Forced Expiratory Volume In 1st Research Articles

The Objective and Subjective Outcome of Bullectomy in Patients of Bullous Lung Disease: A Prospective Study

Background: This study aimed to evaluate the outcome of bullectomy in patients with bullous lung by comparative analysis of their preoperative and postoperative pulmonary function parameters and subjective dyspnea score.
 Materials and Methods: The study included 42 cases of bullous lung disease, who underwent open or video-assisted thoracoscopic surgery (VATS) bullectomy at our hospital from November 2019 till January 2022. All patients were subjected to set protocol which included preoperative comprehensive history and physical examination, chest X-ray, lung CT, and pulmonary function tests. Postoperative evaluation included 3 monthly follow-up for three visits, with clinical assessment for subjective dyspnea score and pulmonary function tests (PFTs). Preoperative and postoperative comparisons of parameters were made using the student’s paired t-test to calculate the statistical significance.
 Results: Primary bullous lung disease was the most common underlying lung pathology in our population, followed by COPD. Spontaneous pneumothorax was the most common presenting feature, and the most patients presented in their fourth decade of life with a history of smoking.
 All cases underwent VATS/open bullectomy. Most patients were discharged on the 4th postoperative day. Statistically, significant improvement was seen in mean FEV1 (forced expiratory volume in 1st second), FVC (forced vital capacity), and FEV1/FVC. FEV1 appeared to be the most reliable indicator of postoperative progress. The subjective dyspnea score improved in a statistically meaningful way. Diffuse parenchymal disease patients had a higher rate of complications. Our research found no evidence of mortality.
 Conclusion: We conclude that surgery remains the standard treatment for bullous lung disease. Most of the patients who got benefitted are those having localized disease with remaining normal parenchyma. Statistically significant improvement in subjective and objective parameters is seen in all cases. Those with the diffuse emphysematous disease need careful selection given their high complication rate.

Screening for chronic obstructive pulmonary disease in elderly subjects with dyspnoea and/or reduced exercise tolerance – A hospital based cross sectional study

BackgroundChronic obstructive pulmonary disease (COPD) is a very common lung disease most often related to history of smoking. It becomes more prevalent with increasing age but remains under-diagnosed and under-treated in the elderly population. Under diagnosis of COPD is universal in elderly patients because of multiple pathology, difficulty with measurement of lung function, under-reporting of symptoms and reduced perception of dyspnoea. However the screening of the elderly (age >60years) is not performed routinely even when they are symptomatic. ObjectiveThe study was undertaken to screen elderly subjects with dyspnoea and/or reduced exercise tolerance for COPD. Study designA cross sectional hospital based study. MethodsA total of 1000 elderly subjects were screened for COPD using standard spirometry as per GOLD guidelines. Diagnostic evaluation and classification of patients as “no COPD”, “new COPD” and “known COPD” were done by panel of experts which included a Pulmonologist, Cardiologist, General Physician and Physiotherapist. Subjects were categorized as mild, moderate, severe and very severe COPD based on FEV1 (forced expiratory volume in 1st sec) values. ResultsOf the total 1000 elderly participants screened, 596 (59.6%) were classified as having no COPD, 228 (22.8%) with new COPD and 176 (17.6%) with known COPD. Among the total 228 of new COPD patients 27 (11.8%), 176 (77.4%), 5 (2.1%) and 20 (8.7%) were having mild, moderate, severe and very severe COPD respectively as per GOLD guidelines. Similarly of the total 176 subjects with known COPD, 9 (5.1%), 136 (77.3%), 0 (0%) and 31 (17.6%) were having mild, moderate, severe and very severe COPD respectively. ConclusionAn active screening for COPD in elderly subjects with dyspnoea or reduced exercise tolerance leads to diagnoses of substantially more new patients with COPD.

228 Pulmonary and nutritional outcomes in children with cystic fibrosis diagnosed by meconium ileus in Argentina

Introduction: Early diagnosis in Cystic Fibrosis (CF) still remains a challenge, because it allows the implementation of appropriate therapeutic strategies. It can reach through neonatal screening (NS) an early detection or by meconium ileus a premature clinical manifestation associated with poorer growth. Objective: To compare clinical status and lung function in children with CF diagnosed with meconium ileus and those detected by NS. Methods: We compare two groups: one detected by NS and one diagnosed by meconium ileus (MI) since 1995 (beginning of the program of NS in the state of Buenos Aires). We assessed: Z score Weight/age, Z score Height/age from 6 months up to 6 years of age, Forced Expiratory Volume in 1st (FEV1). We also registered first isolation of Pseudomonas aeruginosa (Pa). Student’s t-test was performed to compare the means of the indicators. Results: We included 26 patients in NS group and 31 in MI, all with pancreatic insufficiency. p.PHE508del/p.PHE508del was present in 52% of NS and 41.4% in MI. In MI group were four deaths and one in NS. The NS group showed better nutritional parameters than MI, as seen in the table. We found no significant differences in first isolation of Pa (p = 0.55) and FEV1 (p = 0.11) between the two groups.

