Predictors of the need to initiate noninvasive ventilation in stable outpatients with acute exacerbation of chronic obstructive pulmonary disease.

OBJECTIVE: Predictors of the need to initiate noninvasive ventilation (NIV) in stable COPD outpatients with acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) are insufficiently defined. The objective of this study was to investigate predictors of the need to initiate NIV in stable COPD-AE outpatients. METHODS: A total of 140 consecutive stable COPD outpatients who were hospitalized for COPD-AE for the first time were retrospectively examined. Demographic and clinical parameters measured in the stable state were evaluated, including data for arterial blood gases, the pulmonary function, body mass index and dyspnea scores. RESULTS: Of the 140 patients included, NIV was used in 32 (23%) patients. In a univariate Cox proportional hazards analysis, the baseline partial pressure of arterial carbon dioxide (PaCO2) (hazard ratio (HR), 1.14 per mmHg; 95% confidence interval (CI), 1.08-1.21) and forced expiratory volume in one second (FEV1)% predicted (HR, 1.03 per %; 95% CI, 1.01-1.05) were identified to be significant predictors. A multivariate logistic regression analysis showed only the PaCO2 (HR, 1.18 per mmHg; 95% CI, 1.12-1.26) to be a significant predictor. CONCLUSION: Our results suggest that the PaCO2 measured in the stable state is an independent significant predictor of the need to initiate NIV in COPD-AE patients who are hospitalized for the first time.

[A case of environmental infection with pulmonary Mycobacterium avium complex disease from a residential bathroom of a patient suggested by variable-number tandem-repeat typing of Mycobacterium avium tandem repeat loci].

A 63-year-old woman was referred to our hospital because of bilateral infiltrations and nodular opacities in her chest radiograph taken in the mass radiography screening in September 2010. The chest computed tomography showed patchy infiltrations with bronchiectasis in the lower lung fields on both sides. She was diagnosed with pulmonary Mycobacterium avium complex (MAC) disease based on the bacteria recovered from the sputum and the bronchoalveolar lavage fluid. To elucidate an environmental MAC source, we investigated her home, and isolated M. avium and M. gordonae from the bathtub and shower tap, respectively, in her residential bathroom. Analysis of the hsp65-PRA variants digested with BamHI and some insertion sequences showed that the clinical strains recovered from sputum and strains from the bathtub were M. avium subsp. hominissuis. A dendrogram of the Mycobacterium avium tandem repeat loci variable-number tandem-repeat (MATR-VNTR) analysis of the MAC strains showed that the bathtub strains formed a polyclonal colonization, and that 1 of the 5 MATR-VNTR patterns was identical to the corresponding pattern of the sputum strain from the patient. In conclusion, we believe that the residential bathroom of the patient was the environmental source of her pulmonary MAC disease, as has been previously reported.

[The clinical study on efficacy of clarithromycin, levofloxacin, and streptomycin for pulmonary Mycobacterium avium-intracellulare complex infection].

OBJECTIVE: The purpose of this study was to elucidate retrospectively the clinical effects of using RFP, EB, CAM, LVFX, and SM for pulmonary Mycobacterium avium-intracellulare complex infection. MATERIALS AND METHODS: During 9-year (1995-2003) period, 72 patients diagnosed according to the criteria of the Japanese Society for Tuberculosis Guidelines and treated for at least 6 months were available for this study. RESULTS: The age averaged 68 (range, 32-92) years. The male to female ratio was approximately 2 : 3. The follow-up period averaged 344 (190-365) days. 59 of 72 patients were treated for the first time. 58 of 72 patients were diagnosed as primary infection type. Among them, 20, 38, and 14 patients were treated by RFP, EB, and CAM (REC group), RFP, EB, CAM and LVFX (LVFX group), and RFP, EB, CAM, and SM (SM group), respectively. Comparing the baseline patient characteristics among three groups, we found significant difference (measured by ANOVA) in gender (male/female, REC group: 8/12, LVFX group: 20/18, and SM group: 2/12, p < 0.05), age (REC group: 75.2 +/- 9.1, LVFX group : 66.5 +/- 12.5, and SM group: 63.9 +/- 11.9, p < 0.01) and body mass index (REC group: 17.2 +/- 2.9, LVFX group: 18.9 +/- 2.8, and SM group: 19.7 +/- 2.4, p < 0.05). However, we did not find any significant difference in the clinical outcomes (improving rate of the symptoms, change of the erythrocyte sedimentation rate, improving rate of the chest X-ray, and the results of follow-up on bacteriological effect). In the 60 of 72 patients treated for 1 year, the results were superior to those of some previous reports (1-year improving rate of the symptoms, 1-year improving rate of the chest X-ray, 1-year improving rate of the sputum conversion, and 1-year rate of the relapse were 54.3%, 65.0%, 60.0%, and 15.3%, respectively). CONCLUSION: Further study was warranted that no advantage was shown by an additional use of LVFX or SM on REC from the point of view of the clinical effects for pulmonary Mycobacterium avium-intracellulare complex infection, in spite of the higher age and deteriorated nutritional status of REC group.