Severity Of Respiratory Impairment Research Articles

High-dose corticosteroids in patients hospitalized for COVID-19 pneumonia: an observational study of comparative effectiveness

ObjectivesTo assess whether high- compared with low-dose corticosteroids started upon hospitalization reduce mortality in patients with severe COVID-19 pneumonia or in subgroups stratified by severity of respiratory impairment on admission. MethodsWe conducted a retrospective cohort study of patients with confirmed SARS-CoV-2 infection who required oxygen supplementation upon hospitalization between March 1 and December 31, 2020. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving low- or high-dose corticosteroid (dexamethasone 6-10 mg daily or >10-20 mg daily or other corticosteroid equivalents). ResultsWe analyzed 13,366 patients who received low-dose and 948 who received high-dose corticosteroids, of whom 31.3% and 40.4% had severe respiratory impairment (>15 l/min of oxygen or mechanical ventilation) upon admission, respectively. There were no differences in the propensity score-adjusted odds of death (odds ratio 1.17, 95% CI 0.72-1.90) or infections (odds ratio 0.70, 95% CI 0.44-1.11) for patients who received high-dose compared with low-dose corticosteroids, beginning on the day of admission. No significant differences in subgroups stratified by severity of respiratory impairment were found. ConclusionInitiating high-dose compared with low-dose corticosteroids among newly hospitalized patients with COVID-19 pneumonia did not improve survival. However, benefit of high-dose corticosteroids in specific subgroups cannot be excluded.

A review of respiratory management in children with Duchenne muscular dystrophy

Duchenne muscular dystrophy is an X-linked genetic dis­order that involves the gene responsible for the synthesis of dys­trophin. Decreased dystrophin levels in the body cause a progressive loss in muscle strength that affects ske­le­tal muscle structures and evolves towards disability. Death occurs after a variable period, depending on the case manage­ment. Impaired lung function is gradual and progresses to chronic respiratory failure. The severity of respiratory impairment is assessed by careful and periodic monitoring. Along with the information pro­vided by spirometry and muscle inspiratory and ex­pi­ra­tory pressures, the ap­pli­ca­tion of the pediatric sleep questionnaire, the study of poly­somno­graphic sleep and the monitoring of CO2 levels during sleep are practiced. All these provide information about the impact of this disease on the respiratory system, about the time of sleep respiratory disorders onset and select patients who need support through assisted cough and noninvasive ventilation. The authors present the results of respiratory monitoring in children diagnosed with Duchenne mus­cu­lar dystrophy and sleep respiratory disorders and ob­serve the impact over time of the non­inva­sive nocturnal ven­ti­la­tion treatment.

Delivering Safe and Effective Hemodialysis in Patients with Suspected or Confirmed COVID-19 Infection: A Single-Center Perspective from Italy.

New “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) is responsible for a clinical entity named Coronavirus Disease 2109 (COVID-19) by the World Health Orgazination, which is now a pandemic (1). In Europe, Italy was the first, and so far the largest, epicenter of the epidemic. It is now clear that many asymptomatic and paucisymptomatic patients went undetected, causing significant diffusion of the disease. Asymptomatic infections are common: among 634 confirmed patients on board the “Diamond Princess” cruise ship, 306 were symptomatic and 328 asymptomatic at the time of testing (2). It is now clear that when a patient with atypical severe pneumonia was diagnosed as COVID-19 in a small city, Codogno, in a previously healthy 38-year-old man, on February 20, 2020, more patients with undetected COVID-19 were present in Northern Italy. In addition to the cluster around Codogno, about 50 km south of Milan, which was promptly put under strict lockdown, two additional relevant clusters emerged near the cities of Bergamo and Brescia. The delay in enforcing a lockdown in the latter areas is probably one of the leading causes of the more severe outbreak now affecting these provinces. Extensive testing in the initial phase of disease diffusion was adopted in the Italian Veneto area, resulting in better containment of new cases. A nationwide lockdown measure was passed by the Italian government when Northern Italy, which has the highest concentration of well organized hospitals in the country, started showing signs of difficulty handling the rapid increase of patients in need of treatment in intensive care units (ICUs). A comparison of Chinese and Italian data on COVID-19 may be of interest to other countries where the disease is now spreading. The Chinese Center for Disease Control and Prevention described the characteristics of a large cohort of COVID-19 patients (3), showing that …

