Current Respiratory Medicine Reviews - Volume 15, Issue 1, 2019

Idiopathic pulmonary fibrosis (IPF) is a debilitating, progressive, and fatal fibrotic lung disease with a poor prognosis. Antifibrotic therapy slows but does not halt disease progression. Patient education and management needs change during disease progression. Management is complicated by comorbidities, adverse events associated with antifibrotic therapy, and difficulties with long-term oxygen therapy and pulmonary rehabilitation. Treating IPF requires coordination between physicians and nurses in community and interstitial lung disease center settings. This review provides guidance for the healthcare professional who manages the essential aspects of care in IPF from diagnosis, through disease progression, and to the end of life.

Background: The Glittre ADL test was done to assess the functional capacity of patients with COPD. 6 MWT was used to check for functional capacity, but there was a limitation of upper limb work or activities other than walking. Objective: To develop reference equations for Glittre ADL test on the basis of anthropometric and demographic variables in healthy individual among Indian population. Methods: This cross-sectional study was conducted with 423 healthy participants of either gender between 20-70 years. Participants were divided into 5 groups based on age. Each participant underwent anthropometric assessment & two glitter ADL tests. Two out of the best performance out of two was considered and the minimum time spend was taken. Results: The mean time spent by males in different age groups was 20-30 years 3.18±0.56, 30-40 years 3.36±0.17, 40-50 years 3.46±0.18, 50-60 years 3.53±0.15, 60-70 years 4.02±0.27.For females in different age groups the mean time was 20-30 years 3.31±0.14, 30-40 years 3.41±0.13, 40-50 years 3.48±0.13, 50-60 years 3.75±0.28, 60-70 years 4.30±0.19. Equation 1 : Glittre ADL-test predicted =3.399+(0.018×age years)+(-0.004eight cm), Equation 2 : Glittre ADL-test predicted =2.805+(-0.002BMI)+(0.018×age year). Conclusion: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, height as independent variables and can be useful for predicting the performance of adult individuals.

Background: Most TB deaths can be prevented with timely diagnosis and appropriate treatment. In fact, millions of people are diagnosed and treated successfully every year, avoiding millions of deaths. However, globally, there are still huge gaps in detection and treatment. Objective: To identify the social determinants associated with mortality due to TB in a general hospital in Mexico. Methodology: All patients admitted with a diagnosis of pulmonary tuberculosis to the Emergency Department of a hospital in Mexico were included during a 10-month period. At the end of the study, the condition of discharge of all cases was obtained from the electronic database of the State Tuberculosis Program. Results: One-hundred and twenty-four patients with tuberculosis were included in the sample. Thirty-eight patients (30.6%) died during their hospital stay and eleven (8.9%) died outside the hospital after their discharge, for a total of 49 (39.5%) deaths. Of the 29 patients with HIV/AIDS, 12 died (41.3%). Logistic regression analysis showed that older age, imprisonment, and previous tuberculosis were significant predictors of mortality. Conclusion: The mortality of tuberculosis patients diagnosed in HGT is very high, mainly because the diagnosis is established at the hospital level, which implies a late diagnosis.

Background: Open access (OA) publishing is rapidly emerging in almost all disciplines, with variable intensity and effect on the discipline itself. The move toward OA is also observed in the field of respiratory and pulmonology, where both OA data repositories and OA journals are rapidly emerging. Objective: we aim to study the open-access status of respiratory and pulmonology journals and the impact of the open-access status on journal indices. Methods: We collected journal’s data from Scopus Source List on 1st of November 2018. We filtered the list for respiratory and pulmonology journals. Open Access Journals covered by Scopus are recognized as Open Access if the journal is listed in the Directory of Open Access Journals (DOAJ) and/or the Directory of Open Access Scholarly Resources (ROAD). For each journal, we used several metrics to measure its strength, and then we compared these metrics between OA and non- OA journals. Results: There were 125 respiratory and pulmonology journals, a number that has increased by 12.6% since 2011. Moreover, the percentage of OA journals has increased from 21.6% to 26.4% during the same period. Non-OA journals have significantly higher scholarly output (p= 0.033), but OA journals have significantly higher percentage of citation (p= 0.05). Conclusion: Publishing in OA journals will yield a higher citation percentage compared to non-OA journals. Although this should not be the only reason to publish in an OA journal, it is still an important factor to decide where to publish.

Background: The modified Medical Research Council scale (mMRC) is a standardized measure of the effect of dyspnea on the activities of the daily life of patients suffering from Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to determine the differences in the quality of life, tolerance to effort and symptoms among patients with COPD with lower (mMRC 0-1) and greater symptoms (mMRC ≥2). Methods: Cross-sectional study that included patients admitted to a pulmonary rehabilitation program and who were classified into 2 groups: a group containing the less symptomatic patients and another group with the more symptomatic ones. We collected these patients’ sociodemographic, clinical, anthropometric, anxiety, depression and quality of life (SGRQ) data. Likewise, the subjects performed the 6-minute walk test (6MWT). Finally, we measured the multidimensional BODE index score. Results: 130 subjects were included, 35 presenting an mMRC of 0 to1 and 95 having an mMRC ≥ 2, with an age of 70.87 ± 9.45 years old. The 6MWT distance, the VO2e, the total score of SGRQ, and its domains of activities and impact showed significant differences between the groups (p <0.05). Significant correlations were found in the group presenting an mMRC of 0-1 between the mMRC and the FEV1 (p = 0.028), and in the group with an mMRC ≥2 for the FVC (p = 0.031), the 6MWT distance (p = 0.000), the VO2e (p = 0.010) and the BODE index (p = 0.000). Conclusion: Patients with an mMRC of 0 to1 had better results in the 6MWT, the VO2e and the SGRQ in comparison with the most symptomatic ones.

