Pub Date : 2022-11-01DOI: 10.1080/17476348.2022.2159382
Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo
Background: Many patients need repeated bronchoscopies with tissue sampling to obtain the final pathological results and guide the optimal subsequent treatment of pulmonary lesions. However, few studies have explored the safety of repeated biopsies.
Methods: The records of patients who underwent bronchoscopy-guided tissue sampling because of pulmonary lesions at the respiratory department between 1 January 2008 and 31 December 2019 were revised. The patients' clinical characteristics, information about bronchoscopy and incidence of complications were collected and analyzed.
Results: In total, 3899 bronchoscopy-guided tissue sampling procedures were conducted in the 1781 participants. There was no significant difference in the incidence of major complications between the initial bronchoscopies and repeated bronchoscopies (1.12% vs. 1.13%, χ2 < 0.01, df = 1, p = 0.98), as was the incidence of hemoptysis (χ2 = 2.18, df = 1, p = 0.14). However, the bleeding rate of patients who experienced bleeding during the first bronchoscopies was significantly higher than that of patients who did not experience bleeding (61.19% vs. 32.63%, χ2 = 253.00, df = 1, p < 0.01).
Conclusions: For patients with pulmonary lesions, re-bronchoscopy with tissue sampling appears to infer the same risk of bleeding including severe bleeding as experienced during the initial bronchoscopy. However, it should be treated with discretion when performing repeated tissue sampling on patients who once bled.
背景:许多患者需要反复的支气管镜检查和组织取样来获得最终的病理结果,并指导肺部病变的最佳后续治疗。然而,很少有研究探讨重复活检的安全性。方法:对2008年1月1日至2019年12月31日期间因肺部病变在呼吸科接受支气管镜引导下组织取样的患者记录进行修订。收集并分析患者的临床特征、支气管镜检查信息及并发症的发生情况。结果:在1781名参与者中,总共进行了3899次支气管镜引导下的组织取样程序。首次支气管镜检查与多次支气管镜检查的主要并发症发生率比较,差异无统计学意义(1.12% vs 1.13%, χ2 = 2.18, df = 1, p = 0.14)。然而,第一次支气管镜检查出血的患者出血率明显高于未出血的患者(61.19% vs. 32.63%, χ2 = 253.00, df = 1, p)。结论:对于肺部病变患者,再次支气管镜检查并组织取样似乎推断出血的风险与第一次支气管镜检查时相同,包括严重出血。然而,在对曾经出血的患者进行重复组织采样时,应谨慎处理。
{"title":"The bleeding risk and safety of repeated bronchoscopies with tissue sampling in patients with pulmonary lesions.","authors":"Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo","doi":"10.1080/17476348.2022.2159382","DOIUrl":"https://doi.org/10.1080/17476348.2022.2159382","url":null,"abstract":"<p><strong>Background: </strong>Many patients need repeated bronchoscopies with tissue sampling to obtain the final pathological results and guide the optimal subsequent treatment of pulmonary lesions. However, few studies have explored the safety of repeated biopsies.</p><p><strong>Methods: </strong>The records of patients who underwent bronchoscopy-guided tissue sampling because of pulmonary lesions at the respiratory department between 1 January 2008 and 31 December 2019 were revised. The patients' clinical characteristics, information about bronchoscopy and incidence of complications were collected and analyzed.</p><p><strong>Results: </strong>In total, 3899 bronchoscopy-guided tissue sampling procedures were conducted in the 1781 participants. There was no significant difference in the incidence of major complications between the initial bronchoscopies and repeated bronchoscopies (1.12% vs. 1.13%, χ<sup>2</sup> < 0.01, df = 1, p = 0.98), as was the incidence of hemoptysis (χ<sup>2</sup> = 2.18, df = 1, p = 0.14). However, the bleeding rate of patients who experienced bleeding during the first bronchoscopies was significantly higher than that of patients who did not experience bleeding (61.19% vs. 32.63%, χ<sup>2</sup> = 253.00, df = 1, p < 0.01).</p><p><strong>Conclusions: </strong>For patients with pulmonary lesions, re-bronchoscopy with tissue sampling appears to infer the same risk of bleeding including severe bleeding as experienced during the initial bronchoscopy. However, it should be treated with discretion when performing repeated tissue sampling on patients who once bled.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10609145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1080/17476348.2022.2152332
Ahmad R Alsayed, Abdullah Al-Dulaimi, Mohammad Alkhatib, Mohammed Al Maqbali, Mohammad A A Al-Najjar, Mamoon M D Al-Rshaidat
Introduction: Pneumocystis jirovecii is an opportunistic, human-specific fungus that causes Pneumocystis pneumonia (PCP). PCP symptoms are nonspecific. A patient with P. jirovecii and another lung infection faces a diagnostic challenge. It may be difficult to determine which of these agents is responsible for the clinical symptoms, preventing effective treatment. Diagnostic and treatment efforts have been made more difficult by the rising frequency with which coronavirus 2019 (COVID-19) and PCP co-occur.
