Multidisciplinary Respiratory Medicine最新文献

Background: Home spirometry using portable devices offers a potential alternative for asthma management by reducing hospital dependence and improving accessibility. This study aimed to assess the feasibility of a home spirometry program with bronchodilator response (BDR) testing performed without direct medical supervision.  Methods: A prospective observational study was conducted with 47 asthma patients from a tertiary hospital. Participants received clear instructions and performed forced spirometry with BDR testing at home using a portable device. The primary outcomes included spirometry quality, variability compared to hospital tests, and patient satisfaction.

Results: A total of 78% of participants achieved high-quality spirometry (A or B, according to ATS/ERS -criteria), despite greater variability in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) compared to hospital tests. However, the results remained clinically acceptable. Patients reported high satisfaction with the device, highlighting its ease of use and convenience.

Conclusions: Home spirometry with BDR testing is a feasible tool for asthma follow-up, maintaining acceptable quality while reducing hospital-based testing. Although improvements are needed to minimize variability and enhance consistency, this program has the potential to optimize asthma management, increase accessibility, and reduce the burden on healthcare facilities.

Lung collapse, commonly associated with conditions such as atelectasis, pneumonia, and acute respiratory distress syndrome, significantly impairs gas exchange and respiratory function. Monitoring lung re-aeration is therefore crucial in evaluating the effectiveness of therapeutic interventions, including non-invasive ventilation, invasive mechanical ventilation, and physiotherapy, which aim to restore lung volume and improve respiratory efficiency. Lung re-aeration involves two key physiological processes such as recruitment and inflation. Both mechanisms improve lung compliance and optimize ventilation-perfusion matching, improving overall respiratory function. LUS has emerged as a promising alternative for assessing lung aeration, supporting its feasibility in detecting and tracking lung re-aeration across various clinical scenarios, and providing real-time insights into lung recruitment and inflation. This review integrates current evidence on the physiological mechanisms of lung collapse and the clinical applications of ultrasound as a tool for monitoring lung re-aeration, highlighting its potential to optimize respiratory management in critically ill patients.

Introduction: Despite the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines providing a detailed pathway for the management of chronic obstructive pulmonary disease (COPD), the Italian reality is characterized by underdiagnosis, organizational disharmony, and poor adherence to treatments. COPD entails significant economic and organizational costs, including healthcare expenses, delayed diagnoses, and fragmented management. Therapeutic approaches are often non-standardized and influenced by local practices.

Methods: The audit presented here aims to provide suggestions to optimize COPD patient management, from the acute phase to stabilization, focusing on diagnosis, therapies, respiratory rehabilitation and follow-up, while proposing a coordinated pathway that could optimize patients and healthcare needs.

Results: Eight specialists (1 internist and 7 pulmonologists) with extensive professional experience participated in the audit meetings. During three 4-hour sessions spread over three months, participants discussed background information, challenges and suggestions related to disease management. Topics were presented by designated leads, discussed by the group, and summarized into suggestions voted on using a Delphi-like process. Suggestions were approved if at least 75% of participants rated them above seven out of ten. The process produced a final list of shared suggestions. The audit group highlighted that the current management approach for COPD -patients-both in the stable phase and during exacerbations requiring hospital admission, discharge, and post-acute respiratory rehabilitation-remains fragmented, inconsistent, and poorly standardized. The group approved 29 improvement suggestions (21 achieved unanimous approval) across six main areas: a) The pathway for suspected or confirmed COPD patients; b) Therapy during the stable phase; c) Exacerbations/hospitalizations; d) Intensive care admissions requiring tracheostomy; e) Hospital discharge and f) Indications for respiratory rehabilitation.

Conclusions: This work offers a unique pulmonologist's point of view and suggestions based on literature, best practices, and field experiences to improve collaboration among stakeholders and provide more effective care for COPD patients.

Background: Chest physical exam (CPE) is based on the four pillars of classical semiotics. However, CPE's sensitivity and specificity are low, and is affected by operators' skills. The aim of this work was to explore the contribution of chest ultrasound (US) to the traditional CPE.

Methods: For this purpose, a survey was submitted to US users. They were asked to rate the usefulness of classical semiotics and chest US in evaluating each item of CPE pillars. The study was conducted and described according to the STROBE checklist. The study used the freely available online survey cloud-web application (Google Forms, Google Ireland Ltd, Mountain View, CA, USA).

