<b><i>Background:</i></b> Relapsing polychondritis (RP) is a rare systemic disease of unknown origin, with cartilaginous involvement in multiple organs. Airway involvement is the most important prognostic factor in RP. <b><i>Objectives:</i></b> Spirometric measurements and minimum tracheal cross-sectional area (mtCSA) have been reported as useful to assess the degree of airway stenosis. Because the length and severity of tracheal involvement in RP can vary, mtCSA might not provide enough information to assess tracheal abnormalities. We introduced tracheal volume (TrV) as a new method to evaluate correlations between chest computed tomography (CT) measurements and pulmonary function tests, including impulse oscillometry (IOS). <b><i>Method:</i></b> We analyzed chest CT images, spirometry, and IOS collected at our institution from April 2004 to March 2019. We calculated correlations between chest CT measurements using software (TrV, TrV/tracheal length [TrV/TL], and mtCSA) and pulmonary function parameters. <b><i>Results:</i></b> Twenty-five of 73 clinically diagnosed patients with RP were included. Spirometric findings showed moderate airway obstruction. Peak flow (PEF) was strongly correlated with mtCSA, TrV, and TrV/TL (ρ = 0.74, <i>p</i> < 0.001). FEV1 was significantly correlated with mtCSA (ρ = 0.56, <i>p</i> = 0.004), TrV (ρ = 0.52, <i>p</i> = 0.007), and TrV/TL (ρ = 0.53, <i>p</i> = 0.006). Whereas respiratory resistance at 5 Hz (R5) and 20 Hz (R20) and resonant frequencies (RFs) were significantly correlated with TrV (ρ = −0.46, <i>p</i> = 0.021; ρ = −0.46, <i>p</i> = 0.046; and ρ = −0.42, <i>p</i> = 0.037, respectively), IOS parameters and mtCSA were not. <b><i>Conclusions:</i></b> In patients with RP, TrV and mtCSA were strongly correlated with spirometric measurements. Respiratory resistances assessed by IOS correlated only with TrV. This suggests TrV assessment reflects pulmonary function in patients with RP more appropriately than mtCSA.
Introduction: Bronchial asthma (BA) and obstructive sleep apnea syndrome (OSAS) are common causes of respiratory disturbance. Many cases of patients with both conditions have been reported, and BA and OSAS may exacerbate each other, but information remains sparse.Methods:We retrospectively evaluated 60 patients under treatment for BA in our department between April 2016 and March 2018 who also underwent portable polysomnography (PSG) for suspected OSAS to assess potential association between PSG results and asthma treatment or respiratory function. BA was diagnosed and treated according to the Asthma Prevention and Management Guideline 2015.Results: We found that BA treatment intensity step was significantly higher for patients with BA who had concurrent moderate or severe OSAS (p = 0.0016). However, neither respiratory function, fraction of exhaled nitric oxide (FeNO), nor forced oscillation technique (FOT) differed significantly between patients with and without OSAS, and apnea hypopnea index was not significantly correlated with respiratory function, FeNO or FOT parameters.Conclusion:We conclude that even though BA patients with OSAS had good respiratory function, their BA was more severe than that of patients without OSAS, suggesting that OSAS may exacerbate BA. Background factors and asthma parameters were not predictive of PSG results, and patients with suspected OSAS should be evaluated proactively by using PSG.
Background: Since patients with severe COVID-19 who undergo invasive ventilation can take time to recover, it provides an opportunity to investigate the long-term prognosis and evaluate which factors influence outcomes. Methods: Patients with severe COVID-19 who received mechanical ventilation were reviewed. On admission, comorbidities and laboratory findings were collected from clinical records. For patients transferred to another hospital, clinical information was obtained from the hospitals to which patients were transferred. Results and conclusions: Prognostic information 90 days after diagnosis was reviewed for 158 patients, 126 were male. Of the 158 patients, 72 were discharged, 26 were under inpatient care, and 60 died at 90 days. Age (65.5 vs 57.4yo, p<0.001) and Charlson Risk Index (1.78 vs 1.04, p<0.01) of those who died were significantly higher than the survival group. Furthermore, the number of patients with chronic respiratory disease (26.7% vs 9.2%, p<0.01) and chronic kidney disease (26.7% vs 6.1%, p<0.001) in those who died was significantly higher than in the survival group. Laboratory findings at admission showed significantly higher levels of blood lactate dehydrogenase (LDH), urea nitrogen, creatinine, and C-reactive protein (CRP), and significantly lower hemoglobin levels and platelet counts in those who died compared to the survival group. Conclusions: Fewer than half the patients treated with invasive ventilation were discharged 90 days after diagnosis. Older patients with respiratory and renal comorbidities, higher CRP and higher LDH, or renal impairment on admission appeared to be at higher risks for a poor prognosis.
Recently, several biologics have been approved for the treatment of severe asthma. Dupilumab, a biologic used to treat severe asthma, is a monoclonal antibody targeting interleukin-4 and interleukin-13. In the present case, inhaled corticosteroid-induced glucocorticoid hypersensitivity was suspected, and the administration of omalizumab and mepolizumab had no beneficial effects. Subsequently, we switched to dupilumab therapy, which produced better effectiveness. Therefore, when a biologic agent proves ineffective, changing to another suitable biologic agent should be considered.
