Background and Objective: Cryobiopsy using a 1.1-mm cryoprobe through a therapeutic bronchoscope with a 3.0-mm working channel permits en bloc retrieval of the cryoprobe and guide sheath while the bronchoscope remains wedged in the target bronchus, potentially facilitating immediate haemostatic control. This study investigated the safety and efficacy of this technique. Methods: This prospective observational study enrolled patients with peripheral pulmonary lesions suspected of lung cancer who underwent forceps biopsy (FB), followed by cryobiopsy using a 1.1-mm cryoprobe through a therapeutic bronchoscope with a 3.0-mm working channel. The primary endpoint was procedural safety, as assessed by bleeding grade. The secondary endpoints included procedure-related complications, diagnostic yield, specimen size, procedural success rate, and biomarker analysis success rate. Results: Of 100 enrolled patients, 96 were included in the analysis, and 84 underwent cryobiopsy. Bleeding severity was Grade 0 in 35.4% (34 of 96), Grade 1 in 41.7% (40 of 96), Grade 2 in 8.3% (8 of 96), and Grade 3 in 2.1% (2 of 96) of patients. Diagnostic yields were 77.0% (74 of 96) for FB and 79.1% (76 of 96) for cryobiopsy, with an overall yield of 87.5% (84 of 96). Cryobiopsy provided the sole diagnosis in 10 patients and yielded significantly larger specimens than FB (7.06 vs. 2.46 mm(2); p < 0.001). The success rate of multiplex genetic testing was 95.8% for cryobiopsy (23 of 24). Conclusion: Direct retrieval of cryobiopsy specimens through the working channel of a therapeutic bronchoscope is safe and feasible, yielding larger specimens with complementary diagnostic value.
Background No instruments exist to assess palliative care knowledge among Portuguese with chronic respiratory diseases. Aim To translate and cross-culturally adapt the Palliative Care Knowledge Scale (PaCKS) into European Portuguese and explore its measurement properties in chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD). Methods Translation and cross-cultural adaptation procedures were followed. Internal consistency (Cronbach's alpha); test-retest reliability [intraclass correlation coefficient with 95% confidence interval (ICC2,1 [95% CI]), standard error of measurement (SEM/SEM%), minimal detectable change at 95% confidence level (MDC95/MDC%) and Bland-Altman method]; floor/ceiling effects; and, construct validity [convergent/divergent, correlation (Spearman's -r(s)) with the Bristol COPD Knowledge Questionnaire (BCKQ)/modified Medical Research Council dyspnoea questionnaire/lung function] were evaluated. Results Two forward translations/back-translations were conducted. Five experts approved the prefinal version. Cognitive debriefing involved 12 participants. Measurement properties were analysed in 102 people with COPD and 54 with ILD (73.1% male; 67.6 +/- 10.0 years). PaCKS score was 11.0 [9.0-12.0] and 10.0 [8.8-11.0] in COPD and ILD, respectively. Internal consistency was acceptable (alpha(COPD) = 0.76; alpha(ILD) = 0.80). The test-retest reliability was good in COPD (ICC2,1 0.84 [0.77-0.89]) and ranged from good to excellent in ILD (ICC2,1 0.89 [0.78-0.94]). SEM/SEM% and MDC95/MDC% were 1.0/9.6% and 2.8/26.6%, and 1.0/10.1% and 2.7/28.0% in COPD and ILD, respectively. The Bland-Altman method did not suggest systematic bias, with 95% limits of agreement of approximately +/- 3.0. No floor/ceiling effects were observed, except for a ceiling effect in COPD (20.6%). The PaCKS/BCKQ correlation was significant, positive and moderate (r(s) = 0.40, p < 0.001) in COPD. Other correlations were non-significant and ranged from negligible to weak. Conclusion The European Portuguese PaCKS is now available and provides reliable and valid data on palliative care knowledge in COPD and ILD
Background Prior to the onset of overt ventilatory failure, patients with Duchenne Muscular Dystrophy (DMD) can display non-uniform respiratory mechanics, resulting from atelectasis in small lung regions secondary to rapid, shallow breathing and/or peripheral airway obstruction, thereby predisposing to the development of ventilation inhomogeneity. Objectives To investigate ventilation distribution in DMD patients before the initiation of long-term assisted ventilation by using electrical impedance tomography (EIT). Methods Patients and interventions: Eighteen DMD patients underwent EIT between 1 January and 31 December 2025. Primary study endpoint: Global Inhomogeneity Index (GI). EIT data were compared with those obtained from a group of 11 healthy, similarly aged male medical residents. Results GI was significantly higher in the DMD patients with respect to healthy males [0.44 +/- 0.13 (0.36-0.77) vs 0.37 +/- 0.03 (0.32-0.43); p < 0.001]. A GI of 0.5 maximised the distinction between DMD patients with a ventilation distribution pattern similar to or different from the healthy subjects. Conclusions Before initiation of assisted ventilation, a subset of DMD patients may develop lung ventilation inhomogeneity, which can be readily assessed by means of EIT. Whether such inhomogeneity is predictive of major clinical events therefore constitutes a critical question to be addressed.
