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1.
Medicine (Baltimore) ; 98(47): e17893, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764784

RESUMO

The purpose of this study was to understand the incidence, clinical characteristics and related factors of bronchiectasis in chronic obstructive pulmonary disease (COPD) patients.From January 2015 to January 2017, 133 patients with moderate to severe COPD admitted to our hospital were enrolled in the study. Bronchiectasis analysis was performed by high resolution CT of the chest, the clinical data of all patients were collected including increasing state of COPD, peripheral blood samples, pulmonary function, blood gas. And sputum samples were collected for detection of microorganisms.the patients were aged 70.18 ±â€Š8.31 years, and 62.4% of the patients were male. FEV1 accounted for an estimated value of 37.91 ±â€Š10.68%, and 104 (78.2%) were severe COPD, and 43 (32.3%) had bronchiectasis. Bronchiectasis is mainly bilateral, multiple and columnar bronchiectasis. The most easily involved sites are the left lower lobe, left lingual lobe and right middle lobe. Bronchiectasis is associated with history of disease (P = .027), at least one hospitalization exacerbated by COPD in the past year (P = .025), and the separation of potential pathogenic microorganisms from sputum (P = .022). The most commonly isolated pathogen was Pseudomonas aeruginosa (P < .001).Bronchiectasis should be noted in patients with COPD who often suffer from exacerbation or repeated respiratory infections, especially in those who isolate P aeruginosa from respiratory specimens.


Assuntos
Bronquiectasia/diagnóstico , Bronquiectasia/epidemiologia , Idoso , Bronquiectasia/etiologia , Feminino , Humanos , Incidência , Masculino , Doença Pulmonar Obstrutiva Crônica/complicações
3.
BMC Infect Dis ; 19(1): 764, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477038

RESUMO

BACKGROUND: Environmental bacteria, nontuberculous mycobacteria (NTM), are recognized as one of the major human infection pathogens. NTM are prone to be mistaken as multidrug-resistant Mycobacterium tuberculosis and challenge our fight against TB. In addition, treatment of NTM per se is intractable. Remarkably, the distribution of NTM pathogenic species is geographically specific. Thus, it is very important to summarize the prevalent features and clinical symptoms of NTM pulmonary disease. However, In Nanjing district, southeast China, there is no such a report. METHODS: Through investigating electronic medical records and analyzing data of clinical examination system (Lis), we retrospectively summarized the NTM species from 6012 clinical isolates from May 2017 to August 2018, and analyzed the association between NTM species and clinical symptoms. RESULTS: Of 6012 clinical specimens, 1461 (24.3%) could grow in the MGIT 960 broth. Among these positive isolates, 1213 (83%) were M. tuberculosis, 22 (1.5%) were M. bovis, and 226 (15.5%) were NTM. After deducting redundancy, those NTM specimens were confirmed from 154 patients, among which, 87 (56.5%) patients met the full ATS/IDSA NTM disease criteria. The most common etiologic agent was M. intracellulare (70.1%). NTM infection was associated with age, based on which 68.6% male patients and 77.8% female patients were over 50 years old. The older patients were more likely to have hemoptysis, but the younger patients were more likely to manifest chest congestion. Male patients were more likely to have shortness of breath and females were more likely to have hemoptysis. The most common radiographic presentation of NTM pulmonary disease was bronchiectasis, accounting for 39.1%. Remarkably, multiple and thin-walled cavities were outstanding. The most frequent comorbidity of NTM disease was previous tuberculosis (64%), followed by clinical bronchiectasis (19.5%), HIV (19.5%), and 6.9% chronic obstructive pulmonary disease (COPD). There was no association between NTM species and clinical symptoms. CONCLUSION: This study retrospectively investigated the prevalence of NTM pulmonary disease in Nanjing district, southeast China. Similar to Beijing area, north China, M. intracellulare was the major pathogenic NTM species. Clinical symptoms of the disease were not species-specific. Previous TB and HIV infection immensely enhanced risk of NTM disease.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/epidemiologia , Micobactérias não Tuberculosas/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/diagnóstico , Bronquiectasia/epidemiologia , Bronquiectasia/microbiologia , China/epidemiologia , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , Humanos , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas/classificação , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Adulto Jovem
5.
Arch. bronconeumol. (Ed. impr.) ; 55(8): 427-433, ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186100

