Early Airway Research Articles

Effect of poultry dust on pulmonary functions in poultry farm workers of India

Background: Individuals engaged in poultry production are exposed to varying concentrations of airborne contaminants including organic dust, gases, endotoxins, fungi, bacteria, and bacterial constituents. Long-term exposure to this environment may put the poultry workers at risk for developing respiratory dysfunction. A periodic measurement of pulmonary functions can be a guiding factor to detect pulmonary abnormalities in early stages. Objectives: The objectives of this study were to record and compare pulmonary function parameters in poultry farm workers and healthy controls. Materials and Methods: The study was conducted in 132 subjects. Pulmonary function parameters were recorded in 66 healthy volunteers and 66 poultry workers using autospirometer (Helios 701: Chandigarh). Data were analyzed using Student’s t-test. Results: We found that all the pulmonary function parameters, namely, forced vital capacity (FVC), forced expiratory volume , FEV1, and FEV3 were significantly lower (P = 0.000) in poultry workers as compared to healthy controls, whereas FEV1/FVC% was normal indicating restrictive type of ventilatory changes in poultry workers. There was a significant decrease (P = 0.001) in forced expiratory flow indicating early small airway obstruction and FEF 0.2–1.2 (P = 0.000) indicating large airway obstruction. A significant decrease in maximum voluntary ventilation (P = 0.000) can be due to obstructive and/or restrictive lung diseases. Conclusion: The results suggest that poultry workers should be made aware of hazardous effects of poultry dust, and the use of appropriate personal protective equipment during work should be implemented legally.

Outcome of early bubble CPAP in children presenting at paediatric in-tensive care unit from 2016-2017

The aim of this study is to analyze the introduction of early continuous positive airway pressure(CPAP) for children admitted in PICU in correcting respiratory distress with or without hypoxaemia and impending respiratory failure in order to improve respiratory function, avoid the need for mechanical ventilation and its complications. Objective: To determine the outcome of early bubble CPAP in children admitted in paediatric intensive care of Abbasi Shaheed hospital. Methods: This pilot study is being conducted in paediatric intensive care of paediatric unit 2 department at Abbasi Shaheed hospital Karachi. The study was conducted from march 2016 to December 2016. The study design was cross-sectional study and sample technique was non probability(purposive).Total 70 patients of both genders having age ranging between 0-12years exhibiting clinical features of respiratory distress with hypoxaemia (SpO2 <92%) and impending respiratory failure initially received oxygen supplementation through bCPAP delivered via an underwater tube through nasal prongs. Data regarding outcome after receiving bCPAP and need for mechanical ventilation was collected and analyzed. Results: Oxygen was initiated by bCPAP in 70 patients. Out of these, forty-one (58.5%) were male and twenty-nine (41.2%) were females. The age group ranges from 0- 12years. Forty-nine (70%) patients survived after bCPAP and shift to ward. Twenty-one (30%) were intubated for worsening distress and hypoxaemia. Eight (11.4%) were removed from vent, put on bCPAP and survived. Ten (14.2%) expired on ventilatory support. Conclusion: According to our results early bubble CPAP supplementation helps in correcting respiratory illness and contributes to reduce the number of children requiring endotracheal tube intubation and mechanical ventilation. In addition to the benefits mentioned above, it is a simple device which can be made locally, very cheap and effective.

Loss of Vascular CD34 Results in Increased Sensitivity to Lung Injury.

Survival during lung injury requires a coordinated program of damage limitation and rapid repair. CD34 is a cell surface sialomucin expressed by epithelial, vascular, and stromal cells that promotes cell adhesion, coordinates inflammatory cell recruitment, and drives angiogenesis. To test whether CD34 also orchestrates pulmonary damage and repair, we induced acute lung injury in wild-type (WT) and Cd34-/- mice by bleomycin administration. We found that Cd34-/- mice displayed severe weight loss and early mortality compared with WT controls. Despite equivalent early airway inflammation to WT mice, CD34-deficient animals developed interstitial edema and endothelial delamination, suggesting impaired endothelial function. Chimeric Cd34-/- mice reconstituted with WT hematopoietic cells exhibited early mortality compared with WT mice reconstituted with Cd34-/- cells, supporting an endothelial defect. CD34-deficient mice were also more sensitive to lung damage caused by influenza infection, showing greater weight loss and more extensive pulmonary remodeling. Together, our data suggest that CD34 plays an essential role in maintaining vascular integrity in the lung in response to chemical- and infection-induced tissue damage.

