Annals of Thoracic Medicine最新文献

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in children and adults. The burden is especially high among older adults and those with comorbidities. It is also the leading cause of hospital admissions during the annual Islamic pilgrimage (Hajj). CAP is a heterogeneous illness, varying in both etiology and clinical course across different patients. The Saudi Thoracic Society (STS) has developed evidence-based guidelines for the diagnosis, management, and prevention of CAP in both adult and pediatric populations in Saudi Arabia. This is the first guideline of its kind to combine both patient populations in one guideline. Although data on various aspects of CAP - especially within Saudi Arabia - remain limited, the task force based its recommendations on the best available evidence and a structured voting process to answer preset clinical questions. Main highlights from the guidelines include that routine complete blood count may assist in guiding management, particularly in severe disease, while acute-phase reactants (C-reactive protein, procalcitonin) are not recommended at initial diagnosis but may be useful if patients fail to improve. Blood cultures and sputum Gram stain/culture should not be routinely performed, except in severe or deteriorating cases or in hospitalized patients. Respiratory testing for viral pathogens and atypical bacteria is suggested when clinically indicated, especially during outbreaks or in high-risk groups. Chest radiography is recommended in adults and hospitalized children. Short-course antibiotic therapy is favored for improving patients, with early transition from intravenous to oral therapy when hospitalized. Macrolides are preferred over fluoroquinolones in outpatients, while combination beta-lactam plus macrolide therapy is recommended for inpatients. Preventive measures, particularly vaccination, are strongly endorsed. Special considerations apply to elderly, pregnant, chronic obstructive pulmonary disease, and immunocompromised patients. Corticosteroids may benefit select severe cases but are not recommended routinely. These guidelines are intended primarily for general practitioners, emergency physicians, pediatricians, and internal medicine specialists. To enhance accessibility and implementation, STS has simplified the guidelines and provided an executive summary of the key recommendations.

Background: Asthma and chronic obstructive pulmonary disease (COPD) contribute significantly to the global respiratory disease burden, with treatment adherence and nocturnal symptom control remaining key challenges. The Tulobuterol Transdermal Patch (Tuloplast™) provides continuous 24-h drug release, potentially improving adherence and symptom management. This Phase-IV clinical study evaluated its safety, tolerability, and efficacy in patients with asthma and COPD.

Methods: This multicentric, open-label Phase-IV trial enrolled 300 patients (189 asthma, 111 COPD) across seven Indian centers. Patients received Tuloplast™ in age-appropriate doses for 4-6 weeks. Primary endpoints included safety and tolerability, assessed by adverse events, global ratings, and rescue medication use. Efficacy (secondary endpoint) was evaluated through symptom severity (GINA/GOLD criteria) and pulmonary function (peak expiratory flow [PEF], forced expiratory volume in 1 second [FEV₁], forced vital capacity [FVC]), with statistical significance determined using paired t-tests.

Results: Only one patient (0.3%) reported an adverse event (mild swelling), with no serious safety concerns. At Day 28, 51.9% of asthma patients and 79.3% of COPD patients rated tolerability as "good," while 43.9% and 12.6%, respectively, rated it "excellent." Significant reductions in symptom severity were observed in asthma (P < 0.0001) and COPD patients (P < 0.0001), particularly for nocturnal symptoms (-74.88% for COPD, and -82.79% and -77.29% for pediatric and adolescent patients, respectively). Pulmonary function parameters (PEF, FEV₁, FVC) improved significantly in both groups (P < 0.0001).

Conclusion: Tuloplast™ demonstrated excellent safety, tolerability, and efficacy in improving symptom control and lung function. Its once-daily application enhances adherence, making it a promising alternative for asthma and COPD management.

Background: Incentive spirometry (IS) is a cost-effective, easy-to-use, and accessible device used peri-postoperative period for prevention or management of complications via maintaining maximum inhalation and open collapsed alveoli and resolving atelectasis. Although early pulmonary rehabilitation (PR) is known to reduce the length of stay (LOS), it is controversial whether the addition of IS provides a further contribution. This study aimed to investigate whether using IS in addition to early PR in patients with chronic obstructive pulmonary disease (COPD) exacerbation reduces LOS and whether it is a safe technique by assessing hemodynamic responses.

