bluuebunny/crossref_metadata_2025_split huggingface dataset:
Noninvasive ventilation and obstructive lung diseases
Authors: Cuvelier A. , Muir J-F. 
Published: October 2002

The key role of noninvasive positive pressure ventilation (NPPV) is well documented in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) since it may avoid endotrachal intubation in >50% of cases when used as the initial treatment. However, currently only minimal data is available to assess usefulness of NPPV in COPD patients on a long-term basis. Even if such studies are difficult to manage, there is clearly a need for prospective studies comparing long-term oxygen therapy (LTOT) and NPPV in the most severe COPD in a large amount of patients and on a real long-term basis of several years. Two randomized prospective studies are being completed in Europe and the first preliminary results show that NPPV is associated with a reduction of hospitalization for chronic respiratory failure decompensation.The main beneficial effect of long-term mechanical ventilation in COPD patients with chronic respiratory failure implies a correction of nocturnal hypoventilation that could persist beyond the ventilation period because of a temporary improvement in carbon dioxide sensitivity that is often blunted in these patients.A synthesis from the literature suggest to consider NPPV for severe COPD patients who present with chronic hypoxia and hypercapnia and develop an unstable respiratory condition. Instability may be appreciated on a clinical basis and confirmed by a progressive worsening of arterial blood gas tensions, leading to frequent cardiorespiratory decompensations with ominous ARF episodes. NPPV should also be considered after an ARF episode successfully treated by noninvasive ventilation but with the impossibility to wean the patient from the ventilator.Thus, noninvasive positive pressure ventilation could be proposed as a preventive treatment in severe chronic obstructive pulmonary disease patients with unstable respiratory condition associated with fluctuating hypercapnia before, during and after an acute respiratory failure episode, avoiding the need for a tracheotomy. Adjunction of noninvasive ventilation to exercise rehabilitation is under evaluation.
Microbial investigation in ventilator-associated pneumonia
Authors: Ioanas M. , Ferrer R. , Angrill J. , Ferrer M. , Torres A. 
Published: October 2002

Ventilator-associated pneumonia (VAP) is a serious infectious condition in intensive care unit (ICU) patients, currently related to a high mortality rate. Therefore, this complication of mechanical ventilation requires a prompt diagnosis and adequate antibiotic treatment. The detection of the causative organism is imperative for guiding an appropriate therapy as there is strong evidence of the adverse effect of inadequate empirical treatment on outcome. The major difficulty of the microbial investigation is to obtain the sample from the lower respiratory tract, mainly because of the potential contamination with upper airways flora, which may result in a misinterpretation of the cultures.Microbial investigation in VAP is based on the culture of samples obtained from lower respiratory tract by noninvasive or invasive methods. The most common techniques of sampling are the endotracheal aspirate (ETA), which is considered a noninvasive method, the protected specimen brush (PSB) and the bronchoalveolar lavage (BAL), both being invasive methods of investigation. The latter were designed as an attempt to avoid the colonizing flora of the upper airways. The best of these diagnostic approaches is still controversial. In terms of outcome, there is strong evidence that the impact of both invasive and noninvasive methods seems to be similar. In terms of cost, however, the endotracheal aspirate is less expensive compared to BAL or PSB. On the other hand, invasive methods could be particularly beneficial in patients who are not responding to the initial empirical antibiotic treatment.The rationale for the quantitative culture of the respiratory samples is to differentiate between infection and colonization of lower airways, because the bacterial colonization is a frequent event in mechanically ventilated patients. The thresholds currently employed for the diagnosis of the pneumonia are the following: ETA samples, ≥105–106colony forming units (cfu)·mL−1; PSB samples, ≥103cfu·mL−1; and BAL samples, ≥104 cfu·mL−1.Intending to provide a practical approach to the issue, the present manuscript reviews the available noninvasive (blood culture, endotracheal aspirate) and invasive (protected specimen brush, bronchoalveolar lavage, blinded methods and lung biopsy) techniques used for the diagnosis of ventilator-associated pneumonia.
High or standard initial dose of budesonide to control mild-to-moderate asthma?
Authors: Chanez P. , Karlstrom R. , Godard P. 
Published: October 2002