Subclinical pulmonary dysfunction contributes to high altitude pulmonary edema susceptibility in healthy non-mountaineers

HAPE susceptible (HAPE-S, had HAPE episode in past) subjects may have subclinical cardio-pulmonary dysfunction. We compared the results of pulmonary function tests in 25 healthy HAPE-S non-mountaineers and 19 matched HAPE resistant (HAPE-R, no HAPE episode in past). Acute normobaric hypoxia (FIo2 0.12) was administered at sea level to confirm hypoxia intolerance in HAPE-S. Unlike HAPE-R, HAPE-S subjects had elevated baseline and post-hypoxia systolic pulmonary arterial pressures (20.9 ± 3 vs 27.3 ± 5 mm Hg during normoxia and 26.2 ± 6 vs 45.44 ± 10 mm Hg during hypoxia, HAPE-R vs HAPE-S). Forced vital capacity (FVC) and single breath alveolar volume (SBVA) were significantly lower in HAPE-S compared to HAPE-R (FVC: 4.33 ± 0.5 vs 4.6 ± 0.4; SBVA: 5.17 ± 1 vs 5.6 ± 1 Lt; HAPE-S vs HAPE-R). Two subgroups with abnormal pulmonary function could be identified within HAPE-S; HAPE-S1 (n = 4) showed DLCO>140% of predicted, suggestive of asthma and HAPE-S2 (n = 12) showed restrictive pattern. Each of these patterns have previously been linked to early small airway disease and may additionally represent a lower cross-sectional area of the pulmonary vascular bed, related to lower lung volumes. HAPE susceptibility in healthy non-mountaineers may be related to sub-clinical pulmonary pathology that limits compensatory rise in ventilation and pulmonary circulation during hypoxic stress.

Pediatric Emergency Medicine Simulation Curriculum: Submersion Injury With Hypothermia and Ventricular Fibrillation.

Submersion injury or drowning is a leading preventable cause of pediatric mortality and morbidity. Submersion injuries are often accompanied by hypothermia and asphyxia that can lead to inadequate oxygen delivery to tissues and subsequent cardiac arrhythmias. This simulation-based curriculum involves the identification and management of a submersion injury in a 4-year-old boy who was rescued from a cold-water submersion. The simulated patient is apneic, pulseless, bradycardic, and hypothermic; he is being bag-mask ventilated on arrival without intravenous access. He ultimately develops ventricular fibrillation. Providers must recognize the degree of submersion injury, initiate early airway protection, adequately address circulation, and be alert to developing hypothermia and cardiac arrhythmias to prevent further decompensation. This scenario can be modified based on trainee level (pediatric residents vs. pediatric emergency medicine fellows). A total of 22 trainees (PGY 1-PGY 6 pediatric residents and pediatric emergency medicine fellows) participated in this simulation curriculum on separate occasions and rated it as an overall positive learning experience. The curriculum's goal is to provide learners with an opportunity to manage life-threatening pediatric submersion injuries, where the correct steps need to be taken in a limited period of time. We have provided preparatory materials to help instructors set up, run, and debrief the scenario in a standardized fashion. The debriefing tools allow for adaptation depending on learners' needs and individual experiences during the simulated scenario. Also included are supporting educational materials and a learner feedback form that can be used to evaluate the session.

Early rescue Neopuff for infants with transient tachypnea of newborn: a randomized controlled trial

Objective: To examine the efficacy of early continuous positive airway pressure (CPAP), delivered using a T-piece-based infant resuscitator (Neopuff) via a face mask, in reducing the severity and duration of transient tachypnea of the newborn (TTN) as well as testing a hypothesis suggesting that rapid clearance of fetal lung fluid to the circulation via CPAP would increase plasma B-type natriuretic peptide (BNP). Methods: A randomized controlled trial (NCT01859533) was conducted on 64 late preterm/term neonates, delivered by cesarean section and presented by respiratory distress shortly after birth. The Neopuff group included 34 neonates received 20 min of early CPAP and control group included 30 neonates received free flow O2. Plasma BNP was measured baseline and 2 h later. Results: The duration of tachypnea was shorter in Neopuff group with less need of neonatal intensive care unit admission and need of mechanical support (p < .05) with no effect on duration of hospitalization (p > .05). Plasma BNP showed no significant difference between pre- and post-Neopuff levels (p > .05). A positive correlation was found between BNP and duration of tachypnea as well as the length of hospitalization (p < .05) among Neopuff group. Conclusion: Early rescue CPAP reduces the duration and severity of respiratory distress among infants with TTN. Trial registration: ClinicalTrials.gov identifier: NCT01859533.

