Advances in Respiratory Medicine

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Open AccessCase Report

First Lung Transplantation As A Treatment of A Patient Supported with Extracorporeal Membrane Oxygenation (ECMO) after COVID-19 in Poland

by Maciej Urlik, Konstanty Szułdrzyński, Tomasz Stącel, Mirosław Nęcki, Piotr Bielański, Miłosz Jankowski, Remigiusz Antończyk, Magdalena Latos, Anna Pióro, Marian Zembala, Krzysztof Pyrć and Marek Ochman

Adv. Respir. Med. 2021, 89(3), 328-333; https://doi.org/10.5603/ARM.a2021.0042 - 30 Jun 2021

Cited by 5 | Viewed by 728

Abstract

A 44-year-old male with no history of underlying diseases was referred to academic hospital due to ARDS with confirmed SARSCoV-2 infection after 7 days of mechanical ventilation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was initiated as no improvement was noted in prone position. [...] Read more.

A 44-year-old male with no history of underlying diseases was referred to academic hospital due to ARDS with confirmed SARSCoV-2 infection after 7 days of mechanical ventilation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was initiated as no improvement was noted in prone position. Mechanical ventilation was continued with TV of 3–4 mL/kg. A gradual decline of static lung compliance was observed from baseline 35 mL/cm H₂O to 8 mL/cm H₂O. The chest CT scan revealed extensive ground-glass areas with a significant amount of traction bronchiectasis after 3 weeks since admission. When the patient was negative for SARS-CoV-2 during the 4th week of ECMO, the decision to perform an emergency lung transplantation (LTx) was made based on the ongoing degradation of lung function and irreversible damage to lung structure. The patient was transferred to the transplant center where he was extubated, awaiting the transplant on passive oxygen therapy and ECMO. Double lung transplantation was performed on the day 30th of ECMO. Currently, the patient is self-reliant. He does not need oxygen therapy and continues physiotherapy. ECMO may be life-saving in severe cases of COVID-19 ARDS but some of these patients may require LTx, especially when weaning proves impossible. VV ECMO as a bridging method is more difficult but ultimately more beneficial due to insufficient number of donors, and consequently long waiting time in Poland. Full article

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Open AccessReview

Comprehensive Assessment of Respiratory Function, a Step towards Early Weaning from the Ventilator

by Camila del Mar Sánchez Sánchez, María Erika Molina-Peña and Claudia Yaneth Rodriguez-Triviño

Adv. Respir. Med. 2021, 89(3), 299-310; https://doi.org/10.5603/ARM.a2021.0055 - 30 Jun 2021

Cited by 2 | Viewed by 1088

Abstract

Methods for assessing diaphragmatic function can be useful in determining the functional status of the respiratory system and can contribute to determining an individual’s prognosis, depending on their pathology. They can also be a useful tool for making objective decisions regarding mechanical ventilation [...] Read more.

Methods for assessing diaphragmatic function can be useful in determining the functional status of the respiratory system and can contribute to determining an individual’s prognosis, depending on their pathology. They can also be a useful tool for making objective decisions regarding mechanical ventilation weaning and extubation. Esophageal and transdiaphragmatic pressure measurement, diaphragm ultrasound, diaphragmatic excursion, surface electromyography (sEMG) and some serum biomarkers are of increasing interest and use in clinical and intensive care settings to offer a more objective process for withdrawing mechanical ventilation; especially in the situation that we are experiencing with the increased demand for mechanical ventilation to treat patients with Covid-19-associated viral pneumonia. In this literature review, we updated the clinical and physiological indicators with more evidence to improve ventilator withdrawal techniques. We concluded that, to ensure successful extubation in a way that is useful, cost-effective, practical for health personnel and non-invasive for the patient, further studies of novel techniques such as surface electromyography should be implemented. Full article

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Open AccessReview

Self-Management and Integrated Pulmonary Care As an Essential Part of Treatment of Patients with Chronic Obstructive Pulmonary Disease

by Michał Dębczyński, Katarzyna Guziejko and Robert Marek Mróz

Adv. Respir. Med. 2021, 89(3), 291-298; https://doi.org/10.5603/ARM.a2021.0057 - 30 Jun 2021

Viewed by 590

Abstract

Chronic obstructive pulmonary disease (COPD) is a common, chronic and progressive disease that is a major public health problem worldwide. Treatment for stable COPD relies on pharmacological and non-pharmacological procedures. Education, self-management interventions and personalized pulmonary rehabilitation should be part of chronic care [...] Read more.

