William Lunn

Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial.

RATIONALE Bronchial thermoplasty (BT) is a bronchoscopic procedure in which controlled thermal energy is applied to the airway wall to decrease smooth muscle. OBJECTIVES To evaluate the effectiveness and safety of BT versus a sham procedure in subjects with severe asthma who remain symptomatic despite treatment with high-dose inhaled corticosteroids and long-acting beta(2)-agonists. METHODS A total of 288 adult subjects (Intent-to-Treat [ITT]) randomized to BT or sham control underwent three bronchoscopy procedures. Primary outcome was the difference in Asthma Quality of Life Questionnaire (AQLQ) scores from baseline to average of 6, 9, and 12 months (integrated AQLQ). Adverse events and health care use were collected to assess safety. Statistical design and analysis of the primary endpoint was Bayesian. Target posterior probability of superiority (PPS) of BT over sham was 95%, except for the primary endpoint (96.4%). MEASUREMENTS AND MAIN RESULTS The improvement from baseline in the integrated AQLQ score was superior in the BT group compared with sham (BT, 1.35 +/- 1.10; sham, 1.16 +/- 1.23 [PPS, 96.0% ITT and 97.9% per protocol]). Seventy-nine percent of BT and 64% of sham subjects achieved changes in AQLQ of 0.5 or greater (PPS, 99.6%). Six percent more BT subjects were hospitalized in the treatment period (up to 6 wk after BT). In the posttreatment period (6-52 wk after BT), the BT group experienced fewer severe exacerbations, emergency department (ED) visits, and days missed from work/school compared with the sham group (PPS, 95.5, 99.9, and 99.3%, respectively). CONCLUSIONS BT in subjects with severe asthma improves asthma-specific quality of life with a reduction in severe exacerbations and healthcare use in the posttreatment period. Clinical trial registered with www.clinialtrials.gov (NCT00231114).

Multislice CT evaluation of airway stents.

Tracheobronchial stents are playing an increasing role in the palliative treatment of large airway obstruction due to a variety of conditions, including extrinsic compression, intraluminal disease, and malacia. Computed tomography (CT) plays an important role in aiding planning of stent placement and in detecting various stent complications. In this pictorial essay, we illustrate and review the role of multislice CT in the pre- and post-stent placement settings. A special emphasis is placed upon the characteristic CT appearance of specific stent complications and upon the role of CT multiplanar reformations and 3-dimensional (3-d) reconstruction techniques.

Outcomes, Health-Care Resources Use, and Costs of Endoscopic Removal of Metallic Airway Stents

BACKGROUND The use of self-expandable metallic airway stents (SEMAS) for airway compromise may be associated with significant complications requiring their removal/replacement. The aim of this study is to describe the complications, health-care resources use (HRU), and costs associated with endoscopic removal of SEMAS. METHODS A retrospective analysis of patients who underwent endoscopic removal of SEMAS during a 10-year period (January 2000-August 2009) was performed. HRU was analyzed in terms of the number of endoscopic procedures, hospital and ICU stay, need for mechanical ventilation and airway restenting, and estimation of respective hospital costs. RESULTS Fifty-five SEMAS were removed from 46 patients with a mean age of 58.6 +/- 15.8 years. Eighty percent of the stents were placed for benign airway disorders with an average stent in situ duration of 292 days. The median number of removal and total procedures during each encounter was one and two, respectively. Patients required hospitalization and ICU admission in 78% and 39% of the encounters with a median length of stay of 3.5 and 0 days, respectively. The estimated median total cost per encounter to remove the stents was

Reducing Maintenance and Repair Costs in an Interventional Pulmonology Program

10,700, ranging from

Pleural Effusion After Ventricular Assist Device Placement: Prevalence and Pleural Fluid Characteristics

3,700 to

An unusual case of hürthle cell carcinoma presenting as metastatic pleural disease 16 years after thyroidectomy.

69,800. The measured outcomes were statistically significantly better when in situ stent duration was <or= 30 days (P < .05). CONCLUSIONS Endoscopic removal of SEMAS is feasible; however, it is associated with significant complications, HRU, and costs. The use of SEMAS should be restricted to a well-selected patient population and should be planned by a team experienced with this type of therapeutic strategy.

Transbronchial versus Transesophageal Ultrasound-guided Aspiration of Enlarged Mediastinal Lymph Nodes

BACKGROUND In the current economic climate, hospitals and academic institutions demand that medical departments function in an efficient and cost-effective manner. Detailed business plans are necessary to build new clinical programs, and institutions have learned that new programs are associated with significant costs for purchasing and maintaining equipment. We report our experience with repairs to equipment before and after starting our interventional pulmonary (IP) program, and with the effect of an educational program on reducing these costs. METHODS We retrospectively studied the costs of equipment repair in the 3 years preceding and in the 5 years following the development of an IP program in our institution, a university-based tertiary referral center. We also studied the effect of an educational program that was designed to enhance the skills of physicians and technical staff in handling the equipment. RESULTS The cost of repairs to the equipment during the 3 years prior to the development of the IP program was

Endoscopic Removal of Metallic Airway Stents

42 (US dollars) per procedure. In the initial 3 years following the start of the IP program, the yearly average cost rose 21% to

Relapsing polychondritis: prevalence of expiratory CT airway abnormalities.

51 per procedure. After the introduction of the educational program, the yearly repair costs decreased by 84% to

Ultrasound vs CT in Detecting Chest Wall Invasion by Tumor: A Prospective Study

8 per procedure. Based on our experience, we estimate that a reasonable budget for the cost of repairs is