Accidental hanging injuries in children: recognition and management.

Accidental hanging is rare in childhood but is often fatal. Window blind cords pose a particular and unique risk to young children in the UK, accounting for one to two deaths annually. These accidents are frequently associated with non-adherence to the safety instructions provided by the manufacturers. Early discovery of the child and initiation of effective cardiopulmonary resuscitation at the site of the incident are likely to improve the outcome. Prolonged suspension, children who are pulseless at first contact by the emergency paramedic responder, and patients with prolonged periods of remaining in asystole before return of spontaneous circulation after starting cardiopulmonary resuscitation are unlikely to have intact neurological survival. Management in the hospital includes early airway protection by intubation, maintenance of normal oxygen saturation, normothermia, active control of clinical and sub-clinical seizures, and strict electrolyte and glucose regulation. Child safeguarding concerns should be considered when children have asphyxial injuries, and other signs of child physical abuse should be actively looked for. There is a need for stronger legislation in the UK to prevent some of these accidents, especially those relating to window blind cords.

Association of Antibiotics, Airway Microbiome, and Inflammation in Infants with Cystic Fibrosis

The underlying defect in the cystic fibrosis (CF) airway leads to defective mucociliary clearance and impaired bacterial killing, resulting in endobronchial infection and inflammation that contributes to progressive lung disease. Little is known about the respiratory microbiota in the early CF airway and its relationship to inflammation. To examine the bacterial microbiota and inflammatory profiles in bronchoalveolar lavage fluid and oropharyngeal secretions in infants with CF. Infants with CF from U.S. and Australian centers were enrolled in a prospective, observational study examining the bacterial microbiota and inflammatory profiles of the respiratory tract. Bacterial diversity and density (load) were measured. Lavage samples were analyzed for inflammatory markers (interleukin 8, unbound neutrophil elastase, and absolute neutrophil count) in the epithelial lining fluid. Thirty-two infants (mean age, 4.7 months) underwent bronchoalveolar lavage and oropharyngeal sampling. Shannon diversity strongly correlated between upper and lower airway samples from a given subject, although community compositions differed. Microbial diversity was lower in younger subjects and in those receiving daily antistaphylococcal antibiotic prophylaxis. In lavage samples, reduced diversity correlated with lower interleukin 8 concentration and absolute neutrophil count. In infants with CF, reduced bacterial diversity in the upper and lower airways was strongly associated with the use of prophylactic antibiotics and younger age at the time of sampling; less diversity in the lower airway correlated with lower inflammation on bronchoalveolar lavage. Our findings suggest modification of the respiratory microbiome in infants with CF may influence airway inflammation.

Inert gas washout: background and application in various lung diseases.

Multiple breath inert gas washout (MBW) is a lung function technique to measure ventilation inhomogeneity. The technique was developed more than 60 years ago, but not much used for many decades. Technical improvements, easy protocols and higher sensitivity compared with standard lung function tests in some disease groups have led to a recent renaissance of MBW. The lung clearance index (LCI) is a common measure derived from MBW tests, and offers information on lung pathology complementary to that from conventional lung function tests such as spirometry. The LCI measures the overall degree of pulmonary ventilation inhomogeneity. There are other MBW-derived parameters, which describe more regional airway ventilation and enable specific information on conductive or acinar ventilation inhomogeneity. How this specific ventilation distribution is exactly related to different disease processes has not entirely been examined yet. MBW measurements are performed during tidal breathing, making this technique attractive for children, even young children and infants. These benefits and the additional physiological information on ventilation inhomogeneity early in the course of lung diseases have led to increasing research activities and clinical application of MBW, especially in paediatric lung diseases such as cystic fibrosis (CF). In these patients, LCI detects early airway damage and enables monitoring of disease progression and treatment response. Guidelines for the standardisation of the MBW technique were recently published. These guidelines will, hopefully, increase comparability of LCI data obtained in different centres or intervention trials in children and adults. In this non-systematic review article, we provide an overview of recent developments in MBW, with a special focus on children. We first explain the physiological and technical background to this technique with a short explanation of several methodological aspects that are important for understanding the principle behind the technique and enable high quality measurements. We then provide examples of MBW application in different lung diseases of children and adults, with regards to both clinical application and research activities. Lastly, we report on ongoing clinical trials using MBW as outcome and give an outlook on possible future developments.

