BACKGROUND: Postoperative pulmonary complications (PPCs) are a leading cause of morbidity and prolonged hospitalization after thoracic surgery. While pulmonary rehabilitation (PR) and noninvasive positive-pressure ventilation (NIPPV) have individually demonstrated benefits, evidence for their combined use, particularly with intermittent NIPPV, remains limited. This study aimed to evaluate the impact of PR combined with intermittent NIPPV on postoperative recovery. METHODS: This retrospective cohort study analyzed 135 thoracic surgery patients who received either PR alone (N.=78) or PR combined with intermittent NIPPV (N.=57). Outcomes included chest tube duration, hospital stay, bronchoscopy frequency, spirometric improvement, and 6-month pulmonary-related readmissions. RESULTS: Compared with PR alone, the PR + NIPPV group had shorter chest tube duration (5.42 +/- 2.14 vs. 6.61 +/- 4.12 days; P=0.03), shorter hospital stay (7.38 +/- 3.04 vs. 9.56 +/- 6.16 days; P=0.01), fewer bronchoscopies (0.51 +/- 0.89 vs. 1.04 +/- 1.36; P=0.01), and greater spirometric improvement (842 +/- 356 mL vs. 713 +/- 287 mL; P=0.03). Readmission rates showed no significant difference between groups (P=0.13). CONCLUSIONS: Integrating intermittent NIPPV into standard PR protocols appears to enhance postoperative pulmonary recovery, shortens hospital stay, and reduces bronchoscopy needs, while maintaining good tolerability. This combined approach merits considered for thoracic surgery patients, particularly those at high risk for PPCs. (Cite this article as: Chen HJ, Wu WL, Chung WC, Tsai JR, Tsai PC, Lin CC, et al. Intermittent noninvasive positive-pressure ventilation combined with pulmonary rehabilitation enhances postoperative recovery in thoracic surgery patients: a retrospective study. Minerva Respir Med 2026;65:7-13. DOI: 10.23736/S2784-8477.26.02237-0)
BACKGROUND: It is known that comorbidities associated with chronic obstructive pulmonary disease (COPD) can influence its course. However, according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, it is not clear which can affect the disease exacerbations in group E patients being regularly treated with single inhaler triple therapy (SITT). METHODS: We retrospectively extracted from our database SITT individuals treated with fluticasone furoate/vilanterol/umeclidinium (FF/UMEC/VI) or beclometasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/GLI) for 1 year. Only patients who were prescribed more than 7 triple-therapy packages/year were considered. At least 3 oral corticosteroid (OC) packages prescribed during the triple treatment were used to identify COPD exacerbations. RESULTS: The number of patients enrolled on SITT therapy for 1 year was 5107 (1844-36.1%/females; 3263-63.9%/males; mean age: 74.9 +/- 9.3). SITT treatment adherence, i.e., triple therapy packages/year, was 10.8 +/- 2.9. The most common comorbidities associated to COPD were cardiovascular diseases (CVD - 73.4%), hypertension HYP (71.8%), and gastroesophageal reflux/dyspepsia (GER/D - 63.1%) and then all the others. Comorbidities increasing the risk of having >= 3 OC packages/year were: CVD (OR: 1.242 [95% CI: 1.033-1.494]; P=0.021), GER/G (OR: 3.164 [95% CI: 2.702-3.717]; P=0.0001), psychiatric disorders (OR: 1.751 [95% CI: 1.508-2.036]; P=0.0001), oncological diseases (OR: 2.227 [95% CI: 1.890-2.617]; P=0.0001), anemia (OR: 1.283 [95% CI: 1.046-1.577]; P=0.017), osteoporosis (OP) (OR: 1.631 [95% CI: 1.261-2.114]; P=0.0001), autoimmune diseases (OR: 1.748 [95% CI: 1.251-2.444]; P=0.001) and chronic kidney diseases (OR: 2.247 [95% CI: 1.453-3.412]; P=0.0001). Conversely, the association of COPD and HYP (OR: 0.788 [95% CI: 0.671-0.926]; P=0.004) and dyslipidemia (DYS) (OR: 0.753 [95% CI: 0.646-0.877]; P=0.0001) significantly reduced the exacerbation risk. CONCLUSIONS: In conclusion, in GOLD-Group E, many comorbidities are associated with increased risk of COPD exacerbations despite SITT. GER/D was the disease leading to a greater exacerbation risk. Conversely, HYP/DYS associations were protective against them. In higher risk patients, treatment increases for both COPD and comorbidities should be considered.
