Tuberculosis and Respiratory Diseases最新文献

Chronic obstructive pulmonary disease (COPD) is a major global health issue, as acute exacerbation COPD (AECOPD) significantly worsens outcomes and increases healthcare burden. This review explores non-pharmacologic strategies to prevent AECOPD. Pulmonary rehabilitation consistently demonstrates its effectiveness in reducing exacerbations and mortality, while improving exercise capacity and the quality of life. Lung volume reduction, through both surgical and bronchoscopic methods, has shown promise in select patient groups, leading to improved lung function and reduced exacerbation risk. Smoking cessation remains a critical intervention, while the role of electronic cigarettes remains debatable; some evidence suggests they may help patients unable to quit tobacco smoking. Vitamin D supplementation has shown potential in reducing exacerbations, particularly in patients with severe deficiency, though conflicting results warrant further research. Furthermore, shielding measures, like mask-wearing and social distancing, have gained attention during the coronavirus disease 2019 (COVID-19) pandemic for their role in reducing exacerbation risk. Lastly, vaccination, diet and nutrition, and non-invasive ventilation may be important to prevent AECOPD. These non-pharmacologic approaches should be integrated into comprehensive COPD management to improve outcomes and prevent AECOPD.

Background: Chronic obstructive pulmonary disease (COPD), characterized by progressive airflow obstruction and frequent exacerbations, is a significant global health burden. COPD severity has traditionally been assessed using expiratory flow measurements, like forced expiratory volume in 1 second. However, the role of inspiratory flow, specifically maximal forced inspiratory flow (FIFmax), in predicting exacerbation risk is gaining attention.

Methods: This retrospective cohort study evaluated COPD patients with a history of exacerbations who were receiving inhaled therapy. The eligible patients were followed up for 3 years with spirometric assessments. Patients were categorized into quartiles based on the annual change in FIFmax, from the greatest decrease (Q1) to the greatest increase (Q4). Primary outcome was acute exacerbation, stratified by severity as moderate-to-severe and severe exacerbation.

Results: In total, 180 patients were followed up for 3 years. A greater increase in FIFmax was linearly associated with lower rates of both moderate-to-severe and severe exacerbations (p-value for trend <0.001 for both), but time-to-event analysis revealed no significant association between FIFmax changes and moderate-to-severe exacerbations. In contrast, a significant association with severe exacerbations was observed (log-rank p=0.005). Even after adjusting for confounders, FIFmax remained an independent predictor of severe exacerbations (Q3: hazard ratio, 0.506 [95% confidence interval, 0.306 to 0.836], p=0.008; Q4: hazard ratio, 0.491 [95% confidence interval, 0.291 to 0.830], p=0.008).

Conclusion: Changes in FIFmax were not significantly associated with moderate-to-severe exacerbations, but were related to a reduced risk of severe exacerbations in COPD patients receiving inhaled therapy. These findings indicate that FIFmax may serve as a valuable prognostic marker for severe exacerbations in high-risk COPD patients.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a predominantly used method for lymph node (LN) metastasis assessment. This study aims to identify tissue adequacy improvement with the addition of EBUS-guided miniforcep biopsy (EBUS-MFB) to EBUS-TBNA in sampling LNs.

Methods: We assessed tissue adequacy in patients with mediastinal and hilar lymphadenopathy, comparing the combination of EBUS-MFB and EBUS-TBNA with EBUS-TBNA alone. EBUS-MFB was performed with the guide sheath (GS) dilatation technique. Tissue adequacy was a tumor cell count (TCC) of >100 and neoplastic cell neoplastic cell estimate of >25%. Further, we reported the diagnostic yield, tumor cell characteristics, and safety outcomes.

Results: Among 69 patients (74 nodes), malignant diseases were diagnosed in 41 nodes using both techniques. Tissue adequacy with EBUS-TBNA (93.8% in 30/32 nodes) was comparable with the combined group (96.9% in 31/32 nodes, p=0.317). EBUS-TBNA yielded higher TCC (84.4% with >1,000 cells) than EBUS-MFB (53.1%, p=0.004). The combined approach significantly improved the diagnostic yield in non-malignant diseases compared with EBUS-TBNA alone (97% vs. 78.8%, p=0.014). Of the 32 nodes, 20 demonstrated discordant results between EBUS-TBNA and EBUS-MFB, with EBUS-MFB correctly diagnosing six nodes that EBUS-TBNA misdiagnosed. The complication rate was low (2.9%) with only minor bleeding reported.

Conclusion: EBUS-TBNA alone and the combination of EBUS-MFB and EBUS-TBNA demonstrated comparable tissue adequacy, with EBUS-TBNA exhibiting better specimen characteristics, potentially sufficient for various molecular analyses. The addition of EBUS-MFB, performed using the GS-dilatation technique, to EBUS-TBNA improved the diagnostic yield and proved to be a safe and efficient approach, particularly in non-malignant diseases.

Background: Understanding of the life-sustaining treatment (LST) decisions in critically ill coronavirus disease 2019 (COVID-19) patients remains limited. This study aimed to identify factors influencing LST decisions, and compare clinical outcomes between patients with, and without, LST.

Methods: This multicenter, retrospective cohort study analyzed data from 1,081 COVID-19 patients admitted to intensive care units (ICUs) across Korea from January 1, 2020, to August 31, 2021. Patients were divided into LST and non-LST groups. Demographic, clinical, and outcome data were collected and compared.

