Pulmonary Medicine
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Pulmonary Medicine publishes research related to the prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.

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Research Article

A Retrospective Cohort Study Evaluating the Safety and Efficacy of Sequential versus Concurrent Intrapleural Instillation of Tissue Plasminogen Activator and DNase for Pleural Infection

Background and Objective. Intrapleural tissue plasminogen activator/deoxyribonuclease (tPA/DNase) is increasingly being used for pleural infections. Compared to sequential instillation of tPA/DNase, concurrent instillation considerably reduces the complexity of the administration process and reduces workload and the number of times the chest drain is accessed. However, it remains unclear if concurrent intrapleural therapy is as efficacious or safe as sequential intrapleural therapy. Methods. We conducted a retrospective review of patients with pleural infection requiring intrapleural therapy at two tertiary referral centres. Results. We included 84 (62.2%) and 51 (37.8%) patients who received sequential and concurrent intrapleural therapy, respectively. Patient demographics and clinical characteristics, including age, RAPID score, and percentage of pleural opacity on radiographs before intrapleural therapy, were similar in both groups. Treatment failure rates (defined by either in-hospital mortality, surgical intervention, or 30-day readmission for pleural infection) were 9.5% and 5.9% with sequential and concurrent intrapleural therapy, respectively (). This translates to a treatment success rate of 90.5% and 94.1% for sequential and concurrent intrapleural therapy, respectively. There was no significant difference in the decrease in percentage of pleural effusion size on chest radiographs (15.1% [IQR 6-35.7] versus 26.6% [IQR 9.9-38.7], ) between sequential and concurrent therapy, respectively. There were also no significant differences in the rate of pleural bleeding (4.8% versus 9.8%, ) and chest pain (13.1% versus 9.8%, ) between sequential and concurrent therapy, respectively. Conclusion. Our study adds to the growing literature on the safety and efficacy of concurrent intrapleural therapy in pleural infection.

Research Article

Chronic Obstructive Pulmonary Disease in Cameroon: Prevalence and Predictors—A Multisetting Community-Based Study

Objective. Little is known concerning chronic obstructive pulmonary disease (COPD) in Sub-Saharan Africa (SSA), where the disease remains underdiagnosed. We aimed to estimate its prevalence in Cameroon and look for its predictors. Methods. Adults aged 19 years and older were randomly selected in 4 regions of Cameroon to participate in a cross-sectional community-based study. Data were collected in the participant’s home or place of work. Spirometry was performed on selected participants. COPD was defined as the postbronchodilator forced expiratory volume in 1 second/forced vital capacity ratio limit of normal, using the global lung initiative (GLI) equations for Black people. Binomial logistic regression was used to seek COPD-associated factors. The strength of the association was measured using the adjusted odds ratio (aOR). Results. A total of 5055 participants (median age (25th-75th percentile) = 43 (30–56) years, 54.9% of women) were enrolled. COPD prevalence (95% confidence interval (95% CI)) was 2.9% (2.4, 3.3)%. Independent predictors of COPD (aOR (95% CI)) were a high educational level (4.7 (2.0, 11.1)), living in semiurban or rural locality (1.7 (1.4, 3.0)), tobacco smoking (1.7 (1.1, 2.5)), biomass fuel exposure (1.9 (1.1, 3.3)), experience of dyspnea (2.2 (1.4, 3.5)), history of tuberculosis (3.6 (1.9, 6.7)), and history of asthma (6.3 (3.4, 11.6)). Obesity was protective factor (aOR (0.2, 0.5)). Conclusion. The prevalence of COPD was relatively low. Alternative risk factors such as biomass fuel exposure, history of tuberculosis, and asthma were confirmed as predictors.

Research Article

Pediatric COVID-19: Correlations between Clinical and Imaging Perspectives

Background. Although SARS-CoV-2 infection primarily affects adults, the increasing emergence of infected pediatric patients has been recently reported. However, there is a paucity of data regarding the value of imaging in relation to the clinical severity of this pandemic emergency. Objectives. To demonstrate the relationships between clinical and radiological COVID-19 findings and to determine the most effective standardized pediatric clinical and imaging strategies predicting the disease severity. Patients and Methods. This observational study enrolled eighty pediatric patients with confirmed COVID-19 infection. The studied patients were categorized according to the disease severity and the presence of comorbidities. Patients’ clinical findings, chest X-ray, and CT imaging results were analyzed. Patients’ evaluations using several clinical and radiological severity scores were recorded. The relations between clinical and radiological severities were examined. Results. Significant associations were found between severe-to-critical illness and abnormal radiological findings (). In addition, chest X-ray score, chest CT severity score, and rapid evaluation of anamnesis, PO2, imaging disease, and dyspnea-COVID (RAPID-COVID) score were significantly higher among patients with severe infection (, <0.001, and 0.001) and those with comorbidities (, 0.002, and <0.001). Conclusions. Chest imaging of pediatric patients with COVID-19 infection may be of value during the evaluation of severe cases of infected pediatric patients and in those with underlying comorbid conditions, especially during the early stage of infection. Moreover, the combined use of specific clinical and radiological COVID-19 scores are likely to be a successful measure of the extent of disease severity.

