ABSTRACT
BACKGROUND: Hemoptysis is a challenging and potentially life-threatening medical condition. The most appropriate diagnostic work-up is debated and several diagnostic approaches are implemented worldwide. METHODS: An international, online survey was carried out to investigate the current practice of the diagnostic work-up of patients with hemoptysis of unknown etiology. RESULTS: overall, 604 physicians responded to the survey. At baseline, chest X-ray was suggested as the first diagnostic investigation by 342 (56.6%) participants. Computed tomography (CT) was suggested in each patient with non- and life-threatening hemoptysis by 310 (51.3%) and 526 (87.1%) respondents, respectively. Contrast-enhanced CT is the currently preferred technique (333, 55.1%). In case of patchy ground glass opacities and negative CT, 287 (47.5%) and 222 (36.8%) participants, respectively, would always offer bronchoscopy. Otorhinolaryngological evaluation was mostly suggested in case of suspected upper airways bleeding before other investigations (212, 35.1%). A follow-up was recommended for idiopathic hemoptysis by the majority of the participants (316, 52.3%). A multidisciplinary assessment is deemed crucial for each patient with life-threatening hemoptysis (437, 72.4%). CONCLUSIONS: Chest X-ray and contrast-enhanced CT are currently preferred as the first diagnostic investigations, regardless of hemoptysis severity. Bronchoscopy is suggested in case of negative radiological examination and when CT shows only ground glass opacities. Otorhinolaryngological evaluation is advised before any other investigations when upper airways bleeding is suspected. Patients with idiopathic hemoptysis are suggested to undergo a clinical follow-up and in case of life-threatening bleeding a multidisciplinary assessment is deemed crucial. Due to the heterogeneous approaches a consensus statement would be needed.
Subject(s)
Humans , Female , Adult , Hemoptysis/etiology , Lung , Arteries , Aorta, Abdominal/abnormalitiesABSTRACT
BACKGROUND: The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. PATIENTS AND METHODS: This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression. RESULTS: A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032). CONCLUSION: Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.
ABSTRACT
No disponible
Subject(s)
Humans , Biopsy/methods , Lung Neoplasms/pathology , Cryotherapy/methods , Balloon Occlusion/methods , Specimen Handling/methodsABSTRACT
No disponible
Subject(s)
Humans , Bronchial Hyperreactivity/diagnosis , Asthma/physiopathology , Practice Patterns, Physicians'ABSTRACT
Dentro de las patologías adquiridas tras la instauración de una vía aérea artificial figuran las estenosis, los granulomas, la presencia de pseudomembranas y la formación de tabiques traqueales, entre otros. La forma más habitual de presentación en el adulto es la estenosis circunferencial, y para su resolución muchas veces requiere medidas endoscópicas terapéuticas. En esta Nota clínica se describe el caso de una pseudomembrana traqueal inflamatoria obstructiva (en forma de tabique traqueal) secundaria a intubaciones repetidas y que se resolvió con tratamiento conservador. La presentación clínica de esta entidad generalmente incluye la aparición de infección respiratoria y/o atelectasia tras la retirada del tubo orotraqueal, como consecuencia de la acumulación de secreciones entre la pared traqueal y el tabique formado. Los tabiques traqueales inflamatorios se pueden resolver espontáneamente con ayuda de glucocorticoides, y otras veces requieren de un procedimiento endotraqueal invasivo en función de la evolución (AU)
Pathologies acquired after the establishment of an artificial airway include stenosis, granulomas and the formation of pseudomembranes, to name a few. The most common form of presentation in adults is circumferential stenosis, which often requires therapeutic endoscopic measures to achieve resolution. This Case Report describes the case of an obstructive inflammatory tracheal pseudomembrane secondary to repeated intubations that was resolved with conservative treatment. The clinical presentation of this entity generally includes the appearance of respiratory infection and/or atelectasis after the withdrawal of the orotracheal tube as a consequence of the accumulation of secretions between the tracheal wall and the pseudomembrane. Inflammatory pseudomembranes can resolve spontaneously with the help of glucocorticoids, although on occasion they require an invasive endotracheal procedure depending on the evolution (AU)
Subject(s)
Humans , Intubation, Intratracheal/adverse effects , Tracheal Stenosis/etiology , Bronchoscopy , Airway Management/adverse effects , Risk FactorsSubject(s)
Asthma/complications , Bronchial Hyperreactivity/etiology , Diagnostic Techniques, Respiratory System , Asthma/physiopathology , Asthma, Exercise-Induced/complications , Asthma, Exercise-Induced/physiopathology , Athletes , Bronchial Hyperreactivity/diagnosis , Bronchial Hyperreactivity/physiopathology , Bronchial Provocation Tests/methods , Bronchial Provocation Tests/standards , Bronchoconstrictor Agents/administration & dosage , Contraindications , Diagnostic Techniques, Respiratory System/standards , Dose-Response Relationship, Drug , Exercise Test/adverse effects , Exercise Test/standards , Humans , Hyperventilation/physiopathology , Nebulizers and Vaporizers , Saline Solution, Hypertonic , Spirometry/methodsABSTRACT
Pathologies acquired after the establishment of an artificial airway include stenosis, granulomas and the formation of pseudomembranes, to name a few. The most common form of presentation in adults is circumferential stenosis, which often requires therapeutic endoscopic measures to achieve resolution. This Case Report describes the case of an obstructive inflammatory tracheal pseudomembrane in the shape of a tracheal septum secondary to repeated intubations that was resolved with conservative treatment. The clinical presentation of this entity generally includes the appearance of respiratory infection and/or atelectasis after the withdrawal of the orotracheal tube as a consequence of the accumulation of secretions between the tracheal wall and the pseudomembrane. Inflammatory pseudomembranes can resolve spontaneously with the help of glucocorticoids, although on occasion they require an invasive endotracheal procedure depending on the evolution.
