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Interstitial lung disease was suspected, but biopsy revealed pulmonary lymphangitis carcinomatosa. 怀疑是间质性肺病,但活检发现是肺淋巴管癌变。
IF 1.8 Q3 RESPIRATORY SYSTEM Pub Date : 2024-06-18 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2365510
Solveig Randers Olesen, Sissel Kronborg-White, Line Bille Madsen, Elisabeth Bendstrup

Introduction: Pulmonary lymphangitis carcinomatosa is a rare and severe manifestation of metastatic disease that causes pulmonary symptoms and radiologic patterns similar to interstitial lung diseases.

Case presentation: We report a case of a 78-year-old woman who presented to our department with insidiously developed symptoms of fatigue, dry cough, and severe dyspnea for 3 months. Chest radiography showed bilateral interstitial changes. On suspicion of interstitial lung disease, bronchoscopy and transbronchial cryobiopsy were carried out. Surprisingly, histopathological investigation revealed pulmonary lymphangitis carcinomatosa originating from primary breast adenocarcinoma.

Conclusion: To achieve an accurate diagnosis and prevent delay of initiation of proper treatment a thorough diagnostic approach is necessary. In case of doubt, biopsy should be performed to secure clarification. In this case report we discuss the diagnostic value of transbroncial cryobiopsy for this purpose.

导言:肺癌性淋巴管炎是转移性疾病的一种罕见而严重的表现,它引起的肺部症状和影像学形态与间质性肺病相似:我们报告了一例 78 岁妇女的病例,她因隐匿性乏力、干咳和严重呼吸困难症状 3 个月而到我科就诊。胸片显示双侧肺间质改变。由于怀疑是间质性肺病,医生对其进行了支气管镜检查和经支气管冷冻活检。令人惊讶的是,组织病理学检查显示,肺淋巴管癌变源于原发性乳腺癌:结论:为了获得准确的诊断,避免延误适当的治疗,必须采取彻底的诊断方法。如有疑问,应进行活检以明确诊断。在本病例报告中,我们讨论了经支气管冷冻活检术的诊断价值。
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引用次数: 0
Added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in diagnosing and staging of lung cancer. 在肺癌诊断和分期方面,EUS-B-FNA 比支气管镜检查和 EBUS-TBNA 更有价值。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2024-06-09 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2362995
Mohammad A Issa, Paul F Clementsen, Christian B Laursen, Ida S Christiansen, Laurence Crombag, Peter Vilmann, Uffe Bodtger

Background: Bronchoscopy and EBUS are standard procedures in lung cancer work-up but have low diagnostic yield in lesions outside the central airways and hilar/mediastinal lymph nodes. Growing evidence on introducing the EBUS endoscope into the oesophagus (EUS-B) in the same session as bronchoscopy/EBUS gives access to new anatomical areas that can be safely biopsied.

Objective: To summarize the current evidence of the added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in lung cancer work-up.

Methods: A narrative review.

Results: Few randomized trials or prospective studies are available. Prospective studies show that add-on EUS-B-FNA increases diagnostic yield when sampling abnormal mediastinal lymph nodes, para-oesophageal lung and left adrenal gland. A large retrospective series on EUS-B-FNA from retroperitoneal lymph nodes suggests high diagnostic yield without safety concerns, as do casuistic reports on EUS-B-FNA from mediastinal pleural thickening, pancreatic lesions, ascites fluid and pericardial effusions. No study has systematically assessed both diagnostic yield, safety, patient reported outcomes, adverse events and costs.

Conclusion: The diagnostic value of add-on EUS-B to standard bronchoscopy and EBUS in lung cancer work-up appears very promising without safety concerns, giving the pulmonologist access to a variety of sites out of reach with other minimally invasive techniques. Little is known on patient-reported outcomes and costs. Future and prospective research should focus on effectiveness aspects to clarify whether overall benefits of add-on EUS-B sufficiently exceed overall downsides.

