Lung India最新文献

Background and objective: There are very few studies in the Indian population on the prevalence of phenotypes in asthma patients. To phenotype patients with bronchial asthma and characterise the phenotypes based on asthma control, exacerbation frequency, and associated comorbidities.

Methods: The current cross-observational study was conducted between January 2022 and June 2022 in the department of pulmonary medicine in a tertiary care hospital. One hundred and seventeen patients aged 13 or above of both genders diagnosed with asthma as per Global Initiative for Asthma guidelines were enrolled. The blood eosinophil count and serum immunoglobulin E were measured. The Asthma Control Test (ACT) Questionnaire was used to calculate the ACT score. The patients were categorised into various asthma phenotypes such as atopic asthma, eosinophilic asthma, overlap phenotype, and biomarker-negative.

Results: Phenotypes such as atopic, eosinophilic, overlap, and both negative were observed in 33.3%, 20.5%, 42.7%, and 3.4% patients, respectively. The mean BMI was significantly lower in both negative patients. There was no statistically significant association observed between allergic rhinitis, chronic rhinosinusitis, and eczema with various phenotypes, whereas nasal polyposis had a significant association with eosinophilic phenotype and overlap. The median asthma exacerbations per year were significantly higher in patients of bronchial asthma, atopic and overlap phenotypes. The percentage of patients who required baseline corticosteroid support was significantly less in both negative phenotypes.

Conclusion: There is a substantial overlap of inflammatory blood biomarkers, suggesting that a more comprehensive approach is needed to identify the optimal therapy for individual patients.

Background and objective: Oxygen desaturation events occur commonly during Endobronchial endobronchial ultrasound (EBUS) guided-transbronchial needle aspiration (TBNA) performed under conscious sedation. We hypothesized that high-flow nasal cannula (HFNC) would be superior to conventional nasal cannula (NC) in preventing these hypoxemic episodes.

Methods: We randomized consecutive subjects ≥18 years undergoing EBUS-TBNA to receive oxygen with HFNC or NC. The primary objective was to compare the proportion of subjects experiencing oxygen desaturation events (defined as SPO2 < 90% for at least 30 sec) during the EBUS-TBNA procedure between the two study arms. The key secondary outcomes were the number of desaturation events during the procedure and patient comfort on a visual analogue scale (VAS [0 mm-100 mm]).

Results: We randomized 300 subjects (150 in each arm). The mean ± SD age of the study population (129 [43%] females) was 46.5 ± 14 years. The proportion of subjects experiencing clinically significant hypoxemic episodes was significantly (P < 0.0001) higher in NC (42.7% [64/150]) than in the HFNC (20% [30/150]) arm. The median nadir SPO2 was significantly lower in the NC arm than in HFNC (91% vs. 93%, P < 0.0001). The use of HFNC during EBUS-TBNA resulted in fewer desaturation events (mean difference [95% confidence interval], 0.55 [0.22-0.88]) and better patient comfort (mean difference in VAS, 7.1 [4.3 mm-9.9 mm]). We found no difference in the complication rates.

Conclusion: HFNC during EBUS reduced the number of subjects experiencing clinically significant hypoxemia, the number of desaturation events, and improved patient comfort compared to conventional oxygen therapy.

Background and objectives: Tobacco use is a major global health concern, contributing to six of the eight most common causes of death worldwide. In Turkey, the average number of cigarettes smoked per day by individuals over 15 years old surpasses the global average. To mitigate this public health issue, it is crucial to develop strategic education models and state policies. Additionally, closely monitoring patients who seek smoking cessation services can improve outcomes by identifying specific smoking patterns and tailoring treatments accordingly. This study aimed to analyze the smoking behavior, characteristics, and cessation outcomes of patients aged 25-65 years who visited the smoking cessation outpatient clinic.

Methods: This cross-sectional prospective study included 307 patients. We collected socio-demographic data, prior smoking cessation experiences, addiction levels, and conducted medical examinations to assess health status and medical history. This information was used to develop personalized treatment and follow-up plans.

Results: The mean age of the patients was 42±11 years, with 74% being married and 55% being male. At the end of a three-month period, the smoking cessation rate was 49% for women and 33% for men. Notably, patients who started smoking at a median age of 19±5 years had higher cessation rates compared to those who started at 17±4 years. The most common reasons cited for starting smoking were environmental, social, and curiosity factors.

Conclusion: Our findings suggest that a personalized approach to smoking cessation, which takes into account factors such as age, gender, and comorbidities, may be more effective in helping patients quit smoking. Future research should focus on long-term outcomes and the impact of specific interventions tailored to individual patient characteristics.

Objectives: Tuberculosis (TB) poses a serious health risk in Turkey and globally and is often difficult to diagnose. It may be sometimes necessary to obtain bronchoalveolar lavage (BAL) and, in some cases, biopsy samples via bronchoscopy to acquire an adequate sample. Our aim is to assess the contribution of transbronchial lung biopsy (TBLB) alongside BAL in diagnosing TB. In addition, we will evaluate the risk of pneumothorax associated with TBLB and determine the overall risk-benefit ratio.

