Speleotherapy as an Effective Treatment of Chronic Obstructive Pulmonary Disease

Abstract Objectives: Chronic obstructive pulmonary disease (COPD) as a liberal illness requires constant anti-inflammatory therapy. As praise of conventional treatments, patients ofen turn to alternate therapy. Current study aimed to evaluate the frst study in Iran emphasizing on halotherapy influence on improving lung function testing results and relieving symptoms of Chronic Obstructive Pulmonary Disease patients, presented at respiratory referral hospital, Tehran in 2016. Materials and Methods: In this double-blind clinical study, 84 components suffering from COPD detached to two experimental and control groups. Following two months treatment with salitair or placebo, one month clearance phase was carried. Eventually, groups were treated with salitair and placebo for next two months. Influence was determined assessed6-minute walk distant, arterial oxygen saturation drop of six minutes walking, CAT enquiry and spirometry FEV1, FVC and FEV1/ FVC parameters. Results: Current study revealed that halotherapy might exert a positive effect on 6-minute walk distant and arterial oxygen saturation drop of six minutes walking parameters, since has no effect on CAT enquiry and FEV1, FVC and FEV1/FVC parameters. Conclusions: Advice for containing halotherapy as a healing treatment for COPD is doubtful. More studies are recommended to be done, including a larger study group to supply the best evidence. Keywords: Chronic obstructive pulmonary disease (C08.381.495.389); Spirometry (E01.370.386.700.750); Vaporizers (E07.605); Halotherapy; Spleotherapy; Salitai

Procalcitonin and Proinflammatory Cytokines in Early Diagnosis of Bacterial Infections after Bronchoscopy

BACKGROUND: Fiberoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) remains as the chief diagnostic tool in respiratory disorders. 1.2-16% of patients frequently experience fever after bronchoscopy. To exclude the need for multiple antibiotic prescribing in patients with post-bronchoscopy fever, the presence of the self-limiting inflammatory responses should be excluded. AIM: The current study was conducted to test the serum of patients undergoing bronchoscopy for some proinflammatory cytokines including Tumor Necrosis Factor-alpha (TNF-ɑ), Interleukin-1beta (IL-1β), Interleukin-8 (IL-8) and Interleukin-6 (IL-6) and the value of Procalcitonin (PCT). MATERIAL AND METHODS: Current case-control study was conducted at the National Research Institute of Tuberculosis and Lung Disease in Iran. Nineteen patients (48.72%) that attended with a reasonable sign for a diagnostic bronchoscopy from January 2016 to December 2017 were included in the case group. The control group consisted of 20 patients who underwent a simple bronchoscopy and without FOB-BAL. The laboratory findings for PCT concentrations and cytokine levels in the three serum samples (before FOB-BAL (t0), after 6 hr. (t1), and at 24 hr. past (t2) FOB-BAL) were compared between two groups. RESULTS: The frequency of post-bronchoscopy fever was 5.12, and the prevalence of post-bronchoscopy infectious fever was 2.56%. PCT level was considerably higher in the patient with a confirmed bacterial infection when compared to other participants (p-value < 0. 05). Interestingly, IL-8 level in the bacterial infection proven fever patient was higher than in other patients (p < 0.001). IL-8 levels displayed a specificity of 72.7% and a sensitivity of 100%, at the threshold point of 5.820 pg/ml. PCT levels had a specificity of 84% and a sensitivity of 81%, at the threshold point of 0.5 ng/ml. CONCLUSION: The present findings show that in patients with fever after bronchoscopy, PCT levels and IL-8 levels are valuable indicators for antibiotic therapy, proving adequate proof for bacterial infection. The current findings also illustrate that to monitor the serum levels of PCT and proinflammatory cytokines in the patients undergoing FOB-BAL, the best time is the 24-hour postoperative bronchoscopy

Iranian clinical practice guideline for amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegeneration involving motor neurons. The 3–5 years that patients have to live is marked by day-to-day loss of motor and sometimes cognitive abilities. Enormous amounts of healthcare services and resources are necessary to support patients and their caregivers during this relatively short but burdensome journey. Organization and management of these resources need to best meet patients' expectations and health system efficiency mandates. This can only occur in the setting of multidisciplinary ALS clinics which are known as the gold standard of ALS care worldwide. To introduce this standard to the care of Iranian ALS patients, which is an inevitable quality milestone, a national ALS clinical practice guideline is the necessary first step. The National ALS guideline will serve as the knowledge base for the development of local clinical pathways to guide patient journeys in multidisciplinary ALS clinics. To this end, we gathered a team of national neuromuscular experts as well as experts in related specialties necessary for delivering multidisciplinary care to ALS patients to develop the Iranian ALS clinical practice guideline. Clinical questions were prepared in the Patient, Intervention, Comparison, and Outcome (PICO) format to serve as a guide for the literature search. Considering the lack of adequate national/local studies at this time, a consensus-based approach was taken to evaluate the quality of the retrieved evidence and summarize recommendations

