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1.
Diagnostics (Basel) ; 12(10)2022 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-36292061

RESUMO

Background: Since December 2019, SARS-CoV-2 has been causing cases of severe pneumonia in China and has spread all over the world, putting great pressure on health systems. Nasopharyngeal swab (NPS) sensitivity is suboptimal. When the SARS-CoV-2 infection is suspected despite negative NPSs, other tests may help to rule out the infection. Objectives: To evaluate the yield of the lower respiratory tract (LRT) isolation of SARS-CoV-2. To evaluate the correlations between SARS-CoV-2 detection and clinical symptoms, and laboratory values and RSNA CT review scores in suspect patients after two negative NPSs. To assess the safety of bronchoscopy in this scenario. Method: A retrospective analysis of data from LRT sampling (blind nasotracheal aspiration or bronchial washing) for suspected COVID-19 after two negative NPS. Chest CT scans were reviewed by two radiologists using the RSNA imaging classification. Results: SARS-CoV-2 was detected in 14/99 patients (14.1%). A correlation was found between SARS-CoV2 detection on the LRT and the presence of a cough as well as with typical CT features. Typical CT resulted in 57.1% sensitivity, 80.8% accuracy and 92.3% NPV. Neither severe complications nor infections in the personnel were reported. Conclusions: In suspect cases after two negative swabs, CT scan revision can help to rule out COVID-19. In selected cases, with consistent CT features above all, LRT sampling can be of help in confirming COVID-19.

2.
Eur Respir J ; 50(4)2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28982774

RESUMO

Inhaled corticosteroid-containing medications reduce the frequency of COPD exacerbations (mainly infectious in origin) while paradoxically increasing the risk of other respiratory infections. The aim was to determine the effects of inhaled corticosteroids on airway microbial load in COPD patients and evaluate the influence of the underlying inflammatory profile on airway colonisation and microbiome.This is a proof-of-concept prospective, randomised, open-label, blinded endpoint study. Sixty patients with stable moderate COPD were randomised to receive one inhalation twice daily of either a combination of salmeterol 50 µg plus fluticasone propionate 500 µg or salmeterol 50 µg for 12 months. The primary outcome was the change of sputum bacterial loads over the course of treatment.Compared with salmeterol, 1-year treatment with salmeterol plus fluticasone was associated with a significant increase in sputum bacterial load (p=0.005), modification of sputum microbial composition and increased airway load of potentially pathogenic bacteria. The increased bacterial load was observed only in inhaled corticosteroid-treated patients with lower baseline sputum or blood eosinophil (≤2%) levels but not in patients with higher baseline eosinophils.Long-term inhaled corticosteroid treatment affects bacterial load in stable COPD. Lower eosinophil counts are associated with increased airway bacterial load.


Assuntos
Carga Bacteriana , Glucocorticoides , Efeitos Adversos de Longa Duração , Doença Pulmonar Obstrutiva Crônica , Infecções Respiratórias , Escarro/microbiologia , Carga Viral , Administração por Inalação , Carga Bacteriana/efeitos dos fármacos , Carga Bacteriana/métodos , Broncodilatadores/administração & dosagem , Broncodilatadores/efeitos adversos , Monitoramento de Medicamentos/métodos , Eosinófilos/patologia , Feminino , Fluticasona/administração & dosagem , Fluticasona/efeitos adversos , Volume Expiratório Forçado , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/microbiologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/microbiologia , Testes de Função Respiratória , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/microbiologia , Xinafoato de Salmeterol/administração & dosagem , Xinafoato de Salmeterol/efeitos adversos , Resultado do Tratamento , Carga Viral/efeitos dos fármacos , Carga Viral/métodos
4.
ScientificWorldJournal ; 2013: 927835, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24453924

RESUMO

BACKGROUND: Inhalation of thermal water with antioxidant properties is empirically used for COPD. AIMS: To evaluate the effects of sulphurous thermal water (reducing agents) on airway oxidant stress and clinical outcomes in COPD. METHODS: Forty moderate-to-severe COPD patients were randomly assigned to receive 12-day inhalation with sulphurous thermal water or isotonic saline. Patients were assessed for superoxide anion (O2 (-)) production in the exhaled breath condensate and clinical outcomes at recruitment, the day after the conclusion of the 12-day inhalation treatment, and one month after the end of the inhalation treatment. RESULTS: Inhalation of reducing agents resulted in a significant reduction of O2 (-) production in exhaled breath condensate of COPD patients at the end of the inhalatory treatment and at followup compared to baseline. A significant improvement in the COPD assessment test (CAT) questionnaire was shown one month after the end of the inhalatory treatment only in patients receiving sulphurous water. CONCLUSION: Thermal water inhalation produced an in vivo antioxidant effect and improvement in health status in COPD patients. Larger studies are required in order to evaluate whether inhalation of thermal water is able to modify relevant clinical outcomes of the disease (the study was registered at clinicaltrial.gov-identifier: NCT01664767).


Assuntos
Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Substâncias Redutoras/uso terapêutico , Explosão Respiratória/efeitos dos fármacos , Enxofre/administração & dosagem , Administração por Inalação , Idoso , Idoso de 80 Anos ou mais , Antioxidantes/uso terapêutico , Testes Respiratórios , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Resultado do Tratamento , Água
5.
Clin Chest Med ; 33(3): 473-84, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22929096

RESUMO

There are increasing data to support the "hygiene" and "microbiota" hypotheses of a protective role of infections in modulating the risk of subsequent development of asthma. There is less evidence that respiratory infections can actually cause the development of asthma. There is some evidence that rhinovirus respiratory infections are associated with the development of asthma, particularly in childhood, whereas these infections in later life seem to have a weaker association with the development of asthma. The role of bacterial infections in chronic asthma remains unclear. This article reviews the available evidence indicating that asthma may be considered as a chronic infectious disease.


Assuntos
Asma/microbiologia , Doença Crônica , Humanos , Infecções Respiratórias/microbiologia
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