Tanaffos Respiration Journal
Volume:11 Issue: 1, Winter 2012

The purpose of this article is to describe noninvasive respiratory management for patients with neuromuscular respiratory muscle dysfunction (NMD) and spinal cord injury (SCI) and the role of electrophrenic pacing (EPP) and diaphragm pacing (DP) in this respect. Long term outcomes will be reviewed and the use of noninvasive intermittent positive pressure ventilation (NIV), MAC, and EPP/DP to prevent pneumonia and acute respiratory failure, to facilitate extubation, and to avoid tracheotomy will be evaluated. Although ventilator dependent patients with most NMDs and high level SCI can be indefinitely managed noninvasively, most ALS patients can be managed for a limited time by continuous NIV before tracheostomy is necessary for survival.

Approximately 25-30% of patients with non-small cell lung cancer (NSCLC) present with early stage disease and undergo surgery with curative intent. Despite complete tumor resection, many of these patients will develop systemic relapses with or without local relapses and will eventually die from the disease. Systemic relapses occur due to the presence of micro-metastatic disease at the time of surgery. In order to treat these micro-metastases in an early stage, adjuvant chemotherapy following complete tumor resection has been studied. A meta-analysis of early trials indicated a trend towards improved survival for adjuvant platinum-based chemotherapy (1) and led to re-evaluation of adjuvant chemotherapy in clinical trials on large patient populations (2-8). Several of these trials demonstrated that adjuvant chemotherapy improves survival (3-6). The survival benefit was then further confirmed in a meta-analysis that included all five cisplatin-based trials (9). Thus adjuvant chemotherapy has been established for patients with stages II and III. Here we summarize the current status of adjuvant chemotherapy in patients with completely resected NSCLC.

Cardiopulmonary exercise testing evaluates the ability of one’s cardiovascular and respiratory system in maximal exercise. This was a descriptive cross-sectional pilot study conducted at Masih Daneshvari Hospital in order to determine predicted values of cardiopulmonary exercise testing in individuals with normal physical activity patterns. Thirty four individuals (14 women, 20 men) between 18-57 years of age were chosen using simple sampling method and evaluated with an incremental progressive cycle-ergometer test to a symptom-limited maximal tolerable work load. Subjects with a history of ischemic heart disease, pulmonary disease or neuromuscular disease were excluded from the study. Smokers were included but we made sure that all subjects had normal FEV1 and FEV1/FVC.This study aimed to compare measured values of VO2, VCO2, VO2/Kg, RER, O2pulse, HRR, HR, Load, Ant, BF, BR, VE, EQCO2, and EQO2 with previously published predicted values. We found that our obtained values for VO2 max, HRR max and HR max were different from standard tables but such difference was not observed for other understudy variables. Multiple linear regression analysis was done for height, weight and age (due to the small number of samples, no difference was detected between males and females). VO2 max and load max had reverse correlation with age and direct correlation with weight and height (P<0.05) but the greatest correlation was observed for height. Due to the small number of samples and poor correlations it was not possible to do regression analysis for other variables. In the next study with a larger sample size predicted values for all variables will be calculated.If the future study also indicates a significant difference between the predicted values and the reference values, we will need standard tables made specifically for our own country, Iran.

The results of bronchodilator therapy in chronic obstructive pulmonary disease (COPD) are not satisfactory and because of this, many drugs are administered for treatment of disease. We examined the short-term additive bronchodilator effects of tiotropium in patients with stable COPD already treated with salmeterol twice daily. in a double-blind, double- dummy randomized study we evaluated the acute bronchodilator efficacy of a single 18 µg dose of tiotropium in patients with COPD under chronic treatment with a long acting beta-adrenergic (salmeterol 50µg twice a day). Measurements of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and six-minute walking test (6 MWT) as indicator of daily activities were made before and after giving the drug. A total of 129 outpatients with stable COPD (Gold level 2 -3- 4) were enrolled and 92 completed the study. Tiotropium elicited a significantly greater bronchodilation than the placebo. The action of the drug was elicited as increase in FEV1 (p≤0.001) and FVC (p≤0.001); 6-MWT increased 35 meters in patients treated with tiotropium compared to 2.5 meters in those receiving placebo (p≤0.001). Addition of tiotropium to chronic administration of a beta- adrenergic drug such as salmeterol induced an increase in pulmonary function parameters and in exercise capacity suggesting that association of the two drugs can be more efficient for treatment of disease and improvement of daily living activities than beta- adrenergics alone.

