Saudi guidelines for the diagnosis and management of COPD

The Saudi Thoracic Society [STS] launched the Saudi Initiative for Chronic Airway Diseases [SICAD] to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease [COPD]. This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test [CAT] and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation [<2 in the past year] can be classified as either Class I when they have less symptoms [CAT < 10] or Class II when they have more symptoms [CAT >/= 10]. High-risk COPD patients, as manifested with >/= 2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score >/= 10. The article also discusses the diagnosis and management of acute exacerbations in COPD.

Sleep apnea syndrome: a report of 20 Saudi patients

Patients with sleep apnea syndrome [SAS] suffer considerable morbidity and increased mortality. The most common symptoms of SAS include excessive daytime sleepiness, nocturnal breath cessation, snoring and gasping sounds. We reviewed the characteristics of 20 Saudi patients with sleep apnea [15 males, five females] who were studied at our tertiary care center in 1992 and 1993. The ages ranged from 15 to 61 years. All were obese. Two each were acromegalic and hypothyroid. Hypertension was noted in seven [35%] patients and one had symptomatic bradycardia. Two [10%] patients presented with recurrent pulmonary emboli and two were involved in multiple road traffic accidents as a result of falling asleep while driving. One male student had poor performance at school. Three patients were known to have chronic obstructive airway disease. Six males and one female were hypercapnic [PCO[2]]> 6.1 kPa] while 10 patients had hypoxemia [paO[2]<8.0kpa]. Four patients were polycythemic. Pulmonary function tests showed that 15 [75%] had restrictive patterns, three [15%] had obstructive patterns and two [10%] had mixed patterns. A [saw-tooth] pattern was seen in the inspiratory limb of a flow-volume curve in four patients. Daytime polysomnography showed that eight had obstructive sleep apnea, four had central sleep apnea and six had mixed type sleep apnea. Both hypothyroid patients improved with replacement therapy; one acromegalic patient and one patient with tracheal stenosis responded to specific treatment. Nasal positive airway pressure machine [BIPAP[tm] Resperonics Inc] was effective in relieving apnea and reducing symptoms in five patients. None of the patients were able to lose a substantial amount of weight. All these patients were investigated extensively at different places prior to establishing the diagnosis