Prognostic factors in the management of exacerbation of chronic obstructive pulmonary disease in Kuwait

To evaluate the clinical presentation and the factors of prognostic importance in the management of exacerbation of chronic obstructive pulmonary disease [COPD]. Subjects and One hundred and four patients who were hospitalized because of exacerbation of COPD between 1996 and 2000 were selected for further evaluation. Only patients who fulfilled the American Thoracic Society criteria for diagnosis of COPD were included. The factors examined included age, clinical features, duration of symptoms of exacerbation, severity of underlying disease, comorbid diseases, level of consciousness, previous hospitalization, intubation and assisted ventilation, hypercapnia, degree of acidemia and complications. Seventy-four of 104 [71%] hospitalized patients reviewed met the inclusion criteria for COPD. The mean age was 63.68 ' 12.6 years. There was a male:female ratio of 3:1. Fifty-eight patients [78%] had a baseline FEV1 <50% before hospitalization and 45 [64%] had previous hospitalization. Comorbid disease was found in 50% of the cases, while 78% had acidemia and 70% hypercapnia. Fourteen [19%] died on admission. Risk factors identified included severity of disease [p < 0.05]; presence of comorbid disease [p < 0.01]; acidemia [p < 0.0001]; hypercapnia [p < 0.0001]; previous hospitalization [p < 0.01], and assisted ventilation [p < 0.001]. This study revealed that the presence of comorbid disease, acidemia, previous hospitalization and assisted ventilation significantly contributed to mortality in patients with exacerbation of COPD.

Prevalence and severity of symptoms of asthma, allergic rhinoconjiunctivitis, and atopic eczema in 6-to 7-year-old Nigerian primary school children: the international study of asthma and allergies in childhood

To determine the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis and eczema in Nigerian children aged 6-7 years. Subjects and A cross-sectional study of selected children in primary schools in Ibadan, Nigeria was conducted using phase I of the International Study of Asthma and Allergies in Childhood [ISAAC] format. Standardized questionnaires were distributed to parents and guardians of 2,325 children aged 6-7 years in 31 primary schools randomly selected among 272 in Ibadan. Data was collected from 1,704 children [797 boys and 907 girls; M:F ratio 1:1.14], giving a participation rate of 73.3%. Both recent rhinoconjunctivitis and wheeze were reported by 5.1%, and itchy flexural rash in the past 12 months was reported by 8.5%. The cumulative prevalences of reported symptoms of wheezing, rhinitis and eczema were 7.2, 11.3 and 10.1%, respectively. These symptoms were basically the same among the boys and girls [rhinitis 11.4 vs. 11.2%; eczema 10.7 vs. 9.5%], except for wheezing, which was higher in boys [9.0%] than girls [5.6%], p = 0.015. Current symptoms of rhinitis and atopic eczema were associated with current wheeze and severe wheezing, whereas current symptoms of allergic rhinoconjunctivitis were only associated with severe wheezing attacks. One or more current symptoms occurred in 13.2% of the children, and all three symptoms were reported by 0.5%. The study demonstrates a high prevalence of atopic conditions among children 6-7 years old in Ibadan, Nigeria, with more than three fifths of the children who had current wheezing also showing symptoms of other atopic diseases. Children with allergic rhinoconjunctivitis were more likely to have severe wheezing attacks if they had developed atopic eczema before 2 years of age

Clinical patterns of diffuse parenchymal lung disease in Kuwait: aprospective study

To report our experience of the clinicopathological patterns of diffuse parenchymal lung disease [DPLD]. Subjects and Over a 4-year period, 75 patients [41 males, 34 females], aged 13-76 years, who were referred to Mubarak Al-Kabeer and the Chest Diseases Hospitals, Kuwait with a diagnosis of diffuse lung disease, were included in the study. After a comprehensive history and physical examination, further investigations were done, including hematological and immunological profiles, sputum and bronchoalveolar lavage fluid examination, chest radiograph, high resolution computed tomography [HRCT], pulmonary function test and lung biopsy. Of the 75 patients 60 [80%] were over 40 years of age. The duration of symptoms in 34 patients [45%] was less than 6 months and longer than 1 year in 28 [37.7%] patients. Twenty-five of the patients were cigarette smokers. The mean forced lung capacity [FVC], total lung capacity and diffusing capacity for carbon monoxide were less than 60% of the predicted values in most patients. There was a significant difference in mean FVC value between smokers and nonsmokers [p < 0.05]. The HRCT findings were at an advanced stage in 65 patients, with additional honeycombing in 21 of the 65 patients. Idiopathic pulmonary fibrosis was the most common cause of DPLD, occurring in 52 patients, followed by sarcoidosis and collagen vascular diseases. DPLD was observed predominantly in middle aged and elderly patients, due probably to increasing industrialization in the country. The role of cigarette smoking as a contributory factor remains unclear

Risk factors and outcome in Patients with severe acute asthma requiring mechanical ventilation

Severe acute asthma has been recognized as a cause of significant morbidity and mortality. Mechanical ventilation may be necessary to support life in the most critically ill patients. In this study, we set out to identify factors which may affect the outcome of management in severe acute asthma. Patients with severe acute asthma admitted to the intensive care unit of the Mubarak Al-Kabeer Hospital, Kuwait, over a 2-year period [1996 and 1997] were recruited for the study. The clinical features at presentation, drug treatment and the type of ventilation used, the duration of ventilation and the outcome were monitored. PaCO2, pH, and ventilation parameters were monitored. Thirty patients selected from a total of 36 patients admitted to the intensive care unit with diagnosis of severe acute asthma were studied. Twenty-one [70%] of these patients were mechanically ventilated. The duration of ventilation, and the duration in the intensive care unit for the patients who developed complications and for those who did not were found to be significant [p < 0.02 and p < 0.01, respectively]. There was no statistical difference in patients with or without complications in the following parameters at presentation: pulse rate, respiratory rate, pH, PaCO2, duration of onset of symptoms, peak airway pressure, minute ventilation, tidal volume, and fraction of inspired oxygen. Two [9.5%] patients died. Factors found to affect outcome include duration of intubation, duration in intensive care unit and pulse rate at presentation. This study revealed that mechanical ventilation is effective and safe in management when it is critically applied and monitored