Pulmonology for the rhinologist.

PURPOSE OF REVIEW: The upper and lower airways are inter-related despite serving different functions and can no longer be considered separately. Rhinologists are becoming increasingly aware of the role the lower airway plays in optimizing outcomes for their patients. This review highlights recent developments in pulmonology that impact rhinologic conditions. RECENT FINDINGS: The unified airway concept now supports the multidisciplinary management of respiratory and rhinologic pathologies. Biomarkers, biologics and the concept of treatable traits have permitted the development of personalized and precise treatment of the entire respiratory tract. The concept of corticosteroid stewardship, the introduction of steroid sparing agents for the treatment of respiratory diseases and the development of biomarkers, now forces us to be more considerate and precise with oral corticosteroid (OCS) prescribing and to consider reduction regimens. Finally, current research on climate change and vaping will allow us to better educate and prepare our patients to improve adherence and avoid exacerbations to maintain optimal global respiratory health. SUMMARY: The inter-relatedness of the upper and lower airway has encouraged a multidisciplinary focus in respiratory medicine. More research is required to improve the precision respiratory medicine model, particularly in the realm of biomarkers and endotyping. These developments must also consider the impact of climate change, pollution and toxins for us to provide optimum care for our patients.

A pilot study on the effectiveness of a language-specific (Chinese) pulmonary rehabilitation programme for individuals with chronic pulmonary disease: a 2-year prospective cohort study in Sydney, Australia.

BACKGROUND AND AIMS: Pulmonary rehabilitation (PR) improves dyspnoea, fatigue and healthcare-related quality of life (QoL) in patients with chronic lung disease (CLD). Non-English-speaking background (NESB) patients face language and cultural barriers that hinder their access to PR programmes, contributing to health disparities. Our trial aimed to demonstrate the effectiveness and feasibility of a Chinese language-specific PR programme on lung function, functional exercise capacity and QoL measures. METHODS: A prospective cohort study was conducted over a 2-year period. Participants were enrolled in an 8-week PR programme with biweekly sessions conducted by Chinese-speaking physiotherapists. Baseline and post-rehabilitation testing included pulmonary function testing, 6-min walk test (6MWT), St. George Respiratory Questionnaire (SGQR) and Short Form Health Survey (SF-36). RESULTS: We enrolled 76 patients (58% male) with a median age of 77 years (interquartile range (IQR) 68-81) and achieved a completion rate of 86.8% (n = 66). CLD included chronic obstructive pulmonary disease (42%), asthma (15%) and interstitial lung disease (3%). Baseline median forced expiratory volume in 1 s (FEV1) was 1.63 L (IQR 1.17-2.05), and the median 6MWT was 282 m (IQR 232-332). Post-intervention median 6MWT increased to 332 m (IQR 290-390), and the median FEV1 was 1.99 L (IQR 1.3-2.1). Both QoL measures (SGQR and SF-36) showed significant improvement after intervention (P < 0.05). CONCLUSION: Our study demonstrates that a language-specific PR programme is feasible, improving outcomes in NESB patients with CLD. The improvement in 6MWT and QoL measures was comparable to English-based programmes. Ensuring equal access to healthcare programmes, regardless of cultural background or language barriers, is crucial in promoting health equity.

Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement.

BACKGROUND: The indications for tricuspid valve repair in the setting of mitral valve disease and concomitant tricuspid regurgitation (TR) remain unclear. We examined patients undergoing mitral valve replacement (MVR) to determine the effect of TR and tricuspid valve repair on survival, functional status, and postoperative TR. METHODS: Between 1990 and 2005, 624 patients underwent MVR. Data included detailed serial echocardiographic tricuspid valve measurements, functional status, and survival data. Preoperative TR exceeded 2+ in 231: 125 received tricuspid repair and MVR, whereas 106 received MVR alone. Clinical and echocardiographic follow-up were complete (average, 6.8 +/- 4.8 years). Parametric and semi-parametric tests were used to analyze outcomes. RESULTS: TR exceeding 2+ at operation was associated with a 53% increase in late death (p = 0.003). Tricuspid repair prevented echocardiographic progression of TR and improved congestive heart failure symptoms (both p < 0.01). Overall survival did not improve (p = 0.3). A trend to worsening TR in patients was noted with a larger tricuspid annulus diameter and without significant (