High sensitivity C-reactive protein (hs-CRP) is an inflammatory marker known to be related to inflammation, infection, and cardiovascular diseases. The aim of this study was to evaluate hs-CRP level in serum of asthmatics and its relationship with pulmonary function tests, serum IgE levels, and peripheral blood white blood cell (WBC) counts. The under study subjects were 108 patients with acute asthma and 93 healthy volunteers. The levels of hs-CRP of 108 patients with acute bronchial asthma and 93 non-asthmatic control subjects were measured. Spirometry, serum immunoglobulin-E (IgE) measurement, and WBC counts were done for patient and control groups. The mean serum hs-CRP levels were significantly higher in patients with acute asthma compared with controls (5.47±7.33 mg/l versus 1.46± 1.89 mg/l, p<0.001). Among asthmatic patients, mean hs-CRP levels were not correlated with indices of pulmonary function tests (forced expiratory volume in one second, forced vital capacity and forced mid-expiratory flow), serum IgE level, eosinophil count or WBC count. Serum C-reactive protein levels measured by high-sensitivity assays increase in acute asthma and may be useful as a diagnostic tool for detecting and monitoring inflammation in these patients. In our study on patients with acute asthma, no significant correlation was revealed between hs-CRP and pulmonary function tests, total serum IgE, or peripheral blood white blood cell counts.

The association between asthma and obesity is becoming increasingly established but the mechanism that might explain the observed differences in asthma severity, control and quality of life between obese and non-obese adult asthmatics is not clear.The purpose of this study was: 1) to determine asthma severity, control and quality of life in obese asthmatics and 2) to explore, according to the body mass index (BMI), the systemic inflammatory state of asthmatic people. A cross-sectional study was conducted between 2009 and 2010. Two hundred adult asthmatic patients were included. Data analysis consisted of univariate analysis with chi-square comparison test followed by a multivariate logistic regression. Obesity worsens the severity of asthma. This finding was more strongly observed among women than men. Obesity and overweight are associated with a poorer control of asthma. According to BMI, obese asthmatics had 6 times more frequent emergency visits, 5 times more frequent hospitalizations for asthma related complaints, increased missed work days and greater dose of inhaled corticosteroids (1025µg/day vs. 759µg/day of beclometasone equivalent). Mean serum level of C-reactive protein (CRP) and leptin was significantly correlated with asthma severity based on GINA classification (5.75 vs. 2.81 mg/l; 20.5 vs. 5.38 ng/ml; respectively). In summary, it appears that obesity is significantly associated with a greater asthma severity and a poorer asthma control and quality of life. Chronic systemic inflammation state may explain the relationship between obesity and asthma.

Cystic fibrosis and asthma are considered among the chronic respiratory diseases. Taking care of the sick child by the mother-which is usually the main care taker- can be associated with high loads of stress and result in behavioral problems like anxiety, depression and change in sleep quality. This study aimed at evaluating the correlation between depression- anxiety and sleep quality in mothers of children suffering from cystic fibrosis and asthma hospitalized in Masih Daneshvari Hospital. This was an analytical descriptive cross-sectional study conducted on 148 subjects (mothers of children with cystic fibrosis and asthma hospitalized in Masih Daneshvari Hospital) during 2008-2010. Data were collected using a questionnaire for demographic characteristics, sleep quality and Hospital Anxiety and Depression Scale (HADS). Pittsburgh sleep quality index questionnaire (PQSI) was developed by Dr. Buysse and colleagues at the University of Pittsburgh’s Western Psychiatric Institute and Clinic in the late 1980s. The PSQI was created after observing that most patients with psychiatric disorders had sleep disorders as well. Also, required data regarding the pulmonary function of patients was extracted from their medical records. In this study, high levels of anxiety and depression and poor sleep quality requiring clinical intervention were seen in 37.2%, 29.1% and 39% of mothers, respectively. A significant association was detected between sleep quality and depression-anxiety (P-value<0.005). Also, depression-anxiety was significantly correlated with number of children and smoking (P-value<0.005). A total of 20% of mothers suffering from depression and 14.3% of mothers with anxiety disorder had a history of cigarette smoking (P-value<0.005). No significant association was found between substance abuse and occupation with depression-anxiety. Susceptibility was only correlated with anxiety (P-value<0.005). Our study showed a significant association between sleep quality and depression-anxiety in mothers of children suffering from cystic fibrosis and asthma. Greater attention should be paid to prevent development and aggravation of these conditions in susceptible mothers who are the main care taker of their sick child with chronic diseases.