RESUMO

En la mayoría de los ámbitos de la neumología se sigue utilizando un principio osleriano (basado en los síntomas y signos) en los que la enfermedad es el centro de toda actividad, pero este paradigma está cambiando. Actualmente, gracias al reconocimiento de la heterogeneidad y complejidad de las enfermedades pulmonares, la tendencia es a realizar una medicina más personalizada, de precisión, o centrada en el paciente. En la presente revisión se intentará establecer la situación actual sobre el conocimiento de las bronquiectasias, o mejor, del síndrome bronquiectásico, como una enfermedad multidimensional, sistémica, heterogénea y compleja, los pasos que ya se han dado en este sentido, y sobre todo, en los muchos que quedan por dar. Asimismo, se propondrán algunas herramientas que podrían facilitar la traslación de estos conceptos a la práctica clínica, y con ellos seguir avanzando hacia una imagen más holística de esta enfermedad


Most areas of respiratory medicine continue to use an Oslerian approach, based on signs and symptoms, in which the disease is the center of all activity. However, this paradigm is changing. Now that lung diseases have been recognized as heterogeneous and complex, we are moving towards more personalized, precise, patient-oriented medicine. The aim of this review was to define the current state of the knowledge on bronchiectasis, or, more accurately, the bronchiectasis syndrome, as a multidimensional, systemic, heterogeneous, complex disease. We explore the advances that have already been made, and above all the many steps that are still to be taken. We also propose some tools which might facilitate the application of these concepts in clinical practice, and help us continue our journey towards a more holistic view of this disease


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/epidemiologia , Bronquiectasia/diagnóstico , Fenótipo , Dispneia/diagnóstico , Dispneia/epidemiologia , Pseudomonas aeruginosa , Doença Pulmonar Obstrutiva Crônica/complicações , Recidiva , Qualidade de Vida , Saúde Holística
6.
Clin Respir J ; 13(8): 521-529, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31295770

RESUMO

INTRODUCTION: Quality of life (QoL) is known to be impaired in patients with bronchiectasis, which is generally attributed to exacerbations and chronic pulmonary symptoms. The aim of this study was to determine if aetiology and disease severity are associated with QoL in bronchiectasis. METHODS: We conducted a retrospective analysis of clinical stable patients with bronchiectasis. Diagnostic workup into the aetiology of bronchiectasis was conducted according to the current guidelines. QoL was measured by QoL-B questionnaire (QoL-B), data on sputum microbiology, pulmonary function tests and the disease severity were obtained. RESULTS: The aetiology of bronchiectasis was investigated in the total of 200 patients. The most commonly identified aetiologies were post-infective (39.5%) and idiopathic (12.5%). Patients with chronic obstructive pulmonary disease (COPD)-related bronchiectasis showed a significant lower QoL (P < .05) as compared to the other aetiologies. In the total population, an increasing disease severity as measured by FACED, E-FACED and the bronchiectasis severity index was correlated with a lower QoL. CONCLUSIONS: Our results showed that QoL in bronchiectasis is related both to aetiology, with worse QoL in COPD-related bronchiectasis, and to disease severity, which suggests more attention in advance for these specific patient groups with bronchiectasis.


Assuntos
Bronquiectasia/etiologia , Bronquiectasia/psicologia , Qualidade de Vida/psicologia , Idoso , Bronquiectasia/diagnóstico , Bronquiectasia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/psicologia , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Escarro/microbiologia , Inquéritos e Questionários
7.
Klin Padiatr ; 231(5): 240-247, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31340404

