Introduction:Pulmonary hypertension (PH) is a frequent and serious complication of advanced chronic obstructive pulmonary disease (COPD) and is associated with a poor prognosis and limited treatment options. Current management focuses on optimizing COPD care, while the role of pulmonary vasodilators remains controversial. Ensifentrine, a dual phosphodiesterase (PDE) 3/4 inhibitor with bronchodilatory and anti-inflammatory properties, may offer a therapeutic benefit in COPD-associated PH. This study aims to retrospectively evaluate the effects of six months of nebulized ensifentrine on pulmonary hemodynamics and functional outcomes in patients with severe COPD and associated pre-capillary PH. Methods:We conducted a single-center, retrospective chart review of patients with GOLD stage III and IV COPD and confirmed pre-capillary PH (mean pulmonary artery pressure [mPAP] ≥20 mmHg, pulmonary vascular resistance [PVR] >2 Wood units, pulmonary capillary wedge pressure ≤15 mmHg). Five patients treated with nebulized ensifentrine (3 mg twice daily) between September 2024 and May 2025 were included. Hemodynamics via right heart catheterization (RHC) and 6-minute walk distance (6MWD) were measured at baseline and at 6 months. Results:The cohort (mean age 76 years, 60% male, mean FEV1 33.4% predicted) demonstrated severe emphysema and PH (baseline mPAP 53.2 mmHg, PVR 9.5 WU, cardiac index 2.5 L/min/m2). After 6 months, mean changes were as follows: • mPAP: decreased by 1.6 mmHg • Cardiac index: increased by 0.1 L/min/m2 • PVR: decreased by 1.0 WU • 6MWD: improved by 31 m • mMRC dyspnea score improved from 3.6 to 3.2 • CAT score from 23 to 21.6 • DLCO increased modestly (29%→31.2% predicted). • No adverse events, exacerbations, or hospitalizations were observed during this period. • The combination of ensifentrine with roflumilast was well tolerated. Discussion:Pulmonary hypertension in COPD is associated with worse outcomes, yet treatment options remain limited and uncertain. In this small retrospective case series of five patients with very severe COPD and confirmed pre-capillary PH, the addition of ensifentrine to optimized therapy was associated with modest but potentially meaningful improvements in symptoms, exercise capacity (6MWD), and select hemodynamic parameters, without worsening oxygenation. Its dual PDE3/PDE4 inhibition and inhaled delivery provide a plausible mechanism for bronchodilation, anti-inflammatory effects, and selective pulmonary vasodilation while minimizing ventilation-perfusion mismatch. However, the findings are highly preliminary given the very small sample size, lack of a control group, retrospective design, and significant selection bias, limiting generalizability and causal inference. Overall, the results are hypothesis-generating and suggest that ensifentrine may have therapeutic potential in COPD-associated PH, but larger, prospective, randomized trials are needed to confirm efficacy, safety, and its role in treatment algorithms. Conclusion:In this retrospective study, ensifentrine was safe and was associated with modest improvements in pulmonary hemodynamics and functional status in patients with severe COPD with pre-capillary PH. These preliminary findings warrant confirmation in larger, prospective, controlled trials.
Introduction Patients with Inflammatory Bowel Disease (IBD) may experience a range of extraintestinal pulmonary manifestations. Anti-TNFα therapy has emerged as a crucial treatment option for IBD patients. Despite the pro-inflammatory role of TNFα in pulmonary diseases, anti-TNFα therapy has no major value in their treatment. Therefore, this study aimed to investigate the prevalence of pulmonary manifestations and the impact of anti-TNFα therapy on lung function parameters in IBD patients. Methods Thirty two patients with IBD were recruited. These patients received pulmonary function tests prior to and at least 6 weeks after initiating anti-TNFα therapy. Pulmonary function was evaluated by standardized body plethysmography, including the measurement of lung diffusion capacity (DLCO SB). Results FEV1 and vital capacity (VC) were within normal range before and during anti-TNFα therapy. Mean residual volume (RV) was moderately increased before initiation of anti-TNFα therapy. RV decreased during the course of therapy, from 2.7 L (interquartile range (IQR) 2.04 - 3.06) or 159% (IQR 129.25 - 184.75) prior to anti-TNFα therapy to 2.5 L (IQR 2.14 - 3.00) or 138% (IQR 127.00 - 165.25) during anti-TNFα therapy ( p =0.031 for absolute values and p =0.014 for relative values. DLCO SB was slightly reduced before anti-TNFα therapy and decreased even further during anti-TNFα therapy, from 76.1% to 72%. Discussion Lung function tests in our IBD cohort were almost normal. FEV1 and VC were within normal range. RV was moderately increased, and DLCO SB was slightly decreased. These might indicate an extraintestinal involvement of IBD. During anti-TNFα therapy, RV slightly improved, whereas DLCO SB decreased even further, albeit only slightly. In our IBD cohort, anti-TNFα therapy did not significantly influence lung function parameters. Conclusion Our study shows that anti-TNFα therapy in Inflammatory Bowel Disease (IBD) only slightly changes lung function parameters, including diffusion capacity, at least in patients with mild IBD.
