Comparison of the efficacy and safety of nebulized beclometasone dipropionate and budesonide in severe persistent childhood asthma

AbstractInhaled steroids are recommended for long-term control of asthma, but their use may be limited in young children because of difficulties in using the associated inhaler device. The use of nebulizers may help to overcome this issue, without compromising therapeutic efficacy or safety. This 14-week, multicentre, randomized, controlled, open-label, parallel-group study compared the efficacy and safety of nebulized corticosteroids in paediatric patients (aged 6 months to 6 years) with severe persistent asthma. Beclometasone dipropionate (BDP) 800 μg day−1 suspension for nebulization and budesonide (BUD) 750 μg day−1 given by nebulization in a twice-daily regimen, and when used in addition to the usual maintenance therapy, resulted in comparable clinical efficacy across all parameters. The primary efficacy endpoint was the number of patients who did not experience any major exacerbation, this being 40·4% and 51·7% in the BDP and BUD groups respectively in the ITT population (P=0·28), and the mean number of global exacerbations (major plus minor) decreased respectively by −37.5% in the BDP group and −23.3% in the BUD group. Both treatments were also associated with marked reductions in the number of nights with wheezing and the number of days of oral steroid use. Moreover, the two treatment groups had a similar adverse-event incidence and profile. Only 11 adverse events were reported, and no serious adverse events were related to treatment. Urinary cortisol and the time course of height and weight were unaffected by both treatments, and BDP was confirmed to have a neutral effect on bone metabolism. In conclusion, this study demonstrates that both BDP 800 μg day−1 suspension for nebulization and BUD 750 μg day−1 administered by nebulization are effective, with an acceptable safety profile, for treatment of severe persistent asthma in infants and young children

Thoracoscopic Assessment of Pleural Tumor Burden in Patients with Malignant Pleural Effusion: Prognostic and Therapeutic Implications

Background:Malignant pleural effusion (MPE) is encountered at an advanced stage of disease progression and often heralds a poor prognosis. The most reliable predictive factor of survival in such patients is the primary tumor. Thoracoscopy is often performed for accurate diagnosis and/or thoracoscopic talc insufflation as a therapeutic modality. It remains unknown whether pleural tumor burden, as visualized on thoracoscopy, has potential prognostic value. The objective of this study was to determine the prognostic accuracy of pleural tumor extent and localization (parietal, visceral, or diaphragmatic involvement), as assessed during medical thoracoscopy.Methods:Medical records of all patients who underwent thoracoscopy for suspicion of MPE between 2001 and 2008 at a tertiary care referral hospital were reviewed. Patients were included if pleural metastatic invasion was confirmed on tissue biopsy and survival status ascertained.Results:Four hundred twenty-one patients underwent diagnostic or therapeutic medical thoracoscopy at our referral center. Among them, 122 had confirmed metastatic pleural spread, but survival data were lacking in 15. Primary tumor consisted of non-mall cell lung cancer in 56, breast cancer in 23, melanoma in eight, and other malignancies in 20. Median survival of the entire population was 9.4 months. On univariate analysis, the following variables were significantly associated with reduced median overall survival: pleural metastatic melanoma, age less than 60 years, bloody MPE, extensive pleural adhesions, and widespread visceral pleural nodules (p < 0.05). On multivariate analysis, only melanoma as a primary tumor, pleural fluid appearance and extent of pleural adhesions remained independent and significant predictors of survival.Conclusion:No significant association was found between the extent or localization of pleural tumor burden and overall survival

An eleven-year retrospective cross-sectional study on pulmonary alveolar proteinosis

Introduction: Pulmonary alveolar proteinosis (PAP) is a rare disease in the field of pulmonary medicine. The efficacy of whole-lunglavage (WLL) as the treatment of PAP had never been evaluated in the Iranian population. Therefore, there is a real need to investigatethe characteristics of PAP and also to evaluate the efficacy of WLL in this rare disease. The study aimed to investigatedemographic features, clinical presentation and treatment outcomes of the disease in Iranian PAP patients. Material and methods: Data of 45 patients with definite diagnosis of PAP, who had regular follow-ups from March 2004 to March2015 at an Iranian referral respiratory hospital, were collected. Whole-lung lavages (WLL) efficacy was assessed by comparingspirometric, arterial blood gas parameters and six-minute walk test (6MWT) results before and after all lavages. Results: Mean age at diagnosis of disease was 30.33 ± 14.56 years. Four patients (8.8%) reported non-massive hemoptysis and threesubjects (6.6%) had concomitant pulmonary tuberculosis. In 71.1% of cases, transbronchial lung biopsy and bronchoalveolar lavage weresufficient for diagnosis. Spirometric results and arterial blood gas parameters and 6MWD improved significantly after all the lavages. Fourpatients (8.8%) died because of respiratory failure. The only variable capable of predicting treatment failure was the history of hemoptysis. Conclusion: The study revealed sufficiency of WLL as the PAP patients’ treatment. Also hemoptysis was found to be the independentfactor that can predict treatment failure

Jedenastoletnie, retrospektywne badanie przekrojowe dotyczące proteinozy pęcherzyków płucnych

