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Vol.86 No.4

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Abstract

The healing process of tracheobronchial tuberculosis (TB) results in tracheobronchial fibrosis causing airway stenosis in 11% to 42% of patients. In Korea, where pulmonary TB is still prevalent, post-TB tracheobronchial stenosis (PTTS) is one of the main causes of benign airway stenosis causing progressive dyspnea, hypoxemia, and often life-threatening respiratory insufficiency. The development of rigid bronchoscopy replaced surgical management 30 years ago, and nowadays PTTS is mainly managed by bronchoscopic intervention in Korea. Similar to pulmonary TB, tracheobronchial TB is treated with combination of anti-TB medications. The indication of rigid bronchoscopy is more than American Thoracic Society (ATS) grade 3 dyspnea in PTTS patients. First, the narrowed airway is dilated by multiple techniques including ballooning, laser resection, and bougienation under general anesthesia. Then, most of the patients need silicone stenting to maintain the patency of dilated airway; 1.5 to 2 years after indwelling, the stent could be removed, this has shown a 70% success rate. Acute complications without mortality develop in less than 10% of patients. Subgroup analysis showed successful removal of the stent was significantly associated with male sex, young age, good baseline lung function and absence of complete one lobe collapse. In conclusion, rigid bronchoscopy could be applied to PTTS patients with acceptable efficacy and tolerable safety.

Chung Chaeuk(Chungnam National University School of Medicine) ; Hyon YunKyong(Division of Industrial Mathematics, National Institute for Mathematical Sciences, Daejeon, Republic of Korea) ; Woo Seong-Dae(Division of Pulmonology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon) ; Lee Sunju(Division of Industrial Mathematics, National Institute for Mathematical Sciences, Daejeon, Republic of Korea) ; ; Ha Taeyoung(2Division of Industrial Mathematics, National Institute for Mathematical Sciences, Daejeon, Republic of Korea) ; Yoonjoo Kim(Division of Pulmonology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon) pp.251-263 https://doi.org/10.4046/trd.2023.0065
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Abstract

The stethoscope has long been used for the examination of patients, but the importance of auscultation has declined due to its several limitations and the development of other diagnostic tools. However, auscultation is still recognized as a primary diagnostic device because it is non-invasive and provides valuable information in real-time. To supplement the limitations of existing stethoscopes, digital stethoscopes with machine learning (ML) algorithms have been developed. Thus, now we can record and share respiratory sounds and artificial intelligence (AI)-assisted auscultation using ML algorithms distinguishes the type of sounds. Recently, the demands for remote care and non-face-to-face treatment diseases requiring isolation such as coronavirus disease 2019 (COVID-19) infection increased. To address these problems, wireless and wearable stethoscopes are being developed with the advances in battery technology and integrated sensors. This review provides the history of the stethoscope and classification of respiratory sounds, describes ML algorithms, and introduces new auscultation methods based on AI-assisted analysis and wireless or wearable stethoscopes.

Vertigan Anne E.(Department of Speech Pathology, John Hunter Hospital, Newcastle, 2School of Medicine and Public Health, University of Newcastle, Newcastle, 3Department of Asthma and Breathing, Hunter Medical Research Institute, Newcastle, Australia) pp.264-271 https://doi.org/10.4046/trd.2023.0036
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Abstract

Chronic cough is a common problem that can be refractory to medical treatment. Nonpharmaceutical management of chronic cough has an important role in well selected patients. This review article outlines the history of chronic cough management, current approaches to speech pathology management of the condition and new modalities of nonpharmaceutical treatment. There is a need for further research into nonpharmaceutical options with well described randomised control trials.

Byun Min Kwang(Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea) ; Yong Jun Choi(Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea) ; Hye Jung Park(Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea) ; JaeHwa Cho(Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) pp.272-283 https://doi.org/10.4046/trd.2023.0008
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Abstract

