Respiration; international review of thoracic diseases
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Comparative Study
Airway wall thickness in patients with COPD and healthy current smokers and healthy non-smokers: assessment with high resolution computed tomographic scanning.
Chronic obstructive pulmonary disease (COPD) is characterized by airflow obstruction caused by emphysema or airway narrowing, or both. Recently airway dimensions have been measured using high-resolution computed tomography (HRCT). To evaluate large and small airway dimensions by HRCT and compare them with pulmonary function tests in patients with COPD and in smokers with or without airflow obstruction. ⋯ Computed tomography measurements of large and small airway dimensions are useful for evaluating lung function in patients with COPD and healthy current smokers. Airway wall thickening is inversely related to the degree of airflow obstruction and positively related to cumulative smoking history.
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Malignant pleural effusions (MPEs) can produce significant respiratory symptoms and diminished quality of life in patients with terminal malignancies. Control of MPEs to palliate respiratory symptoms can be performed via several different approaches. Ideally, a minimally invasive procedure to control MPEs and to provide relief of respiratory symptoms would be optimal. ⋯ The PCs used in the present study provided an effective modality not only to alleviate respiratory symptoms associated with MPE, but also to achieve pleurodesis in 58% of our patients. These catheters may provide a significantly less invasive outpatient approach to the palliative management of MPEs.
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Dyspnea, the subjective symptom feeling of breathlessness, is a common symptom in terminally ill patients with cystic fibrosis (CF). The palliation of the dyspnea is a reasonable goal to improve patient comfort as the progression of the disease worsens. We report the successful use of inhaled fentanyl for 3 days in a 17-year-old female with terminal CF lung disease, as measured by improved oxygenation and a reduction in the modified Borg score, and the subjective feeling of less air hunger reported by parents and patient.
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Orexin-A, also known as hypocretin, is a neuropeptide implicated in appetite and sleep regulation. Because the obstructive sleep apnea syndrome (OSAS) is characterized by obesity and excessive daytime sleepiness, we hypothesized that orexin-A levels may be abnormal in patients with OSAS. Further, since treatment with continuous positive airway pressure (CPAP) in patients with OSAS is very effective in normalizing daytime sleepiness, we also hypothesized that the chronic use of CPAP may influence plasma levels of orexin-A in these patients. ⋯ Orexin-A plasma levels are abnormally low in patients with OSAS, independently of the level of somnolence and/or presence of obesity. These results suggest that these low orexin-A levels may be related to the pathogenesis of OSAS.
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Comment Letter Case Reports
Interferon-gamma-1b: therapeutic option in advanced idiopathic pulmonary fibrosis?