Areas covered: Herein, we provide a comprehensive review of clinical and pharmacological recommendations along with a literature review of PCP in immunocompromised patients focusing on HIV-uninfected patients.
Expert opinion: PCP may be masked by identifying co-existing pathogens that are not necessarily responsible for the observed infection. Patients with severe form COVID-19 should be examined for underlying immunodeficiency, and co-infections must be considered as co-infection with P. jirovecii may worsen COVID-19's severity and fatality. PCP should be investigated in patients with PCP risk factors who come with pneumonia and suggestive radiographic symptoms but have not previously received PCP prophylaxis. PCP prophylaxis should be explored in individuals with various conditions that impair the immune system, depending on their PCP risk.
{"title":"A comprehensive clinical guide for <i>Pneumocystis jirovecii</i> pneumonia: a missing therapeutic target in HIV-uninfected patients.","authors":"Ahmad R Alsayed, Abdullah Al-Dulaimi, Mohammad Alkhatib, Mohammed Al Maqbali, Mohammad A A Al-Najjar, Mamoon M D Al-Rshaidat","doi":"10.1080/17476348.2022.2152332","DOIUrl":"https://doi.org/10.1080/17476348.2022.2152332","url":null,"abstract":"<p><strong>Introduction: </strong><i>Pneumocystis jirovecii</i> is an opportunistic, human-specific fungus that causes <i>Pneumocystis</i> pneumonia (PCP). PCP symptoms are nonspecific. A patient with <i>P. jirovecii</i> and another lung infection faces a diagnostic challenge. It may be difficult to determine which of these agents is responsible for the clinical symptoms, preventing effective treatment. Diagnostic and treatment efforts have been made more difficult by the rising frequency with which coronavirus 2019 (COVID-19) and PCP co-occur.</p><p><strong>Areas covered: </strong>Herein, we provide a comprehensive review of clinical and pharmacological recommendations along with a literature review of PCP in immunocompromised patients focusing on HIV-uninfected patients.</p><p><strong>Expert opinion: </strong>PCP may be masked by identifying co-existing pathogens that are not necessarily responsible for the observed infection. Patients with severe form COVID-19 should be examined for underlying immunodeficiency, and co-infections must be considered as co-infection with <i>P. jirovecii</i> may worsen COVID-19's severity and fatality. PCP should be investigated in patients with PCP risk factors who come with pneumonia and suggestive radiographic symptoms but have not previously received PCP prophylaxis. PCP prophylaxis should be explored in individuals with various conditions that impair the immune system, depending on their PCP risk.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10611592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Lung transplantation (LTx) remains the only therapeutic strategy for patients with incurable lung diseases. However, its use has been severely limited by the narrow donor pool and potential concerns of inferior quality of donor lungs, which are more susceptible to external influence than other transplant organs. Multiple insults, including various causes of death and a series of perimortem events, may act together on donor lungs and eventually culminate in primary graft dysfunction (PGD) after transplantation as well as other poor short-term outcomes.
Areas covered: This review focuses on the predisposing factors contributing to injuries to the donor lungs, specifically focusing on the pathogenesis of these injuries and their impact on post-transplant outcomes. Additionally, various maneuvers to mitigate donor lung injuries have been proposed.
Expert opinion: The selection criteria for eligible donors vary and may be poor discriminators of lung injury. Not all transplanted lungs are in ideal condition. With the rapidly increasing waiting list for LTx, the trend of using marginal donors has become more apparent, underscoring the need to gain a deeper understanding of donor lung injuries and discover more donor resources.