Objective: Pulmonary hydatid cyst is caused by Echinococcus Species and has high prevalence in low and middle income countries. Surgery remains the gold standard method for this parasitic pulmonary disease. Here, we report 20 cases of pulmonary hydatid cysts that underwent minimally invasive videothoracoscopic surgery. Methodology: All the patients who underwent minimally invasive complete thoracoscopic removal of pulmonary hydatid cysts in our clinic, which were recorded in the hospital database had been extracted. Clinical properties and complications of the surgeries were analy zed retrospectively. Results: Minimally invasive method was performed in all 20 cases. The mean duration of operation was 95 minutes (min-max: 45-175), and the mean length of hospitalization was 3.55 days (min-max: 2-7). The complication rate was 15% (n=3) and there was no recurrence in 6 months of follow- up. Conclusion: Videothorascopic pulmonary hydatid cysts removal seems to be a safe and useful method. This method is applied in all suitable patients with pulmonary hydatid cysts.

Background: COPD being a systemic inflammatory disease is accompanied by alteration of various inflammatory cytokines which affect the metabolic equilibrium of body. Some therapeutic options, mainly statins via their wide range of pharmacologic actions alter the level of proinflammatory cytokines hence, helpful in attenuating various extra-pulmonary consequences of COPD. We did a randomised case-control study to study the effect of statin supplementation on pulmonary function and inflammatory markers in patients of COPD. Methods: We included 40 stable COPD subjects & randomized them in two groups, Intervention & Non-intervention. Intervention group received 40 mg atorvastatin once daily for 3 months in addition to the conventional treatment of COPD similar to the prior one. We studied levels of IL-6 & CRP and correlated them with disease severity before and after the aforementioned intervention. Results: We observed that CRP levels decreased in both the groups after a follow up of 3 months, but neither of them was statistically significant (p=0.57 & 0.63 respectively) nor the mean of their difference (p=0.969). IL-6 levels showed a persistent decline in intervention group but, was not significant (p=0.91). In this study, we noticed statistically significant improvement in FEV1 (p=0.008) in the intervention group which was in contrast to non-intervention group. Similarly, the exercise capacity also statistically increased in the intervention group (p=0.002). There was also evident negative correlation between exercise capacity and IL-6 as well CRP levels. FEV1 also showed statistically significant negative correlation with IL-6 levels (p=0.023). Conclusion: We can improve the disease outcome and alter its natural progression by altering the levels of inflammatory markers with the aid of some additional pharmacological interventions i.e., in this study was atorvastatin.

Background: Lymphoblastic lymphomas (LL) of the mediastinum are rare tumours that present a challenging diagnosis. The positive diagnosis is based on microscopic findings. Our aim was to highlight the diagnostic difficulties in such situations. Methods: We conducted a descriptive retrospective study including 31 patients presenting mediastinal LL. Results: Radiologic features consisted in all cases in a mediastinal infiltrating mass. Microscopic examination showed in all cases a crowded tumour with many artefacts made of diffuse tumour cells. Immunohistochemial study was performed in all cases. It was quite difficult to interprete in the samples used for extemporaneous examination and repeated in 10 cases. Conclusion: The diagnosis of LL is based on the microscopic examination which is usually performed on small samples with crowding artefacts. Thus, this pathology must be managed by a trained team that is used to deal with such a specimen in order to avoid repeating the biopsy and inducing diagnostic delay.

Objectives: Primary cardiac tumors are rare and account for 0.001 to 0.03% of cardiac lesions. The authors aim to describe the clinical, the microscopic and the therapeutic characteristics of these tumors through a 13-year-experience in order to highlight the diagnostic challenges faced. Methods: We report 10 primary cardiac tumors diagnosed in the Departments of Pathology and Thoracic Surgery of the same hospital through a 13-year-period. Results: Our study was conducted on 7 women and 3 men. The mean age of the patients was 54.22 years (average, 12 to 79 years). Dyspnea represented the most frequent symptom. Physical examination was normal in all patients. Trans-thoracic ultra-sound examination was performed in all patients. Cardiac MRI allowed localizing the tumors in 2 patients. They were located into the left auricle (6 cases), the right auricle (1 case) and the pericardium (3 cases). The microscopic examination was concluded to myxoma (7 cases), haemangioma (2 cases) and hemangioendothelioma (1 case). Surgical resection was possible in 9 patients. It was impossible in the case of hemangioendothelioma because of the adherence. One death was recorded secondary to postoperative arrhythmia. The other patients presented no complications after a follow-up period ranging from 2 months to 5 years. Conclusion: Cardiac tumors are challenging in their diagnosis and management. A positive diagnosis is based on microscopic examination. Surgical treatment plays a key role and is possible in the majority of benign tumors. The prognosis of malignant tumors remains poor even if a complete surgical resection is possible.

In the current technical note, the structure of pulmonary hydatid cysts has been presented and the included layers have been discussed. Then, some critical notes have been provided for the management of intact pulmonary hydatid cyst which should not be removed by bronchoscopic approaches due to high rates of possible complications of tearing; however, it has been performed by some cases available in the literature which is not acceptable.