Clinical evidence on high flow oxygen therapy and active humidification in adults

AbstractRecently there has been growing interest in an alternative to conventional oxygen therapy: the heated, humidified high flow nasal cannula oxygen therapy (HFNC). A number of physiological effects have been described with HFNC: pharyngeal dead space washout, reduction of nasopharyngeal resistance, a positive expiratory pressure effect, an alveolar recruitment, greater humidification, more comfort and better tolerance by the patient, better control of FiO2 and mucociliary clearance. There is limited experience of HFNC in adults. There are no established guidelines or decision-making pathways to guide use of the HFNC therapy for adults. In this article we review the existing evidence of HFNC oxygen therapy in adult patients, its advantages, limitations and the current literature on clinical applications. Further research is required to determine the long-term effect of this therapy and identify the adult patient population to whom it is most beneficial

Pneumonite de hipersensibilidade: A experiência portuguesa

Resumo: A suberose é uma das mais frequentes pneumonites de hipersensibilidade (PH) em Portugal. Comparativamente com os doentes com pulmão de criadores de aves (PCA), os doentes com suberose apresentam mais frequente-mente formas subagudas ou crónicas de PH. Apesar de a alveolite linfocítica de tipo CD8+ predominar em ambas as doenças, a relação CD4/CD8 é significativamente mais elevada no PCA.Para além das formas intersticiais, nas descrições iniciais da suberose também foram referidos quadros de tipo asmatiforme. Recentemente identificámos casos de asma ocupacional em trabalhadores da indústria da cortiça, associada a inflamação eosinofílica broncoalveolar. Enquanto os doentes com PH apresentam reactividade IgG intensa para vários fungos, e sobretudo a antigénios de peso molecular de 12-13.5 kDa e 33 kDa do Penicillium glabrum, não encontrámos sensibilização IgE a estes fungos nos doentes com asma.A pneumonite de hipersensibilidade dos corticeiros tem uma forma de apresentação clínica diferente do pulmão de criador de aves, o que sugere que diferentes tipos de exposições antigénicas podem causar uma diferente dinâmica da resposta imunológica/inflamatória do pulmão. A identificação de antigénios major na pneumonite de hipersensibilidade dos corticeiros (como os identificados por immunoblotting no Penicillium glabrum) poderá auxiliar no desenvolvimento de novos métodos diagnósticos. Abstract: Suberosis is one of the most common Hypersensitivity Pneumonitis (HP) in Portugal. Compared with Bird Fancierâs Disease (BFD), patients with Suberosis have predominately subacute and chronic presentations of HP. Although BAL CD8+ lymphocytes predominate in both diseases, CD4/CD8 ratio is significantly higher in BFD. Apart from these interstitial forms, in the initial descriptions of Suberosis asthma-like syndromes were also reported. We have recently described cases of Cork workerâs Occupational Asthma, associated with bronchoalveolar eosinophilic inflammation. While patients with HP had high IgG reactivity tomoulds and especially recognized Penicillium glabrum antigens of molecular weight of 12-13.5 kDa and 33 kDa, we could not find evidence of IgE sensitisation to these fungi in asthmatics.Cork workerâs Hypersensitivity Pneumonitis has a different clinical profile compared with Bird Fancierâs Disease, suggesting that different antigenic ex-posures may result in a different dynamic of the lung immune/inflammatory response. The identification of major antigens in cork workerâs HP (like those identified by immunoblotting in Penicillium glabrum) may be helpful to develop new diagnostic tests. Palavras-chave: Pneumonite de hipersensibilidade, suberose, pulmão de criadores de aves, fungos, Key-words: Hypersensitivity pneumonitis, suberosis, bird fancierâs disease, mould

Sleep bruxism associated with obstructive sleep apnoea syndrome â A pilot study using a new portable device

Sleep bruxism (SB) and obstructive sleep apnoea syndrome (OSAS) share common pathophysiologic pathways.We aimed to study the presence and relationship of SB in a OSAS population.Patients referred with OSAS suspicion and concomitant SB complains were evaluated using a specific questionnaire, orofacial evaluation and cardio-respiratory polygraphy that could also monitor audio and EMG of the masseter muscles.From 11 patients studied 9 had OSAS. 55.6% were male, mean age was 46.3 ± 11.3 years, and apnea hypopnea index of 11.1 ± 5.7/h. Through specific questionnaire 55.6% had SB criteria. Orofacial examination (only feasible in 3) confirmed tooth wear in all. 77.8% had polygraphic SB criteria (SB index > 2/h). Mean SB index was 5.12 ± 3.6/h, phasic events predominated (72.7%). Concerning tooth grinding episodes, we found a mean of 10.7 ± 9.2 per night. All OSAS patients except two (77.8%) had more than two audible tooth-grinding episodes. These two patients were the ones with the lowest SB index (1.0 and 1.4 per hour). Only in one patient could we not detect tooth grinding episodes. There was a statistically significant positive correlation between tooth grinding episodes and SB index and phasic event index (R = 0.755, p = 0.019 and R = 0.737, p = 0.023 respectively, Pearson correlation).Mean apnoea to bruxism index was 0.4/h, meaning that only a minority of SB events were not secondary to OSAS. We could not find any significant correlation between AHI and bruxism index or phasic bruxism index (R = â0.632 and R = â0.611, p > 0.05, Pearson correlation).This pilot study shows that SB is a very common phenomenon in a group of mild OSAS patients, probably being secondary to it in the majority of cases. The new portable device used may add diagnostic accuracy and help to tailor therapy in this setting. Keywords: Sleep bruxism, Obstructive sleep apnea syndrome, Masseter EM