Annals of Thoracic Medicine最新文献

[This corrects the article on p. 284 in vol. 19, PMID: 39544350.].

A 32-year-old Chinese woman with a cough and bloody sputum was diagnosed with chronic eosinophilic pneumonia. After starting corticosteroid therapy, chest radiography showed improvement in the bilateral infiltrative shadow. However, chest image findings showed worsening of the bilateral infiltrative shadow and pulmonary cavities during the 20 mg/day of oral prednisolone therapy. Transbronchial lung biopsy and bronchoalveolar lavage were repeated, and the patient was diagnosed with pulmonary paragonimiasis. After starting praziquantel treatment, chest radiography findings and clinical symptoms improved. Careful follow-up during corticosteroid therapy is important to judge whether transient improvement and true deterioration of radiological findings.

The pathogenesis of cervical extension of the thymus has been postulated to be incomplete descent of the thymus in the midline of the neck, which is considered normal in children. The thymus normally extends to the neck in approximately two-thirds of children. Ectopic thymus mainly occurs in 1%-13% of the younger population. In this study, we report two cases of asymptomatic neck swelling, one due to cervical extension of the thymus and the other due to a right submandibular ectopic thymus. None of the patients required any intervention. Recurrent suprasternal swelling in children that becomes more pronounced during coughing/crying or Valsalva maneuvers can be more accurately diagnosed using neck ultrasonography and/or magnetic resonance imaging.

A 39-year-old female has postoperative empyema with bronchial stump fistula (BSF) after pneumonectomy due to ineffective tuberculosis chemotherapy. Transpleural reamputation of the right main bronchial stump with simultaneous 8-rib thoracoplasty, 6 attempts at endobronchial valve implantation and thoracostomy have failed to cure BSF and empyema. Consequently, an alternative treatment-transsternal transpericardial wedge-shaped resection of the tracheal bifurcation was performed despite its difficulty and was successful. This clinical case demonstrates the complications of BSF with tuberculosis empyema treatment in spite of there existing many alternative therapies. The need for new more effective treatments is highlighted, as well as safe and less technically difficult interventions which could assist patients with BSF.

Bronchopleural fistula (BPF) is a rare yet severe complication following lobectomy, with no standardized treatment protocol established. We present a case of a 65-year-old male with chronic obstructive pulmonary disease who developed multiple BPFs postresection of the right lower lobe due to lung cancer and with tumor recurrence and metastasis. We employed a comprehensive management strategy comprising rigorous infection control, meticulous chest drainage, antitumor treatment, and targeted deployment of bronchial stents. This approach not only resolved the BPFs but also achieved a complete response of the lung cancer, extending progression-free survival to over 3 years.

Adult patients with chronic respiratory diseases (CRDs) are considered high risk group who are more likely to experience worse clinical outcomes if they acquire viral or bacterial infections. Vaccination is the best preventive tool to reduce the risk of infection and disease occurrence and to reduce the level of severity of complications associated with the various vaccine-preventable infections. These guidelines were developed by the Saudi Thoracic Society task force to emphasize the critical importance of improving the vaccine coverage rates in adult patients with CRD. They are intended to serve as a reference for healthcare practitioners managing CRD patients. The guidelines aimed to review the current knowledge related to vaccination efficacy in adult patients with CRD, based on the recent evidence and recommendations. Integrating the administration of the recommended vaccines in routine healthcare, such as during outpatient visits or before hospital discharge, is crucial for improving the vaccination rates in high-risk patients. The key strategies to address this public health priority include simplifying vaccination guidelines to enhance their accessibility and implementation by healthcare providers, increasing awareness in both the patients and healthcare providers that vaccines are not only intended for children. Additional strategies include maintaining continuous surveillance and advance research to discover novel vaccines. This approach aims to expand the range of preventable diseases and improve overall health and well-being. Vaccine hesitancy remains a significant challenge that necessitates a clear understanding of the community concerns. Providing appropriate education and communication, as well as addressing these concerns, are the crucial steps toward improving vaccine acceptance and uptake. By implementing these guidelines and multifaceted strategies, healthcare systems can optimize vaccine coverage and protection for patients with CRD, reduce the burden of vaccine-preventable complications, and improve the clinical outcomes in this vulnerable population.

The Saudi Thoracic Society (STS) developed an updated evidence-based guideline for diagnosing and managing chronic obstructive pulmonary disease (COPD) in Saudi Arabia. This guideline aims to provide a comprehensive and unbiased review of current evidence for assessing, diagnosing, and treating COPD. While epidemiological data on COPD in Saudi Arabia are limited, the STS panel believes that the prevalence is increasing due to rising rates of tobacco smoking. The key objectives of the guidelines are to facilitate accurate diagnosis of COPD, identify the risk for COPD exacerbations, and provide recommendations for relieving and reducing COPD symptoms in stable patients and during exacerbations. A unique aspect of this guideline is its simplified, practical approach to classifying patients into three classes based on symptom severity using the COPD Assessment Test and the risk of exacerbations and hospitalizations. The guideline provides the reader with an executive summary of recommended COPD treatments based on the best available evidence and also addresses other major aspects of COPD management and comorbidities. This guideline is primarily intended for use by internists and general practitioners in Saudi Arabia.

Objective: The objective of the study was to systematically evaluate and perform a meta-analysis on the adherence to high-flow nasal cannula (HFNC) humidified oxygen therapy and its influencing factors in elderly patients with stable chronic obstructive pulmonary disease (COPD).