背景:支气管镜检查和 EBUS 是肺癌检查的标准程序,但对中央气道和腹腔/纵隔淋巴结以外的病变诊断率较低。越来越多的证据表明,在支气管镜/EBUS检查的同时将EBUS内窥镜引入食道(EUS-B),可进入新的解剖区域进行安全活检:目的:总结EUS-B-FNA与支气管镜检查和EBUS-TBNA在肺癌检查中的附加价值的现有证据:方法:叙述性综述:很少有随机试验或前瞻性研究。前瞻性研究显示,在采样异常纵隔淋巴结、食管旁肺和左肾上腺时,附加 EUS-B-FNA 可提高诊断率。一项关于腹膜后淋巴结 EUS-B-FNA 的大型回顾性系列研究表明,诊断率高且无安全问题,关于纵隔胸膜增厚、胰腺病变、腹水和心包积液 EUS-B-FNA 的病例报告也是如此。目前还没有研究对诊断率、安全性、患者报告结果、不良事件和成本进行系统评估:结论:在标准支气管镜检查和 EBUS 检查的基础上增加 EUS-B 对肺癌检查的诊断价值似乎很有希望,而且没有安全问题,可让肺科医生检查其他微创技术无法检查到的各种部位。关于患者报告的结果和成本,目前所知甚少。未来的前瞻性研究应重点关注有效性方面,以明确附加 EUS-B 的总体益处是否足以超过总体弊端。
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引用次数: 0
Inhaled corticosteroid treatment and pneumonia in patients with chronic obstructive pulmonary disease - nationwide development from 1998 to 2018. 吸入皮质类固醇治疗与慢性阻塞性肺病患者的肺炎--1998 年至 2018 年的全国发展情况。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2024-05-29 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2359768
Allan Klitgaard, Rikke Ibsen, Jesper Lykkegaard, Ole Hilberg, Anders Løkke

Background: A decreasing use of inhaled corticosteroids (ICS) in patients with a hospital-registered diagnosis of chronic obstructive pulmonary disease (COPD) has recently been documented in Denmark. ICS treatment is not recommended in patients with high pneumonia risk, and we aimed to assess the development of ICS treatment in relation to pneumonia occurrence.

Methods: Annual nationwide register-based cross-sectional studies from 1998 to 2018 including all patients ≥40 years of age with a hospital-registered ICD-10 diagnosis of COPD on the 31st of December each year. We calculated the annual proportion of patients with at least one outpatient pneumonia (redeemed prescription of relevant antibiotics) or pneumonia hospitalization (hospitalization or ER visit), and stratified by ICS dose (No ICS, low dose, medium dose, or high dose).

Results: The study population increased from 35,656 patients in 1998 to 99,057 patients in 2018. The annual proportion of patients experiencing a pneumonia decreased from 69.4% to 55.2%. The proportion of patients with at least one outpatient pneumonia, but no hospitalization, decreased (59.2% to 46.2%). The overall proportion of patients with at least one pneumonia hospitalization remained unchanged (10.2% to 9.0%), but this proportion increased in patients in high dose ICS (9.9% to 14.6%). The overall proportion of patients in high dose treatment decreased (12.7% to 5.7%), but not in patients with pneumonia hospitalization (16.5% to 15.1).

Conclusions: Our study demonstrates a nationwide decrease from 1998 to 2018 in the proportion of patients who redeemed a prescription for antibiotics used mainly for respiratory tract infections, which may reflect a decrease in the number of outpatient pneumonias. This decrease was largely caused by an increase in the number of patients without pneumonia. No differences over time were seen regarding hospitalization-requiring pneumonia. High dose ICS treatment was unchanged in patients with hospitalization-requiring pneumonia.

背景:最近,在丹麦,经医院登记确诊为慢性阻塞性肺病(COPD)的患者使用吸入性皮质类固醇(ICS)的情况有所减少。我们的目的是评估 ICS 治疗的发展与肺炎发生率的关系:1998年至2018年期间每年在全国范围内进行的基于登记的横断面研究,包括每年12月31日在医院登记的ICD-10诊断为慢性阻塞性肺病的所有年龄≥40岁的患者。我们计算了每年至少有一次肺炎门诊(兑换相关抗生素处方)或肺炎住院(住院或急诊室就诊)的患者比例,并按 ICS 剂量(无 ICS、低剂量、中剂量或高剂量)进行了分层:研究人群从1998年的35656名患者增加到2018年的99057名患者。每年发生肺炎的患者比例从 69.4% 降至 55.2%。至少有一次门诊肺炎但未住院的患者比例有所下降(59.2% 降至 46.2%)。至少有一次肺炎住院治疗的患者总比例保持不变(从 10.2% 降至 9.0%),但大剂量 ICS 患者的这一比例有所上升(从 9.9% 升至 14.6%)。接受大剂量治疗的患者总体比例有所下降(从 12.7% 降至 5.7%),但肺炎住院患者的比例没有下降(从 16.5% 降至 15.1):我们的研究表明,从 1998 年到 2018 年,全国范围内兑换主要用于呼吸道感染的抗生素处方的患者比例有所下降,这可能反映了门诊肺炎数量的减少。这一下降主要是由非肺炎患者人数的增加造成的。在需要住院治疗的肺炎方面,没有发现不同时期的差异。需要住院治疗的肺炎患者接受大剂量 ICS 治疗的情况没有变化。
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引用次数: 0
The relationship of gastroesophageal reflux disease and asthma control. 胃食管反流病与哮喘控制的关系。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2024-05-11 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2348267
Arzoe Singh, Rahul Khanna, Annya Suman, Jack Pollack, Sudhir Sekhsaria