Research Article

Characteristics, Management, and Outcomes of Community-Acquired Pneumonia due to Respiratory Syncytial Virus: A Retrospective Study

Background. Respiratory syncytial virus (RSV), a well-known cause of bronchiolitis in children, can cause community-acquired pneumonia (CAP) in adults, but this condition is not well studied. Hence, we described the characteristics and outcomes of patients hospitalized for CAP due to RSV. Methods. This was a retrospective study of patients admitted to a tertiary-care hospital between 2016 and 2019 with CAP due to RSV diagnosed by a respiratory multiplex PCR within 48 hours of admission. We compared patients who required ICU admission to those who did not. Results. Eighty adult patients were hospitalized with CAP due to RSV (median age 69.0 years, hypertension 65.0%, diabetes 58.8%, chronic respiratory disease 52.5%, and immunosuppression 17.5%); 19 (23.8%) patients required ICU admission. The median pneumonia severity index score was 120.5 (140.0 for ICU and 102.0 for non-ICU patients; ). Bacterial coinfection was rare (10.0%). Patients who required ICU admission had more hypotension (systolic blood  mmHg) and a higher prevalence of bilateral infiltrates on chest X-ray (CXR) (89.5% versus 32.7%; ). Systemic corticosteroids were used in 57.3% of patients (median initial dose was 40 mg of prednisone equivalent) with ICU patients receiving a higher dose compared to non-ICU patients (). Most (68.4%) ICU patients received mechanical ventilation (median duration of 4 days). The overall hospital mortality was 8.8% (higher for ICU patients: 31.6% versus 1.6%, ). Conclusions. Most patients with CAP due to RSV were elderly and had significant comorbidities. ICU admission was required in almost one in four patients and was associated with higher mortality.

Research Article

Home Respiratory Polygraphy and Spirometry in Normal Weight and Children with Obesity Suspected for Obstructive Sleep Apnea Syndrome: Are There Any Associations?

Aim. It is known that children and adolescents with obesity are more prone to obstructive sleep apnea syndrome (OSAS) and that their lung function may show some disturbance. Literature is scarce about potential associations; therefore, we aimed to study the relationship between OSAS, lung function, and adiposity in a population of children suspected of OSAS. Material and Methods. We performed home respiratory polygraphy and spirometry in all subjects. The relationships between body mass index -score (zBMI), polygraphy, and spirometry data were analyzed. Results. We recruited 81 subjects aged between 5 and 16 years, 63% being obese. 43.2% of subjects were diagnosed with OSAS (32.1% mild, 4.9% moderate, and 6.2% severe). We found no correlation between respiratory polygraphy and the zBMI. The mean spirometric value FEV1, FVC, and FEV1/FVC ratio ’s were normal in all subjects, whereas FVC ’s and FEV1/FVC ratio ’s were significantly positively related for obesity and negatively for normal weight (). FEV1’s was inversely correlated to the percentage of analyzed time passed below 90% of SpO2 (). All subjects with FEV1 () and/or FVC () ’s below the lower limit for normal (LLN) had an (FEV1: ; FVC: ), especially subjects with normal weight (FEV1: ; FVC: ). Conclusion. When comparing normal-weight children and adolescents with obesity, the prevalence of OSAS but not spirometric values was strongly related to BMI -score, probably because obesity engenders advanced puberty and an accelerated growth spurt. FEV1 was more frequently <LLN in normal-weight children, while obese subjects presented low FEV1/FVC ratio ’s and FEF25-75%’s. Moreover, all subjects with abnormal spirometric values were suffering from at least mild OSAS, again more frequently in normal-weight subjects.

Research Article

Patient Perspectives on the Use of Digital Technology to Help Manage Cystic Fibrosis

Background. Digital health technologies (DHTs) have shown potential to improve health outcomes through improved medication adherence in different disease states. Cystic fibrosis (CF) requires care coordination across pharmacies, patients, and providers. DHTs can potentially support patients, providers, and pharmacists in diseases like CF, where high medication burden can negatively impact patient quality of life and outcomes. Methods. In this prospective cohort study, a CF-specific mobile application (Phlo) was distributed to adults with CF who received care at the University of Utah Cystic Fibrosis Center, used an iPhone, and filled prescriptions through the University of Utah Specialty Pharmacy services. Participants were asked to use Phlo for 90 days with an optional 90-day extension period. Participants completed four surveys at baseline and after 90 days. Changes in patient-reported outcomes, adherence, clinical outcomes, and healthcare resource utilization from baseline to 90 days were tracked. Results. Phlo allowed users to track daily regimen activities, contact their care team, receive medication delivery reminders, and share progress with their healthcare team. A web-based dashboard allowed the care team to review reported performance scores from the app. Most patients (67%) said the app improved confidence in and motivation for continuing their regimen. The most important reported benefit of Phlo was having a single location to manage their whole routine. Conclusions. Phlo is a mobile health technology designed to help patients with CF manage their treatment regimen and improve patient-provider communication.

Pulmonary Medicine
 Journal metrics
See full report
Acceptance rate-
Submission to final decision-
Acceptance to publication-
CiteScore7.300
Journal Citation Indicator0.710
Impact Factor4.3
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