RESUMO

BACKGROUND: Non cystic fibrosis bronchiectasis (NCBE) is an increasingly recognized chronic, progressive respiratory disorder with significant morbidity also in children and adolescents. METHODS: We longitudinally assessed a cohort of 35 pediatric patients with NCBE and investigated underlying diagnosis, symptoms, clinical course, treatment, and quality of life. RESULTS: NCBE were diagnosed at a mean age of 9.5 (±5.3) years. In half of the children NCBE were found prior to identification of the causative diagnosis. Primary immunodeficiency (PID) was identified as the underlying diagnosis in 24/35 (68%) cases, of which two-thirds showed antibody deficiency. In the 11 non-PID cases ciliopathies were most common (n=7). Clinical aspects such as manifestation age, cough or dyspnea symptoms, and exacerbation frequency did not differ significantly between PID and non-PID patients. Likewise, quality of life (QoL) was equally reduced in both groups. Lung function test parameters were stable under appropriate therapy in all children. The majority in both groups was insufficiently vaccinated against influenza and pneumococci. CONCLUSION: Our data indicates that NCBE need to be especially appreciated as a presenting sign of PID in pediatric patients. Thus, occurrence of NCBE should warrant rigorous diagnostics to identify the underlying condition. In our cohort NCBE themselves rather than the causative diagnoses seem to dictate the clinical course of disease and reduce QoL in children. More intensive efforts have to be undertaken to vaccinate patients according to recommendations.


Assuntos
Bronquiectasia/diagnóstico , Bronquiectasia/psicologia , Pulmão/fisiopatologia , Qualidade de Vida/psicologia , Adolescente , Bronquiectasia/fisiopatologia , Criança , Pré-Escolar , Estudos de Coortes , Tosse/fisiopatologia , Fibrose Cística , Humanos
8.
BMC Pulm Med ; 19(1): 136, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349825

RESUMO

BACKGROUND: Chest computed tomography (CT) scans have a recognised role in investigating adults with severe asthma to exclude alternative diagnoses, but its role in children is less clear. The objective of this study was to review the CT findings of our local cohort of children with severe asthma and to explore whether clinical or pathobiological parameters predicted CT changes. METHODS: Retrospective observational single centre study including all children attending the Leicester difficult asthma clinic (DAC) who underwent a chest CT from 2006 to 2011. Additionally, we recruited eight age-matched, non-asthmatic controls to compare differences in CT findings between asthmatic and non-asthmatic children. All CT images were independently scored by two radiologists. The DAC patients were sub-divided into binary groups for each abnormality identified so that comparisons could be made against recorded clinical variables including age, lung function, serum total IgE levels, and sputum leukocyte differential cell counts. RESULTS: Thirty DAC patients (median 12 yrs., range 5-16) were included. The most common abnormalities were bronchial wall thickening (BWT) and air trapping (AT), observed in 80 and 60% of DAC patients. Bronchiectasis (BE) was identified in 27% of DAC patients. DAC patients with evidence of BE on CT images were older than those without BE (13.9 ± 0.67 vs 11.5 ± 0.61, p = 0.038). We also identified a positive correlation between increasing BE severity and extent with age (r = 0.400, p = 0.028). CONCLUSION: Abnormal CT findings were highly prevalent in our cohort of children with severe asthma, with bronchiectasis identified in approximately one third of children. We found no alternative diagnoses that resulted in a change in clinical management.


Assuntos
Asma/fisiopatologia , Bronquiectasia/diagnóstico , Tomografia Computadorizada por Raios X , Adolescente , Asma/diagnóstico por imagem , Bronquiectasia/epidemiologia , Criança , Pré-Escolar , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Escarro/citologia , Capacidade Vital
9.
Neumol. pediátr. (En línea) ; 14(2): 86-91, jul. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1015004

RESUMO

Bronchiectasis is a suppurative lung disease with heterogeneous phenotypic characteristics. It is defined as abnormal dilation of the bronchi, losing the existing relationship between bronchial sizes and accompanying artery. According to their form, they can be cylindrical, varicose, saccular or cystic. According to its location, they could be diffuse or localized. The diagnosis of bronchiectasis is usually suspected in patients with chronic cough, mucopurulent bronchorrea, and recurrent respiratory infections. The etiology can be varied, being able to classify in cystic fibrosis bronchiectasis, when there is cystic fibrosis transmembrane regulator (CFTR) gene mutation and not cystic fibrosis, being post infectious the most frequent. Its relationship with childhood is unknown. Severe respiratory infections can predispose in a susceptible subject the so-called theory of the "vicious circle" and the development of these. Persistent bacterial bronchitis in children has been described as a probable cause of not cystic fibrosis bronchiectasis in adults. The treatment is based on the management of symptoms and the prevention of exacerbations. The evidence is poor and many treatments are extrapolated from cystic fibrosis bronchiectasis. We are going to describe the diagnostic and therapeutic approach of non-cystic fibrosis bronchiectasis in adults.


