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[Lymphatics in non-tumoral pulmonary diseases. Review.]

Rev Pneumol Clin. 2013 Mar 5;

Authors: Kambouchner M, Bernaudin JF

Abstract
Whereas lymphatics in pulmonary non-tumoral diseases have been less studied than blood microcirculation, they clearly play a significant role. This review is a short update on lymphatics in various non-tumoral pulmonary diseases, from asthma to interstitial pneumonitis, excluding lymphangioleiomyomatosis. A lymphatic remodelling has been evidenced in asthma as well as in acute or chronic (UIP as NSIP) interstitial lung diseases. Such a remodelling can be explained as a side effect of local changes in fluidics but could also be an active player in the fibrosing process. Moreover the association of juxta-alveloar lymphatics and granulomas provides new insights in the emergence of these lesions in pulmonary sarcoidosis.

PMID: 23474099 [PubMed - as supplied by publisher]

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Induced sputum in interstitial lung diseases - A pilot study.

Rev Port Pneumol. 2013 March - April;19(2):53-58

Authors: Araújo L, Beltrão M, Palmares C, Morais A, Delgado L

Abstract
INTRODUCTION: Induced sputum with hypertonic saline has been suggested as a safer and cheaper alternative to bronchoalveolar lavage for evaluation of patients with interstitial lung diseases (ILD). OBJECTIVE: To evaluate the safety and feasibility of sputum induction in ILD and to compare sputum cellular profiles with paired bronchoalveolar lavage fluid results. MATERIAL AND METHODS: Twenty patients underwent sputum induction with 4.5% saline within 2 weeks of bronchoalveolar lavage. Total, differential cell counts and cellular viability were assessed. Wilcoxon test and Spearman's rank correlation coefficient were used and a p<0,05 was considered statistically significant. RESULTS: From a total of 20 subjects (mean age 49.4±16.4 years, 70% male) a satisfactory sputum sample was obtained in 15 subjects (75%). Induction was stopped in one subject, due to a significant decrease in PEF. The cell profiles for induced sputum and bronchoalveolar lavage fluid (BALF) were different (P <.05), except for eosinophils, and there were no significant correlations between the two methods. Compared to sputum reference values there was an increase of lymphocytes (3.2% vs 0.5%) and eosinophils (1.4% vs 0.0%). Comparing sarcoidosis and hypersensitivity pneumonitis sputum, both diseases had an increase in lymphocytes (4.4 vs 3.9%), with a significant higher neutrophil count in hypersensitivity pneumonitis (65.4% vs 10.6% P <0.05), a finding also seen in BALF. CONCLUSION: Induced sputum is feasible and safe in interstitial lung diseases. Although sputum cellular counts are not correlated with bronchoalveolar lavage fluid, sputum cellular profiles may help to distinguish different ILD.

PMID: 23477805 [PubMed - as supplied by publisher]

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ARE OXYGEN-CONSERVING DEVICES EFFECTIVE FOR CORRECTING EXERCISE HYPOXEMIA?

Respir Care. 2013 Mar 19;

Authors: Martí S, Pajares V, Morante F, Ramón MA, Lara J, Ferrer J, Güell MR

Abstract
Background:Correction of exercise hypoxemia in advanced lung diseases is crucial and often challenging. However, oxygen-conserving devices have been introduced in the market with limited evidence of its effectiveness. In the present study, the efficacy of two oxygen-conserving devices, a pulse demand oxygen delivery (DOD) system and pendant reservoir cannula (PRC), was evaluated in patients with COPD and interstitial lung disease (ILD).Methods:A cross-sectional, crossover study included 28 COPD and 31 ILD patients with oxygen desaturation on the 6-min walk test (average saturation <88%). Each patient underwent 3 walk tests with DOD, PRC and continuous oxygen flow by standard nasal cannula (CFNC) in random order, taking average saturation ≥ 90% as resaturation criteria.Results:Exercise desaturation was corrected in 79%, 79% and 86% of COPD patients with CFNC, DOD, and PRC, respectively, and in 77%, 61% and 81% of ILD patients with CFNC, DOD, and PRC, respectively. When compared to CFNC, oxygen-conserving devices showed similar efficacy, except a lower performance for DOD in ILD (p=0.012).Conclusions:Although oxygen-conserving devices are capable of correcting exercise hypoxemia in most COPD and ILD patients, correction is not achieved in about 20% of severe COPD regardless of the device, and in nearly 40% of ILD patients with DOD. These findings underscore that individualized adjustment of oxygen flow is needed for optimal correction of exercise hypoxemia, especially when DOD is used in ILD patients.

PMID: 23513249 [PubMed - as supplied by publisher]

Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: a population-based study.

Ann Am Thorac Soc. 2013 Feb;10(1):10-7

Authors: Walkey AJ, Wiener RS

Abstract
Rationale: Although evidence supporting use of noninvasive ventilation (NIV) during acute exacerbations of chronic obstructive pulmonary disease (COPD) is strong, evidence varies widely for other causes of acute respiratory failure. Objectives: To compare utilization trends and outcomes associated with NIV in patients with and without COPD. Methods: We identified 11,659,668 cases of acute respiratory failure from the Nationwide Inpatient Sample during years 2000 to 2009 and compared NIV utilization trends and failure rates for cases with or without a diagnosis of COPD. Measurements and Main Results: The proportion of patients with COPD who received NIV increased from 3.5% in 2000 to 12.3% in 2009 (250% increase), and the proportion of patients without COPD who received NIV increased from 1.2% in 2000 to 6.0% in 2009 (400% increase). The rate of increase in the use of NIV was significantly greater for patients without COPD (18.1% annual change) than for patients with COPD (14.3% annual change; P = 0.02). Patients without COPD were more likely to have failure of NIV requiring endotracheal intubation (adjusted odds ratio, 1.19; 95% confidence interval, 1.15-1.22; P < 0.0001). Patients in whom NIV failed had higher hospital mortality than patients receiving mechanical ventilation without a preceding trial of NIV (adjusted odds ratio, 1.14; 95% confidence interval, 1.11-1.17; P < 0.0001). Conclusion: The use of NIV during acute respiratory failure has increased at a similar rate for all diagnoses, regardless of supporting evidence. However, NIV is more likely to fail in patients without COPD, and NIV failure is associated with increased mortality.

PMID: 23509327 [PubMed - in process]