Advances in Respiratory Medicine

1453 KiB

Open AccessGuidelines

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

by Wojciech J. Piotrowski, Iwona Bestry, Adam J. Białas, Piotr W. Boros, Piotr Grzanka, Ewa Jassem, Dariusz Jastrzębski, Dariusz Klimczak, Renata Langfort, Katarzyna Lewandowska, Sebastian Majewski, Magdalena M. Martusewicz-Boros, Karina Oniszh, Elżbieta Puścińska, Alicja Siemińska, Małgorzata Sobiecka, Małgorzata Szołkowska, Elżbieta Wiatr, Gracjan Wilczyński, Dariusz Ziora and Jan Kuś Show full author list Hide full author list

Adv. Respir. Med. 2020, 88(1), 42-94; https://doi.org/10.5603/ARM.2020.0081 - 28 Feb 2020

Cited by 23 | Viewed by 1361

Abstract

Introduction: This document presents the Guideliness of the Polish Respiratory Society (PTChP, Polskie Towarzystwo Chorób Płuc) for diagnosis and treatment of idiopathic pulmonary fibrosis (IPF), developed by agroup of Polish experts. Material and methods: The recommendations were developed in the form of answers [...] Read more.

Introduction: This document presents the Guideliness of the Polish Respiratory Society (PTChP, Polskie Towarzystwo Chorób Płuc) for diagnosis and treatment of idiopathic pulmonary fibrosis (IPF), developed by agroup of Polish experts. Material and methods: The recommendations were developed in the form of answers to previously formulated questions concer-ning everyday diagnostic and therapeutic challenges. They were developed based on acurrent literature review using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: We formulated 28 recommendations for diagnosis (8), pharmacological treatment (12) as well as non-pharma-cological and palliative therapy (8). The experts suggest that surgical lung biopsy (SLB) not be performed in patients with the probable usual interstitial pneumonia (UIP) pattern, with an appropriate clinical context and unanimous opinion of a multidisciplinary team. The experts recommend using antifibrotic agents in IPF patients and suggest their use irrespective of the degree of functional impairment. As regards non-pharmacological and palliative treatment, strong re-commendations were formulated regarding pulmonary rehabilitation, oxygen therapy (in patients with chronic respiratory failure), preventive vaccinations as well as referring IPF patients to transplant centres. Table 1 presents an aggregate list of recommendations. Conclusions: The Polish Respiratory Society Working Group developed Guideliness for IPF diagnosis and treatment. Full article

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Open AccessLetter

COPD 2020 Guideliness—What Is New and Why?

by Nitesh Gupta, Sumita Agrawal, Shibdas Chakrabarti and Pranav Ish

Adv. Respir. Med. 2020, 88(1), 39-41; https://doi.org/10.5603/ARM.2020.0080 - 28 Feb 2020

Cited by 20 | Viewed by 1807

Abstract

The new year dawns with new guidelines [...] Full article

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Open AccessCase Report

Defying the Paradigm—Rescue Thrombolysis in a Postoperative Patient with Pulmonary Embolism

by Kunal Deokar, Ram Niwas, Nishant Chauhan and Gopal Chawla

Adv. Respir. Med. 2020, 88(1), 37-38; https://doi.org/10.5603/ARM.2020.0079 - 28 Feb 2020

Viewed by 527

Abstract

Parenteral anticoagulation is recommended for patients of intermediate—high early mortality risk pulmonary embolism [...] Full article

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Open AccessCase Report

Double or Nothing: Old Chest X-ray as a Clue to Lung Mass

by Ralph Llewel Sabang, Sevak Keshishyan, Christia Salib, Qiqi Ye, Liying Han, Anna Rozenshtein and Oleg Epelbaum

Adv. Respir. Med. 2020, 88(1), 31-34; https://doi.org/10.5603/ARM.2020.0076 - 28 Feb 2020

Viewed by 628

Abstract

Mucoepidermoid carcinoma is ayoung person’s lung cancer with no apparent causal connection to smoking. It exhibits slow growth, which can make it challenging to detect changes in size on serial chest imaging. Another way of describing its growth pattern is that mucoepidermoid carcinoma [...] Read more.

Mucoepidermoid carcinoma is ayoung person’s lung cancer with no apparent causal connection to smoking. It exhibits slow growth, which can make it challenging to detect changes in size on serial chest imaging. Another way of describing its growth pattern is that mucoepidermoid carcinoma has an unusually long volume doubling time. We describe acase of an incidental lung nodule diagnosed as mucoepidermoid carcinoma in which aprior chest radiograph provided aclue to the indolent nature of the abnormality and therefore argued against typical lung cancer. In the same context, we underscore the value of volumetric analy-sis in improving the accuracy of nodule growth determinations, which further strengthens the argument that the importance of locating prior imaging has not diminished in contemporary pulmonary practice. Full article

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Open AccessReview

Imaging Methods for Pulmonary Sarcoidosis

by Małgorzata Węcławek, Dariusz Ziora and Dariusz Jastrzębski

Adv. Respir. Med. 2020, 88(1), 18-27; https://doi.org/10.5603/ARM.2020.0074 - 28 Feb 2020

Cited by 2 | Viewed by 891

Abstract

Sarcoidosis is achronic systemic granulomatous disease of unknown etiology. In more than 90% of patients with diagnosed sarcoidosis, mediastinal and hilar lymph nodes are affected. The objective of this paper is to discuss the most important chest imaging methods in pulmonary sarcoidosis. Achest [...] Read more.