Guidelines on the use of inhaled steroids in asthma advocate that the daily dose should be chosen according to the severity of the disease. However, the question of the optimal starting dose remains to be properly addressed, as does the issue of the adjustment in dose required for a given patient.Whether a high initial dose of budesonide (800 µgb.i.d) was more efficacious than a standard dose (200 µgb.i.d) in controlling mild-to-moderate asthma was investigated, and whether the dose could be decreased, based on peak expiratory flow (PEF), symptom-score, β2-agonist use in a double-blind, randomized, parallel-group 18-week study.One-hundred and sixty-nine patients (mean age 38 yrs, mean forced expiratory volume in one second 74% predicted) were enrolled. No difference was detected between the two groups in improvement in morning PEF (+61 L·min−1in the high-dose group, +60 L·min−1in the standard-dose group by 16 weeks). Morning and evening PEF values stabilized before the end of the first 4 weeks.No difference between groups was observed in symptom score, β2-agonist use, number of exacerbation per interval and the best forced expiratory volume in one second achieved. The proportion of subjects being able to decrease the doses of budesonide was similar in both treatment strategies. It is concluded that both high and standard initial doses are equally effective in controlling symptoms and improving lung function in mild-to-moderate asthma.
Increased nitric oxide production by neutrophils in bronchial asthma
Authors: Ramesh G. , Jindal S.K. , Ganguly N.K. , Dhawan V. 
Published: October 2002

This study was designed to assess the production of nitric oxide (NO) by neutrophils in bronchial asthma.Thirty asthmatic patients (ten each of mild, moderate and severe asthma) and ten healthy controls were included in the study. Neutrophils from peripheral venous blood were stimulated with latex, and production of nitrite (an NO metabolise) and l-citrulline (a co-product of NO) was studied. It was postulated that peripheral blood neutrophils, being in a primed or activated state in asthma, would reflect the changes occurring in bronchial tree neutrophils.Nitrite and l-citrulline production by neutrophils was significantly higher in asthmatics (p<0.001) and increased with disease severity. A strong negative correlation was observed between peak expiratory flow and both nitrite (r=−0.87, p<0.001) and l-citrulline (r=−0.88, p<0.001) production.It is concluded that nitric oxide production by neutrophils is increased in bronchial asthma and can possibly contribute to airway narrowing and disease severity.
Off-line sampling of exhaled air for nitric oxide measurement in children: methodological aspects
Authors: Jöbsis Q. , Schellekens S.L. , Kroesbergen A. , Hop W.C.J. , de Jongste J.C. 
Published: October 2002

Measurement of nitric oxide in exhaled air is a noninvasive method to assess airway inflammation in asthma. This study was undertaken to establish the reference range of exhaled NO in healthy school-aged children and to determine the influence of ambient NO, noseclip and breath-holding on exhaled NO, using an off-line balloon sampling method.All children attending a primary school (age range 8–13 yrs) underwent NO measurements on two occasions with high and low ambient NO. Each time, the children performed four expiratory manoeuvres into NO-impermeable balloons, with and without 10 s of breath-holding and with and without wearing a noseclip. Exhalation flow and pressure were not controlled. NO was measured within 4 h after collection, by means of chemiluminescence. All children completed a questionnaire on respiratory and allergic disorders, and performed flow/volume spirometry.With low ambient NO, the mean exhaled NO value of 72 healthy children with negative questionnaires and normal lung function was 5.1±0.2 parts per billion (ppb)versusa mean of 6.8±0.3 ppb in the remaining 49 children with positive questionnaires for asthma and allergy, and/or recent symptoms of cold (p=0.001). Exhaled and ambient NO were significantly related, especially with ambient NO >10 ppb (r=0.86, p=0.0001versusr=0.34, p=0.004 for ambient values <10 ppb). The use of a noseclip, with low ambient NO and without breath-holding, caused a small decrease in exhaled NO values (p=0.001). The effect of breath-holding on exhaled NO depended on ambient NO. With ambient NO >10 ppb, exhaled NO decreased, whereas with ambient NO <10 ppb, exhaled NO increased after 10 s breath-hold.It is concluded that off-line sampling in balloons is a simple and, hence, attractive method for exhaled nitric oxide measurements in children which differentiates between groups with and without self-reported asthma, allergy and colds, when ambient nitric oxide is <10 parts per billion. Wearing a noseclip and breath-holding affected measured values and should, therefore be standardized or, preferably, avoided.
Lymphocyte population and apoptosis in the lungs of smokers and their relation to emphysema
Authors: Majo J. , Ghezzo H. , Cosio M.G. 
Published: October 2002