Physiological Changes And Clinical Findings In Females Textile Factory Workers

About 60 million people worldwide work in the textile or clothing industry. The conditions of working and the dust that produced from processing of cotton in industries can cause many morbidities to the health of workers. Many recent studies have found a high ratio of chronic diseases especially chronic obstructive pulmonary disease (COPD) in those workers. This study was done to assess the effect of working in textile industry from physiological and clinical points of view. A cross-sectional study was conducted among 75 randomly selected textile factory workers, all subjects were females. Information was collected through interview, in addition to physical examination and some needed investigations were performed including: packed cell volume (PCV),white blood cell count (WBC), erythrocyte sedimentation rate (ESR), random blood sugar (RBS), blood urea (Bur), serum creatinine (Scr), serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALP), electrocardiography (ECG), echocardiography, chest x-ray (CXR) and general urine examination (GUE), in addition to pulmonary function tests (PFTs) using portable medical spirometer. The results of this study was shown that the mean duration of exposure of workers to cotton dust was 15.67±4.86 years, the higher percentage of workers had low back pain (LBP) (85%), while lower percentage of them had contact dermatitis (27%), urinary tract infection (23%), while 2% of workers had left ventricular hypertrophy as revealed by ECG and echocardiography. Regarding the mean values of blood parameters, the study showed no significant difference between workers and control groups apart from ESR changes (26.8 ± 15.95 vs. 8.3 ± 3.3 with P ≤ 0.05). Regarding the respiratory findings, the highest percentage of workers complained from shortness of breath (45.3%), some of them had no symptoms (17.3%), severity of symptoms was moderate restriction in most workers (24%), the study also showed negative non-significant relation between duration of exposure and severity of respiratory impairment (r = 0.1, P= 0.2). In conclusion; this study provides evidence of a strong relationship between exposure to cotton dust and respiratory impairments, also there was a considerable percentage of workers had muscular and dermatolo

Bronchodilator Response in FVC Is Larger and More Relevant Than in FEV1 in Severe Airflow Obstruction

Recommendations on interpreting tests of bronchodilator responsiveness (BDR) are conflicting. We investigated the dependence of BDR criteria on sex, age, height, ethnicity, and severity of respiratory impairment. BDR test data were available from clinical patients in the Netherlands, New Zealand, and the United States (n= 15,278; female subjects, 51.7%) and from surveys in Canada, Norway, and five Latin-American countries (n= 16,250; female subjects, 54.7%). BDR calculated according to FEV1, FVC, and FEV1/FVC was expressed as absolute change, a percentage of the baseline level (%baseline), a percentage of the predicted value (%predicted), and z score. Change (Δ) in FEV1 and FVC, in milliliters, was unrelated to the baseline value but was biased toward age, height, sex, and level of airways obstruction; ΔFEV1 was significantly lower in African Americans. In 1,106 subjects with low FEV1 (200-1,621mL) the FEV1 increased by 12%to 44.7%relative to baseline but< 200mL. Expressing BDR as a percentage of the predicted value or as a z score attenuated the bias and made the 200-mL criterion redundant, but reduced positive responses by half. ΔFEV1 %baseline increased with the level of airflow obstruction but decreased with severe obstruction when expressed as z scores or %predicted; ΔFVC, however expressed, increased with the level of airflow obstruction. Expressing FEV1 responsiveness as %baseline spuriously suggests that responsiveness increases with the severity of respiratory impairment. Expressing change in FEV1 or FVC as %predicted or as z scores eliminates this artifact and renders the required 200-mL minimum increase redundant. In severe airways obstruction ΔFVC should be critically evaluated as an index of clinically important relief of hyperinflation, with implications for bronchodilator drug trials.

