Pulmonary Disease Patients Research Articles

Speckle tracking echocardiography has an additive value to differentiate pulmonary hypertension associated with left heart or lung diseases in patients presenting with dyspnoea

Abstract Background The diagnostic pathway of pulmonary hypertension (PH) is complex and requires several parameters. Differential diagnosis between left heart disease (group 2) and pulmonary disease (group 3) as PH etiology is also challenging. The latest European guidelines recommend a comprehensive echocardiographic evaluation for suspected PH, and the use of several basic echocardiographic indices to assess cardiac etiology of PH. Speckle tracking echocardiography (STE) has emerged as a more sensitive technique to evaluate myocardial performance in different clinical settings and is recommended for the diagnosis of HFpEF. Purpose Our ai was to assess the potential value of STE to predict left heart disease in patients presenting with dyspnoea and PH. Methods Consecutive outpatients with dyspnoea with efforts and subsequent diagnosis of PH were retrospectively enrolled. Inclusion criteria were New York heart association (NYHA) class≥II, LV ejection fraction≥50%, echocardiographic evidence of systolic pulmonary artery pressure≥35 mmHg and tricuspid regurgitant velocity≥2.8 ms, known diagnosis of PH with relative etiology (heart failure with preserved ejection fraction, HFpEF or lung diseases i.e. sarcoidosis, idiopathic pulmonary fibrosis, chronic obstructive lung disease). Patients underwent clinical, biohumoral and echocardiographic evaluation, STE was performed offline. Primary endpoint was the prediction of HFpEF. Results Overall, 145 patients were enrolled (80 with HFpEF, 65 with lung disease). Mean age was 75±12 years, 53% were female. Patients with HFpEF were older (77±10 vs. 68±14 years, p<0.0001) and had higher LA volume (93±37 vs. 64±31 ml, p<0.0001), E/E’ by tissue Doppler imaging (TDI) (15±5 vs. 9±3, p<0.0001), mitral regurgitation (MR) grading (p=0.002), lower tricuspid regurgitation (TR) grading (p=0.004). Regarding STE, patients with HFpEF had lower peak atrial longitudinal strain (PALS) (15 ± 8 vs. 24 ± 11%, p<0.0001) and LV global longitudinal strain (-13 ± 9 vs. -17 ± 6%, p=0.009). LA stiffness, calculated as the ratio between E/E’ and PALS, an index of LA dysfunction and fibrosis, was higher in patients with HFpEF (median LA stiffness = 1.09 [CI = 0.64-1.73] 0. Vs.0.35 [CI = 0.20-0.59], p<0.0001). With ROC curves, both E/E’ and global PALS provided a good prediction for HFpEF (AUC 0.73 and 0.79 respectively), but LA stiffness significantly enhanced the predictive power (AUC = 0.83) with an optimal cutoff value ≥0.53. With multivariate analysis including age, LA volume, LV GLS, LA stiffness, mitral and tricuspid regurgitation grade, LA stiffness≥0.53 (RR = 19.14, CI 5.86-62.55) was the only independent predictor of HFpEF in our cohort of patients with PH (Fig.1). Conclusions STE may aid differential diagnosis of etiology between left heart disease and pulmonary disease in patients with PH. The combination of TDI E/E’ and PALS to calculate LA stiffness offers the most accurate prediction of PH with cardiac etiology.

Diagnostic accuracy of ultra-low-dose chest CT vs chest X-ray for acute non-traumatic pulmonary diseases.

