Parapneumonic effusions complicating pneumonia are associated with increased morbidity and mortality. Along with increased mortality, complicated parapneumonic effusion and empyema often necessitate prolonged treatment, longer hospital stay and interventions. Parapneumonic effusions arise from inflammation in the lungs and pleural space from direct invasion of bacteria, cascade of inflammatory events and bacteriologic virulence features. Patient factors and comorbidities also contribute to the pathophysiology of parapneumonic effusion development. The evolution of parapneumonic effusion can be divided into three progressive stages: (I) exudative stage; (II) fibrinopurulent stage; and (III) organizing stage with pleural peel formation. These stag...

Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in forced expiratory volume in 1 second (FEV1) over time. Yet it is possible that a normal decline in FEV1 could also lead to COPD in persons whose maximally attained FEV1 is less than population norms. METHODS: We stratified participants in three independent cohorts (the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort) according to lung function (FEV1 ≥80% or <80% of the predicted value) at cohort inception (mean age of patients, approximately 40 years) and the presence or absence of COPD at the last study visit. We then determined the rate of decline in FEV1 over time among the participants according to their FEV1 at cohort inception and COPD status at study end. RESULTS: Among 657 persons who had an FEV1 of less than 80% of the predicted value before 40 years of age, 174 (26%) had COPD after 22 years of observation, whereas among 2207 persons who had a baseline FEV1 of at least 80% of the predicted value before 40 years of age, 158 (7%) had COPD after 22 years of observation (P<0.001). Approximately half the 332 persons with COPD at the end of the observation period had had a normal FEV1 before 40 years of age and had a rapid decline in FEV1 thereafter, with a mean (±SD) decline of 53±21 ml per year. The remaining half had had a low FEV1 in early adulthood and a subsequent mean decline in FEV1 of 27±18 ml per year (P<0.001), despite similar smoking exposure. CONCLUSIONS: Our study suggests that low FEV1 in early adulthood is important in the genesis of COPD and that accelerated decline in FEV1 is not an obligate feature of COPD. (Funded by an unrestricted grant from GlaxoSmithKline and others.).

Dyspnea and fatigue are the most mutual symptoms known to be present in chronic obstructive pulmonary disease (COPD) patients. COPD patients have extra trouble breathing out fully. They can apply relaxed breathing techniques any time taking a breath such as following coughing or physical activity. By training to preserve energy with daily chores, patients can perform many physical actions with less dyspnea. AIM: The aim of the current study was to assess the effect of an educational intervention on knowledge, practices, and disease severity in patients with COPD.
PARTICIPANTS AND METHODS: A purposive sample of 100 adult male patients was selected randomly from the Respiratory Clinic at King Abdul-Aziz University Hospital, Jeddah. Patients were assessed using a clinical sheet, patients' dyspnea knowledge questionnaire, patients' practices observational checklists, the Modified Borg Scale, and the Hospital Anxiety and Depression Scale. RESULTS: More than 50% of patients had insufficient knowledge and 100% of them reported that they did not practice respiratory muscles exercises before the educational intervention. These improved after the intervention, showing a highly statistically significant difference. In addition, dyspnea and anxiety improved in COPD patients who had received supervised guidelines. CONCLUSION AND RECOMMENDATIONS: Application of dyspnea-management guidelines has enhanced patients' knowledge of their disease, practice, as well as dyspnea and anxiety levels. Health instruction materials for COPD patients can be useful by means of providing simplified guidelines, explanatory videos, leaflets, and/or brochures to clarify, avoid, and manage dyspnea. An additional estimate of the outcome of instructions to avoid and improve dyspnea and distress reactions in a larger sample size is proposed.

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