La bronquiectasia es una enfermedad pulmonar supurativa con características fenotípicas heterogéneas. Se define como la dilatación anormal de los bronquios, perdiendo la relación existente entre tamaño bronquial y arteria que acompaña. Según su forma, pueden ser clasificadas en cilíndricas, varicosas, saculares o quísticas y según su etiología presentarse de forma difusa o localizada. El diagnóstico de bronquiectasias se sospecha generalmente en pacientes con tos crónica, broncorrea mucosa, mucupurulenta e infecciones respiratorias recurrentes. La etiología es variada, pudiendo clasificarse en bronquiectasias fibrosis quística, aquellas que se encuentran en el contexto de la mutación del gen regulador transmembrana de fibrosis quística (CFTR) y no fibrosis quística, de etiologías diversas, siendo post infecciosas la gran mayoría. No se conoce con certeza su relación con la infancia, es sabido que infecciones respiratorias severas pueden predisponer en un sujeto susceptible, a la llamada teoría del "circulo vicioso" y el desarrollo de estas. La bronquitis bacteriana persistente en niños se ha descrito como una causa probable del desarrollo de bronquiectasias no fibrosis quística en adultos. El tratamiento se basa en el manejo de los síntomas y la prevención de las exacerbaciones. La evidencia es escasa y la mayoría de las terapias se han investigado en las bronquiectasias tipo fibrosis quística. En este trabajo se explicará el enfrentamiento diagnóstico y terapéutico de los adultos portadores de bronquiectasias no fibrosis quística.


Assuntos
Humanos , Masculino , Criança , Adulto , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/terapia , Bronquiectasia/fisiopatologia , Bronquiectasia/terapia , Fibrose Cística/diagnóstico , Aspergilose Broncopulmonar Alérgica/diagnóstico por imagem , Bronquiectasia/diagnóstico , Bronquiectasia/etiologia , Bronquiectasia/epidemiologia , Radiografia Torácica , Macrolídeos/uso terapêutico , Fibrose Cística/terapia , Fibrose Cística/epidemiologia , Antibacterianos/uso terapêutico
10.
Pan Afr Med J ; 32: 82, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223373

RESUMO

Bronchiectasis, once an orphan disease is now gaining renewed attention as a significant cause of morbidity and mortality. It is a morphologic term used to describe abnormal, irreversibly dilated and thick-walled bronchi, with many etiologies. The management of bronchiectasis can be challenging because its pathogenetic mechanisms is still evolving. Its diagnosis and management is particularly more demanding especially in resource-limited settings like Nigeria because of delayed diagnosis and improper management with devastating consequences, hence this case study.


Assuntos
Brônquios/patologia , Bronquiectasia/diagnóstico , Adulto , Bronquiectasia/terapia , Diagnóstico Tardio , Feminino , Humanos , Nigéria
12.
PLoS One ; 14(4): e0215051, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970022

RESUMO

AIM: The aim of this study was to ascertain whether mannose binding lectin deficiency is implicated in coexistent rheumatoid arthritis and bronchiectasis and to determine whether undetectable mannose binding lectin confers poorer long-term survival in coexistent rheumatoid arthritis and bronchiectasis or in rheumatoid arthritis in general. MATERIALS AND METHODS: A retrospective audit was conducted in a rheumatoid arthritis cohort in which mannose binding lectin had been measured by enzyme linked immunosorbent assay from 2007-11. Rheumatoid arthritis patients with physician diagnosed HRCT proven bronchiectasis were recruited during this time and compared to those with uncomplicated rheumatoid arthritis. Survival from disease onset was recorded in October 2018. Kaplan-Meier survival estimates were performed to assess mortality over time in the two groups. Log rank tests were used for equality of survivor functions. RESULTS: The two groups were demographically comparable. A higher frequency of undetectable mannose binding lectin was observed in coexistent rheumatoid arthritis and bronchiectasis (37.5%) compared to uncomplicated rheumatoid arthritis, (8.9%, P = 0.005). Undetectable mannose binding lectin correlated with a strong trend toward poor survival in rheumatoid arthritis overall (P = 0.057). Cox regression analysis however, showed no difference in the hazard ratio for survival between the two groups when corrected for age, gender, prednisolone use ever, rheumatoid factor status and the full range of MBL concentrations. CONCLUSION: In summary, undetectable mannose binding lectin is associated with coexistent rheumatoid arthritis and bronchiectasis and correlates with poor survival in rheumatoid arthritis overall. These findings further implicate immunodeficiency in the genesis of bronchiectasis in rheumatoid arthritis.