To compare the diagnostic accuracy of ULDCT to CXR for detecting non-traumatic pulmonary diseases at the emergency department (ED) and to study diagnostic confidence levels. Secondary analysis of the prospective OPTIMACT trial (2418 ED participants randomly allocated to ULDCT or CXR). Diagnoses at imaging at the ED were compared to the reference diagnosis on day 28. Ratios of positive diagnoses, true positives (TP), false positives (FP), false negatives (FN), and positive predictive values (PPV) were assessed with 95% confidence intervals (CI). The diagnostic confidence levels of the radiologists were studied. One thousand one hundred sixty-one ULDCT participants (mean age, 59 years ± 18 [standard deviation], 587 female) and 1151 CXR participants (mean age, 59 years ± 18 [standard deviation], 561 female) were evaluated. With ULDCT, pneumonia was 1.55 times (95% CI: 1.33-1.80) more often diagnosed at imaging at the ED, with significantly more TP (ratio 1.50; 95% CI: 1.26-1.76) and fewer FN (0.61; 95% CI: 0.37-0.99) but more FP (1.75; 95% CI: 1.19-2.58); a similar pattern was observed for other lower respiratory tract infections (LRTI). Pulmonary congestion was less often observed with ULDCT (0.45; 95% CI: 0.34-0.61), with fewer TP (0.50; 95% CI: 0.34-0.73), and FP (0.40; 95% CI: 0.24-0.65). PPVs were not significantly different. With ULDCT, radiologists were more often certain in diagnosing pneumonia (ULDCT 121/324, 37% vs CXR 48/208, 23%), LRTI (84/192, 44% vs 18/63, 29%), and no established disease (350/382, 92% vs 447/544, 82%). Compared to CXR, ULDCT led to more TP but also more FP in detecting pneumonia and LRTI, while fewer TP and FP were found for pulmonary congestion. PPVs were comparable. Question Is ultra-low dose CT (ULDCT) more accurate than chest X-ray (CXR) for identifying non-traumatic pulmonary diseases in patients presenting at the ED? Findings ULDCT detects more pulmonary infections in patients presenting at the ED with non-traumatic pulmonary complaints, while CXR detects more pulmonary congestion. Clinical relevance ULDCT is superior to CXR in detecting pneumonia and other LRTI in ED patients, while CXR is superior in detecting pulmonary congestion. ULDCT can be an alternative for CXR in a selected group of patients.

Clinical features of chronic obstructive pulmonary disease in patients with pulmonary tuberculosis and HIV infection

Clinical features of chronic obstructive pulmonary disease in patients with pulmonary tuberculosis and HIV infection

Polymeric Infrared and Fluorescent Probes to Assess Macrophage Diversity in Bronchoalveolar Lavage Fluid of Asthma and Other Pulmonary Disease Patients.

Bronchial asthma remains a serious medical problem, as approximately 10% of patients fail to achieve adequate symptom control with available treatment options. Macrophages play a pivotal role in the pathophysiology of asthma, as well as in some other respiratory disorders. Typically, they are classified into two major classes, M1 and M2; however, recent findings have indicated that in fact there is a whole range of macrophage polarization and functional diversity beyond this bimodal division. The isolation of individual cell sub-populations and the identification of their role and diagnostic/therapeutic significance is still a challenge. Here, we have attempted to assess the differences between patient-derived macrophage populations from bronchoalveolar lavage fluid (BALF) samples in different pulmonary disease conditions, based on their capability to interact with a range of specific and relatively non-specific carbohydrate-based ligands (containing galactose (linear or cyclic form), mannose, trimannose, etc.). Obviously, the main target of these ligands was CD206; however, other minor receptors, able to bind carbohydrates, have also been reported for macrophages. Trimannose binds most specifically to CD206 macrophage receptors, while monomannose has intermediate affinity, and galactose has low affinity and may involve binding to other receptors. This clearly indicates the ligands were chosen based on their predicted binding strength and specificity for CD206, providing the rationale for the study. In some cases, the activated macrophage affinity to galactose base ligands was higher than that to mannose, indicating that complexes of CD206 or other carbohydrate-binding receptors may contribute substantially to macrophage functional features. In addition, variations in receptor clustering and distribution may substantially affect affinity to the same ligand. Interestingly, with a panel of 6-10 different carbohydrate-based ligands with FTIR or fluorescent marker, we were able not only to distinguish between healthy and disease states but also between closely related diseases such as purulent endobronchitis, obstructive bronchitis, pneumonia, and bronchial asthma. For further investigation, specific sub-populations of macrophages, seen as hallmarks to specific diseases, can be isolated and studied separately, likely giving new insights with diagnostic and therapeutic significance for hard-to-treat patients. The group of patients with resistant disease can also be identified with this approach as a fingerprint method to find a more targeted therapeutic strategy, improving their clinical outcomes. As expected, this will provide a large additional array of data for analysis, compared to the work going on in the world. The dataset used by other researchers mainly for known "antibody" ligands is semi-quantitative and insufficient for the purposes of typing as yet unknown and uncomplicated sub-populations. The analysis of the presented data in combination with personalized information from patients' medical records will be carried out using both traditional methods and machine learning methods.

Prevalence of Chronic Obstructive Pulmonary Disease in Patients with Nontuberculous Mycobacterial Pulmonary Disease: A Systemic Review and Meta-Analysis.