Postoperative Respiratory Complications in Patients at Risk for Obstructive Sleep Apnea: A Single-Institution Cohort Study.

Obstructive sleep apnea (OSA) is a prevalent condition that is associated with early postoperative respiratory complications (PRCs). As the majority of patients with OSA are undiagnosed, preoperative screening remains the most efficient method to identify suspected OSA. This retrospective study was performed on patients undergoing anesthesia in a single academic medical center. We assigned OSA risk class retrospectively to all patients in the study by using the Perioperative Sleep Apnea Prediction (PSAP) score. We evaluated the relationship between PSAP categories and early postoperative invasive airway placement after adjusting for several preoperative and intraoperative factors (including surgical risk) previously associated with PRC occurrence. A total of 108,479 patients were included in the final analysis with an incidence of PRC was 0.3% (n = 280). High PSAP score was associated with postoperative intubation (adjusted odds ratio, 2.3; 95% confidence interval, 1.5-3.7). Several risk factors reflecting anesthetic agents, neuromuscular blocking agents, and opioids were also independently associated with early PRC. We report that suspected OSA based on the PSAP score is independently associated with increased risk of early PRC. Specific anesthetic agents are independently associated with early PRC, pointing to the potential for examining risk modification through these exposures in future studies.

The tidal breathing lung function in very low birth weight preterm infants with bronchopulmonary dysplasia

Objective To investigate the development of tidal breathing lung function in very low birth weight infants with bronchopulmonary dysplasia(BDP). Methods Two hundred and sixty-two very low birth weight infants hospitalized in Wenzhou Children′s Hospital were enrolled as objects.All infants were given the tidal breathing pulmonary function test within a week before discharge and at the corrected age of 6 to 8 months.According to clinical diagnosis, they were divided into BPD group(n=65) and non-BPD group(n=197), and BPD group were divided into mild group(n=31), moderate group(n=20) and severe group(n=14) according to the severity.The lung function indexes were compared between different groups. Results The results of the test within a week before discharge displayed that the respiratory rates in the BPD groups were higher than those in the non-BPD group(all P 0.05). The result at the corrected age of 6 to 8 months displayed that TPEF, TEF75, TEF50, TEF25 in severe BPD group were still higher than those in any other group(all P 0.05). Conclusion Preterm infants BPD have different degrees of lung injury, but as the age grows some lung function indexes can improve gradually(at the corrected age of 6 to 8 months). However, early severe small airway obstruction is still serious.Therefore, it′s important to prevent and treat BPD for the prevention and regulation of respiratory tract disease in future. Key words: Bronchopulmonary dysplasia; Tidal breathing pulmonary function; Very low birth weight infant,

Does a prenatal bacterial microbiota exist?

Does a prenatal bacterial microbiota exist?

Current management of spontaneous intracerebral haemorrhage

Intracerebral haemorrhage (ICH) is the most devastating and disabling type of stroke. Uncontrolled hypertension (HTN) is the most common cause of spontaneous ICH. Recent advances in neuroimaging, organised stroke care,...

Surfactant Need by Gestation for Very Preterm Babies Initiated on Early Nasal CPAP: A Danish Observational Multicentre Study of 6,628 Infants Born 2000-2013

Background: In recent years, early nasal continuous positive airway pressure (nCPAP) as respiratory support for preterm infants is being advocated as an alternative to prophylactic surfactant and treatment with mechanical ventilation. A number of infants treated with early nCPAP do not need treatment with surfactant, but few studies provide data on this. Since the 1990s, the first approach to respiratory support to preterm infants in Denmark has been early nCPAP combined with surfactant administration by the INSURE method by which the infant is intubated and surfactant administration is followed by rapid extubation to nCPAP if possible. Objectives: To investigate how often surfactant was administered in preterm infants with a gestational age below 34 weeks treated with early nCPAP as a first approach to respiratory support. Methods: An observational multicentre study including all inborn infants with a gestational age below 34 weeks admitted to 1 of the 4 level 3 neonatal intensive care units in Denmark in the period from 2000 to 2013. Results: A total of 6,628 infants were included in this study. We found that surfactant was administered in 1,056 of 1,799 (59%; 95% CI: 57-61%), in 821 of 2,864 (29%; 95% CI: 27-31%), and in 132 of 1,796 (7%; 95% CI: 6-8%) of the infants with a gestational age from 24 to 27, 28 to 31, and 32 to 33 weeks and 6 days, respectively. Conclusions: A large proportion of preterm infants treated with early nCPAP as the first approach to respiratory support was never treated with surfactant.

