Multidisciplinary Respiratory Medicine最新文献

Background: Different therapies are recommended for the management of COVID-19 at home, use of steroids is the reference for the home management of COVID-19 in second phase of the disease. Several steroids are recommended in the treatment of COVID-19; however, the use of steroids is known to bring to problems in the management of diabetic patients.

Methods: This is a retrospective observational study, conducted with the aim of evaluating the efficacy and safety of the administration of deflazacort in diabetic outpatients infected with SARS-CoV-2, versus standard use of dexamethasone/methylprednisolone.

Results: A total of 63 patients were enrolled: 15 in the "deflazacort" group and 48 in the " dexamethasone/-methylprednisolone " group. The study population was 49.2% male with a median age of 63.6 years (IQR 54.5-71.0). 44 (69.8%) patients had at least one comorbidity in addition to diabetes. A total of 4 (6.3%) patients (50% females) required hospital care for glycaemic decompensation, all in the dexamethasone/methylprednisolone group (0 vs 4 p=0.019). Hospitalization occurred in 19 (30.1%) for respiratory failure related to SARS-CoV-2 infection: 5 in the deflazacort group, 14 in the dexamethasone/methylprednisolone group (p=0.76) The mean number of days between illness onset and the first negative swab was 28.4 days in the deflazacort group and  27.4 days in the dexamethasone/methylprednisolone group (p=0.40).

Conclusion: Deflazacort demonstrated a lower incidence of hospital admission for glycaemic decompensation compared to standard treatment with dexamethasone/methylprednisolone in SARS-CoV-2 positive outpatients. There were no differences in COVID-19-related hospitalizations between the two groups.

Background: Chronic respiratory diseases represent a significant global health burden, affecting millions of individuals. Long-term oxygen therapy (LTOT) has been a key treatment for patients with chronic hypoxemia due to these conditions, demonstrating benefits for survival and quality of life.

Methods: An observational, analytical, retrospective cohort study was conducted to evaluate clinical indicators for safely discontinuing oxygen therapy in 36 patients aged 50 years or older with chronic respiratory diseases residing in five nursing homes. Data included sociodemographic and clinical variables, such as comorbidities, oxygen saturation levels, and treatment details. A cohort of 36 nursing home residents with chronic respiratory diseases was analyzed.

Results: The study revealed that 83.3% of patients had at least one comorbidity. Most patients (80.6%) used a nasal cannula for oxygen delivery, with a mean flow rate of 2.06 L/min. Approximately 80.6% achieved oxygen saturation >92% without supplemental oxygen. None of the patients who discontinued oxygen required readmission or oxygen reinstatement within the 4-week follow-up period.

Conclusions: This study provides preliminary evidence that achieving oxygen saturation >92% at rest or in exertion may represent a potential clinical indicator for safely discontinuing supplemental oxygen in patients with chronic respiratory diseases. However, given the retrospective design and small sample size, these findings should be interpreted cautiously and validated in larger, prospective studies.

Background: OSA is a chronic disorder associated with significant health and social risks. CPAP therapy is the gold standard treatment, but adherence remains a major challenge. Telemonitoring offers a potential tool to improve adherence and optimize long-term management. This multicenter observational retrospective study evaluates long-term CPAP adherence in OSA patients telemonitored in the province of Treviso, Italy. The primary objective is to evaluate adherence rates over a six-year period in comparison to existing data with conventional follow-up strategies. Secondary objectives include subgroup analyses based on age, sex, mask type, and the presence of comorbid respiratory conditions beyond OSA, such as OSA-obesity hypoventilation syndrome and complex sleep-related breathing disorders.

Methods: Data from 579 OSA patients who initiated CPAP therapy from July 2018 onwards were analyzed. Patients underwent routine telemonitoring follow-up every 3 months, during which CPAP adherence, residual apnea-hypopnea index, and air leakage were recorded. Statistical analyses included Welch's t-test, Mann-Whitney test, chi-square test, and Fisher's exact test, with significance set at p ≤ 0.05.

Results: The overall CPAP adherence rate was 80.66% over the 6-year follow-up period. Mean nightly usage was 6.6 hours, with a usage rate of 89.9% of nights. Elderly patients (>65 years) had higher rAHI (4.4 vs. 3) and air leakage (45.7% vs. 24.9%) compared to younger individuals but exhibited comparable adherence. Nasal masks were associated with superior adherence (6.8 vs. 6.4 hours per night) and lower rAHI (3.3 vs. 4.4) compared to oronasal masks. OSA patients with obesity-hypoventilation syndrome and complex sleep-related breathing disorders demonstrated similar adherence rates to general OSA patients, despite distinct characteristics.

Conclusions: In this first real-life study with a large sample size conducted in Italy so far, CPAP adherence in telemonitored patients was significantly higher compared to previous studies without telemonitoring. These findings suggest that telemonitoring enhances long-term adherence by facilitating early detection and management of nonadherence. The study highlights the advantages of nasal masks and emphasizes the greater challenges associated with managing elderly patients and those with comorbid conditions. Telemedicine appears to be a promising approach for optimizing OSA management.

