Exhaled breath condesate nitric oxide end products and pH in controlled asthma

Asthma imposes a growing burden on the society in terms of morbidity, quality of life, and healthcare costs. It has the highest morbidity amongst inflammatory lung diseases and its prevalence continues to increase over the world. Inquiry into recent day or nighttime symptoms alone underestimates the burden of asthma and may lead to inadequate treatment of asthma. The aim of the present work is to evaluate the role of nitric oxide [NO] and hydrogen ion concentration [pH] levels in exhaled breath condensate [EBC] in cases of controlled bronchial asthma. The present study was conducted on 49 controlled asthmatic patients and 12 control subjects. All patients were subjected to thorough history taking, complete clinical examination and plain postero-anterior chest X-ray. All asthmatics and control subjects were subjected to routine laboratory investigations, spirometric study, EBC collection, processing and analysis for its content of both nitric oxide end products: nitrite and nitrate [NOx] and pH. All asthmatics represented Group IT which was further divided into Group Ia: 34 patients on regular inhaled corticosteroid [ICS] therapy and Group Ib: 15 patients on no regular therapy. The control subjects represented Group II. The forced vital capacity [FVC], forced expiratory volume in the first second [FEV1], FEV1/FVC, peak expiratory flow rate [PEFR] and forced expiratory flow during the middle portion of a forced expiration [FEF 25-75%] were significantly lower in asthmatics than control subjects. The EBC-NOx mean +/- SD in micro mol/L in Group IT [5.99 +/- 1.63], in Group Ia [5.27 +/- 1.26] and in Group Ib [7.63 +/- 1.15] were significantly higher than in Group II [3.66 +/- 0.67] with, respectively [p = 0.000], [p = 0.000] and [p = 0.000]; and was significantly higher in Group Ib than Group Ia [p = 0.000]. The EBC-pH mean +/- SD in Group IT [7.32 +/- 0.27], in Group Ia [7.35 +/- 0.25] and in Group Ib [7.27 +/- 0.3] were significantly lower than in Group II [7.82 +/- 0.09] with, respectively [p = 0.000], [p = 0.000] and [p = 0.000]; with no significant difference between Group Ia and Group Ib. The EBC-NOx was significantly directly correlated to eosinophils count [p = 0.017] and neutrophils count [p = 0.002]; and inversely correlated to FEV1 [p = 0.016], FEV1/FVC [p = 0.001], PEFR [p = 0.030] and EBC-pH [p = 0.003]. The EBC-pH was significantly inversely correlated to eosinophils count [p = 0.017] and neutrophils count [p = 0.036]; and directly correlated to FVC [p = 0.004], FEV1 [p = 0.004] and PEFR [p = 0.000]. EBC-NOx is significantly higher and EBC-pH is significantly lower in asthmatic patients than in control subjects. Asthmatics receiving ICS have a lower EBC-NOx level than those not. EBC-NOx and EBC-pH were significantly correlated and both of them showed significant correlations with spirometric parameters of airway obstruction

Fiberoptic thoracoscopy in management of exudative pleural effusion

Exudative pleural effusion represents a common diagnostic task to the clinician. The two commonest causes of exudative pleural effusion are parapneumonic followed by malignant ones. However, obtaining a definite diagnosis is essential for proper management of the effusion. The aim of this work was to evaluate the role of the fiberoptic bronchoscope used as a thoracoscope in management of exudative pleural effusion. Eighty-four patients with exudative pleural effusion of undetermined etiology were enrolled in this study. All patients were subjected to full history taking, thorough clinical examination, pleural fluid aspiration and analysis, computed tomography of the chest and ultrasound examination of the pleural cavity. Under conscious sedation and local anaesthesia, fiberoptic thoracoscopy was then carried out using fiberoptic bronchoscope inserted through a rigid large siliconized chest tube. After drainage of the pleural fluid, the pleural cavity was carefully explored and multiple forceps biopsies were taken and sent for histopathological examination. Pleurodesis was then done using iodopovidone in patients with apparent pleural pathology. After lung expansion and pleural fluid drainage of less than 100 cc/day, the chest tube was removed. Successful histopathological diagnosis was achieved in all patients. It revealed that 63 [75%] cases had malignant pathology and 21 [25%] cases had inflammatory pathology. The malignant pathology was caused by: bronchogenic carcinoma in 28 [33.3%] cases, malignant mesothelioma in 2 [2.38%] cases and metastatic malignant deposits from other organs in 33 [39.28%] cases. The inflammatory pathology was tuberculosis in 16 [19%] cases and non-specific pleurisy in 5 [5.95%] cases. Pleurodesis was performed and was successful in all the patients. Two [2.38%] patients developed empyema after the procedure and they were successfully managed by intercostals tube drainage and anitibiotic therapy. Other complications encountered included local wound infection in 3 [3.57%] cases, subcutaneous emphysema in 3 [3.57%] cases and chest pain following pleurodesis in 15 [17.85%] cases. Thoracoscopy using the fibroptic bronchoscope is safe and effective. It is an alternative technique to rigid thoracoscopy with some advantages as it allows better exploration of the pleura. It is equally as efficient as the rigid thoracoscope and hardly more time consuming. With proper handling, there will not be any damage or abuse of the fibroptic bronchoscope