Labour room Continuous Positive Airway Pressure (LR CPAP) in preterm neonates

Early continuous positive airway pressure (CPAP) has proven to be beneficial in reducing ventilator dependence and subsequent chronic lung disease in neonates suffering from Respiratory distress syndrome (RDS). However, the efficacy of initiating labour room (LR) CPAP has not been determined prospectively in resource limited settings like India. Hence the objective of the present study was to study the efficacy of LR CPAP in preterm neonates with RDS in resource limited Indian settings. This was a prospective observational study including preterm neonates (26-34 weeks with RDS) carried out over a period of 6 months (January to June 2016) when the CPAP was initiated in LR. The outcome was compared with a similar population during the corresponding period of the previous year when CPAP was initiated in NICU. The historical controls were retrieved from case records and matched for gestational age and birth weight with the study population. There was 36% absolute risk reduction in the need for surfactant and 56% for mechanical ventilation in the LR CPAP group respectively. LR CPAP reduces the need for mechanical ventilation and surfactant in preterm neonates with RDS in resource limited settings.

Group B Streptococcus Infection Presenting as Ludwig's Angina Beyond Infancy

Ludwig’s angina is a serious and rapidly progressive cellulitis of the floor of the mouth which involves the submandibular, sub-maxillary, and sublingual spaces of the face. It uncommonly occurs in adults and children and its early recognition is paramount. With early diagnosis, airway observation and management, aggressive intravenous antibiotic therapy, and judicious surgical intervention, this disease should resolve without any complications. Here we report a case of an immunocompetent adolescent who developed Ludwig’s Angina due to Group B Streptococcus (GBS) infection who was successfully treated with surgical intervention and antibiotics therapy. To our knowledge this is the first reported case of GBS infection beyond infancy presenting as Ludwig’s Angina in an immunocompetent adolescent. There are other reported cases in the literature of GBS infection presenting beyond infancy but none of the cases presented with Ludwig’s Angina.

The importance of impulse oscillometry in bronchial provocation testing in confirming the diagnosis of asthma in male army recruits

Background/Aim. Impulse oscillometry (IOS) is a technique valid for measuring the lung function in obstructive lung diseases and bronchial provocation tests. However, no consensus exists for its use. The aim of the study was to assess impulse oscillometry sensitivity for detection of early airways changes during bronchial provocation testing and to compare with changes obtained with spirometry and bodyplethysmography in male army recruits. Methods. Male military recruits were submitted to bronchial provocation test with histamine by the aerosol provocation system. Out of 52 male military recruits subjected to attempts to make the diagnosis of asthma the study included 31 subjects with fall of forced expiratory volume in one second (FEV1) above 20%. The changes of impulse oscillometry were measured one step before and after provocation dose (PD) of histamine and compared with the changes of bodyplethysmography and spirometry. Results. The average age of male army recruits was 23.3 year. After bronchoprovocation there was an average increase of the total resistance at 5 Hz (R5) by 66.6%, resonant frequency (Fres) by 102.2%, Goldman index (AX) by 912.1%, the arway resistance (Raw) by 121.5%, and a decrease in reactance at 5 Hz (X5) by 132.1% and FEV1 by 25.6%. One step before the last inhaled of PD20 there was an average increase of 26.7% in R5, 24.1% in Fres, 85.3% in AX, 11.9% in Raw and a decrease in X5 by 26.9% and FEV1 by 4.3%. A correlation between impulse oscillometry and bodyplethysmography parameters was obtained. Conclusion. This paper demonstrates a sufficient sensitivity of impulse oscillometry to detect changes in airways, so it may play a complementary role in the diagnosis of asthma in male military recruits.

Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants.

