Medicina Pulmonar e Respiratória

Background: Self-management of asthmatics is thought to facilitate early detection and treatment of asthma exacerbations, and to reduce asthma-related morbidity and mortality.
Aim: To evaluate the efficacy of a self-management program on the long-term follow-up of asthma and determine the factors influencing the success of such program in asthmatic patients.
Methods: Objective parameters (criteria of asthma control, FEV1 and FEV1/FVC) were assessed at inclusion and at the end of the retrospective study, 8.9±8 years later, using a 1-year recall patient-based questionnaire and lung function measurements.
Results: Among the 112 patients who answered the questionnaire (63% of response), 69 patients followed the self-management program, either partially with the help of a phone call to their physician (22%) or exclusively (78%), the latter displaying higher education levels (p<0.05). In the “self-management” group, GINA status was stabilized or improved (80%), FEV1 was significantly improved, a less frequent use of emergency services was reported, corticosteroid dependence was reduced (22% vs. 7%, p=0.03) and smoking dropped (p=0.05). Additionally, higher global quality of life scores were obtained in the self-management group (21% vs. 7.9%, p= 0.05).
Conclusion: A self-management program significantly improved control of asthma and quality of life of asthmatics. Because control of asthma is lacking for the vast majority of asthmatics, these results argue for an usual employment of such program in the long term follow-up of asthmatics.

Bronchial cast is a rare clinical problem that is more often reported in children than in adults. Reported mean ages ranges from 4 to 12.8 years. It is associated with underlying diseases such as asthma, cystic fibrosis, allergic bronchopulmonary aspergillosis, and congenital heart defects. Bronchial casts vary in size, and clinical presentations may differ depending on the size of the casts. Prognosis also depends on the associated disease and the type of cast, ranging from rapid recovery after cast removal to life-threating respiratory impairment. It is generally expectorated spontaneously or with a cough, but sometimes needed bronchoscopy to remove from bronchi. Moreover, the understanding of pathogenesis is still insufficient. There have been reported a few cases of bronchial cast with hemoptysis in patients without an underlying disease. Herein, we report a patient with bronchial cast following hemoptysis, secondary to an aortopulmonary collateral artery, in the absence of a lung or systemic disease.

Background: The use of noninvasive positive pressure ventilation (NIPPV) in treating of respiratory failure with diverse etiology is now widely studied. The recent increase in the use of NIPPV in the critical care units has been motivated by the desire to minimize complications of invasive ventilation. The present study was conducted to study the indications, outcome and complications of NIPPV in acute respiratory failure patients.
Material and Methods: In this prospective observational study, a total 110 adult patients of respiratory failure and impending respiratory failure due to various diseases attending a tertiary care centre and admitted in intensive respiratory care unit were studied for outcome and complications of NIPPV utilization.
Results: The most common indication of NIPPV was exacerbation of COPD 37 (33.63%) followed by post extubation 30 (27.27%), asthma 14 (12.72%), ARDS 9 (8.18%) and pneumonia 10 (9.09%). NIPPV was effective in 88 (80%) and non-effective in 22 (20%). There was significant improvement which also persisted after successful weaning. Common complications observed were dry mouth in 60 (54.54%) patients, facial injury in 21 (19.09%) patients.
Discussion: NIPPV can be utilized as an effective modality in the management of ARF due to diverse etiologies. NIPPV was associated with a reduced need for invasive mechanical ventilation and significant outcome and minor complications.

Sarcoidosis is a disease of involving the unusual accumulation on inflammatory cells which forms lumps called as granulomas. Though the pathogenesis remains undefined, it has been proposed that an initial CD4+ T cell infiltration is the spark in the inflammatory cascade that results in granulomatous formation in affected organs. In this case report we have described an unusual presentation of sarcoidosis detailing the mutable iterations of this disease.