Lung India最新文献

Introduction: Compliance or adherence with positive airway pressure (PAP) therapy is a major issue in obstructive sleep apnea (OSA). The telemonitoring gives an opportunity to track a group of patients on cloud-based devices. In this study, we followed up patients with this cloud-based method for more than a year and followed up two different cohorts who are on continuous PAP (CPAP) and auto adjusting PAP (APAP) devices. The main objective was to judge whether one device scores over the other.

Methods: This was a retrospective study. We included 60 patients in the CPAP group and 80 patients in the APAP group in the study who are using the device for 1 year or more; they all were on cloud-based devices, and for them, we had data of completed 1 year at least. The data were reviewed periodically for compliance, AHI (Apnea-Hypopnea Index), and leak and compared.

Results: Both the groups were matched in terms of age, BMI, and AHI. Adherence at 365 days was significantly more (P < 0.001) for CPAP than APAP. Overall adherence was not lesser than 60% for CPAP in any patient. The mean AHI was 1.48 in CPAP group and 2.30 in APAP group. When we measured the leak in CPAP versus APAP group, it was 0.53 liter/minute more in CPAP group than in APAP group, but it was statistically non-significant (P = 0.8553). The mean pressure level between APAP and CPAP was 11.11 cmH2O in CPAP group and 11.62 cm H2O in APAP group, and it was again statistically non-significant (P = 0.1960). CPAP group used the machine 5.77 hours average, while APAP group used it for 4.51 hours average.

Conclusion: CPAP adherence at 1 year was better over APAP in this study, which has a large cost implication.

Abstract: The Interleukin-5 (IL-5)-mediated pathogenic role of eosinophils in airway disorders including severe eosinophilic asthma (SEA), chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic granulomatosis with polyangiitis (EGPA), and rare hyper-eosinophilic syndrome (HES) is well established. Mepolizumab, an IL-5-targeting humanised antibody, is approved as an add-on maintenance therapy for SEA, EGPA, CRSwNP, and HES. Here, we review the safety and efficacy findings of mepolizumab in clinical trials and real-world evidence studies in patients with SEA, CRSwNP, EGPA, and HES. We specifically explore the data on mepolizumab that support early initiation of IL-5-targeted therapy to maximise its corticosteroid-sparing effect. This review consolidates the clinical data on mepolizumab, highlights other promising IL-5-targeting agents, and supports the IL-5 pathway as the key therapeutic target across eosinophilic indications.

Background: Flexible bronchoscopy is the diagnostic tool of choice to diagnose endobronchial lesions. Pathological samples can be harvested using various techniques, for example, forceps biopsy, brushing, washing, and recently cryobiopsy. The major drawbacks of forceps biopsy technique are (a) obtaining of smaller tissues and (b) presence of crush artefacts. This results in a significant failure rate. Cryobiopsy is the procedure where application of extreme cold to the pathological tissues is used for obtaining samples. As a cryoprobe allows procurement of larger biopsy samples which is devoid of any crush artefacts, these result in better histopathology, immunohistochemistry, and identification of specific genetic mutations.

Methods: The current trial tried to assess (i) the diagnostic yield of endobronchial cryobiopsies in comparison with endobronchial forceps biopsies and (ii) assess the duration of procedures and requirement of interventions to control bleeding, among 49 patients who had undergone forceps biopsy and 48 patients who had undergone cryobiopsy. The types of endobronchial lesions observed during bronchoscopic procedures were divided into (a) exophytic type and (b) infiltrative type. Biopsy interpretations were done by an expert pathologist.

Results: Cryobiopsy compared to forceps biopsy had a statistically significant higher diagnostic yield for diagnosis of overall endobronchial lesions (P < 0.0001) for both exophytic (P = 0.015) and infiltrative (P < 0.0001) growth. Cryobiopsy obtained larger tissue (P < 0.001). No statistically significant difference was found in the incidence of haemorrhage (P = 0.378) and duration (P = 0.173) between two procedures.

Conclusions: Cryobiopsies were more successful than forceps biopsies particularly for diagnosis of infiltrative growth. The complication rate was similar between the two procedures.

Abstract: Pulmonary Veno-Occlusive Disease (PVOD) is a rare cause of pulmonary hypertension (PH) in patients with systemic sclerosis (SSc), posing significant diagnostic and therapeutic challenges. Here, we present a case of a patient with systemic sclerosis who presented with symptoms of progressive dyspnea for 1 year. Her chest radiogram was normal, and echocardiography was suggestive of severe PH. She was started on a combination of Ambrisentan and Tadalafil. However, she developed pulmonary edema after the initiation of pulmonary vasodilators. Diagnostic workup, including imaging studies, with clinical and radiological worsening with pulmonary vasodilators, confirmed PVOD in the setting of SSc. The patient gradually improved with diuretic therapy. This case emphasizes the importance of early clinical suspicion and multidisciplinary discussion in managing rare pulmonary complications associated with systemic sclerosis. Additionally, it highlights the urgent need for further research to delineate the underlying pathophysiological mechanisms and optimize therapeutic strategies for this challenging clinical entity.

Abstract: Hamartoma is a common benign tumour of the lung. Although most pulmonary hamartomas are located within the lung parenchyma, rarely they present as endobronchial tumours. We are describing one case of a 75-year-old gentleman with endobronchial hamartoma removed via traditional flexible bronchoscopy and another case of a 55-year-old gentleman whose endobronchial hamartoma was diagnosed via robotic navigational bronchoscopy. We are also describing the salient features of three other cases of endobronchial hamartoma diagnosed at our institution in the last 13 years. With the emergence of advanced navigational bronchoscopy techniques, we predict that the incidence of identifying endobronchial hamartomas will increase.

Abstract: Endobronchial ultrasound (EBUS) guided mediastinal cryobiopsy is a novel technique which can be combined with EBUS -TBNA to improve the diagnostic yield. Recent studies report, this technique is safe and superior to EBUS TBNA alone in terms of acquisition of larger tissue samples and thereby a better diagnostic yield and adequacy of tissue for molecular studies. However, safety of this technique in patients do not tolerate a bronchoscopic procedure due to hypoxia or respiratory distress is not clarified yet. Alternatively, EBUS guided FNA via trans-esophageal route(EUS-B-FNA) is a proven technique with a similar diagnostic yield as EBUS TBNA with a better tolerance and a more patient comfort. We report two patients here, in whom EUS- B guided cryobiopsy was successfully done via trans-esophageal route, due to intolerance for bronchoscopic procedure and inconclusive ROSE reports.