92 research outputs found
Early or delayed bronchoscopy in patients admitted to the emergency department for mild-to-moderate hemoptysis?
No full textBACKGROUND: The correct timing for bronchoscopy in massive hemoptysis is well established, whereas in mild-to-moderate hemoptysis there still is uncertainty. The aim of our study was to evaluate if performing a fibrobronchoscopy (FBS) within 48 hours after the onset of mild-to-moderate hemoptysis was related to a higher possibility to identify the site and the cause of bleeding, compared to a delayed one.
METHODS: We conducted a retrospective study over one-year period from March 2015, in which consecutive patients admitted to the emergency department underwent FBS for spontaneous mild-to-moderate hemoptysis in our medium-size teaching hospital.
RESULTS: We included 69 patients. Definitive diagnosis was achieved in 52 cases (75%) combining clinical, imaging and endoscopic data (neoplastic diseases 22%, infections 20%, alveolar hemorrhage 13%). FBS was performed within 48 hours of symptoms onset in 41 patients (59%). The site of bleeding was identified in 28 cases (41%), 64% of which underwent FBS within 48 hours. Endoscopic diagnosis was reached in 45 patients (65%), 60% of which underwent FBS within 48 hours. No statistical association with localization (P=0.62) or diagnosis (P=1.00) was found with early FBS. Despite a high prevalence in our cohort of patients treated with anticoagulant or antiplatelet drugs (39%), we found no statistical association with bronchoscopy localization (P=0.12) and diagnosis (P=0.21).
CONCLUSIONS: In conclusion, in case of mild to moderate hemoptysis, an early bronchoscopy in the emergency department setting does not seem to improve the possibility to find neither the cause nor the localization of the bleeding source
Efficacy of Pirfenidone and Nintedanib in Interstitial Lung Diseases Other than Idiopathic Pulmonary Fibrosis: A Systematic Review
No full textPirfenidone and nintedanib are antifibrotic medications approved for idiopathic pulmonary fibrosis treatment by regulatory agencies and available for clinical use worldwide. These drugs have been shown to reduce the rate of decline in forced vital capacity and the risk of acute exacerbation among patients with idiopathic pulmonary fibrosis. Recent data suggest that different interstitial lung diseases with a progressive pulmonary fibrosis phenotype can share similar pathogenetic and biological pathways and could be amenable to antifibrotic therapies. Indeed, historical management strategies in interstitial lung disease have failed to identify potential treatments once progression has occurred despite available drugs. In this systematic review, we summarized data on the efficacy of pirfenidone and nintedanib in interstitial lung diseases other than idiopathic pulmonary fibrosis as well as ongoing and upcoming clinical trials. We identify two well-designed trials regarding nintedanib demonstrating the efficacy of this drug in slowing disease progression in patients with interstitial lung diseases other than idiopathic pulmonary fibrosis. On the other hand, results on the use of pirfenidone in interstitial lung diseases other than idiopathic pulmonary fibrosis should be interpreted with more caution on the basis of trial limitations. Several randomized control trials are underway to improve the quality of evidence in the interstitial lung disease field
Microbial inflammatory networks in bronchiectasis exacerbators with Pseudomonas aeruginosa
No full textThis is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recor
Genetic and Serum Screening for Alpha-1-Antitrypsin Deficiency in Adult Patients with Cystic Fibrosis: A Single-Center Experience
No full textCystic fibrosis (CF) and alpha-1 antitrypsin (AAT) deficiency are two of the commonest
genetic diseases affecting the Caucasian population. Neutrophil-mediated inflammation due to
protease–antiprotease imbalance leads to progressive pulmonary involvement in both diseases. The
aim of this study was to investigate the prevalence of AAT deficiency in CF adults. A prospective
study enrolling CF adults was conducted at the Adult CF Center based in Milan from January 2018 to
March 2019. Patients were tested for AAT serum protein quantification and expanded genotyping
characterization of SERPINA1 during clinical stability. Genotyping characterization of SERPIN1 was
compared to a control population of 2848 Caucasian individuals with the same geographical origin
and similar demographic characteristics. Among 173 patients included in the study, the prevalence of
AAT deficiency was 0. Genotype analysis was piMM in 166 (94.9%) patients and piMS in 9 patients
(5.1%), respectively. No differences in terms of genotype characterization were found between the CF
population and the control population. These data show that AAT deficiency is not common among
adults with CF
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