Joseph Milic-Emili Joseph Milic-Emili was born in 1931 in the village of Sezana, then part of Italy, but now in Slovenia. After obtaining his medical degree from the University of Milan in 1955, he was appointed Assistant Professor in the Department of Physiology in that institution, where he carried out research on exercise physiology with Rodolfo Margaria. He was enticed to move to the University of Liège in 1958 by the Belgian physiologist Jean-Marie Petit, with whom he developed methods to measure pleural pressure with the esophageal balloon catheter as well as the electrical activity of the diaphragm using esophageal electrodes, techniques still applied in patients to this day. In 1960 Milic-Emili moved to Boston to work at the Harvard School of Public Health. Then in 1963, at the invitation of David Bates, Milic-Emili moved to McGill University, where he spent the remainder of his career. Milic-Emili was Chairman of the Department of Physiology at McGill between 1973 and 1978, prior to becoming Director of the Meakins-Christie Labs in 1979. He was appointed Professor Emeritus in the Departments of Physiology and Medicine at McGill in 1998. Throughout his career he received many honors and distinctions. He was elected Fellow of the Royal Society of Canada in 1980 and was conferred the Order of Canada in 1990. He was granted the degree of Doctor Honoris Causa by the Université Catholique de Louvain (1987), the University of Kunming (1988), Université de Montpellier (1994), and the University of Ljubljana (1999).
Joseph Milic-Emili于1931年出生于塞扎纳村，当时是意大利的一部分，但现在在斯洛文尼亚。1955年在米兰大学获得医学学位后，他被任命为该校生理学系的助理教授，在那里他与Rodolfo Margaria一起进行运动生理学的研究。1958年，他被比利时生理学家让-玛丽·佩蒂(Jean-Marie Petit)吸引到法国里昂奇大学(University of li)。佩蒂和他一起开发了用食道球囊导管测量胸膜压力的方法，以及用食道电极测量横膈膜电活动的方法，这些技术至今仍在病人身上应用。1960年，米利-埃米利搬到波士顿，在哈佛大学公共卫生学院工作。1963年，在大卫·贝茨的邀请下，米利-埃米利来到麦吉尔大学，在那里度过了他职业生涯的剩余时间。在1979年成为Meakins-Christie实验室主任之前，Milic-Emili于1973年至1978年担任麦吉尔大学生理学系主任。1998年，他被任命为麦吉尔大学生理学和医学系名誉教授。在他的职业生涯中，他获得了许多荣誉和荣誉。他于1980年当选为加拿大皇家学会会员，并于1990年被授予加拿大勋章。先后被鲁汶天主教大学(1987年)、昆明大学(1988年)、蒙彼利埃大学(1994年)和卢布尔雅那大学(1999年)授予荣誉博士学位。
{"title":"Farewell to Joseph Milic-Emili","authors":"N. Siafakas, Nikolaos K. Koulouris","doi":"10.18332/pne/146744","DOIUrl":"https://doi.org/10.18332/pne/146744","url":null,"abstract":"Joseph Milic-Emili Joseph Milic-Emili was born in 1931 in the village of Sezana, then part of Italy, but now in Slovenia. After obtaining his medical degree from the University of Milan in 1955, he was appointed Assistant Professor in the Department of Physiology in that institution, where he carried out research on exercise physiology with Rodolfo Margaria. He was enticed to move to the University of Liège in 1958 by the Belgian physiologist Jean-Marie Petit, with whom he developed methods to measure pleural pressure with the esophageal balloon catheter as well as the electrical activity of the diaphragm using esophageal electrodes, techniques still applied in patients to this day. In 1960 Milic-Emili moved to Boston to work at the Harvard School of Public Health. Then in 1963, at the invitation of David Bates, Milic-Emili moved to McGill University, where he spent the remainder of his career. Milic-Emili was Chairman of the Department of Physiology at McGill between 1973 and 1978, prior to becoming Director of the Meakins-Christie Labs in 1979. He was appointed Professor Emeritus in the Departments of Physiology and Medicine at McGill in 1998. Throughout his career he received many honors and distinctions. He was elected Fellow of the Royal Society of Canada in 1980 and was conferred the Order of Canada in 1990. He was granted the degree of Doctor Honoris Causa by the Université Catholique de Louvain (1987), the University of Kunming (1988), Université de Montpellier (1994), and the University of Ljubljana (1999).","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82618871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Petros Pouliopoulos, K. Manika, E. Faniadou, Stavros Galanis, K. Vasileiou, M. Sionidou, A. Avgerinos, I. Kioumis
{"title":"Hepatocellular carcinoma (HCC) in a patient with cystic fibrosis and liver disease (cirrhosis)","authors":"Petros Pouliopoulos, K. Manika, E. Faniadou, Stavros Galanis, K. Vasileiou, M. Sionidou, A. Avgerinos, I. Kioumis","doi":"10.18332/pne/145338","DOIUrl":"https://doi.org/10.18332/pne/145338","url":null,"abstract":"","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88052111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