Nasal continuous positive airway pressure (NCPAP) is a strategy for maintaining positive airway pressure throughout the respiratory cycle through the application of bias flow of respiratory gas to an apparatus attached to the nose. Treatment with NCPAP is associated with decreased risk of mechanical ventilation and might be effective in reducing chronic lung disease. Nasal intermittent positive pressure ventilation (NIPPV) is a form of noninvasive ventilation during which patients are exposed intermittently to higher levels of airway pressure, along with NCPAP through the same nasal device. To examine the risks and benefits of early NIPPV versus early NCPAP alone for preterm infants at risk of or in respiratory distress within the first hours after birth.Primary endpoints are respiratory failure and the need for intubated ventilatory support during the first week of life. Secondary endpoints include chronic lung disease (CLD) (oxygen therapy at 36 weeks' postmenstrual age), air leaks, duration of respiratory support, duration of oxygen therapy, intraventricular hemorrhage, and incidence of mortality. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 9), MEDLINE via PubMed (1966 to September 28, 2015), Embase (1980 to September 28, 2015), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to September 28, 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. A member of the Cochrane Neonatal Review Group handsearched abstracts from the European Society of Pediatric Research (ESPR). We contacted the authors of ongoing clinical trials to ask for information. We considered all randomized and quasi-randomized controlled trials. Studies selected compared NIPPV versus NCPAP treatment, starting at birth or shortly thereafter in preterm infants (< 37 weeks' gestational age). We performed data collection and analysis using the recommendations of the Cochrane Neonatal Review Group. Ten trials, enrolling a total of 1061 infants, met criteria for inclusion in this review. Meta-analyses of these studies showed significantly reduced risk of meeting respiratory failure criteria (typical risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.82; typical risk difference (RD) -0.09, 95% CI -0.13 to -0.04) and needing intubation (typical RR 0.78, 95% CI 0.64 to 0.94; typical RD -0.07, 95% CI -0.12 to -0.02) among infants treated with early NIPPV compared with early NCPAP. The meta-analysis did not demonstrate a reduction in the risk of CLD among infants randomized to NIPPV (typical RR 0.78, 95% CI 0.58 to 1.06). Investigators observed no evidence of harm. Review authors graded the quality of the evidence as moderate (unblinded studies). Early NIPPV does appear to be superior to NCPAP alone for decreasing respiratory failure and the need for intubation and endotracheal tube ventilation among preterm infants with respiratory distress syndrome. Additional studies are needed to confirm these results and to assess the safety of NIPPV compared with NCPAP alone in a larger patient population.

Usefulness of House Dust Mite Nasal Provocation Test in Asthma.

PurposeWe previously reported that the skin prick test was sensitive and the serum specific immunoglobulin E test was specific for predicting positive airway responses to house dust mites (HDMs) in patients with asthma. Because the nose and bronchus are one airway, the nasal provocation test would be more specific for predicting the bronchial responses to HDM than the skin test.MethodsThe allergy skin prick test and nasal and bronchial provocation tests using HDM (Dermatophagoides farinae) were performed in 41 young men (age, 19–28 years) who wanted military certification for asthma. The nasal responses to HDM was scored according to the severity of rhinorrhea, sneezing, and nose itching.ResultsThe prevalence of a positive skin prick test to HDM did not significantly differ between patients with (n=24) and without (n=17) an early airway reaction (EAR; 79.2% vs 70.6%, P=0.534). However, the prevalence of a positive nasal test was significantly higher in the airway responders than in the others (37.5% vs 0%, P=0.005). The concordance of a positive response to the nasal test (κ=0.332, P=0.004) but not to the skin prick test (κ=0.091, P=0.529) was significant with an EAR. The diagnostic sensitivity of the nasal test (37.5%) was lower than that of the skin prick test (79.2%), but the specificity was higher (100% vs 29.4%).ConclusionsThe skin prick test is more sensitive, whereas the nasal test is more specific and accurate, for predicting an EAR to HDM in patients with asthma.

Safety and efficacy of bridging to lung transplantation with antifibrotic drugs in idiopathic pulmonary fibrosis: a case series.

BackgroundFollowing recent approval of pirfenidone and nintedanib for idiopathic pulmonary fibrosis (IPF), questions arise about the use of these antifibrotics in patients awaiting lung transplantation (LTx).MethodsSafety and efficacy of antifibrotic drugs in IPF patients undergoing LTx were investigated in a single-centre retrospective cohort analysis.ResultsA total of nine patients, receiving antifibrotic therapy for 419 ± 315 days until subsequent LTx, were included. No major side effects were noted. Significant weight loss occurred during antifibrotic treatment (p = 0.0062). FVC tended to stabilize after 12 weeks of treatment in most patients. A moderate decline in FVC, TLC and DLCO was noted during the whole pretransplant time period of antifibrotic therapy. Functional exercise capacity and lung allocation score remained unchanged. No post-operative thoracic wound healing problems, nor severe early anastomotic airway complications were attributable to prior antifibrotic treatment. None of the patients developed chronic lung allograft dysfunction after a median follow-up of 19.8 (11.2–26.5) months; and post-transplant survival was 100% after 1 year and 80% after 2 years.ConclusionsAntifibrotic drugs can probably be safely administered in IPF patients, possibly attenuating disease progression over time, while awaiting LTx.