Long term efficacy of war related bronchiolitis obliterans treatment
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Abstract:
Introduction: There is few data about war related bronchiolitis obliterans (BO) treatment. We compared FVC and FEV1 changes during BO treatment in comparison to non bronchiolitis obstructive pulmonary disease in a cohort of chemical victims. Materials and methods: Seventy two Iranian veterans, with chronic pulmonary disease were followed from September 2005 to December 2010. All of them had documented exposure to Sulfur Mustard gas from 1982 to 1988. The bronchiolitis group (diagnosed based on HRCT and/or biopsy) was treated with inhaled Seretide (500-1000 μg/day), Azithromycin (500 mg/3 times per week) and N -acetylcysteine (1200-1800/day). The non bronchiolitis patients were treated according to GINA and GOLD guidelines. Results: 16 patients had BO and 56 had non bronchiolitis obstructive pulmonary disease. The baseline FVC and FEV1 were not different between bronchiolitis and non bronchiolitis groups. Mean FVC and FEV1 has decreased significantly during the 5 years followup despite standard treatments in all patients (baseline FVC=3.50±0.78 L, Final FVC=3.21±0.75 L; P Discussion: The five year spirometric parametric changes were not different between bronchiolitis and non bronchiolitis group in mustard gas victims. This finding suggests the long term efficacy of treatment with inhaled steroid, macrolide and N -acetylcysteine in war related bronchiolitis obliterans.Cite
Background
Postinfectious bronchiolitis obliterans (BO) is a chronic respiratory disease that usually follows a severe adenovirus infection.Objective
To determine the evolution of pulmonary function and clinical outcome of children with postinfectious BO during childhood.Methods
The study included patients diagnosed with postinfectious BO in whom at least two spirometries were performed within a minimum interval of 3 months.Results
46 met the inclusion criteria. The mean (±SD) follow-up period was 12.5 (±3.5) years. 197 spirometries and 41 plethysmographies were performed. Initial (9±3 years old) lung function was as follows (z score, mean±SD): forced vital capacity (FVC) −3.8±1; forced expiratory volume in 1 s (FEV1) −4.4±1; FEV1/FVC −2.2±1; forced expiratory flow (FEF)25–75 −3.7±1; total lung capacity (TLC) 120±26%; residual volume (RV) 309±108%; and RV/TLC 55±13. During childhood, FVC and FEV1 increased by a mean of 11%/year (95% CI 9.3% to 12.6%; p<0.0001) and 9%/year (95% CI 7.7% to 10.2%; p<0.0001), and the FEV1/FVC ratio decreased by 1.9%/year (95% CI 1% to 2.8; p<0.001). The z score for FVC, FEV1 and FEV1/FVC decreased by 0.07 z score/year (95% CI 0.1 to 0.01; p<0.05), 0.09 z score/year (95% CI 0.1 to 0.05; p<0.01) and 0.04 z score/year (95% CI 0.09 to 0.001; p<0.02), respectively. During the follow-up period, 69% of patients required at least one hospital readmission and five required mechanical ventilation. Nine patients developed a thoracic deformity, and seven whose bronchiectasis did not respond to clinical treatment underwent a lobectomy.Conclusions
After a 12 year follow-up period, pulmonary function remained severely impaired, showing an obstructive pattern with air trapping that slowly improved during childhood. An unequal growth of lung parenchyma over the airways suggests dysinaptic growth. Patients required frequent readmission due to recurrent respiratory infections, and hypoxaemia improved slowly over time.Vital capacity
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Objective:To observe the effects of inhaled salmeterol/fluticasone propionate (Seretide) on lung function of the patients with chronic obstructive pulmonary disease(COPD).Methods:85 diagnosed patients were randomly divided into experimental and control group. Baseline treatments were similar in all patients. In experimental group, twice-daily 50/250 μg dosage form of Seretide were additionally given to the patients for six month. In control group , twice-daily peroral Slow-release Theopylline(0.2g) were additionally given to the patients for six month. Before and after the cause of treatment , lung function of the two groups patients were examined and compared respectively.Results:Before experiment , the difference of FEV1,FEV1/FVC and FEV1/predictive between the two groups were not significant (P0.05) . But at the end of experiment , the values of above-mentioned items in the experimental group were higher than the control group(all P0.05) . At the end of experiment , the values of FEV1,FEV1/FVC and FEV1/predictive in experimental group became higher in different extent than the baseline values (all P0.05) . But in the control group ,the value of FEV1 became lower than the baseline value (P=0.0422) . After and before the experiment,the values of FEV1/FVC and FEV1/predictive in control group were not significant (all P0.05).Conclusion:Seretide can improve lung function of the patients with stable COPD of severity or .