Background: In patients with chronic obstructive pulmonary disease (COPD), decreased muscle mass is a frequently encountered comorbidity in clinical practice. However, the evaluation of muscle mass in patients with COPD in real-world practice is rare.Methods: We retrospectively reviewed the electronic medical records of all patients with COPD who underwent bioelectrical impedance analysis at least once between January 2011 and December 2021 in three hospitals. Then, we analyzed the performance rate of muscle mass measurement in the patients and the correlation between muscle mass, clinical parameters, and COPD prognosis.Results: Among the 24,502 patients with COPD, only 270 (1.1%) underwent muscle mass measurements. The total skeletal muscle mass index was significantly correlated with albumin, alanine transaminase, and creatinine to cystatin C ratio in patients with COPD (r=0.1614, p=0.011; r=0.2112, p=0.001; and r=0.3671, p=0.001, respectively). Acute exacerbation of COPD (AE COPD) was significantly correlated with muscle mass, especially the truncal skeletal muscle mass index (TSMI) in males (r=–0.196, p=0.007). In the multivariate analysis, TSMI and cystatin C were significant risk factors for AE COPD (hazard ratio, 0.200 [95% confidence interval, CI, 0.048 to 0.838] and 4.990 [95% CI, 1.070 to 23.278], respectively).Conclusion: Low muscle mass negatively affects the clinical outcomes in patients with COPD. Despite its clinical significance, muscle mass measurement is performed in a small proportion of patients with COPD. Therefore, protocols and guidelines for the screening of sarcopenia in patients with COPD should be established.

Nyanti Larry Ellee(Medical Department, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu) ; Chua Chia Zhen(Medical Department, Hospital Queen Elizabeth II, Kota Kinabalu) ; Loo Han Chuan(Medical Department, Queen Elizabeth Hospital, Kota Kinabalu) ; Khor Cheng Zhi(Medical Department, Hospital Queen Elizabeth II, Kota Kinabalu) ; Toh Emilia Sheau Yuin(Medical Department, Hospital Queen Elizabeth II, Kota Kinabalu) ; Gill Rasvinder Singh(Medical Department, Queen Elizabeth Hospital, Kota Kinabalu) ; Chan Eng Tat(Medical Department, Hospital Queen Elizabeth II, Kota Kinabalu) ; Tan Ker Yin(Medical Department, Hospital Queen Elizabeth II, Kota Kinabalu) ; Rosli Taufiq(Respiratory Department, Queen Elizabeth Hospital, Kota Kinabalu) ; Rahim Muhammad Aklil Abd(Public Health Department, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu, Malaysia) ; Ibrahim Arfian(Department of Respiratory, Gleneagles Hospital Kota Kinabalu, Kota Kinabalu) ; Huan Nai Chien(Respiratory Department, Queen Elizabeth Hospital, Kota Kinabalu) ; Ramarmuty Hema Yamini Devi(Respiratory Department, Queen Elizabeth Hospital, Kota Kinabalu) ; Kannan Kunji Kannan Sivaraman(Respiratory Department, Queen Elizabeth Hospital, Kota Kinabalu) pp.284-293 https://doi.org/10.4046/trd.2023.0051
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Abstract

Background: Attitudes towards smoking, lung cancer screening, and perceived risk of lung cancer have not been widely studied in Malaysia. The primary objective of this study was to describe the factors affecting the willingness of high-risk current smokers and ex-smokers to undergo low-dose computed tomography (LDCT) screening for lung cancer.Methods: A prospective, cross-sectional questionnaire study was conducted in current smokers or ex-smokers aged between 55 and 80 years at three hospitals in Kota Kinabalu, Sabah, Malaysia. The questionnaire recorded the following parameters: perceived lung cancer risk; Prostate Lung Colon Ovarian Cancer 2012 risk prediction model excluding race and ethnicity predictor (PLCOm2012norace); demographic characteristics; psychosocial characteristics; and attitudes towards lung cancer and lung cancer screening.Results: A vast majority of the 95 respondents (94.7%) indicated their willingness to undergo screening. Stigma of lung cancer, low levels of knowledge about lung cancer symptoms, concerns about financial constraints, and a preference for traditional medication were still prevalent among the respondents, and they may represent potential barriers to lung cancer screening uptake. A desire to have an early diagnosis (odds ratio [OR], 11.33; 95% confidence interval [CI], 1.53 to 84.05; p=0.02), perceived time constraints (OR, 3.94; 95% CI, 1.32 to 11.73; p=0.01), and proximity of LDCT screening facilities (OR, 14.33; 95% CI, 1.84 to 111.4; p=0.01) had significantly higher odds of willingness to undergo screening.Conclusion: Although high-risk current smokers and ex-smokers are likely to undergo screening for lung cancer, several psychosocial barriers persist. The results of this study may guide the policymakers and clinicians regarding the need to improve lung cancer awareness in our population.