Previously, it had been shown that T-lymphocytes are the predominant inflammatory cells found in the alveolar wall of smokers and their numbers correlated with the extent of emphysema. However, the phenotype of these cells was not defined. The aim of this study was to describe the different T-cell phenotypes and investigate the possible presence of apoptosis in the lung parenchyma of smokers.Samples from lungs were obtained at surgery from 15 patients who smoked and six who had never smoked. Samples were frozen and prepared for histological and immunocytochemical examination. Slides were stained for CD3+, CD4+, CD8+, γδ T-cells, CD56 natural killers ((NK) cells), and elastase (neutrophils). Anti-CD95 monoclonal antibodies andin situend-labelling techniques were used to detect Fas expression and apoptosis. Positive staining cells were expressed as cells·mm alveolar wall−1, percentage of total cells, and Fas/APO and apoptosis index. Emphysema was identified macroscopically, microscopically and reported as present or absent. All subjects had pulmonary function tests before surgery.Neutrophils were the predominant cell in the lung parenchyma of nonsmokers and smokers without emphysema. In smokers with emphysema, the CD3+ and CD8+ were the predominant cells (p<0.05) in the alveolar wall. γδ cells were increased in all smokers and no increased numbers of NK cells was found. The T-cell numbers·mm alveolar wall−1showed a bilinear relationship with the amount smoked increasing at an inflection point of 30 packs yr−1(R2=0.345; p<0.01). Apoptosis in smokers showed a bilinear relationship with the amount smoked increasing sharply in smokers with emphysema (R2=0.3613; p<0.009).It is concluded that the pathogenesis of emphysema might be mediated by T-lymphocytes, mainly CD8+ cytolytic T-cells, and that apoptosis might be one of the mechanisms of lung destruction leading to the development of emphysema. If this is the case, it could be speculated that T-cell inflammation is a response to antigenic stimuli originating in the lung and induced by cigarette smoking.
Pulmonary ventilation imaged by magnetic resonance: at the doorstep of clinical application
Authors: Kauczor H.U. , Chen X.J. , van Beek E.J.R. , Schreiber W.G. 
Published: October 2002

Over the past few years, magnetic resonance imaging (MRI) has emerged as an important instrument for functional ventilation imaging. The aim of this review is to summarize established clinical methods and emerging techniques for research and clinical arenas.Before the advent of MRI, chest radiography and computed tomography (CT) dominated morphological lung imaging, while functional ventilation imaging was accomplished with scintigraphy. Initially, MRI was not used for morphological lung imaging often, due to technical and physical limitations. However, recent developments have considerably improved anatomical MRI, as well as advanced new techniques in functional ventilation imaging, such as inhaled contrast aerosols, oxygen, hyperpolarized noble gases (Helium‐3, Xenon‐129), and fluorinated gases (sulphur­hexafluoride). Straightforward images demonstrating homogeneity of ventilation and determining ventilated lung volumes can be obtained. Furthermore, new image­derived functional parameters are measurable, such as airspace size, regional oxygen partial pressure, and analysis of ventilation distribution and ventilation/perfusion ratios.There are several advantages to using MRI: lack of radiation, high spatial and temporal resolution and a broad range of functional information. The MRI technique applied in patients with chronic obstructive pulmonary disease, emphysema, cystic fibrosis, asthma, and bronchiolitis obliterans, may yield a higher sensitivity in the detection of ventilation defects than ventilation scintigraphy, CT or standard pulmonary function tests.The next step will be to define the threshold between physiological variation and pathological defects. Using complementary strategies, radiologists will have the tools to characterize the impairment of lung function and to improve specificity.
Noninvasive pressure preset ventilation for the treatment of Cheyne-Stokes respiration during sleep
Authors: Willson G.N. , Wilcox I. , Piper A.J. , Flynn W.E. , Norman M. , Grunstein R.R. , Sullivan C.E. 
Published: October 2002

