School indoor air quality and allergen exposure

There is growing concern about the association of school indoor air quality (SIAQ) with asthma, rhinitis and rhinoconjunctivitis. The most commonly studied allergens are cat (Fel d 1), dog (Can f 1) and dust mite (Der f 1, Der p 1). Very few studies have analysed the significance of cockroach (Bla g 1 and 2) and mould allergens in schools and not much is known about SIAQ in island nations such as Malta. Schools with high allergen levels have an increased incidence of atopic disease resulting in a negative impact on the childrens’ health and performance. An acceptable SIAQ can be achieved by adopting published recommendations regarding the control and prevention of indoor allergens. The absence of a European SIAQ monitoring programme highlights the urgent need for more research in this field so as to issue the necessary evidence based recommendations specific to the individual countries.peer-reviewe

Pulmonary rehabilitation : insight into current trends

Pulmonary rehabilitation is a widely accepted therapeutic tool used to improve the quality of life and functional capacity of individuals with chronic lung disease. It is a multidisciplinary, comprehensive program designed to optimise autonomy and physical performance in patients with chronic respiratory impairment. There is sufficient evidence to support the use of pulmonary rehabilitation for a subset of patients and to indicate that it can improve exercise tolerance and symptoms of dyspnoea, as well as enhance health-related quality of life of patients with COPD and other respiratory conditions. According to projections in the Global Burden of Disease Study, COPD will be the fifth leading cause of disability-adjusted-life-year loss worldwide in 2020.peer-reviewe

Community-Acquired Pneumonia : what is new in aetiology and treatment

Community-Acquired Pneumonia (CAP) remains a considerable problem in terms of morbidity, mortality and use of hospital resources despite the remarkable advances in antibiotic therapy. This study describes the changes in the pattern of pneumonias, as manifested by new diseases, new modes of transmission and new manifestations of old diseases.peer-reviewe

Endoscopic bronchial ultrasound in mediastinal staging of lung cancer

Lung cancer is a global healthcare concern with a low 5-year survival rate and a high proportion of advanced-stage cases at diagnosis. In the absence of distant metastasis, the most important prognostic marker is mediastinal lymph node involvement. Timely diagnosis and staging improves prognosis, making rapid, safe, and accurate investigation essential. Endoscopic bronchial ultrasound (EBUS) is a minimally invasive technique which allows for ultrasound-guided transbronchial needle aspiration (TBNA) during bronchoscopy, with cytological sampling of several intrathoracic groups of lymph nodes. EBUS reduces need for open surgical biopsy, with good sensitivity and specificity and excellent safety profile. This article reviews current evidence regarding use of EBUS in lung cancer staging, including its role in other intrathoracic malignancies.eviews current evidence regarding use of EBUS in lung cancer staging, including its role in other intrathoracic malignancies.peer-reviewe

Interstitial lung disease in Malta

Aim: To establish the prevalence, management and response to treatment of interstitial lung disease (ILD) in Malta. Methodology: The personal files of 102 living and 26 deceased patients with ILD under the care of 4 respiratory physicians were reviewed retrospectively. The investigations utilised for reaching the diagnosis, patient management and response to treatment were analysed. Results: The prevalence of ILD was estimated at 24.9 per 100,000 population. Pulmonary function tests were performed at least once in 109 patients (n=128, 85%), and pletysmography and exercise oximetry in 36 patients (n=128, 28%). A chest x-ray (CXR) was performed in 120 patients (n=128, 93.7%), of which 8 (n=120, 6.66%) were normal, a computed tomography scan of the thorax in 113 patients (n=128, 88.3%), all of which showed fibrotic changes and a DTPA scan in 17 patients (n=128, 13.3%). Regarding more invasive investigations, bronchoalveolar lavage was performed in 10 patients (n=128, 7.8%), open lung biopsy in 4 patients (n=128, 3.1 %), video-assisted thoracoscopic surgery in 4 patients (n=128, 3.1%) and transbronchial lung biopsy in 7 patients (n=128, 5.5%). Corticosteroids were the most common drugs prescribed in 64 patients (n=128, 50%) followed by azathioprine in 23 patients (n=128, 18%) and cyclophosphamide in 3 patients (n=128, 2.3%). There was a definite worsening in lung function associated with increasing age. There was no standardisation of follow up for these patients. Conclusion: The method of diagnosis, management and follow up of patients with ILD locally requires improvement to optimise standards of care and hence compare with proposed international guidelines.peer-reviewe

Addressing the need for an adult allergy clinic in Malta

The incidence of allergy is globally on the increase. Allergology is a relatively new speciality with rapidly growing needs. Many patients have co-existent allergic conditions including asthma, eczema, allergic rhinitis, food and drug allergy. It is recommended internationally that patients suffering from allergic conditions including anaphylaxis are investigated, treated and followed up by an allergy specialist in a safe environment with resuscitation facilitations readily available, especially when certain investigations are performed. This article highlights the importance of the need for such an allergy service for adult patients at Mater Dei Hospital, in patients with new onset or previously undiagnosed allergic conditions as well as transition of care from paediatric services, with the intention of performing specialist investigations, providing optimal expert management and expert to allergy sufferers locally whilst improving patients’ quality of life. A multidisciplinary team approach would further improve this service.peer-reviewe