1 A 68-year-old man with a recent diagnosis of small cell lung carcinoma, presented for a routine evaluation at our local lung cancer department, aiming to start treatment with carboplatin and etoposide. During the evaluation he seemed disoriented and complained of a headache. On physical examination only spatiotemporal disorientation stood out on the neurologic examination, with no other changes to report. Blood tests revealed hyponatremia, and elevated creatinine, alkaline phosphatase, gamma-GT, bilirubin, C reactive protein and procalcitonin. He was then admitted and treated for possible urinary infection, later confirmed by positive urine and blood cultures for Escherichia coli. Considering maintained symptoms, he was further investigated with a head CT scan with contrast to rule out brain metastases and it end up revealing a sphenoidal osteolytic lesion measuring 20×20×14 mm (Figure 1A), in addition to other smaller cranial bone metastases. Head MRI was also requested to allow a better characterization, showing an osteolytic lesion centered on the right paramedian region of the basisphenoid, with pronounced hyperintensity on T2-FLAIR images (Figure 1B), and homogeneous signal enhancement after contrast administration (Figures 1C and 1D). The case presented poses an unusual finding. Although imaging study was performed to clarify the presence of brain metastases, the sphenoid metastasis
{"title":"Sphenoid bone metastasis in lung cancer: An unusual finding","authors":"S. Braga, João Costa, Gonçalo Santos","doi":"10.18332/pne/144108","DOIUrl":"https://doi.org/10.18332/pne/144108","url":null,"abstract":"1 A 68-year-old man with a recent diagnosis of small cell lung carcinoma, presented for a routine evaluation at our local lung cancer department, aiming to start treatment with carboplatin and etoposide. During the evaluation he seemed disoriented and complained of a headache. On physical examination only spatiotemporal disorientation stood out on the neurologic examination, with no other changes to report. Blood tests revealed hyponatremia, and elevated creatinine, alkaline phosphatase, gamma-GT, bilirubin, C reactive protein and procalcitonin. He was then admitted and treated for possible urinary infection, later confirmed by positive urine and blood cultures for Escherichia coli. Considering maintained symptoms, he was further investigated with a head CT scan with contrast to rule out brain metastases and it end up revealing a sphenoidal osteolytic lesion measuring 20×20×14 mm (Figure 1A), in addition to other smaller cranial bone metastases. Head MRI was also requested to allow a better characterization, showing an osteolytic lesion centered on the right paramedian region of the basisphenoid, with pronounced hyperintensity on T2-FLAIR images (Figure 1B), and homogeneous signal enhancement after contrast administration (Figures 1C and 1D). The case presented poses an unusual finding. Although imaging study was performed to clarify the presence of brain metastases, the sphenoid metastasis","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74672823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The fixed-dose combinations (FDC) of inhaled corticosteroids (ICS) with longacting β2-agonists (LABA) represent one of the most widely used controller options for the management of patients with asthma, worldwide. Recently, the Global Initiative for Asthma (GINA) reports recommended the use of ICScontaining regimens in all the steps of asthma management, suggesting that the preferred reliever option would be combinations of ICS/formoterol, setting consequently these inhalers as the preferred controller option for such patients1. In the quest of the selection of the appropriate inhaled medication for our patients with asthma, a broad choice of inhalers is currently available. The treating physician needs to take into consideration several characteristics of the inhalation device, involving both the substances included but also the characteristics of the device that will be most appropriate for the individual patient, in order to ensure the acceptability of the device by the patient that will consequently lead to better adherence to the inhaled treatment and better disease outcomes2. The ‘ideal’ inhaler should carry several properties, including being userand environmental-friendly (e.g. being breath-actuated, being multi-dose and portable yet robust, avoiding harmful additives, e.g. propellants), allowing for control of the appropriate dosing by providing