Assuntos
Artrite Reumatoide/diagnóstico , Bronquiectasia/diagnóstico , Lectina de Ligação a Manose/sangue , Idoso , Anticorpos/sangue , Artrite Reumatoide/complicações , Artrite Reumatoide/mortalidade , Bronquiectasia/complicações , Bronquiectasia/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Peptídeos Cíclicos/imunologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
13.
Turk J Med Sci ; 49(2): 551-557, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30997791

RESUMO

Background/aim: Non-cystic fibrosis bronchiectasis (non-CF BR) is common in developing countries.Limited data are available regarding the impact of atopy, and no data are available regarding allergic rhinitis in patients with adult bronchiectasis.The aim of this study was to evaluate the prevalence of atopy and allergic rhinitis in the clinical conditions of patients with BR. Materials and methods: The study enrolled 101 patients who were diagnosed with non-CF BR using high-resolution computed chest tomography. Allergic rhinitis (AR) was defined by skin prick test (SPT) positivity and the presence of any nasal symptoms (watery runny nose, nasal obstruction, nasal itching, and sneezing). Results: The mean age of patients was 48 ± 15 years (range 18­82); 55 (54.5%) patients were female. SPT positivity was detected in 37 (36.6%) cases. AR was detected in 32 (31.7%) patients with non-CF BR. AR was related to dyspnea (P = 0.04) and number of admissions to an emergency department in the previous year (P = 0.01). Forced expiratory volume in 1 s and forced vital capacity in patients with and without AR were different (P = 0.01 and P = 0.01, respectively). AR was correlated with number of admissions to an emergency department in the last year (r = 0.417, P = 0.005). Conclusion: We concluded that atopy was detected in more than one-third of adult non-CF BR patients. This study demonstrated that non-CF BR patients might have AR; it might be important to be aware of nasal symptoms in non-CF BR patients.


Assuntos
Bronquiectasia/diagnóstico , Bronquiectasia/epidemiologia , Rinite Alérgica/diagnóstico , Rinite Alérgica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/complicações , Bronquiectasia/fisiopatologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Radiografia Torácica , Estudos Retrospectivos , Rinite Alérgica/etiologia , Rinite Alérgica/fisiopatologia , Testes Cutâneos , Tomografia Computadorizada por Raios X , Turquia/epidemiologia , Capacidade Vital , Adulto Jovem
16.
J Coll Physicians Surg Pak ; 29(3): 278-280, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30823959

RESUMO

Nocardia species usually cause opportunistic infections, and the frequency of these infections is increasing owing to the growing population of immunocompromised hosts. However, Nocardia may sometimes causes an infectious disease in immunocompetent hosts. Herein, we report two cases of pulmonary nocardiasis in immunocompetent individuals, whose chest computed tomography (CT) findings mimicked bronchiectasis. Samples of bronchalveolar lavage (BAL) fluid obtained by bronchoscopy showed filamentous, branching, gram-positive rods, acid-fast filamentous branching rods, and a colony of suspected Nocardia was cultured. Based on 16sRNA and hsp65 gene sequence analysis, case 1 was identified as N. cyriacigeorgica, but case 2 was not matched. The patients responded well to treatment with the combination of sulfamethoxazole and linezolid.