Acute eosinophilic pneumonia (AEP) is a rare, potentially life-threatening pulmonary disease characterized by eosinophilic infiltration of the lung parenchyma. While usually idiopathic or associated to infectious or drug-induced etiologies, sertraline-induced AEP is exceedingly uncommon. We report a case of a 25-year-old female presenting with fever, dyspnea, and hypoxemic respiratory failure following 2 months of sertraline use and recent cigarette smoking initiation. Chest imaging revealed diffuse bilateral alveolo-interstitial infiltrates and bilateral pleural effusion. Extensive microbiological and autoimmune investigations were negative. Eosinophilia was identified in bronchoalveolar lavage (BAL) and pleural fluid cytology, suggesting the diagnosis of AEP. The patient required intensive care admission with noninvasive ventilation and bilateral pleural drainage, which significantly improved respiratory parameters. Discontinuation of sertraline and initiation of systemic corticosteroid therapy resulted in rapid clinical and radiological improvement. At follow-up, the patient remained asymptomatic with complete resolution of radiographic abnormalities and normalization of pulmonary function. This case underscores the importance of detailed drug history and multidisciplinary evaluation in diagnosing AEP. The temporal association between sertraline initiation and symptom onset, combined with eosinophilic findings, supports sertraline as the likely etiologic agent. While bilateral pleural effusions are common in AEP, reports of eosinophilic pleural involvement in drug-induced forms are rare. This case highlights the need for awareness of atypical drug-related causes of AEP. Sertraline-induced AEP is a rare, potentially life-threatening but reversible condition. Timely recognition and management are critical for favorable outcomes.
BACKGROUND: Chest high-resolution computed tomography (HRCT) plays a key role in the diagnosis and follow-up of patients with organizing pneumonia (OP). However, its repeated use is limited by high cost and radiation exposure. The aim of the study was to evaluate the utility of diffusion lung carbon monoxide (DLCO) test in monitoring OP response to oral corticosteroid (OCS) therapy and in relation to HRCT modifications. METHODS: It was a retrospective study. Among 40 OP patients, 20 had complete pulmonary function test and HRCT at baseline (T0) and after 3 months (T3) of OCS therapy and 16 after 6 months (T6). HRCT response to OCS was defined "complete" or "partial" in absence or persistence of any OP radiological findings, respectively. RESULTS: In comparison with T0, at T3 both DLCO and forced vital capacity (FVC), percentage (%) and absolute values, significantly increased (P<0.001, P<0.001, P=0.015, P=0.028, respectively), while at T6 in comparison with T3, only DLCO, % and absolute values, significantly increased (P=0.0007, P=0.02, respectively).At T3, 10 patients showed a complete and 10 a partial radiological response. Comparing the two groups of patients, although at T0 there was no significant difference in pulmonary functional test (PFT) parameters, the complete radiological response group showed significantly higher % DLCO values in comparison with the partial response group (P=0.03). No significant difference in FVC was observed. CONCLUSIONS: DLCO is a safe test that resembles HRCT modifications and can be used in the follow-up of patients affected by OP.