Chronic obstructive pulmonary disease (COPD) and asthma remain among the most prevalent respiratory disorders worldwide, characterized by chronic inflammation, oxidative stress, and impaired quality of life. Although there has been significant advancement in the pharmacologic therapies, complementary strategies that can potentially target the underlying mechanisms and complement the conventional treatment are growing in interest among numerous patients and providers. This narrative review used systematic search methods in PubMed, Google Scholar, and ScienceDirect to select herbal medicines and nutraceuticals that were studied for COPD and asthma, with a specific selection using objective pulmonary functionality parameters (FEV1, FVC, FEV1/FVC). Analysis of evidence identified multiple interventions with a clinically significant effect, such as Astragalus membranaceus, Rhodiola rosea, nanocurcumin, Bufei granule, and Wuqinxi breathing exercises, most of which have anti-inflammatory, antioxidant, and immunomodulatory effects. The other agents, including Withania somnifera, Maxingshigan decoction, and L-carnitine, exhibited significant but inconsistent efficacy, whereas compounds like N-acetylcysteine, resveratrol, and cannabis had little effect. Mechanistic research indicates NF-kB, MAPK, Nrf2, and cytokine signaling pathways as typical therapeutic targets. Despite the limitations of methodological heterogeneity, the results indicate the judicious use of the choice of herbal and nutraceutical interventions in comprehensive respiratory care. Such supportive interventions can be patient-centered, enhance medication compliance, and offer an added effect in combination with evidence-based pharmacologic therapies. The quality of therapeutic application of the drug needs to be established through further high-quality therapeutic trials in order to determine the safety, dosing, and long-term outcomes.
Introduction:Peak Expiratory Flow (PEF) is a practical marker of airway patency and cough effectiveness, yet perioperative evidence from Latin American surgical populations is limited. This study aimed to quantify postoperative PEF variability after abdominal surgery and identify associated factors. Methods:We conducted a prospective observational study at a Peruvian hospital in 2024. Adults undergoing elective abdominal surgery performed PEF testing with a Mini-Wright meter preoperatively and on postoperative day 7 using a standard three-maneuver protocol. The highest valid value was retained. The primary outcome was PEF variability, defined as the difference between preoperative and postoperative PEF (L/min). Group comparisons used non-parametric tests, and multivariable linear regression identified independent predictors. Results:Eighty-two patients were included; 58.5% were women, and the median age was 48 years. Mean preoperative and postoperative PEF values were 367.9 ± 71.9 and 346.0 ± 74.8 L/min, respectively. Median PEF variability was 20 L/min (IQR 10-30). Variability did not differ by sex or BMI. Age was the only independent predictor of greater decline. Discussion:Abdominal surgery was associated with an early postoperative reduction in expiratory flow, particularly in older adults. Conclusion:Routine perioperative PEF assessment may help identify patients who require closer respiratory monitoring and early supportive therapy in resource-constrained surgical settings.