Purpose: To study whether ACT responses are confounded by gastro-esophageal status (GERD), and if this is in concordance with the variation in Forced Expiratory Volume in 1 second (FEV1%) and Fractional Excretion of Nitric Oxide (FeNO).

Materials and methods: This is a prospective cohort study (n = 307). Patients were surveyed for demographics data, and underwent ACT scoring, FEV1% and FeNO testing.

Results: Patients with GERD had mean ACT scores that were 4.1 (p < .001) lower than without-GERD group. Not-well-controlled asthmatics (FEV1% <80, high FeNO) with-GERD had mean ACT scores that were 2.9 (p < .001) for FEV1% <80 and 3.8 (p = .008) for high FeNO lower than without-GERD group respectively. Well-controlled asthmatics (FEV1% ≥80, low FeNO) with-GERD had mean ACT scores that were 5.2 (p < .001) for FEV1% ≥80 and 5.1 (p < .001) for low FeNO lower than without-GERD group respectively.

Conclusion: Our study demonstrates that symptoms of GERD can lead to an inaccurate perception of asthma control and ACT as compared to objective measures, such as FEV1% and FeNO. Hence, this can lead to mismanagement of asthma, especially when objective measures are not conducted along with ACT.

目的:研究 ACT 反应是否受到胃食管反流状态(GERD)的影响,以及这种影响是否与 1 秒内用力呼气容积(FEV1%)和一氧化氮分排泄量(FeNO)的变化一致:这是一项前瞻性队列研究(n = 307)。患者接受了人口统计学数据调查,并接受了 ACT 评分、FEV1% 和 FeNO 测试:结果:胃食管反流病患者的平均 ACT 评分为 4.1 分(p p = .008),而高 FeNO 评分则分别低于无胃食管反流病患者组。胃食管反流患者中,哮喘控制良好者(FEV1% ≥80,低 FeNO)的平均 ACT 得分为 5.2(p p p 结论:我们的研究表明,胃食管反流患者的症状与哮喘控制良好者(FEV1% ≥80,低 FeNO)的症状相似:我们的研究表明,与 FEV1% 和 FeNO 等客观指标相比,胃食管反流病的症状会导致对哮喘控制和 ACT 的认识不准确。因此,这可能会导致哮喘管理不善,尤其是在没有进行客观测量和哮喘治疗的情况下。
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引用次数: 0
Musculoskeletal aspects of respiratory function in cystic fibrosis: a cross-sectional comparative study. 囊性纤维化患者呼吸功能的肌肉骨骼方面:一项横断面比较研究。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2024-05-08 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2350206
Niklas Sinderholm Sposato, Kristofer Bjerså, Marita Gilljam, Louise Lannefors, Monika Fagevik Olsén

Background: Respiration is an intricate interaction between visceral and musculoskeletal structures. In cystic fibrosis (CF), the airways and lungs are subject to progressive obstruction and destruction. However, knowledge about the musculoskeletal aspects of respiratory function and symptoms is still limited in this patient group.

Methods: In a cross-sectional comparative study, 21 adults with CF enrolled at the Gothenburg CF Centre were matched with 42 healthy controls. The two groups were examined and compared in terms of thoracic mobility, respiratory muscle strength, lung function, and musculoskeletal pain in accordance with a predefined protocol.

Results: Significant differences were observed between the groups in the number of tender points, thoracic excursion, forced vital capacity (FVC), and forced expiratory volume (FEV). The CF group also demonstrated a tendency toward reduced function in other measurements, although these were not statistically significant.