Chronic obstructive pulmonary disease (COPD) is a common, chronic and progressive disease that is a major public health problem worldwide. Treatment for stable COPD relies on pharmacological and non-pharmacological procedures. Education, self-management interventions and personalized pulmonary rehabilitation should be part of chronic care for patients with COPD at all stages of their disease. The comprehensive care should be provided by integrated pulmonary care based on pulmonary centers and a multidisciplinary team to all patients with COPD. Holistic approach to the patient with COPD and his involvement in therapy and working closely with healthcare professionals will improve quality of life of COPD patients. It also modifies the course of the disease, prevents progression and may reduce the frequency of exacerbations. In this article, we present the proposed model of integrated pulmonary care, structures necessary for multidisciplinary treatment and self-management intervention as essential elements in the treatment of patients with COPD. Full article

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Open AccessCommunication

A Pilot Study of the Breath Stacking Technique Associated with Respiratory Muscle Endurance Training in Patients with Amyotrophic Lateral Sclerosis: Videofluoroscopic Findings in the Upper Airway

by Alessandra Dorça, Max Sarmet, Edna Maria de Sena Sousa Rocha, Murilo Bufaiçal Marra, Janae Lyon Million, Denise Sisterolli Diniz and Vinicius Maldaner

Adv. Respir. Med. 2021, 89(3), 284-290; https://doi.org/10.5603/ARM.a2021.0045 - 30 Jun 2021

Cited by 4 | Viewed by 666

Abstract

Introduction: Bulbar impairment represents a hallmark feature of amyotrophic lateral sclerosis (ALS) that significantly impacts survival and quality of life. Respiratory complications arise because of the weakness of the upper airway and respiratory muscles leading to respiratory failure, impaired swallowing, and reduced [...] Read more.

Introduction: Bulbar impairment represents a hallmark feature of amyotrophic lateral sclerosis (ALS) that significantly impacts survival and quality of life. Respiratory complications arise because of the weakness of the upper airway and respiratory muscles leading to respiratory failure, impaired swallowing, and reduced airway safety. Breath stacking and respiratory muscle endurance training are techniques that have been described to improve respiratory and bulbar function in patients with ALS. Considering the above, a respiratory technique named TR3 was developed. This study aimed to measure the acute effects of this technique on the upper airway through videofluoroscopy and to assess its clinical trial feasibility in patients with ALS. Material andmethods: In this cross-sectional study, we enrolled participants diagnosed with ALS to perform a single session of TR3. Epidemiological data and baseline assessments were collected. The assessments included kinematics from videofluoroscopy measuring the retropalatal airspace size, the size of the narrowest airway, and the pharyngeal area during rest and TR3. Results: Eight participants were included. During TR3, an acute increase of 15% was observed in the retropalatal airspace size (t = 5.14, p < 0.01), a 123% increase was observed in the size of the narrowest airway (t = –4.18, p < 0.001), and a 277% increase was observed in the pharyngeal area (t = –5.34, p < 0.001). Conclusions: During the intervention, TR3 showed acute effects in increasing pharyngeal constriction, pharyngeal expansion, retropalatal airspace size, and post-lingual narrowest airway size and is feasible for a larger research program. A clinical trial (NCT04226144) is already being conducted to assess the chronic therapeutic effects of this technique and its impact on the clinical evolution of ALS. Full article

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Open AccessArticle

Auto-Titrating Versus Fixed-EPAP Intelligent Volume-Assured Pressure Support (iVAPS) Ventilation in Patients with COPD and Hypercapnic Respiratory Failure

by Doaa M. Magdy and Ahmed Metwally

Adv. Respir. Med. 2021, 89(3), 277-283; https://doi.org/10.5603/ARM.a2021.0056 - 30 Jun 2021

Cited by 3 | Viewed by 747

Abstract

Background: Intelligent volume-assured pressure support (iVAPS) is a new noninvasive ventilation (NIV) mode that can automatically adjust pressure support to deliver effective ventilation. Our aim was to compare treatment efficacy and level of satisfaction between auto-titrating expiratory positive airway pressure (auto-EPAP) and [...] Read more.

