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Introduction Chronic obstructive pulmonary disease (COPD) is a preventable disease of the airways characterized by limited airflow. Acute exacerbations of COPD (AECOPD) may be precipitated by noxious stimuli. N-acetylcysteine (NAC) has mucolytic, antioxidant, and anti-inflammatory activity. We conducted this study to evaluate the effect of adding high-dose NAC to the protocol treatment of AECOPD. Methods In this single-center, prospective, interventional study, patients admitted with AECOPD, airflow obstruction on spirometry, and who were current smokers with 10 or more packs per year were included after attaining informed consent. NAC granules 600 mg twice daily orally (high dose) were included in the regimen of 25 randomly selected patients and the other 25 were managed without NAC. An improvement in clinical and biochemical markers was observed on day three and day seven. For statistical analysis, SPSS for Windows version 21.0 (IBM Corp., Armonk, NY) was utilized. Results The study was completed by 21 patients in the NAC group and 19 in the non-NAC group. In the NAC group, there was a significant improvement in the mean partial pressure of oxygen (PaO2) both on day three (p=0.03) and day seven (p=0.01). The mean partial pressure of carbon dioxide (PaCO2) was at the borderline in the two groups on day three; however, on day seven, the NAC group showed significantly improved PaCO2 as compared to the non-NAC group (p=0.007). There were significant improvements in oxygen saturation of the NAC group on day seven (p=0.02). There were significant improvements in clinical signs, including wheezing and dyspnea and the need for nasal oxygen support (p≤0.05). Conclusion The addition of 600 mg twice daily NAC (high dose) to the protocol treatment of patients with acute exacerbation of COPD may have beneficial outcomes. In the future, the role of high-dose NAC in AECOPD must be studied through multicenter, double-blinded, placebo-controlled trials with larger sample sizes in order to either establish or invalidate this association.
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Introduction Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of poor quality of life and mortality in developing countries. Noninvasive positive pressure ventilation (NIPPV) remains the first-line intervention in hospitalized patients with acute respiratory failure (ARF) due to AECOPD. However, NIPPV may fail in some patients. This study was conducted to assess the frequency of NIPPV failure and clinical parameters and outcomes in AECOPD patients with failed NIPPV and their conversion to invasive positive pressure ventilation (IPPV). Methods This prospective observational study was conducted in the pulmonology unit of a tertiary care hospital in Pakistan. AECOPD patients with ARF who were candidates of NIPPV were included after securing informed consent. Their demographic characteristics, clinical parameters, and in-hospital outcomes were recorded on a semi-structured proforma. For statistical analysis, SPSS software version 22.0 for Windows (IBM, Armonk, NY) was used. Results With 24 hours of NIPPV, 73 (70.2%) patients improved and the remaining 31 (29.8%) were shifted to IPPV. Patients in the IPPV group had higher systolic blood pressure (BP) [133.8 mmHg (±21.2) vs. 121.1 mmHg (±8.3); probability value (p): <0.000] and lower diastolic BP [68.7 mmHg (±13.4) vs. 76.2 mmHg (±10.8); p: 0.003]. Their pH was more acidic [7.20 (±0.13) vs. 7.42 (±0.01); p: <0.000], heart rates were high [131.1 (±10.5) vs. 100.2 (±7.5); p: <0.000], and the percentage of oxygen saturation was low [90.7 (±3.0) vs. 93.4 (±4.5); p: 0.004]. Patients who were managed on NIPPV throughout their hospital stay required respiratory support for fewer days [3.2 (±1.3) vs. 4.1 (±1.8); p: 0.005], and their hospital stay was shorter [3.5 (±1.2) vs. 5.3 (±2.5) days; p: <0.000]. Mortality rate in the NIPPV group was significantly lower (1.4% vs. 12.9%; p: 0.01). Conclusions Deranged blood pressure, increased heart rate, acidemia, and a low percentage of oxygen saturation are crucial clinical and biochemical parameters that can predict the success of NIPPV with 24 hours of therapy in patients with AECOPD and secondary ARF. Patients who do not improve with 24 hours of NIPPV therapy usually have poor in-hospital outcomes including mortality.
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Introduction Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be fatal. In 2012, a comprehensive score was developed to predict the risk of in-hospital mortality in AECOPD called the dyspnoea, eosinopenia, consolidation, acidemia, and atrial fibrillation (DECAF) score. We conducted this study to assess the value of the DECAF score as a clinical prediction tool that claims to stratify all patients with AECOPD by risk accurately. Methods We conducted a prospective study of patients admitted to the intensive care unit (ICU) of the Department of Pulmonology in Civil Hospital, Jamshoro, from January 2016 to December 2018. Our inclusion criteria were that the patient must be age 35 years or older, have a primary clinical diagnosis of AECOPD, spirometry consistent with airflow obstruction, and have a smoking history of ≥10 cigarette pack per year. We excluded patients who had domiciliary ventilation, survival-limiting comorbidities (such as metastatic malignancy), and a primary reason for admission other than AECOPD. All sociodemographic data were collected at the time of admission, including age, gender, co-morbidities, housebound status, and number of previous AECOPD. Clinical data collected included plain chest x-ray, spirometry, electrocardiogram, arterial blood gases analysis, complete blood count, kidney function test, liver function test, and serum electrolytes. A DECAF score was applied to each patient. We noted in-hospital mortality and compared the characteristics of survivors and non-survivors. Data were analyzed using IBM SPSS for Windows, version 19.0 (IBM Corp, Armonk, NY). Results A total of 162 patients were included in the study. The mortality rate was 13% (n=21). More survivors had a DECAF score from zero to three than non-survivors. The difference in the number of survivors vs. non-survivors was statistically significant for DECAF scores zero and one. For DECAF scores four and five, there were more patients in the "non-survivors" group, and the differences were statistically significant. None of the patients scored six on DECAF. Conclusion Patients with a DECAF score of four or higher have a significant risk of mortality. DECAF is a simple tool that predicts mortality that incorporates routinely available indices to stratify AECOPD patients into mortality risk categories.
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Introduction Allergic rhinitis (AR) is the most common non-infectious rhinitis and is associated with sneezing, cough, and flu-like symptoms. The exact pathophysiology of AR remains uncertain. The deficiency of vitamin D3 has been documented as a probable cause of allergic conditions due to its role in immunomodulation. The aim of this study was to evaluate the role of vitamin D3 deficiency in allergic rhinitis. Methods This case-control study was conducted with 50 patients of AR and 50 healthy individuals. Serum immunoglobulin (Ig) E and vitamin D3 levels were measured in all study participants. Data were analyzed using SPSS v. 21.0 (IBM Corp., Armonk, NY). Results Mean serum IgE levels in the AR group were 553.5 ± 53.9 IU/L as compared to 219.4 ± 32.1 IU/L in the control group (p <0.0001). AR patients had mean serum vitamin D levels of 14.8 ± 7.4 ng/mL as compared to 19.1 ± 6.6 ng/mL in the control group (p=0.002). Only 10% of participants in the AR group had adequate serum vitamin D levels as compared to 26% in the controls (p=0.08). Conclusion Vitamin D deficiency was present in both study groups. The AR group had significantly lower mean levels of serum vitamin D than the control group. However, upon stratification, the differences were insignificant.