Introduction The neutrophil-lymphocyte ratio (NLR) is an emerging inflammatory biomarker in community-acquired pneumonia (CAP) with potential prognostic implications. Biomarker-concordant corticosteroid dosing strategies based on other inflammatory markers have been found to be associated with improved clinical outcomes. The NLR is a readily available and affordable biomarker and could help guide corticosteroid use in CAP. Our goal is to evaluate the association between NLR-concordant corticosteroid prescription and patient outcomes. Methods Single-center prospective cohort study of adults with CAP who were admitted to the Mayo Clinic in Rochester, Minnesota, between December 10, 2023, and March 11, 2025. Patients with available NLR within 24 hours of admission were evaluated. Those who received steroids after 24 hours of admission, stayed in the hospital shorter than 24 hours, and were not yet discharged were excluded. Steroid use was classified as 'biomarker-concordant' if given when NLR > 12 or withheld when NLR <= 12, and 'biomarker-discordant' otherwise. All-cause mortality was the primary outcome. Results Of 545 admissions with CAP, 465 were included. Steroid use was biomarker-discordant in 222 (47.7%) patients and biomarker-concordant in 243 (52.3%) patients. Systemic corticosteroid use within 24 hours was more common in the discordant group (127 (57.2%) versus 77 (31.7%)). After adjusting for the pneumonia severity index, there were no significant differences in clinical outcomes between groups including in-hospital mortality (odds ratio [95% C.I.] = 1.120 [0.463, 2.706]), 30 – day mortality (hazard ratio [95% C.I.] = 1.423 [0.747, 2.710]), oxygen-free days (estimate [95% C.I.] = 0.61 [–0.655, 1.879), or hospital-free days (estimate [95% C.I.] 0.222 [–0.943, 1.386]) between biomarker-discordant versus concordant corticosteroid use. Discussion Despite growing interest in biomarker-guided corticosteroid strategies, NLR-based concordance was not associated with clinical outcomes in this cohort, suggesting that its role may be limited to risk stratification rather than treatment guidance. Conclusions In this observational cohort of hospitalized CAP patients, a biomarker-concordant corticosteroid treatment strategy based on the NLR was not associated with improved clinical outcomes.
Introduction/background The prognosis of patients with Pulmonary Hypertension (PAH) associated with the intake of anorexigens and amphetamines has not been clearly defined. Published data are suboptimal due to a scarcity of corroborating hemodynamic information. There are reports of worse, the same, and better prognoses compared to patients with idiopathic pulmonary arterial hypertension. Case presentation Our experience with three patients who had PAH, a history of amphetamine-like drug use, and comorbidities is described, and the pertinent literature is summarized. Conclusion Three patients with PAH and a history of amphetamine-like drug use demonstrated markedly improved hemodynamics at follow-up catheterizations.
Sarcoidosis is a systemic granulomatous disorder of unknown etiology, most commonly affecting the lungs but potentially involving multiple organs. Fatigue and Excessive Daytime Sleepiness (EDS) represent highly prevalent and disabling symptoms, often persisting despite stable systemic disease. Growing evidence indicates an increased prevalence of Obstructive Sleep Apnoea (OSA) among patients with sarcoidosis, suggesting a complex and multifactorial association. Several mechanisms contribute to this link. Shared inflammatory pathways promote systemic inflammation and vascular dysfunction. Corticosteroid therapy, although central to sarcoidosis management, indirectly predisposes to OSA through weight gain, fat redistribution, and myopathy. Direct upper airway involvement (sarcoidosis of the upper respiratory tract, SURT) may cause mechanical obstruction, while restrictive pulmonary disease reduces lung volumes and increases pharyngeal collapsibility. Clinical studies consistently report a higher prevalence of OSA in sarcoidosis compared with the general population, even in non-obese and treatment-naïve patients. While OSA contributes to fatigue and EDS, these symptoms are also influenced by immune dysregulation, chronic inflammation, and treatment side effects. Continuous Positive Airway Pressure (CPAP) therapy has demonstrated efficacy in reducing apnoea burden and improving both fatigue and quality of life, underscoring the importance of systematic OSA screening in sarcoidosis patients with persistent sleep-related symptoms. Despite increasing recognition, current evidence is limited by small sample sizes, heterogeneous diagnostic methods, and confounding effects of corticosteroid therapy. Future studies should clarify pathophysiological mechanisms, evaluate the impact of OSA treatment on sarcoidosis outcomes, and investigate wake-promoting agents such as solriamfetol and pitolisant as potential adjunctive therapies in patients with residual EDS.