Background The six-minute walk test (6MWT) is a simple, widely used measure of functional exercise capacity in children. Standard protocols recommend a 30-meter walking course; however, this is often impractical in routine clinical settings, particularly in resource-limited environments. Normative data for Indian children, especially younger age groups and under pragmatic testing conditions, remain limited. Objectives To establish age-and sex-specific reference values for six-minute walk distance (6MWD) in apparently healthy Indian children aged 4-14 years using a pragmatic 15-meter walking course and evaluate associations with anthropometric variables. Methods In this community-based cross-sectional study, 400 healthy school-going children underwent the 6MWT using a standardized 15-meter indoor course. Anthropometric and baseline physiological parameters were recorded. Percentile reference values were generated, and multivariable linear regression was performed to identify determinants of 6MWD and derive a predictive equation. Results Mean (SD) 6MWD was 365.3 (50.8) meters. Distance increased significantly with age, height, weight, and body mass index (all p<0.001). After adjustment, no independent sex-based differences were observed. The predictive equation was: 6MWD = 279.5 + 8.6 & times; age (years) + 2.7 & times; weight (kg) - 5.0 & times; BMI (kg/m(2)) (R-2 = 0.62). No significant differences were observed by residence or school type. Conclusions This study provides 15-meter course-specific reference values for 6MWD in healthy Indian children aged 4-14 years. The derived predictive equation may assist interpretation of 6MWD obtained using this protocol; however, external validation and direct comparison with the standard 30-meter course are required before broader application, where longer courses are not feasible.
Background and Objective Non-invasive ventilation (NIV) and inhaled bronchodilator therapy are foundational in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, optimal drug-delivery strategies during NIV remain uncertain. This study compared bronchodilator delivery via a pressurized metered-dose inhaler (pMDI) interface versus standard jet nebulization during NIV.Methods This randomized, open-label trial enrolled adults with hypercapnic AECOPD requiring NIV. Participants were randomized 1:1 to receive ipratropium bromide via pMDI using a modified NIV mask, or via jet nebulizer integrated into the inspiratory limb. Serum ipratropium concentrations at 30 min constituted the primary bioequivalence endpoint, analysed using geometric mean ratios (GMR) and Bayesian posterior probabilities. Secondary outcomes included changes in physiologic parameters, blood gases, ventilatory asynchrony, duration of stay and cost effectiveness.Results Forty-four patients were randomized; 41 were included in the intention-to-treat analysis (pMDI n = 20, nebulizer n = 21). At 30 min, geometric mean serum ipratropium levels were higher with pMDI (110.9 pg/mL) versus nebulization (51.6 pg/mL), yielding a GMR of 2.15. Bayesian analysis showed a 95.9% probability that GMR exceeded the non-inferiority threshold (0.80). At 6 h, differences again favoured pMDI (GMR 3.18; p = 0.022; posterior probability 99.8%). Physiologic outcomes, gas exchange, and NIV duration were similar between groups, though ICU stay was shorter in the pMDI arm. No safety concerns or device-related complications were observed. Post hoc cost analysis showed markedly lower therapy cost with pMDI.Conclusions pMDI-based bronchodilator delivery during NIV using a customized interface is feasible, safe, cost-efficient, and achieves higher systemic drug levels than jet nebulization. Larger multicentre trials are warranted to determine clinical impact.Trial Registration Clinical Trials Registry of India CTRI/2023/07/054734
