Journal des maladies et soins respiratoires cliniques : accès libre

The communication between pulmonary artery and pulmonary vein or between a bronchial artery and the pulmonary vein is called as pulmonary arterio-venous malformation. Dyspnea on exertion, fatigue, nasal bleeding, bluish discoloration of lips and nail beds and hemoptysis are common presenting complaints. In childhood only 10% of cases are identified. Cerebral vascular accidents, brain abscess, hemothorax, life threatening hemoptysis are the complications of large pulmonary arteriovenous malformation. We present you a series of three cases that were diagnosed to have pulmonary AV malformations and presented to us with various clinical pictures. All three patients were surgically managed and discharged uneventfully.

Background: Despite of the major effort to improve asthma management, there are still poor public knowledge and perception among patients with asthma and their family in the Kingdom of Saudi Arabia. Methods: Across sectional descriptive study was conducted last May 20, 2015 during World Asthma Day at Medical Tower ground floor in King Saud Medical City in Riyadh, Kingdom Saudi Arabia with more than 100 participants in the said activity from different area of Riyadh. Questionnaires were distributed to the participants after given asthma awareness by healthcare providers. Results: A total of 55 participants during Asthma day responded to the questionnaire, Majority are male (50.94%) and Saudi nationality (67.92%). After intervention and awareness given to the participants, most of them are aware that asthma is shortness of breath and coughing (87%) which considered being the major signs and symptoms of asthma. Furthermore they don't believe that abdominal pain causes asthma (25%). Participants are aware that most of the common risk factors of asthma is exposure to smoke (94%) followed by exposure to polluted air (91%). The knowledge and perception of the participants towards the medication needs to be used for asthma, most of them answered ventolin spray (77%) and followed by oxygen (72%). Conclusions: Different model of educational activity for bronchial asthma helps in improving the knowledge and awareness of patients and family about asthma disease.

Clinical trials for the development of respiratory drugs have for years been reliant upon measurements of physiologic tests, combined with the use of questionnaires. New drugs were mostly administered by inhalation and increasingly in fixed combinations. However, these lung function tests have a lack of sensitivity for patient-relevant clinical outcomes. Moreover, new insights in phenotypes and endotypes of these diseases in the basic mechanisms and the discovery of new targets for therapy, have led to the need for a more personalized patient-centered approach and precision medicine. In recent years, a great number of techniques have been proposed but some need further validation. These include fractional exhaled nitric oxide, health-related quality of life and the use of biomarkers like blood and sputum eosinophils and neutrophils, IgE, sIgE, periostin, copeptin and specific cytokines. Additionally, exhaled breath condensate and lung deposition studies by functional residual imaging and by local bronchial pharmacokinetics can be used. In rare diseases like cystic fibrosis, Lung Clearance Index and CT and PET scan fusion images seem to be valuable outcome measurements. Lastly leverage of lung function tests can be done by using body plethysmography, measuring respiratory impedance, variability and the use of modeling and simulation. The need for a patient-centric approach through all stages of clinical development is becoming mandatory. So, an evolution from classical randomized clinical trials (RCTs) to more efficient and patient-relevant designs will be seen more in the future. RCTs will remain necessary for regulatory submission but more efficient and adaptive designs with lower heterogeneity and the use of pragmatic trials are needed. This evolution from undefined targets to a more targeted approach will lead us closer to precision medicine. In this overview, the unmet medical need for better outcomes and study designs in the development of treatments for respiratory diseases, are discussed.

Central sleep apnea (CSA) rather than obstructive sleep apnea (OSA) is widely believed to be the dominant form of sleep apnea (SA) in patients with heart failure (HF). Hitherto, no study has characterized sleep disordered breathing (SDB) in Indian subjects with heart failure and evaluated its impact on severity of HF, which this study attempts to do. A retrospective data-analysis was done in 65 consecutive patients with stable mild-to-moderate HF referred for evaluation on the basis of fatigue and excessive daytime somnolence (EDS) regarded by the institute’s cardiologists. Patients with ejection fraction (EF) <55% or LV fractional shortening of 28% were included in the study. PSG was scored according to current AASM recommendations. Based on the Apnea-Hypopnea Index (AHI), OSA was classified as mild (AHI:5-15), moderate (AHI: 15-30) and severe (AHI: >30). HF was arbitrarily classified as mild (EF:<35%) moderate (EF:35-45%) and severe (EF:45-55%). OSA emerged as the exclusive form of SA (95.4%; n=65) and was more severe in males. Patients with more severe HF tended to be less obese, and interestingly to have less severe OSA. In contrast to Western literature, OSA seems to be by far the most prevalent form of sleep apnea in Indian subjects with HF. HF mortality is known to be high in underweight individuals yet, persons with severe HF are often less obese and partly by reason of a lower BMI, appear to be relatively protected against severe OSA and severe nocturnal hypoxemia. This study thus raises important and intriguing questions which merit further enquiry.

Self-management methods for chronic diseases using mobile phone and tablet applications have recently become popular. Although several applications for asthma management are available, there are no reports concerning the long-term treatment effects of inhaled corticosteroid (ICS)/long-acting beta agonist (LABA) treatment on diurnal peak flow variability according to digital asthma diary records or its utility. A 31-year-old female diagnosed with moderate persistent asthma was treated with ICS/LABA. On approximately 2 years after the treatment, we were able to observe that diurnal peak flow variability disappeared gradually and completely when the time axis set that all records can be observed in one screen. Self-monitoring the peak flow using digital asthma diaries is suitable for long-term recording and allows an adequate understanding of long-term asthma state and treatment effects especially for minor diurnal peak flow variability by ICS/LABA.