{"title":"Exploring predisposing factors and pathogenesis contributing to injuries of donor lungs.","authors":"Jing Yu, Nan Zhang, Zhiyuan Zhang, Yuping Li, Jiameng Gao, Chang Chen, Zongmei Wen","doi":"10.1080/17476348.2022.2157264","DOIUrl":"https://doi.org/10.1080/17476348.2022.2157264","url":null,"abstract":"<p><strong>Introduction: </strong>Lung transplantation (LTx) remains the only therapeutic strategy for patients with incurable lung diseases. However, its use has been severely limited by the narrow donor pool and potential concerns of inferior quality of donor lungs, which are more susceptible to external influence than other transplant organs. Multiple insults, including various causes of death and a series of perimortem events, may act together on donor lungs and eventually culminate in primary graft dysfunction (PGD) after transplantation as well as other poor short-term outcomes.</p><p><strong>Areas covered: </strong>This review focuses on the predisposing factors contributing to injuries to the donor lungs, specifically focusing on the pathogenesis of these injuries and their impact on post-transplant outcomes. Additionally, various maneuvers to mitigate donor lung injuries have been proposed.</p><p><strong>Expert opinion: </strong>The selection criteria for eligible donors vary and may be poor discriminators of lung injury. Not all transplanted lungs are in ideal condition. With the rapidly increasing waiting list for LTx, the trend of using marginal donors has become more apparent, underscoring the need to gain a deeper understanding of donor lung injuries and discover more donor resources.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10616793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-11-16DOI: 10.1080/17476348.2022.2145948
Fabio Perrotta, Vittorio Chino, Valentino Allocca, Vito D'Agnano, Chandra Bortolotto, Andrea Bianco, Angelo Guido Corsico, Giulia Maria Stella
Introduction: Many data already suggested that cancer and IPF are underlined by a number of common pathogenic biologic pathways. However, fewer data regards the interconnections, in terms of synergy or increased toxicities, of drugs used in cancer and IPF. Particularly, how the specific therapy influences the concurrent condition and prognostic factors of response in patients with both lung cancer and IPF are far to be clarified. Similarly, identification of features of IPF patients with higher risk of developing pulmonary adverse events when treated with chemotherapy, immune checkpoint inhibitors, TKIs, or radiotherapy is of primary importance in clinical practice.
Areas covered: We will discuss the scientific rationale, based on the extensive analysis of literature data, by consulting several databases for combining anticancer and antifibrotic treatments and for the design of novel therapeutic strategies. The role of immunotherapy in cancer aroused in IPF context will be discussed with specific interested, based on the continuously increasing role of immune checkpoint inhibition against lung tumors.
Expert opinion: This work will help to improve knowledge, based on a multidisciplinary perspective, on IPF and cancer patients, which identify an unmet clinical need. A better management during each phase of disease progression will require the design innovative trials and the development of new drugs and molecules both in the oncologic and respiratory medicine pipeline.
{"title":"Idiopathic pulmonary fibrosis and lung cancer: targeting the complexity of the pharmacological interconnection.","authors":"Fabio Perrotta, Vittorio Chino, Valentino Allocca, Vito D'Agnano, Chandra Bortolotto, Andrea Bianco, Angelo Guido Corsico, Giulia Maria Stella","doi":"10.1080/17476348.2022.2145948","DOIUrl":"https://doi.org/10.1080/17476348.2022.2145948","url":null,"abstract":"<p><strong>Introduction: </strong>Many data already suggested that cancer and IPF are underlined by a number of common pathogenic biologic pathways. However, fewer data regards the interconnections, in terms of synergy or increased toxicities, of drugs used in cancer and IPF. Particularly, how the specific therapy influences the concurrent condition and prognostic factors of response in patients with both lung cancer and IPF are far to be clarified. Similarly, identification of features of IPF patients with higher risk of developing pulmonary adverse events when treated with chemotherapy, immune checkpoint inhibitors, TKIs, or radiotherapy is of primary importance in clinical practice.</p><p><strong>Areas covered: </strong>We will discuss the scientific rationale, based on the extensive analysis of literature data, by consulting several databases for combining anticancer and antifibrotic treatments and for the design of novel therapeutic strategies. The role of immunotherapy in cancer aroused in IPF context will be discussed with specific interested, based on the continuously increasing role of immune checkpoint inhibition against lung tumors.</p><p><strong>Expert opinion: </strong>This work will help to improve knowledge, based on a multidisciplinary perspective, on IPF and cancer patients, which identify an unmet clinical need. A better management during each phase of disease progression will require the design innovative trials and the development of new drugs and molecules both in the oncologic and respiratory medicine pipeline.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40683502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-11-16DOI: 10.1080/17476348.2022.2145951
Rezwanul Hasan Rana, Khorshed Alam, Syed Afroz Keramat, Jeff Gow
Introduction: Evidence from non-randomized studies shows benefits for single-inhaler users compared with multiple-inhaler users who receive the same medication. As a result, comparative cost-effectiveness studies are required to inform treatment decisions with an increasing choice of medications and devices for chronic obstructive pulmonary disease (COPD). This study conducted a systematic literature review to evaluate the cost-effectiveness of using a single combination inhaler regimen for patients with severe COPD. This review also investigated the health impact on patients in different settings.