Nontuberculous mycobacterial pulmonary disease (NTM-PD) is an important comorbidity of COPD. Although many studies have reported an association between COPD and NTM-PD, no clear estimate of the prevalence of COPD and its effects on survival times in patients with NTM-PD is available. This study aimed to investigate the prevalence of COPD and its impact on survival in patients with NTM-PD. All studies reporting the prevalence of COPD in patients with NTM between 1952 and 2021 were searched using PubMed in May 2023. The inclusion criteria were studies about patients with NTM and COPD. A random-effects meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The pooled overall prevalence of COPD in patients with NTM-PD was 28% (95% confidence interval [CI], 22-35). Patients with NTM-PD were six times more likely to have COPD than those without NTM-PD (pooled odds ratio [OR], 6.26; 95% CI, 3.37-11.65). Male patients with NTM-PD had a four-fold higher risk of COPD than females (OR, 3.81; 95% CI, 1.18-12.35). The co-existence of COPD and NTM-PD was significantly associated with an increased risk of mortality compared with NTM-PD without COPD (OR, 3.65; 95% CI, 1.28-10.40). COPD is common in patients with NTM-PD, and patients with NTM-PD had a six-fold increase in the odds of having COPD than those without NTM-PD. The presence of COPD and NTM-PD had a significant negative effect on survival. These findings may support the need to assess the presence of COPD in patients with NTM-PD and the potential negative effects associated with the co-existence of COPD and NTM-PD.

Heart failure and chronic obstructive pulmonary disease in patients with newly initiated sodium-glucose transport protein 2 inhibitors

Heart failure and chronic obstructive pulmonary disease in patients with newly initiated sodium-glucose transport protein 2 inhibitors

Sirtuins and mechanisms of diabetic lung damage: a scientific discussion. A review

Induced tissue damage in target organs (kidneys, heart, eyes, liver, skin, nervous system) significantly contributes to the morbidity and mortality of patients from diabetes mellitus (DM). In recent decades, the question has been actively discussed: should the lungs be regarded as a target organ for diabetes? The c collected data demonstrate histological and functional lung disorders in DM patients. This suggests that the lungs are a target organ for diabetes. It is known that sirtuins regulate a number of physiological processes and affect obesity, insulin resistance, type 2 DM, heart disease and aging. In this review, we have tried to summarize the knowledge about the contribution of sirtuins to cellular regulation and the formation of pulmonary disease in patients with type 2 DM.

What happens between first symptoms and first acute exacerbation of COPD - observational study of routine data and patient survey.

Chronic obstructive pulmonary disease affects nearly 400 million worldwide - over a million in the United Kingdom - and is the third leading cause of death. However, there is limited understanding of what prompts a diagnosis, how long this takes from symptom onset and the different approaches to clinical management by primary care professionals. Map out the clinical management and National Health Service contacts from symptom presentation to chronic obstructive pulmonary disease diagnosis and first acute exacerbation of chronic obstructive pulmonary disease in three time periods; construct risk prediction for first acute exacerbation of chronic obstructive pulmonary disease. Retrospective cohort study and cross-sectional survey. Primary care. Patients with incident chronic obstructive pulmonary disease aged > 35 years in England. None. First acute exacerbation of chronic obstructive pulmonary disease. Clinical Practice Research Datalink Aurum; new online survey. Forty thousand five hundred and seventy-seven patients were diagnosed between April 2006 and March 2007 (cohort 1), 48,249 between April 2016 and March 2017 (cohort 2) and 4752 between March and August 2020 (cohort 3). The mean (standard deviation) age was 68.3 years (12.0); 47.3% were female. Around three-quarters were diagnosed in primary care, with a slight fall in cohort 3. Compliance with National Institute for Health and Care Excellence diagnostic guidelines was slightly higher in cohorts 2 and 3 for all patients; 35.8% (10.0% in the year before diagnosis) had all four elements met for all cohorts combined. Multilevel modelling showed considerable between-practice variation in spirometry. The survey on the charity website had 156 responses by chronic obstructive pulmonary disease patients. Many respondents had not heard of the condition, hoped the symptoms would go away and identified various healthcare-related barriers to earlier diagnosis. Clinical Practice Research Datalink analysis showed notable changes in post-diagnosis prescribing from cohort 1 to 2, such as increases in long-acting muscarinic antagonist (21.7-46.3%). Triple therapy rose from 2.9% in cohort 2 to 11.1% in cohort 3. Documented pulmonary rehabilitation rose from just 0.8% in cohort 1 to 13.7% in cohort 2 and 20.9% in cohort 3. For all patients combined, the median time to first acute exacerbation of chronic obstructive pulmonary disease in patients who had one was 1.4 years in cohorts 1 and 2. Acute exacerbation of chronic obstructive pulmonary disease prediction models identified some consistent predictors, such as age, deprivation, severity, comorbidities, post-diagnosis spirometry and annual review. Models without post-diagnosis general practitioner actions had a c-statistic of around 0.70; the highest c-statistic was 0.81, for cohort 2 with post-diagnosis general practitioner actions and 6-month follow-up. All models had good calibration. The three most important predictors in terms of their population attributable risks were being a current smoker and offered smoking cessation advice (32.8%), disease severity (30.6%) and deprivation (15.4%). The highest population attributable risks for variables with adjusted hazard ratios < 1 were chronic obstructive pulmonary disease review (-27.3%) and flu vaccination (-26.6%). Symptom recording and chronic obstructive pulmonary disease diagnosis vary between practice; predicted forced expiratory volume in 1 second had many missing values. There has been some improvement over time in chronic obstructive pulmonary disease diagnosis and management, with large changes in prescribing, though patient and system barriers to further improvement exist. Data available to general practitioners cannot generate risk prediction models with sufficient accuracy. It will be important to expand the COVID-era cohort with longer follow-up and augment general practitioner data for better prediction. This study is registered as Researchregistry.com: researchregistry4762. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/72) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 43. See the NIHR Funding and Awards website for further award information.