Cheyne-Stokes respiration (CSR) during sleep is common in patients with congestive heart failure (CHF). This pattern of breathing fragments sleep, leading to daytime symptoms of sleepiness and fatigue. It was hypothesized that by controlling CSR with noninvasive pressure preset ventilation (NPPV), there would be a decrease in sleep fragmentation and an improvement in sleep quality.Nine patients (eight males, one female; mean±sd 65±11 yrs) with symptomatic CSR diagnosed on overnight polysomnography (apnoea/hypopnoea index (AHI) 49±10·h−1, minimum arterial oxygen saturation (Sa,O2, 77±7%) and CHF (left ventricular ejection fraction 25±8%) were studied. After a period of acclimatization to NPPV (variable positive airway pressure (VPAP) II STTM, Sydney, NSW, Australia and bilevel positive airway pressure (BiPAP)TM, Murraysville, PA, USA), sleep studies were repeated on therapy.NPPV almost completely abolished CSR in all patients with a reduction in AHI from 49±10 to 6±5·h−1(p<0.001). Residual respiratory events were primarily due to upper airway obstruction at sleep on-set. Arousal index was markedly decreased from 42±6 to 17±7·h−1(p<0.001). Sleep architecture showed a trend toward improvement with a reduction in stage 1 and 2 (79±7% during the diagnostic nightversus72±10% during NPPV, (p=0.057)), whilst sleep efficiency, slow-wave sleep (SWS), and rapid eye movement (REM) were not altered.Controlling Cheyne-Stokes respiration with noninvasive pressure preset ventilation resulted in reduced arousal and improved sleep quality in the patients with congestive heart failure. Noninvasive pressure preset ventilation should be considered a potential therapy for Cheyne-Stokes respiration in congestive heart failure in those patients who do not respond or fail to tolerate nasal continuous positive airway pressure therapy.
ABO/Secretor genetic complex and susceptibility to asthma in childhood
Authors: Ronchetti F. , Villa M.P. , Ronchetti R. , Bonci E. , Latini L. , Pascone R. , Bottini N. , Gloria-Bottini F. 
Published: October 2002

A positive association has recently been reported in adult subjects between O/nonSecretor phenotype and asthma. To confirm this association, this study investigated the joint ABO/Secretor phenotype in a cohort of 165 asthmatic children. Three-hundred and sixty-two consecutive newborn infants from the same population were also studied as controls.The proportion of O/nonSecretor in asthmatic children was higher than in controls, thus confirming the association found in adults. The association was more marked in males than in females. In males, the pattern of association between the joint ABO/Secretor phenotype and asthma is dependent on the age at on-set of symptoms.Since the oligosaccharide composition of cell membrane and mucosal secretions is controlled by the cooperative interaction of ABO and Secretor genes, and since such composition influences the adhesion of infectious agents, the age pattern could reflect a more general interaction between developmental maturation and oligosaccharide structure concerning their effects on susceptibility to viral and bacterial agents.
Formoterol in patients with chronic obstructive pulmonary disease: a randomized, controlled, 3-month trial
Authors: Aalbers R. , Ayres J. , Backer V. , Decramer M. , Lier P.A. , Magyar P. , Malolepszy J. , Ruffin R. , Sybrecht G.W. 
Published: October 2002

The aim of this study was to investigate formoterol, an inhaled long-acting β2-agonist, in patients with chronic obstructive pulmonary disease (COPD).Six-hundred and ninety-two COPD patients, mean baseline forced expiratory volume in one second (FEV1) 54%, FEV1/forced vital capacity 75% of predicted, reversibility 6.4% pred, were treated with formoterol (4.5, 9 or 18 µgb.i.d.) or placeboviaTurbuhaler® for 12 weeks. Symptoms were recorded daily. Spirometry and the incremental shuttle walking test (SWT) were performed at clinic visits.Compared with placebo, 18 µgb.i.d. formoterol reduced the mean total symptom score by 13% and increased the percentage of nights without awakenings by 15%. Formoterol (9 and 18 µgb.i.d.) significantly reduced symptom scores for breathlessness (−7% and −9%, respectively) and chest tightness (−11% and −8%, respectively), reduced the need for rescue medication (−25% and −18%, respectively), and increased symptom-free days (71% and 86%, respectively). FEV1improved significantly after all three doses of formoterol (versusplacebo). No differences were found between groups in SWT walking distance. No unexpected adverse events were seen.In conclusion, 9 and 18 µgb.i.d.formoterol reduced symptoms and increased the number of symptom-free days in a dose-dependent manner in chronic obstructive pulmonary disease patients. Formoterol improved lung function at a dose of 4.5 µgb.i.d.and higher.
Hospitalization trends for paediatric asthma in eastern Finland: a 10-yr survey
Authors: Korhonen K. , Reijonen T.M. , Malmström K. , Klaukka T. , Remes K. , Korppi M. 
Published: October 2002