Sarcoidosis is achronic systemic granulomatous disease of unknown etiology. In more than 90% of patients with diagnosed sarcoidosis, mediastinal and hilar lymph nodes are affected. The objective of this paper is to discuss the most important chest imaging methods in pulmonary sarcoidosis. Achest X-ray remains the method of choice at both the diagnostic stage and during follow-up of the disease progress. High-resolution computed tomography allows for amore thorough description of lesions in terms of their location. Research demonstrates the superiority of FDG PET over both aforementioned techniques in the assessment of active inflammatory lesions. Magnetic resonance imaging is currently being used in diagnosing cardiac sarcoidosis. Although EBUS constitutes the basic diagnostic tool, the invasiveness of the method results in it not being used when monitoring the activity of the disease. Full article

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Open AccessArticle

Screening Diabetes Mellitus Patients for Tuberculosis in Southern Nigeria: A Pilot Study

by Ngozi Ekeke, Elias Aniwada, Joseph Chukwu, Charles Nwafor, Anthony Meka, Chukwuka Alphonsus, Okechukwu Ezeakile, Adeyemi Ajayi, Festus Soyinka, Francis Bakpa, Victoria Uwanuruochi, Ezechukwu Aniekwensi and Chinwe Eze

Adv. Respir. Med. 2020, 88(1), 6-12; https://doi.org/10.5603/ARM.2020.0072 - 28 Feb 2020

Cited by 14 | Viewed by 995

Abstract

Introduction: Diabetes mellitus (DM) and tuberculosis (TB) are of great public health importance globally, especially in Sub-Saharan Africa. Tuberculosis is the third cause of death among subjects with non-communicable diseases. DM increases risk of progressing from latent to active tuberculosis. The study aimed [...] Read more.

Introduction: Diabetes mellitus (DM) and tuberculosis (TB) are of great public health importance globally, especially in Sub-Saharan Africa. Tuberculosis is the third cause of death among subjects with non-communicable diseases. DM increases risk of progressing from latent to active tuberculosis. The study aimed to ascertain yield of TB cases and the number needed to screen (NNS) among DM patients. Material and methods: Across-sectional study was conducted at 10 health facilities with high DM patient load and readily accessible DOTS center in 6 states of southern region of Nigeria over aperiod of 6 months under routine programme conditions. All patients who gave consent were included in the study. Yield and NNS were calculated using an appropriate formula. Results: 3 457 patients were screened with amean age (SD) of 59.9 (12.9) years. The majority were male, 2 277 (65.9%). Overall prevalence of TB was 0.8% (800 per 100 000). Sixteen (0.5%) were known TB cases (old cases). There were 221 presumptive cases (6.4%) out of which 184 (83.3%) were sent for Xpert MTB/Rif assay. Eleven (0.3%) new cases of TB were detected, giving additional yield of 40.7% and the number needed to screen (NNS) of 315. All the 11 patients were placed on anti-TB treatment. Conclusions: The prevalence of TB among DM patients was higher than in the general population. The yield was also good and comparable to other findings. This underscores the need for institute active screening for TB among DM patients. Further stu-dies are recommended to identify associated factors to guide policy makers in planning and development of TB-DM integrated services. Full article

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Open AccessArticle

Differences in Right Ventricular Dysfunction in Patients with Idiopathic Pulmonary Hypertension versus Secondary Pulmonary Hypertension

by Sepideh Emami, Niloufar Samiei, Ahamd Amin, Sepideh Taghavi, Mozhghan Parsaee, Nasim Naderi, Alireza Serati and Mohammad Reza Movahed

Adv. Respir. Med. 2020, 88(1), 1-5; https://doi.org/10.5603/ARM.2020.0071 - 28 Feb 2020

Cited by 1 | Viewed by 834

Abstract

Introduction: Right ventricular (RV) function in the setting of pulmonary hypertension based on different etiologies has not been well studied. In this study, we evaluated the RV function in patients with idiopathic pulmonary hypertension (IPH) versus secon-dary pulmonary hypertension (SPH) due to congestive [...] Read more.