Sang Hoon Lee(Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul) ; Hye Jin Jang(Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University) ; Cho Young-Jae(Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital,) ; Eunkyung Lee(Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju) pp.294-303 https://doi.org/10.4046/trd.2022.0149
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Abstract

Background: The human lung serves as a niche for a unique and dynamic bacterial community related to the development and aggravation of multiple respiratory diseases. Therefore, identifying the microbiome status is crucial to maintaining the microecological balance and maximizing the therapeutic effect on lung diseases. Therefore, we investigated the histological type-based differences in the lung microbiomes of patients with lung cancer.Methods: We performed 16S rRNA sequencing to evaluate the respiratory tract microbiome present in bronchoalveolar lavage fluid. Patients with non-small cell lung cancer were stratified based on two main subtypes of lung cancer: adenocarcinoma and squamous cell carcinoma (SqCC).Results: Among the 84 patients analyzed, 64 (76.2%) had adenocarcinoma, and 20 (23.8%) had SqCC. The α- and β-diversities showed significant differences between the two groups (p=0.004 for Chao1, p=0.001 for Simpson index, and p=0.011 for PERMANOVA). Actinomyces graevenitzii was dominant in the SqCC group (linear discriminant analysis [LDA] score, 2.46); the populations of <i>Haemophilus parainfluenza</i> (LDA score, 4.08), <i>Neisseria subflava</i> (LDA score, 4.07), <i>Porphyromonas endodontalis</i> (LDA score, 3.88), and <i>Fusobacterium nucleatum</i> (LDA score, 3.72) were significantly higher in the adenocarcinoma group.Conclusion: Microbiome diversity is crucial for maintaining homeostasis in the lung environment, and dysbiosis may be related to the development and prognosis of lung cancer. The mortality rate was high, and the microbiome was not diverse in SqCC. Further large-scale studies are required to investigate the role of the microbiome in the development of different lung cancer types.

Sang-Won Um(Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea) ; Hyewon Lee(Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences) ; Mina Hwang(Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea) ; Seonae Jang(Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea) pp.304-318 https://doi.org/10.4046/trd.2022.0129
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Abstract

Background: Cancer-associated fibroblasts (CAFs) are key components of the tumor microenvironment and significantly contribute to immune evasion. We investigated the effects of CAFs on the immune function of CD4+ and CD8+ T cells in non-small cell lung cancer (NSCLC).Methods: We isolated CAFs and normal fibroblasts (NFs) from tumors and normal lung tissues of NSCLC patients, respectively. CAFs were co-cultured with activated T cells to evaluate their immune regulatory function. We investigated the effect of CAF conditioned medium (CAF-CM) on the cytotoxicity of T cells. CAFs were also co-cultured with activated peripheral blood mononuclear cells and further incubated with cyclooxygenase- 2 (COX2) inhibitors to investigate the potential role of COX2 in immune evasion.Results: CAFs and NFs were isolated from the lung tissues (n=8) and lymph nodes (n=3) of NSCLC patients. Immune suppressive markers, such as COX2 and programmed death-ligand 1 (PD-L1), were increased in CAFs after co-culture with activated T cells. Interestingly, CAFs promoted the expression of programmed death-1 in CD4+ and CD8+ T cells, and strongly inhibited T cell proliferation in allogenic and autologous pairs of CAFs and T cells. CAF-CM decreased the cytotoxicity of T cells. COX2 inhibitors partially restored the proliferation of CD4+ and CD8+ T cells, and downregulated the expression of COX2, prostaglandin E synthase, prostaglandin E2, and PD-L1 in CAFs.Conclusion: CAFs promote immune evasion by suppressing the function of CD4+ and CD8+ T cells via their effects on COX2 and PD-L1 in NSCLC. The immunosuppressive function of CAFs could be alleviated by COX2 inhibitors.

Pawan Kumar Singh(Pulmonary and Critical Care Medicine Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India) ; Kuldeep Gulia(Pulmonary and Critical Care Medicine Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India) ; Suresh Singhal(Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India) ; Promil Jain(Pathology Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India) ; Dhruva Chaudhry(Pulmonary and Critical Care Medicine Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India) ; Aman Ahuja(Pulmonary and Critical Care Medicine Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India) pp.319-321 https://doi.org/10.4046/trd.2023.0074

Tuberculosis & Respiratory Diseases