A novel hematological score (HS) and its related nomogram model to predict nontuberculous mycobacterial pulmonary disease in patients with suspected multidrug-resistant pulmonary tuberculosis

Background Nontuberculous mycobacteria pulmonary disease (NTM-PD) exhibits clinical and radiological characteristics similar to those of pulmonary tuberculosis (PTB). This study aimed to develop a novel hematological score (HS) and its related nomogram model to identify NTM-PD in patients with suspected multidrug-resistant pulmonary tuberculosis (SMDR-PTB) due to lack of response to first-line anti-TB treatment (ATT). Methods We retrospectively recruited patients with SMDR-PTB from Wuhan Jinyintan Hospital between January 2014 and January 2022. These patients were divided into NTM-PD and MDR-PTB groups based on pathogen test results. Participants were randomly allocated to training and validation set in a 7:3 ratio. The ROC and LASSO regression were employed to select variables. Multivariate logistic analysis was conducted on the training set to develop the HS and its related nomogram models, followed by internal validation on the validation set. Results The HS was constructed and developed on CKMB, ADA, GGT, LDL, and UHR, demonstrating good predictive value with AUCs of 0.900 and 0.867 in the training and validation sets, respectively. The HS-based nomogram model consists of Age, Gender, DM, HIV infection, ILD and HS, and exhibited strong discriminative ability, accuracy, and clinical utility in two sets. The AUCs were 0.930 and 0.948 in the training set and validation set, respectively. Conclusion HS may be a useful biomarker for identifying NTM-PD in patients with SMDR-PTB. The HS-based nomogram model serves as a convenient and efficient tool for guiding the treatment of SMDR-PTB patients.

Screening for Chronic Obstructive Pulmonary Disease in Patients with Coronary Artery Disease at a Tertiary Care Hospital

Chronic Obstructive Pulmonary Disease is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious gases or particles and influenced by host factors, including abnormal lung development. COPD was the 4th most common cause of death globally, and it was anticipated to rise to the 3rd position by 2020 or sooner. Over 80% of these patients go undiagnosed. COPD and CAD frequently co-exist and interact due to various reasons like similar risk factors and pathogenesis. Although there are global studies on the prevalence of COPD in CAD patients, data from India are scarce. This study aims to find the prevalence of COPD among CAD patients and find the correlation between the occurrence of COPD and cardiac status. This study was conducted as a prospective observational cross-sectional study at Chettinad Hospital and Research Institute in India. 293 patients with angiographically proven CAD underwent pulmonary function evaluation by spirometry to assess the prevalence of COPD. Recent 2D-ECHO was also correlated. The study found that 18.77% of 293 Coronary Artery Disease (CAD) patients had COPD and 3.07% had PRISM( preserved ratio impaired spirometry, a new term coined), making it one of the few studies to report the prevalence of PRISM among CAD patients. Outside of India, studies have found that COPD prevalence ranges from 7% to 33.6% among ischemic heart disease patients. Impairment of spirometry positively correlated with the severity of CAD. Our study found a considerable frequency of missed COPD diagnoses. Hence, we recommend that when CAD is diagnosed, the initial evaluation should include a complete history of respiratory symptoms, clinical examination, and spirometry to assess pulmonary function, particularly in those who have risk factors such as smoking and the use of biomass fuel so as to identify COPD at an early stage and treat it. Identifying PRISM can help prevent its progression to COPD by making the required lifestyle modifications. A multidisciplinary approach is advised for all those diagnosed to have CAD.

