multidisciplinary team discussion based on etiological treatment improves refractory chronic cough outcomes

BackgroundRefractory chronic cough (RCC) causes significant impairments in the life quality of patients. Further research into the identification of etiologies and development of the treatment schedules for RCC is needed. Patients and methodsWe established an multidisciplinary team (MDT) clinic, by integrating respiratory medicine, otorhinolaryngology, and gastroenterology departments, to investigate cough etiologies and the effectiveness of treatment. The therapeutic effect was assessed quantitatively using the Cough Visual Analog Scales (VAS), Leicester Cough Questionnaire (LCQ), and Reflux Symptoms Index (RSI) scores. ResultsIn total, 213 patients attending the MDT outpatient clinic were examined, and 115 patients with RCC were included for analysis. The RCC diagnosis rate among the outpatient was 88.7%. Common causes of RCC included gastroesophageal reflux cough (63.5%), upper airway cough syndrome (UACS) (43.5%), and cough variant asthma (CVA) (14.8%). After an average treatment period of 2.17 ± 1.06 weeks (wk), 73.9% of the patients had partial cough remission, and 6.1% had complete cough remission. The cough VAS score before and after treatment was 6.11 ± 2.02 vs. 3.66 ± 2.22 (P < 0.05), respectively; LCQ total score before and after treatment was 10.24 ± 3.11 vs. 13.16 ± 3.59 (P < 0.05), respectively; and RSI score before and after treatment was 15.82 ± 7.01 vs. 10.71 ± 6.64 (P < 0.05), respectively. ConclusionThe etiologies of most patients with RCC could be identified in the MDT clinic, and the cough-related symptoms of a significant number of patients with RCC improved in a short period.

Increased risk of respiratory events during endobronchial ultrasound examination in patients with reduced forced expiratory volume: a prospective observational study.

The incidence of adverse events during endobronchial ultrasound is low. Nevertheless, it is unclear, whether patients with impaired pulmonary function have an increased risk of respiratory events during the intervention. A monocentric prospective observational study was performed at the Department of Respiratory Medicine, University Hospital Frankfurt/Main, Germany. Adult patients undergoing an endobronchial ultrasound examination with propofol-sedation were included. Pre-interventional screening included pulmonary function testing, laboratory tests and electrocardiogram. The occurrence of hypercapnia >55 mmHg or reduced oxygen saturation <85% was defined as a respiratory event was recorded and compared between patients with normal and impaired pulmonary function tests. In total, 126 patients were included. Pulmonary function testing revealed a median FEV1 of 2.2 l (range 0.4-6.04l) and a predicted FEV1 of 79.5% (range 20-127.8%) respectively. The median FVC was 3.0 l (range 0.87-7.28l), the median predicted FVC was 82% (range 31.4-128.4%). In 72 examinations (60%) pCO2 levels >55 mmHg were measured. Transient oxygen desaturation <85% occurred in 31 cases (25.8%). The Mann Whitney U-test showed a significantly lower FEV1 (% predicted value) in patients with respiratory events (p = 0.007). ROC analysis identified a predicted FEV1 of 78.5% as the optimal cut-off with a sensitivity of 58% and a specificity of 71%. Using Z-score instead of predicted values, there was no significant association between a lower Z- score of FEV or FVC and hypercapnic or hypoxic events. However, both a lower absolute value of FEV1/FVC and a lower Z-score of the FEV1/FVC index were associated with the occurrence of respiratory events. In binary logistic regression analysis, we could not demonstrate any association with other relevant parameters (age, BMI, sedation dosage, sedation duration, or ASA-score). An impaired forced expiratory volume is associated with the frequency of respiratory events during endobronchial ultrasound examination under propofol-sedation.

Chronic Airway Obstruction in the Post-COVID-19 Era: Is There a Cause or Effect?

ABSTRACT Introduction: Chronic airway obstruction (CAO) is the terminology used to address chronic obstructive airway diseases, namely bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), bronchiectasis, and posttuberculosis (TB) COPD. We studied the profile of the CAO at the respiratory medicine department post the COVID-19 lockdown to understand any cause or effect of past COVID-19. Materials and Methods: This prospective observational study enrolled 164 cases of CAO. Clinical and radiological details of the two groups of CAO with and without a past history of COVID-19 were noted. Results: Of 164, 101 (61.59%) were men and 63 (38.41%) were women. Thirty-nine had a history of COVID-19. Of the 164 cases, 39 (23.7%) had BA, 51 (31.09%) had COPD, 61 (37.19%) had post-TB COPD, and 13 (7.92%) had bronchiectasis. In patients with a history of COVID-19, 9 (23.1%) had BA, 9 (23.1%) had COPD, 15 (38.5%) had post-TB COPD, and 6 (15.3%) had bronchiectasis. Eight had normal lung functions, 4 had mild obstructions, 75 had moderate obstruction, and 74 had severe obstructions. The clinical and spirometry differences in those with and without a history of COVID-19 were statistically insignificant. On high-resolution computed tomography thorax, 46 (28.1%) had emphysema, 16 (9.7%) had air trapping, 65 (39.7%) had fibrobronchiectasis, and 37 (22.5%) were normal. In patients with a history of COVID-19, 6 (15.3%) had emphysema, 2 (5.2%) had air trapping, 23 (58.9%) had fibrobronchiectasis, and 8 (20.5%) were normal. The difference in radiological findings was statistically significant and more in the group with a history of COVID-19 (P = 0.029). Conclusion: COVID-19 did not affect the distribution, clinical characteristics of CAO, however, impacted radiological findings significantly.