Results: The results showed a tendency to prefer chest US to palpation and percussion, suggesting a possible -future approach based on inspection, auscultation and palpatory ultrasound evaluation.

Conclusion: The results of our survey introduce, for the first time, the role of ultrasound as a pillar of physical examination. Our project CHEPHEUS has the aim to study and propose a new way of performing the physical exam in the future.

Background: Tuberculosis (TB) is a leading cause of morbidity and mortality in people living with human immunodeficiency virus (HIV). Data are very scarce on the burden of TB in HIV patients in Sub-saharan African populations. This study aimed to determine the prevalence of pulmonary tuberculosis (PTB) and associated factors among people living with human immunodeficiency virus (HIV) in three West African countries: Benin, Guinea, and Senegal.

Methods: A cross-sectional study was conducted among people living with HIV in three outpatient care centres (one in each country). All HIV-positive patients included in this study were routinely screened for PTB using microscopy, GeneXpert and culture. Participants free of TB were reassessed clinically and biologically six months later. Data were analyzed using R-3.4.3 software. Logistic regression was used to identify factors associated with PTB.

Results: A total of 2859 participants were enrolled in the study, of whom 2820 were screened for TB, 1000 were ARV-naive (35.46%), and 1820 were on ARV prior to screening (64.54%). A total of 127 cases of bacteriologically confirmed PTB (BCPTB) were diagnosed: 117 at baseline and 10 at the 6-month visit. The overall prevalence of BCPTB was 7.90% [95% CI: 6.38-9.75] for ARV-naive participants and 2.64% [95% CI: 1.99-3.48] for participants on ARV at the time of screening. Participants from Guinea were more likely to be diagnosed with TB (OR: 2.95 [95% CI: 1.60-5.45], p=0.001). Underweight HIV-positive patients had higher odds of TB diagnosis (OR: 2.09 [95% CI: 1.40-3.12], p<0.001), while overweight/obesity was associated with lower odds of TB (OR: 0.35 [95% CI: 0.15-0.81], p=0.015). Other factors associated with BCPTB in HIV patients were male sex (OR: 1.81 [95% CI: 1.18-2.77], p=0.007), CD4 count <200/ml (OR: 2.24 [95% CI: 1.15-4.37], p=0.018), and irregular disease follow-up (OR: 2.57 [95% CI: 1.29-5.15], p=0.018).

Conclusion: The prevalence of TB among people living with HIV is high in Benin, Guinea and Senegal. These results highlight the need to improve TB screening and diagnosis in PLHIV, especially in ARV-naive patients.

Background: Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality worldwide. Effective infection control in pulmonary rehabilitation units is essential but remains insufficiently studied. This study investigated bacterial contamination, the distribution of species, and the effectiveness of antimicrobial strategies in a pulmonary rehabilitation center.

Methods: Surface swab sampling and ZnO-based antimicrobial strategies were employed to assess bacterial contamination in a pulmonary rehabilitation center. The swab samples were cultured, and species were identified.

Results: Bacterial contamination on six key sampling surfaces was initially high (over 500 CFUs/100 cm2) but was significantly reduced after the application of ZnO tape to these surfaces. The antibacterial rates exceeded 80% after one week of using ZnO tape and nanoparticle suspension; however, on some surfaces, the effectiveness declined even after three weeks. These findings suggest that antibacterial protection should be renewed weekly to maintain its efficacy.

Conclusions: The application of ZnO tape and nanoparticle solution effectively reduced bacterial contamination in a pulmonary rehabilitation center, underscoring the need for regular disinfection and innovative infection control strategies.

Background: Chronic respiratory diseases cause significant global morbidity and mortality, with asthma being a major contributor. Globally, 461,000 asthma-related deaths and a prevalence of 262 million subjects were estimated in 2019. The objective of this paper is to summarize experts' opinions in the field of asthma to produce evidence on the clinical and economic impact of FeNO test in asthma management, as well as on its standard operational procedures.

Methods: The analysis conducted is based on a literature review of the FeNO test's role in asthma, focusing on its clinical and economic impact, strengths and limitations. Insights were gathered through interviews with ten Key Opinion Leaders in asthma management from various Italian regions. Their thoughts were summarized into key-messages and discussed in a joint meeting. A final document consolidating these discussions was outlined and approved by the experts involved.