Conclusion: This cross-sectional study revealed that people with CF have reduced thoracic mobility and an increased prevalence of muscular tender points, alongside decreased lung function, compared to healthy controls. These findings stress the need for greater emphasis on the often-overlooked musculoskeletal aspects of CF care, especially as people with CF are living longer and may require more musculoskeletal health support.

背景:呼吸是内脏和肌肉骨骼结构之间错综复杂的相互作用。在囊性纤维化(CF)患者中,气道和肺部会受到进行性阻塞和破坏。然而,对于这一患者群体,有关呼吸功能和症状的肌肉骨骼方面的知识仍然有限:在一项横断面比较研究中,哥德堡 CF 中心的 21 名成年 CF 患者与 42 名健康对照者进行了配对。按照预定方案对两组患者的胸廓活动度、呼吸肌力量、肺功能和肌肉骨骼疼痛进行了检查和比较:结果:两组在触痛点数量、胸廓偏移、用力肺活量(FVC)和用力呼气容积(FEV)方面存在显著差异。CF组在其他测量指标上也表现出功能减退的趋势,但在统计学上并不显著:这项横断面研究显示,与健康对照组相比,CF 患者的胸廓活动度降低,肌肉触痛点增加,同时肺功能下降。这些发现强调,有必要更加重视CF护理中经常被忽视的肌肉骨骼方面,尤其是CF患者的寿命越来越长,可能需要更多的肌肉骨骼健康支持。
{"title":"Musculoskeletal aspects of respiratory function in cystic fibrosis: a cross-sectional comparative study.","authors":"Niklas Sinderholm Sposato, Kristofer Bjerså, Marita Gilljam, Louise Lannefors, Monika Fagevik Olsén","doi":"10.1080/20018525.2024.2350206","DOIUrl":"10.1080/20018525.2024.2350206","url":null,"abstract":"<p><strong>Background: </strong>Respiration is an intricate interaction between visceral and musculoskeletal structures. In cystic fibrosis (CF), the airways and lungs are subject to progressive obstruction and destruction. However, knowledge about the musculoskeletal aspects of respiratory function and symptoms is still limited in this patient group.</p><p><strong>Methods: </strong>In a cross-sectional comparative study, 21 adults with CF enrolled at the Gothenburg CF Centre were matched with 42 healthy controls. The two groups were examined and compared in terms of thoracic mobility, respiratory muscle strength, lung function, and musculoskeletal pain in accordance with a predefined protocol.</p><p><strong>Results: </strong>Significant differences were observed between the groups in the number of tender points, thoracic excursion, forced vital capacity (FVC), and forced expiratory volume (FEV). The CF group also demonstrated a tendency toward reduced function in other measurements, although these were not statistically significant.</p><p><strong>Conclusion: </strong>This cross-sectional study revealed that people with CF have reduced thoracic mobility and an increased prevalence of muscular tender points, alongside decreased lung function, compared to healthy controls. These findings stress the need for greater emphasis on the often-overlooked musculoskeletal aspects of CF care, especially as people with CF are living longer and may require more musculoskeletal health support.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"11 1","pages":"2350206"},"PeriodicalIF":1.9,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11080665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ultrasound in predicting improvement in dyspnoea after therapeutic thoracentesis in patients with recurrent unilateral pleural effusion. 超声波预测复发性单侧胸腔积液患者治疗性胸腔穿刺术后呼吸困难的改善情况。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2024-05-05 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2337446
Katrine Fjaellegaard, Jesper Koefod Petersen, Gitte Alstrup, Søren Skaarup, Paul Frost Clementsen, Christian B Laursen, Rahul Bhatnagar, Uffe Bodtger

Background: In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following drainage may support the management of these patients. This study aimed to assess the association between ultrasound (US) characteristics and a relevant improvement in dyspnoea immediately following drainage.

Methods: In a prospective, observational study, patients with recurrent unilateral pleural effusion underwent US evaluation of effusion characteristics and diaphragm movement measured by M-mode and the Area method before and right after drainage. The level of dyspnoea was assessed using the modified Borg scale (MBS). A minimal important improvement in dyspnoea was defined as delta MBS ≥ 1.

Results: In the 104 patients included, 53% had a minimal important improvement in dyspnoea following thoracentesis. We found no association between US-characteristics, including diaphragm shape or movement (M-mode or the Area method), and a decrease in dyspnoea following drainage. Baseline MBS score ≥ 4 and a fully drained effusion were significant correlated with a minimal important improvement in dyspnoea (OR 3.86 (1.42-10.50), p = 0.01 and 2.86 (1.03-7.93), p = 0.04, respectively).