Background: Intelligent volume-assured pressure support (iVAPS) is a new noninvasive ventilation (NIV) mode that can automatically adjust pressure support to deliver effective ventilation. Our aim was to compare treatment efficacy and level of satisfaction between auto-titrating expiratory positive airway pressure (auto-EPAP) and fixed expiratory positive airway pressure (fixed-EPAP) during iVAPS treatment in stable hypercapnic chronic obstructive pulmonary disease (COPD) patients. Material and methods: In this prospective single-blinded, randomized study, 50 patients with chronic stable hypercapnia (COPD) who met the study criteria were randomized into a group I treated with auto-EPAP and a group II who received fixed-EPAP during iVAPS treatment for 5 consecutive days. The patients’ characteristics, arterial blood gases, and lung function test were recorded. Numeric rating scale (NRS), dyspnea and comfort scale were obtained. The study subjects were evaluated and followed up after initiating therapy for 5 consecutive days. Outcome measures were recorded at baseline (T0) and after three (T1) and five (T2) days of each consecutive period All parameters were collected and statistically analyzed. Result: No significant differences were found regarding age, sex, or BMI between the both groups. It was noted that daytime PaCO₂ decreased significantly over the follow-up period in the group I patients treated with auto-EPAP as compared with fixed-EPAP. Regarding the patient comfort and dyspnea during iVAPS treatment, dyspnea sensation was significantly lower with auto-EPAP 7.9 ± 1.8 (T0) vs. 3.5 ± 1.1 (T2), p = 0.001 and fixed-EPAP 7.7 ± 1.9 (T0) vs. 3.4 ± 1.6 (T2), p = 0.001, but no significance was reached between the both groups. However, auto-EPAP demonstrated significant improvement in comfort when compared with fixed-EPAP modality. However, the overall satisfaction of the patients receiving auto-EPAP modality was significantly increased. Mean tidal volume tended to be higher in auto-EPAP 698 ± 213 mL compared with 628 ± 178 mL in fixed-EPAP (p = 0.001). The air leak was significantly lower in auto-adjusting mode (2.5 ± 1.3 vs. 3.7 ± 2.2 L/ min) in fixed-EPAP modality. Conclusion: Auto-titrating NIV mode may provide additional benefit in decreasing PaCO₂ more efficiently and improve patient comfort and satisfaction. Full article

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Open AccessArticle

A Randomized Comparison of Sample Adequacy and Diagnostic Yield of Various Suction Pressures in EBUS-TBNA

by Anant Mohan, Hariharan Iyer, Karan Madan, Vijay Hadd, Saurabh Mitta, Pawan Tiwari, Deepali Jain, Ravindra M. Pandey, Avneet Garg and Randeep Guleria

Adv. Respir. Med. 2021, 89(3), 268-276; https://doi.org/10.5603/ARM.a2021.0054 - 30 Jun 2021

Cited by 6 | Viewed by 535

Abstract

Introduction: The evidence for using vacuum suction during EBUS is sparse and the optimal suction pressure for obtaining adequate samples has not yet been determined. Our aim was to assess the influence of suction on the adequacy and diagnostic yield of EBUS-TBNA. [...] Read more.

Introduction: The evidence for using vacuum suction during EBUS is sparse and the optimal suction pressure for obtaining adequate samples has not yet been determined. Our aim was to assess the influence of suction on the adequacy and diagnostic yield of EBUS-TBNA. Material and methods: This single-center, prospective, randomized, non-inferiority trial assessed whether no-suction and 10 mL suction are inferior to 20 mL suction for adequacy and diagnostic yield of EBUS-TBNA aspirates. Results: Three hundred twenty three lymph nodes were sampled using EBUS-TBNA. Baseline characteristics of lymph nodes were comparable in the three suction groups. The overall adequacy of EBUS-TBNA aspirates in the no-suction, 10 mL, and 20 mL suction was 90%, 83.49%, and 77.88%, respectively. The differences in adequacy were 12.1% (95% CI: 3.9–20.3) and 5.6% (95% CI: –3.3–14.5) for no-suction vs. 20 mL, and 10 mL vs. 20 mL suction, respectively. No-suction and 10 mL were not inferior to 20 mL suction in terms of sample adequacy. At a superiority margin of 3.92%, no-suction was superior to 20 mL suction in terms of sample adequacy (p < 0.05). The overall diagnostic yield was comparable (63.6%, 52.3%, and 57.7% in 0, 10 mL, and 20 mL, respectively; p-value was not significant). The proportion of aspirates which were predominantly bloody was similar (no-suction—10.9%, 10 mL—13.8%, 20 mL—15.4%; p = 0.62). Conclusions: EBUS-TBNA with or without the application of vacuum suction does not influence specimen adequacy and diagnostic yield. Full article

