Presence Of Bronchial Obstruction Research Articles

Risk factors for severe community-acquired pneumonia in infants and preschool children

Introduction. The relevance of studying community-acquired pneumonia in children is associated with its high prevalence, despite timely prevention and effective approaches to the treatment of respiratory diseases. Factors influencing the severity of pneumonia are diverse and include comorbid pathology, early age of the child, the state of the immune system, etc.Objective. To identify and rank risk factors for severe community-acquired pneumonia in infants and preschool children.Materials and methods. This article presents the results of a retrospective analysis of 291 medical histories of children from 3 months to 7 years with community-acquired pneumonia. 83 children had severe CAP, of which 63 patients were hospitalized in the ICU.Results and discussion. The average age of a patient with community-acquired pneumonia was 33 months. Children from families with two or more children fell ill more often. On average, children were hospitalized for 4–5 days of illness. Concomitant diseases in children with CAP were quite common and often complicated the course of pneumonia. According to the results of our study, more than 70% of children were not vaccinated against pneumococcus, Haemophilus influenzae and influenza. We established significant linear relationships between the presence of bronchial obstruction and complications of CAP such as respiratory failure and transfer to the ICU (odds ratio (OR) 7.1; Cramer coefficient 0.40; relationship 0.005). It was shown that patients who received outpatient antibiotic therapy were less likely to require transfer to the ICU.Conclusion. Risk factors for severe community-acquired pneumonia and hospitalization in the ICU were: male gender, age under 2 years, lack of vaccination against pneumococcus, Haemophilus influenzae and influenza, combination of bronchial obstruction with CAP, presence of ENT pathology, lack of antibacterial therapy during prehospital stage, as well as the presence of a serious condition already upon admission.

A Case of Lipoid Pneumonia - Hydrocarbon Pneumonitis

Lipoid pneumonia is a rare lung disease that occurs when lipid-containing products are aspirated or inhaled.[1] Exogenous lipoid pneumonia is typically caused by the inhalation or aspiration of animal fats, mineral oils, or vegetable oils, while endogenous lipoid pneumonia occurs due to lipid accumulation within intra-alveolar macrophages in the presence of bronchial obstruction, chronic pulmonary infection, pulmonary alveolar proteinosis, or fat storage diseases.[2] The clinical and radiological features of this condition are non-specific, and a careful history is crucial for accurate diagnosis. Organizing pneumonia can also be observed as a non-specific consequence of interstitial inflammatory diseases such as nonspecific interstitial pneumonia, usual interstitial pneumonia, organizing diffuse alveolar damage, vasculitis, or aspiration pneumonia. In this case report, we discuss the presentation of lipoid pneumonia in a 23-year-old male with a history of petroleum ingestion.

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Abstract. The aim: to study the prevalence of respiratory symptoms and pulmonary function (PF) in patients with various chronic lymphoproliferative diseases (CLPD) in the Dnipro region of Ukraine. Methods. In all patients who were included in this prospective single-center study, complaints and anamnesis data were collected, anthropometric and general physical examinations, mMRC and CAT questionnaires, analysis of the results of high-resolution computed tomography of the chest organs to determine the presence of intrathoracic lymphadenopathy (ITLAP) were performed. In all patients, parameters of PF were determined using computer spirometry, and when signs of bronchial obstruction were detected, a test with a bronchodilator was performed to determine its reversibility. We analyzed the level of FEV1 , FVC and the ratio of FEV1 /FVC, PEF, MEF25, MEF50 and MEF75. Patients with a confirmed diagnosis of bacterial or viral pneumonia (including patients with COVID-19) were excluded from the study. The methods of descriptive and analytical statistics of the software product STATISTICA v.6.1 (Statsoft Inc., USA) (license number AGAR909E415822FA) were used to process the obtained results. Results. The study found that 37.8 % of patients had complaints from the respiratory system, and 42 % of all patients had significant severity of respiratory symptoms according to the CAT questionnaire. At the same time, only 4.4 % of patients, according to the anamnesis, had established diagnoses of respiratory comorbidity. Among the examined patients with CLPD, 54.4 % had PF disorders, and 81.6 % of them had only obstruction or mixed disorders with a predominance of obstruction (52.5 % mild obstruction, 37.5 % moderate obstruction, and 10 % severe obstruction) and 12.5 % of cases had a positive bronchodilation test. The ratio of FEV1 /FVC was found to be significantly lower in patients with multiple myeloma than in patients with chronic lymph leucosis and lymphomas, which may hypothetically be related to the formation of fibrosis of the bronchial wall; however, the proportions of patients with obstructive PF disorders were equivalent in the groups. ITLAP was detected in 42.2 % of patients. The presence of ITLAP in patients with lymphomas was significantly associated with a lower FEV1 , while in patients with chronic lymph leucosis, who had bronchial obstruction in 43.4 % of cases, the presence of ITLAP had a tendency, but was not statistically significantly associated with the presence obstruction or a lower FEV1 level. Conclusions The obtained results indicate the need for a thorough examination of the respiratory organs, including chest computed tomography and spirometry, in all patients with CLPD, even in the absence of known respiratory comorbidity. According to the obtained results, the presence of PF violations of the obstructive type and the presence of ITLAP are among the main factors that affect the severity of respiratory symptoms in CLPD, therefore, they require careful diagnosis and, in the presence of bronchial obstruction, the appointment of appropriate broncholytic therapy, which can potentially improve the quality life of this category of patients. Key words: multiple myeloma, chronic lymphocytic leukemia, lymphoma, pulmonary function, respiratory symptoms.

