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Noninvasive Ventilation and Lung Volume Reduction

As parenchymal lung disease in chronic obstructive pulmonary disease becomes increasingly severe there is a diminishing prospect of drug therapies conferring clinically useful benefit. Lung volume reduction surgery is effective in patients with heterogenous upper zone emphysema and reduced exercise tolerance, and is probably underused. Rapid progress is being made in nonsurgical approaches to lung volume reduction, but use outside specialized centers cannot be recommended presently. Noninvasive ventilation given to patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease reduces mortality and morbidity, but the place of chronic non-invasive ventilatory support remains more controversial. (Source: Clinics in Chest Medicine)

Role of D-dimer in predicting mortality in patients with community-acquired pneumonia.

Aim To determine whether D-dimer in patients with communityacquired pneumonia (CAP) can predict mortality risk better than standard biomarkers.

Methods White blood cell (WBC), C-reactive protein (CRP) and D-dimer in 129 patients with CAP were analyzed. The recommended Pneumonia Severity Index (PSI) score was used to classify CAP patients into five groups according to the severity of disease (Group PSI I-V), and for predicting mortality. Additionally, the patients were divided in surviving and non-surviving group.

Results White blood cell and CRP were not in correlation with the severity of CAP and the risk of mortality. The correlation between plasma D-dimer and severity of CAP was found (r=0.4993; p less than 0.001). The level of D-dimer was significantly higher in nonsurviving (2498.38±1248.83ng/mL) than in surviving patients (966.44 ± 968.73ng/mL) (p less than 0.001). In predicting mortality risk, D-dimer showed sensitivity of 0.84 (cut of >1538 mg/mL), specificity 0.86 and AUC 0.859 (95%CI; 0.787-0.914). Pneumonia Severity Index in predicting of mortality risk for cut of > PSI III showed sensitivity of 0.92, specificity 0.62 and AUC 0.868 (95%CI; 0.797-0.921). There was no statistical difference between AUC of PSI and D-dimer (delta AUC= 0.00895) (p=0.9005).

Conclusion Coagulation abnormalities were presented in older patients with severe infections and comorbidity. Plasma D-dimer correlated better than standard inflammatory markers with severity of disease and risk of mortality in patients with CAP. In predicting mortality risk, D-dimer did not show difference among the PSI score.

Asthma control in obesity-associated asthma phenotype in East Croatia.

Aim To determine if obese asthmatics represent a distinct clinical phenotype than non-obese and the level of asthma control in obese asthmatics.

Methods The study was conducted in the pulmonary clinic of the Department of Pulmonary Diseases, Osijek University Hospital Centre during 201, on 201 outpatients with asthma, who came to a regular examination.

Each patient underwent a clinical examination with an extensive anamnesis and lung auscultation. During the examinationIanninternally made questionnaire, spirometry, fractional exhaled nitric oxide (FeNO), Asthma Control Test and Asthma Control Questionnaire were used to estimate the level of asthma control, wheread the Hospital Anxiety and Depression scale was used to estimate the presence of mood disorderd.

Results The severity of asthma was increased in obese patients. There was no significant difference in the number and frequency of hospitalizations in obese compared to non-obese asthmatics. Non-obese asthmatics had more frequent visits to their general practitioner/Emergency medical services (GP/EMS) during the last month compared to obese asthmatics, which is a new finding inconsistent to any study conducted before. Obese asthmatics had more symptoms and had them almost every day. Lung function of obese asthmatic was worse compared to non-obese, especially in women. Values of exhaled nitric oxide showed no significant difference for obese asthmatics. No significant difference in intake of corticosteroids or combination therapy was found. Obese patients with asthma had more frequent and multiple comorbidities.

Conclusion Results confirmed that obese asthmatics represent a different phenotype of asthma, more severe and poorly controlled.

Transthoracic ultrasound in the assessment of pleural and pulmonary diseases: use and limitations.

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Interest in transthoracic ultrasound (US) procedures increased after the availability of portable US equipment suitable for use at the patient's bedside. It is possible to detect space-occupying lesions of the pleura, pleural effusion, focal or diffuse pleural thickening and subpleural lesions of the lung, even in emergency settings.

Transthoracic US is useful as a guidance system for thoracentesis and peripheral lesion biopsy, where it minimises the occurrence of pneumothorax and haemorrhage. Transthoracic US imaging is strongly influenced by physical interaction of the ultrasonic beam at the tissue/air interface, which gives rise to reverberations classified as simple (A-line), "comet tail" and "ring down"(B-line) artifacts. Although these artifacts can be suggestive of a disease condition, they are essentially imaging errors present even in normal subjects and in empty-pleura post-pneumonectomy patients. In order to clarify some confusion and to report on the state of the art, we present a review of the literature on transthoracic US in diseases of the pleura and peripheral lung regions and our own clinical experience over 3 decades.

The review focuses on quality assurance procedures and their value in diagnostic imaging and patient monitoring and warns against possible inappropriate indications and misleading information. Thoracic US is much more than "fishing for the moon in the well".

Increased risk of wheeze and decreased lung function after respiratory syncytial virus infection.

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A relationship between hospitalization for respiratory syncytial virus (RSV) bronchiolitis and asthma development has been suggested in case-control studies.
OBJECTIVE: The aim of this study was to assess the risk of current wheeze, asthma, and lung function at school age in infants previously hospitalized for RSV bronchiolitis compared to non-hospitalized children.

METHODS: For this study, data from a prospective birth cohort of unselected, term-born infants (n = 553), of whom 4 (0.7%) were hospitalized for RSV bronchiolitis, and a prospective patient cohort of 155 term infants hospitalized for RSV bronchiolitis were used. Respiratory outcomes at age 6 in children hospitalized for RSV bronchiolitis were compared to non-hospitalized children.

RESULTS: The risk of current wheeze was higher in hospitalized patients (n = 159) compared to non-hospitalized children (n = 549) (adjusted odds ratio (OR) 3.2 (95% CI 1.2-8.1). Similarly, the risk of current asthma, defined as a doctor's diagnosis of asthma plus current symptoms or medication use, was higher in hospitalized patients (adjusted OR 3.1 (95% CI 1.3-7.5). Compared to non-hospitalized children, RSV bronchiolitis hospitalization was associated with lower lung function (mean difference FEV1% predicted -6.8 l (95% CI (-10.2 to -3.4).

CONCLUSIONS AND CLINICAL RELEVANCE: This is the first study showing that hospitalization for RSV bronchiolitis during infancy is associated with increased risk of wheezing, current asthma, and impaired lung function as compared to an unselected birth cohort at age 6.

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