Clinical highlights: messages from Munich

This article reviews a selection of presentations in the area of clinical problems that were presented at the 2014 European Respiratory Society International Congress in Munich, Germany. We review the most recent and relevant topics of interest in the area of clinical respiratory medicine, encompassing novel reports and studies that are of particular interest to healthcare professionals. Topics ranging from basic science to translation research are presented and discussed in the context of the most up-to-date literature. In particular, the reviewed topics deal with chronic obstructive pulmonary disease and asthma, idiopathic pulmonary fibrosis (pathogenesis and therapy), advances in functional chest imaging, interventional pulmonology, pulmonary rehabilitation, and chronic care

Is the lung a target organ in diabetes?

BACKGROUND The lung is not considered a target organ in diabetes mellitus. In English language literature there are many papers showing the opposite. DISCUSSION Many studies demonstrated a thickened alveolar epithelial and pulmonary capillary basal lamina and a reduced lung elasticity, others showed that these histopathological alterations develop into functional abnormalities such as reduced lung volumes, pulmonary diffusion capacity and elastic recoil. The diabetes related pulmonary disease has not an impact on normal life in otherwise “healthy” patients, but it is possible that in specific pathologic (such as heart, kidney and lung comorbidities) or paraphysiologic (such as physical exercise, smoking or exposure to high altitude) conditions, diabetes could contribute to the clinical manifestation of a restricitive lung disease. On the other hand, diabetic patients have an increased propensity to acquire infections. The prevalence of pulmonary tuberculosis is reported to be four times than in healthy subjects; there is a predilection for the lower lobes and the disease is more aggressive in poorly controlled diabetes mellitus

Acute pneumonitis or vasculitis? A severe case with multiple organ involvement

This report describes a case of a 37-year-old man affected by weakness, cough, fever and arthralgia for three months and a single episode of arthritis affecting the left ankle. The symptoms worsened and he was admitted to our hospital. First level blood tests showed an increase in inflammatory proteins, leukocytosis with eosinophilia, positive anti-neutrophil cytoplasm antibody (ANCA) and PR-3 ANCA antibodies, initial renal failure with elevation of creatinine and microscopic hematuria and initial proteinuria in the urine tests. As the chest x-ray revealed a perihilar pneumonitis with a well-defined margin area in the right lung, we started antibiotic therapy. The lung was studied with high-resolution chest computed tomography, which showed interstitial lung disease with more consolidative areas, some of which had a reverse halo sign. As clinical and laboratory data suggested a multiple organ involvement, second level tests were performed to look for the presence of systemic vasculitis

Lung Manifestation of IgG4-related Disease. A multifaceted disorder. Presentation of two cases and short review of literature

Abstract. Immunoglobulin (Ig) G4-related disease (IgG4-RD) is a recently described systemic inflammatory disease associated with elevated circulating levels of IgG4. IgG4-RD may affect one or more organs and lesions can present synchronously or metachronously in different organs. Pulmonary involvement of IgG4-related disease includes airway, lung parenchyma, pleura and mediastinum. In this article, we report two cases of IgG4-RD to show the multifaceted manifestations of this disease in the lungs. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 74-80

Global cognitive profile and different components of reaction times in obstructive sleep apnea syndrome: effects of continuous positive airway pressure over time

Obstructive sleep apnea syndrome (OSAS) has been recurrently associated with cognitive and psychomotor impairments. However, the occurrence and possible reversibility of these deficits are still extremely con- troversial, also as a result of different methodologies adopted used by scholars. The aim of the present study was to compare over time the global cognitive profile of patients with OSAS undergoing the continuous positive airway pressure treatment (CPAP; N = 23) with that of patients with OSAS who were not (N = 10). A group of healthy participants (N = 30) was also included. This study adopted a specific methodological approach al- lowing the researchers to distinguish between the cognitive and the motor component of reaction times (RTs). After baseline assessment, the same tests were administered after three and six months. No significant differences emerged between groups at each time point. On the other hand, the analysis of cognitive score trajectory over time revealed differences between groups. While healthy controls and OSAS patients undergoing CPAP showed increased MoCA test scores after three months, patients not undergoing CPAP improved their scores only after six months. In addition, patients treated with CPAP also showed significantly faster psychomotor response in motor RTs over time. Results seem to conceivably support a global cognitive vulnerability of non-treated OSAS patients. Conversely, the RT response of treated patients can be increased over time by CPAP, at least in the motor component of RTs. Therefore, our study suggests that CPAP may play an important role by slowing down the negative effects of OSAS, and by fostering sufficient cognitive functioning and adequate psychomotor speed

Regular CPAP utilization reduces nasal inflammation assessed by nasal cytology in obstructive sleep apnea syndrome

Abstract not availableMatteo Gelardi, Giuseppe Carbonara, Enrico Maffezzoni, Maurizio Marvisi, Nicola Quaranta, Raffaele Ferr

Regular CPAP utilization reduces nasal inflammation assessed by nasal cytology in obstructive sleep apnea syndrome

a b s t r a c t Objectives: To analyze nasal inflammation in a group of patients with obstructive sleep apnea syndrome (OSAS) by means of nasal cytology and to describe the changes induced by continuous positive air pressure (CPAP) treatment. Subjects and methods: Thirty-two consecutive patients affected by OSAS (mean age 46.9 years) and 13 control subjects (mean age 49.1 years) were enrolled. Detailed clinical, laboratory, and polysomnographic studies were obtained in all participants and, in particular, nasal cytology was performed; inflammatory cells (neutrophils, eosinophils, mast cells, lymphocytes), bacteria, and spores were counted. A subgroup of 19 OSAS patients underwent regular nasal CPAP for eight weeks while the remaining 13 were noncompliant. Nasal cytology was repeated after eight weeks in all patients and controls. Results: All patients with OSAS were affected by some form of rhinopathy, mostly subclinical, which was not found to influence compliance to CPAP. Regular CPAP treatment induced a significant reduction of cell infiltration (neutrophils, eosinophils, lymphocytes, and muciparous cells), which was not seen in nontreated patients. Conclusion: Nasal inflammation/infection is a very frequent finding in OSAS and can be reverted by the regular use of CPAP