Pulmonary manifestations in a cohort of patients with inborn errors of immunity : an 8-year follow-up study

Background: Inborn errors of immunity (IEIs) are a group of congenital diseases caused by genetic defects in the development and function of the immune system. The involvement of the respiratory tract is one of the most common presentations in IEIs. Methods: Overall, 117 patients with diagnosed IEIs were followed-up within 8 years at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD). Demographic, clinical, and laboratory data were collected in a questionnaire. Pulmonary function test (PFT), chest X-ray (CXR), and high-resolution computed tomography (HRCT) scans were obtained where applicable. Results: Our study population consisted of 48 (41%) patients with predominantly antibody deficiencies (PADs), 39 (32%) patients with congenital defects of phagocytes, 14 (11.9%) patients with combined immunodeficiency (CID), and 16 (14%) patients with Mendelian susceptibility to mycobacterial diseases (MSMD).. Recurrent pneumonia was the most common manifestation, while productive cough appeared to be the most common symptom in almost all diseases. PFT showed an obstructive pattern in patients with PAD, a restrictive pattern in patients with CID, and a mixed pattern in patients with CGD. HRCT findings were consistent with bronchiectasis in most PAD patients, whereas consolidation and mediastinal lesions were more common in the other groups. Conclusions: Pulmonary manifestations vary among different groups of IEIs. The screening for lung complications should be performed regularly to reveal respiratory pathologies in early stages and follow-up on already existing abnormalities. (C) 2022 Codon Publications. Published by Codon Publications.Peer reviewe

Effectiveness of Cough Assist Device in Exercise Capacity in COPD Patients

Coughing is the body’s defense mechanism to clear the airways from the foreign bodies and secretions. In patients with neuromuscular disorders or other diseases affecting the airways such as cystic fibrosis (CF), the effectiveness of this defense mechanism is often reduced due to respiratory exhaustion. Some COPD patients have also difficulty in airway clearance.  The aim of this study was to evaluate the effectiveness of cough assist device in COPD patients. In this study, we randomized 20 COPD patients admitted to the pulmonary ward of Masih Daneshvari hospital (Tehran, Iran) into two groups of routine physiotherapy (including active cycle of breathing technique, pursed-lips breathing, diaphragmatic/abdominal breathing, huffing, and coughing) and routine physiotherapy plus 10 sessions of cough assist, each for 20 minutes. Cough assist pressure was set +5 to +30 cmH2O for inspiration and -8 to -33 for expiration, for 1-3 and 3-5 seconds, respectively. The two groups were then compared regarding the results of 6-minute walk test (distance) and spirometry parameters. The mean age of the patients was 61 ± 4 years. The results of the analysis demonstrated that there was a significant difference between the two groups.Keywords: cough assist; respiratory physiotherapy; COP

Comparison of Comfort and Effectiveness of Total Face Mask and Oronasal Mask in Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure: A Clinical Trial

Background. There is a growing controversy about the use of oronasal masks (ONM) or total facemask (TFM) in noninvasive positive pressure ventilation (NPPV), so we designed a trial to compare the uses of these two masks in terms of effectiveness and comfort. Methods. Between February and November 2014, a total of 48 patients with respiratory failure were studied. Patients were randomized to receive NPPV via ONM or TFM. Data were recorded at 60 minutes and six and 24 hours after intervention. Patient comfort was assessed using a questionnaire. Data were analyzed using t-test and chi-square test. Repeated measures ANOVA and Mann–Whitney U test were used to compare clinical and laboratory data. Results. There were no differences in venous blood gas (VBG) values between the two groups (P>0.05). However, at six hours, TFM was much more effective in reducing the partial pressure of carbon dioxide (PCO2) (P=0.04). Patient comfort and acceptance were statistically similar in both groups (P>0.05). Total time of NPPV was also similar in the two groups (P>0.05). Conclusions. TFM was superior to ONM in acute phase of respiratory failure but not once the patients were out of acute phase

Effectiveness of mechanical insufflation-exsufflation device in pediatric patients with cystic fibrosis

Introduction: Coughing is the body’s defense mechanism to clear the airways from the foreign bodies and secretions. In patients with neuromuscular disorders or other diseases affecting the airways such as cystic fibrosis (CF), the effectiveness of this defense mechanism is often reduced due to respiratory exhaustion. The aim of our study was to evaluate the effectiveness of mechanical insufflation-exsufflation device (MI-E) in pediatric patients with CF. Materials and Methods: In this study, we randomized 31 patient’s whit CF admitted to the pediatric pulmonary ward of Masih Daneshvari hospital (Tehran – Iran) into two groups of routine physiotherapy (including an active cycle of breathing technique, pursed-lips breathing, diaphragmatic/abdominal breathing, huffing, and coughing) or, routine physiotherapy plus 10 sessions of MI-E, each for 20 minutes. MI-E pressure was set +5 to +30 cmH2O for inspiration and -8 to -33 for expiration, for 1-3 and 3-5 seconds, respectively. Two groups were then compared regarding the results of the 6-minute walk test (distance), spirometry, echocardiography, and arterial blood gases.Results: The mean age of the patients was 16.4± 4.6 years and 16 (23.6%) were male. Results of the analysis demonstrated that there were no significant differences between the two groups. Our results demonstrated similar efficacy for conventional physiotherapy versus physiotherapy and MI-E regarding the improvement of pulmonary function and airway clearance in CF patients.   &nbsp