Methods: One hundred thirty patients with acute exacerbation of COPD (AECOPD) during hospitalization were randomized to an early PR group and an additional IS group (PR + IS). LOS (days), pre-, and postsession hemodynamic responses were recorded.

Results: The LOS was significantly lower in the PR + IS (5.34 days) group than in the PR group (7.17 days) (P = 0.026). Changes in respiratory rate (breaths/min) and oxygen saturation (%) were within the well-tolerated interval in both groups and there was a statistically significant difference in the PR + IS group (P < 0.001). Other hemodynamic changes were also within well-tolerated intervals, with no statistically significant differences between the groups (P > 0.05).

Conclusion: The usage of IS in addition to early PR in patients with AECOPD reduced LOS by approximately 1 day compared to PR alone. Furthermore, no significant signs of intolerance were observed, suggesting that IS was well-tolerated, similar to PR alone.

Background: This study aimed to investigate the impact of parenchymal infarction (PI) on the progression of pulmonary thromboembolism (PTE).

Methods: This retrospective, multicenter study evaluated patients diagnosed as having PTE via thoracic computed tomography angiography (CTA). Patients were divided into two groups, those with PI (Group 1) and those without PI (Group 2), based on CTA parenchymal windows. Clinical, demographic, radiologic, and laboratory characteristics, prognostic scores (Pulmonary embolism severity ındex [PESI]), early mortality evaluations, and 30-day mortality outcomes were recorded and compared between the groups, adhering to the European Society of Cardiology PTE guidelines.

Results: The study included 455 patients (mean age: 63.2 ± 16.8 years; 244 women [53.6%], 211 men [46.4%]). Group 1 consisted of 160 patients (35.2%), and Group 2 included 295 patients (64.8%). The mean age in Group 1 was 59 years, with a comorbidity rate of 70%. In Group 2, these were 65 years and 87%. Fever and C-reactive protein levels were significantly higher in Group 1 (P < 0.05). PESI scores and 30-day mortality rates were not statistically significant between the groups (P > 0.05). However, hemodynamic instability and high-risk PTE rates were significantly higher in Group 1 (P < 0.05).

Conclusion: PI, observed in approximately one-third of PTE patients, may influence certain parameters affecting the prognosis of PTE.

Background: Existing evidence suggests that regular physical activity is associated with improved outcomes in asthma. However, the impact of exercise on TH2 inflammation in patients with mild and well-controlled asthma is not well understood. This study aimed to determine if a short bout of exercise, alters serum inflammatory cytokines in obese and nonobese patients with well-controlled asthma.

Methods: Participants were categorized into three groups: normal-weight asthma (NW-A), asthma with obesity (O-A), and a control group of obesity without asthma (O-Ctrl). Serum cytokines were measured before and at the peak of a cardiopulmonary exercise and tested using a cycle ergometer.

Results: A total of 43 participants were included: NW-A (n = 15), O-A (n = 12), and O-Ctrl (n = 16). At baseline, the O-A group exhibited elevated levels of interleukin-5 (IL-5), IL-6, and leptin compared to the other groups. The NW-A group had higher baseline levels of IL-13 compared to the O-A group, but tumor necrosis factor-α levels were not significantly different among the groups. At peak exercise, both the O-A and NW-A groups showed reductions in plasma concentrations of IL-5, IL-6, and leptin. The O-A group showed a statistically significant increase in IL-13 levels at maximum exercise intensity, while the NW-A group did not exhibit a significant change.

Conclusion: A short bout of exercise modifies the inflammatory cytokine profile in all participants, with the most significant changes observed in the O-A group. Future studies on exercise training should include inflammatory cytokine measurements to validate these findings and further explore the unique inflammatory responses in obese asthmatic patients.