Introduction:Given the widespread prevalence of vitamin D insufficiency and its clinical manifestations (such as rickets and compromised immune status) in children, this study aimed to assess the likelihood of tuberculosis (TB) diagnosis in children with TB infection and positive ESAT-6/CFP-10 test results, alongside signs of vitamin D deficiency (clinical rickets and/or low serum vitamin D levels). Method:A total of 98 children aged 1-14 years were examined at the TB department of St. Petersburg Children's Infectious Diseases Hospital No. 3 (2022-2024). Inclusion criteria were a positive ATP test and/or IGRA result. Exclusion criteria included immunodeficiency disorders and hereditary diseases. Diagnostic evaluation for TB and vitamin D status (via serum calcidiol (25(OH)D) measurement was performed. Result:Rickets-related changes were observed in 70.4±4.6% of cases. Vitamin D insufficiency was detected in 21.4±4.4%, moderate deficiency in 36.7±5.1%, and severe deficiency in 33.7±5.0%. A significantly higher probability of active TB diagnosis was found in children with: • Rickets signs: OR=4.009 (95% CI 1.609-9.987), RR=1.872 (1.148-3.054), φ=0.310. • Vitamin D deficiency: OR=10.411 (3.762-28.809), RR=3.182 (1.648-6.145), φ=0.493. • Either factor: OR=41.167 (10.699-158.404), RR=27.986 (2.720-23.443), φ=0.677 (strong association). Discussion:The low vitamin D levels in children require not only special attention from TB specialists to patients with tuberculosis infection who test positive in immunological tests for ESAT-6 and CFP-10 antigens and show signs of rickets and/or vitamin D deficiency, but also increased vigilance from pediatricians in the timely diagnosis and treatment of rickets. Rickets often manifests early, has a prolonged course, and can lead to impaired immune status, which is significant for the progression from latent tuberculosis infection to active disease. Conclusion:Vitamin D deficiency and rickets should prompt heightened TB monitoring in high-risk children, emphasizing early pediatric intervention to prevent immunodeficiency and TB progression.
Introduction/ObjectivesCommunity-acquired pneumonia (CAP) remains one of the leading sources of morbidity/mortality in the world. However, the increasing problem of antimicrobial resistance (AMR) aggravates the issue. This research intends to explore the prevalent levels of resistance to antibacterial drugs in bacteria isolated from patients in Iraq experiencing CAP. MethodsA cross-sectional study was conducted on 122 clinically and radiologically confirmed CAP patients at Al-Yarmouk Teaching Hospital, Baghdad, from May 2023 to June 2024. Sputum samples were evaluated microscopically and analyzed for culture and sensitivity using the VITEK® 2 system. ResultsOf 122 patients, 44 (36.1%) had positive bacterial cultures. S. pneumoniae and S. sanguinis bacteria, along with S. aureus and P. aeruginosa, stood out as the common ones, causing 18.2% each. S. aureus comprised 11.4%, followed by P. aeruginosa. S. pneumoniae and S. sanguinis showed 100% resistance to azithromycin, clindamycin, and ciprofloxacin. S. aureus was 60% & 20% resistant to vancomycin & linezolid. Extremely alarming was the near-total resistance of Acinetobacter baumannii. DiscussionThis study provides the first detailed resistance profile for CAP pathogens in Iraq using modern automated diagnostics. The findings reveal alarmingly high levels of antibiotic resistance, including pan-resistant strains. ConclusionThe problem of antibiotic resistance in CAP in Iraq is very serious and rising because of the development of pan-resistant bacteria. Currently, the requirement exists for comprehensive antibiotic stewardship programs in the whole of Iraq, along with strict implementation of measures against the free sale of antibiotics.
Introduction:Pulmonary Arterial Hypertension (PAH) is a significant comorbidity that can complicate the care of patients in the Intensive Care Unit (ICU). PAH's hemodynamic burden and systemic effects add complexity to managing fluid balance, ventilatory support, and other critical care interventions. This study aims to investigate the impact of fluid balance in ICU patients with PAH. Methods:We conducted a retrospective cohort study using the MIMIC-IV v3.1 database. Patients with diagnosed PAH (ICD-9: 4160; ICD-10: I270) and complete ICU records were included. Exclusions were applied for missing data, duplicate ICU stays, and secondary causes of pulmonary hypertension. An initial cohort of 178 patients was identified. Further data validation led to a final cohort comprising 102 patients. Analyses were conducted in Google BigQuery and Python-based tools (Google Colab). Results:Among 102 patients, 77 (75.4%) had a positive fluid balance, and 25 (24.5%) had a negative balance. Positive fluid balance was associated with higher ICU mortality (14.49% vs. 5.88%), shorter ICU stays (2.29 vs. 3.06 days), and a 74% increase in ICU mortality odds (OR: 1.74, 95% CI: 1.10-2.85). The lowest ICU mortality was seen in patients with net fluid balance between -2000 mL and +2000 mL. Severely positive balance (>+5000 mL) was associated with the highest ICU mortality (19%) and longest ICU LOS (6.16 days). Discussion:This study highlights the critical importance of fluid balance in PAH patients, a population uniquely susceptible to right ventricular failure. The findings suggest that even modest positive fluid balance may worsen outcomes, supporting prior physiologic models linking volume overload to RV dysfunction. While limited by retrospective design and lack of hemodynamic data, the results underscore the potential benefit of individualized fluid strategies and the selective use of advanced monitoring. Further prospective research is needed to define safe fluid thresholds and guide therapy in this high-risk group. Conclusion:Our findings suggest that both excessive positive and severe negative fluid balance may be detrimental in ICU patients with PAH. A moderate fluid balance range (-2000 mL to +2000 mL) showed the most favorable outcomes.
