multi dimensional grading system for assessment and follow up of COPD

Recently, the BODE [body mass index, airflow obstruction, dyspnea and exercise capacity] index, a multidimensional grading system was shown to be better than FEV1 in predicting the risk of hospitalization and death among patients with COPD. Evaluation of BODE [body mass index, air flow obstruction, dyspnea and exercise capacity] index as better predictor of hospitalization in COPD patients than FEV1 alone. Design: Randomized, double blind, prospective study. Methods: This study was conducted on 50 patients, with wide range of severity of COPD their age range was from age 32 - 81 years, including 49 males and 1 female, with smoking index 897.115 +/- 53.75, all patients provided written informed consent. They were from the outpatient clinic and others were admitted as inpatient in Ain Shams University hospital. All patients were subjected to the following: Complete history taking, Careful physical examination, Chest x-ray Routine investigation [CBC, ESR, kidney function, liver function and ECG], Arterial blood gas of admitted patients and O2 saturation for outpatient clinic, Measurement of spirometric lung function tests, The BODE index [body mass index, air flow obstruction, dyspnea and exercise capacity] was calculated for each patient, for calculation of the BODE index, we used suggestive model. Patient was followed up for 6 months after doing the test to know number of hospitalization and mortality during this period. Comparison was done between COPD staging as defined by GOLD and BODE index as a predictor of hospitalization during follow up period. In this study using FEV1 [as defined by GOLD] alone as a single prediction of hospitalization of COPD patients the results were statistically significant as shown the incidence of hospitalization in stage 1 was 0%, Stage II was 31%, in stage III was 66% and stage IV was 75%, and by using BODE index as a predictor of risk of hospitalization in COPD patients the results were statistically highly significant as shown the incidence of hospitalization in Quartile BODE index 1 [0-2] was 0%, in quartile 2 [3-4] was 30%, in quartile 3 [5-6] was 58% and quartile 4 [7-10] was 80%. It is noticed that there were statistically differences between two systems as prediction of hospitalization using BODE index was highly statistically significant. from the present study we conclude that the BODE staging system, which includes in addition to FEV1 other physiologic and clinical variables, helps to better predict hospitalization in patients with COPD. The BODE index is simple to calculate and requires no special equipment. This makes it a practical tool of potentially widespread applicability

Interventional bronchoscopy: ain Shams University Hospital experience

Bronchoscopy has evolved considerably in our hospital. During recent years, we implemented the concept of interventional bronchoscopy [IB] for the first time in Egypt. IB is defined as a diagnostic and invasive therapeutic interventions that extend beyond routine Flexible bronchoscopy. In this article, we will review our clinical experience with IB during the last five years as regards methodology requirements, available equipments, clinical applications and presentation of selected research outcomes. We retrospectively reviewed all available reports of therapeutic IB performed in our bronchoscopy unit to determine the indications, application sites, methods of disobliteration and complications of therapeutic IB. In addition, recent interesting research work done on endobronchial ultrasound, autofluorescence bronchoscopy, Nd: YAG laser bronchoscopy and endobronchial electrocautery was reviewed. In order to perform an interventional procedure, well-equipped facilities, trained personnel, preprocedure evaluation, and monitoring are mandatory. More than 500 invasive therapeutic interventions were performed in the past 5 years. The results and analysis of these IB were reviewed. We concluded from the presented data that IB has quickly gained recognition and drawn interest with its promising results. Much effort is needed to overcome challenges facing IB awareness, financial concerns, training and verification of competency in our country