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Open AccessArticle

Is the Nox-T3 Device Scoring Algorithm Accurate Enough for the Diagnosis of Obstructive Sleep Apnea?

by Margarida Valério, Samuel Pereira, Joaquim Moita, Fátima Teixeira, Conceição Travassos, Ana Sofia Coutinho and Denny Marques Rodrigues

Adv. Respir. Med. 2021, 89(3), 262-267; https://doi.org/10.5603/ARM.a2021.0053 - 30 Jun 2021

Cited by 2 | Viewed by 1771

Abstract

Introduction: Obstructive sleep apnea (OSA) is highly prevalent. Home sleep apnea testing (HSAT) for OSA is rapidly expanding because of its cost effectiveness in the diagnosis of OSA. Type 3 portable monitors are used for this purpose. In most cases, these devices [...] Read more.

Introduction: Obstructive sleep apnea (OSA) is highly prevalent. Home sleep apnea testing (HSAT) for OSA is rapidly expanding because of its cost effectiveness in the diagnosis of OSA. Type 3 portable monitors are used for this purpose. In most cases, these devices contain an algorithm for automatic scoring of events. We propose to study the accuracy of the automatic scoring algorithm in our population in order to compare it with the manually edited scoring of Nox-T3^®. Material and methods: For five months, a prospective study was performed. Patients were randomly distributed to the available HSAT devices. We collected the data of patients who performed HSAT with Nox-T3^®. We used normality plots, the Spearman correlation, the Wilcoxon signed-rank test, and Bland–Altman plots. Results: The sample consisted of 283 participants. The average manual apnea and hypopnea index (AHI) was 23.7 ± 22.1 events/h. All manual scores (AHI, apnea index, hypopnea index, and oxygen desaturation index) had strong correlations with their respective automated scores. When AHI > 15 and AHI > 30 the difference between the values of this index (automatic and manual) was not statistically significant. Also, for AHI values > 15 the mean difference between the two scoring methods was 0.17 events/h. For AHI values > 30, this difference was—1.23 events/h. Conclusions: When AHI is < 15, there may be a need for confirmation of automatic scores, especially in symptomatic patients with a high pretest probability of OSA. But, for patients with AHI > 15, automatic scores obtained from this device seem accurate enough to diagnose OSA in the correct clinical setting. Full article

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Open AccessArticle

Comparison of Clinical Characteristics and Outcomes Between COVID-19 Pneumonia and H1N1 Influenza

by Nosheen Nasir, Iffat Khanum, Kiren Habib, Rimsha Ahmed, Mujahid Hussain, Zahra Hasan and Muhammad Irfan

Adv. Respir. Med. 2021, 89(3), 254-261; https://doi.org/10.5603/ARM.a2021.0049 - 30 Jun 2021

Cited by 4 | Viewed by 660

Abstract

Introduction: The COVID-19 pandemic has been likened to the 2009 H1N1 influenza pandemic. We aim to study the similarities and differences between patients hospitalized with COVID-19 and H1N1 influenza in order to provide better care to patients, particularly during the co-circulation of [...] Read more.

Introduction: The COVID-19 pandemic has been likened to the 2009 H1N1 influenza pandemic. We aim to study the similarities and differences between patients hospitalized with COVID-19 and H1N1 influenza in order to provide better care to patients, particularly during the co-circulation of Influenza A Subtype H1N1 and SARS-CoV-2. Material and methods: A retrospective cohort study was conducted in order to compare clinical characteristics, complications, and outcomes of hospitalized patients with PCR-confirmed H1N1 influenza pneumonia and COVID-19 at a tertiary care center in Karachi, Pakistan. Results: A total of 115 patients hospitalized with COVID-19 were compared with 55 patients with H1N1 Influenza A pneumonia. Median age was similar in both COVID-19 patients (54 years) and in patients with H1N1 influenza (59 years), but there was male predominance in COVID-19 patients (OR = 2.95; 95% CI: 1.12–7.79). Patients with COVID-19 pneumonia were 1.34 (95% CI: 1.14–1.62) times more likely to have a greater duration of illness prior to presentation compared to H1N1 influenza patients. COVID-19 patients were 4.59 times (95% CI: 1.32–15.94) more likely to be admitted to a general ward compared to H1N1 pneumonia patients. Moreover, patients with COVID-19 were 7.62 times (95% CI: 2.42–24.00) more likely to be treated with systemic steroids compared to patients with H1N1 pneumonia. The rate of nosocomial infections as well as mortality was similar in both H1N1 and COVID-19 pneumonia. Conclusion: Our study found a male predominance and longer duration of illness in hospitalized patients with COVID-19 compared to H1N1 influenza patients but no difference in outcomes with either infection. Full article