WSTĘP: Proteinoza pęcherzyków płucnych (PAP, pulmonary alveolar proteinosis) to rzadka choroba płuc. W populacji irańskiej nie analizowano nigdy skuteczności płukania całego płuca (WLL, whole-lung lavage) jako leczenia PAP. Z tego powodu oceniono charakterystykę PAP, a także skuteczność WLL w tej rzadkiej chorobie. Niniejsze badanie miało na celu analizę cech demograficznych, obrazu klinicznego i wyników leczenie tej choroby u irańskich pacjentów z PAP. MATERIAŁ I METODY: Zgromadzono dane 45 pacjentów z pewnym rozpoznaniem PAP, regularnie obserwowanych od marca 2004 do marca 2015 roku w irańskim szpitalu referencyjnym. Skuteczność WLL oceniano, porównując parametry spirometryczne, gazometrii krwi tętniczej oraz testu 6-minutowego marszu (6MWT, 6 minute walk test) przed i po wykonaniu wszystkich zabiegów płukania płuca. WYNIKI: Średni wiek w momencie rozpoznania choroby wynosił 30,33 ± 14,56 roku. U czterech pacjentów (8,8%) występowało niemasywne krwioplucie, u trzech (6,6%) współistniała gruźlica płuc. Biopsja przezoskrzelowa płuca i płukanie oskrzelowo- -pęcherzykowe w 71,1% przypadków były wystarczającymi badaniami do postawienia rozpoznania. Wyniki spirometryczne, parametry gazometrii krwi tętniczej i 6MWD poprawiły się znamiennie po przeprowadzeniu wszystkich zabiegów płukania płuca. Czterech pacjentów (8,8%) zmarło z powodu niewydolności oddechowej. Jedyną zmienną mogącą przewidzieć niepowodzenie leczenia było występowanie krwioplucia w wywiadzie chorobowym. WNIOSKI: W badaniu wykazano, że WLL jest leczeniem skutecznym u pacjentów z PAP. Krwioplucie było niezależnym czynnikiem predykcyjnym niepowodzenia leczenia.WSTĘP: Proteinoza pęcherzyków płucnych (PAP, pulmonary alveolar proteinosis) to rzadka choroba płuc. W populacji irańskiej nie analizowano nigdy skuteczności płukania całego płuca (WLL, whole-lung lavage) jako leczenia PAP. Z tego powodu oceniono charakterystykę PAP, a także skuteczność WLL w tej rzadkiej chorobie. Niniejsze badanie miało na celu analizę cech demograficznych, obrazu klinicznego i wyników leczenie tej choroby u irańskich pacjentów z PAP. MATERIAŁ I METODY: Zgromadzono dane 45 pacjentów z pewnym rozpoznaniem PAP, regularnie obserwowanych od marca 2004 do marca 2015 roku w irańskim szpitalu referencyjnym. Skuteczność WLL oceniano, porównując parametry spirometryczne, gazometrii krwi tętniczej oraz testu 6-minutowego marszu (6MWT, 6 minute walk test) przed i po wykonaniu wszystkich zabiegów płukania płuca. WYNIKI: Średni wiek w momencie rozpoznania choroby wynosił 30,33 ± 14,56 roku. U czterech pacjentów (8,8%) występowało niemasywne krwioplucie, u trzech (6,6%) współistniała gruźlica płuc. Biopsja przezoskrzelowa płuca i płukanie oskrzelowo- -pęcherzykowe w 71,1% przypadków były wystarczającymi badaniami do postawienia rozpoznania. Wyniki spirometryczne, parametry gazometrii krwi tętniczej i 6MWD poprawiły się znamiennie po przeprowadzeniu wszystkich zabiegów płukania płuca. Czterech pacjentów (8,8%) zmarło z powodu niewydolności oddechowej. Jedyną zmienną mogącą przewidzieć niepowodzenie leczenia było występowanie krwioplucia w wywiadzie chorobowym. WNIOSKI: W badaniu wykazano, że WLL jest leczeniem skutecznym u pacjentów z PAP. Krwioplucie było niezależnym czynnikiem predykcyjnym niepowodzenia leczenia

Towards Individualized Tracheobronchial Stents: Technical, Practical and Legal Considerations

Stent placement has been established as a standard procedure for treating airway obstructions. Other indications are localized malacias and fistulas. Though many different stents with various diameters and lengths are available, the shapes are hardly ever ideal because of the distorted anatomy in patients with diseased airways. There are technical and legal limitations for customizing purchased airway stents. Individually tailored stents would be preferable. New techniques of additive manufacturing such as 3D printing make it possible to produce optimized stents for a particular patient. Using CT data and bronchoscopic images, stents can be constructed that match a particular anatomical situation and apply the optimized expansion force. We give an overview of the currently available manufacturing techniques for polymeric stents and report about our own experience. Direct on-site printing of polyurethane stents in a hospital and printing individual extrusion molds for silicone stents in a certified cleanroom are both feasible. Furthermore, there are promising attempts of combining mechanically customized stents with surface modifications, drug-eluting features, biodegradability, and time-dependent adaptation (4D printing). Truly optimized airway stents with the potential of solving the well-known stent problems such as granulation tissue formation, remodeling, mucostasis, and infections are in reach. The technical hurdles are probably easier to overcome than the legal constraints. The legal situations are discussed from a physician's and a manufacturer's perspective