Introduction: Right ventricular (RV) function in the setting of pulmonary hypertension based on different etiologies has not been well studied. In this study, we evaluated the RV function in patients with idiopathic pulmonary hypertension (IPH) versus secon-dary pulmonary hypertension (SPH) due to congestive heart failure. Material and method: Forty-five patients with pulmonary hypertension and New York Heart Association (NYHA) functional class II or III were enrolled. Of these, 22 were diagnosed with IPH and 23 with SPH. Echocardiographic data, including Doppler and Doppler based strain, were assessed according to the American Society of Echocardiography (ASE) Guideliness for detailed evaluation of RV function in these two groups. Results: Mean PAP was 60 ± 14.5 mm Hg in patients with IPH versus 43 ± 11.5 mm Hg in patients with SPH (p = 0.001). Considering conventional indexes of RV function, only Sm and dp/dt were significantly better in the first group compared with the second group (p-value for Sm = 0.042 and for dp/dt = 0.039). RV end diastolic dimension was significantly higher in the IPH group (p = 0.013). Using deformation indexes of RV function, the basal and mid portion of RV free wall strain and basal RV strain rates were significantly worse in the chronic systolic heart failure (PH-HF) group in comparison to the IPH group (p < 0.001 in basal RV strain, p = 0.034 in mid RV strain and p = 0.046 in basal RV strain rate respectively). Conclusion: IPH has less impact on RV function in comparison to PH-HF. Considering both entities are in the category of RV pressure overload, we conclude that the etiology of pulmonary hypertension also plays an important role in RV function in addition to pressure overload. Full article

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Open AccessArticle

Extracorporeal Life Support after Failure of Thrombolysis in Pulmonary Embolism

by Sven Kaese and Pia Lebiedz

Adv. Respir. Med. 2020, 88(1), 13-17; https://doi.org/10.5603/ARM.a2020.0073 - 25 Feb 2020

Cited by 5 | Viewed by 722

Abstract

Introduction: Fulminant pulmonary embolism (PE) may lead to cardiogenic shock or cardiac arrest with high mortality rates (65%) despite treatment with thrombolysis. Patients not responding to this therapy might benefit from extracorporeal life support (ECLS). Only occasional Case Reports of ECLS in PE [...] Read more.

Introduction: Fulminant pulmonary embolism (PE) may lead to cardiogenic shock or cardiac arrest with high mortality rates (65%) despite treatment with thrombolysis. Patients not responding to this therapy might benefit from extracorporeal life support (ECLS). Only occasional Case Reports of ECLS in PE patients are available. We studied the use of ECLS after thrombolysis in patients suffering from refractory cardiogenic shock due to PE. Material and methods: Patients who were admitted to our university intensive care unit (ICU) with PE, not responding to throm-bolysis, and who received subsequent ECLS treatment were studied. Results: 12 patients with severe PE were included. 6 patients were admitted by emergency medical services, 5 patients were transferred to the ICU from other hospitals and one patient presented at the emergency department by herself. 11 of 12 patients suffered from cardiac arrest and needed cardiopulmonary resuscitation (CPR) before ECLS implantation. Three ECLS were im-planted during CPR and nine ECLS were implanted during emergency conditions in patients with cardiogenic shock. All patients received thrombolysis before implementation of ECLS. Mean duration of ICU treatment was 22.4 ± 23.0 days. Mean duration of ECLS therapy was 5.6 ± 6.5 days. Bleeding complications occurred in four patients. Complications directly related to the ECLS system occurred in two patients (overall complication rate 42%). Overall, 6 of 12 patients (50%) survived. Conclusions: ECLS may be considered as abailout therapy in PE patients not responding to prior definitive treatment such as thrombolysis. ECLS therapy seems to be feasible with an acceptable complication rate even after thrombolysis. Full article

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Open AccessCase Report

Hemoptysis with Lung Cavity—Triple Whammy

by Vidushi Rathi and Pranav Ish

Adv. Respir. Med. 2020, 88(1), 35-36; https://doi.org/10.5603/ARM.a2020.0078 - 20 Feb 2020

Cited by 2 | Viewed by 560

Abstract

A 37-year male presented with cough and dyspnoea for 9 months that had worsened over the past 7 days and was complicated by haemoptysis [...] Full article

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Open AccessCase Report

Treatment of Persistent Air Leak with Endobronchial Valves

by Fransien Van Hende and Kris Carron

Adv. Respir. Med. 2020, 88(1), 28-30; https://doi.org/10.5603/ARM.a2020.0075 - 20 Feb 2020

Viewed by 558

Abstract

Persistent pulmonary air leaks are usually treated conservatively with prolonged thoracostomy tube drainage. In case this approach fails, surgical revision used to be the only option. This Case Report describes the successful treatment of a 66-year old patient who developped a pulmonary air [...] Read more.

Persistent pulmonary air leaks are usually treated conservatively with prolonged thoracostomy tube drainage. In case this approach fails, surgical revision used to be the only option. This Case Report describes the successful treatment of a 66-year old patient who developped a pulmonary air leak after cardiothoracic surgery that persisted despite attempted surgical repair and talc pleurodesis. The treatment was successfully completed with endobronchial valves thereby demonstrating that treatment with endobronchial valves doesn’t only represent an alternative to surgery, but that it can also be successful in case surgical intervention fails. Full article

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Adv. Respir. Med., Volume 88, Issue 1 (February 2020) – 10 articles , Pages 1-94

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