Conclusions: In our study population, US-characteristics including assessment of diaphragm movement or shape was not associated with a minimal important improvement in dyspnoea immediately following thoracentesis.

背景:对于复发性胸腔积液患者,治疗性胸腔穿刺术是一种缓解方法。正确预测哪些患者在引流后症状会得到缓解,有助于这些患者的治疗。本研究旨在评估超声(US)特征与引流后呼吸困难立即得到改善之间的关联:在一项前瞻性观察研究中,复发性单侧胸腔积液患者在引流前和引流后立即接受了超声评估,通过 M 型和面积法测量了积液特征和横膈膜运动。呼吸困难程度采用改良博格量表(MBS)进行评估。结果:在纳入的 104 名患者中,53% 的患者在胸腔穿刺术后呼吸困难得到了最小程度的改善。我们发现 US 特征(包括横膈膜形状或移动(M 模式或区域法))与引流后呼吸困难的减轻之间没有关联。基线 MBS 评分≥4 和完全引流的积液与呼吸困难的最小重要改善显著相关(OR 分别为 3.86 (1.42-10.50),p = 0.01 和 2.86 (1.03-7.93),p = 0.04):在我们的研究人群中,包括评估横膈膜运动或形状在内的 US 特征与胸腔穿刺术后呼吸困难的最小重要改善无关。
{"title":"Ultrasound in predicting improvement in dyspnoea after therapeutic thoracentesis in patients with recurrent unilateral pleural effusion.","authors":"Katrine Fjaellegaard, Jesper Koefod Petersen, Gitte Alstrup, Søren Skaarup, Paul Frost Clementsen, Christian B Laursen, Rahul Bhatnagar, Uffe Bodtger","doi":"10.1080/20018525.2024.2337446","DOIUrl":"10.1080/20018525.2024.2337446","url":null,"abstract":"<p><strong>Background: </strong>In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following drainage may support the management of these patients. This study aimed to assess the association between ultrasound (US) characteristics and a relevant improvement in dyspnoea immediately following drainage.</p><p><strong>Methods: </strong>In a prospective, observational study, patients with recurrent unilateral pleural effusion underwent US evaluation of effusion characteristics and diaphragm movement measured by M-mode and the Area method before and right after drainage. The level of dyspnoea was assessed using the modified Borg scale (MBS). A minimal important improvement in dyspnoea was defined as delta MBS ≥ 1.</p><p><strong>Results: </strong>In the 104 patients included, 53% had a minimal important improvement in dyspnoea following thoracentesis. We found no association between US-characteristics, including diaphragm shape or movement (M-mode or the Area method), and a decrease in dyspnoea following drainage. Baseline MBS score ≥ 4 and a fully drained effusion were significant correlated with a minimal important improvement in dyspnoea (OR 3.86 (1.42-10.50), <i>p</i> = 0.01 and 2.86 (1.03-7.93), <i>p</i> = 0.04, respectively).</p><p><strong>Conclusions: </strong>In our study population, US-characteristics including assessment of diaphragm movement or shape was not associated with a minimal important improvement in dyspnoea immediately following thoracentesis.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"11 1","pages":"2337446"},"PeriodicalIF":1.9,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adult-onset asthma, allergy, and aspirin hypersensitivity associate with self-reported food avoidance. 成人哮喘、过敏和阿司匹林过敏与自我报告的食物回避有关。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2024-05-02 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2347073
Marie Lundberg, Helena Voutilainen, Annina Lyly, Jussi Karjalainen, Heini Huhtala, Tanya M Laidlaw, Stella E Lee, Mikko Nuutinen, Sanna Toppila-Salmi

Background: The adoption of avoidance diets by adult-onset asthmatics has not previously been studied. We hypothesized that avoidance diets would associate with adult-onset asthma, allergy, and aspirin-exacerbated respiratory disease (AERD).

Methods: A total of 1247 subjects with adult-onset asthma (age range: 31-91) from the Finnish national registry, and age- and sex-matched controls (n = 1970) participated in a questionnaire study in 1997. We estimated the association between asthma/allergy/AERD and avoidance diets, adjusting for potential confounding factors and validated the results in two retrospective cohorts of 5080 rhinitis/rhinosinusitis patients and 167 AERD patients from 2019 to 2020.