Methods: Flexible fiberoptic bronchoscopy (FFB) reports performed for suspected TB between March 2011 and July 2018 were retrospectively reviewed. Patients who had both BAL and tissue samples taken via TBLB were included in the study. Of the 606 patients included, age, sex, the lung area where the biopsy was taken, BAL and biopsy AFB and culture results, and complications such as pneumothorax and chest tube application were recorded.

Results: A total of 606 patients were included in the study. Of these, 391 patients were male (64.5%) and 215 were female (35.5%). A total of 37 (6.1%) patients had a positive culture for TB. Nineteen (59.4%) patients were positive on both BAL and tissue culture, while 5 patients were only positive on tissue culture. Pneumothorax developed in 34 patients (5.6%), 28 of whom required a chest tube.

Conclusion: Using various modalities such as BAL and TBLB together for diagnosing pulmonary TB can be advantageous when appropriate, particularly given the absence of significant complications during the procedure. Our findings indicate that incorporating TBLB alongside BAL impacted the diagnosis of pulmonary TB.

Bronchiectasis is a chronic airway disease with recurrent exacerbations and hospitalisations. No inhaled antibiotic has shown consistently beneficial effects in trials. This review analyses the evidence on inhaled antibiotics in non-cystic fibrosis bronchiectasis (NCFB), identifies patient traits for their use, and highlights research gaps. A PubMed search for "Inhaled antibiotics AND bronchiectasis" identified five inhaled antibiotics studied in randomised controlled trials (RCTs): aztreonam, tobramycin, gentamycin, ciprofloxacin, and colistin. Inhaled antibiotics reduced exacerbation frequency, sputum bacterial density, and increased bacterial eradication but did not improve lung function. They also increased antimicrobial resistance, with aztreonam and aminoglycosides having higher discontinuation rates due to side effects. Increased sputum bacterial density (>107 colony forming units/g), increased exacerbation frequency (≥4) at baseline, and increased sputum volume and/or purulence at baseline are some of identifiable traits associated with benefit from inhaled antibiotics. Inhaled antibiotics may aid in eradicating Pseudomonas aeruginosa after first isolation in NCFB, but their role in acute exacerbations requires further research. There are no direct RCTs comparing different delivery systems, antibiotics, and regimens.

Background and objectives: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive Interstitial lung disease (ILD) that has a significant impact on the health-related quality of life (HRQoL). There are generic and disease-specific questionnaires to assess this, but no literature from India exists.

Hence we decided: to estimate HRQoL and to determine its predictors in a cohort of patients attending a tertiary care centre in Southern India.

Methods: Consecutive consenting patients diagnosed with IPF by the ILD MDD between September 2023 and August 2024 were self-administered the St. George's Respiratory Questionnaire (SGRQ) and the King's Brief Interstitial Lung Disease (KBILD) questionnaire to assess the HRQoL.

Results: In all, 70 patients with IPF were recruited into the study. The median total SGRQ was 35.9 (23.9-57.8), and the median total KBILD was 54.5 (46.4-65.6). Based on SGRQ (>30), 63% (44/70) and based on KBILD (≤50), 34% (24/70) had a poor quality of life. The SGRQ was significantly lower in those not on antifibrotics across all domains, with a trend towards near significance in the activity domain. The Gender, Age, Physiology (GAP) Index had a significant association with the KBILD - breathlessness and activity domain (P value = 0.01) and the total score (P value = 0.02).

Conclusion: This is the first Indian study reporting HRQoL in IPF. IPF impacts HRQoL drastically, with a predominant impact on physical wellness and a lesser effect on psychological well-being. KBILD is associated with the GAP index. A larger study is required to identify independent factors associated with HRQoL.

Pulmonary hamartomas are the most common benign tumours of the lung and are often detected incidentally. Endobronchial hamartomas, though rare, can cause significant symptoms such as dyspnoea, haemoptysis, and recurrent respiratory infections due to bronchial obstruction. This report describes the successful bronchoscopic management of symptomatic endobronchial hamartomas in two young Indian males aged 29 and 34 years. Both cases were diagnosed based on radiological and histopathological findings. The first patient underwent eight sessions of electrocautery fulguration using a flexible bronchoscope, while the second was treated with six sessions of cryotherapy delivered through a flexible bronchoscope guided cryoprobe. All procedures were carried out under conscious sedation via nasal insertion of the flexible bronchoscope, with no requirement for rigid bronchoscopy or general anaesthesia. Both patients showed marked symptomatic improvement and near-complete resolution of endobronchial lesions. Follow-up bronchoscopies at 18 and 12 months, respectively, revealed no recurrence, and no procedure-related complications were observed. These cases highlight the safety, efficacy, and minimally invasive nature of flexible bronchoscopic techniques such as electrocautery and cryoablation in managing endobronchial hamartomas, particularly in settings where surgical options may be limited.