Current Issue : July-September Volume : 2025 Issue Number : 3 Articles : 5 Articles
Introduction: Smoking is a risk factor for chronic obstructive pulmonary disease (COPD) and lung cancer. In addition to pulmonary damages, peripheral muscle impairments are present in this population. Pulmonary limitation is observed in smokers before disease diagnosis, but functional capacity limitations are uncertain, contrary to patients who have already been diagnosed. The aim of this study was to compare muscular strength and endurance between non-smoker and smoker populations without any diagnosed respiratory disease. Method: This cross-sectional study assessed subjects without diagnosed respiratory disease in terms of physical capacity using two tests (one-minute sit-to-stand test (STST) and Jamar dynamometer test (JDT)). Results: The sample consisted of 147 subjects. The number of repetitions and the muscle strength were lower in the smoker than in the non-smoker population (28.5 ± 8.7 vs. 33.5 ± 8.2 (p < 0.001), and 38.2 ± 10.1 vs. 42.4 ± 10.5 (p = 0.04), respectively). The relative change in heart rate during STST was lower in the smokers compared to the non-smokers (p = 0.01). No significant differences were found based on gender. Conclusions: Smokers without alcohol or drug dependence and without diagnosed lung disease exhibit non-clinically but statistically reduced muscular strength and endurance. Their heart rate response to exercise is also reduced....
Background/Objectives: Non-invasive respiratory support and invasive mechanical ventilation are critical interventions that can induce significant changes not only in the lungs but also in extra-pulmonary organs, which are often overlooked. Understanding the extra-pulmonary effects of non-invasive respiratory support and invasive mechanical ventilation is crucial since it can help prevent or mitigate complications and improve outcomes. This narrative review explores these consequences in detail and highlights areas that require further research. Main Text: Non-invasive respiratory support and invasive mechanical ventilation can significantly impact various extrapulmonary organs. For instance, some ventilation strategies can affect venous return from the brain, which may lead to neurological sequelae. In the heart, regardless of the chosen ventilation method, increased intrathoracic pressure (ITP) can also reduce venous return to the heart. This reduction in turn can decrease cardiac output, resulting in hypotension and diminished perfusion of vital organs. Conversely, in certain situations, both ventilation strategies may enhance cardiac function by decreasing the work of breathing and lowering oxygen consumption. In the kidneys, these ventilation methods can impair renal perfusion and function through various mechanisms, including hemodynamic changes and the release of stress hormones. Such alterations can lead to acute kidney injury or exacerbate preexisting renal conditions. Conclusions: This review emphasizes the critical importance of understanding the extensive mechanisms by which non-invasive respiratory support and invasive mechanical ventilation affect extrapulmonary organs, including neurological, cardiovascular, and renal systems. Such knowledge is essential for optimizing patient care and improving outcomes in critical care settings....
Background/Objectives: Robot-assisted bronchoscopy (RAB) is a novel platform for sampling peripheral pulmonary nodules (PPNs). To further clarify the role robotassisted platforms have in diagnosing PPNs, we performed a review of the recent literature. Methods: A systematic review was performed in Medline from 2019 to 2024 using the search terms “robotic bronchoscopy”, “diagnostic yield”, “sensitivity”, and “positive predictive value”, alone and in combination. Studies that focused on earlier electromagnetic bronchoscopies were excluded. The patient demographic information, nodule characteristics, intra-procedure imaging modality, biopsy methods, diagnostic yield, sensitivity for malignancy, and adverse outcomes were analyzed. A total of 22 studies were available for the analyses. Results: The diagnostic yield was variable and ranged from 69 to 93%, with a median of 86%. The sensitivity ranged from 69% to 91.7%, with a median of 85%. The effect of the nodule size on the diagnostic yield was variable across the literature. Obtaining an eccentric or concentric view on a radial endobronchial ultrasound (rEBUS) was associated with a higher diagnostic yield than obtaining no view. A nodule appearance on CT imaging and the location were not definitively associated with a higher diagnostic yield. Fine needle aspiration usage ranged from 93.5 to 100%, with a median of 96.95%, while the use of biopsy forceps ranged from 2.7 to 96%, with a median of 69.9%. The most common complication was a pneumothorax, which occurred in 1–5.7% of cases, with a median of 1.6%. Conclusions: Robot-assisted transbronchial biopsies produce diagnostic yields that approach those of transthoracic needle aspirations. The nodule location and appearance may not affect the diagnostic yield. Obtaining a concentric or eccentric view on rEBUS is likely associated with an increased diagnostic yield. Additional prospective studies would better inform practitioners as this technology becomes more widespread....
Background: Home-based pulmonary rehabilitation (PR) is an effective alternative to center-based PR. However, not all participants exhibit sufficient therapeutic improvement, highlighting the need to identify appropriate candidates to maximize costeffectiveness. This study aimed to identify the factors associated with favorable outcomes in home-based PR, focusing on the role of digital therapeutics (DTx). Methods: This secondary analysis used data from a randomized controlled trial. Participants with chronic respiratory disease (CRD) were divided into responders and non-responders based on a change in 6 min walk distance (6MWD) and patient-reported outcome measures (PROM) representing dyspnea and health-related quality of life. Factors such as baseline 6MWD, DTx use, and pulmonary function were analyzed for their predictive value in improving 6MWD and PROM scores. Results: Responders, particularly those using DTx, showed significantly greater improvements in 6MWD than non-responders. Participants with a baseline 6MWD under 500 m demonstrated a higher likelihood of exceeding the minimum clinically important difference in 6MWD. DTx use strongly predicted improvements in both 6MWD and PROM scores. The baseline diffusing capacity of the lungs for carbon monoxide was also a significant factor influencing improvements in the modified Medical Research Council scale. Conclusions: Responders to 8-week program of home-based PR exhibited a relatively lower baseline health status. Encouraging participants with poorer baseline health could improve adherence to PR and enhance cost-effectiveness. Additionally, improvements in 6MWD and PROM scores were associated with the use of DTx. Considering the functions of DTx, proper supervision for home-based exercise may be crucial for achieving optimal outcomes....
Pulmonary fibrosis is a severe disease that involves the lung parenchyma. The pattern of the disease progresses with increasing fibrosis, resulting in severe restrictive lung disease. Also, revealed that each patient normally has a median survival rate of 2 to 5 years after a diagnosis. Having said that, current treatment options focus on only alleviating the symptoms and trying to stabilise or reverse their progression, and no cure can be seen on the horizon. Some natural immunity elements play a role in the development of pulmonary fibrosis, and macrophages are among them. At first, they prevent lung injury by encouraging inflammation and attracting immune cells. However, prolonged, persistent activation has the paradoxical effect of preventing the clearance of inflammatory mediators and prolonging inflammation. This, in turn, activates the mediator-producing molecules that will lead to remodelling and fibrosis. Current investigations show that macrophages have phenotypic versatility and can enhance tissue remodelling or fibrosis, so pulmonary fibrosis may be exploited by targeting macrophages. In this review, we propose the functions of macrophages in pulmonary fibrosis: Considering polarity, activity control factors, macrophage to other cell types, and signalling networks. The issue of the potential of advertised opportunities in modulating macrophage polarisation and the developments related to the noncoding RNA drugs are also considered. Last of all, special attention should be paid to the enhancement of the investigations concerning macrophages within this disease and on experiments with different therapies for pulmonary fibrosis....
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