Results: Of 1,081 patients, 207 (19.2 %) received LST. LST patients were older (median age: 76 years vs. 67 years, p<0.001), and had more comorbidities (85.5% vs. 70.4%, p<0.001), especially cardiovascular and chronic lung disease. They showed higher blood urea nitrogen, lower albumin, and elevated D-dimer levels (all p<0.05). ICU interventions, including mechanical ventilation (82.6% vs. 50.9%, p<0.001) and extracorporeal membrane oxygenation (ECMO) (18.8% vs. 9.8%, p<0.001), were more common. ICU and hospital mortality rates were significantly higher in LST patients (82.6% and 94.2%, respectively, p<0.001). Logistic regression identified age (odds ratio [OR], 1.054 per year; p<0.001), mechanical ventilation (OR, 2.789; p=0.002), and ECMO use (OR, 3.580; p=0.002) as independent predictors of LST.

Conclusion: Age, comorbidities, and ICU interventions significantly influence LST decisions, highlighting the need for ethical and evidence-based critical care guidelines.

Background: Pelargonium sidoides has been known to be effective in treating respiratory diseases. P. sidoides extract (Umckamin®, Han Wha Pharmaceuticals) was approved in Korea for acute bronchitis. YJP-40 (Umckamin plus®) is formulated with extract of P. sidoides and ivy leaf. Ivy leaf extract has an expectorant effect and has been used to treat bronchitis. The aim of this study was to compare the efficacy of YJP-40 syrup with Umckamin® syrup in patients with acute bronchitis.

Methods: This was a multicenter, randomized, double-blind, active-controlled, non-inferiority, phase III clinical trial. Patients were randomized 1:1 to either the test (YJP-40) or the control (Umckamin®) group. The primary endpoint was the change in bronchitis severity score (BSS) total score 7 days after administration.

Results: A total of 240 subjects (test group 121; control group 119) from seven hospitals were enrolled in this clinical trial. The average change in BSS total score 7 days after administration compared to before was -4.31±2.09 and -4.36±1.71 in the test group and the control group, respectively. The non-inferiority of the test group to the control group was demonstrated. The response rate at 7 days after administration was 87.16% (95/109) in the test group and 86.92% (93/107) in the control group (p=0.9778). There was no statistically significant difference between the groups in the incidence of adverse events.

Conclusion: YJP-40 can be a safe and effective treatment option for acute bronchitis.

Background: Pneumothorax is a notable complication of lung biopsy, and its early detection is crucial. This study aimed to compare the sensitivities of handheld portable lung ultrasonography and chest radiography in identifying early pneumothorax post-lung biopsy.

Methods: Upright chest radiography and lung ultrasonography were conducted at 3 and 24 hours following lung biopsy. The disappearance of lung sliding and the appearance of lung points on lung ultrasonography were indicative of pneumothorax.

Results: In this study of 86 patients, 23 were diagnosed with pneumothorax within 24 hours post-biopsy. No significant differences in sex, age, or baseline lung function were noted between the pneumothorax and non-pneumothorax groups. The sensitivities of lung ultrasonography and chest radiography for detecting pneumothorax were 73.9% and 47.8%, respectively, at 3 hours and 91.3% and 78.3%, respectively, at 24 hours. Additionally, at 3 hours, the area under the curve for lung ultrasonography in diagnosing pneumothorax was significantly higher than that for chest radiography (0.870 vs. 0.739, p=0.043); however, the difference was not significant at 24 hours (p=0.254).

Conclusion: These preliminary findings indicate that lung ultrasonography is more sensitive than chest radiography in detecting early pneumothorax following lung biopsy and could be beneficial for rapid pneumothorax diagnosis.

Sarcoidosis is a granulomatous inflammatory disease of unknown etiology that can affect the entire body, but its respiratory tract involvement is most common. In radiological findings, bilateral hilar and mediastinal lymph node enlargement is the most common finding, and when lung parenchyma is involved, findings such as micronodules, ground-glass shadows, reticular shadows, and fibrosis are seen. Biopsies for histological diagnosis are mainly performed on lymph nodes or lungs, and mediastinal lymph node biopsies are done via endobronchochial ultrasound-guided fine needle aspiration. Pathological findings are characterized by non-caseating, non-necrotizing granulomas, and in Korea, differentiation from tuberculosis is especially important. The natural history of sarcoidosis is very variable, with approximately two-thirds of subjects showing spontaneous remission and only 10% to 30% of patients showing a chronic or progressive form. The most important factor in determining treatment for sarcoidosis is whether there is a risk of death, organ failure, or loss of quality of life. Glucocorticosteroids are the mainstay of treatment, and if the disease progresses despite treatment, or if glucocorticosteroids cannot be reduced or cannot be used, immunosuppressants such as methotrexate and azathioprine can be considered. Response to glucocorticosteroids treatment is good, and most of the patients stabilize or improve, with a low mortality rate of around 3% to 5%.

In the field of chronic obstructive pulmonary disease (COPD), there is growing interest in methods for early detection with the goal of altering disease progression. At the same time, pulmonary function test (PFT) remains central to the diagnosis and management of COPD. Yet, spirometry remains underused, particularly in primary care, contributing to the underdiagnosis and misdiagnosis of COPD. Challenges hindering more aggressive use of spirometry include a lack of access in primary care clinics or public venues, the complexity of performing spirometry and a lack of comfort with interpretation. Enhancing PFT utilization will require new approaches including broadening availability and adopting different approaches to interpretation.