Clinical and imaging features in lung torsion and description of a novel imaging sign.

We set out to identify the clinical and imaging features seen in lung torsion, a rare but emergent diagnosis leading to vascular compromise of a lobe or entire lung. We retrospectively identified 10 patients with torsion who underwent chest CT. We evaluated each case for the presence of bronchial obstruction and abnormal fissure orientation. In seven patients who underwent contrast-enhanced CTs, we assessed for the presence of the antler sign, a novel sign seen on axial images demonstrating abnormal curvature of the artery and branches originating on one side. Five patients had right middle lobe (RML) torsion after right upper lobectomy, and the remaining occurred following thoracentesis, aortic surgery, or spontaneously. Chest CTs demonstrated bronchial obstruction in eight cases and presence of abnormal fissure orientation in four patients. The antler sign was present in three patients with whole-lung torsion and one patient with lobar torsion; vascular swirling was seen on 3-D imagesin all seven patients with contrast-enhanced CTs. Lung parenchymal imaging findings in lung torsion may be non-specific. Identification of the antler sign on contrast-enhanced chest CT, in combination with other signs such as bronchial obstruction and abnormal fissure orientation, indicates rotation of the bronchovascular pedicle. The presence of this sign should prompt further evaluation with 3-dimensional reconstructions.

Effects of the Airway Obstruction on the Skin Microcirculation in Patients with Bronchial Asthma

Pulmonary hemodynamic disorders depend on the inflammatory phases and severity of the obstructive syndrome. However, the effect of asthma bronchial obstruction on the state of peripheral hemodynamics remains insufficiently known. To study the effects of airway obstruction on skin blood flow parameters and its regulatory systems in patients with persistent atopic bronchial asthma in the remission state. A comparative study of the skin peripheral blood flow in patients with bronchial asthma with severe airway obstruction (1st group) and without obstruction (2nd group) was conducted. 20 patients with confirmed diagnosis of atopic asthma of 50–74 years old participated in the study. All patients received basic therapy in a constant dosing of high doses of inhaled glucocorticosteroids/long-acting beta-2-agonists. The control group included 20 healthy volunteers without evidence of bronchial obstruction. The study lasted for 3 months. The forced expiratory volume in 1 s (FEV1) was used to evaluate the bronchial obstruction by spirometry technique. Skin blood perfusion changes were recorded by laser Doppler flowmetry at rest and in response to short-term local ischemia. Registered peripheral blood flow signals were examined using the amplitude temporal filtering in five frequency intervals to identify the functional features of the peripheral blood flow regulation systems. Consistent two-fold decrease of the oscillation amplitudes was found in the neurogenic interval at rest (p=0.031), as well as in the myogenic (p=0.043; p=0.031) and endothelial intervals (p=0.037; p≤0.001) both at rest and during the postocclusive reactive hyperemia respectively in the 1st group of patients with bronchial obstruction (FEV1 <80%) compared with the control group. No significant changes were revealed for skin blood flow parameters in the 2nd patient group (without obstruction, FEV1 >80%) in comparison to control subjects. The presence of bronchial obstruction has a significant impact on the changes of the amplitudes of skin blood flow oscillations in patients with bronchial asthma in the myogenic, neurogenic and endothelial intervals.