feedback and dose receipt confirmation, providing the dosing independently of environmental conditions and inspiratory flow rate, and achieving high lung deposition with high respirable fine particle fraction3. In the journey of the management of patients with airways disease, the treating physicians should be familiar with the properties of the inhalation devices that they prescribe, choose the appropriate device based on the characteristics of each individual patient, involve actively the patients in the device and treatment selection, evaluate the patients’ inhalation technique and train them appropriately at each visit, and re-evaluate the need for a different device whenever they identify a potential gap in the use of the previous one, but switch to a new device only with the patients’ involvement and appropriate education4. The dry powder inhaler (DPI) combination of budesonide and formoterol in the Elpenhaler® has been shown to be bioequivalent in terms of lung deposition to the same formulation delivered by the Turbuhaler® device in a crossover pharmacokinetic study in 100 patients with asthma5. Moreover, there is evidence of high satisfaction and acceptability of the Elpenhaler® in patients with asthma and COPD using the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire that was comparable or better to other DPI devices6,7, whereas it also presented lower rates of critical errors that affect drug delivery to the lungs when compared with the Diskus® and Turbuhaler® devices in a prospective study of 755 patients with asthma and COPD8. In this issue of Pneumon, Bakakos et al.9 pro
{"title":"Real-life effectiveness of ICS/LABA inhalers in\u0000asthma: The evidence generated and future needs for\u0000optimal patient management","authors":"K. Kostikas","doi":"10.18332/pne/144496","DOIUrl":"https://doi.org/10.18332/pne/144496","url":null,"abstract":"The fixed-dose combinations (FDC) of inhaled corticosteroids (ICS) with longacting β2-agonists (LABA) represent one of the most widely used controller options for the management of patients with asthma, worldwide. Recently, the Global Initiative for Asthma (GINA) reports recommended the use of ICScontaining regimens in all the steps of asthma management, suggesting that the preferred reliever option would be combinations of ICS/formoterol, setting consequently these inhalers as the preferred controller option for such patients1. In the quest of the selection of the appropriate inhaled medication for our patients with asthma, a broad choice of inhalers is currently available. The treating physician needs to take into consideration several characteristics of the inhalation device, involving both the substances included but also the characteristics of the device that will be most appropriate for the individual patient, in order to ensure the acceptability of the device by the patient that will consequently lead to better adherence to the inhaled treatment and better disease outcomes2. The ‘ideal’ inhaler should carry several properties, including being userand environmental-friendly (e.g. being breath-actuated, being multi-dose and portable yet robust, avoiding harmful additives, e.g. propellants), allowing for control of the appropriate dosing by providing feedback and dose receipt confirmation, providing the dosing independently of environmental conditions and inspiratory flow rate, and achieving high lung deposition with high respirable fine particle fraction3. In the journey of the management of patients with airways disease, the treating physicians should be familiar with the properties of the inhalation devices that they prescribe, choose the appropriate device based on the characteristics of each individual patient, involve actively the patients in the device and treatment selection, evaluate the patients’ inhalation technique and train them appropriately at each visit, and re-evaluate the need for a different device whenever they identify a potential gap in the use of the previous one, but switch to a new device only with the patients’ involvement and appropriate education4. The dry powder inhaler (DPI) combination of budesonide and formoterol in the Elpenhaler® has been shown to be bioequivalent in terms of lung deposition to the same formulation delivered by the Turbuhaler® device in a crossover pharmacokinetic study in 100 patients with asthma5. Moreover, there is evidence of high satisfaction and acceptability of the Elpenhaler® in patients with asthma and COPD using