Methods: Relevant literature on HFNC and COPD was retrieved from PubMed, EMbase, Web of Science, and Cochrane Library databases. Cross-sectional studies, case-control studies, and cohort studies were included. Screening and quality assessment were conducted using Endnote X9 software. Quality scores were assigned using the Newcastle-Ottawa Scale and the AHRQ assessment tool. Basic information, sample size, and adherence-related factors were extracted, and heterogeneity and publication bias were assessed.

Results: A total of 321 articles were initially identified, with 8 English articles involving 325 patients included after screening. Quality assessment yielded five high-quality articles (score > 8), two medium-quality articles (score = 7), and one low-quality article (score = 6). Meta-analysis results showed a COPD patient HFNC adherence rate of 32.7%. Negative factors included the number of acute exacerbations (odds ratio [OR] =2.17), adverse reactions (OR = 4.13), regular follow-up (OR = 9.45), educational level (OR = 5.38), and concurrent medications (OR = 4.71). Positive factors included age < 70 years (OR = 0.45), duration of use (OR = 0.30), inhalation technique (OR = 0.31), treatment satisfaction (OR = 0.35), and adverse reactions (OR = 0.15). Funnel plot and Egger's test results indicated minimal publication bias.

Conclusion: Adherence to HFNC in elderly COPD patients is relatively low, influenced by negative factors such as the number of acute exacerbations, adverse reactions, regular follow-up, educational level, and concurrent medications. Positive factors include age < 70 years, duration of use, inhalation technique, treatment satisfaction, and adverse reactions.

Introduction: The choice of treatment strategy in patients with idiopathic pulmonary arterial hypertension (IPAH)/HPAH/DPAH (Hereditary pulmonary arterial hypertension/ Drug-induced pulmonary arterial hypertension) II-III functional class (FC) (WHO) based on an acute vasoreactive testing result (VRT). Positive VRT (VRT+) is an indication for calcium channel blockers therapy. Long-term vasoresponders demonstrate sustained low-risk status and the highest survival among all PH subtypes.

The study aimed: To characterize VRT performance in IPAH patients and differences in presentation between patients with positive, negative VRT, and patients with not done VRT due to physicians' decision.

Methods: One hundred and sixty-six adult IPAH patients (44.2 ± 15.3 years, 34 males) comprised into prospective single-center study between 2008 and 2023 years. Inhaled iloprost was used for VRT. Positive VRT was defined with established Sitbon criteria. Standard baseline pulmonary arterial hypertension (PAH) evaluation including cardiopulmonary exercise test (CPET) was performed. Risk status was evaluated using ESC/ERS (European Society of Cardiology/European Respiratory Society) risk scale 2015. Survival was assessed with the Kaplan-Mayer method.

Results: Eighty-five (51.2%) patients underwent VRT. VRT not done (ND VRT) due to the physicians' decision in 26.7% patients, due to the technical inability in 15.4% and IV FC (WHO) in 16.2% patients. Positive VRT registered in 26 (15.6%) patients. Patients with negative VRT demonstrated worse hemodynamics and exercise tolerance, higher N-terminal pro-brain-type natriuretic peptide (NT-proBNP) level, and right heart dilatation compared with VRT+. Patients with ND VRT due to the physicians decision were often older than 60 years, had higher body mass index, symptoms of right heart failure, hemoptysis, arrhythmias, high NT-proBNP, and hemodynamic criteria of high risk in comparison with patients with done VRT. Some CPET parameters were similar between VRT + group and patients ND VRT group. Loss of vasoreactivity and PAH worsening were detected in 50% of VRT + patients in a 1.76 year of follow-up. Patients with vasoreactivity loss exhibited the criteria of intermediate risk at a baseline. Five-year survival was 97% in VRT + group in comparison with 61% in VRT - and 53% in ND VRT group.

Conclusions: Physicians' decision was the most common reason for not doing VRT in IPAH patients. Intermediate high-risk criteria presence at a baseline were associated with not done VRT due to physicians decision, negative VRT, and the vasoreactivity loss during the follow-up. CPET should be used more widely to detect the early signs of PAH progression in low risk or VRT + patients.

Background: This study aimed to examine the impact of the COVID-19 lockdown on adherence to continuous positive airway pressure (CPAP) therapy among Saudi patients with obstructive sleep apnea (OSA). It also sought to assess the influence of demographic variables and comorbidities on CPAP adherence.

Methods: A prospective cohort study was conducted at the University Sleep Disorders Center at King Saud University Medical City. The study included 67 OSA patients who exclusively used CPAP for treatment across three distinct intervals: prelockdown, during lockdown, and postlockdown. Adherence to CPAP therapy was objectively measured using "mask-on on-time monitoring" data from the CPAP machines.

Results: The study found a significant decrease in the number of days with CPAP usage during the lockdown period, which persisted postlockdown. Approximately half of the patients adhered to CPAP treatment throughout the three study intervals. The decrease in CPAP usage days during lockdown was particularly noticeable among patients younger than 50 and older than 65 years of age. The presence of comorbidities, body mass index, and sex did not significantly influence CPAP treatment adherence.

Conclusion: The COVID-19 lockdown significantly impacted CPAP treatment adherence among OSA patients, with a decrease in adherence persisting postlockdown. This highlights the need for interventions to support CPAP adherence during challenging times such as a pandemic. Further research is needed to understand the long-term effects of the pandemic on CPAP therapy adherence.