BACKGROUND: Inspiratory muscle training (IMT) has been widely used to enhance inspiratory muscle strength and pulmonary function. It may, therefore, have a role improving execution of wind musicians, however, this is largely unknown. This study investigated the impact of IMT on woodwind and brass players. METHODS: A cross-over randomized controlled study was conducted. Data on peripheral oxygen saturation, heart rate, electromyography-EMG, forced expiratory volume in the first second-FEV1, forced vital capacity-FVC and the ratio between FEV1/FVC, maximum inspiratory pressure-MIP, rate of perceived exertion and self-perceived levels of dyspnea were gathered before and after the intervention. Participants were also questioned about their instrumental study routines, daily habits and their experience with the IMT. RESULTS: Fourteen wind players, seven males and seven females, were included. Significant improvements in MIP were registered for time (F-(1.26)=18.0, P<0.001, eta(2)(p)=0.409) and for the interaction between time and groups (F-(1.26)=12.9, P=0.001, eta(2)(p)=0.331), with an increase in MIP scores favoring the EG. For the rate of perceived exertion a decrease was observed during performance with a significant difference, for time (F-(1.26)=6.6, P=0.016, eta(2)(p)=0.203) and for the interaction between time and groups (F-(1.26)=5.1, P=0.033, eta(2)(p)=0.163), favoring the EG. CONCLUSIONS: This study showed significant improvements in the MIP, decrease in the rate of perceived exertion after five-weeks of IMT in wind players. IMT may be effective in improving respiratory muscle strength in wind players.
BACKGROUND: Postextubation respiratory failure is a major problem facing clinicians. It increases the economic burden, length of hospital stay and mortality. The aim of this study was to assess the efficacy of high flow nasal oxygen in prevention of postextubation respiratory failure. METHODS: Patients extubated after mechanical ventilation for type 2 respiratory failure, received either high flow nasal oxygen or non-invasive ventilation. Physiological parameters, outcome and length of hospital stay were recorded. RESULTS: Sixty-seven patients were enrolled, 34 patients received high flow nasal oxygen and 33 patients received non-invasive ventilation. There was no statistically significant difference between both groups regarding outcome, length of stay and physiological parameters. CONCLUSIONS: High flow nasal oxygen can be as effective as non-invasive ventilation in prevention of postextubation failure in hypercapnic patients. (Cite this article as: Elnady MA, Assal HH, Abo Elhasab MA, Abo Elwafa GS. High flow nasal oxygen in prevention of postextubation failure in hypercapnic patients. Minerva Respir Med 2025;64:19-24. DOI: 10.23736/S2784-8477.24.02160-0)
BACKGROUND: Telemedicine and tele monitoring represent an emerging-study area in several and chronic diseases. Tele-rehabilitation during COVID-19 disease became an essential tool to promote physical activity in total safety. In fact, for pwCF physical activity was fundamental not only for the respiratory program but also. The aim of the study was to evaluate the feasibility of home web-based program of home exercise training program in patients with cystic fibrosis (CF) during COVID-19 pandemic. METHODS: Thirty-two patients (12 M/ 20 F) age 20.52 (+/- 9.3); FEV1 mean was 84.88% (+/- 21.1) and Ph angle mean at T0 was 6.11 (+/- 0.83). Patients performed at the beginning spirometry, CF questionnaire-revised, bioimpedance analysis and handgrip-test. At the end of study, patients replaced the same examinations with also satisfaction and utility Likert Scales. RESULTS: Adherence average rate was 61.5%. Satisfaction and utility scores were respectively 4.5 and 4.3(Likert Scale); about QoL the Body-domain had a statistically significant increase (P value <0.05). CONCLUSIONS: Web-based rehabilitation could be a good tool but more studies are needed to confirm optimal values of adherence. Although data are based on a small sample size and longer periods of treatment are requested to analyze especially the physiological answer about heart rate and lung volumes.
Posterior cranial fossa neoplastic pathologies, particularly in the fourth ventricle, can lead to debilitating conditions requiring multidisciplinary rehabilitation. This case report aims to clarify the role of multidisciplinary management in major vital functions and in improving the quality of life in a 28-year-old male undergoing resection of solitary hemangioblastoma of the IV ventricle. The main rehabilitation courses the patient underwent and the 6-month follow-up are discussed.