STRATEGIES OF LUNG FUNCTION TESTING IN WORK OF THE PRIMARY CARE PHYSICIANS

The lung function tests have become standard practice to confirm the diagnosis, evaluate the severity of respiratory impairment, assess the therapy response and follow-up patients with various respiratory disorders. Frequently, no single pulmonary function tests yields all information in an individual patient and multiple tests have to be combined to allow proper evaluation of the patients.

Rescue therapy in adult and pediatric patients with pH1N1 influenza infection: A tertiary center intensive care unit experience from April to October 2009*

Severe respiratory failure is a well-recognized complication of pH1N1 influenza infection. Limited data regarding the efficacy of rescue therapies, including high-frequency oscillatory ventilation and extracorporeal membrane oxygenation, have been previously reported in the setting of pH1N1 influenza infection in the United States. Retrospective, single-center cohort study. Pediatric, cardiac, surgical, and medical intensive care units in a single tertiary care center in the United States. One hundred twenty-seven consecutive patients with confirmed influenza A infection requiring hospitalization between April 1, 2009, and October 31, 2009. Electronic medical records were reviewed for demographic and clinical data. The number of intensive care unit admissions appears inversely related to age with 39% of these admissions <20 yrs of age. Median duration of intensive care unit care was 10.0 days (4.0-24.0), and median duration of mechanical ventilation was 8.0 days (0.0-23.5). Rescue therapy (high-frequency oscillatory ventilation or extracorporeal membrane oxygenation) was used in 36% (12 of 33) of intensive care unit patients. The severity of respiratory impairment was determined by Pao²/Fio² ratio and oxygenation index. High-frequency oscillatory ventilation at 24 hrs resulted in improvements in median Pao²/Fio² ratio (71 [58-93] vs. 145 [126-185]; p < .001), oxygenation index (27 [20-30] vs. 18 [12-25]; p = .016), and Fio2 (100 [70-100] vs. 45 [40-55]; p < .001). Extracorporeal membrane oxygenation resulted in anticipated improvement in parameters of oxygenation at both 2 hrs and 24 hrs after initiation of therapy. Despite the severity of oxygenation impairment, overall survival for both rescue therapies was 75% (nine of 12), 80% (four of five) for high-frequency oscillatory ventilation alone, and 71% (five of seven) for high-frequency oscillatory ventilation + extracorporeal membrane oxygenation. In critically ill adult and pediatric patients with pH1N1 infection and severe lung injury, the use of high-frequency oscillatory ventilation and extracorporeal membrane oxygenation can result in significant improvements in Pao²/Fio² ratio, oxygenation index, and Fio². However, the impact on mortality is less certain.

Pentraxin-3 in late-preterm newborns with hypoxic respiratory failure

The aim of this study was: echocardiographical assessment of cardiac alterations in late-preterm newborns with hypoxic respiratory failure (HRF), and, study serum pentraxin-3 (PTX-3) in relation to the severity of respiratory impairment and to some echocardiographic parameters (i.e. ejection fraction (EF), stroke volume (SV) and cardiac output (CO). We enrolled in this study 40 newborn infants whose 22 (group I) with moderate HRF and 18 (group II) with severe HRF. In group I the mean values of EF, SV and CO were significantly higher than in the group II. Our results showed a significant increase of PTX-3 in group II patients at 24h of life when compared to group I. Taking patients all together (n=40), we found a significant (R=-73) reverse correlation between EF and serum values of PTX-3. PTX-3 in our patients with HRF is affected by the severity of the hypoxic insult and correlate with the cardio-vascular impairment.

Secondary spontaneous pneumothorax in rapidly progressive forms of silicosis: characterization of pulmonary function measurements and clinical patterns