Fluticasone propionate
Salmeterol
Fluticasone
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Rational: The Coronavirus Disease 2019 (COVID-19) pandemic is a growing public health concern, with over 18 million cases reported to-date in the United States. The Centers for Disease Control and Prevention reports that up to 15% of COVID-19 cases warranted hospitalization between March and December 2020 due to symptom severity. With significant respiratory manifestations, there has been increased interest in the characterization of pulmonary function following recovery from COVID-19 and the potential role of inhaled medications. The following represents a single-center study investigating the pulmonary function of patients hospitalized for COVID-19 at 1- and 2.5-months following discharge. Methods: Patients without prior pulmonary pathology (n= 25, mean age= 59.28 ±2.07 years, 52% male) hospitalized for COVID-19 (mean hospitalization= 8.32 ±0.93 days) underwent pulmonary function testing 1-month (27.23 ±2.67 days) following hospital discharge using the Platinum Elite body plethysmograph (MGC Diagnostics, Minnesota, USA). Patients were prescribed albuterol with or without an inhaled corticosteroid according to symptom severity on the modified Medical Research Council dyspnea scale. Subsequent pulmonary testing was conducted at 2.5-months (76.45 ±11.68 days) postdischarge using the EasyOne Plus Spirometer (NND Medical Technologies, Zurich, Switzerland). Results: At 1-month post-discharge, characterization of pulmonary function noted moderately-severe restrictive lung disease (FEV1= 64.36 ±2.86%, FVC= 59.36 ±2.71%, FEV1/FVC= 92.40 ±3.10%) with reduced total lung capacity (TLC= 79.68 ±6.84%) and preserved diffusion capacity for carbon monoxide divided by alveolar volume (DLCO/VA= 97.50 ±8.89%). At 2.5-months post-discharge, significant improvement of FEV1 (+13.82%, p<0.001) and FVC (+13.16%, p<0.001) was found, with an overall restrictive lung disease pattern of mild severity and near-normalization of FEV1 (FEV1= 78.19 ±2.78%, FVC= 72.52 ±2.46%, FEV1/FVC= 95.82 ±4.32%). At 2.5-months post-discharge, patients prescribed albuterol sulfate with an inhaled corticosteroid were found to have a tendency for greater improvement of pulmonary function (n= 12, FEV1= +15.73%, FVC= +12.75%, p<0.01 and p<0.01 respectively) compared to patients prescribed albuterol sulfate alone (n= 11, FEV1= +12.36%, FVC= +10.64%, p<0.05 and p<0.01 respectively). However, this improvement difference did not reach significance. Conclusions: The current study aimed to characterize the pulmonary function of patients hospitalized with COVID-19 at 1- and 2.5-months following hospital discharge. At 1-month post-discharge, patients were found to have moderately-severe restrictive lung disease with reduced total lung capacity and preserved diffusion capacity. Significant improvement in pulmonary function was noted at 2.5-months postdischarge, with FEV1 nearing normalization. Pulmonary function improvement did not differ significantly between patients prescribed albuterol sulfate versus albuterol sulfate with an inhaled corticosteroid.
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Objective
To investigate the effect of rosuvastain on the lung function and quality of life in patients with stable chronic obstructive pulmonary disease(COPD).
Methods
88 patients with COPD were selected, they were divided into the research group and the control group by digital table method, each group had 44 cases.Traditional treatment was used to treat patients in the control group, the research group was treated with rosuvastain 20mg, 1 time one day on the basis of the traditional treatment, all patients were treated for 6 months.Before treatment, 1 month after therapy and 6 months after therapy, the first second forced expiratory volume(FEV1), forced expiratory volume in first second(FEV1), forced vital capacity(FVC%) value and the patients' lung function were determined, the patients' quality of life was evaluated by the COPD Assessment Test(CAT).
Results
After1 and 6 months of therapy, the FEV1, FEV1/FVC of the two groups were higher than before treatment, and after 6 months of therapy, the FEV1, FEV1/FVC of the research group were (1.49±0.40)L, (59.35±5.51)% respectively, which were significantly higher than (1.28±0.31)L, (53.02±5.60)% of the control group(t=2.753, 5.345, all P<0.05). After 1 and 6 months of therapy, the CAT scores of the two groups were lower than before treatment, and after 6 months of therapy, the CAT score of the research group was (17.27±3.32)points, which was significantly lower than (21.25±4.51)points of the control group(t=-4.714, P<0.05).