Background: Narrow-band imaging (NBI) bronchoscopy increases the diagnostic accuracy of lung cancer by enhancing mucosal surface structure images. The accuracy of NBI bronchoscopy for morphological abnormalities of tracheobronchial cells is unknown. This study aims to determine the diagnostic performance of NBI bronchoscopy in assessing tracheobronchial cell morphological abnormalities in nontumor mucosal airways.

Methods: This diagnostic study was conducted at Persahabatan Hospital from March 2023 to January 2024 using consecutive sampling. Participants aged over 18 with central lesions underwent NBI bronchoscopy. NBI vascular patterns were evaluated as the index test, with the gold standard being tracheobronchial cell morphological abnormalities assessed through histopathological examination. Diagnostic metrics, including sensitivity, specificity, and area under the curve (AUC), were analyzed using IBM SPSS Statistics 26.0.

Results: Among the 99 analyzed subjects, 46 exhibited abnormal vascular patterns on NBI bronchoscopy. A tortuous pattern exhibited the highest sensitivity and specificity (42.8% and 91.5%, respectively), compared with dotted and abrupt-ending patterns. Specificity for dotted and abrupt-ending patterns was 90.1% and 85.9%, respectively. However, as a potential screening modality, each NBI vascular pattern demonstrated low sensitivity, ranging from 14.3% to 42.8%. Combining tortuous, abrupt-ending, and dotted patterns improved diagnostic performance, achieving an AUC of 71.0%, sensitivity of 75.0%, and specificity of 67.6%.

Conclusion: NBI bronchoscopic vascular patterns are correlated with tracheobronchial cellular morphological abnormalities, demonstrating high specificity and moderate sensitivity.

Background: For the early detection and prevention of lung cancer, it is critical to know how smokers are aware of warning signs, symptoms, and risk factors for this disease.

Methods: A cross-sectional study was conducted in Saudi Arabia to evaluate the smokers' awareness of lung cancer's signs, symptoms, and risk factors.

Results: Only 54% of smokers recruited (n = 1317) were aware of lung cancer symptoms with 56% of smokers expressing low confidence in recognizing them. The commonly missed symptoms include persistent shoulder pain (38%), prolonged cough (49%), and finger shape changes (49%). Around 73% were aware of lung cancer risk factors and the top known risk factors were smoking (75%), radon gas (65%), and air pollution (57%). Male and light smokers had higher knowledge scores of lung cancer signs and symptoms compared to female and heavy smokers (7.82 ± 4.0 vs. 6.34 ±2.9, P < 0.001, and 7.66 ± 3.9 vs 6.98 ± 4.0, P = 0.023, respectively). Furthermore, male and light smokers had significantly greater lung cancer awareness of risk factors than female and heavy smokers (P < 0.001). A significant positive correlation exists between the identifying signs and symptoms and knowing lung cancer risk factors (r = 0.71, P < 0.001).

Conclusion: Heavy smokers are more likely to be unaware of lung cancer warning signs, symptoms, and risk factors than light smokers. Over 55% of smokers lacked confidence in recognizing lung cancer symptoms. Public health measures should address the specific needs of heavy and light smokers, including tailored health education initiatives considering regional and social support differences.

Background: Spirometry is one of the basic methods used in the diagnosis, treatment, and follow-up of respiratory disease. Spirometric test results that do not comply with international standards may be misinterpreted and lead to misdiagnosis and treatment. We aimed to assess the tests of patients that meet the "American Thoracic Society/European Respiratory Society (ATS/ERS) 2019" recommendations, to identify the most common errors, and to explore patient characteristics possibly associated with failure to reach these standards.

Methods: A total of 1000 spirometries performed between January and December 2023 were randomly selected retrospectively. Spirometric maneuvers were evaluated for meeting the acceptability criteria of the ATS/ERS 2019 guidelines.