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Open AccessArticle

Effectiveness of Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease after Lobectomy Due to Non-Small Cell Lung Cancer—A Single-Center Retrospective Study

by Magdalena Klimczak, Damian Piekielny, Adam Antczak, Jacek Śmigielski and Damian Tworek

Adv. Respir. Med. 2021, 89(3), 247-253; https://doi.org/10.5603/ARM.a2021.0060 - 30 Jun 2021

Cited by 5 | Viewed by 876

Abstract

Introduction: The procedure of lung parenchyma resection may result in impairment of physical capacity and quality of life. In patients with operable non-small cell lung cancer (NSCLC), lobectomy is an elective procedure. Chronic obstructive pulmonary disease (COPD) is a common coexisting condition [...] Read more.

Introduction: The procedure of lung parenchyma resection may result in impairment of physical capacity and quality of life. In patients with operable non-small cell lung cancer (NSCLC), lobectomy is an elective procedure. Chronic obstructive pulmonary disease (COPD) is a common coexisting condition in patients with NSCLC. Effectiveness of post-operative pulmonary rehabilitation (PR) in patients who underwent lobectomy due to NSCLC and suffering from COPD as compared to individuals without COPD has not been determined yet. The aim of the study was to compare effectiveness of post-operative PR in patients with COPD after lobectomy due to NSCLC (COPD[+] L [+]) with individuals with COPD without lung parenchyma resection (COPD(+) L(–)) and those who underwent lobectomy due to NSCLC and not suffering from COPD (COPD[–] L[+]). Material and methods: Thirty-seven patients with non-small cell lung cancer (21 patients with and 16 patients without COPD) who underwent lobectomy and 29 subjects with COPD referred to the Lung Diseases Treatment and Rehabilitation Centre in Lodz in 2018–2019 were included in this retrospective analysis. The patients participated in a 3-week inpatient pulmonary rehabilitation (PR) program which included breathing exercises, physical workout, relaxation exercises, education, psychological support and nutrition consulting. The evaluation included lung function measurements, six-minute walking test (6MWT) and the St. George’s Respiratory Questionnaire (SGRQ) score. The results obtained before the rehabilitation were compared to those achieved after the 3-week PR program and compared between the study groups. Results: A significant increase in the distance covered during 6MWT was observed in all the three groups studied: COPD(+) L(+) (Δ = 62.52 ± 14.58 m); COPD(–) L(+) (Δ = 73.67 ± 11.58 m); and COPD(+) L(–) (Δ = 59.93 ± 10.02 m) (p < 0.001 for all). Similarly, a statistically and clinically significant improvement in the total SGRQ score was recorded: COPD(+) L(+) ∆ = –12.05 ± 3.96 points; p < 0.05 and COPD(–) L(+) ∆ = –12.30 ± 4.85 points; p < 0.01 and COPD(+) (L–) ∆= –14.07 ± 3.36 points (p < 0.001). No significant differences in the outcome improvement between the study groups were identified. Conclusions: The results of the study show that COPD(+) L(+) patients gained benefits from post-operative PR comparable to COPD(+) L(–) and COPD(–) L(+) subjects by improving their physical capacity and quality of life. Full article

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Open AccessArticle

Comparison of the Diagnostic Effectiveness Between an Expert and a Student in the Diagnosis of Sarcoidosis by Transbronchial Biopsy of Mediastinal Lymph Nodes under the Control of Endosonography

by Piotr Kubicki, Artur Szlubowski, Dariusz Jastrzębski, Damian Czyżewski and Dariusz Ziora

Adv. Respir. Med. 2021, 89(3), 241-246; https://doi.org/10.5603/ARM.a2021.0050 - 30 Jun 2021

Cited by 1 | Viewed by 510

Abstract

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes is currently considered to be the most effective minimally invasive diagnostic method in patients with suspected stage I and II sarcoidosis. However, diagnostic effectiveness depends on the experience and skills of [...] Read more.