IntroductionThis study aims to investigate the association between bacterial pneumonia and acute kidney injury (AKI), which develops during hospitalizations for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and their impact on patient outcomes. MethodsWe performed a retrospective observational study on the United States National Inpatient Sample (USNIS) from 2016 to 2022, using ICD-10 codes to identify patients admitted to hospitals with an AECOPD who developed bacterial pneumonia and/or AKI during their hospital stay. We compared the clinical outcomes, including endotracheal intubation, in-hospital length of stay, and all-cause hospital mortality among four groups of patients: AECOPD, AECOPD with bacterial pneumonia and no AKI (PAECOPD), AECOPD with AKI and no bacterial pneumonia (KAECOPD), AECOPD with both bacterial pneumonia and AKI (PKAECOPD). We investigated the microorganism distribution of bacterial pneumonia and mortality by pathogen. We also used multivariate logistic and linear regression to investigate the correlation between outcomes and variables, including age, gender, race, hospital bed size, hospital location, bacterial pneumonia, AKI, and Charlson’s comorbidity index. ResultsThere were 2,548,188 weighted admissions, including 2,247,833 cases of AECOPD (88.21%); 34,930 cases of PAECOPD (1.37%); 258,360 cases of KAECOPD (10.14%); and 7,065 cases of PKAECOPD (0.28%). The average age of patients who died in hospitals was 6 years older than that of survivors (73.19 vs 67.70 years, p<0.01). Patients requiring endotracheal intubation were, on average, a year younger than those who did not (66.61 vs 67.77 years, p<0.01). White patients had poorer survival than Black, Hispanic, and other races. Females had lower hospital mortality than males by odds ratio (OR) 0.91 (p=0.004). AECOPD patients with bacterial pneumonia had a higher AKI rate than those without bacterial pneumonia (16.82% vs 10.31%, p<0.01). The PKAECOPD group had the poorest outcomes compared with the other groups, including higher endotracheal intubation incidence (27.18%), longer hospital stay (12.89 days), and higher all-cause hospital mortality (13.39%). Factors leading to increased all-cause hospital mortality included endotracheal intubation (OR 32.75, p<0.01), AKI (OR 2.33, p<0.01), bacterial pneumonia (OR 1.71, p<0.01), Charlson’s comorbidity index (OR 1.10, p<0.01), and older age (OR 1.05, p<0.01). Factors leading to increased hospital stay by at least a day included endotracheal intubation (6.13 days, p<0.01), bacterial pneumonia (3.03 days, p<0.01), and AKI (1.12 days, p<0.01). The most commonly identified pathogens causing bacterial pneumonia included other gram-negative bacilli (12.47%), Pseudomonas aeruginosa (11.54%), Streptococcus pneumoniae (7.22%), Methicillin-resistant Staphylococcus aureus (MRSA) (7.00%), Mycoplasma pneumoniae (4.70%), and Hemophilus influenzae (4.63%). In approximately forty percent of cases, no specific pathogen was identified. Mortality was highest for patients with “other bacteria” (23.43%), MRSA (22.86%), and Pseudomonas aeruginosa (20%). DiscussionPatients admitted with an AECOPD had a high incidence of AKI during hospital admission, approximately 10%. Patients with an AECOPD who developed bacterial pneumonia represented a small proportion of admissions (1.65%) but had a higher risk of AKI (16.82%). These patients were likely to be infected with pathogens including Pseudomonas aeruginosa, other gram-negative bacteria, and MRSA. Patients with both AKI and bacterial pneumonia had the highest all-cause hospital mortality. ConclusionOur study found that hospitalized AECOPD patients with bacterial pneumonia had a higher rate of AKI than those without bacterial pneumonia, and the population of AECOPD patients with both bacterial pneumonia and AKI had markedly higher all-cause hospital mortality, longer hospital stays, and greater need for endotracheal intubation. Therefore, minimizing the association between bacterial pneumonia and AKI may help improve the prognosis of patients admitted with an AECOPD.