Evaluation of novel indices of walking performance taking oxygen desaturation into account during six-minute walk test in cardiovascular disease patients.

In pulmonary disease patients since oxygen desaturation during 6-min walk test (6MWT) affects walk distance (6MWD), some novel indices such as desaturation/distance ratio [DDR, oxygen desaturation area (DAO2)/6MWD] and distance-saturation product [DSP, 6MWD × minimum peripheral oxygen saturation (SpO2)] are evaluated. However, there has been no study examining these indices that consider exercise-induced desaturation (EID) in patients with cardiovascular disease. In 94 cardiovascular disease patients without pulmonary complications, 6MWT and echocardiography were performed at the entry of cardiac rehabilitation. SpO2 was measured during 6MWT using a continuously monitorable pulse oximeter, and DSP and DDR were calculated using minimum SpO2 and DAO2 [sum of (100-SpO2) per second during 6MWT], respectively. EID was defined as SpO2 decrease of ≥ 4% or minimum SpO2 of < 90% during 6MWT. DSP was slightly lower and DDR was markedly higher in patients with EID than in those without. When examining correlations of DSP and DDR with their components, DSP was correlated with 6MWD much closely than minimum SpO2, while DDR was correlated as closely with DAO2 as 6MWD. Furthermore, DAO2, but not minimum SpO2, had a direct correlation with 6MWD. As for associations with cardiac function, DSP was correlated with several cardiac parameters, but DDR was not correlated with any of these parameters. Our findings suggest that oxygen desaturation during 6MWT affects walking distance in cardiovascular disease patients even without pulmonary complications and that DDR is more appropriate than DSP as an index of walking performance that takes EID into consideration, independently of cardiac function.

The use of antibiotics in the early stage of acute exacerbation of chronic obstructive pulmonary disease in patients without obvious signs of infection: a multicenter, randomized, parallel-controlled study.

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with high prevalence and mortality. In some acute exacerbations of COPD (AECOPD) in patients with no obvious signs of infection, early antibiotic treatment seems to clinically improve the disease, but more studies are needed to determine the prognostic impact of antibiotic treatment in AECOPD patients with no obvious signs of infection. To clarify the impact of antibiotic treatment on the short-term and long-term prognoses of AECOPD patients without obvious signs of infection. The impact of the two treatment methods on the prognosis of patients was compared at 30, 90, 180, and 360days after discharge. A multicenter, randomized, parallel-controlled clinical trial was conducted in a department of respiratory and critical care medicine in Central China. All patients met the inclusion criteria for AECOPD, and the patients were randomly assigned to the antibiotic group or the nonantibiotic group at a 1:1 ratio. Patients in the antibiotic group were given moxifloxacin 400mg/day intravenously for 7days. Patients in the nonantibiotic group were intravenously injected with the same amount of normal saline as the amount of moxifloxacin given to those in the antibiotic group for 7days. There were 406 patients in the antibiotic group and 410 patients in the nonantibiotic group. During the short-term and long-term follow-ups, the acute exacerbation frequency, intensive care unit (ICU) treatment rate, mortality, and mMRC and CAT scores were not significantly different between the two groups (p > 0.05). At the 180- and 360-day follow-ups, the forced expiratory volume in 1s (FEV1%) and peak expiratory flow (PEF) were not significantly different between the two groups (p > 0.05). The 30-day readmission rate was significantly lower in the antibiotic group than in the nonantibiotic group (p < 0.05). The time from discharge to the first acute exacerbation was not significantly different between the two groups (p > 0.05). The length of the first hospital stay after discharge was significantly lower in the antibiotic group (5.84days) than in the nonantibiotic group (6.75days) (p < 0.05). At the 30-day follow-up, the acute exacerbation frequency, age, C-reactive protein (CRP) level, and sputum viscosity were significantly greater in the nonantibiotic group than in the antibiotic group (p < 0.05). In addition, according to the receiver operating characteristic (ROC) analysis, the frequency of acute exacerbations at the 30-day follow-up was significantly greater in COPD patients aged >62.5years, with a CRP level >12.56mg/L or with a sputum viscosity >III, in the nonantibiotic group than in those in the antibiotic group, suggesting that the short-term prognosis was poor. Patients who are >62.5years of age, have a CRP concentration >12.56mg/L, or have a sputum viscosity >III without obvious signs of infection should be treated with antibiotics to improve their short-term prognosis. (https://www.chictr.org.cn), (ChiCTR1800018921).

