A Case of Pulmonary Nodular Lymphoid Hyperplasia Responding to Corticosteroid Treatment.

Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare non-neoplastic disease that presents with mass lesions in the lung. It is radiologically difficult to differentiate it from adenocarcinoma of the lung or pulmonary lymphoma. There has been no consensus regarding the treatment of PNLH; however, in many case series, patients usually undergo surgical resection for diagnostic and therapeutic purposes. Here, we present the case of a 60-year-old Chinese male who presented with cough and hemoptysis. A computed tomography scan of the thorax revealed a mass-like lesion. A biopsy was performed which showed lymphocytic pneumonitis. He was treated with a tapering dose of corticosteroids with good clinical and radiological outcomes. Upon a subsequent review of the case, a diagnosis of PNLH was made. This case report suggests that corticosteroids may be an alternative therapy to surgical resection. They have the advantage of being non-invasive and can be used in patients who are otherwise not surgical candidates due to other comorbidities. However, further research is required before we can recommend corticosteroids as a treatment for PNLH.

"High-Risk" Clinical and Inflammatory Clusters in COPD of Chinese Descent.

BACKGROUND: COPD is a heterogeneous disease demonstrating inter-individual variation. A high COPD prevalence in Chinese populations is described, but little is known about disease clusters and prognostic outcomes in the Chinese population across Southeast Asia. We aim to determine if clusters of Chinese patients with COPD exist and their association with systemic inflammation and clinical outcomes. RESEARCH QUESTION: We aim to determine if clusters of Chinese patients with COPD exist and their association with clinical outcomes and inflammation. STUDY DESIGN AND METHODS: Chinese patients with stable COPD were prospectively recruited into two cohorts (derivation and validation) from six hospitals across three Southeast Asian countries (Singapore, Malaysia, and Hong Kong; n = 1,480). Each patient was followed more than 2 years. Clinical data (including co-morbidities) were employed in unsupervised hierarchical clustering (followed by validation) to determine the existence of patient clusters and their prognostic outcome. Accompanying systemic cytokine assessments were performed in a subset (n = 336) of patients with COPD to determine if inflammatory patterns and associated networks characterized the derived clusters. RESULTS: Five patient clusters were identified including: (1) ex-TB, (2) diabetic, (3) low comorbidity: low-risk, (4) low comorbidity: high-risk, and (5) cardiovascular. The cardiovascular and ex-TB clusters demonstrate highest mortality (independent of Global Initiative for Chronic Obstructive Lung Disease assessment) and illustrate diverse cytokine patterns with complex inflammatory networks. INTERPRETATION: We describe clusters of Chinese patients with COPD, two of which represent high-risk clusters. The cardiovascular and ex-TB patient clusters exhibit high mortality, significant inflammation, and complex cytokine networks. Clinical and inflammatory risk stratification of Chinese patients with COPD should be considered for targeted intervention to improve disease outcomes.

Resection with preserved histologic morphology of a rare tumour via bronchoscopic cryosurgery.

Tracheobronchial leiomyoma is a rare pulmonary neoplasm accounting for <2% of benign tumours of the lower airway. Published case series reported bronchoscopic resectability with laser ablation for lesions located in the large airway. Surgery was performed for tumours with wide-based and tumours located in segmental bronchus or lung parenchyma. This is the first reported case of complete bronchoscopic cryoresection of leiomyoma arising from the subsegmental bronchi and illustrating the cryopreservation of its histologic morphology. A 55-year-old Chinese male who was a life-long non-smoker presented with chronic cough, left-sided chest pain and loss of weight. Chest radiograph showed left lower lobe (LLL) collapse, with the accompanying computed tomography scan of the thorax showing a non-enhancing soft tissue lesion in the LLL bronchus. Rigid bronchoscopy was performed, with rigid forceps resection followed by cryosurgery of the tumour to its base. Histology was consistent with a primary bronchial leiomyoma. Surveillance bronchoscopy performed 6 months later revealed no tumour recurrence. The patient also had complete resolution of his symptoms. Cryosurgery is a promising treatment modality, in complement with conventional forceps resection, for benign airway neoplasms.

Nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease phenotype: Topical NSAID and asthma control - A possible oversight link.

BACKGROUND: Patients with aspirin-exacerbated respiratory disease (AERD) also recently known as nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (NERD) must avoid aspirin and all other oral NSAIDs. The effect of topical NSAID (tNSAID), especially salicylates which are commonly present in topical medicated preparations, on asthma control of this phenotype is studied. METHODS: The study inclusion criteria were adults with: 1) NSAID hypersensitivity; 2) nasal polyposis/chronic rhinosinusitis; 3) not well-/poorly controlled asthma and 4) exposure to tNSAID. Patients were given verbal and written instructions to cease tNSAIDs exposure and asthma control was evaluated during the 6 months prior and after intervention. RESULTS: There were eleven patients (ten females) with a mean age of 56.5 (range 37-71) years. Prior known oral NSAIDs hypersensitivity included aspirin (5), mefenamic acid (2), diclofenac (2), Synflex (2) and ibuprofen (1). All, except 2, had arthropathies or spinal disorders and were using tNSAID for a mean of 4.2 years. One, four and six patients were using over-the-counter medicated oil containing salicylates, NSAID gel/plasters and both respectively. All patients had cutaneous, with 4 having concomitant inhalational exposure to these tNSAIDs. The mean duration of asthma diagnosis and uncontrolled asthma were 25.2 and 4.5 years respectively. Except for 2 patients, there was no change in asthma maintenance medications pre and post-intervention. Asthma control significantly (p < 0.05) improved based on pre and post-intervention ACT score, number of exacerbations, FEV1 were 14.9 and 22.1, 1.9 and 0.43, 1.28L and 1.67L respectively. CONCLUSIONS: It is paramount to eliminate not only oral but topical NSAID exposure in NERD phenotype asthmatic patients. When a long-standing asthma progressed to uncontrolled, a meticulous evaluation of tNSAIDs exposure is warranted especially if the patient has developed chronic pain.