Conclusion
Rosuvastain can improve lung function and quality of life in patients with COPD, the clinical curative effect is distinct, and it is worthy of popularization and application.
Key words:
Pulmonary disease, chronic obstructive; Rosuvastain; Pulmonary function; Quality of life
Vital capacity
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Background: Lung function deficits and increased risk of COPD after lower respiratory infection in infancy may be present in adulthood. Aim: To evaluate lung function, with a special focus on irreversible airway obstruction, thirty years after bronchiolitis or pneumonia in infancy. Methods: In 1981-82, 83 children under 2 years of age were hospitalized for bronchiolitis and 44 for pneumonia at Kuopio University Hospital, Finland. In 2010, 47 former bronchiolitis patients and 22 former pneumonia patients, and 138 matched controls attended the clinical study, including flow volume spirometry before (pre-BD) and after bronchodilatation (post-BD). The measured parameters were forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FVC/FEV1-ratio and FEV% (FVC/FEV1-ratio % of predicted). Irreversible airway obstruction was defined as two ways: post-BD FEV1/FVC-ratio Results: Former bronchiolitis patients had lower post-BD FEV1/FVC-ratio (mean 0.78, 95%CI 0.76-0.81 vs. controls 0.83, 0.82-0.84, p Conclusion: Irreversible airway obstruction is present 30 years after bronchiolitis in infancy suggesting permanent, structural changes in airways.
Vital capacity
Airway obstruction
Bronchodilatation
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CTD
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Objective
To explore the efficiency of bundled pulmonary rehabilitation in patients with severe and very severe chronic obstructive pulmonary disease (COPD).
Methods
One hundred and thirty consecutive patients with acute exacerbation of severe and very severe COPD admitted in our hospital from Jan.2014 to Jun.2015 were randomly divided into two groups: pulmonary rehabilitation group(65 cases) and control group(65 cases). All patients in the two groups were given the conventional treatment, but patients in pulmonary rehabilitation group were given bundled pulmonary rehabilitation when the acute exacerbation were relived.The differences in FVC, FVC%pred, FEV1, FEV1%pred, 6 minute's walking distance(6MWD) and St George's respiratory questionnaire(SGRQ) were analyzed before and after the treatment in the two groups.
Results
After three months' treatment, the FVC, FVC%pred, FEV1, FEV1%pred in PR group were significantly higher than the control group.The 6MWD after treating for three months in PR group were significantly longer than treatment before [(206.50±34.01) m vs (183.73±31.65) m, P<0.05], and longer than the control group [(206.50±34.01) m vs (183.80±20.58) m, P<0.05]. The SGRQ scores in pulmonary rehabilitation group were significantly improved after three months' treatment [(60.83±5.78) vs (64.87±5.03), P<0.05], and were improved better than the control group after six months [(57.53±6.04) vs (63.55±6.84), P<0.05]. The number of readmission in the following twelve months were reduced than the control group [(0.97±0.72) vs (1.56±0.89), P<0.05].
Conclusions
The early treatment of bundled pulmonary rehabilitation in patients with severe and very severe COPD can improve the pulmonary function, exercise capacity and quality of life, and was worthy of widely promoted.
Key words:
Chronic obstructive pulmonary disease; Pulmonary rehabilitation; Bundled
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Background: The purpose of this study was to evaluate the effectiveness of perioperative tiotropium therapy for patients undergoing pulmonary resection for primary lung cancer. The short-term tiotropium effect was investigated by perioperative pulmonary function and “lung age”. Methods: The fifty-five patients who underwent a lobectomy and had tiotropium treatment available from October 2007 through May 2009 were the subjects. The patients were divided into 3 groups according to their airway limitation such as Chronic Obstructive Pulmonary Disease (COPD) or a history of smoking; those with COPD (%FEV1 ≤70%, C-group, n = 22), smokers (%FEV1 > 70%, S-group, n = 10) and non-smokers (%FEV1 > 70%, N-group, n = 23). As the bronchodilator groups, the C- and S-groups received inhaled tiotropium bromide (18 μg once daily) for 1 week before surgery until at least 3 weeks after surgery without interruption, and as a control, the N-group had no treatment. The preoperative baselines, the predicted postoperative values, and the actual postoperative ones were measured by the pulmonary function test. The changed rates were calculated and denoted as ΔVC, ΔFEV1, ΔVC%, and ΔFEV1/FVC, from the baseline of the predicted postoperative values. The mean “real age” and “lung age” were calculated. Results: In the S-group, the parameters of ΔVC, ΔFEV1, ΔVC%, and ΔFEV1/FVC significantly increased compared to those of the N-group. In the C-group, the increased extents of ΔFEV1 and ΔFEV1/FVC were lower compared to those in the S-group (not significant). In the N-group, the parameters of ΔVC, ΔFEV1, and ΔVC% decreased. The postoperative “lung age” and “real age” were increased to 29.5 ± 18.0 year-old in the C-group, 25.8 ± 18.0 in the S-group, and 24.7 ± 17.0 in the N-group. Lung resection affected the “lung age”; the aging was a 28.9 ± 12.7 year-old increase in the N-group. In the C- and S-group, the “lung age” was a 14-year-old increase. The effect of tiotropium treatment affected the “lung age” as a 15-year-old increase. Conclusion: Perioperative interventional tiotropium contributed to the lobectomy patients with COPD and for smokers with a non-obstructive airway and played a role of preserving the postoperative lung function.