the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire that was comparable or better to other DPI devices6,7, whereas it also presented lower rates of critical errors that affect drug delivery to the lungs when compared with the Diskus® and Turbuhaler® devices in a prospective study of 755 patients with asthma and COPD8. In this issue of Pneumon, Bakakos et al.9 pro","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82586171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Very limited real-world data have been captured in the Greek asthmatic population regarding the effects of treatment with a fixeddose combination of budesonide/formoterol via the Elpenhaler® device, on the course of the disease and its impact on the patients’ quality of life score. METHODS In this multicenter, observational study, 1230 adult asthmatic patients in Greece that had been recently prescribed a fixed-dose combination budesonide/formoterol, Elpenhaler® were enrolled. The primary endpoint was the evaluation of the effectiveness of the treatment at six months in symptom control using the 7-item Asthma Control Questionnaire (ACQ-7). The secondary endpoints included the quality of life score using the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), pulmonary function, patients’ satisfaction with the Elpenhaler® device, and safety. RESULTS In total, 60.3% (742/1230) of the participants were female and the mean age was 51.10±16.98 years. A statistically significant improvement of the mean ACQ-7 score was noted at 3 months (1.01±0.70) and 6 months (0.79±0.66), compared to baseline (2.18±0.91). Similar statistically significant results were noted for the MiniAQLQ score with an improvement from 4.58±1.06 at baseline to 5.95±0.79 at 3 months, and 6.21±0.74 at 6 months. The mean Forced Expiratory Volume at 1 second (FEV1) showed continuing improvement, being 2.36±0.86, 2.58±0.88, and 2.64±0.88 L, at baseline, 3, and 6 months, respectively. CONCLUSIONS These real-world data showed that the administration of a fixed dose combination of budesonide/formoterol using the Elpenhaler® device was well-tolerated and effective in significantly reducing the symptoms of asthma and improving the quality of life. INTRODUCTION The health-related quality of life (HRQoL) of patients with asthma is affected by the presenting symptoms and their limiting effects on their physical, work and social aspects of their everyday life1. Hence, early and effective control of the disease can significantly impact their HRQoL, as assessed through various tools, and, in turn, decrease the use of healthcare resources1,2. When referring to disease control in asthmatic patients, two aspects should be considered, the repression of symptoms and the reduction of the risk for potentially unfavorable outcomes, which include the incidence of exacerbations, persistent effects on lung function, and adverse events emerging from the treatment itself. In prospect, inadequate symptom control usually results in increased exacerbations and overall a negative effect on the quality of life2. Spirometry and, particularly, persistent airway obstruction are additive parameters for predicting future risk2. Self-reported outcomes and physician-assessed tools provide a method for harmonizing and quantifying asthmatic patients’ initial state and changes occurring thereafter. The Asthma Control Questionnaire (ACQ) is a 7-item questionnaire that incorporates and evaluates symptoms and the
{"title":"Budesonide/formoterol via the Elpenhaler® device in asthmatic patients: A real-world effectiveness study\u0000(The BOREAS Study)","authors":"P. Bakakos, D. Papakosta, S. Loukides","doi":"10.18332/pne/144485","DOIUrl":"https://doi.org/10.18332/pne/144485","url":null,"abstract":"INTRODUCTION Very limited real-world data have been captured in the Greek asthmatic population regarding the effects of treatment with a fixeddose combination of budesonide/formoterol via the Elpenhaler® device, on the course of the disease and its impact on the patients’ quality of life score. METHODS In this multicenter, observational study, 1230 adult asthmatic patients in Greece that had been recently prescribed a fixed-dose combination budesonide/formoterol, Elpenhaler® were enrolled. The primary endpoint was the evaluation of the effectiveness of the treatment at six months in symptom control using the 7-item Asthma Control Questionnaire (ACQ-7). The secondary endpoints included the quality of life score using the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), pulmonary