The prevalence of childhood asthma has increased during the past 20 yrs in eastern Finland. The use of regular medication for asthma has, consequently, also risen at the same time. The aim of the present study was to assess how these factors have influenced hospitalization for asthma in children.Data concerning the annual number of children aged <16 yrs treated for asthma, their number of hospital periods, and length of hospitalization were collected using patient-specific medical records for the years 1988–1997.Admissions for asthma more than doubled (from 1.2 in 1,000 to 2.7 in 1,000) (p<0.001), whereas re-admissions decreased from 28.1% to 8.7% (p<0.001) during the study period. The greatest increase was seen among children aged <2 yrs, whereas during recent years the admission rate among children aged >2 yrs has declined by one-third.Despite the increased prevalence of asthma, the decline in admissions seen in all but the youngest children may, at least partly, be attributed to the decrease in re-admissions, resulting from the early onset and increased use of inhaled steroids.
What is the optimal treatment strategy for chronic obstructive pulmonary disease exacerbations?
Authors: Willaert W. , Daenen M. , Bomans P. , Verleden G. , Decramer M. 
Published: October 2002

The present study aims to determine whether treating chronic obstructive pulmonary disease (COPD) exacerbations with intravenous steroids and aerosol bronchodilators (group I) is superior to oral steroids and multiple dose inhaler (MDI) bronchodilators with a spacer (group II).Group I received 40 mg methylprednisolone·day−1intravenously with a decrease to 20 mg after 10 days and a further decrease of 4 mg·4 days−1. Aerosol therapy consisted of 10 mg salbutamol and 1 mg ipratropiumbromide·day−1. Group II received 32 mg methylprednisolone orally for 1 week followed by 24 mg·day−1for 4 days and a subsequent decrease of 4 mg·week−1. Duovent® MDI with a spacer was given at a dose of 1.6 mg fenoterol and 640 µg ipratropiumbromide·day−1.In group I (n=19) forced expiratory volume in one second (FEV1) rose from 0.82±0.46 to 0.91±0.47 L and average dyspnoea decreased from 6.0±1.9 to 4.1±2.6 within 10 days. The Chronic Respiratory Disease Index Questionnaire (CRQ) score increased from 78±24 to 90±24 points after 4 weeks. In group II (n=18) FEV1increased from 0.70±0.27 to 0.90±0.29 L, dyspnoea regressed from 6.2±2.4 to 2.7±2.6 and CRQ from 67±17 to 86±20. Both groups showed similar results in dropout rate, length of hospital stay and patient satisfaction.In conclusion, the two treatment strategies appear equally effective in treating chronic obstructive pulmonary disease exacerbations, although oral steroids and metered dose inhaler bronchodilators appear associated with a higher risk of hospital re-admission.
Computed tomography in staging for lung cancer
Authors: Verschakelen J.A. , Bogaert J. , De Wever W. 
Published: October 2002

Computed tomography (CT) provides the most detailed imaging information, hence it is generally used as a routine imaging procedure in the tumour, node, metastasis (TNM)-staging of patients with lung cancer. However, despite the continuously ongoing process of improvement in CT scanning in which today's CT scanners combine fast acquisition, fast data reconstruction and high detail, the technique has important limitations.
CT can, in some cases, very accurately show tumour extent within, and predict spread beyond the lung. However, the question of whether the tumour has invaded the chest wall or the mediastinum and, if so, whether it is still potentially surgically curable often remains unanswered. In addition, the only sign for predicting lymph node involvement using CT is enlargement. Many studies have shown that this sign is not very reliable. CT is also, with success, being used to evaluate distant metastases although other techniques such as ultrasound and magnetic resonance imaging can have similar or higher accuracies.
Despite these well-known limitations, computed tomography will most likely stay the routine imaging procedure for determining resectability and for assessing intra- and extrathoracic spread of lung cancer. The improvement in technology will probably result a better T-staging. The role of computed tomography in nodal staging remains important. It offers the surgeon a road map of the lymph nodes and guides towards the nodes that need biopsy. Combining computed tomography with positron emission tomography, when it becomes more widely available, will add functional images to the detail of computed tomography and will not only improve nodal staging but will probably also allow a better evaluation of distant metastasis and reduce the number of unnecessary interventional procedures.