The correlation between lung sound distribution and pulmonary function in COPD patients.

BACKGROUND: Regional lung sound intensity in chronic obstructive pulmonary disease (COPD) patients is influenced by the severity and distribution of emphysema, obstructed peripheral airways, and altered ribcage and diaphragm configurations and movements due to hyperinflation. Changes in the lung sound distribution accompanied by pulmonary function improvements in COPD patients were observed after bronchodilator inhalation. We investigated the association of lung sound distribution with pulmonary functions, and the effects of emphysematous lesions on this association. These studies were designed to acquire the basic knowledge necessary for the application of lung sound analysis in the physiological evaluation of COPD patients. METHODS: Pulmonary function tests and the percentage of upper- and lower-lung sound intensity (quantitative lung data [QLD]) were evaluated in 47 stable male COPD patients (54 - 82 years of age). In 39 patients, computed tomography taken within 6 months of the study was available and analyzed. RESULTS: The ratio of lower QLD to upper QLD showed significant positive correlations with FEV1 %predicted (%FEV1; ρ=0.45, p<0.005) and MEF50 %predicted (%MEF50; ρ=0.46, p<0.005). These correlations were not observed in COPD patients with dominant emphysema (% low attenuation area >40%, n=20) and were stronger in less emphysematous patients (n=19, %FEV1; ρ=0.64, p<0.005, %MEF50; ρ=0.71, p<0.001). CONCLUSIONS: In COPD patients, the ratio of lower- to upper-lung sound intensities decreased according to the severity of obstructive changes, although emphysematous lesions considerably affected lung sound distribution

Bronchoscopic and CT findings, flow-volume loops and lung sound recordings for bronchial obstruction (before, A–E; after, F–J).

<p>The left bronchus was severely stenotic as a result of lung adenocarcinoma. The development of lung sound intensity in the left lung lagged behind the right lung (right, red; left, blue). After intervention, these asynchronies were mostly resolved.</p

Bronchoscopic and CT findings, flow-volume loops and lung sound recordings for extensive obstruction (before, A–E; after, F–J).

<p>This figure shows data of a patient with lung adenocarcinoma. The tumor protrudes from the right side of the trachea and obstructs the right main stem bronchus. The development of lung sound intensity in the right lung, especially the lower lung field, was weaker and lagged behind the left lung (right, red; left, blue). After intervention, these asynchronies were mostly resolved.</p

Left and Right Lung Asynchrony as a Physiological Indicator for Unilateral Bronchial Obstruction in Interventional Bronchoscopy

<div><p>Background</p><p>In patients with bronchial obstruction, pulmonary function tests may not change significantly after intervention. The airflow asynchrony in both lungs due to unilateral bronchial obstruction may be applicable as a physiological indicator. The airflow asynchrony is reflected by the difference in the left and right lung sound development at tidal breathing.</p><p>Objectives</p><p>To investigate the usefulness of left and right lung asynchrony due to unilateral bronchial obstruction as a physiological indicator for interventional bronchoscopy.</p><p>Methods</p><p>Fifty cases with central airway obstruction were classified into three groups: tracheal, bronchial and extensive obstruction. The gap index was defined as the absolute value of the average of gaps between the left and right lung sound intensity peaks for a 12-second duration.</p><p>Results</p><p>Before interventional bronchoscopy, the gap index was significantly higher in the bronchial (p<0.05) and extensive obstruction groups (p<0.05) than in the tracheal group. The gap index in cases with unilateral bronchial obstruction of at least 80% (0.18±0.04 seconds) was significantly higher than in cases with less than 80% obstruction (0.02±0.01 seconds, p<0.05). After intervention for bronchial obstruction, the dyspnea scale (p<0.001) and gap index significantly improved (p<0.05), although no significant improvements were found in spirometric assessments. The responder rates for dyspnea were 79.3% for gap indexes over 0.06 seconds and 55.6% for gap indexes of 0.06 seconds or under.</p><p>Conclusions</p><p>Assessment of left and right lung asynchrony in central airway obstruction with bronchial involvement may provide useful physiological information for interventional bronchoscopy.</p></div

Relation between the baseline of the degree of gap index and the change in MMRC scale after interventional bronchoscopy in cases with bronchial involvement.

<p>Definition of abbreviations: MMRC  =  modified Medical Research Council.</p><p>Δ MMRC  =  change in MMRC scale.</p><p>Responders  =  improvement in MMRC scale by 1 or more.</p

Scatter plot of the gap index versus the degree of bronchial obstruction.

<p><i>Closed circles, before-intervention; open circles, after-intervention.</i> This figure shows the correlations between the gap index and the degree of bronchial obstruction in the bronchial obstruction group. The gap index more than 0.06 sec was observed only when the degree of bronchial obstruction was more than 80%. The gap index of cases with 80% or more unilateral bronchial obstruction (0.18±0.18 seconds) was significantly higher than cases with less than 80% obstruction (0.02±0.02 seconds, p<0.05).</p

Dyspnea scale, pulmonary function tests and lung sound recordings before and after intervention.

<p>Definition of abbreviation: MMRC  =  modified Medical Research Council Scale.</p><p>Continuous valuables before and after intervention were tested by Wilcoxon signed-rank test.</p><p>Values are represented as mean ± standard error. *p<0.05, **p<0.01, ***p<0.001.</p><p>MMRC responder  =  improvement in MMRC scale grade by 1 or more.</p

High efficacy of brigatinib for brain metastases in ALK fusion gene‐positive non‐small cell lung cancer: A case series

Abstract Anaplastic lymphoma kinase (ALK) fusion gene‐positive lung cancer often shows brain metastasis at initial diagnosis or during the course of treatment. However, molecular‐targeted drugs are known to pass through the blood–brain barrier and present positive effects for central nervous system lesions. There are few reports suggesting how effective molecular‐targeted drug therapy alone is for brain metastasis lesions of ALK fusion‐positive lung cancer, especially after the first use of ALK‐tyrosine kinase inhibitor (TKI) or for bulky brain metastases. A patient in his mid‐fifties with stage IV pleural dissemination developed brain metastases after 10 years of crizotinib use, but showed a complete response after switching to brigatinib. Moreover, a patient in her early sixties with stage III recurrent large brain metastases 5 years after chemoradiation therapy experienced dramatic tumor shrinkage with brigatinib. In each case of ALK fusion gene‐positive lung cancer with brain metastases, brigatinib showed a high efficacy and was well‐tolerated after previous ALK‐TKI and for bulky lesions

Characteristics of patients with central airway obstruction.

<p>Characteristics of patients with central airway obstruction.</p