Areas covered: A systematic literature search was conducted in PubMed (MEDLINE), EMBASE, Web of Science, Scopus, Cochrane Library, EBSCO Host (including CINAHL and EconLit), Health Technology Assessment Database, National Institute for Health Research Economic Evaluation Database, Cost-Effectiveness Analysis Registry and Google Scholar.
Expert opinion: Based on the primary findings of 13 included studies: (1) single-inhaler triple therapy was a cost-effective treatment option for patients with severe COPD, and (2) triple therapy also resulted in better health outcomes (reduced exacerbations, life-years gained) and increased QALYs for patients with severe COPD. Nonetheless, eleven out of the thirteen selected studies were funded by the pharmaceutical industry, and none were conducted in the least developed countries. Therefore, the results should be interpreted with caution.
来自非随机研究的证据表明,与接受相同药物的多个吸入器使用者相比,单吸入器使用者获益。因此,随着慢性阻塞性肺疾病(COPD)药物和设备的选择越来越多,需要进行成本效益比较研究,以便为治疗决策提供信息。本研究进行了系统的文献综述,以评估重度COPD患者使用单一联合吸入器方案的成本效益。本综述还调查了不同环境下对患者健康的影响。研究领域:系统检索PubMed (MEDLINE)、EMBASE、Web of Science、Scopus、Cochrane Library、EBSCO Host(包括CINAHL和EconLit)、Health Technology Assessment Database、National Institute for Health Research Economic Evaluation Database、Cost-Effectiveness Analysis Registry和Google Scholar。专家意见:基于纳入的13项研究的主要发现:(1)单吸入器三联疗法对于严重COPD患者是一种具有成本效益的治疗选择,(2)三联疗法还可以改善严重COPD患者的健康结果(减少恶化,获得生命年)并增加QALYs。然而,在选定的13项研究中,有11项是由制药业资助的,而且没有一项是在最不发达国家进行的。因此,研究结果应谨慎解读。
{"title":"Cost-effectiveness of single-inhaler triple therapy for patients with severe COPD: a systematic literature review.","authors":"Rezwanul Hasan Rana, Khorshed Alam, Syed Afroz Keramat, Jeff Gow","doi":"10.1080/17476348.2022.2145951","DOIUrl":"https://doi.org/10.1080/17476348.2022.2145951","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence from non-randomized studies shows benefits for single-inhaler users compared with multiple-inhaler users who receive the same medication. As a result, comparative cost-effectiveness studies are required to inform treatment decisions with an increasing choice of medications and devices for chronic obstructive pulmonary disease (COPD). This study conducted a systematic literature review to evaluate the cost-effectiveness of using a single combination inhaler regimen for patients with severe COPD. This review also investigated the health impact on patients in different settings.</p><p><strong>Areas covered: </strong>A systematic literature search was conducted in PubMed (MEDLINE), EMBASE, Web of Science, Scopus, Cochrane Library, EBSCO Host (including CINAHL and EconLit), Health Technology Assessment Database, National Institute for Health Research Economic Evaluation Database, Cost-Effectiveness Analysis Registry and Google Scholar.</p><p><strong>Expert opinion: </strong>Based on the primary findings of 13 included studies: (1) single-inhaler triple therapy was a cost-effective treatment option for patients with severe COPD, and (2) triple therapy also resulted in better health outcomes (reduced exacerbations, life-years gained) and increased QALYs for patients with severe COPD. Nonetheless, eleven out of the thirteen selected studies were funded by the pharmaceutical industry, and none were conducted in the least developed countries. Therefore, the results should be interpreted with caution.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40689150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-11-21DOI: 10.1080/17476348.2022.2147508
Estee P M Lau, Calvinjit Sidhu, Natalia D Popowicz, Y C Gary Lee
Introduction: Pleural infection causes significant morbidity and mortality. An important aspect in the treatment of pleural infection is the pharmacokinetics of antibiotics, an area often neglected.
