Age as a Risk Factor in the Occurrence of Complications during or after Bronchoscopic Lung Biopsy.

INTRODUCTION: Bronchoscopic lung biopsy (BLB) is a widely used procedure. As the world's population is ageing, more BLBs are performed for older people with comorbidities. The aim of the study was to investigate if an older age is a risk factor for BLB related complications. MATERIALS AND METHODS: A prospective study at the Centre of Pulmonology and Allergology of Vilnius University Hospital Santaros klinikos was conducted. Seven hundred and eighty-six patients (male 60.6%), mean age 57 ± 16, who underwent BLB, were included. The complications that occurred due to BLB were evaluated. Bleeding and pneumothorax were classified into I° or II° grades depending on their severity. Potential determinants, which may increase the risk of complications, emphasizing on age, were analyzed. RESULTS: Fifty-seven (7.2%) BLB-related complications occurred. There were 27 (3.4%) pneumothoraxes, and 19 (70%) of them required thoracic drainage. Thirty (3.8%) bleeding complications occurred, and four (16%) of them were severe. Higher rates of bleeding were found in the age group ≥65 years, p = 0.001. The risk of bleeding in older patients was 3.2 times higher (95% CI 1.51-6.87). CONCLUSIONS: Older age is related to a higher incidence of mild bleeding during BLB. However, the risk of life-threatening complications is low despite the age, and older age should not be considered as a contraindication for the procedure if needed.

Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness.

Background and Objective: Obstructive sleep apnea (OSA) is a heterogeneous chronic sleep associated disorder. A common apnea-hypopnea index (AHI)-focused approach to OSA severity evaluation is not sufficient enough to capture the extent of OSA related risks, it limits our understanding of disease pathogenesis and may contribute to a modest response to conventional treatment. In order to resolve the heterogeneity issue, OSA patients can be divided into more homogenous therapeutically and prognostically significant groups-phenotypes. An improved understanding of OSA phenotype relationship to treatment effectiveness is required. Thus, in this study several clinical OSA phenotypes are identified and compared by their treatment effectiveness. Methods and materials: Retrospective data analysis of 233 adult patients with OSA treated with continuous positive airway pressure (CPAP) was performed. Statistical analysis of data relating to demographic and anthropometric characteristics, symptoms, arterial blood gas test results, polysomnografic and respiratory polygraphic tests and treatment, treatment results was performed. Results: 3 phenotypes have been identified: "Position dependent (supine) OSA" (Positional OSA), "Severe OSA in obese patients" (Severe OSA) and "OSA and periodic limb movements (PLM)" (OSA and PLM). The highest count of responders to treatment with CPAP was in the OSA and PLM phenotype, followed by the Positional OSA phenotype. Treatment with CPAP, despite the highest mean pressure administered was the least effective among Severe OSA phenotype. Conclusions: Different OSA phenotypes vary significantly and lead to differences in response to treatment. Thus, treatment effectiveness depends on OSA phenotypes and treatment techniques other than CPAP may be needed. This emphasizes the importance of a more individualized approach when treating OSA.

Diagnosing COPD in primary care: what has real life practice got to do with guidelines?

BACKGROUND: The role of primary care physician in COPD management varies in different health care systems. According to the researches in various countries, extent of spirometry use in diagnosing and grading COPD frequently remains insufficient. Inaccurate diagnosis results in mistreatment and disease progression.The aims of our study were to investigate the accuracy of COPD diagnosis, grading, and treatment according to guidelines in daily practice of primary care. METHODS: A retrospective analysis of ambulatory records in a large primary care center was conducted. Digital medical records of current patients were screened for ICD-10-AM codes J44.0, J44.1, J44.8 and J44.9. All medical records starting from the first visit in this primary care center were reviewed. RESULTS: Two hundred twenty-eight patients diagnosed with COPD were included in the study, 118 male, mean age 67 yrs. (SD 14). A spirometry report was available to 58% of the patients, 75% of them met the guidelines for COPD diagnosis. The grade was correct for 56.8% of the patients. 54% were consulted by the pulmonologist at least once. After re-analyzing spirometry, correcting the diagnosis, and grading, it was determined that only 70% of the patients were receiving appropriate treatments. Sixteen per cent of patients were undertreated and 14% were overtreated. CONCLUSIONS: COPD care in primary practice remains suboptimal. Incorrect approach often leads to incorrect grading and mistreatment. Points for improvement should be identified in further studies.