Using peak expiratory flow (PEF) as an alternative to spirometry parameters (FEV1 and FVC), for detection of airway reversibility in diseases with airflow limitation is challenging. We developed logistic regression (LR) model to discriminate bronchodilator responsiveness (BDR) and then compared the results of models with a performance of >18%, >20%, and >22% increase in ΔPEF% (PEF change relative to baseline), as a predictor for bronchodilator responsiveness (BDR). PEF measurements of pre-bronchodilator, post-bronchodilator and ΔPEF% of 90 patients with asthma (44) and chronic obstructive pulmonary disease (46) were used as inputs of model and the output was presence or absence of the BDR. Although ΔPEF% was a poor discriminator, LR model could improve the accuracy of BDR. Sensitivity, specificity, positive predictive value, and negative predictive value of LR were 68.89%, 67.27%, 71.43%, and 78.72%, respectively. The LR is a reliable method that can be used clinically to predict BDR based on PEF measurements.

Smoking prevalence is high among psychiatric patients. This study aimed to evaluate the prevalence of smoking, related factors and nicotine dependence in patients suffering from psychiatric disorders. This analytical descriptive study was performed on patients who had been hospitalized for at least 2 days in Razi Hospital during 2010. Data were collected via an interview and the obtained information was recorded in a questionnaire. Fagerstrom test was also used. After determining the prevalence of smoking in these patients, the related factors and nicotine dependence were also evaluated using multiple logistic regression test and SPSS software. A total of 78.4% of men and 36.2% of women in this study were smokers and 64.4% had high nicotine dependence. Final logistic regression models showed that smoking was related with advanced age, male sexuality, hookah consumption, and depression. High nicotine dependence was correlated with hookah consumption and history of suicide attempt. Prevalence of smoking is higher among psychiatric patients compared to the public. Adequate intervention and strategies are necessary in these patients to promote smoking cessation

Dental foreign body aspiration is a known complication in patients with maxillofacial trauma. Although diagnosis may be delayed, especially in elderly people with radiolucent dental appliances, clinician must be aware of dental tracheobronchial aspiration to minimize potentially serious consequences. We present a 50-year-old man with three months history of progressive dyspnea due to foreign body aspiration occluding distal trachea. The patient had a history of car accident with facial trauma and denture fracture two years before presentation. Fiberoptic bronchoscopy revealed almost totally obstructing mass-like lesion with nodular infiltration in distal trachea. The patient underwent rigid bronchoscopy and a piece of denture with three teeth was extracted.

Askin’s tumor is a rare neoplasm of the chest wall with a dismal prognosis and is usually observed in young subjects. We describe a 15-year-old female with massive hemoptysis who had an extensive thoracopulmonary tumor on chest CT. She underwent bronchoscopy which showed the location of the tumor in the bronchus intermedius. The biopsy obtained from the tumor enabled a diagnosis of Askin’s tumor to be made. After induction of chemotherapy, hemoptysis stopped and her constitutional symptoms improved. We focus on the clinical features, imaging, and histopathological characteristics of Askin’s tumor.

Clinically significant metastatic spread to the thyroid is considered uncommon in spite of the fact that thyroid is a highly vascularized organ. Though it is not a very uncommon finding at autopsies, it is rare to be found in clinical situations, especially in an individual without a prior history of malignancy. We present an apparently healthy 66 year-old male patient with squamous cell carcinoma of the proximal esophagus presenting as a thyroid nodule along with sternal deposit as a coincidental finding. Esophageal carcinoma rarely metastasizes to the thyroid. This case highlights the importance of thorough work-up when evaluating a thyroid mass/nodule. A high index of suspicion should be kept in mind in order to detect the unusual etiologies of thyroid conditions, especially when clinicopathological features are not characteristic for primary thyroid malignancies.