Open Journal of Respiratory Diseases

Journal Information
ISSN / EISSN : 2163-940X / 2163-9418
Published by: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 123
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SHERPA/ROMEO
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Sameera Peumal Senanayake, Rathugamage Sithija Priyankara Fernando, Heeraluge Erandie Hasini Perera, Ridmi Shashiprabha Maddumage, Athuraliya Gamacharige Kasuni Neranja, Kathaluwa Liyana Kankanamge Tharini Dilanka Sandharenu
Open Journal of Respiratory Diseases, Volume 11, pp 27-36; doi:10.4236/ojrd.2021.112003

Abstract:
Idiopathic pulmonary fibrosis (IPF) is a chronic, life-limiting with an average life expectancy of 05 years following the onset of the disease, with no curative treatments. These patients need palliative care and rehabilitation is one of the methods that can be used to improve quality of life (QoL) among these patients. Yet the research conducted to assess benefits of pulmonary rehabilitation (PR) in terms of improving physical activity and QoL in IPF patients remains limited. Hence this study aims to evaluate the effect of a bespoke pulmonary rehabilitation programme, on the physical, physiological and psychological parameters and improvements of QoL among IPF patients. Eleven (11) subjects with IPF received 6 weeks of pulmonary rehabilitation. An interviewer administered quality of life questionnaire, six-minute walking test (6MWT), Incremental bicycle exercise tests were performed, and cardiac and respiratory parameters were assessed pre- and post-rehabilitation. The 6MWT was significantly increased following training (Pre 312.55 ± 89.99; Post, 380.73 ± 59.60). A significant improvement was observed in overall QoL (2.226 ± 0.026), dyspnoea (-0.455 ± 0.004) anxiety (-2.070 ± 0.038), depression (-2.217 ± 0.027) scores. No significant changes were found in the VO2 max and other cardiopulmonary parameters, while non-significant improvement was seen in SpO2 at peak exercise from 85.8 - 86.5. Bespoke pulmonary rehabilitation program is beneficial in short term improvement of the functional exercise capacity, dyspnoea and QoL among IPF patients.
Ana Alfaiate, David Noivo, Vera Clérigo, Vera Durão, Fernando Durão, Margarida Castanho, Susana Sousa, Lígia Fernandes, Paula Duarte
Open Journal of Respiratory Diseases, Volume 11, pp 49-60; doi:10.4236/ojrd.2021.112005

Abstract:
Objectives: Early identification of patients with the novel coronavirus induced-disease 2019 (COVID-19) and pneumonia is currently challenging. Few data are available on validated scores predictive of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. The Portuguese Society of Intensive Care (PSIC) proposed a risk score whose main goals were to predict a higher probability of COVID-19 and optimize hospital resources, adjusting patients’ intervention. This study aimed to validate the PSIC risk score applied to inpatients with pneumonia. Methods: A retrospective analysis of 207 patients with pneumonia admitted to a suspected/confirmed SARS-CoV-2 infection specialized ward (20/03 to 20/05/2020) was performed. Score variables were analyzed to determine the significance of the independent predictive variables on the probability of a positive SARS-CoV-2 rRT-PCR test. The binary logistic regression modeling approach was selected. The best cut-off value was obtained with the Receiver Operating Characteristic (ROC) curve together with the evaluation of the discriminatory power through the Area Under the Curve (AUC). Results: The validation cohort included 145 patients. Typical chest computed-tomography features (OR, 12.16; 95% CI, 3.32 - 44.50) and contact with a positive SARS-CoV-2 patient (OR, 6.56; 95% CI, 1.33 - 32.30) were the most significant independent predictive variables. A score ≥ 10 increased suspicion for SARS-CoV-2 pneumonia. The AUC was 0.82 (95% CI, 0.73 - 0.91) demonstrating the good discriminating power for COVID-19 probability stratification in inpatients with pneumonia. Conclusions: The application of the PSIC score to inpatients with pneumonia may be of value in predicting the risk of COVID-19. Further studies from other centers are needed to validate this score widely.
Safwat A. M. Eldaboosy, Amgad Awad, Ayman Ghoneim
Open Journal of Respiratory Diseases, Volume 11, pp 76-83; doi:10.4236/ojrd.2021.112007