Assuntos
Bronquiectasia/diagnóstico por imagem , Linezolida/uso terapêutico , Nocardiose/diagnóstico por imagem , Nocardiose/tratamento farmacológico , Sulfametoxazol/administração & dosagem , Tomografia Computadorizada por Raios X/métodos , Bronquiectasia/diagnóstico , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Imunocompetência/imunologia , Masculino , Pessoa de Meia-Idade , Nocardia/efeitos dos fármacos , Nocardia/isolamento & purificação , Nocardiose/diagnóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
17.
Eur Respir Rev ; 28(151)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30872400

RESUMO

Bronchiectasis is an increasing clinical problem, but multiple recent clinical trials have failed to reach their primary end-point. Difficulties in achieving "positive" bronchiectasis trials is reflected in a lack of agreement from trialists and regulators on what are the optimal end-points.To evaluate the use of end-points in bronchiectasis trials, we conducted a systematic review of published bronchiectasis trials from 2008 to 2018 and extracted end-points used, definitions, methods of analysis and responsiveness.Our analysis shows that quality of life and exacerbation end-points are most frequently used. Trials using exacerbation end-points have been characterised by varying definitions, multiple methods of analysis and durations of follow-up. There are multiple quality of life tools for bronchiectasis (Quality of Life - Bronchiectasis questionnaire, St George's Respiratory Questionnaire, etc.). The majority of studies measure lung function (e.g. forced expiratory volume in 1 s), but this is shown to be nonresponsive to the majority of interventions. Microbiology end-points frequently show statistically significant differences in phase 2 antibiotic studies but their correlation with clinical end-points is unknown.This systematic review demonstrates a need for guidance to standardise definitions and design features to improve reproducibility and increase the likelihood of demonstrating statistically significant benefits with new therapies.


Assuntos
Bronquiectasia/tratamento farmacológico , Ensaios Clínicos como Assunto/métodos , Determinação de Ponto Final , Pulmão/efeitos dos fármacos , Projetos de Pesquisa , Fármacos do Sistema Respiratório/uso terapêutico , Bronquiectasia/diagnóstico , Bronquiectasia/fisiopatologia , Ensaios Clínicos como Assunto/normas , Progressão da Doença , Determinação de Ponto Final/normas , Humanos , Pulmão/fisiopatologia , Qualidade de Vida , Recuperação de Função Fisiológica , Projetos de Pesquisa/normas , Fármacos do Sistema Respiratório/efeitos adversos , Resultado do Tratamento
18.
Indian J Tuberc ; 66(1): 44-48, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30797282

RESUMO

BACKGROUND: Cough of more than two weeks has become sine quo non with pulmonary tuberculosis (PTB) in a developing country like India. The causes may be different in patients reporting to respiratory OPD vis a vis general OPD. AIMS AND OBJECTIVES: To study the prevalence of PTB and causes of cough other than PTB among respiratory OPD attendees with cough of more than two weeks duration. METHODS: A cross sectional study was carried out over two years in respiratory OPD of a tertiary care chest center of Indian armed forces. Of the 13,004 patients, 505 non HIV PTB suspects were included. Patients with definitive diagnosis of chronic cough were excluded. Efforts were made to establish diagnosis of pulmonary TB using clinical, microbiological and radiological features. However, patients were also subjected to further evaluation (spirometry, bronchoscopy, CECT) based on clinical features, radiological and lab profile to establish definitive diagnosis. RESULTS: Out of the 505 patients, 10.5% patients had smear positive pulmonary TB, 13.5% smear negative PTB, bronchial asthma (24%), COPD (9.3%), diffuse parenchymal lung diseases (DPLD's) (12.5%), bronchiectasis (6.3%), lung cancer (5.3%) and congestive cardiac failure (4.2%). CONCLUSION: Though prevalence of PTB in the study correlated well with the national statistics, but a significant number of patients had other causes of chronic cough, especially, obstructive airway diseases and DPLDs. Thus, there is a need to spread awareness regarding other causes of chronic cough and all efforts should be made to establish alternate diagnosis especially in patients who do not conclusively have PTB.