Pulmonary diseases in patients with classical Hodgkin lymphoma relative to a matched background population: A Danish national cohort study.

Late toxicities can impact survivorship in patients with classical Hodgkin lymphoma (cHL) with pulmonary toxicity after bleomycin-containing chemotherapy being a concern. The incidence of pulmonary diseases was examined in this Danish population-based study. A total of 1474 adult patients with cHL treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) or BEACOPP (bleomycin, vincristine, etoposide, doxorubicin, cyclophosphamide, procarbazine and prednisone) between 2000 and 2018 were included along with 7370 age- and sex-matched comparators from the background population. Median follow-up was 8.6 years for the patients. Patients with cHL had increased risk of incident pulmonary diseases (HR 2.91 [95% CI 2.30-3.68]), with a 10-year cumulative risk of 7.4% versus 2.9% for comparators. Excess risks were observed for interstitial lung diseases (HR 15.84 [95% CI 9.35-26.84]) and chronic obstructive pulmonary disease (HR 1.99 [95% CI 1.43-2.76]), with a 10-year cumulative risk of 4.1% and 3.5% respectively for patients. No excess risk was observed for asthma (HR 0.82 [95% CI 0.43-1.56]). Risk factors for interstitial lung diseases were age ≥60 years, the presence of B-symptoms and low albumin. These findings document a significant burden of pulmonary diseases among patients with cHL and emphasize the importance of diagnostic work-up of pulmonary symptoms.

Is there a role for lung or bronchial biopsies for the diagnosis of mycobacterial pulmonary disease in patients with bronchiectasis?

BackgroundWorkup of bronchiectasis patients mandates microbiological characterization often being sought via Bronchoscopy. However, whether to perform bronchial or lung biopsies, is unknown, especially for the diagnosis of NTM pulmonary disease. We aimed to assess the current practice and yield of the different bronchoscopic procedures in this setting. MethodsData from an adult cohort with bronchiectasis referred for bronchoscopy for microbiologic sampling was reviewed, including demographics, etiology, imaging and results of the different bronchoscopic procedures performed. Results127 subjects were analyzed (mean age 61, 56% female). BAL culture was positive in 44%. Frequent pathogens were Hemophilus Influenza (20%), pseudomonas aeruginosa (8%) and Staphylococcus aureus (7%). NTM and tuberculosis were found in 6% and 1.5% respectively. BAL cytology was sent in 125 procedures, EBB was performed in 51 patients (40%) and TBLB in 38 patients (30%). BAL cytology and both EBB and TBB (including tissue cultures) had no benefit over BAL with respect to microbiological diagnosis, including identification of mycobacterial disease. ConclusionsIn adult subjects with Non-CF bronchiectasis requiring bronchoscopy for microbiological characterization, BAL cytology and lung tissue biopsies were frequently performed but were of minimal additional benefit over BAL culture (including for mycobacterial pulmonary disease), and are most likely futile.

The prevalence of chronic obstructive pulmonary disease in patients with spondyloarthritis compared to the general population in the southernmost region of Sweden: a case–control study

Spondyloarthritis (SpA) has been associated with comorbidities, e.g., cardiovascular disease. However, little is known about the relation between SpA and chronic obstructive pulmonary disease (COPD). The aim of the study was to compare the prevalence of COPD in SpA to the general population. Patients with prevalent SpA in Skåne, Sweden, on December 31, 2018, were identified based on diagnostic codes in a regional register on primary care, secondary outpatient care and inpatient care. Population-based controls (5 per SpA case) were matched for age, sex and municipality. The base case definition for COPD required at least two prior visits with a registered COPD diagnosis. Stricter definitions included dispensed prescriptions for COPD and a COPD diagnosis made by a specialist in lung medicine. The prevalence of COPD in patients with SpA and controls, overall and stratified by sex and age, and the corresponding prevalence ratios, were estimated. A total of 3571 patients with SpA (51% male, mean age 53 years) were compared to 17,855 matched controls. The prevalence of COPD in patients with SpA was 37.8/1000, with a prevalence ratio compared to controls of 1.03 (95% CI 0.85–1.24). There were no significant differences in COPD prevalence between patients with SpA and controls in men or women, in any of the age groups, or in analyses using stricter definitions of COPD. In this regional study including data from primary care, the prevalence of COPD was not increased in patients with SpA compared to the background population.