Abstract:
The common causes of stridor in adults are abscesses or swelling of the upper airway, tumors, paralysis, or malfunction of vocal cords. Tracheitis due to immunoglobulin deficiency may be a rare explanation for stridor in adults, although occasionally reported in children. We report an adult man having stridor secondary to isolated immunoglobulin A deficiency. We did an in-depth review of the literature to seek out no reported cases of stridor thanks to immunoglobulin deficiency in adults. This case underlines the very fact that a standard symptom like stridor rarely occurs thanks to uncommon causes. This case is exclusive because it reports the presence of stridor associated with isolated immunoglobulin A deficiency in an adult patient. The explanation for the stridor was an intraluminal narrowing of the upper part of the extrathoracic trachea.
Uchenna Onubogu, Boma West
Open Journal of Respiratory Diseases, Volume 11, pp 1-18; doi:10.4236/ojrd.2021.111001

Abstract:
Background: Asthma exits with comorbidities which can affect the quality of life of children with asthma. Objective: To identify the common comorbidities with asthma, identify factors associated with the presence of specific comorbidities and evaluate their impact on asthma severity and control among children attending the respiratory clinic in the Rivers State University Teaching Hospital. Materials & Methods: All asthma cases seen in the paediatric respiratory clinic, from 1st November 2014 to 30th October 2019 were consecutively recruited. Results: Of 264 children with asthma, 190 (72.0%) had other comorbidities with a F:M ratio of 1.56:1. Difficulty in breathing, chest pain, and the degree of asthma control were significantly associated with having other comorbidities while SPO2 at 1st consult was significantly lower in children with comorbidities, P value 0.05. Allergic rhinitis 116 (43.9%), adenotonsillar hypertrophy 99 (37.5%), atopic dermatitis 54 (20.5%), allergic conjunctivitis 37 (14%), food allergy 27 (10.2) and Gastroesophageal reflux14 (5.3%) were the commonest comorbidities identified. Majority (24, 88.9%) had allergy to one type of food. Children years and those whose age at diagnosis was years were significantly at lower risk of having atopic dermatitis. Gastroesophageal reflux disease was significantly more likely to be seen in children aged > 11 years, overweight children, and those presenting with chest pain or chest tightness. Presence of various comorbidities increased the odds of having a more severe asthma, and likelihood of which increased with increasing number of coexisting comorbidities. Conclusion: The prevalence of allergic comorbidity is high among asthmatic children with allergic rhinitis being the commonest cause. Most children with asthma have more than one allergic comorbidity. A comprehensive evaluation of these comorbidities is thus essential in the management of asthmatic children for improved outcomes and quality of life.
Clay Wu, Gloria Wu, Lynn Fukushima, Adupa P. Rao, Ahmet Baydur
Open Journal of Respiratory Diseases, Volume 11, pp 19-25; doi:10.4236/ojrd.2021.111002

Abstract:
Rationale: Survival and longevity in patients with cystic fibrosis (CF) have improved with new treatments, so that pregnancy can be safely undertaken despite physiologic limitations. Dyspnea still develops in the latter stages of pregnancy. To explain this symptom, we evaluated the effect of pregnancy on lung function before and after delivery. Methods: Records of 23 pregnant patients with CF were retrospectively reviewed for data analysis. Spirometry was recorded prior to pregnancy, at first and third trimesters, and every three months following delivery up to one year. Comparisons between time points were adjusted for age and pre-gestational BMI by analysis of variance (ANOVA). Results: Complete clinical and spirometric data were available for eleven of these patients (13 pregnancies total), obtained between 2009 and 2017. FEV1 and FVC declined significantly from baseline to third trimester (by 8.1%, p Conclusions: The changes in FEV1 and FVC occur as a result of increases in intravascular blood volume and lung water during the third trimester. At the same time, FEV1/FVC increases as there is reversal of bronchiolar constriction with elimination of extracellular fluid and lung water. Furthermore, restoration of end-expiratory lung volume post-partum counteracts reversal of air trapping with resolution of peribronchiolar edema, with FVC remaining unchanged. These changes would explain decrease in dyspnea following delivery in CF patients.
Safwat A. M. Eldaboosy, Amgad Awad, Hussein Al Qurni, Saber Abo Al Hassan, Mohamed O. Nour
Open Journal of Respiratory Diseases, Volume 11, pp 37-48; doi:10.4236/ojrd.2021.112004