Background: Chest examination alone may be insufficient to declare cardiorespiratory diseases specially in its early stages and/or silent forms, also it is impractical for the CXR and cardiac consultation to be requested for every patient in the outpatient clinic, therefore involving the chest US and FoCUS (Focused Cardiac Ultra Sound) examination in the bedside practice of outpatient chest clinic may influence the clinical diagnosis and management plan.

Objective: To determine how the bedside thoracic US including FoCUS can alter the clinical diagnosis in patients who are clinically diagnosed as acute bronchitis in the outpatient chest clinic.

Subjects and methods: This study was conducted at Chest outpatient clinic, Al-Azhar University in the period between January 2024 to March 2025. 300 patients diagnosed clinically as acute bronchitis were evaluated by bedside chest ultrasound and FoCUS.

Results: A prospective cross sectional study including 300 patients clinically diagnosed as acute bronchitis and evaluated by the bedside chest US including FoCUS which was additive and/or changing in clinical diagnosis in 31 (10.3%) of the studied patients, the sonographic evidence of pneumonia was present in 17 (5.7%) patients, the interstitial lung disease ILD was suggested in 5 (1.7%) patients, the clinic-sonographic diagnosis of heart failure was present in 7 (2.3%), the findings of mitral stenosis was present in 2 (0.7%).

Conclusion: The practice of bedside chest US including FoCUS should not be restricted to the emergency rooms and ICUs but also should be extended to the outpatient clinic as it can diagnose unexpected clinical problems, guide to the next investigational step, and shorten the time to the clinical diagnosis and recovery.

Background: To determine the diagnostic performance of a new questionnaire (COPD-WS) that considers also exposure to wood smoke for diagnosing Chronic Obstructive Pulmonary Disease (COPD) in a Colombian population.

Methods: A cross-sectional study was conducted with analysis of diagnostic tests in subjects with and without COPD. Clinical variables were selected based on their relevance to COPD diagnosis, including age, sex, smoking status, exposure to wood smoke, dyspnea, cough, chronic expectoration, and wheezing. A bivariate analysis was performed with the diagnosis of COPD by spirometric criteria. The area under the receiver operating characteristic curve (AUROC) was calculated for the new questionnaire and compared with the LFQ, CDQ, PUMA, COULD IT BE COPD, and COPD-PS questionnaires. The cutoff point for the new questionnaire was obtained through the Youden index, and a p-value <0.05 was considered statistically significant.

Results: A total of 681 patients were included, 187 (27.5%) diagnosed with COPD. The mean age of the population was 65.9 (SD: ±11.79) years, with 53.7% being women and 58.3% having been exposed to wood smoke. The variables included in the questionnaire were age, sex, smoking status, exposure to wood smoke, dyspnea, cough, chronic expectoration, and wheezing. The AUROC for the new COPD-WS questionnaire was 0.69 (95%CI:0.65-0.74;p<0.001), and for a cutoff point ≥6, sensitivity was 0.711 (95%CI:0.677-0.745), specificity was 0.575 (95%CI:0.538-0.612), PPV was 0.388 (95% CI:0.351-0.424), NPV was 0.840 (95%CI:0.813-0.868), LR+ was 1.673 (95%CI:1.458-1.919), LR- was 0.502 (95% CI:0.438-0.576).

Conclusion: This new questionnaire COPD-WS demonstrates acceptable diagnostic capability for diagnosis of COPD in this symptomatic population, and its performance is comparable to other questionnaires currently in use.

Background: Telemedicine (TM) is increasingly recognised as a valuable tool in the management of interstitial lung diseases (ILDs). Despite its potential, its integration and application still remain limited. Our work aimed to assess pulmonologists' (physicians and trainees) perception regarding the use of TM in ILDs management.

Methods: This national survey was created and distributed to all pulmonologists, both physicians and trainees, affiliated with Società Italiana di Pneumologia/Italian Respiratory Society (SIP/IRS). Responses were collected anonymously and analysed by using descriptive statistical analysis and the chi-square test.  Results: Among 2,906 invited participants, 44 completed the survey. While 95.5% of respondents considered TM useful in ILDs monitoring, only 36% reported its use in clinical practice. Current barriers included reduced availability of TM services (64%) and limited knowledge of TM software (56.8%). Moreover, the majority of participants referred a supportive but not substitutive role of TM in-person consultations, especially in monitoring and patient education. A significant proportion of repliers (over 50%) claimed that it may reduce waiting lists and enhance patient satisfaction (63.6%). However, concerns regarding data security and absence of standardised protocols were also reported.  Conclusions: TM is positively perceived by both physicians and trainees' pulmonologist for ILDs follow-up and educational purposes in ILD management. Nevertheless, its integration and application are still hindered by some concerns such as limited infrastructure and digital literacy as well as lack of standardisation of reimbursement protocols and evolving regulatory frameworks. Broader integration of TM will require to address these challenges through investments in technology, structured protocols, and training initiatives.