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes is currently considered to be the most effective minimally invasive diagnostic method in patients with suspected stage I and II sarcoidosis. However, diagnostic effectiveness depends on the experience and skills of the doctor which is dependent on the number of correctly performed procedures. The aim of the study is to compare the diagnostic effectiveness of the EBUS-TBNA test obtained by an expert in this field vs that of his student. Material and methods: in patients with a clinical and radiological suspicion of sarcoidosis, EBUS-TBNA procedures were performed by an expert (over 1000 previously performed tests) and by his student who completed basic training (15 procedures performed). In the expert’s opinion, the student was experienced enough to perform the EBUS-TBNA on his own. Previously, more than 100 conventional fibreoptic bronchoscopies had been performed by the student. During that time, he had been working in the department of pulmonary diseases and tuberculosis for two years. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and accuracy of the EBUS-TBNA test in diagnosing sarcoidosis were calculated. Statistical evaluation was made using ROC curves for the expert and for the student. Results: The study included 215 patients between 22–68 years of age with suspected sarcoidosis who were diagnosed between 2013–2016. 124 EBUS-TBNA tests were performed by the expert, and 91 procedures were performed by the student. The presence of sarcoid granulomas was confirmed by a biopsy in 165 (76.7%) patients. In terms of the diagnosis of sarcoidosis, a higher sensitivity and accuracy of the EBUS test was found in the procedures done by the expert (76.7% and 95.3%, respectively) as compared to the results obtained by the student (66.1% and 93.1%, respectively). However, these differences were not statistically significant (p = 0.11). All tests were assessed in a hospital pathology unit, but not necessarily by one person, which may be a limitation of our research. In this study, only cytological smears were taken into consideration. Conclusions: In the diagnosis of sarcoidosis, the student, after appropriate training by an expert, achieved a comparable level of diagnostic effectiveness with EBUS-TBNA after performing 90 tests independently. Full article

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Open AccessLetter

Candidate Immunomodulators for COVID-19: Heat-Killed Mycobacterium w and BCG Vaccine

by Tarun Krishna Boppana, Anant Mohan, Karan Madan, Pawan Tiwari, Vijay Hadda, Randeep Guleria and Saurabh Mittal

Adv. Respir. Med. 2021, 89(3), 350-351; https://doi.org/10.5603/ARM.a2021.0043 - 07 May 2021

Cited by 3 | Viewed by 424

Abstract

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and has killed millions across the globe [...] Full article

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Open AccessCase Report

A Tracheobronchial Adenoid Cystic Carcinoma Incidentally Detected by Chest Radiography and Pulmonary Function Test

by Shotaro Ono, Haruka Namikawa, Hideji Nakajima, Katsunori Kagohashi, Hiroaki Satoh and Kinya Furukawa

Adv. Respir. Med. 2021, 89(3), 320-323; https://doi.org/10.5603/ARM.a2021.0003 - 07 May 2021

Cited by 2 | Viewed by 483

Abstract

Tracheobronchial adenoid cystic carcinomas are rare tumors that progress slowly.　Diagnosis by chest plain radiography is difficult, and suspecting the existence of a disease that causes stenosis in the airways is an important key for diagnosis. A 51-year-old woman referred to our hospital because [...] Read more.

Tracheobronchial adenoid cystic carcinomas are rare tumors that progress slowly.　Diagnosis by chest plain radiography is difficult, and suspecting the existence of a disease that causes stenosis in the airways is an important key for diagnosis. A 51-year-old woman referred to our hospital because of dyspnea on exertion. Chest plain radiograph showed a slight widening of the mediastinum. The flow–volume curve of respiratory function test revealed flat portions of the curve suggesting the central airway obstruction pattern. Chest CT confirmed the existence of tracheobronchial tumor, which was pathologically diagnosed as adenoid cystic carcinoma. Chest physicians and thoracic surgeons should be careful not to miss these trivial findings in the first inspections. Full article

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Open AccessCase Report

Pseudoprogression during Successful Rechallenge of Immune Checkpoint Inhibitor in a NSCLC Patient

by Katsunori Kagohashi, Kunihiko Miyazaki, Toshihiro Shiozawa and Hiroaki Satoh

Adv. Respir. Med. 2021, 89(3), 316-319; https://doi.org/10.5603/ARM.a2021.0016 - 07 May 2021

Viewed by 517

Abstract

Rechallenge of immune checkpoint inhibitors (ICPIs) is one of the attractive but unestablished treatment for recurrent non-small cell lung cancer (NSCLC) patients who have been treated with several-lines of systemic chemotherapy. In some NSCLC patients, effects of ICPI rechallenge therapy have become apparent. [...] Read more.