Domiciliary nasal respiratory support : first experiences in Malta

Nasal respiratory support is a non-invasive alternative to conventional assisted ventilation with endotracheal intubation, or the more cumbersome negative pressure ventilators. The two main types of this relatively new therapy are nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) respiratory support, which are mostly used in chronic hypoventilatory states and obstructive sleep apnoea (OSA) respectively. We have introduced these two types of respiratory support to five patients suffering from neuromuscular disorders and twenty-four patients with OSA with marked improvement in the quality of life of all patients concerned. Our experiences with these patients should hopefully lead to further development in the diagnostic and therapeutic facilities in this field in Malta.peer-reviewe

Recurrent chest infections in two young non-smoker men

Pulmonary mucinous cystic carcinomas are rare salivary gland type carcinomas of the lung. They form part of a wide spectrum of mucin secreting glandular mixed type tumours. They comprise 0.1 – 0.2% of all lung tumours. They occur more frequently in young patients and present with cough or recurrent chest infections and therefore may be easily misdiagnosed. Since treatment depends fully on complete surgical resection early diagnosis is essential. Even with treatment the 10-year survival is quoted at 53%. We describe two cases of such rare tumours both of who underwent curative surgical resection. Both patients were younger than 35 years old and presented with recurrent chest infections. The patients were followed for up to eight years and the outcome recorded. A literature search confirms the occurrence in younger patients, who often present with pneumonias and that surgery is the only hope for cure.peer-reviewe

Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three

We are grateful to the children and parents who participated and the coordination and assistance by the school staff is sincerely appreciated.Certain foods may increase or decrease the risk of developing asthma, rhinoconjunctivitis and eczema. We explored the impact of the intake of types of food on these diseases in Phase Three of the International Study of Asthma and Allergies in Childhood. Written questionnaires on the symptom prevalence of asthma, rhinoconjunctivitis and eczema and types and frequency of food intake over the past 12 months were completed by 13–14-year-old adolescents and by the parents/guardians of 6–7-yearold children. Prevalence ORs were estimated using logistic regression, adjusting for confounders, and using a random (mixed) effects model. For adolescents and children, a potential protective effect on severe asthma was associated with consumption of fruit ≥3 times per week (OR 0.89, 95% CI 0.82 to 0.97; OR 0.86, 95% CI 0.76 to 0.97, respectively). An increased risk of severe asthma in adolescents and children was associated with the consumption of fast food ≥3 times per week (OR 1.39, 95% CI 1.30 to 1.49; OR 1.27, 95% CI 1.13 to 1.42, respectively), as well as an increased risk of severe rhinoconjunctivitis and severe eczema. Similar patterns for both ages were observed for regional analyses, and were consistent with gender and affluence categories and with current symptoms of all three conditions. If the association between fast foods and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is causal, then the findings have major public health significance owing to the rising consumption of fast foods globally.peer-reviewe

Cigarette smoking across three Maltese generations

Cigarette smoking, currently the single most preventable cause of disease and death, is very common in the Maltese Islands. Various aspects of smoking among three different Maltese generations were investigated using a standardized questionnaire among 200 randomly chosen subjects from each of three age groups (16-21yrs, 40-45 yrs and 60-65 yrs). They were asked to answer questions regarding duration, amount, mode and effects of smoking and their attempts at quitting. They were also asked to undergo spirometry and expired CO measurement. 66.1% of 16-21 yr olds, 59% of 40-45 yr olds and 75% of 60-65 yr olds chosen participated in the study. 27.7% of the participants were smokers - this comprised 31.1% of the 16-21 yr olds, 34.8% in the 40-45 yr olds and 19.2% in the 60-65 yr older age subset. (p = 0.0105). As a total study population 35 % of the males and 21% of the females (p = 0.0013) were regular smokers. In the 16 ­21 year olds 43.6% of the males smoked vs 20% of the females, while the gender differences for the other two groups were 32.7% males vs 36.5% females in the 40-45 year olds and 28.1% males vs 6.5% females in the oldest age group. The mean cigarette consumption in the 16-21 yr olds was significantly less than the other two age groups studied (p=0.0076). Females were more likely to be heavier smokers in the 40-45 yr olds. There was no significant geographical distribution in smoking and the less skilled workers and unemployed were more likely to be smokers (p=0.0001). 43.9% of the 16-21 year olds tried to stop smoking while 73.2% and 82.8% of the two older age groups tried even harder (p=0.0013). Only 5.3 % of smokers sought medical help to try and stop smoking. Smokers had more chest symptomatology (p<0.0001) but only the oldest age-group of smokers had decreased PEFR 19% of smokers suffered from asthma, 29% from ischaemic heart disease and 16% were diabetics. The Maltese are quite heavy smokers across all ages and gender and most are not seeking medical help to try and stop the habit.peer-reviewe