Subject(s)
Airway Obstruction/etiology , Intubation, Intratracheal/adverse effects , Trachea/injuries , Tracheitis/complications , Aged , Airway Obstruction/diagnostic imaging , Anti-Inflammatory Agents/therapeutic use , Bronchi/metabolism , Combined Modality Therapy , Cough/etiology , Exudates and Transudates , Female , Humans , Hypercapnia/therapy , Kyphosis/complications , Methylprednisolone/therapeutic use , Mucus/metabolism , Prednisone/therapeutic use , Pulmonary Atelectasis/etiology , Pulmonary Disease, Chronic Obstructive/complications , Respiration, Artificial , Respiratory Insufficiency/therapy , Respiratory Therapy , Scoliosis/complications , Tomography, X-Ray Computed , Tracheitis/diagnostic imaging , Tracheitis/drug therapy , Tracheitis/etiologyABSTRACT
Asthma continues to be a global health problem, despite advances in diagnostic techniques and treatment. The inflammatory nature of asthma is currently indisputable, as is the involvement of the entire respiratory tree, both the proximal and most distal airways, which has been demonstrated in multiple studies. The development of the therapeutic arsenal, with more potent drugs and improved inhalation devices, has allowed a certain control to be maintained over the inflammatory process, although the inability to reach the most distal points of the airways has posed a stumbling block that seems difficult to overcome. However, the available information on the real role of distal airway involvement in asthma remains very scarce. Physiopathological evidence shows that, in addition to the large airways, the small or distal airways (those with a diameter of less than 2 mm) substantially contribute to the severity of asthma. Several studies have shown that the inflammatory process seems to be more intense in this area. This finding has been related to nocturnal asthma and an increase in glucocorticoid receptor-beta-expressing cells, associated with corticosteroid-resistant asthma and fatal asthma. Equally, small airway involvement seems to be a highly important factor in asthma in the pediatric age group.
Subject(s)
Airway Remodeling , Asthma/physiopathology , Bronchi/pathology , Administration, Inhalation , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/pharmacokinetics , Adrenal Cortex Hormones/therapeutic use , Airway Obstruction/drug therapy , Airway Obstruction/etiology , Airway Remodeling/drug effects , Airway Remodeling/physiology , Airway Resistance , Anti-Asthmatic Agents/administration & dosage , Anti-Asthmatic Agents/pharmacokinetics , Anti-Asthmatic Agents/pharmacology , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Asthma/metabolism , Asthma/pathology , Bronchi/physiopathology , Bronchioles/pathology , Bronchioles/physiopathology , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/pharmacokinetics , Bronchodilator Agents/pharmacology , Bronchodilator Agents/therapeutic use , Child , Functional Residual Capacity , Humans , Inflammation , Plethysmography , Pulmonary Alveoli/pathology , Pulmonary Alveoli/physiopathology , Pulmonary Eosinophilia/etiology , Respiratory Function Tests , Smoking/adverse effects , Tissue DistributionABSTRACT
El asma sigue siendo un problema de salud mundial pese a los avances en las técnicas diagnósticas y en eltratamiento. El carácter inflamatorio de esta patología es, hoy en día, indudable y el hecho de que esta inflamaciónafecta a todo el árbol respiratorio, tanto en las vías proximales con en las áreas más distales, se hacorroborado en múltiples estudios. El desarrollo del arsenal terapéutico, con fármacos más potentes y mejoresdispositivos de inhalación, ha permitido mantener cierto control sobre el fenómeno inflamatorio pero seha encontrado con un escollo, a simple vista difícil de superar, que es la incapacidad de llegar hasta los puntosmás distales de la vía respiratoria. Sin embargo, la información disponible sobre el papel real de la afectaciónde la vía aérea pequeña en la clínica del paciente con asma es, aún hoy día, muy escasa. Las evidencias fisiopatológicasexistentes demuestran que, además de las grandes vías respiratorias, las denominadas vías pequeñaso distales (con diámetros inferiores a 2 mm) contribuyen en gran parte a la gravedad del asma. Variostrabajos han demostrado que el proceso inflamatorio parece ser más intenso en esta zona, hecho que se harelacionado con el asma nocturna, y un incremento de células que expresan el receptor b de los corticoides,asociado con el asma resistente a corticoides y al asma con desenlace fatal. Del mismo modo, la afectación dela vía aérea pequeña parece ser un factor muy importante en el asma en edad pediátrica(AU)