Rechallenge of immune checkpoint inhibitors (ICPIs) is one of the attractive but unestablished treatment for recurrent non-small cell lung cancer (NSCLC) patients who have been treated with several-lines of systemic chemotherapy. In some NSCLC patients, effects of ICPI rechallenge therapy have become apparent. In ICPI treatment, although very rare, a phenomenon called pseudoprogression is known. We report the first case of a patient who had pseudoprogression during successful rechallenge of ICPI in a NSCLC patient. Although not fully clarified, factors related to the onset of pseudoprogression and good response to ICPI rechallenge are being investigated. Our case showed that pseudoprogression could be developed even in patients with ICPI rechallenge therapy. Full article

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Open AccessLetter

Pulmonary Thromboembolism Post-COVID Convalescent Plasma Therapy: Adding Fuel to A Smoldering Fire!

by Vikas Marwah, Robin Choudhary, Deepu Peter and Gaurav Bhati

Adv. Respir. Med. 2021, 89(3), 347-349; https://doi.org/10.5603/ARM.a2021.0022 - 21 Apr 2021

Cited by 3 | Viewed by 355

Abstract

The current coronavirus disease 2019(COVID-19) pandemic has caused millions of cases worldwide and is still creating havoc all around the world [...] Full article

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Open AccessLetter

GOLD 2021 Guideliness for COPD—What’s New and Why

by Nitesh Gupta, Nipun Malhotra and Pranav Ish

Adv. Respir. Med. 2021, 89(3), 344-346; https://doi.org/10.5603/ARM.a2021.0015 - 21 Apr 2021

Cited by 23 | Viewed by 1728

Abstract

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 report dawns with an update to the diagnostic [...] Full article

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Open AccessLetter

Ambient Temperature and COVID-19 Outcomes

by Manu Madan, Sourabh Pahuja, Rahul Tyagi, Anant Mohan, Ravindra Mohan Pandey, Karan Madan, Vijay Hadda, Pawan Tiwari, Randeep Guleria and Saurabh Mittal

Adv. Respir. Med. 2021, 89(3), 341-343; https://doi.org/10.5603/ARM.a2021.0021 - 21 Apr 2021

Cited by 1 | Viewed by 425

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has affected the world in different manners [...] Full article

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Open AccessCase Report

Boerhaave Syndrome: An Unusual Cause of Bilateral Exudative Pleural Effusion

by Rishabh Goel, Benhur Joel Shadrach, Ritesh Kumar Nayak and Anukool Jain

Adv. Respir. Med. 2021, 89(3), 339-340; https://doi.org/10.5603/ARM.a2021.0005 - 21 Apr 2021

Cited by 2 | Viewed by 364

Abstract

A 45-year-old male, security guard, chronic alcoholic, presented to us with complaints of low-grade fe-ver, recurrent vomiting, bilateral pleuritic chest pain, dry cough, and progressive breathlessness for the past 4 days [...] Full article

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Open AccessCase Report

A Middle-Aged Female with Dyspnoea and Skin Rash

by Tarun Krishna Boppana, Saurabh Mittal, Karan Madan and Anant Mohan

Adv. Respir. Med. 2021, 89(3), 338; https://doi.org/10.5603/ARM.a2021.0013 - 21 Apr 2021

Viewed by 337

Abstract

A 42-year-old lady presented to Pulmonary Medicine outpatient services with the complaints of cough and shortness of breath for the last 2 years [...] Full article

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Open AccessCase Report

A Left Hilar Mass with An Uncommon Etiology

by Nitesh Gupta, Sourabh Agstam, Nipun Malhotra, Pranav Ish, Baljeet Singh Virk and Neeraj Kumar Gupta

Adv. Respir. Med. 2021, 89(3), 336-337; https://doi.org/10.5603/ARM.a2021.0006 - 21 Apr 2021

Viewed by 419

Abstract

A 30-year-old lady presented with complaints of fever, haemoptysis, dyspnoea and chest pain for 1 week [...] Full article

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Open AccessCase Report

An Unusual Cause of Chronic Cough

by Suman Kumar Jagaty, Bhabani Shankar Behera, Amit Kiran Rath and Sudarsan Pothal

Adv. Respir. Med. 2021, 89(3), 334-335; https://doi.org/10.5603/ARM.a2021.0017 - 19 Apr 2021

Viewed by 387

Abstract

A 68-year-old male presented with a history of on and off cough for several years which was increased over last month and was associated with low-grade intermittent fever since last four weeks [...] Full article