Areas covered: Pathophysiology of pleural infection and the importance of antibiotic therapy in the treatment of pleural infection are discussed. After reviewing all available literature on pharmacokinetics of antibiotics for pleural infection, the scarcity of data and knowledge gaps are highlighted.
Expert opinion: This review aims to heighten awareness of the limited pharmacokinetic data of commonly used antibiotics for pleural infection. It serves to remind clinicians that choice of antibiotics for pleural infection should be based not only on bacterial sensitivity but also adequate delivery of antibiotics to the infected pleural cavity. Antibiotic pharmacokinetics may vary with agents used, pleural thickness and individual characteristics. Consideration must be given to insufficient pleural delivery of systemic antibiotics in patients lacking clinical improvement. Pleural infection research has disproportionately focused on fluid drainage. Optimizing delivery of effective antibiotic therapy to the pleural cavity must be regarded a key priority to progress clinical care. Large comprehensive cohort studies on pharmacokinetic variability are the essential next step. The possibility of intrapleural administration is also an area that warrants additional research.
{"title":"Pharmacokinetics of antibiotics for pleural infection.","authors":"Estee P M Lau, Calvinjit Sidhu, Natalia D Popowicz, Y C Gary Lee","doi":"10.1080/17476348.2022.2147508","DOIUrl":"https://doi.org/10.1080/17476348.2022.2147508","url":null,"abstract":"<p><strong>Introduction: </strong>Pleural infection causes significant morbidity and mortality. An important aspect in the treatment of pleural infection is the pharmacokinetics of antibiotics, an area often neglected.</p><p><strong>Areas covered: </strong>Pathophysiology of pleural infection and the importance of antibiotic therapy in the treatment of pleural infection are discussed. After reviewing all available literature on pharmacokinetics of antibiotics for pleural infection, the scarcity of data and knowledge gaps are highlighted.</p><p><strong>Expert opinion: </strong>This review aims to heighten awareness of the limited pharmacokinetic data of commonly used antibiotics for pleural infection. It serves to remind clinicians that choice of antibiotics for pleural infection should be based not only on bacterial sensitivity but also adequate delivery of antibiotics to the infected pleural cavity. Antibiotic pharmacokinetics may vary with agents used, pleural thickness and individual characteristics. Consideration must be given to insufficient pleural delivery of systemic antibiotics in patients lacking clinical improvement. Pleural infection research has disproportionately focused on fluid drainage. Optimizing delivery of effective antibiotic therapy to the pleural cavity must be regarded a key priority to progress clinical care. Large comprehensive cohort studies on pharmacokinetic variability are the essential next step. The possibility of intrapleural administration is also an area that warrants additional research.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40703177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-10-05DOI: 10.1080/17476348.2022.2130764
Andrea Portacci, Paola Pierucci, Vitaliano Nicola Quaranta, Sara Quaranta, Ilaria Iorillo, Cristian Locorotondo, Enrico Buonamico, Silvano Dragonieri, Giovanna Elisiana Carpagnano
Background: Residual alveolar inflammation seems to be paramount in post-COVID pathophysiology. Currently, we still lack a reliable marker to detect and track alveolar phlogosis in these patients. Exhaled Breath Condensate (EBC) pH has robust evidences highlighting its correlation with lung phlogosis in various diseases. We aim to define the reliability of alveolar and bronchial EBC pH in the assessment and in the follow up of post-COVID-related inflammation.
Research design and methods: We enrolled 10 patients previously hospitalized due to COVID-19 pneumonia. We performed a complete follow-up after 3 months and 6 months from discharge. Each visit included routine blood tests, arterial blood gas analysis, 6-minute walking test, spirometry, diffusing capacity and body plethysmography. Finally, bronchial and alveolar EBC were collected at the end of each visit.