SPUTUM EOSINOPHIL COUNT IN ATHLETES WITH ANTIASTHMATIC THERAPEUTIC USE EXEMPTION

Dear Editor-in-Chief: The prevalence of asthma has increased steadily in recent years, and it is surprisingly high in athletes (1,2,4). Although several drugs are banned in competitive sports, antiasthmatics such as beta-agonists and corticosteroids are legally admitted when administrated by metered-dose inhaler in the treatment of asthma. However, a variety of beta-adrenergic drugs, particularly clenbuterol, when administered orally or parenterally, develops an illicit activity on the myosin fibers and on the muscles (2). Accordingly, clear rules must be stated to set or verify a diagnosis of asthma in athletes to prevent cheating and harm during competition (1,2,4). Declared medications are commonplace in sports, embracing a wide series of drugs (6). However, the extraordinary number of therapeutic use exemption for antiasthmatics in sportsmen (2,4) calls for the implementation of enhanced thresholds. The diagnosis of asthma is mainly based on history of symptoms, physical examination of signs indicating the presence of bronchial obstruction, and variability in lung function spontaneously or due to bronchodilators (1). Hull et al. (4) recently highlighted that the diagnosis of asthma in athletes is particularly important because of potential implications on performance and strict regulations concerning the use of medications. Accordingly, when an athlete participates in international sports, the Joint Task Force of the European Respiratory Society and the European Academy of Allergy and Clinical Immunology recommend that a combination of medical history and laboratory tests should be documented as basis for the diagnosis of asthma and the possibility to use medications (1). Functional tests include lung function, in particular, maximum expiratory flow volume loops, with the assessment of reversibility to an inhaled beta-2 agonist such as salbutamol and the assessment of bronchial responsiveness either by a direct or by an indirect method (1). However, the use of these tests has some caveats because neither are they usually performed under direct jurisdiction of a sport medical commission nor can they be easily repeated on all athletes competing in the athletic field. Therefore, an alternative, cost-effective screening strategy should be designed (4) to verify whether therapeutic use exemptions are clinically motivated. Sputum analysis for evaluating the percentage of eosinophilia directly measures airway inflammation and objectively monitors asthma (5). Induced sputum eosinophil count was proven sensitive (90%) and specific (92%) in patients with bronchial asthma compared to subjects with asthmalike symptoms, all asthma patients presenting with eosinophil count >1% (3). At variance with blood testing, which requires a venipuncture and a dedicated apparatus for collection and handling, sputum is easily collected by noninvasive means. Moreover, eosinophil count is affordable at reasonable costs because it is routinely performed in clinical laboratories and can also be transferred to the athletic field using a common hematological analyzer. Indeed, eosinophil count in the induced sputum is not intended to replace a diagnosis on the basis of clinical signs and functional tests, but it may be a reliable and an inexpensive screening to preliminarily identify those athletes who are unlikely to suffer from asthma.

Influence of an end inspiratory pause on pulmonary ventilation, gas distribution, and lung perfusion during artificial ventilation

Using a constant tidal volume and ventilatory frequency, anesthetized piglets were ventilated with a new tidal volume ventilator. A short inspiratory time without a pause (10% of breathing cycle) was compared with a longer inspiratory time with a pause (33%) both with and without bronchial obstruction. Mechanics of ventilation, pulmonary ventilation, gas exchange, gas distribution, and lung perfusion were measured. The longer inspiratory time with a pause resulted in lower peak airway and end inspiratory pressures and a higher total compliance. Dead space/tidal volume ratio was reduced and the RQ was increased. While the cranial pulmonary fields were less well ventilated, the right caudal field was better ventilated. In the presence of bronchial obstruction, better alveolar ventilation was achieved when an end inspiratory pause was added. The results emphasize the importance of static end inspiratory tracheal conditions although the tidal volumes were kept unchanged.

Correlation Between the Roentgenologic and Pathologic Findings in Chronic Pneumonitis of the Cholesterol Type

THERE HAS BEEN seen with increasing frequency during the past few years a form of chronic pneumonitis that hitherto we have not recognized in the absence of bronchial obstruction. The process characterized by its chronicity, with either acute or insidious onset, has been considered as a particular type of chronic pneumonitis because of the unusual tissue reactions. The lung is involved in a chronic interstitial inflammation in which the exudate is largely composed of mononuclear cells filled with cholesterol and choJ.esterol esters. Often cholesterol is concentrated to such a high degree in the parenchyma that grossly the tissue appears bright yellow. This type of pneumonitis is common in the presence of bronchial obstruction and is often found in small localized areas in such chronic affections as bronchiectasis, pulmonary abscess, and tuberculosis. In the cases to be reported, however, no major bronchial obstruction or significant coexistent lung disease could be demonstrated roentgenologically or anatomically in the area of pneumonitis. Why this condition is now appearing is difficult to explain. No description of it has been found in the literature other than Adams' (1) presentation of a group of patients with chronic, non-specific suppurative pneumonitis. The possibility that it might represent atypical healing of an infarct has been suggested, but nothing in the histologic studies has confirmed this supposition, even though cholesterol is frequently laid down in slow necrosis of tissue. That the process might be a variation of the ordinary lipoid pneumonitis has also been considered, but again certain factors, from the standpoint of history and of pathology, are not in accord with such a diagnosis. The lesion has been observed in cases in which neither sulfonamides nor penicillin has been administered. The recognition of this type of pneumonitis may be in part due to the recent advances in thoracic surgery and anesthesia. With improvement in technic and the decreasing mortality rate, more and more conditions forme-rly considered inoperable are now being subjected to prompt surgical measures, particularly when there is the least suspicion of tumor. This study is based on 11 cases seen at the Massachusetts General Hospital during the past four years. All but one of the patients were males; the only female was a child of twelve. The age range for the remainder of the group was from thirty-two to sixty-seven years. In more than half, the onset of illness was quite abrupt, characterized by pain, cough, fever, and sputum. In the others, the onset was insidious, with gradual development of cough, sputum, night sweats, weight loss, and in certain instances pain in the chest. The sputum usually varied from mucoid to brownish; in only 3 cases was there frank hemoptysis. As a rule only bacteria of the species generally present in the respiratory tract could be isolated.