Results: The presence of asthma positively associated with adoption of any avoidance diet (adjusted OR [CI95%] 1.24 [1.02-1.51], p = 0.029) as did allergic disease and self-reported AERD within the asthmatic group (1.79 [1.29-2.48], p = 0.001 and 1.69 [1.15-2.49], p = 0.007, respectively). Asthmatics and allergic asthmatics were more likely to report avoidance of fish, fruits and vegetables, and spices (p ≤ 0.03) compared to controls and non-allergic asthmatics. The adjusted OR for multiple diets among AERD patients was 2.57 [1.34-4.95] p = 0.005. In the validation, 26.2% of the allergic asthmatics and 10.8% of AERD patients had documented avoidance diets.

Conclusions: Our study shows a positive association between avoidance diets and adult-onset asthma, and with allergic disease or AERD within asthmatic patients. Although we lack information on the reason patients chose to observe a specific diet, our results reinforce the importance of asking patients about their diet and if needed, giving dietary advice for adult asthma patients to help them avoid the adoption of unnecessarily restrictive diets.

背景:以前从未研究过成年哮喘患者采用忌口饮食的情况。我们假设忌口饮食与成人哮喘、过敏和阿司匹林加重呼吸道疾病(AERD)有关:1997年,来自芬兰国家登记处的1247名成人哮喘患者(年龄在31-91岁之间)以及年龄和性别匹配的对照组(n = 1970)参加了一项问卷调查。我们估算了哮喘/过敏/肺气肿与忌口饮食之间的关系,调整了潜在的混杂因素,并在2019年至2020年的两个回顾性队列中对5080名鼻炎/鼻窦炎患者和167名肺气肿患者的结果进行了验证:哮喘与采用任何忌口饮食呈正相关(调整后 OR [CI95%]为 1.24 [1.02-1.51],p = 0.029),哮喘组中的过敏性疾病和自我报告的 AERD 也是如此(分别为 1.79 [1.29-2.48],p = 0.001 和 1.69 [1.15-2.49],p = 0.007)。与对照组和非过敏性哮喘患者相比,哮喘患者和过敏性哮喘患者更有可能报告避免食用鱼类、水果和蔬菜以及香料(p ≤ 0.03)。过敏性哮喘患者多种饮食的调整 OR 值为 2.57 [1.34-4.95] p = 0.005。在验证中,26.2% 的过敏性哮喘患者和 10.8% 的过敏性胃食管反流病患者有忌口的记录:我们的研究表明,忌口与成人哮喘、过敏性疾病或哮喘性呼吸道疾病之间存在正相关。虽然我们缺乏有关患者选择特定饮食的原因的信息,但我们的研究结果加强了询问患者饮食情况的重要性,并在必要时为成年哮喘患者提供饮食建议,以帮助他们避免采用不必要的限制性饮食。
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引用次数: 0
Case series of complicated bronchopulmonary lophomoniasis. Differential diagnosis of tuberculosis? 复杂性支气管肺吸虫病病例系列。肺结核的鉴别诊断?
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2024-03-06 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2325170
Cristian Morán-Mariños, Juan Salas López, Felix Llanos-Tejada, Renato Casanova-Mendoza, Renzo Villanueva-Villegas, Antonella Chavez-Huamani, Kenneth G Vargas-Ponce, Margaret Condori-Zevallos

Pulmonary lophomoniasis is a rare and life-threatening disease, most commonly reported across Asian and Latin American countries. Here, we have reported two cases of pulmonary lophomoniasis presenting with atypical manifestations. Case #1 represents a 19-year-old male patient with clinical characteristics suggestive of tuberculosis, presenting with hemoptysis and receiving antituberculosis treatment. Case #2 represents a 69-year-old man with post-tuberculosis pulmonary disease with cystic bronchiectasis presenting with polymicrobial co-infection. Based on our case experience, lophomoniasis should be considered in patients with pneumonia who do not respond to antibiotic treatment, and the corresponding epidemiological factors should be carefully considered in addition to bronchoscopy for precise diagnosis.