Background: Paediatric-to-adult transition represents an unmet need in many chronic conditions. Data and -outcomes on pulmonary transition clinics (PTC) are limited.  Methods: We report the structure, organization, and patients' characteristics of a multidisciplinary outpatient PTC started in 2022 by two secondary level academic hospitals in Milan, Italy. Consecutive adult patients  (≥18 years old) that entered the PTC from January 2022 until January 2023 and completed ≥2 follow-up visits were asked to answer a custom designed, anonymized, online questionnaire to test improvement in disease perception, self-confidence, and evaluate their experience with the clinic.  Results: Out of thirty-three patients, twenty-one completed the survey (62% males, median age 19 years). The most common diagnoses included asthma (57%) and bronchiectasis (19%). The disease control rate was optimal, only <2% of visits were unscheduled emergency visits. 100% of patients rated the presence of a dedicated service, a direct relationship with the treating physician and the possibility to improve self-management extremely useful.

Conclusions: Our questionnaire revealed that transitioning from caregiver-based disease management to patient-based disease management was perceived as more arduous. PTCs are an impactful resource for patients transitioning to adult care, but our knowledge on disease specific management strategies in transitioning patients remains limited.

Background: Pulmonary alveolar proteinosis (PAP) has an unpredictable clinical course. Although usually benign, an association with pulmonary fibrosis is described in literature, with troubling therapeutic and prognostic implications.

Clinical case: We report the case of a patient affected by autoimmune PAP who developed pleuro-parenchymal fibroelastosis (PPFE) after 6 years of disease and underwent bilateral lung transplantation due to end stage respiratory failure.

Conclusion: Punctual descriptions of pulmonary fibrosis in PAP are still lacking and no predictors of fibrotic evolution of PAP are known. It is necessary to ensure a strict follow up in order to promptly recognize signs of fibrotic evolution and early refer patients with evolutive disease to lung transplant center. Moreover, an extended genetic analysis by targeted next-generation sequencing could provide high-resolution information that may allow the identification of susceptible patients in a pre-fibrotic stage of disease.

Tuberculosis (TB), induced by Mycobacterium tuberculosis, is a significant global health concern. It affects approximately 25% of the global population and ranks among the primary causes of mortality from infectious diseases. Notwithstanding progress, TB treatment and diagnosis continue to encounter substantial obstacles, such as restricted access to precise diagnostics and efficacious therapies. By 2035, international objectives seek to diminish tuberculosis-related fatalities by 95% and enhance treatment accessibility. Multiple factors affect the success of TB treatment, including personal behaviors, social and demographic circumstances, and concurrent health conditions. Critical risk factors for suboptimal treatment outcomes encompass low body mass index, tobacco use, substance abuse, and various demographic variables, including gender, age, unemployment, geographic location, and migration status. Co-infections with HIV, diabetes, chronic kidney disease, and COVID-19 are associated with increased rates of treatment failure. Supplementary challenges, including loss to follow-up and drug-resistant TB, elevate the probability of treatment failure. This review's findings intend to furnish essential insights for policymakers, healthcare professionals, and TB control programs, enhancing strategies and interventions. The primary objective is to improve the efficacy of TB management globally, with an emphasis on attaining superior treatment outcomes, particularly in the most underserved regions.

Background: Indoor environments, particularly in schools, are a significant source of bacterial exposure, posing a public health risk. The aim of this study was to investigate the bacterial load and associated factors in the indoor environments of governmental and private primary schools in Hawassa, City, Ethiopia, 2023.

Methods: A comparative cross-sectional study design was used in March, 2023; in 56 randomly selected classrooms focusing in five governmental and five private primary schools in Hawassa, City. The bacterial load was estimated using the settle-plate method of passive air sampling. Differences in the mean bacterial load between government and private primary schools were evaluated using a non-parametric test. Multiple linear regression analysis using log-transformed data was performed.

Result: The average bacterial load in government primary schools was 8684.84 CFU/m3; while in private schools, it was 4396.43 CFU/m3. The isolated bacterial species included coagulase-negative Staphylococcus species (CoNS), gram-negative Bacillus species, gram-positive Bacillus species, and Staphylococcus aureus. A significant difference in the mean bacterial load (p=0.002) was observed between government and private primary schools with private primary schools showing lower levels. In government schools, the bacterial load was significantly associated with classroom cleanliness, occupant density, cleaning frequency, and classroom area. Conversely, the bacterial load in private schools showed strong association with the occupant density, cleaning frequency, relative humidity, and ventilation conditions.

Conclusion: In government and private primary schools, the level of bacterial loads exceeded the WHO -criteria. This study revealed significant differences in indoor bacterial loads between government and private primary schools, with private schools showing lower levels. The correlation between bacterial load and environmental factors was distinct in each setting. As a recommendation; improving cleanliness, layout optimization, ventilation improvement, and hygiene education for both sectors, with regular air quality monitoring are crucial for tracking progress.