Results: Alveolar EBC pH was significantly lower than bronchial EBC pH at T1, alveolar EBC pH tended to be more acid after 3 months from hospital discharge compared to the same sample 6 months later. Serum inflammatory biomarkers showed no significant differences from T1 to T2. Alveolar EBC pH was positively correlated with neutrophil-lymphocyte ratio.
Conclusions: Collecting EBC pH could help to understand pathophysiologic mechanism as well as monitoring alveolar inflammation in the post-COVID syndrome.
{"title":"A glimpse in post-COVID pathophysiology: the role of exhaled breath condensate pH as an early marker of residual alveolar inflammation.","authors":"Andrea Portacci, Paola Pierucci, Vitaliano Nicola Quaranta, Sara Quaranta, Ilaria Iorillo, Cristian Locorotondo, Enrico Buonamico, Silvano Dragonieri, Giovanna Elisiana Carpagnano","doi":"10.1080/17476348.2022.2130764","DOIUrl":"https://doi.org/10.1080/17476348.2022.2130764","url":null,"abstract":"<p><strong>Background: </strong>Residual alveolar inflammation seems to be paramount in post-COVID pathophysiology. Currently, we still lack a reliable marker to detect and track alveolar phlogosis in these patients. Exhaled Breath Condensate (EBC) pH has robust evidences highlighting its correlation with lung phlogosis in various diseases. We aim to define the reliability of alveolar and bronchial EBC pH in the assessment and in the follow up of post-COVID-related inflammation.</p><p><strong>Research design and methods: </strong>We enrolled 10 patients previously hospitalized due to COVID-19 pneumonia. We performed a complete follow-up after 3 months and 6 months from discharge. Each visit included routine blood tests, arterial blood gas analysis, 6-minute walking test, spirometry, diffusing capacity and body plethysmography. Finally, bronchial and alveolar EBC were collected at the end of each visit.</p><p><strong>Results: </strong>Alveolar EBC pH was significantly lower than bronchial EBC pH at T1, alveolar EBC pH tended to be more acid after 3 months from hospital discharge compared to the same sample 6 months later. Serum inflammatory biomarkers showed no significant differences from T1 to T2. Alveolar EBC pH was positively correlated with neutrophil-lymphocyte ratio.</p><p><strong>Conclusions: </strong>Collecting EBC pH could help to understand pathophysiologic mechanism as well as monitoring alveolar inflammation in the post-COVID syndrome.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-09-08DOI: 10.1080/17476348.2022.2114899
Sepideh Tahsini Tekantapeh, Morteza Ghojazadeh, Ali Akbar Ghamari, Aida Mohammadi, Hassan Soleimanpour
Background: Due to the high incidence and mortality of the worldwide COVID-19 pandemic, beneficial effects of effective antiviral and anti-inflammatory drugs used in other diseases, especially rheumatic diseases, were observed in the treatment of COVID-19.
Methods: Clinical and laboratory parameters of eight included cohort studies and five Randomized Control Trials between the baricitinib group and the control group were analyzed on the first day of admission and days 7, 14, and 28 during hospitalization.
Results: According to the meta-analysis result of eight included cohort studies with 2088 patients, the Pooled Risk Ratios were 0.46 (P < 0.001) for mortality, 6.14 (P < 0.001) for hospital discharge, and the mean differences of 76.78 (P < 0.001) for PaO2/FiO2 ratio was -47.32 (P = 0.02) for CRP, in the baricitinib group vs. control group on the seventh or fourteenth day of the treatment compared to the first day. Based on the meta-analysis of five RCT studies with 11,825 patients, the pooled RR was 0.84 (P = 0.001) for mortality and 1.07 (P = 0.014) for patients' recovery. The mean differences were -0.80 (P < 0.001) for hospitalization days, -0.51(P = 0.33) for time to recovery in the baricitinib group vs. control group.
Conclusions: Baricitinib prescription is strongly recommended in moderate to severe COVID-19.
