The prevalence of sleep impairments and predictors of sleep quality among patients with asthma.

BACKGROUND: Sleep is a significant dimension of daily life. However, only a few studies have examined the sleep quality of asthmatics in a real-world clinical settings. OBJECTIVE: This study is aimed to estimate the prevalence of sleep impairments among asthmatic patients and examine the relationship between sleep quality, asthma control, rhinitis symptoms, and sociodemographic characteristics. METHODS: The present study adopted the observational cross-sectional research design that has been designed by the Italian Respiratory Society and used valid assessments to measure the study variables. RESULTS: Data from 1150 asthmatic patients (mean age 51.01 years ± 16.03) were subjected to analysis. 58.3% of the patients had impaired sleep quality (Pittsburgh Sleep Quality Index [PSQI] total scores > 5), and their mean PSQI score was 5.68 (SD = 3.4). A significant correlation emerged between sleep quality and asthma control (p = 0.0001) and a significant albeit weak correlation emerged between PSQI total scores and Total 5 Symptoms Score (r = 0.24, p = 0.0001). Sleep quality was significantly associated health-related quality of life [HRQoL]. (r = 0.50, p < 0.001). After exclusion of patients at risk for Obstructive Sleep Apnea Syndrome (OSAS) and Gastro Esophageal Reflux Disease (GERD), the most important determinants of PSQI score were HRQoL, In the entire sample asthma control is the strongest predictor of both sleep quality and HRQoL. CONCLUSIONS: The results of this real-world study highlight the prevalence, impact and predictors of sleep disturbances in asthmatic patients and suggest the need for physicians to detect poor sleep quality.

Clinical applications of diaphragm ultrasound: moving forward.

Establishing the correct time of weaning from mechanical ventilation is a crucial issue in the clinical practice. The difficult process of weaning can be due to pathological conditions that result in an imbalance between respiratory-muscle strength and respiratory load. Recently it has been suggested that ultrasound measurements of diaphragm muscle thickening in inspiration during weaning could provide an estimation of extubation success. Bedside ultrasonography, particularly sonographic evaluation of the diaphragm by measuring the percentage variation of diaphragm thickness (tdi) between end-inspiration and end-expiration (Δtdi%), has become a valuable tool in the management of intensive care unit patients. This non-invasive, low-cost and fast to perform technique seems to predict with a good accuracy the extubation failure. Some limitations derive from the difficulty to determine the maximum (end inspiratory) and minimum (end expiratory) tdi observing a dynamic image in B-mode, in particular in non-collaborating patients. In addition, some dynamic situations causing extubation failure could not be predicted by an ultrasound measure performed at the beginning of the weaning trial. Nowadays the technique proposed remains a useful tool for helping the prediction of extubation failure. It would be useful in the future to set up multicentric studies with a standardised description of the procedure and serial measurements in different timing during the weaning trial. Furthermore, randomized controlled trials to evaluate the efficiency of Δtdi% versus other indexes in predicting extubation failure are needed.

Lung cancer: can staging improvement ensure a better survival?

Lung cancer is among the most common cancers in the world. Despite advances in defining the molecular mechanisms involved in lung oncogenesis and the remarkable efforts made to improve screening programs for secondary cancer prevention, patients' prognosis remains poor. Moreover, wide international inequalities remain apparent, even among developed countries. Here we analyze and discuss the findings of the extensive work by Walters S et al., recently published in "Thorax", which aimed to clarify whether differences in stage at diagnosis might explain these divergences. A better understanding of why survival differences between different states still exist will facilitate policy design to increase lung cancer overall survival itself and to bring it up to the highest international standards. It is the first international population-based study of lung cancer survival by stage at diagnosis and includes nearly 60,000 patients. By using a well detailed and appropriate statistical approach, authors conclude that improvement in outcomes is primarily related to a proper initial disease staging and that socioeconomic international and interregional inequalities might play a relevant role in this scenario. Our review takes in consideration both the methodological and scientific issues of the paper, focusing on the potential consequences in lung cancer management and on the need, in the post genomic era, of a molecular-based epidemiologic approach.

Ultrasound-guided thoracenthesis: the V-point as a site for optimal drainage positioning.

INTRODUCTION: In the latest years the use of lung ultrasound is increasing in the evaluation of pleural effusions, because it makes follow-up easier and drainage more efficient by providing guidance on the most appropriate sampling site. However, no standardized approach for ultrasound-guided thoracenthesis is actually available. AIM: To evaluate our usual ultrasonographic landmark as a possible standard site to perform thoracenthesis by assessing its value in terms of safety and efficiency (success at first attempt, drainage as complete as possible). MATERIALS AND METHODS: Hospitalized patients with non organized pleural effusion underwent thoracenthesis after ultrasound evaluation. The point showing on ultrasound the maximum thickness of the effusion ("V-point") was chosen for drainage. RESULTS: 45 ultrasound guided thoracenthesis were performed in 12 months. In 22 cases there were no complications; 16 cases of cough, 2 cases of mild dyspnea without desaturation, 4 cases of mild pain; 2 cases of complications requiring medical intervention occurred. No case of pneumothorax related to the procedure was detected. In all cases drainage was successful on the first attempt. The collected values of maximum thickness at V-point (min 3.4 cm - max 15.3 cm) and drained fluid volume (min 70 ml - max 2000 ml) showed a significative correlation (p < 0.0001). When the thickness was greater or equal to 9.9 cm, drained volume was always more than 1000 ml. CONCLUSIONS: The measure of the maximum thickness at V-point provides high efficiency to ultrasound guided thoracentesis and allows to estimate the amount of fluid in the pleural cavity. It is also an easy parameter that makes the proposed method quick to learn and apply.