46 research outputs found
Bronchoscopic needle aspiration in the diagnosis of mediastinal lymphadenopathy and staging of lung cancer
Transbronchial needle aspiration (TBNA) has the potential to allow
adequate mediastinal staging of non-small cell lung cancer with
enlarged lymph nodes in most patients without the need for
mediastinoscopy. Metastasis to the mediastinal lymph nodes is one of
the most important factors in determining resectability and prognosis
in non-small cell lung cancer. The importance of TBNA as a tool for
diagnosing intrathoracic lymphadenopathy as well as in the staging of
lung cancer has been reported in various studies. We performed a
literature search in PubMed and Journal of Bronchology using the
keyword transbronchial needle aspiration. TBNA is a safe and effective
procedure to diagnose mediastinal lymphadenopathy. Real-time
bronchoscopic ultrasound-guided TBNA is the new kid on the block, which
can further enhance the sensitivity of bronchoscopy in the diagnosis of
mediastinal lesions
Resting and Post Bronchial Challenge Testing Carbon Dioxide Partial Pressure in Individuals with and without Asthma
Objective: There is conflicting evidence about resting carbon dioxide levels in asthmatic individuals. We wanted to determine if transcutaneously measured carbon dioxide levels prior and during bronchial provocation testing differ according to asthma status reflecting dysfunctional breathing. Methods: We investigated active firefighters and policemen by means of a validated questionnaire on respiratory symptoms, spirometry, bronchial challenge testing with methacholine (MCT) and measurement of transcutaneous blood carbon dioxide partial pressure (PtcCO 2) at rest prior performing spirometry, one minute and five minutes after termination of MCT. A respiratory physician blinded to the PtcCO2 results assigned a diagnosis of asthma after reviewing the available study data and the files of the workers medical screening program. Results: The study sample consisted of 128 male and 10 female individuals. Fifteen individuals (11%) had physiciandiagnosed asthma. There was no clinically important difference in median PtcCO 2 at rest, one and five minutes after recovery from MCT in asthmatics compared to non-asthmatics (35.6 vs 35.7 mmHg, p = 0.466; 34.7 vs 33.4 mmHg, p = 0.245 and 37.4 vs 36.4 mmHg, p = 0.732). The median drop in PtcCO2 during MCT and the increase after MCT was lower in asthmatics compared to non-asthmatics (0.1 vs 3.2 mmHg, p = 0.014 and 1.9 vs 2.9 mmHg, p = 0.025). Conclusions: PtcCO2 levels at rest prior and during recovery after MCT do not differ in individuals with or without physicia
Therapeutic bronchoscopy for malignant airway stenoses: Choice of modality and survival
Background: There are no data regarding the factors influencing the
choice of therapeutic bronchoscopic modality in the management of
malignant airway stenoses. Objectives: To assess the choice of
therapeutic bronchoscopy modality and analyze factors influencing
survival in patients with malignant central airway obstruction.
Materials and Methods: We performed 167 procedures in 130 consecutive
patients, for malignant central airway obstruction, over six years.
Results: Laser was used either alone or in combination with stent
insertion in 76% procedures. Laser only was used in 53% procedures for
lesions below the main bronchi. Stents alone were used for extrinsic
compression or stump insufficiency. Combined laser and stent insertion
was most frequently used for lesions involving the trachea plus both
main bronchi or only the main bronchi. The Dumon stent was preferred in
lesions of the trachea and the right bronchial tree, the Ultraflex
stent for lesions on the left side and stenoses below the main bronchi.
Survival was better in patients with lung cancer, lesions restricted to
one lung and when laser alone was used compared to esophageal cancer,
metastases and tracheal involvement. Conclusion: The choice of
different airway stents can be made based on the nature and site of the
lesion. Dumon stents are suited for lesions in trachea and right main
bronchus and the Ultraflex stents on the left side and stenoses beyond
the main bronchi. Survival can be estimated based on the diagnosis,
site of the lesion and treatment modality used
Risk Factors for Recurrent Exacerbations in the General-Practitioner-Based Swiss Chronic Obstructive Pulmonary Disease (COPD) Cohort.
BACKGROUND
Patients with chronic obstructive pulmonary disease (COPD) often suffer from acute exacerbations. Our objective was to describe recurrent exacerbations in a GP-based Swiss COPD cohort and develop a statistical model for predicting exacerbation.
METHODS
COPD cohort demographic and medical data were recorded for 24 months, by means of a questionnaire-based COPD cohort. The data were split into training (75%) and validation (25%) datasets. A negative binomial regression model was developed using the training dataset to predict the exacerbation rate within 1 year. An exacerbation prediction model was developed, and its overall performance was validated. A nomogram was created to facilitate the clinical use of the model.