Introduction The prognostic implications of developing pneumothorax (PT) or pneumomediastinum (PM) in COVID-19 pneumonia remain a topic of debate, with current literature showing conflicting data. We aimed to assess mortality rates and the characteristics of patients with COVID-19 pneumonia who developed these complications compared to those who did not. Methods We analyzed data and outcomes for patients aged 18 years or older who were admitted for COVID-19 pneumonia to a tertiary care referral center in Lebanon. Results A total of 527 patients (356 men and 171 women) were identified. Events were reported in 43 patients (18 PM, 10 PT, and 15 both). Overall mortality was 28.3%. Mortality was significantly higher in patients with events compared to those without events (69.7% vs . 24.5%). Most events occurred in patients with severe lung involvement on computed tomography (CT). Only three patients died within the first 48 hours after the development of an event. Incidence was higher in patients who were overweight or obese and increased with age. Distribution was similar between both genders. Ventilation data showed that 79% of events occurred during non-invasive or invasive mechanical ventilation. Discussion Barotrauma events, including PT and PM in COVID-19 pneumonia, were associated with significantly higher mortality and appear to reflect more severe lung involvement. Mortality was not directly caused by the events themselves. A significant proportion occurred in patients on supplemental oxygen or high-flow nasal cannula (21%), highlighting the need for a high index of suspicion for such events even in non-ventilated patients. Conclusion There is a strong association between the development of PT and/or PM and mortality in COVID-19 pneumonia.
Background:Idiopathic Pulmonary Fibrosis (IPF) is a progressive lung disease with limited life expectancy after diagnosis. The median survival time ranges from 2 to 4 years, indicating a poor prognosis. Multiple telomere-related genes that cause telomere shortening have been associated with a significant percentage of IPF cases. This review aims to analyze the association of short telomere length with IPF incidence. Methods:A systematic online search was conducted on PubMed, Scopus, and Cochrane. Articles that met the criteria were included. Quality of included literature was assessed using the Newcastle-Ottawa Scale (NOS). The pooled standard mean difference (SMD) with 95% confidence interval (CI) of telomere length was calculated using a random-effect model. Results:Six original studies containing 622 IPF patients and 544 controls were included in the meta-analysis. The study designs were case control and cohort. Pooled analysis showed shorter telomere length in IPF patients compared to controls (SMD: -0.84, 95%CI -1.21 to -0.48, Z = 4.55, p < 0.00001). Subgroup analysis showed that steeper telomere shortening was found in lung tissue compared to peripheral blood sample. The findings suggested that telomere length may be closely associated with the pathogenesis of pulmonary fibrosis. Discussion:Repeated cell divisions gradually shorten telomeres that lead to senescence and apoptosis. Premature senescence disrupts the balance of lung epithelial cells, potentially activating lung remodeling processes that result in fibrotic damage through senescence-associated secretory phenotype (SASP). Conclusion:This study shows significant shorter telomere lengths in IPF patients compared to healthy controls that suggest telomere as a risk factor for IPF occurrence. These findings highlight the value of telomere assessment not only for early detection but also as a potential predictive biomarker for clinical outcomes.
IntroductionAcute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) frequently result in hospitalization of the patients. The sleep health of patients admitted to the hospital with COPD exacerbations may be overlooked. The objective of this study was to assess and define the prevalence of sleep and mental health complaints among patients admitted with acute exacerbations of COPD. MethodsIn this prospective study, patients admitted with an episode of COPD exacerbation at a local community hospital were given a list of questionnaires pertaining to sleep and mental health. These questionnaires included the Beck Depression Inventory (BDI-II), the Functional Outcomes of Sleep Questionnaire (FOSQ), the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI). Questionnaires were administered in a stable, steady state on discharge. Results53 patients filled out the questionnaires. 50.9% of patients reported poor sleep quality with scores indicative of chronic insomnia, and 41.2% of patients reported excessive daytime sleepiness on the PSQI. 64% of patients indicated abnormal total scores (<18) on the FOSQ, with 84.3% of patients reporting severe impairment in social outcomes. Clinical depression BDI scores >9) was seen in 73% of patients. ConclusionOur results indicate a significant prevalence of sleep and mental health comorbidities in patients hospitalized for acute COPD exacerbations and highlight the need for screening tools and clinical interventions to reduce the burden of these comorbidities.