Clinical Profile and Treatment Outcome of H-mono/Polydrug-resistant Tuberculosis: A Single-center Retrospective Study

ABSTRACT Background: Isoniazid-monoresistant tuberculosis (Hr-TB) is the most prevalent drug-resistant TB. It often precedes multidrug-resistant TB (MDR-TB) and poses a major threat in the fight against TB control. The treatment outcome in Hr-TB and polydrug-resistant TB (PDR-TB) other than MDR still remains unclear. Aim: The aim of the study is to determine the clinical characteristics and treatment outcome in H-mono/PDR-TB under programmatic conditions. Materials and Methods: The study design was retrospective observational. It was conducted at the respiratory medicine department of a tertiary care institute in Mumbai. The medical records for bacteriologically confirmed TB patients diagnosed between July 2021 and December 2022 were reviewed. A total of 827 patients were enrolled and among them 46 patients with H-mono/PDR-TB were analyzed. The demographic data, clinical characteristics, and treatment outcomes were recorded. Results: Among 46 patients of isoniazid mono-resistant/PDR-TB analyzed from 827 bacteriologically confirmed TB, 24 were women with a mean age of 30.5 years. Twenty-five (54.34%) were resistant to isoniazid and the remaining 21 (45.66%) were PDR-TB. Primary Hr-TB was detected in 43 (93%) patients. The KatG mutation in 30 (65.2%) patients was the most common form of isoniazid (INH) mono resistance followed by inhA mutation 16 (34.8%). The fluoroquinolone (FQ)-based treatment regime as per national program guidelines had favorable outcomes in 42 (91.3%). However, unfavorable outcome with progression to MDR was observed in 3 (6.52%) and death in 1 (2.18%) patients. Conclusion: H-mono/PDR-TB is the most prevalent DRTB and most of them have primary resistance to isoniazid. Availability of first and SL LPA and limited DST with FQ-based regime under the national program has improved treatment outcomes in Hr-TB/PDR-TB.

Proportions and Seasonal Patterns of Respiratory Viruses via Rapid Tests in Adults at a Greek Hospital (Oct. 2023-Mar. 2024).

Respiratory infections pose a major public health threat. The predominant viruses causing viral respiratory infections are influenza A and B (Flu-A, Flu-B), coronaviruses, respiratory syncytial virus (RSV), and adenovirus. This study aims to investigate the proportion of these cases via rapid antigen tests and assess seasonal patterns. Clinical samples were collected from symptomatic adults presenting to the Emergency and Respiratory Medicine Departments of the University Hospital of Larissa (UHL), Greece from 16 October 2023 to 31 March 2024. Nasal specimens were antigen-tested for Flu-A/B, SARS-CoV-2, RSV, and adenovirus. The total sample of specimens collected was 1434, of which 739 (51.5%) were female and 695 were male (48.5%). The mean age of participants was 57 ± 5.5 years. Among the positive results, we recorded a proportion of 40.18% and 11.40% for influenza A and B, respectively, followed by 35.79% for SARS-CoV-2, 10.70% for RSV, and 1.93% for adenovirus. In Greece, surveillance systems in infection control are underutilized. Rapid tests via multiple antigens can quickly identify viral infections, making them a valuable tool with financial benefits for health systems. Early detection of respiratory infections helps allocate resources efficiently, ensures adequate staff and facilities are available, and improves patient care through refined clinical management.

Nasal High-Flow Oxygen Therapy in Chronic Respiratory Failure for Homecare Applications-A Feasibility Study.

Background: While high-flow nasal cannulas (HFNCs) represent the standard of care in the intensive care unit for patients with severe hypoxemia, its use in homecare settings is uncommon despite its potential. The potential benefits and challenges of the high-flow nasal cannula (HFNC) in homecare settings compared to standard long-term oxygen via nasal low-flow therapy are unclear. Methods: We conducted a prospective monocentric feasibility study at the Department of Respiratory Medicine, University Hospital, Goethe University Frankfurt, Germany. Patients with interstitial lung disease or severe bronchiectasis (including cystic fibrosis) were enrolled into the study. The HFNC was introduced during hospitalization. The patients' compliance with home use advice and arterial blood gas results were evaluated at a 4-6-week follow-up. Results: A total of 12 patients were analyzed. HFNC initiation did not result in a significant improvement of the pO2/fiO2 (p/f) ratio. Only 8 out of 12 (66.6%) patients used the HFNC at home after the initial in-hospital initiation. Only 7 of the total 12 patients were using the therapy at a follow-up 3-6 weeks after HFNC onset. Two patients died during the observation, resulting in a surveillance mortality rate of 16.7%. Conclusions: The feasibility data showed low adherence to the HFNC at home. The lack of any positive effect on the p/f ratio may be due to low airflow rates and overall mild hypoxemia compared to patients with severe respiratory failure in the ICU.