BACKGROUND: Long-term non-invasive ventilation (NIV) has a positive effect on symptom reduction, sleep related breathing problems and hypercapnia in obesity hypoventilation syndrome (OHS). After NIV has been established in an inpatient setting, regular inpatient control visits occur. It is unclear whether outpatient control visits are feasible and reduce costs, patient burden and workload on the health care system. Predefined stability criteria may help to identify patients for safe outpatient care in NIV patients with OHS. The aim of this study was to investigate an outpatient setting for NIV follow-up with predefined criteria for stability and hospitalization in patients with OHS. METHODS: Retrospective analysis of patients undergoing regular visits for long-term NIV therapy in an outpatient setting located within a hospital based respiratory care unit. RESULTS: One hundred fifty-nine outpatient visits (49 patients) were analyzed. In 131 cases (82.4%), hospital admission was not necessary following the outpatient visit according to the predefined stability criteria. In 21 cases (13.2%), hospital admission was required; in 7 cases (4.4%) no follow-up visit was planned. Out of the 21 hospitalizations, 5 (23.8%) were prompt admissions and 16 (76.2%) were planned. CONCLUSIONS: Outpatient control of OHS patients with long-term NIV is a feasible alternative. Unstable patients can be identified and admitted, according to predefined stability criteria. These may account for less than 20%.
Severe Acute Respiratory Disease Syndrome Coronavirus 2 has caused a global pandemic. Monoclonal antibodies, antiviral therapy (Remdesivir) and immunomodulatory agents represent one of the most promising therapies to prevent disease progression and reduce the relative risk of severe COVID-19. The aim of this study was to evaluate the impact on the disease progression of the main pharmacological options approved for the patients admitted in hospital with acute COVID-19 infection, according to their vaccination status.. We conducted a study including adult patients with confirmed COVID-19 admitted to the Infectious Diseases Unit of Alessandria’s Hospital in Italy, from October 2021 to March 2022. 102 patients were included in the analysis. The mean age was 69.2 ±15.4 years, 66.7% were males. According to the internal hospital’s guidelines, 47.06% patients with mild to moderate disease were treated with mAbs, 45.10% were treated with Remdesivir, of which 10.78% received combination therapy with mAbs. The most frequently complications were pneumonia (18.63%), respiratory failure (15.68%) and acute respiratory distress syndrome (13.72%). The mean length of hospitalization was 13.42 (±10.90) days and the mortality rate was 11.76%. The treatment with mAbs and immunomodulatory therapy for mild to moderate COVID-19 infection seem to be effective to improve the outcome reducing disease progression and mortality. C-reactive protein (CRP) and ferritin could be considered a good inflammatory marker of disease progression.
BACKGROUND: Both chronic obstructive pulmonary disease (COPD) and periodontitis are widespread diseases with high health economic relevance but with questionable association. This study investigated whether a COPD-Assessment test (CAT) can be used to assess the risk of impaired dental status in a non-specific population of smokers. METHODS: In a prospective cross-sectional pilot trial, patients with smoking history (>= 20 packyears) were examined in a dental practice for the purpose of dental prophylaxis. In addition to the CAT score, the Oral Health Impact Profile (OHIP-14) questionnaire was used to assess subjective oral health. The periodontal screening index (PSI) and the DMF-T (Decayed, Missing, Filled, Teeth) index served as objective indicators. RESULTS: The study enrolled 169 patients (mean age 54.6 +/- 8.9 years). Average CAT score (possible range 0 to 40) was 10.4 +/- 6.2, with 43.4% scoring >= 10. Mean PSI score was 2.9 +/- 0.5 with no age influence, and 91.5% had periodontitis (PSI score 3 or 4; scale: 0 to 4). Median OHIP score was 4.0 (scale: 0 to 51). Mean DMF-T index (possible range 0 to 28) was 17.5 +/- 7.1, indicating higher scores in patients over 60 years compared to those aged 40-49 years (22.0 +/- 6.3 vs. 14.3 +/- 6.1, P<0.001). No correlation was found between CAT scores and objective dental variables, but a significant correlation existed between CAT and OHIP scores (r: 0.524; P<0.001). CONCLUSIONS: In smokers without pulmonary disease, CAT scores indicate high symptom burden but do not predict dental status. However, there is a significant positive correlation between the quality of oral health and COPD-related symptoms.