Assuntos
Asma/diagnóstico , Tosse/etiologia , Doenças Pulmonares Intersticiais/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Idoso , Asma/complicações , Asma/epidemiologia , Bronquiectasia/diagnóstico , Bronquiectasia/epidemiologia , Broncoscopia , Doença Crônica , Tosse/fisiopatologia , Estudos Transversais , Países em Desenvolvimento , Diagnóstico Diferencial , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Índia/epidemiologia , Doenças Pulmonares Intersticiais/epidemiologia , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Espirometria , Escarro/microbiologia , Centros de Atenção Terciária , Fatores de Tempo , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
19.
Pediatr Pulmonol ; 54(5): 587-594, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30758143

RESUMO

BACKGROUND: In children with cystic fibrosis (CF) lung clearance index (LCI) from multiple-breath washout (MBW) correlates with structural lung disease. As a shorter test, single-breath washout (SBW) represents an attractive alternative to assess the ventilation distribution, however, data for the correlation with lung imaging are lacking. METHODS: We assessed correlations between phase III slope (SIII) of double-tracer gas SBW, nitrogen MBW indices (LCI and moment ratios for overall ventilation distribution, Scond, and Sacin for conductive and mainly acinar ventilation, respectively) and structural lung disease assessed by chest computed tomography (CT) in children with CF. RESULTS: In a prospective cross-sectional study data from MBW, SBW, and chest CT were obtained in 32 children with CF with a median (range) age of 8.2 (5.2-16.3) years. Bronchiectasis was present in 24 (75%) children and air trapping was present in 29 (91%). Median (IQR) SIII of SBW was -138.4 (150.6) mg/mol. We found no association between SIII with either the MBW outcomes or CT scores (n = 23, association with bronchiectasis extent r = 0.10, P = 0.64). LCI and Scond were associated with bronchiectasis extent (n = 23, r = 0.57, P = 0.004; r = 0.60, P = 0.003, respectively). CONCLUSIONS: Acinar ventilation inhomogeneity measured by SBW was not associated with structural lung disease on CT. Double-tracer SBW added no benefit to indices measured by MBW.


Assuntos
Testes Respiratórios/métodos , Bronquiectasia/fisiopatologia , Fibrose Cística/fisiopatologia , Pneumopatias Obstrutivas/fisiopatologia , Ventilação Pulmonar , Adolescente , Bronquiectasia/complicações , Bronquiectasia/diagnóstico , Bronquiectasia/diagnóstico por imagem , Criança , Pré-Escolar , Estudos Transversais , Fibrose Cística/complicações , Feminino , Capacidade Residual Funcional , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Pneumopatias Obstrutivas/diagnóstico , Pneumopatias Obstrutivas/diagnóstico por imagem , Masculino , Estudos Prospectivos , Testes de Função Respiratória , Tomografia Computadorizada por Raios X
20.
Rev Mal Respir ; 36(4): 538-542, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30686554

RESUMO

INTRODUCTION: The natural history of orphan lung diseases is often unclear. We report the long-term follow-up of a case of bronchiectasis due to pulmonary non amyloid light chain deposition disease (LCDD). CASE REPORT: A 50-year-old woman who was a smoker, was diagnosed with diffuse thin walled bronchiectasis of uncertain origin after presenting with a respiratory tract infection. Ten years later, the combination of bronchiectasis, the appearance of pulmonary cysts and the identification of increased kappa free light chains evoked the diagnosis of pulmonary LCDD. The diagnosis was confirmed by lung biopsy. No immunoproliferative disorder was identified. During the 12 years follow-up, dyspnea worsened progressively and bronchiectasis and lung cysts extended leading to multicystic lung disease. Pulmonary function tests did not show any ventilatory defect but a small decrease in carbon monoxide transfer factor occurred. CONCLUSION: We describe the evolution of a rare presentation of isolated pulmonary LCDD, characterized by cystic diffuse atypical bronchiectasis with thin walls, associated with progressive cystic destruction of the lung parenchyma. The possibility of pulmonary LCDD should be considered in cases of atypical bronchiectasis of unknown etiology.


Assuntos
Bronquiectasia/etiologia , Amiloidose de Cadeia Leve de Imunoglobulina/complicações , Paraproteinemias/complicações , Bronquiectasia/diagnóstico , Bronquiectasia/patologia , Feminino , Humanos , Cadeias Leves de Imunoglobulina/metabolismo , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Amiloidose de Cadeia Leve de Imunoglobulina/patologia , Pessoa de Meia-Idade , Paraproteinemias/diagnóstico , Paraproteinemias/patologia , Fumantes
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