Results: The FeNO test is crucial in the clinical management of asthma, aiding in phenotypic classification and guiding therapeutic decisions, particularly in severe cases. The value of FeNO assessment is supported by extensive literature evidence and recommended by international guidelines. Moreover, published economic analyses highlight the sustainability of the initial investment in FeNO technology thanks to a reduction of short-term medical costs for National Health Services by decreasing hospital admissions, specialist visits, and exacerbations related to asthma management. The test should be conducted at the first visit at the asthma centre and then regularly during follow-ups to monitor therapy adherence, adjust treatments, and predict response to drugs. FeNO testing facilitates early detection of bronchial inflammation, shortening the time for patients to access appropriate therapy. Despite its ease of use, interpreting the results requires specialist oversight due to potential confounding factors.

Conclusions: FeNO testing significantly improves asthma management by aiding in phenotyping, therapeutic strategy formulation, and monitoring. It enhances disease control, accelerates patient care, and offers economic benefits by reducing hospital admissions and treatment needs. However, practical and economic barriers can limit its adoption. Standardized test execution and result interpretation by specialists are essential for accurate patient management. The inclusion of FeNO assessment among exempt services for asthma patients would at last promote its equitable access.

Allergic rhinitis (AR), non-allergic rhinitis (NAR), and chronic rhinosinusitis with nasal polyps (CRSwNP) share a type 2 inflammation. Thus, intranasal corticosteroids (INCS) are recommended for managing these diseases. In this regard, budesonide aqueous nasal spray (BANS) has been an effective and safe INCS available for decades. As a recent Delphi consensus and a survey explored the use of topical nasal therapy in practice, a panel of experts promoted a multidisciplinary Delphi consensus on BANS in daily practice. Forty-six Italian expert otorhinolaryngologists, allergologists, and pediatricians participated in the initiative. Twenty-one statements were voted on. There was a large agreement with all statements. Thus, this document proposed a valuable BANS use in managing patients with AR, NAR, or CRSwNP considering the relevant activity on dampening type 2 inflammation. Moreover, the safety profile was considered good, also concerning the bioavailability issue. However, based on the severity of the disease, BANS use should be prescribed as cycles or for prolonged periods.  In conclusion, the present multidisciplinary Delphi consensus supported BANS use in upper airway type 2 diseases.

Background: Tuberculosis (TB) treatment non-compliance remains a significant global public health issue, undermining disease control efforts and leading to adverse clinical and epidemiological outcomes. While considerable research has explored this issue, gaps remain in understanding the multifactorial influences on non-compliance, particularly its key factors and impacts, as well as the interconnections that exacerbate these challenges. This study integrates narrative and bibliometric approaches to critically synthesize and visualize factors contributing to TB treatment non-compliance and its impacts. By addressing research gaps, this study aims to provide a comprehensive framework for understanding the multifactorial challenges and proposing evidence-informed strategies to address clinical and epidemiological issues.

Methods: A systematic search of Scopus, EBSCO (Medline), ScienceDirect, and PubMed databases identified empirical studies published up to December 2024. Thematic synthesis categorized factors into overarching themes, while bibliometric analysis using VOSviewer software visualized factors and their interconnections.

Results: The review identified key factors such as poor tuberculosis knowledge, stigma, side effects, and economic constraints, interacting with demographic, psychological, and systemic barriers. Network visualization highlighted the interconnections among these factors, illustrating how they compound to exacerbate non-compliance. Clinical and epidemiological impacts include MDR/XDR-TB, prolonged treatment, and community transmission.

Conclusions: TB treatment non-compliance arises from a complex interplay of individual, socio-economic, and healthcare-related factors. This review emphasizes the importance of integrated narrative and bibliometric approaches to develop context-specific strategies for improving adherence, reducing the global TB burden, and guiding future research and policy.

A personalized approach to management of a COPD patient is currently required due to heterogeneity of this disorder. A functional evaluation of each COPD patient is a fundamental part of the process to achieve this objec- tive and should require a rational step-by-step procedure starting from the etiology of COPD, determination of the predominant underlying disease, assessment of risk severity, therapeutic role of ICS and finally monitoring of disease activity and its impact on the patient's life under the chosen treatment. Aim of this review is to indicate a series of easy sequential measurements that are worth to have for obtaining all this information crucial to taking care of a patient with a new diagnosis of COPD.