{"title":"Therapeutic and anti-inflammatory effects of baricitinib on mortality, ICU transfer, clinical improvement, and CRS-related laboratory parameters of hospitalized patients with moderate to severe COVID-19 pneumonia: a systematic review and meta-analysis.","authors":"Sepideh Tahsini Tekantapeh, Morteza Ghojazadeh, Ali Akbar Ghamari, Aida Mohammadi, Hassan Soleimanpour","doi":"10.1080/17476348.2022.2114899","DOIUrl":"https://doi.org/10.1080/17476348.2022.2114899","url":null,"abstract":"<p><strong>Background: </strong>Due to the high incidence and mortality of the worldwide COVID-19 pandemic, beneficial effects of effective antiviral and anti-inflammatory drugs used in other diseases, especially rheumatic diseases, were observed in the treatment of COVID-19.</p><p><strong>Methods: </strong>Clinical and laboratory parameters of eight included cohort studies and five Randomized Control Trials between the baricitinib group and the control group were analyzed on the first day of admission and days 7, 14, and 28 during hospitalization.</p><p><strong>Results: </strong>According to the meta-analysis result of eight included cohort studies with 2088 patients, the Pooled Risk Ratios were 0.46 (P < 0.001) for mortality, 6.14 (P < 0.001) for hospital discharge, and the mean differences of 76.78 (P < 0.001) for PaO<sub>2</sub>/FiO<sub>2</sub> ratio was -47.32 (P = 0.02) for CRP, in the baricitinib group vs. control group on the seventh or fourteenth day of the treatment compared to the first day. Based on the meta-analysis of five RCT studies with 11,825 patients, the pooled RR was 0.84 (P = 0.001) for mortality and 1.07 (P = 0.014) for patients' recovery. The mean differences were -0.80 (P < 0.001) for hospitalization days, -0.51(P = 0.33) for time to recovery in the baricitinib group vs. control group.</p><p><strong>Conclusions: </strong>Baricitinib prescription is strongly recommended in moderate to severe COVID-19.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40637131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-11-17DOI: 10.1080/17476348.2022.2145950
Eleni Xourgia, Dimitrios E Katsaros, Nikoleta A Xixi, Vasiliki Tsolaki, Christina Routsi, Spyros G Zakynthinos, Anastasia Kotanidou, Ilias I Siempos
Background: We attempted to investigate the change in mortality of intubated patients with coronavirus disease (COVID-19) from first to subsequent waves across several countries.
Methods: We pre-registered our meta-analysis with PROSPERO [Anonymized]. We searched PubMed, Scopus, and gray literature for observational studies reporting data on all-cause mortality of intubated patients with COVID-19 recruited both during first and subsequent waves of the pandemic. We considered studies published after 31 August 2020 up to 12 July 2021. The primary outcome of the meta-analysis was all-cause mortality. We used a random effects model to calculate pooled risk ratio (RR) and 95% confidence intervals (CI).
Results: By incorporating data of 363,660 patients from 43 countries included in 28 studies, we found that all-cause mortality of intubated patients with COVID-19 increased from first to subsequent waves (from 62.2% to 72.6%; RR 0.90, 95% CI 0.85-0.94, p < 0.00001). This finding was independent of the geo-economic variation of the included studies and persisted in several pre-specified subgroup and sensitivity analyses.
Conclusions: The robust finding of this meta-analysis suggests that mortality of intubated patients with COVID-19 did not improve over time. Future research should target this group of patients to further optimize their management.
背景:我们试图调查几个国家的冠状病毒病(COVID-19)插管患者从第一波到随后的死亡率变化。方法:我们在PROSPERO[匿名]预先注册了meta分析。我们检索了PubMed、Scopus和灰色文献,寻找报告在大流行的第一波和随后的浪潮中招募的COVID-19插管患者全因死亡率数据的观察性研究。我们考虑了2020年8月31日至2021年7月12日期间发表的研究。荟萃分析的主要结果是全因死亡率。我们使用随机效应模型计算合并风险比(RR)和95%置信区间(CI)。结果:通过纳入28项研究中来自43个国家的363,660例患者的数据,我们发现COVID-19插管患者的全因死亡率从第一波增加到随后的波(从62.2%增加到72.6%;RR 0.90, 95% CI 0.85-0.94, p < 0.00001)。这一发现独立于纳入研究的地理经济差异,并在几个预先指定的亚组和敏感性分析中持续存在。结论:这项荟萃分析的有力发现表明,COVID-19插管患者的死亡率并没有随着时间的推移而改善。未来的研究应针对这组患者进一步优化其管理。