function, patients’ satisfaction with the Elpenhaler® device, and safety. RESULTS In total, 60.3% (742/1230) of the participants were female and the mean age was 51.10±16.98 years. A statistically significant improvement of the mean ACQ-7 score was noted at 3 months (1.01±0.70) and 6 months (0.79±0.66), compared to baseline (2.18±0.91). Similar statistically significant results were noted for the MiniAQLQ score with an improvement from 4.58±1.06 at baseline to 5.95±0.79 at 3 months, and 6.21±0.74 at 6 months. The mean Forced Expiratory Volume at 1 second (FEV1) showed continuing improvement, being 2.36±0.86, 2.58±0.88, and 2.64±0.88 L, at baseline, 3, and 6 months, respectively. CONCLUSIONS These real-world data showed that the administration of a fixed dose combination of budesonide/formoterol using the Elpenhaler® device was well-tolerated and effective in significantly reducing the symptoms of asthma and improving the quality of life. INTRODUCTION The health-related quality of life (HRQoL) of patients with asthma is affected by the presenting symptoms and their limiting effects on their physical, work and social aspects of their everyday life1. Hence, early and effective control of the disease can significantly impact their HRQoL, as assessed through various tools, and, in turn, decrease the use of healthcare resources1,2. When referring to disease control in asthmatic patients, two aspects should be considered, the repression of symptoms and the reduction of the risk for potentially unfavorable outcomes, which include the incidence of exacerbations, persistent effects on lung function, and adverse events emerging from the treatment itself. In prospect, inadequate symptom control usually results in increased exacerbations and overall a negative effect on the quality of life2. Spirometry and, particularly, persistent airway obstruction are additive parameters for predicting future risk2. Self-reported outcomes and physician-assessed tools provide a method for harmonizing and quantifying asthmatic patients’ initial state and changes occurring thereafter. The Asthma Control Questionnaire (ACQ) is a 7-item questionnaire that incorporates and evaluates symptoms and the ","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90609006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Steiropoulos, P. Bakakos, E. Hatziagorou, P. Katsaounou, S. Loukides, A. Papaioannou, Konstantinos Porpodis, Konstantinos Samaras, A. Tzouvelekis, K. Kalafatakis, K. Kostikas
Inhalation therapy has an ancient history and has been recognized as the most effective and safe way of delivering pharmaceutical compounds directly to the airways for the treatment of respiratory diseases. Nowadays, a great variety of devices exist;nebulizers, soft mist inhalers (SMIs), pressurized Metered Dose Inhalers (pMDIs) and single- or multi-dose Dry Powder Inhalers (DPIs). The choice for the optimal device is patient-specific and depends on the advantages and disadvantages of each device category, and the patients' age and capacity to use them correctly. Factors that determine therapeutic success, apart from the previously mentioned, are: the physician-patient relationship, the patient's opinion, willingness, and preferences for certain medical devices, and proper training on device use. Various sources of evidence indicate that frequent change of devices is associated with treatment failure and should be avoided in order to achieve good therapeutic outcomes. The most frequently used types of inhalation devices for management of chronic and acute obstructive respiratory diseases are the pMDIs. Despite having some environmental footprint and requiring a good technique by the users to achieve reliable therapeutic effects, these devices are essential tools for primary care physicians and pulmonologists. In the COVID-19 era, and despite diametrically opposed opinions on the appropriateness of using nebulizers, most experts recommend against their use in order to reduce the potential risk of spreading the SARS-CoV-2 virus. If required, most experts recommend the use of pMDI via a spacer, except for life threatening exacerbations. The ongoing research, to improve the underlying technologies of these devices, introduce environmentally friendlier propellants and combine these devices with modern applications of telemedicine and artificial intelligence, creates new pathways for the continuous utilization of these inhalation devices in everyday clinical practice.