Introduction Hemophagocytic Lymphohistiocytosis (HLH) is a rare, aggressive, and life-threatening disorder characterized by sustained but ineffective immune system activation that leads to severe and systemic hyperinflammation. It may occur as a genetic or sporadic condition, often triggered by an infection. The multifaceted pathogenesis results in a wide range of non-specific symptoms, signs, and laboratory findings that challenge its recognition. The pulmonary involvement is underdiagnosed and may manifest as pneumonia, which can lead to respiratory failure. Despite the great improvement achieved in terms of survival, a considerable proportion of patients with HLH still die from progressive disease. Case Presentation We discuss the case of a unique form of respiratory distress and multiorgan failure with inconclusive radiological and lung biopsy investigations. The patient was finally diagnosed, by genetic analysis, with HLH, and promptly treated as per HLH-94 treatment protocol. Conclusion This case report aims to emphasize that clinical, laboratory, instrumental, and even pathological findings in HLH might not be unequivocal; nonetheless, a rapid diagnosis and treatment are mandatory, given the high mortality of the disease.
Obstructive sleep apnea (OSA), characterised by apnea or hypopnea, often presents with symptoms such as gasping or snoring. However, these symptoms can be nonspecific and are frequently overlooked, particularly in pregnant women, where they are often attributed to normal physiological adaptations, leading to underdiagnosis and negative maternal and fetal outcomes. This narrative review examines the implications of OSA during pregnancy, highlighting the importance of early screening and evaluating available treatment options. We reviewed various articles on PubMed and Google Scholar about the impact of OSA during pregnancy, screening methodologies, and treatment effectiveness. OSA often increases sympathetic activity along with immune dysfunction, resulting in adverse outcomes like gestational hypertension, preeclampsia, gestational diabetes, cardiomyopathy, depression, and higher rates of cesarean deliveries, while the fetus suffers from intrauterine growth restriction (IUGR), preterm births, and perinatal mortality. Various screening tools, such as the Berlin Questionnaire, Epworth Sleepiness Scale (ESS), STOP-BANG, and Wisconsin questionnaires, aid in early diagnosis. Treatment options include lifestyle modifications, positive airway pressure (PAP) therapy, either continuous (CPAP) or bilevel (BiPAP), hypoglossal nerve stimulation (HGNS), mandibular advancement devices (MAD), and maxillomandibular advancement (MMA) surgery, with CPAP being identified as the preferred treatment. To reduce adverse outcomes for both the mother and the fetus, early detection and treatment of OSA in pregnant women are essential. Increased awareness among expectant mothers, routine screening using validated questionnaires, and appropriate treatment selection can not only decrease fetal complications but also reduce the risk of long-term adverse effects of OSA on maternal health.
Introduction:Glucagon-like Peptide-1 (GLP-1) agonists cause delayed gastric emptying by acting on vagal afferent nerves. Retained gastric contents (RGC) increase the risk of pulmonary aspiration, particularly under anesthesia in endoscopic procedures. This systematic review and meta-analysis aim to summarize the current evidence on pulmonary aspiration in patients receiving GLP-1 agonists undergoing endoscopy. Methods:A systematic review was conducted using Cochrane, Embase, and PubMed from inception to May 2024, including studies and case reports examining GLP-1 agonists and pulmonary aspiration. Data on study characteristics, patient demographics, and GLP-1 agonist use were collected. A pooled analysis of retrospective studies was performed using RevMan version 5.4.1. The study protocol was registered in the PROSPERO database (ID CRD42024595241). Results:A total of five case reports involving six patients and twelve studies including 210,216 patients were identified. Pulmonary aspiration occurred in 143 of 87,691 patients (0.16%) in the GLP-1 agonist group and 149 of 122,525 patients (0.12%) in the placebo group. Notably, three patients experienced aspiration despite stopping GLP-1 agonists more than six days prior and fasting for over eight hours. The meta-analysis showed an odds ratio of 1.23 (P = 0.59; 95% CI, 0.58 to 2.60) for pulmonary aspiration associated with GLP-1 agonist use, which was not statistically significant. Discussion:This analysis did not find a statistically significant association between GLP-1 agonist use and pulmonary aspiration risk during endoscopic procedures. While the findings align with some existing studies suggesting minimal increased risk, the presence of aspiration cases despite prolonged fasting highlights potential gaps in current peri-procedural management. Limitations include reliance on retrospective data and case reports, as well as variability in fasting protocols. Conclusion:The study found no significant association between GLP-1 agonist use and pulmonary aspiration risk during endoscopy. Further research is warranted to develop evidence-based fasting guidelines and optimize peri-procedural management for patients on GLP-1 agonists.