Asthma continues to be a global health problem, despite advances in diagnostic techniques and treatment.The inflammatory nature of asthma is currently indisputable, as is the involvement of the entire respiratorytree, both the proximal and most distal airways, which has been demonstrated in multiple studies. Thedevelopment of the therapeutic arsenal, with more potent drugs and improved inhalation devices, hasallowed a certain control to be maintained over the inflammatory process, although the inability to reach themost distal points of the airways has posed a stumbling block that seems difficult to overcome. However, theavailable information on the real role of distal airway involvement in asthma remains very scarce.Physiopathological evidence shows that, in addition to the large airways, the small or distal airways (thosewith a diameter of less than 2 mm) substantially contribute to the severity of asthma. Several studies haveshown that the inflammatory process seems to be more intense in this area. This finding has been related tonocturnal asthma and an increase in glucocorticoid receptor-beta-expressing cells, associated withcorticosteroid-resistant asthma and fatal asthma. Equally, small airway involvement seems to be a highlyimportant factor in asthma in the pediatric age group(AU)
Subject(s)
Humans , Male , Female , Child , Asthma/physiopathology , Pulmonary Alveoli/physiopathology , Asthma/complications , Adrenal Cortex Hormones/pharmacokinetics , Inflammation/physiopathologySubject(s)
Asthma/surgery , Bronchi/surgery , Catheter Ablation , Adrenergic alpha-Agonists/therapeutic use , Anti-Asthmatic Agents/therapeutic use , Beclomethasone/therapeutic use , Combined Modality Therapy , Double-Blind Method , Humans , Multicenter Studies as Topic , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
A pesar de las normativas y tratamientos existentes, una proporción de pacientes con asma permanecen sintomáticos, están mal controlados y son causa de un mayor impacto sanitario e ingresos por asma. La termoplastia bronquial es una novedosa opción terapéutica en fase experimental, que consiste en la aplicación de calor generado por radiofrecuencia, mediante un catéter que se introduce en el árbol bronquial con broncoscopia flexible, para reducir la cantidad y contractilidad del músculo liso. En una fase inicial se utilizó un modelo experimental animal. Posteriormente, 2 ensayos clínicos aleatorizados han examinado la seguridad y eficacia de la termoplastia en pacientes con asma moderada-grave tras un año de seguimiento. Los resultados muestran que es un procedimiento seguro, con efectos adversos en general transitorios, y que comporta algunos beneficios clínicos. A la espera de nuevos datos que ofrecerán ensayos clínicos en curso, la termoplastia se ha constituido como una posible e innovadora aproximación terapéutica del asma(AU)
Despite the numerous guidelines and treatments available for asthma, the disease remains poorly controlled in some patients, who remain symptomatic, are a considerable burden on the health system, and account for most of the hospitalizations due to asthma. Bronchial thermoplasty is a novel experimental therapeutic option that consists of delivering radiofrequency-generated heat to the airways via a catheter inserted in the bronchial tree through a flexible bronchoscope to reduce smooth muscle quantity and contractility. The first investigations were conducted using an animal model. Subsequently, 2 randomized clinical trials designed to evaluate the safety and efficacy of thermoplasty in patients with moderate to severe asthma with a 1-year follow-up period showed the procedure to be safe, with mostly transient adverse affects and several clinical benefits. Although results from ongoing clinical trials are still awaited, thermoplasty may become an innovative therapeutic approach to asthma(AU)
Subject(s)
Humans , Male , Female , Asthma/epidemiology , Asthma/therapy , Catheter Ablation/methods , Bronchial Hyperreactivity/complications , Bronchial Hyperreactivity/therapy , Bronchoscopy/methods , Muscle, Smooth , Muscle, Smooth/physiopathology , Thoracotomy/methods , Thoracotomy/trends , Glucocorticoids/therapeutic useABSTRACT
Despite the numerous guidelines and treatments available for asthma, the disease remains poorly controlled in some patients, who remain symptomatic, are a considerable burden on the health system, and account for most of the hospitalizations due to asthma. Bronchial thermoplasty is a novel experimental therapeutic option that consists of delivering radiofrequency-generated heat to the airways via a catheter inserted in the bronchial tree through a flexible bronchoscope to reduce smooth muscle quantity and contractility. The first investigations were conducted using an animal model. Subsequently, 2 randomized clinical trials designed to evaluate the safety and efficacy of thermoplasty in patients with moderate to severe asthma with a 1-year follow-up period showed the procedure to be safe, with mostly transient adverse affects and several clinical benefits. Although results from ongoing clinical trials are still awaited, thermoplasty may become an innovative therapeutic approach to asthma.