Abstract:
Background: Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia, insulin resistance, and hypertension (HTN). Purpose: To evaluate if there is a relationship between the severity of OSA and the severity of type 2 diabetes mellitus (T2DM) and HTN in our patients, aiming to understand and optimize the control for comorbidities. Materials and Methods: Patients referred for polysomnography (PSG) were retrospectively recruited during the period from October 2017 to August 2020. A STOP-BANG questionnaire formed eight questions was used to assess the risk of OSAS. We divided the patients into two groups; group 1, who have snoring without T2DM, and group 2, who have snoring with T2DM. PSG was completed for all subjects and data were collected for each patient including apnoea hypopnea index (AHI), mean arterial oxygen saturation (SaO2), and Nadir SaO2 recorded during PSG. Anthropometric data, medical history, and medications for T2DM (for group 2) and HTN and HbA1c were collected (for group 2). AHI was used to evaluate the severity of OSA and its relation to T2DM and HTN. Results: The study included 300 patients who met the inclusion criteria with mean age of 49.9 ± 13.6 years. The majority of subjects (56.3%) were males and the mean body mass index (BMI) was 38.0 ± 8.4 kg/m2. Forty-two percent had HTN and 32.7% had T2DM. OSA was diagnosed in 209 patients (69.7%). OSA was more detected among those with increased age, increased BMI, and those with HTN and T2DM. The severity of both HTN and T2DM was significantly higher among patients with OSA. Conclusions: There is a relation between OSA and T2DM and HTN. The risk of OSA is higher among patients with uncontrolled T2DM and HTN. OSA should be suspected in subjects with obesity, especially with uncontrolled HTN and T2DM.
Houda Gharsalli, Monia Attia, Sarra Zairi, Imen Sahnoun, Aida Ayadi, Henda Neji, Sonia Maalej, Leila Douik ElGharbi
Open Journal of Respiratory Diseases, Volume 11, pp 84-89; doi:10.4236/ojrd.2021.112008

Abstract:
A 32-year-old patient with no previous history was admitted for chest pain, dyspnea, appetite and weight loss. Chest X-ray revealed an opacity involving the lower two-thirds of the right hemithorax, suggestive of a pleural effusion. Because of the absence of fluid return even after ultrasound-guided thoracentesis, a Chest Computed tomography was required showing a heterogeneous anterior mediastinal mass with soft tissue, fat, fluid and calcifications associated with extensive encysted fluid collection in the right hemithorax. A video-assisted mini-thoracotomy revealed a mediastinal tumor firmly attached to the thymus with a cystic wall lined by squamous epithelium and sebaceous gland composed of respiratory tissue, adipose tissue, cartilage, smooth muscle fibers, and well-differentiated pancreatic tissue. These findings led to the diagnosis of a mature thymic teratoma. The patient was discharged 7 days after surgery, with no recurrence on follow-up.
Sameera Peumal Senanayake, Kalpani Abhayasinghe, Rathugamage Sithija Priyankara Fernando, Heeraluge Erandie Hasini Perera, Ridmi Shashiprabha Maddumage, Athuraliya Gamacharige Kasuni Neranja, Kathaluwa Liyana Kankanamge Tharini Dilanka Sandharenu
Open Journal of Respiratory Diseases, Volume 11, pp 61-75; doi:10.4236/ojrd.2021.112006

Abstract:
Background: Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, and life-limiting condition. It has no cure hence it is vital to establish effective methods of improving the quality of remaining life in these patients. One of the key components of improving quality of life is pulmonary rehabilitation. However little research has been conducted to understand the perspectives and lived experience of people with IPF on pulmonary rehabilitation. Hence, we aim to fill this gap in the existing literature. Methods: We sought to understand how patients coped with pulmonary rehabilitation. A patient-centred approach was used to explore the physical and psychological impact of pulmonary rehabilitation. Semi-structured interviews were conducted by experienced academics. Interviews used a topic guide but mostly led by the participants. An inductive thematic approach was used to analyse data, allowing us to identify common themes in the participants’ experiences. Results: Of fifty invited participants, ten took part in the study (aged 53 - 81 years). Inductive analysis of interviews identified seven second-order themes and eleven first-order themes, represented by two General Dimensions: “motivation” and “Advantages and disadvantages”. Overall, participants found the pulmonary rehabilitation programme to be useful and they experienced an increase in their quality of life following rehabilitation.
Carina Rôlo Silvestre, Ricardo Cordeiro, Daniel Duarte, Hugo Ferreira, Carla Cardoso, Teresa Falcão, António Domingos
Open Journal of Respiratory Diseases, Volume 10, pp 43-48; doi:10.4236/ojrd.2020.102005