Clinical Burden of Chronic Obstructive Pulmonary Disease in Patients with Suboptimal Peak Inspiratory Flow.

Many patients with chronic obstructive pulmonary disease (COPD) may derive inadequate benefit from dry powder inhalers (DPIs) because of suboptimal peak inspiratory flow (sPIF). To assess the clinical burden of COPD by characterizing the clinical characteristics of participants with sPIF against medium-low resistance DPIs versus those with optimal PIF (oPIF) from two phase 3 clinical trials. Baseline data were collected from two randomized, controlled, phase 3 trials (NCT03095456; NCT02518139) in participants with moderate-to-severe COPD. oPIF (60 L/min) against the medium-low resistance DPIs was used as the threshold for defining the PIF subgroups (<60 L/min (sPIF) vs ≥60 L/min (oPIF)). Most participants included in this analysis were White (92%) and male (63%); the mean (range) age was 65 (43-87) years. Participants with sPIF had significantly greater dyspnea than those with oPIF as measured using the modified Medical Research Council scoring (mean (95% CI): 2.1 (2.0-2.2) vs 1.6 (1.4-1.7); P < 0.001) and baseline dyspnea index (mean (95% CI): 5.1 (4.9-5.4) vs 6.1 (5.8-6.3); P < 0.001). Based on COPD Assessment Test scores, participants with sPIF had a higher COPD symptom burden than those with oPIF (mean (95% CI): 21.5 (19.7-23.3) vs 19.5 (18.6-20.4); P = 0.05). In these trials, participants with COPD who had sPIF against the medium-low resistance DPIs had more dyspnea and worse health status than those with oPIF. These results demonstrate that sPIF is associated with a higher clinical burden as measured by patient-reported outcomes.

Clinical course of nontuberculous mycobacterial pulmonary disease in patients with rheumatoid arthritis

ObjectivesThe impact of rheumatoid arthritis (RA) on nontuberculous mycobacterial pulmonary disease (NTM-PD) has not been well established. In this study, we investigated the clinical course of NTM-PD in patients with RA and the impact of RA on the prognosis of NTM-PD.MethodsWe analyzed patients who developed NTM-PD after being diagnosed with RA from January 2004 to August 2023 at a tertiary referral hospital in South Korea. The patient’s baseline characteristics, clinical course, and prognosis were evaluated. An optimal matching analysis was performed to measure the impact of RA on the risk of mortality.ResultsDuring the study period, 18 patients with RA [median age, 68 years; interquartile range (IQR) 59–73; female, 88.9%] developed NTM-PD. The median interval between RA diagnosis and subsequent NTM-PD development was 14.8 years (IQR, 8.6–19.5). At a median of 30 months (IQR, 27–105) after NTM-PD diagnosis, 10 of 18 (55.6%) patients received anti-mycobacterial treatment for NTM-PD and 5 (50.0%) patients achieved microbiological cure. When matched to patients with NTM-PD but without RA, patients with both RA and NTM-PD had a higher risk of mortality (adjusted hazard ratio, 8.14; 95% confidence interval, 2.43–27.2).ConclusionNTM-PD occurring after RA is associated with a higher risk of mortality than NTM-PD in the absence of RA.

Prognostic impact of chronic obstructive pulmonary disease in patients with heart failure with mildly reduced ejection fraction

BackgroundThe aging population has led to a significant increase in heart failure (HF) patients. Related to demographic changes, the burden with comorbidities was shown to increase in patients with HF. Whereas chronic obstructive pulmonary disease (COPD) was yet demonstrated to be associated with adverse outcomes in patients with HF, the prognostic impact of COPD in HF with mildly reduced ejection fraction (HFmrEF) has not yet been clarified. ObjectiveThe study investigates the prognostic impact of COPD in patients hospitalized with HFmrEF. MethodsConsecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. Patients with COPD were compared to patients without with regard to the primary endpoint all-cause mortality at 30 months (median follow-up). Secondary endpoints comprised in-hospital mortality, HF-related re-hospitalization, cardiac re-hospitalization and major adverse cardiac and cerebrovascular events (MACCE) at 30 months. ResultsA total of 2184 patients with HFmrEF were included with a prevalence of COPD of 12.0 %. Patients with COPD were older (median 77 vs. 75 years; p = 0.025), had increased burden of cardiovascular comorbidities and more advanced HF symptoms. At 30 months, patients with COPD had an increased risk of all-cause mortality compared to patients without (45 % vs. 30 %; HR = 1.667; 95 % CI 1.366–2.034; p = 0.001), alongside with a higher risk of re-hospitalization for worsening HF (20 % vs. 12 %; HR = 1.658; 95 % CI 1.218–2.257; p = 0.001). ConclusionCOPD is independently associated with adverse outcomes in patients hospitalized with HFmrEF.