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Open AccessCase Report

Amyloid Cystic Lung Disease Presenting in A Patient with Human Immunodeficiency Virus

by Firas Mohammed El-Baba, Harsha Banavasi and Ayman Soubani

Adv. Respir. Med. 2021, 89(3), 324-327; https://doi.org/10.5603/ARM.a2021.0007 - 19 Apr 2021

Cited by 2 | Viewed by 554

Abstract

A 30-year-old gentleman with a medical history of HIV, on HAART therapy and pulmonary amyloidosis proven by lung biopsy presented with progressive, worsening shortness of breath and chronic productive cough over the last year. Pulmonary function tests showed a severely obstructive process and [...] Read more.

A 30-year-old gentleman with a medical history of HIV, on HAART therapy and pulmonary amyloidosis proven by lung biopsy presented with progressive, worsening shortness of breath and chronic productive cough over the last year. Pulmonary function tests showed a severely obstructive process and CT scan of the thorax manifested diffusely thin-walled, air-filled cysts. After reviewing the patient’s prior histories, PFTs and CTof the thorax, the most likely cause of his symptoms was amyloid-related cystic lung disease. After being placed on a LABA/ICS, and LAMA inhaler, the man’s condition remained stable. Active oncologic and pulmonary surveillance were continued every three to six months as the patient’s respiratory status, PFTs and imaging remained stable. Thoughts of chemotherapy and lung transplant have been suggested, but not initiated at this time. Amyloid-related cystic lung disease is a rare presentation of amyloidosis in the thorax. It has been associated with collagen vascular diseases and mucosa-associated lymphoid tissue lymphoma. After an extensive literature search, it does not appear that this condition has been referenced in an HIV-positive patient; thus making this report unique. More Case Reports will need to be published and reviewed to see whether an association with HIV and amyloid-associated cystic lung disease exists. Full article

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Open AccessCase Report

Treatment of Pulmonary Artery Stump Thrombosis after Lobectomy: A Case Report and Literature Review

by Maria Wieteska-Miłek, Kinga Winiarczyk and Włodzimierz Kupis

Adv. Respir. Med. 2021, 89(3), 311-315; https://doi.org/10.5603/ARM.a2021.0010 - 19 Apr 2021

Cited by 3 | Viewed by 781

Abstract

Introduction: Lung cancer surgery is a well-known risk factor for venous thromboembolism. Thus, standard care involves the use of pharmacological and mechanical prophylaxis until discharge from the hospital. Pulmonary artery stump thrombosis (PAST) is a rare condition which can develop months to [...] Read more.

Introduction: Lung cancer surgery is a well-known risk factor for venous thromboembolism. Thus, standard care involves the use of pharmacological and mechanical prophylaxis until discharge from the hospital. Pulmonary artery stump thrombosis (PAST) is a rare condition which can develop months to years after lung cancer surgery. This report describes a patient diagnosed with PAST and the decisions that were made regarding his treatment. Case report: A 67-year-old male was diagnosed with lung cancer due to shortness of breath, dry cough, hemoptysis, and typical chest computed tomography (CT) findings. He underwent right lower lobectomy and mediastinal lymphadenectomy by video-assisted thoracoscopic surgery. The procedure was complicated by the development of a right pleural empyema. After pleural drainage and an antibiotic regimen, he was discharged from the hospital with further improvement. A follow-up CT pulmonary angiography performed three months after lobectomy revealed thrombosis in the right lower lobar pulmonary artery stump. The patient had no symptoms. The attending physician decided to use anticoagulants. Consequently, the patient received low molecular-weight heparin subcutaneously for one month and a non-vitamin-K antagonist oral anticoagulant (NOAC) for the following 5 months. A CT scan performed after 3 months of anticoagulation showed complete resolution of stump thrombosis. Subsequent examinations showed no recurrence of either lung cancer or artery stump thrombosis and no anticoagulant-related bleeding. Discussion: Pulmonary artery stump thrombosis can develop after lung cancer surgery. This complication is uncommon and the prognosis is favorable in most treated cases. However, thrombosis may progress, and pulmonary embolism or chronic thromboembolic pulmonary hypertension may develop. Decisions about instituting anticoagulation therapy and its duration are made on an individual basis after considering both the benefits and the potential risks Full article

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Adv. Respir. Med., Volume 89, Issue 3 (June 2021) – 22 articles , Pages 241-351

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