Phunsup Wongsurakiat

Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer

Abstract The objective of this study was to evaluate the value of bronchoalveolar lavage (BAL) and postbronchoscopic sputum cytology in diagnosing peripheral lung cancer. We performed a prospective study in 55 patients with lesions on chest radiographs who were suspected of having lung cancer and had non‐endoscopically visible lesions on fiberoptic bronchoscopy. The sequence of procedures in all cases was BAL and transbronchial forceps biopsy. The final diagnosis of these patients were primary lung cancer in 30 patients, metatastic lung cancer in five and benign diseases in 20. In the primary lung cancer group, BAL was positive for malignant cells in 14 of the 30 patients (46.7%). In seven (50%) of these patients, the cell type diagnosed by BAL agreed with the final diagnosis. The diagnostic yield of BAL was influenced by the size and segmental location of the lesion. Bronchoalveolar lavage provided a higher diagnostic yield (46.7%) than transbronchial biopsy (16.7%). In five patients with metastatic lung cancer and 20 patients with benign disease, BAL gave negative results in all. Postbronchoscopic sputum cytology was positive in only two of the 26 patients (7.7%) from whom samples could be obtained. Bronchoalveolar lavage cytology proved to be a valuable diagnostic tool in detecting peripheral, primary lung cancer. Postbronchoscopic sputum cytology provided no significant additional information.

Adverse effects associated with influenza vaccination in patients with COPD: a randomized controlled study

Objective:  The aim of this study was to assess the frequency and type of adverse reactions following influenza vaccination and its effects on lung function, dyspnoeic symptoms, exercise capacity, and clinical acute respiratory illness (ARI) in patients with COPD, and the relationship of these adverse effects to the degree of airflow obstruction.

The immunogenicity of intradermal influenza vaccination in COPD patients.

We evaluated the immunogenicity of a reduced-dose intradermal trivalent, inactivated, split-virion seasonal influenza vaccine compared to that of a conventional intramuscular vaccination in chronic obstructive pulmonary disease (COPD) patients. One hundred and fifty-six COPD patients randomly received either 0.2 ml (6 microg hemagglutinin (HA) per strain) split into two-site intradermal (ID) injections or a single 0.5 ml (15 microg HA per strain) intramuscular (IM) injection. Geometric mean titers, seroconversion factors, seroconversion rates and seroprotection rates at 4 weeks post-vaccination in the ID group were less than those in the IM group. Only the seroconversion factor to influenza B in the ID group was statistically less than in the IM group (18.8 in the ID group, n=81 versus 37.3 in the IM group, n=75, p=0.045). Nevertheless, each strain of the ID vaccination met all the Committee for Proprietary Medicinal Products (CPMP) criteria. Seroprotection rates were above 60% throughout the year in influenza A (H3N2), for at least 6 months in influenza A (H1N1) and at least 4 weeks in influenza B in both ID and IM groups. The reduced-dose intradermal vaccination may be considered for use in COPD patients in a vaccine shortage situation.

Induction of Cross-Neutralizing Antibody Against H5N1 Virus After Vaccination with Seasonal Influenza Vaccine in COPD Patients

Archival serum samples from elderly individuals with underlying chronic obstructive pulmonary disease (COPD) who were enrolled in a double-blind case-control study of seasonal influenza vaccine efficacy were assayed for cross-neutralizing antibody formation to avian influenza A (H5N1) virus. Of 118 serum samples, 58 were collected from influenza vaccinees (mean age 68.5 y), and 60 from placebo controls (mean age 68.4 y) who received vitamin B injections. Blood samples were collected before and at 1 mo after seasonal influenza vaccination from all subjects; in addition, for a longitudinal follow-up period of 1 y paired-blood samples were collected again from subjects who developed acute respiratory illness. Hemagglutination inhibition assay for antibodies to influenza A (H1N1), influenza A (H3N2), and influenza B viruses was carried out to determine the serological response to vaccination, and to diagnose influenza viral infection, while microneutralization assays were performed to detect cross-reactive antibody to H5N1 virus. Pre-existing cross-reactive H5N1 antibody at reciprocal titer 10 was found in 6 (10.3%) vaccinees and 4 (6.7%) placebo controls. There was no change in H5N1 antibody titer in these subjects after vaccination. On the other hand, 3 (5.2%) vaccinees developed seroconversion to H5N1 virus at 1 mo after vaccination, even though they had no pre-existing H5N1 antibody in their first blood samples. No cross-neutralizing antibody to H5N1 virus was detected in the placebo controls or in the 22 influenza patients, suggesting that influenza vaccination, but not influenza virus infection, induces cross-neutralizing antibody against avian influenza H5N1 virus.

Comparison between specified percentage and fifth percentile criteria for spirometry interpretation in Thai patients

Objectives: The present study was conducted to determine the degree of agreement between the interpretation of spirometry using a specified percentage of predicted value (SPC) and the fifth percentile (FPC) as the cut off between normal and abnormal.

Clinical pulmonary infection score and a spot serum procalcitonin level to guide discontinuation of antibiotics in ventilator-associated pneumonia: a study in a single institution with high prevalence of nonfermentative gram-negative bacilli infection:

Background We wanted to determine the impact of combined Clinical Pulmonary Infection Score (CPIS) and a spot serum procalcitonin (PCT)-guided protocol to shorten the duration of antibiotic treatment in patients with ventilator-associated pneumonia (VAP), mainly caused by nonfermentative gram-negative bacilli (NF-GNB). Methods Patients with VAP who received appropriate antibiotics for 7 days, temperature ⩽ 37.8°C, without shock, and CPIS ⩽ 6 were allocated to the PCT group or conventional group according to the treating physicians’ decisions. In the PCT group, antibiotics were stopped if the PCT level on day 8 < 0.5 ng/ml. In the conventional group, antibiotics were stopped according to physicians’ discretion. Results There were 24 patients in the PCT group and 26 patients in the conventional group. NF-GNB were responsible for VAP in 79.2% of the PCT group and 65.4% of the conventional group. PCT group had a greater number of antibiotic-free days alive during the 28 days after VAP onset than the conventional group (14.6 ± 5.4 days versus 5.9 ± 5.7 days, respectively; p <.001). In the multivariate, propensity score-adjusted analysis, the PCT group [coefficient = −9.1 (–12.2 to −6); p <.001] and extrapulmonary infections [coefficient = 6.4 (3.3–9.5); p <.001] were independent predictors of total antibiotic exposure days. There was no relapse in both groups. Meanwhile, 12.5% of the PCT group and 26.9% of the conventional group subsequently developed recurrent VAP compatible with superinfections. Conclusions CPIS and a spot serum PCT level appeared effective and safe to guide discontinuation of antibiotic treatment in patients with VAP caused by NF-GNB. Trial registration: TCTR20160726002