Tiotropium bromide
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Objectives: The objective is (1) To evaluate the change in forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), dyspnea grading, body mass index, and oxygen saturation (SpO 2 ) in adults with postinfectious obliterative bronchiolitis (PIOB) over a period of time (2) To evaluate the same parameters in chronic obstructive pulmonary disease (COPD) patients and compare with PIOB. Materials and Methods: It was a retrospective observational study involving appropriately managed patients of PIOB and COPD with minimum 3 years of follow-up. Out of a total of 106 patients who followed up from January 2019 to December 2019 and had a follow-up data of more than 3 years, 61 (31 COPD and 30 PIOB) patients were included in the final analysis after applying the inclusion and exclusion criteria. Results: The baseline FEV 1 and FVC was significantly worse in PIOB group compared to COPD group. In PIOB group, there was nonsignificant increment in both the parameters (FVC by 18.79 ml and FEV 1 by 12.2 ml per year). There was a significant decline in FVC and FEV 1 in the COPD group by 106.8 ml and 63.25 ml per year, respectively. There was a significant difference between PIOB and COPD for the yearly change in FVC and FEV 1 ( P value being 0.000083 and 0.000033, respectively). In PIOB group, there was increment in modified Medical Research Council (mMRC) score and nonsignificant change in SpO 2 whereas the SpO 2 and mMRC score had a yearly decline in the COPD group. Conclusion: The PIOB is characterized by a nonsignificant increase in lung function whereas COPD shows a significant progressive decline.
Vital capacity
Subgroup analysis
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Backgroud: Postinfectious bronchiolitis obliterans (PIBO) is a rare respiratory disease. In recent years, the disease has been recognized and diagnosed increasingly in children. Pulmonary function is important for diagnosis, identifying the severity of the PIBO and monitoring progression. But there have been only a few studies that followed the evolution of PIBO on the basis of pulmonary function tests (PFTs). Objective: The study targeted the evolution of pulmonary function and bronchodilator response in a case series of Chinese children with PIBO. Methods: Twelve children between the ages of 6–99 months with PIBO were studied retrospectively from 2009 to 2019. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1 ), the FEV 1 /FVC ratio, and maximal midexpiratory flow velocity 25–75% (MMEF 25−75%) were collected at each PFT, and bronchodilator responses were evaluated. Spirometric parameters were monitored over time, and generalized linear mixed models were used to analyze longitudinal panel data. Results: The median baseline PFT values for FVC, FEV 1 , the FEV 1 /FVC ratio, and MMEF 25−75% were 41.6, 39.75, 90.7, and 22.2%, respectively. At the initial PFTs, 10 (83.3%) patients demonstrated a significant bronchodilator response. FVC and FEV 1 increased by 8.212%/year and 5.007%/year, respectively, and the FEV 1 /FVC ratio decreased by an average of 3.537%/year. MMEF 25−75% showed improvement at an average rate of 1.583% every year. Overall, FEV 1 and MMEF 25−75% showed different degrees of improvement after the use of inhaled bronchodilators at each PFT session for 10 patients, and FEV 1 measures demonstrated significant (>12%) β 2 -bronchodilation in 56% of PFT sessions. Conclusions: Pediatric patients with PIBO showed an obstructive defect in pulmonary function. The FVC, FEV 1 , and MMEF 25−75% improved as they grew older, while the FEV 1 /FVC ratio decreased. This may be due to the development of lung parenchyma more than airway growth. Airway obstruction in some patients improved with the use of β 2 agonists.
Vital capacity
Bronchodilator Agents
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