Results: The acceptability spirometry rate was 62.5%. The most frequently unmet criterion was failure to meet any of the three ends of forced expiration at 20.7%. There was no significant difference between male and female in terms of the acceptability of maneuvers. The 45-59 and 60-74 age groups were statistically more significant than the younger and older. Smoking, diagnosis of chronic obstructive pulmonary disease, and number of spirometry practices were significantly associated with conformity to test acceptability criteria. The forced expiratory volume in 1 second (FEV1) divided by the forced vital capacity, FEV1, and forced expiratory times had a statistically significant independent effect on the acceptability of spirometric maneuvers.

Conclusion: Nearly one-third of the tests performed by an experienced technician in a tertiary care hospital did not meet the acceptability criteria. Our study shows the importance of the learnability of maneuvers through repeated spirometry experiences.

Background: The aim of this study was to evaluate the effects of nitrous oxide (N₂O) and surgical position on endotracheal tube cuff (ETC) pressure, hoarseness, and sore throat (ST) after surgery under general anesthesia (GA).

Methods: This double-blind clinical trial was conducted on 212 candidates for surgery under GA. They were randomly allocated to four groups, namely a supine position group (Group S), a prone position group (Group P), a supine position and N₂O group (Group SN), and a prone position and N₂O group (Group PN). ST and hoarseness were assessed at recovery and 2, 4, 8, 12, and 24 h after surgery using a visual analog scale and a mild-to-severe scoring system, respectively. ETC pressure was also measured at 15, 30, 60, 90, and 120 min after surgery onset using an Ambu cuff pressure gauge. Moreover, the mean intraoperative propofol concentration was documented. The data were analyzed at a significance level of <0.05 and using the SPSS software (version 20.0).

Results: There was no significant difference among groups regarding surgery duration (P = 0.998), whereas ST and ETC pressure in Groups S and P were significantly less than Groups SN and PN (P = 0.001). Moreover, ST and ETC pressure in Group S were significantly less than the other groups (P = 0.001). None of the participants in Groups S and P had hoarseness, and there was a significant difference among the four groups regarding the frequency of hoarseness (P = 0.001). Moreover, none of the participants in Group SN needed postoperative analgesic, and there was no significant difference between Groups S and P regarding postoperative analgesic use (P = 0.998). Intraoperative propofol use in Group SN was significantly less than the other groups (P = 0.001).

Conclusion: ETC pressure should periodically be monitored and adjusted during lengthy surgeries in prone position and N₂O anesthesia to prevent postoperative ST and hoarseness.

Purpose: The purpose of the study was to explore the influence of table tennis combined with resistance training on coronary heart disease (CHD) rehabilitation and to evaluate its potential in improving cardiopulmonary function, arterial stiffness, blood lipids, and psychological indicators in participants with CHD.

Methods: Seventy patients with confirmed CHD were chosen and randomly separated into two groups, 35 cases each. The test group performed table tennis combined with resistance training, and the reference group (RG) received standard resistance training as the control group. By comparing the differences in cardiopulmonary function, arterial stiffness, sleep and diet, psychological indicators, and blood lipids between the two groups of patients, the role of table tennis combined with resistance training in CHD rehabilitation was evaluated.

Results: Relative to the control group, participants in the table tennis exercise combined with the resistance training group had significant improvement in cardiopulmonary function (P < 0.05). In addition, table tennis combined with resistance training can reduce patients' arterial stiffness, improve sleep and eating habits, and reduce blood lipid levels. Relative to the RG, the data possess the statistical significance (P < 0.05). Finally, the psychological quality of the two groups of patients was compared. The anxiety, depression, and confrontation ability of the patients in the test group were 7.15 ± 0.39, 7.03 ± 0.29, and 6.86 ± 0.46, respectively, which were superior to the RG. The comparison among the participants of data possesses the statistical significance (P < 0.005).

Conclusion: The research results show that table tennis combined with resistance training possesses an essential influence on CHD rehabilitation. It can significantly enhance patients' cardiopulmonary function, reduce arterial stiffness, improve sleeping and eating habits, reduce blood lipid levels, and improve psychological indicators. As a low-intensity aerobic exercise, table tennis possesses an essential influence on facilitating the recovery of patients with CHD and is worthy of further promotion and application in clinical practice.