Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts

Oral and pharyngeal bolus transit in patients with chronic obstructive pulmonary disease

Rachel Aguiar Cassiani, Carla Manfredi Santos, José Baddini-Martinez, Roberto Oliveira Dantas Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil Background: Patients with respiratory diseases, such as chronic obstructive pulmonary disease (COPD), may have swallowing dysfunction. Objective: The aim of this investigation was to evaluate the oral and pharyngeal phases of swallowing in patients with COPD. Methods: We studied 16 patients with clinical manifestations and pulmonary function tests diagnosis of COPD (mean age: 68 years) and 15 nonsmoking healthy volunteers (mean age: 65 years) with normal pulmonary function tests. All subjects were submitted to clinical and videofluoroscopic evaluation of swallowing. Each subject performed in duplicate swallows of 5 mL and 10 mL of liquid bolus, paste bolus, and a solid bolus. Results: In general, the duration of the events of the pharyngeal phase of swallowing was longer in COPD patients than controls. The difference was significant in the laryngeal vestibular closure, hyoid movement, and pharyngeal transit with swallows of both volumes of liquid bolus; in oral–pharyngeal transit with 5 mL paste bolus; and in pharyngeal and oral–pharyngeal transit with solid bolus. The difference between the duration of maximal laryngeal elevation and the duration of pharyngeal transit was higher in control subjects than in patients with COPD. Conclusion: The results suggested that patients with COPD have a longer pharyngeal swallowing phase than normal subjects, which is associated with a decrease in the difference between the duration of maximal laryngeal elevation and the duration of pharyngeal transit. Keywords: COPD, videofluoroscopy, oral–pharyngeal transit, swallowing, deglutitio

Transporte de secreções mucóides de indivíduos saudáveis e pacientes com doença pulmonar obstrutiva crónica e bronquiectasias

Resumo: Objetivo: Analisar e comparar as propriedades de transporte in vitro da secreção respiratória de aspeto mucoide (M) de indivíduos sem doença respiratória e de pacientes com doença pulmonar obstrutiva crónica (DPOC) e bronquiectasias estáveis. Métodos: Foram avaliadas 21 amostras de indivíduos sem doença pulmonar submetidos a processos cirúrgicos, 10 amostras de pacientes com DPOC e 16 amostras de pacientes com bronquiectasias quanto ao transporte mucociliar (TMC), deslocamento na máquina simuladora de tosse (MST) e ângulo de contacto (AC). Resultados: Foi observado uma maior TMC das amostras de indivíduos sem doença respiratória (1,0 ± 0,19) quando comparado com o dos pacientes com DPOC (0,9 1± 0,17) e bronquiectasias (0,76 ± 0,23) (p < 0,05), enquanto que o deslocamento na MST foi maior nos pacientes com DPOC (16,31 ± 7,35 cm) quando comparado com o de pacientes com bronquiectasias (12,16 ± 6,64 cm) e de indivíduos sem doença respiratória (10,50 ± 25,8 cm) (p < 0,05). Não houve diferença envolvendo a avaliação do AC. Conclusão: O muco respiratório dos indivíduos saudáveis tem um melhor transporte ciliar do que o de pacientes com doenças respiratórias. No entanto, o muco de pacientes com DPOC tem uma melhor transportabilidade pela tosse, sugerindo que esses pacientes apresentam adaptações para tais mecanismos de defesa, enquanto que os pacientes com bronquiectasias têm deficiência no transporte ciliar, assim como no transporte pela tosse. Abstract: Objective: To characterise and compare the in vitro transport properties of respiratory mucoid secretion in individuals with no lung disease and in stable patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis. Methodology: Samples of mucus were collected, from 21 volunteers presenting no lung disease who had undergone surgery, from 10 patients presenting chronic COPD, and from 16 patients with bronchiectasis. Mucociliary transport (MCT), transport by cough (SCM), and contact angle (CAM) were evaluated. Results: MCT was found to be greater in healthy individuals (1.0 ± 0.19) than in COPD (0.91 ± 0.17) and bronchiectasis (0.76 ± 0.23) patients (p < 0.05), whereas SCM was greater in COPD patients (16.31 ± 7.35 cm) than in patients with bronchiectasis (12.16 ± 6.64 cm) and healthy individuals (10.50 ± 25.8 cm) (p < 0.05). No significant differences were observed between the groups regarding CAM. Conclusion: Mucus from healthy individuals allows better mucociliary transport compared to that from patients with lung diseases. However, the mucus from COPD patients allows a better transport by coughing, demonstrating that these individuals have adapted to a defence mechanism compared to patients with bronchiectasis, who have impairment in their ciliary and cough transport mechanisms. Palavras-chave: DPOC, Bronquiectasia, Muco respiratório, Depuração mucociliar, Keywords: COPD, Bronchiectasis, Respiratory mucus, Mucociliary clearanc