The Effect of Inspiratory Muscle Training on spirometry parameters of Patients with Chronic Obstructive Pulmonary Disease

Introduction: The present study aimed to investigate the effects of inspiratory muscle training (IMT) on the spirometry parameters of patients with chronic obstructive pulmonary disease (COPD). Materials and methods. In this study, 60 men with COPD referring to Masih Daneshvari Hospital of Tehran were selected and randomly assigned to control (normal rehabilitation) and test (normal rehabilitation with IMT) groups. In addition to standard drug therapy, patients in the test group participated in a 4-week exercise therapy program (for sessions per week) consisting of strength training for the proximal muscles of the upper and lower extremities, aerobic exercises with treadmill, and IMT. The spirometry parameters including FEV1 and FVC were measured before and after the training period. The obtained data were statistically analyzed using the dependent t-test and analysis of covariance at the 0.05 level of significance. Results: The results revealed that IMT significantly improved the FEV1 and FVC in patients with COPD (P<0.05). In addition, the results showed that IMT was more effective than normal rehabilitation in improving the studied variables (P<0.05). Conclusion: It can be generally concluded that respiratory and rehabilitation exercises with an emphasis on inspiratory muscles strengthening can improve the spirometry parameters in patients with COPD. This suggests these patients should benefit from IMT programs. Keywords: Inspiratory Muscle Training, Spirometry Parameters, Chronic Obstructive Pulmonary Diseas

Effect of rehabilitation with or without noninvasive ventilation on pulmonary function and COPD assessment test results in COPD patients

Background: Chronic obstructive pulmonary disease (COPD) is a serious and prevalent health condition, with many patients ultimately requiring ventilation support. Noninvasive ventilation (NIV) has been suggested as a therapeutic option for improving pulmonary function in these patients. This study aimed to evaluate the effectiveness of NIV for improving pulmonary function. Methods: Fifty hemodynamically stable patients with stage 3 or 4 COPD presenting to our center were randomly assigned into two groups of rehabilitation with (n=25) or without NIV (n=25). NIV was administered using I=12 and E=4 with BiPAP settings. Echocardiography, spirometry, six-minute walk test (6MWT), COPD Assessment Test (CAT), and venous blood gas (VBG) analysis were performed at baseline and after 4 weeks of rehabilitation and compared using appropriate statistical tests. Results:  The mean age of the participants was 60.8±10.6 years and 84% were males. The two groups were similar regarding baseline variables, except for the higher number of stage 4 patients in the NIV group. The mean ejection fraction and pulmonary artery pressure were 53.6±4.3% and 37.2±9.6 mmHg, respectively, with no significant difference between the study groups (P>0.05). All pulmonary function indices by spirometry, 6MWT, and VBG values improved significantly after rehabilitation in each group (P<0.05), but NIV patients showed no advantage over the control group. However, NIV significantly increased the CAT scores after rehabilitation: 29.32 vs. 25.04, in the NIV and control groups, respectively (P<0.05). Conclusion: Despite having multiple health benefits in COPD patients including decreasing the mortality rate and the need for invasive ventilation, NIV showed superiority compared with rehabilitation alone only in improving the CAT score. &nbsp

Do Statins Improve Lung Function in Asthmatic Patients? ARandomized and Double-Blind Trial: Role of statins in asthma

There are evidences that statins have anti-inflammatory effects beyond their cholesterol lowering properties. The study was conducted to assess the effects of atorvastatin on asthma as an inflammatory disease. Patients with moderate to sever easthma were entered this randomized, double blind, crossover clinical trial. The impact of oral atorvastatin (10 mg/day) on the lung function of normolipidemic patients was studied. The study was conducted in the National Research Institute of Tuberculosis and Lung Disease. Patients were randomized to receive either atorvastatin or placebo for 4 weeks separated by a 2-week washout period in a crossover fashion.Patients continued on their usual asthma drug treatment throughout the study.Spirometric parameters were determined at baseline and at completion of drug or placebo administration. Seventeen patients with the age of 37.12±12.41 years completed the trial. Data analysis revealed no significant differences in peak expiratory flow rate (PEF), forced expiratory volume in the first second (FEV1),forced vital capacity (FVC) and FEV1/FVC between placebo and atorvastatin therapy. The results showed no significant improvement in the pulmonary function tests in asthmatic patients receiving atorvastatin. Further studies using higher doses of statins and/or higher period of statin use are recommended