Abstract:
Septic arthritis of the sternoclavicular joint is a rare and serious infection. A delay in the diagnosis may lead to serious complications. The appropriate medical and surgical treatment is crucial to the outcome. This article aims to report our experience in the successful management of sternoclavicular joint infection complicated with a lung infection. The authors present an unusual case of sternoclavicular joint infection extending into lung parenchyma with lung abscess formation in a diabetic patient, with uncontrolled diabetes that was successfully treated. At revaluation, he was asymptomatic with no evidence of relapse. Although sternoclavicular joint infection is a rare condition we highlight the importance of clinician’s awareness for an early diagnosis and treatment with broad-spectrum antibiotics and surgery.
Sameera Peumal Senanayake, Kim Harrison, Simon Hilldrup, Michael Lewis
Open Journal of Respiratory Diseases, Volume 10, pp 59-74; doi:10.4236/ojrd.2020.104007

Abstract:
Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive and life-limiting condition of unknown cause with no curative treatment. The impact of IPF on a patient’s quality of life is devastating and palliative treatment such as pulmonary rehabilitation programmes are used to improve quality of life among these individuals, yet relatively little attention has been made to access the effectiveness of rehabilitation programs aimed designed for these patients. There are large gaps in our knowledge on the cardiorespiratory response to exercise and rehabilitation among IPF patients and this study aims to fill this gap in a physiological prospective. We quantified the effects of an eight-week pulmonary rehabilitation program for IPF patients, conducted at Morriston Hospital, Swansea. Fifteen individuals (13 with Idiopathic Pulmonary Fibrosis and two with Pulmonary Fibrosis associated with Rheumatoid Disease) underwent physical and physiological assessments during a three-day testing protocol: 1) On Day 1, physical function (six-minute walk test) and ventilatory function (spirometry) were measured; 2) On Day 2, patients’ cardio-respiratory responses to slowly-increasing, wide-ranging metabolic challenge (using a protocol consisting of periods of rest, incremental bicycle exercise to maximal effort, and post-exercise recovery) were assessed via respiratory gas analysis and ECG recording; 3) On Day 3, patients’ cardio-respiratory responses to rapid-onset, high-workload metabolic challenge were assessed (using a protocol including a rapid-onset, constant workload bicycle exercise) by modelling dynamic respiratory oxygen and heart rate responses. Respiratory gas analysis was used to measure the rate of oxygen uptake ( VO2 ) and oxygen uptake efficiency (OUES). All assessments were performed before and after participants completed the pulmonary rehabilitation programme. A Holter ECG recorder (Pathfinder/Lifecard Digital CF system; Spacelabs Medical Ltd., UK) provided continuous ECG data throughout each exercise test, from which heart rate was derived. Following the rehabilitation programme, heart rate was elevated by 11% - 18% during exercise and recovery states. Post-rehabilitation VO2 was significantly increased (p = 0.01 - 0.03) during the first two minutes of heavy-intensity exercise, whilst HR was reduced (p = 0.04) during this period. OUES and standard measures of respiratory performance (minute ventilation, peak VO2) were unchanged following rehabilitation, whilst peak HR and work rates were significantly reduced during incremental exercise only (p -3). Pulmonary rehabilitation improved the rate of oxygen uptake during heavy-intensity exercise, despite substantially lower heart rates. This suggests that the rehabilitation programme increased systemic arterial-tissue oxygen exchange and/or influenced cardiovascular function to improve systemic oxygen delivery. We might therefore expect that individuals with IPF would find it easier to perform the activities of daily life, including those requiring substantial metabolic demands, following rehabilitation.
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