A secondary spontaneous pneumothorax is a complication of an underlying pulmonary disease. In recent years, there have been only a few scattered reports of patients with silicosis also having a pneumothorax. Silicosis, a form of disabling pulmonary fibrosis, is a well-known occupational disease resulting from high-level exposure to silica or silica-containing dusts. The objective of the present study was to elucidate any associations between the occurrence of a pneumothorax, and pulmonary function tests and clinical observations performed prior to the pneumothorax; these two factors may be predictors for a pneumothorax among workers exposed primarily to silica-containing respirable dust. A diagnosis of silicosis was made on several factors: silica dust exposure, appropriate interval of time after exposure, clinical findings, pulmonary function tests and chest radiological findings. A checklist was designed for collecting data of occupational history, respiratory signs, and symptoms from onset of dust exposure to the occurrence of a pneumothorax. Spirometery was conducted in accordance to the recommendations of standard protocols and guidelines posited by the American Thoracic Society. Autopsies were performed in three cases where the patient had suffered a pneumothorax due to silicosis. Mann-Whitney U-tests and Fisher's exact tests were used to determine any associations between pneumothorax and predictor factors. An association between a progressive decrease in pulmonary function test values and a pneumothorax was observed. The occurrence of a pneumothorax was associated with complaints of pleuretic chest pain, resting dyspnea, respiratory distress, paroxysmal nocturnal dyspnea, orthopnea and crackle. A characteristic decline in pulmonary function test values and the severity of respiratory impairment may facilitate the occurrence of a pneumothorax in silicosis.

When and how to assess quality of life in chronic lung disease.

Since the early 1980s there has been increasing awareness of the importance of quantifying health-related quality of life (HRQL) in patients with chronic respiratory disorders included in clinical trials. HRQL scores are clearly complementary to functional assessments, and have been shown to be better predictors of use of health resources (hospital readmissions, GP consultations exacerbations) than pulmonary function tests alone. Two types of HRQL score are available: "generic scores" cover a wide array of items and allow comparison of patients suffering from various medical conditions; they may however lack responsiveness and therefore underestimate changes in HRQL induced by a pharmacological or non-pharmacological management; "disease-specific scores" are more responsive and sensitive to changes, and thus more suitable for assessing the impact of management on HRQL. The choice of a HRQL instrument must take into account its validity, reliability, and responsiveness in the population studied; it must also be adapted to the severity of respiratory impairment, to ensure optimal discriminant potency. In clinical trials, the use of a "generic" score combined with a "disease-specific" score is recommended for optimum assessment. This is however too time-consuming for clinical practice: the use of short-time HRQL tools quantifying specific items such as resting and exertional dyspnoea, activities of daily life and emotional status appears more appropriate in this setting; furthermore, these items correlate better with HRQL scores than pulmonary function tests.

Evaluating pulmonary impairment: appropriate use of pulmonary function and exercise tests

Pulmonary impairment in patients with occupational lung diseases can frequently be detected and quantified simply by measuring spirometric values (forced vital capacity, forced expiratory volume in 1 second), or single breath-diffusing capacity. When the results of such pulmonary function tests are equivocal or inconsistent with clinical symptoms, cardiopulmonary exercise testing provides helpful ancillary information. Published guidelines are available to assist in grading the severity of respiratory impairment based on pulmonary function and exercise testing.

Angiotensin-Converting Enzyme in Human Adult Respiratory Distress Syndrome

Angiotensin-converting enzyme (ACE) levels, complement activation, and intravascular coagulation were studied in 36 patients with adult respiratory distress syndrome (ARDS) (17 aseptic, 19 septic), in order to investigate the possible interrelations among ACE, immunologic data, and hematologic findings. The severity of respiratory impairment was assessed with measurements of mechanical and gas exchange functional qualities of the lung. Serial measurements of ACE could be done in 14 patients during an eight-day period. During the first 24 hours, ACE levels were always normal (38 percent) or decreased (62 percent). No difference could be found between patients with septic and aseptic ARDS. Complement activation occurred in 78 percent (28/36) and used, in most cases, the classic pathway with presence of circulating immune complexes. Criteria for intravascular coagulation were present in 58 percent (21/36). No relation between coagulation, complement, and ACE could be found except for the patients with a greater respiratory impairment, who had complement activation, intravascular coagulation, and significantly lower ACE levels. In all patients together, ACE levels had no diagnostic value for aseptic cause of ARDS and a poor prognostic value. Only intravascular coagulation was linked with a higher significant mortality and a greater functional impairment. Serial measurements showed a diphasic evolution of ACE levels, with a maximum decrease between the 72nd and 96th hours and a further normalization (seventh day). The persistence of low levels seemed to be associated with evolutive sepsis or secondary aggravation and fibrosis.