肺吸虫病是一种罕见的危及生命的疾病,在亚洲和拉丁美洲国家最常见。在此,我们报告了两例表现不典型的肺吸虫病病例。病例 1 是一名 19 岁的男性患者,临床特征提示为肺结核,出现咯血并正在接受抗结核治疗。病例 2 代表一名 69 岁的男性患者,患有结核病后肺部疾病,伴有囊性支气管扩张,并出现多微生物合并感染。根据我们的病例经验,对抗生素治疗无效的肺炎患者应考虑嗜血杆菌病,除支气管镜检查外,还应仔细考虑相应的流行病学因素,以进行精确诊断。
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引用次数: 0
Incidental pulmonary nodules may lead to a high proportion of early-stage lung cancer: but it requires more than a high CT volume to achieve this. 偶然发现的肺结节可能会导致较高比例的早期肺癌:但要做到这一点,需要的不仅仅是较高的 CT 容量。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2024-02-18 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2313311
M Borg, U Bodtger, K Kristensen, G Alstrup, T Mamaeva, A Arshad, C B Laursen, O Hilberg, M Brun Andersen, T Riis Rasmussen

Background: The management of pulmonary nodules plays a critical role in early detection of lung cancer. Computed tomography (CT) has led to a stage-shift towards early-stage lung cancer, but regional differences in survival rates have been reported in Denmark. This study aimed to evaluate whether variations in nodule management among Danish health regions contributed to these differences.

Material and methods: The Danish Health Data Authority and Danish Lung Cancer Registry provided data on CT usage and lung cancer stage distribution, respectively. Auditing of lung cancer stage IA patient referrals and nodule management of stage IV lung cancer patients was conducted in seven Danish lung cancer investigation centers, covering four of the five Danish health regions. CT scans were performed up to 2 years before the patients' diagnosis from 2019 to 2021.

Results: CT usage has increased steadily in Denmark over the past decade, with a simultaneous increase in the proportion of early-stage lung cancers, particularly stage IA. However, one Danish health region, Region Zealand, exhibited lower rates of early-stage lung cancer and overall survival despite a CT usage roughly similar to that of the other health regions. The audit did not find significant differences in pulmonary nodule management or a higher number of missed nodules by radiologists in this region compared to others.

Conclusion: This study suggests that a high CT scan volume alone is not sufficient for the early detection of lung cancer. Factors beyond hospital management practices, such as patient-related delays in socioeconomically disadvantaged areas, may contribute to regional differences in survival rates. This has implications for future strategies for reducing these differences.

背景:肺结节的管理在早期肺癌的检测中起着至关重要的作用。计算机断层扫描(CT)已导致肺癌分期向早期转移,但在丹麦,有报道称各地区的生存率存在差异。本研究旨在评估丹麦各卫生区在结节管理方面的差异是否导致了这些差异:丹麦卫生数据管理局和丹麦肺癌登记处分别提供了有关 CT 使用情况和肺癌分期分布的数据。七个丹麦肺癌调查中心对肺癌IA期患者的转诊和肺癌IV期患者的结节管理进行了审计,这些中心覆盖了丹麦五个卫生区中的四个。从2019年至2021年,在患者确诊前2年内进行了CT扫描:过去十年间,丹麦的CT使用率稳步上升,早期肺癌,尤其是IA期肺癌的比例也同时增加。然而,丹麦的一个卫生区--新西兰区,尽管CT使用率与其他卫生区大致相同,但早期肺癌发病率和总生存率却较低。与其他地区相比,审计并未发现该地区放射科医生在肺结节管理或漏诊结节数量方面存在明显差异:这项研究表明,仅靠高CT扫描量不足以早期发现肺癌。医院管理实践以外的因素,如社会经济条件较差地区与患者相关的延误,可能是造成地区生存率差异的原因。这对未来缩小这些差异的战略具有影响。
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引用次数: 0
National survey on management of spontaneous pneumothorax from emergency department to specialised treatment: room for improvement. 关于自发性气胸从急诊科到专科治疗的管理的全国调查:改进空间。
IF 1.9 Q3 RESPIRATORY SYSTEM Pub Date : 2024-01-31 eCollection Date: 2024-01-01 DOI: 10.1080/20018525.2024.2307648
Søren Helbo Skaarup, Christian B Laursen, Rob J Hallifax, Beenish Iqbal, Uffe Bødtger

Introduction: Spontaneous pneumothorax (SP) affects both young, otherwise healthy individuals and older persons with known underlying pulmonary disease. Initial management possibilities are evolving and range from observation to chest tube insertion. SP guidelines suggest an individualized approach based on multiple factors such as symptoms, size of pneumothorax, comorbidity and patient preference.