RESULTS
Of the 229 COPD patients analyzed, 77% of the patients did not experience exacerbation during the follow-up. The best subset in the training dataset revealed that lower forced expiratory volume, high scores on the MRC dyspnea scale, exacerbation history, and being on a combination therapy of LABA + ICS (long-acting beta-agonists + Inhaled Corticosteroids) or LAMA + LABA (Long-acting muscarinic receptor antagonists + long-acting beta-agonists) at baseline were associated with a higher rate of exacerbation. When validated, the area-under-curve (AUC) value was 0.75 for one or more exacerbations. The calibration was accurate (0.34 predicted exacerbations vs 0.28 observed exacerbations).
CONCLUSION
Nomograms built from these models can assist clinicians in the decision-making process of COPD care
Clinical characteristics governing treatment adjustment in COPD patients: results from the Swiss COPD cohort study
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a widespread chronic disease characterised by irreversible airway obstruction [1]. Features of clinical practice and healthcare systems for COPD patients can vary widely, even within similar healthcare structures. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy is considered the most reliable guidance for the management of COPD and aims to provide treating physicians with appropriate insight into the disease. COPD treatment adaptation typically mirrors the suggestions within the GOLD guidelines, depending on how the patient has been categorised. However, the present study posits that the reasons for adjusting COPD-related treatment are hugely varied.
OBJECTIVES: The objective of this study was to assess the clinical symptoms that govern both pharmacological and non-pharmacological treatment changes in COPD patients. Using this insight, the study offers suggestions for optimising COPD management through the implementation of GOLD guidelines.
METHODS: In this observational cohort study, 24 general practitioners screened 260 COPD patients for eligibility from 2015–2019. General practitioners were asked to collect general information from patients using a standardised questionnaire to document symptoms. During a follow-up visit, the patient’s symptoms and changes in therapy were assessed and entered into a central electronic database. Sixty-five patients were removed from the analysis due to exclusion criteria, and 195 patients with at least one additional visit within one year of the baseline visit were included in the analysis. A change in therapy was defined as a change in either medication or non-medical treatment, such as pulmonary rehabilitation. Multivariable mixed models were used to identify associations between given symptoms and a step up in therapy, a step down, or a step up and a step down at the same time.
RESULTS: For the 195 patients included in analyses, a treatment adjustment was made during 28% of visits. In 49% of these adjustments, the change in therapy was a step up, in 33% a step down and in 18% a step up (an increase) of certain treatment factors and a step down (a reduction) of other prescribed treatments at the same time. In the multivariable analysis, we found that the severity of disease was linked to the probability of therapy adjustment: patients in GOLD Group C were more likely to experience an increase in therapy compared to patients in GOLD Group A (odds ratio [OR] 3.43 [95% confidence interval {CI}: 1.02–11.55; p = 0.135]). In addition, compared to patients with mild obstruction, patients with severe (OR 4.24 [95% CI: 1.88–9.56]) to very severe (OR 5.48 [95% CI: 1.31–22.96]) obstruction were more likely to experience a therapy increase (p 999; p = 0.109]).
CONCLUSIONS: This cohort study provides insight into the management of patients with COPD in a primary care setting. COPD Group C and airflow limitation GOLD 3–4 were both associated with an increase in COPD treatment. In patients with comorbidities, there were often no treatment changes. Exacerbations did not make therapy increases more probable. The presence of neither cough/sputum nor high CAT scores was associated with a step up in treatment
An open-label study examining the effect of pharmacological treatment on mannitol- and exercise-induced airway hyperresponsiveness in asthmatic children and adolescents with exercise-induced bronchoconstriction
Balloon Dilatation Using Flexible Bronchoscopy for the Management of Benign and Malignant Airway Stenoses
Fatal cerebral air embolism following uneventful flexible bronchoscopy
Flexible bronchoscopy is a widely used and safe procedure with a reported maximal mortality rate of 0.04% and a major-complications rate of 0.5%. There are, however, only few case descriptions for postinterventional cerebral air embolism and the frequency of this supposedly rare complication is unknown. The current study presents 2 patients with non-small cell lung cancer who suffered fatal cerebral air embolism following diagnostic bronchoscopy with transbronchial needle aspiration and transbronchial biopsy, resulting in a frequency of >0.02% for this severe complication in our institution. In addition to early supportive measures, 1 patient received hyperbaric oxygen therapy as further treatment. Prompt recognition of this complication is mandatory in order to implement appropriate supportive measures. High-flow oxygen should be administered and hyperbaric oxygen therapy may be considered, if available. If possible, positive pressure ventilation should be avoided
Bronchoscopic lung volume reduction - current opinion
Bronchoscopic lung volume reduction is a new technology designed to reduce hyperinflation in severe COPD by implantation of endobronchial devices, such as biodegradable material, endobronchial valves or bronchopulmonary stents, via flexible bronchoscopy. This article discusses newest developments and results in bronchoscopic lung volume reduction