Current Respiratory Medicine Reviews - Volume 13, Issue 4, 2017

Background: Pneumothorax occurs when air enters the pleural cavity. Pneumothorax can be generally sub-divided into spontaneous and non-spontaneous subtypes. The most common examples of non-spontaneous pneumothorax include iatrogenic and traumatic. Methods: Current studies provide good evidence of epidemiology of this condition. Similarly, there have been improvements in our understanding of underlying mechanisms of spontaneous pneumothorax. In the recent years new approaches to manage patients with pneumothorax have been proposed. These were led by development of new devices as well as better evidence from clinical studies on how to manage pneumothorax. Conclusions: In this review we will discuss recent developments in our understanding in relation to in epidemiology, pathophysiology as well as management of pneumothorax.

Background: Asthma is one of the major noncommunicable diseases. According to the latest WHO estimates released in December 2016, 235 million people currently suffer from asthma and there were 383 000 deaths due to asthma in 2015. Most asthma-related deaths occur in low- and lower-middle income countries. Asthma is a common disease among children. Objectives: Asthma care requires understanding how diagnose and assess it. The aim of this study is to analyze and discuss the different and various experience on the endeavours produced worldwide to overcome these problems, to comment on their results and highlight best management evidences with the pivotal role of respiratory physicians. Methods: extensive medline search of all relevant studies on “asthma management”, “asthma care”, “asthma primary care”, “asthma pharmacist”, “asthma nurse” and “asthma school”. Results: Despite a huge amount of new data on the disease, produced in last decades and in different settings, asthma management suffers a series of pitfalls that conveys to less than optimal care. Some examples of the persistence of incompletely resolved issues in asthma management are : 1) misdiagnosis - with the related complex consequences -, especially in children population and, 2) poor control of the disease. Also related factors as suboptimal medical management , poor education and health literacy of patients, poor adherence and elevated costs for patients and healthcare systems are some other factors that need urgent implementation. Conclusion: Better and systematic strategies in diagnosis, phenotyping and therapy are available in a specialistic dedicated setting.

Background: Electrical impedance tomography (EIT) is an imaging modality which is getting more attention these days. The main advantages are real time images, small cost, small size and non-ionizing operation. On the other hand, the biggest drawbacks are blurred images obtained and time consuming implementation. Objective: This paper introduces challenges and possible remedies when the electrical impedance tomography (EIT) is applied to a real patient. EIT is a promising method for patient real-time monitoring of thorax. Method: The application of electrodes is time consuming and very sensitive to proper positioning. We propose a method to improve such drawbacks. It enables a pseudo-absolute monitoring, which is superior to classic differential monitoring through the use of VERA device (variable electrical ring analyzer). Results: This superiority has several aspects. The most important is that physician can see whole lungs and possible other features whereas traditional method is capable of monitoring only differences between the inhalation and exhalation of air. Moreover it is possible to see also anomalities which do not change between the course of breathing - possible cancer detection. Other advantages are faster implementation on patient body, which is currently a huge drawback of traditional EIT electrodes positioning and inherent more reliable obtained images since the proposed construction is a well defined object with certain static dimensions. Another advantage comes from the fact that most of the measurement anomalities are near the measuring electrodes and since the electrodes are not in direct contact with a patient body, the anomalities do not appear in the image of human cross section. Conclusion: The proposed method is a viable imaging modality which can be used for imaging predominantly lungs providing better insight into what is happening in real time. We hope that such device can contribute to widespread of EIT, which can be more pleasant to patients than traditional computed tomography or magnetic resonance and, at the same time, provide medicals with all necessary information.

Background: A number of recent studies have shown that a specifically designed odor inhaler containing various scent compositions has the ability to decrease blood pressure, heart rate, and cortisol levels. Similar results were found for the reduction of chronic pain or the enhancement of selective attention and concentration. Objective: This paper follows up on these findings and investigates whether a specially designed inhaler (‘Energy’) is capable of temporarily increasing blood oxygenation. Method: A prospective, controlled experimental study involving standardized breathing cycles was run to compare normal, deep breathing with breathing through an odor inhaler. Results: The difference in blood oxygenation between normal breathing and odor inhalation was very large (d = 2). It lasted three times longer than that of normal breathing. The effect was shown in all individuals and did not abate after repeated use. Conclusion: Blood oxygenation can be increased over and above the effect of deep breathing when using this odor inhaler.