Aim: With this Danish national survey we aimed to map organization of care including involved specialties, treatment choice, training, and follow-up plans to identify aspects, and optimization of spontaneous pneumothorax management.

Method: A survey developed by the national interest group for pleural medicine was sent to all departments of emergency medicine, thoracic surgery, respiratory medicine, and to relevant departments of abdominal or orthopaedic surgery.

Results: The response rate was 75 % (47 of 65). Overall, 21% of responding departments had no guideline for SP management, which was provided by multiple specialties with marked heterogeneity in choice of treatment including tube size, management during admission, and referral procedure to follow-up. Few departments required procedure training, and nearly all of the responders called for improvements in management of pneumothorax.

Conclusion: This survey suggests that SP management and care is delivered heterogeneously across Danish hospitals with marked difference between respiratory physicians, emergency physicians, general surgeons and thoracic surgeons. It is therefore likely that management is sub-optimal. There is a need for a common Danish SP guideline to ensure optimal treatment across involved specialties.

导言:自发性气胸(SP)既影响健康的年轻人,也影响患有潜在肺部疾病的老年人。最初的处理方法不断变化,从观察到插入胸管不等。SP指南建议根据多种因素(如症状、气胸大小、合并症和患者偏好)采取个体化方法。目的:通过这项丹麦全国性调查,我们旨在绘制医疗组织图,包括涉及的专科、治疗选择、培训和随访计划,以确定自发性气胸管理的各个方面和优化方法:方法:向所有急诊科、胸外科、呼吸内科以及相关的腹部或骨科手术部门发送由全国胸膜医学兴趣小组制定的调查问卷:结果:回复率为 75%(65 个回复中的 47 个)。总体而言,21%的回复科室没有制定SP管理指南,该指南由多个专科提供,在选择治疗方法(包括插管大小、入院期间的管理和随访转诊程序)方面存在明显差异。很少有科室要求进行程序培训,几乎所有的受访者都呼吁改善气胸的管理:这项调查表明,丹麦各家医院在气胸管理和护理方面的做法不尽相同,呼吸内科医生、急诊内科医生、普通外科医生和胸外科医生之间存在明显差异。因此,管理很可能不尽如人意。有必要制定丹麦 SP 共同指南,以确保各相关专科都能提供最佳治疗。
{"title":"National survey on management of spontaneous pneumothorax from emergency department to specialised treatment: room for improvement.","authors":"Søren Helbo Skaarup, Christian B Laursen, Rob J Hallifax, Beenish Iqbal, Uffe Bødtger","doi":"10.1080/20018525.2024.2307648","DOIUrl":"https://doi.org/10.1080/20018525.2024.2307648","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous pneumothorax (SP) affects both young, otherwise healthy individuals and older persons with known underlying pulmonary disease. Initial management possibilities are evolving and range from observation to chest tube insertion. SP guidelines suggest an individualized approach based on multiple factors such as symptoms, size of pneumothorax, comorbidity and patient preference.</p><p><strong>Aim: </strong>With this Danish national survey we aimed to map organization of care including involved specialties, treatment choice, training, and follow-up plans to identify aspects, and optimization of spontaneous pneumothorax management.</p><p><strong>Method: </strong>A survey developed by the national interest group for pleural medicine was sent to all departments of emergency medicine, thoracic surgery, respiratory medicine, and to relevant departments of abdominal or orthopaedic surgery.</p><p><strong>Results: </strong>The response rate was 75 % (47 of 65). Overall, 21% of responding departments had no guideline for SP management, which was provided by multiple specialties with marked heterogeneity in choice of treatment including tube size, management during admission, and referral procedure to follow-up. Few departments required procedure training, and nearly all of the responders called for improvements in management of pneumothorax.</p><p><strong>Conclusion: </strong>This survey suggests that SP management and care is delivered heterogeneously across Danish hospitals with marked difference between respiratory physicians, emergency physicians, general surgeons and thoracic surgeons. It is therefore likely that management is sub-optimal. There is a need for a common Danish SP guideline to ensure optimal treatment across involved specialties.</p>","PeriodicalId":11872,"journal":{"name":"European Clinical Respiratory Journal","volume":"11 1","pages":"2307648"},"PeriodicalIF":1.9,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139671474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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European Clinical Respiratory Journal
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