{"title":"Mortality of intubated patients with COVID-19 during first and subsequent waves: a meta-analysis involving 363,660 patients from 43 countries.","authors":"Eleni Xourgia, Dimitrios E Katsaros, Nikoleta A Xixi, Vasiliki Tsolaki, Christina Routsi, Spyros G Zakynthinos, Anastasia Kotanidou, Ilias I Siempos","doi":"10.1080/17476348.2022.2145950","DOIUrl":"https://doi.org/10.1080/17476348.2022.2145950","url":null,"abstract":"<p><strong>Background: </strong>We attempted to investigate the change in mortality of intubated patients with coronavirus disease (COVID-19) from first to subsequent waves across several countries.</p><p><strong>Methods: </strong>We pre-registered our meta-analysis with PROSPERO [Anonymized]. We searched PubMed, Scopus, and gray literature for observational studies reporting data on all-cause mortality of intubated patients with COVID-19 recruited both during first and subsequent waves of the pandemic. We considered studies published after 31 August 2020 up to 12 July 2021. The primary outcome of the meta-analysis was all-cause mortality. We used a random effects model to calculate pooled risk ratio (RR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>By incorporating data of 363,660 patients from 43 countries included in 28 studies, we found that all-cause mortality of intubated patients with COVID-19 increased from first to subsequent waves (from 62.2% to 72.6%; RR 0.90, 95% CI 0.85-0.94, p < 0.00001). This finding was independent of the geo-economic variation of the included studies and persisted in several pre-specified subgroup and sensitivity analyses.</p><p><strong>Conclusions: </strong>The robust finding of this meta-analysis suggests that mortality of intubated patients with COVID-19 did not improve over time. Future research should target this group of patients to further optimize their management.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40675899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2022-11-18DOI: 10.1080/17476348.2022.2145947
Matthew M Smith, Lauren S Buck
Introduction: Laryngotracheal stenosis comprises a broad spectrum of congenital and acquired conditions that commonly cause pediatric airway obstruction. With the introduction and popularization of operative procedures such as laryngotracheoplasty, cricotracheal resection, and slide tracheoplasty more patients are presenting with airway issues at multiple anatomic levels. A combination of endoscopic and open techniques continues to be utilized for these complex issues. Additionally, there are specific long-term considerations for the post reconstruction patient.
Areas covered: This review highlights important aspects of the diagnosis, work up, and surgical treatment of pediatric laryngotracheal stenosis with updates for revision airway surgery and the post reconstruction patient. Important research articles and techniques within pediatric airway reconstruction are summarized and included in the review, in addition to recent articles from the last five years on pediatric laryngotracheal stenosis which were identified through a search of the PubMed database.
Expert opinion: The multidisciplinary concept of evaluation and treatment of laryngotracheal stenosis continues to be essential. Revision airway surgery presents unique challenges to improve the quality of life of patients as they age after reconstruction. Tracheal transplantation remains an important research area in the treatment of laryngotracheal stenosis.
{"title":"Update on the diagnosis and management of pediatric laryngotracheal stenosis.","authors":"Matthew M Smith, Lauren S Buck","doi":"10.1080/17476348.2022.2145947","DOIUrl":"https://doi.org/10.1080/17476348.2022.2145947","url":null,"abstract":"<p><strong>Introduction: </strong>Laryngotracheal stenosis comprises a broad spectrum of congenital and acquired conditions that commonly cause pediatric airway obstruction. With the introduction and popularization of operative procedures such as laryngotracheoplasty, cricotracheal resection, and slide tracheoplasty more patients are presenting with airway issues at multiple anatomic levels. A combination of endoscopic and open techniques continues to be utilized for these complex issues. Additionally, there are specific long-term considerations for the post reconstruction patient.</p><p><strong>Areas covered: </strong>This review highlights important aspects of the diagnosis, work up, and surgical treatment of pediatric laryngotracheal stenosis with updates for revision airway surgery and the post reconstruction patient. Important research articles and techniques within pediatric airway reconstruction are summarized and included in the review, in addition to recent articles from the last five years on pediatric laryngotracheal stenosis which were identified through a search of the PubMed database.</p><p><strong>Expert opinion: </strong>The multidisciplinary concept of evaluation and treatment of laryngotracheal stenosis continues to be essential. Revision airway surgery presents unique challenges to improve the quality of life of patients as they age after reconstruction. Tracheal transplantation remains an important research area in the treatment of laryngotracheal stenosis.</p>","PeriodicalId":12103,"journal":{"name":"Expert Review of Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40687652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}