Personalized medicine using molecular-targeted drugs to achieve better therapeutic response and long-term prognosis is common practice for lung cancer treatment. However, in cases before gene batch tests were available, medical treatment continued without the detection of rare mutations. We report a sixty-seven-old year man diagnosed with adenocarcinoma T1cN3M1a, stage IVA. Initial screening performed 7 years earlier using EGFR mutation and ALK immunohistochemical tests were negative. Although first-line cytotoxic combination chemotherapy was remarkably effective, a gradual regression of the primary lesion was noted. After a recent bronchoscopic re-biopsy,
which subjects are suitable for its use.We therefore aimed to validate the factors that make cryobiopsy for PPLs more effective.Methods: Consecutive patients who underwent diagnostic bronchoscopy, including cryobiopsy, for PPLs at two institutions between January 2019 and December 2020 were extracted from MINERVA, a prospectively registered multicenter registry.Cases using single-use cryoprobes were excluded.Multivariable analyses with backward selection were performed to examine factors that affected cases diagnosed by cryobiopsy and conventional biopsies, respectively.In addition, we analyzed key characteristics, including intraprocedural factors, that affected diagnostic cases by cryobiopsy alone.Results and Conclusions: Excluding two patients with unknown outcomes, 280 patients were analyzed.The overall diagnostic yield was 90.4%, of which 77.1% and 76.1% were diagnosed by cryobiopsy and conventional biopsies, respectively.In each multivariable analysis, smaller lesions were the only significant failure factor in cryobiopsy, whereas ground-glass lesions in addition to smaller lesions had significantly lower diagnostic yield in conventional biopsies.On the other hand, the diagnostic cases of cryobiopsy alone were significantly more in cases where radial endobronchial ultrasound (R-EBUS) was located outside of the target (odds ratio [OR] 3.62; 95% confidence interval [CI] 1.73-7.55;p<0.001) and in female (OR 2.53; 95% CI 1.22-5.23;p=0.012).In conclusion, cryobiopsy might be particularly effective when R-EBUS is located outside, in female, and for ground-glass lesions.
Abstract Previous studies have shown that rapid on-site evaluation (ROSE) improves the diagnostic yield of bronchoscopy using endobronchial ultrasonography with guided sheath (EBUS-GS) for peripheral pulmonary lesions (PPL). There are many reports on the ROSE of imprint cytology of forceps biopsy; however, there are few reports on the ROSE of brush cytology. We investigated the utility of ROSE in brushing PPL specimens during bronchoscopy. We retrospectively analyzed 214 patients who underwent bronchoscopy with EBUS-GS for PPL. Sensitivity to bronchoscopy was significantly higher in the ROSE group than in the non-ROSE group (96.8% vs. 83.3%, P = 0.002), wherein the sensitivity to brushing also significantly improved (92.9% vs. 75.0%, P < 0.001). Conversion of ROSE results from negative to positive was observed in 79.5% of first-time ROSE-negative cases. We also found that brush specimens containing high tumor cell counts increase with repeated ROSE (42.1–69.0%). This study suggests that ROSE of brush cytology improves bronchoscopy sensitivity and increases the collected tumor cell counts.
Abstract Backgrounds : Chronic obstructive pulmonary disease (COPD) decreases quality of life and muscular strength. Inspiratory flow is important for inhalants in the bronchi but is complicated to measure in routine practice. We hypothesized that hand grip strength (HGS) would correlate with inhalation rate in patients with mild COPD. Methods : The COPD patients were recruited at the St. Marianna University School of Medicine, Yokohama Seibu Hospital, from 2015 to 2018. We measured peak inspiratory flow (PIF) through an In-Check flow meter attached with Diskus [PIF(D)] and Turbuhaler [PIF(T)] inhalers. The 6-minute walking test (6MWT), and the fraction of exhaled nitric oxide (FENO), spirometry, HGS, or forced oscillation technique (FOT) parameters were measured. Results : Forty-four subjects were enrolled. All were men, with a mean age (± SD) of 77.8 ± 9.36 years. Thirty-nine patients had mild COPD. PIF(D) was 110 (80, 140) L/min (median, interquartile range), PIF(T) was 80 (70, 90) L/min, and HGS was 28.7 (13.8, 43.6) kgf. PIF(D) and PIF(T) were significantly correlated (r = 0.443, p = 0.003). PIF(D) was significantly correlated with age (r = − 0.327, p = 0.030) and HGS (r = 0.326, p = 0.031). PIF(T) was significantly correlated with age (r = − 0.328, p = 0.030), FVC (r = 0.351, p = 0.019), 6MWT distance (r = 0.392, p = 0.011), and HGS (r = 0.328, p = 0.030). Conclusion : HGS might be more useful for predicting PIF than other parameters. Also, elderly COPD patients need to be taught inhaled methods carefully.
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