Clinical value of CD3-CD56+ natural killer cells, IL-2, and IL-8 in acute exacerbation of chronic obstructive pulmonary disease in patients with respiratory failure.

This study aims to investigate the the content of CD3-CD56+ Natural Killer (NK) cells in peripheral blood and the serum interleukin-2 (IL-2) and interleukin-8 (IL-8) levels in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) complicated by respiratory failure (RF). Besides, their diagnostic and prognostic values for AECOPD combined with RF were also explored. This retrospective study included patients from the Affiliated Jiangning Hospital of Nanjing Medical University between December 2021 and December 2023. A total of 65 AECOPD patients with RF were selected as the RF group, 64 AECOPD patients without RF as the AE group, and 60 patients with stable COPD as the COPD group. Data on gender, age, course of disease, smoking, alcohol consumption, history of hypertension and diabetes were collected. Serum levels of IL-2 and IL-8 were detected by enzyme-linked immunosorbent assay (ELISA). Arterial oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2) at admission were measured by automatic blood gas analyzer. Pulmonary function was assessed using forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) and the percentage of FEV1 to the predicted value (FEV1%). The percentage of NK cells (CD3-CD56+) was detected by flow cytometry. After discharge, patients were followed for one year and categorized into a favorable prognosis (FP) group or an unfavorable prognosis group (UP) based on the severity of lung function impairment. Expression levels of IL-2 in the COPD group, AE group, and RF group were 2.91±0.55, 2.21±0.48 and 1.39±0.43, respectively, while the expression levels of IL-8 were 31.01±4.86, 38.02±5.16 and 44.43±6.54, respectively. The percentages of CD3-CD56+ NK cells in the three groups were 19.93±2.40%, 22.57±3.70% and 25.48±3.64%, and the levels of FEV1/FVC were 60.81±6.00%, 51.31±4.95% and 42.67±8.77%, respectively. FEV1% were 61.11±5.71%, 45.45±6.86% and 38.77±10.07%, and PaCO2 levels were 44.08±4.91 mmHg, 53.02±10.52 mmHg and 65±6.63 mmHg, respectively. PaO2 levels were 81.5±5.64 mmHg, 59.1±5.95 mmHg and 53.86±7.06 mmHg, respectively. The differences in the above indices were statistically significant among the three groups (all P<0.05). In all COPD patients, IL-2, IL-8, and CD3-CD56+ NK cells (%) were associated with lung function and arterial blood gas values. In addition, these markers demonstrated predictive value for the prognosis of AECOPD patients complicated by RF, with their combined detection showing a higher predictive value. The combined assessment of serum IL-2, and IL-8 levels and positive CD3-CD56+ NK cell rate in peripheral blood of AECOPD patients has diagnostic value for identifying AECOPD with RF and predicting poor prognosis. These markers can serve as predictors of outcomes.

A Study on Serum Vitamin D Level in Patients Suffering from Various Pulmonary Disorders

Vitamin D is a critical nutrient for human health. However, our environment, lifestyle and genetic makeup can significantly impact the efficacy of vitamin D production in the body. Unfortunately, our diets do not provide us with sufficient vitamin D, leading to a variety of health issues. Vitamin D also has a pivotal role in the development of pulmonary diseases. Hence this study was done to estimate vitamin D levels in patients suffering from various pulmonary disorders. This is a cross-sectional type of study conducted at a tertiary care centre with a sample size of 160 consisting of 80 cases of respiratory diseases with 80 apparently healthy attendees for a period of 1 year. We found that vitamin D levels were deficient (16.95ng/ ml) in pulmonary disease patients as compared to their apparently healthy attendees(20.69). Patients with infective aetiology i.e., Tuberculosis, community-acquired pneumonia, and bronchiectasis had a much lower value of vitamin D (10.72 ng/ml) as compared to other patients with noninfective aetiology (19.43 ng/ml). Our study shows an inverse relationship between blood vitamin D levels and Body Mass Index and found direct association with occupation and smoking history. However, no link was discovered with gender or geography. This study’s findings add to the growing body of information on the factors related to vitamin D status.