Abrupt withdrawal of inhaled corticosteroids does not result in spirometric deterioration in chronic obstructive pulmonary disease: effect of phenotyping?

Some studies show a decline of FEV [1] only one month after withdrawal of inhaled corticosteroids [ICS], while others show no decline. We speculate that the presence of an asthma phenotype in the Chronic Obstructive Pulmonary Disease [COPD] population, and that its exclusion may result in no spirometric deterioration. We performed a prospective clinical observation study on 32 patients who fulfilled the Global Initiative for Chronic Obstructive lung disease definition of COPD [Grade II-IV]. They were divided into two phenotypic groups. 1. Irreversible asthma [A and B] [n = 13]: A. Asthma: Bronchial biopsy shows diffuse thickening of basement membrane [>/= 6.6 microm]. B. Airflow limitation [AFL] likely to be asthma: KCO > 80% predicted if the patient refused biopsy. 2. COPD [A and B] [n = 19]: A. COPD: hypercapneic respiratory failure with raised bicarbonate, panlobular emphysema with multiple bullas, or bronchial biopsy showing squamous metaplasia and epithelial/subepithelial inflammation without thickening of the basement membrane. B. AFL likely to be COPD: KCO < 80% predicted. The asthma phenotype was significantly younger, had a strong association with hypertrophy of nasal turbinates, and registered a significant improvement of FEV [1] [350 ml] vs a decline of - 26.5 ml in the COPD phenotype following therapy with budesonide/formoterol for one year. Withdrawal of budesonide for 4 weeks in the COPD phenotype resulted in FEV [1] + 1.33% [SD +/- 5.71] and FVC + 1.24% [SD +/- 5.32]; a change of <12% in all patients. We recorded no spirometric deterioration after exclusion of the asthma phenotype from a COPD group

Yield and complications of flexible fiberoptic bronchoscopy in a teaching hospital

To assess the diagnostic yield and safety of flexible fiberoptic bronchoscopy [FFB]. A retrospective review of bronchoscopy reports and corresponding patients charts over 3 years from January 2004 - December 2006 in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Indication for procedure, suspected diagnosis, final diagnosis, and complications were reported. Out of 720 patients, 707 [98.2%] patients had a full follow up. Five hundred and ninety-two [83.7%] underwent FFB for diagnostic purposes and 115 [16.3%] for therapeutic purposes. The mean age was 42 -/+ 18 years. Infection, including mycobacterium tuberculosis, and malignancy were the 2 main indications for FFB [35.9% and 25.9%]. The overall diagnostic yield was 58%. Tuberculosis was diagnosed in 67% of suspected cases, whereas bacterial pneumonia was diagnosed in 40.5%. Malignancy was confirmed in 61.2% of suspected cases. Bronchoscopy diagnosed 37 [43%] of 86 patients with interstitial lung disease. The diagnostic yield was 57% for sarcoidosis, 40% for usual interstitial pneumonia and 88% for bronchiolitis obliterans organizing pneumonia. The overall complication rate was 5%; pneumothorax occurred in 0.56% and was associated exclusively with transbronchial biopsy. No mortality was observed. Flexible fiberoptic bronchoscopy is a useful diagnostic tool with a low rate of complications. The diagnostic yield in our institution is similar to that reported in Western series

Awareness and knowledge of Saudi university students about drug dependence

To find out the most likely acceptable and effective methods of treatment and prevention of drug dependence in Saudi Arabia A sample of the population at risk representing students of King Saud University was surveyed Instruments and Design: A questionnaire designed specifically for this study was distributed to 1000 students, of whom 74% responded. The most frequently cited source of information was media services and the most preferred prevention and treatment methods were religious in nature. To use media services especially television to reach the population at risk for drug awareness programmes To include drug education in the school curriculum and to involve religious leaders to place the drug education programme in a religious context that seems more acceptable to both the clinical and non-clinical population

Pulmonary tuberculosis in Saudi Arabia: a retrospective study of 1566 patients

A review was conducted of 1566 cases of pulmonary tuberculosis admitted to Sahary Chest Hospital in Riyadh between July 1983 and August 1987. The medical records, chest radiographs, and sputum results were studied. The 21 to 30 year age group represented 40.7% of all patients, which indicates the need for improving measures for the control of tuberculosis in young adults, whose protection may have waned despite BCG vaccination in infancy. Non-Saudi male patients constituted more than half of the admissions which raises the question of the efficacy of the current pulmonary tuberculosis screening policy for individuals entering the Kingdom. The four-drug regimen of rifampicin, isoniazid, pyrazinamide, and ethambutol, when properly supervised, was very effective in achieving early sputum conversion. Based on results of this study, decentralizing tuberculosis services and attaching them to other local and general hospitals appears to be recommended