Introduction:Mucus hypersecretion is a significant clinical challenge in patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma, often contributing to poor disease control and frequent exacerbations despite maximal pharmacological therapy. Focused Pulse High-Frequency Chest Wall Oscillation (FP-HFCWO) therapy has been proposed as an adjunctive treatment to enhance mucus clearance and improve clinical outcomes. This retrospective cohort study aimed to assess the impact of FP-HFCWO therapy using the Respin 11 device in patients with COPD and asthma presenting with persistent mucus hypersecretion and inadequate disease control. Methods:A retrospective, single-center analysis was conducted on patients with COPD or asthma attending the pulmonary outpatient clinic at San Carlo di Nancy Hospital in Rome from September 2023 to January 2025. Eligible patients were those receiving maximal inhalation therapy, daily mucolytics, and presenting with mucus hypersecretion, frequent exacerbations or radiological small airways impairment such as tree-in-bud or mucus plug. FP-HFCWO therapy was prescribed for 20 minutes daily, and clinical outcomes were evaluated using the COPD Assessment Test (CAT) and Asthma Control Test (ACT) scores. The effect of FP-HFCWO on CAT/ACT changes and moderate-to-severe exacerbations was evaluated. Results:A total of 27 patients were included (COPD: n=17, asthma: n=10). The mean age was 74.2 years, with 78.0 for COPD and 67.8 for asthma. Baseline spirometry showed greater obstruction in COPD (FEV1% predicted: 64.7%) compared to asthma (78.2%). Both groups share a significant small airway involvement on High-Resolution Computed Tomography (HRCT) and a smoking habit. FP-HFCWO significantly improved the clinical burden, CAT scores decreased by a mean of 7.5 points (p<0.001) in COPD, while ACT scores improved by 7.5 points (p<0.001) in asthma. The number of moderate-to-severe exacerbations was reduced by 66.6% in asthma (Δ-1.20 events) and by 73.0% in COPD (Δ-1.11 events), both statistically significant (p<0.001). Discussion:These findings suggest that FP-HFCWO therapy may serve as a valuable adjunct to standard care in obstructive airway diseases. The observed improvements in symptom scores and reduction in exacerbations support its clinical relevance. Despite the retrospective design and limited sample size, the consistency of benefit across both COPD and asthma groups is noteworthy. This therapy could be considered in selected patients with chronic mucus hypersecretion and poor disease control. Further prospective studies are needed to confirm these promising results and define optimal patient selection criteria. Conclusion:FP-HFCWO therapy (Respin 11, VitalAire®) demonstrated significant clinical benefits in patients with Chronic Mucus Hypersecretion (CMH) and poor disease control, leading to improved symptom burden and reduced exacerbation frequency in both COPD and asthma populations. These findings support the use of FP-HFCWO as an effective adjunctive therapy in COPD and asthma. However, given the study's limitations, including its retrospective design, small sample size, single-center setting, and short follow-up duration, further large-scale prospective studies are warranted to validate these results and assess long-term benefits.
Background Glomus tumors are neoplasms typically arising from the glomus body in the skin or subcutaneous tissue. They are rarely found in visceral organs, including the respiratory tract. Glomangioma is a vascular variant, and its pulmonary subtype is challenging to predict due to the absence of specific symptoms or distinctive radiological features. While most glomangiomas are benign, in rare cases, they can exhibit aggressive clinical and histological characteristics, leading to severe conditions. Case presentation We report a case of malignant endobronchial glomangioma in a patient presenting with hemoptysis and atypical chest pain. Chest computed tomography (CT) revealed an endobronchial tumor in the left distal main stem bronchus, partially obstructing the lumen. The patient was clinically diagnosed with suspected metastatic lung cancer and was scheduled for bronchoscopy and biopsy. During the biopsy, a rounded, bulging mass was partially removed; however, significant intraoperative bleeding occurred, necessitating the formation of an intentional blood clot. Ongoing bleeding and airway necessitated emergency pneumonectomy after 24 hours. Unfortunately, the patient experienced cardiac arrest postoperatively and died. Pathological examination revealed a mass with prominent vascular components lined by endothelial cells, with immunohistochemistry showing positivity only for smooth muscle actin, supporting the diagnosis of glomangioma. Conclusion Although difficult to diagnose clinically prior to biopsy, malignant endobronchial glomangioma should be considered in certain patient populations due to its specific outcomes and complications. Preventive measures and targeted interventions should be implemented to manage iatrogenic bleeding complications associated with biopsy procedures.