Background: Obstructive sleep apnea (OSA) is a common sleep related disorder. Objectives: To identify OSA, its risk factors and to study its association with fatigue and day time sleepiness. Methods: In-patients were interviewed using the STOP-BANG questionnaire, the Fatigue Severity Scale questionnaire and the Epworth Sleepiness Scale. Height, weight and neck circumference of the participants were measured using standard procedures. Results: Of the total 296 participants, 10(3.4%) were known cases of OSA. Of the remaining 286 cases, 189(66.1%) were at low, 82(28.7%) were at intermediate and 15(5.2%) were at high risk of OSA. Age >50 years (P<0.001), male gender (P<0.001) and family history of snoring (P=0.004) among patients were associated with high risk/known status of OSA. Multiple morbidities were seen among greater proportion of participants with higher risk/known status of OSA (P=0.024). Increased body mass index (P=0.013) was associated with higher risk/known status of OSA. High risk/known status of OSA was associated with significant levels of fatigue (P=0.001) and abnormal day time sleepiness (P=0.006) among participants. Multivariate analysis of variables showed age, snoring, witnessed stoppage of breathing, nasal congestion and hypertension as independent risk factors for high risk/known status of OSA. Conclusion: Several factors were identified to predict high risk/known status of OSA among inpatients in this study. High risk/ known cases of OSA were found to suffer from multiple comorbidities, significant levels of fatigue and abnormal day time sleepiness. Therefore, inpatients with these associated risk factors need to be screened for OSA so as to ensure comprehensive case management.

Background: The cardiopulmonary exercise test (CPET) is used in heart failure in order to evaluate the symptoms, determine the differential diagnoses of dyspnea, consider the prognosis and survival in diseases and finally help the patient's treatment. The aim of present study was to determine the correlation between CPET results and the functional class of patients with advanced heart failure candidate for heart transplantation. Methods: A cross-sectional study was conducted in the respiratory department of Imam Khomeini Hospital in Tehran (2016-2017). Total 86 patients (68 males and 18 females) who were candidates for cardiac transplantation were entered in this study without any history, physical examination and pulmonary functional test in favor of lung disease. The functional class was determined according to NYHA classification, and ejection fraction calculated by trans-thoracic echocardiography. The cardiopulmonary exercise test (CPET) was performed based on Bruce protocol and Gonshorn's ergospirometer cycle apparatus. All necessary information was analyzed including BMI, Heart rate at rest and Maximal activity, FEV1, FVC, FEV1/FVC, MEF 25-75, O2Saturation at rest and Maximal activity, AT, peak VO2, WR, VE Max, VT Max VD/VT, respiratory rate, pet CO2, RER, VE/VCO2, ventilatory reservation, functional class, test termination causes and Ejection fraction. The relationship between functional class and CPET parameters was determined based on obtained results. Findings: To sum up, the most common cause of test termination was shortness of breath and generalized fatigue. The relationship between peak Vo2 and the functional class was significant and inverse (P = 0.03). The VE/VCO2 at AT and the functional class were related considerably and directly (p = 0.001). Conclusion: This study showed that the higher grade of functional class in patients is correlated to decline in peak Vo2 and increase in VE/VCO2 ratio at AT. Therefore, VE/VCO2 ratio, that is not dependent on the patient's effort, is recommended in determination of prognosis and survival in patients with heart failure.

Background: Sarcoidosis is a granulomatous disease that primarily affects the lung and lymphatic systems of the body. The Chest X-ray (Roentgenology) is the most common first imaging modality used in the diagnostic approach and follow-up of sarcoidosis, and is still used to determine the stage of sarcoidois based on the classification system proposed by Scadding (1961). Objective: We will assess the relation between different chest x-ray findings in sarcoidosis patients and both, demographic variables of sarcoidosis patients (age, gender, and race), along with different Scadding stages. Method: We included data regarding cases in the case-control ACCESS study, including demographic and clinical data, in addition to X-ray findings. From those with a biopsy-confirmed diagnosis of sarcoidosis in the ACCESS trial, we excluded patients with diseases that might contribute to X-ray abnormalities, including cardiac and respiratory non-sarcoidosis diseases (e.g. asthma and chronic bronchitis). We also excluded sarcoidosis patients without lung involvement. Results: A total of 499 patients were included in this study, of which 195 (39.1%) were men and 304 (60.9%) were women. We found that pleural abnormalities are most commonly associated with Scadding stage 2 (42.9%, p= 0.001), whereas Scadding stage 4 is associated with hilar retraction (52.8%, p< 0.001), bullae and bleps (73.7%, p< 0.001), and pulmonary artery enlargement (66.7%, p< 0.001). Finally, we also observed significant relations between demographic variables (age, gender, and race) and different imaging findings. Conclusion: Upon interpreting chest X-ray of sarcoidosis patients, patients' age, gender, and race should be kept in mind, as demographic variables are associated with chest X-ray findings in those patients. Moreover, each Scadding stage is associated with several findings on chest X-ray in sarcoidosis patients and should be interpreted accordingly.