{"title":"The present and future of inhalation therapy for\u0000the management of obstructive airway diseases:\u0000Emphasis on pressurized metered-dose inhalers","authors":"P. Steiropoulos, P. Bakakos, E. Hatziagorou, P. Katsaounou, S. Loukides, A. Papaioannou, Konstantinos Porpodis, Konstantinos Samaras, A. Tzouvelekis, K. Kalafatakis, K. Kostikas","doi":"10.18332/pne/144614","DOIUrl":"https://doi.org/10.18332/pne/144614","url":null,"abstract":"Inhalation therapy has an ancient history and has been recognized as the most effective and safe way of delivering pharmaceutical compounds directly to the airways for the treatment of respiratory diseases. Nowadays, a great variety of devices exist;nebulizers, soft mist inhalers (SMIs), pressurized Metered Dose Inhalers (pMDIs) and single- or multi-dose Dry Powder Inhalers (DPIs). The choice for the optimal device is patient-specific and depends on the advantages and disadvantages of each device category, and the patients' age and capacity to use them correctly. Factors that determine therapeutic success, apart from the previously mentioned, are: the physician-patient relationship, the patient's opinion, willingness, and preferences for certain medical devices, and proper training on device use. Various sources of evidence indicate that frequent change of devices is associated with treatment failure and should be avoided in order to achieve good therapeutic outcomes. The most frequently used types of inhalation devices for management of chronic and acute obstructive respiratory diseases are the pMDIs. Despite having some environmental footprint and requiring a good technique by the users to achieve reliable therapeutic effects, these devices are essential tools for primary care physicians and pulmonologists. In the COVID-19 era, and despite diametrically opposed opinions on the appropriateness of using nebulizers, most experts recommend against their use in order to reduce the potential risk of spreading the SARS-CoV-2 virus. If required, most experts recommend the use of pMDI via a spacer, except for life threatening exacerbations. The ongoing research, to improve the underlying technologies of these devices, introduce environmentally friendlier propellants and combine these devices with modern applications of telemedicine and artificial intelligence, creates new pathways for the continuous utilization of these inhalation devices in everyday clinical practice.","PeriodicalId":42353,"journal":{"name":"Pneumon","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2021-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88155047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Tzinas, E. Panagiotidou, E. Chatzopoulos, Athanasios Zacharias, A. Boutou, I. Stanopoulos, G. Pitsiou
We present a case of anthracofibrosis with a challenging diagnostic approach, complicated with pulmonary embolism (PE). A coal exposed 71-year-old woman presented with acute respiratory failure. Lung cancer was suspected, as computed tomography (CT) findings included a mass. Apart from mild stenosis of the RUL bronchus, bronchoscopy failed to reveal significant endobronchial findings, while biopsy and cytology were negative for malignancy. Fine needle aspiration (FNA) was performed, leading to the diagnosis of anthracosis, based on the new cytologic findings which included soot particles. Although bronchoscopy is the gold standard, pigmented lesions or bronchial stenosis were not detected. Moreover, during her hospitalization the patient also presented aggravating respiratory failure and CT pulmonary angiography (CTPA) showed PE. There have been reports that anthracofibrosis might generate a hypercoagulant state. The pathophysiological mechanisms that explain this occurrence are presented in this case report. INTRODUCTION Anthracosis belongs to the greater group of environmental lung diseases, called pneumoconiosis1. Although quite frequent in Asia2,3, only few cases are reported in Greece annually. We present a case study in order to highlight the diagnostic challenges and clinical complications that we encountered. CASE PRESENTATION A 71-year-old refugee from Afghanistan presented with acute hypoxemic respiratory failure. She had recently been hospitalized due to fever, dyspnea and intense wheezing, that were treated with intravenous methylprednisolone. She was not a smoker; however, she was exposed to biomass fuels in a poorly ventilated household for at least 50 years and reported having chronic cough and dyspnea the last 5 years. She was also hospitalized 3 years ago for a lower respiratory tract infection. Her vital signs included a pulse rate of 84 beats per minute, body temperature of 37°C, and respiratory rate of 22 breaths per minute. Blood saturation was approximately 90% with a nasal cannula oxygen supply of 4 L/min, while blood pressure was normal. Physical examination of the chest revealed wheezing sounds during respiration in both lungs. Complete blood count showed elevated leukocytes (19400/μL) and neutrophils (93.8%), possibly due to recent corticosteroid treatment. C-reactive protein was slightly elevated at 4.03 mg/dL (normal range <0.8 mg/dL). B-natriuretic peptide, angiotensin converting enzyme and procalcitonin values were normal. Auto-antibodies screen was also negative. Pulmonary function tests showed restrictive ventilatory defects combined with small-airway obstruction with forced vital capacity (FVC) of 1.17 L (50% of predicted value), forced expiratory volume in 1 second (FEV1) of 0.85 L (44% of predicted value), FEV1/FVC ratio of 75.5%, and forced expiratory flow between 25% and 75% of vital capacity (FEF25–75%) of 0.76 L (30% of predicted values). Chest X-ray revealed masses in both hilar areas. Chest computed tomogr
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