229 Prucalopride: a review of the first 12 months of use

Introduction: Early diagnosis in Cystic Fibrosis (CF) still remains a challenge, because it allows the implementation of appropriate therapeutic strategies. It can reach through neonatal screening (NS) an early detection or by meconium ileus a premature clinical manifestation associated with poorer growth. Objective: To compare clinical status and lung function in children with CF diagnosed with meconium ileus and those detected by NS. Methods: We compare two groups: one detected by NS and one diagnosed by meconium ileus (MI) since 1995 (beginning of the program of NS in the state of Buenos Aires). We assessed: Z score Weight/age, Z score Height/age from 6 months up to 6 years of age, Forced Expiratory Volume in 1st (FEV1). We also registered first isolation of Pseudomonas aeruginosa (Pa). Student’s t-test was performed to compare the means of the indicators. Results: We included 26 patients in NS group and 31 in MI, all with pancreatic insufficiency. p.PHE508del/p.PHE508del was present in 52% of NS and 41.4% in MI. In MI group were four deaths and one in NS. The NS group showed better nutritional parameters than MI, as seen in the table. We found no significant differences in first isolation of Pa (p = 0.55) and FEV1 (p = 0.11) between the two groups.

Levosalbutamol versus Salbutamol for Treatment of Acute Exacerbation of Asthma in Bangladesh Children

Introduction: Salbutamol is an effective treatment of acute exacerbation asthma but its use is associated with undesirable side effects like tachycardia and hypokalemia. Published studies have showed that levosalbutamol improves pulmonary function more than racemic salbutamol without the known salbutamol side effects. Objective: To compare the efficacy and tolerability of Levosalbutamol and Salbutamol for the treatment of acute exacerbation of asthma in Bangladesh children aged 8 to 15 years. Methods: A randomized double blind clinical study included 60 known asthmatic children aged between 8 and 15 years, who attended the emergency department for an acute exacerbation. The studied medicines were salbutamol 2.5 mg and levosalbutamol 0.63 mg. The total drug volume was 2.5 ml which was nebulized over a period of 8-10 minutes. Forced expiratory volume in 1st second was measured using Manual Promoter. Spirometry was performed 3 times and the best of the three values was recorded. The following clinical parameters were recorded initially and after giving 3 nebulizations at 20 minutes interval in the 1st hour of presentation: respiratory rate (RR), heart rate (HR), oxygen saturation in room air SPO2, FEV1 (forced expiratory volume in 1st second), asthma score and serum potassium level. Results: In the levosalbutamol group there was significant increment in FEV1 and SpO2 (p<0.05) with decreased tachypnea and asthma score while no significant difference was found in the pre and post treatment HR and serum K+ levels. In the Salbutamol group although there was clinical improvement in terms of FEV1, SpO2 and asthma score, there was significant tachycardia and decrease in K+ levels. Conclusion: Levosalbutamol has similar therapeutic effects with salbutamol in acute exacerbation of asthma but has no side effects such as tachycardia and hypokalemia.

Montelukast As An Add On Therapy In Asthma As Compared To Its Use In Asthma Associated With Concomitant Rhinitis Symptoms

Back ground: The use of Montelukast in mild and moderate asthma has been studied ,allergic rhinitis or rhinitis and asthma are strongly inter related, Montelukast has been used in both conditions, whether treating rhinitis will improve asthma control ,a point which has been stressed recently.Objectives: To evaluate the effect of Montelukast in mild and moderate asthma according to Global INitiative For Asthma guidelines ( GINA),and to compare its use in asthma alone and in asthma which is associated with persistant rhinitis symptoms.Patients and methods: Seventy patients who fulfill the criteria of mild and moderate asthma according to Global INitiative For Asthma guidelines had been recruited from the consultation clinic of the respiratory diseases in Baghdad Teaching Hospital from the 111st.July 2009 to 31st. December 2010,patients were divided in to 2 groups : Group – 1 patients with asthma only which was subdivided into 2 sub groups: 1-a on salbutamol inhaler on need and 1-b on beclomethasone inhaler 800Mgm/day in addition to salbutamol inhaler on need. Group- 2 patients with asthma and rhinitis which was sub divided in to subgroups: 2-a on salbutamol inhaler on need and 2-b on beclomethasone 800Mgmlday in addition to salbutamol inhaler on need.Evaluation of day and night time symptoms, records of rhinitis symptoms and measurement of FEV1(Forced Expiratory Volume in 1st. second) and FEF 25-75%(Forced Expiratory Flow)were done to all patients . Montelukast 10 mg/ day was given to all patients for 4 weeks,and reevaluation for day , night time symptoms , rhinitis symptoms and measurement of FEV1 and FEF 25-75% were done . Results: There was a significant statiscal improvement in day , night time symptoms , FEV1 , FEF 25-75% and rhinitis symptoms after Montelukast treatment than before treatment ( p value &lt; 0.05), Montelukast use in asthma alone as compared to its use in asthma which was associated with rhinitis did not show a significant statiscal improvement in outcome response in day,night symptoms and in percentage of change in FEV1 and FEF25-75% (p value&gt;0.05) .Conclusion: Montelukast improved day , night time symptoms , FEV1 , FEF 25-75% in mild and moderate asthma ,it also improved rhinitis symptoms but Montelukast use in asthma alone ascompared to its use in asthma which was associated with rhinitis did not show a significant statiscal imrovement in asthma control regarding day,night time symptoms,FEV1 and FEF25-75% values .