Diagnosis of hemidiaphragm paralysis: refine ultrasound criteria

BackgroundUltrasound has demonstrated its interest in the analysis of diaphragm function in patients with respiratory failure. The criteria used to diagnose hemidiaphragm paralysis are not well defined.MethodsThe aim of this observational retrospective study was to describe the ultrasound findings in 103 patients with diaphragm paralysis, previously diagnosed by conventional methods after various circumstances such as trauma or surgery. The ultrasound study included the recording of excursions of both diaphragmatic domes and the measurement of inspiratory thickening.ResultsOn paralyzed hemidiaphragm, thickening was less than 20% in all patients during deep inspiration. Thinning was recorded in 53% of cases. In some cases, the recording of the thickening could be difficult. The study of motion during voluntary sniffing reported a paradoxical excursion in all but one patient. During quiet breathing, an absence of movement or a paradoxical displacement was observed. During deep inspiration, a paradoxical motion at the beginning of inspiration followed by a reestablishment of movement in the cranio-caudal direction was seen in 82% of cases. In some patients, there was a lack of movement followed, after an average delay of 0.4 s, by a cranio-caudal excursion. Finally, in 4 patients no displacement was recorded. Evidence of hyperactivity (increased inspiratory thickening and excursion) of contralateral non-paralyzed hemidiaphragm was observed.ConclusionTo accurately detect hemidiaphragm paralysis, it would be interesting to combine the ultrasound study of diaphragm excursion and thickening. The different profiles reported by our study must be known to avoid misinterpretation

A Survey of the European Association of Bronchology and Interventional Pulmonology (EABIP)

Publisher Copyright: © Copyright 2017 S. Karger AG, Basel. All rights reserved.Background: Airway stenting (AS) commenced in Europe circa 1987 with the first placement of a dedicated silicone airway stent. Subsequently, over the last 3 decades, AS was spread throughout Europe, using different insertion techniques and different types of stents. Objectives: This study is an international survey conducted by the European Association of Bronchology and Interventional Pulmonology (EABIP) focusing on AS practice within 26 European countries. Methods: A questionnaire was sent to all EABIP National Delegates in February 2015. National delegates were responsible for obtaining precise and objective data regarding the current AS practice in their country. The deadline for data collection was February 2016. Results: France, Germany, and the UK are the 3 leading countries in terms of number of centres performing AS. These 3 nations represent the highest ranked nations within Europe in terms of gross national income. Overall, pulmonologists perform AS exclusively in 5 countries and predominately in 12. AS is performed almost exclusively in public hospitals. AS performed under general anaesthesia is the rule for the majority of institutions, and local anaesthesia is an alternative in 9 countries. Rigid bronchoscopy techniques are predominant in 20 countries. Amongst commercially available stents, both Dumon and Ultraflex are by far the most commonly deployed. Finally, 11 countries reported that AS is an economically viable activity, while 10 claimed that it is not. Conclusion: This EABIP survey demonstrates that there is significant heterogeneity in AS practice within Europe. Therapeutic bronchoscopy training and economic issues/reimbursement for procedures are likely to be the primary reasons explaining these findings.publishersversionpublishe

Current Practice of Airway Stenting in the Adult Population in Europe: A Survey of the European Association of Bronchology and Interventional Pulmonology (EABIP)

Background: Airway stenting (AS) commenced in Europe circa 1987 with the first placement of a dedicated silicone airway stent. Subsequently, over the last 3 decades, AS was spread throughout Europe, using different insertion techniques and different types of stents. Objectives: This study is an international survey conducted by the European Association of Bronchology and Interventional Pulmonology (EABIP) focusing on AS practice within 26 European countries. Methods: A questionnaire was sent to all EABIP National Delegates in February 2015. National delegates were responsible for obtaining precise and objective data regarding the current AS practice in their country. The deadline for data collection was February 2016. Results: France, Germany, and the UK are the 3 leading countries in terms of number of centres performing AS. These 3 nations represent the highest ranked nations within Europe in terms of gross national income. Overall, pulmonologists perform AS exclusively in 5 countries and predominately in 12. AS is performed almost exclusively in public hospitals. AS performed under general anaesthesia is the rule for the majority of institutions, and local anaesthesia is an alternative in 9 countries. Rigid bronchoscopy techniques are predominant in 20 countries. Amongst commercially available stents, both Dumon and Ultraflex are by far the most commonly deployed. Finally, 11 countries reported that AS is an economically viable activity, while 10 claimed that it is not. Conclusion: This EABIP survey demonstrates that there is significant heterogeneity in AS practice within Europe. Therapeutic bronchoscopy training and economic issues/reimbursement for procedures are likely to be the primary reasons explaining these findings. (C) 2017 S. Karger AG, Base