The natural history of lung hyperinflation in patients with airway obstruction is unknown. In particular, little information exists about the extent of air trapping and its reversibility to bronchodilator therapy in those with mild airway obstruction. We completed a retrospective analysis of data from individuals with airway obstruction who attended our pulmonary function laboratory and had plethysmographic lung volume measurements pre-and post-bronchodilator (salbutamol). COPD was likely the predominant diagnosis but patients with asthma may have been included. We studied 2,265 subjects (61% male), age 65 ± 9 years (mean ± SD) with a postbronchodilator FEV 1 /FVC <0.70. We examined relationships between indices of airway obstruction and lung hyperinflation, and measured responses to bronchodilation across subgroups stratified by GOLD criteria. In GOLD stage I, vital capacity (VC) and inspiratory capacity (IC) were in the normal range; pre-bronchodilator residual volume (RV), functional residual capacity (FRC) and specific airway resistance were increased to 135%, 119% and 250% of predicted, respectively. For the group as a whole, RV and FRC increased exponentially as FEV 1 decreased, while VC and IC decreased linearly. Regardless of baseline FEV 1 , the most consistent improvement following bronchodilation was RV reduction, in terms of magnitude and responder rate. In conclusion, increases (above normal) in airway resistance and plethysmographic lung volumes were found in those with only minor airway obstruction. Indices of lung hyperinflation increased exponentially as airway obstruction worsened. Those with the greatest resting lung hyperinflation showed the largest bronchodilator-induced volume deflation effects. Reduced air trapping was the predominant response to acute bronchodilation across severity subgroups.

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is one of the districts in Chiang Mai, Thailand facing high level of seasonal air pollution every year, the exposure of community dwellers to outdoor air pollutants 24 hours a day during seasonal smog period because of their open-air housing style, and agricultural occupational hazard. In addition, Chiang Dao hospital is the only available hospital serving the community with open-air wards; therefore we could certainly to identify the association between air pollution and mortality of hospitalized patients. Thus, the aim of this study was to determine the association between daily average seasonal air pollutants and daily mortality of hospitalized patients and community dwellers as well as emergency and hospitalization visits for serious respiratory, cardiovascular, and cerebrovascular diseases. Methods: This time series study was conducted between 1 March 2016 and 31 March 2017. The association of various air pollutant concentrations including particulate matter diameter less than 10 and 2.5 microns (PM 10 and PM 2.5), sulfur dioxide (SO 2), nitrogen dioxide (NO 2), carbon monoxide (CO), ozone (O 3) and daily mortality of hospitalized patients and community dwellers as well as relationship with frequencies of serious respiratory, cardiovascular, and cerebrovascular diseases were analyzed using a general linear model with Poisson distribution. Results: Only PM 2.5 was found to be associated with increased daily mortality of hospitalized patients (lag day 6, adjusted RR =1.153, 95% CI: 1.001-1.329), whereas PM 10 , PM 2.5 , NO 2 , and O 3 were associated with increased daily non-accidental mortality of community dwellers (lag day 0-7, adjusted RR =1.006-1.040, 95% CI: 1.000-1.074). For acute serious respiratory events; PM 10 and PM 2.5 were associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), while SO 2 , CO, and O 3 were associated with emergency visits for community-acquired pneumonia (CAP). O 3 was associated with emergency visits for heart failure (HF), NO 2 with emergency visits for myocardial infarction (MI), and SO 2 with hospitalized visits for cerebrovascular accident (CVA). Conclusions: Seasonal air pollutants were found to be associated with higher mortality among hospitalized patients and community dwellers with varying effects on severe acute respiratory, cardiovascular, and cerebrovascular diseases.

Patients receiving botulinum antitoxin on day 4 had decreased ventilator dependency. In addition, for patients with foodborne botulism, an effective referral system and team of specialists are needed.

The combined mechanical effects of obesity and COPD reduced operating lung volumes at rest and throughout exercise with favorable influences on dyspnea perception and peak oxygen uptake during cycle ergometry.

Perceptual responses to MCh-induced bronchoconstriction and lung hyperinflation were similar in obese and normal-weight individuals with asthma despite significant group differences in baseline lung volumes.

SUMMARY:We conducted a retrospective cohort study in the medical intensive care unit of Chaing Mai University Hospital to describe the epidemiology of ventilator-associated pneumonia (VAP) and identify prognostic indicators of 30-day VAP mortality. A total of 621 patients diagnosed with VAP between January 2005 and December 2011 were included. The overall 30-day mortality rate was 44.4z. The major causative pathogens were Acinetobacter baumannii (54.3z), Pseudomonas aeruginosa (35.2z), and methicillin-resistant Staphylococcus aureus (15.1z). Most A. baumannii (90.2z) comprised drug-resistant strains. Identified prognostic indicators were co-morbid malignancy (hazard ratio [HR] ＝ 1.60; 95z confidence interval [CI] 1.02-2.42; P ＝ 0.040), septic shock (HR ＝ 2.51; 95z CI, 1.60-4.00; P ＜ 0.001), Simplified Acute Physiology Score II ＞45 (HR ＝ 1.62; 95z CI, 1.03-2.56; P ＝ 0.041), Sequential Organ Failure Assessment score ＞5 (HR ＝ 3.40; 95z CI 2.00-5.81; P ＜ 0.001), and delayed inappropriate empirical antibiotic treatment (HR ＝ 2.23; 95z CI, 1.12-4.45; P ＝ 0.022). VAP was associated with high mortality. The major causative pathogen was drug-resistant A. baumannii. Therefore, early detection of VAP by surveillance in mechanically ventilated patients leading to earlier treatment may improve patient outcomes. Guidelines for prescribing appropriate empirical antibiotics to cover drug-resistant bacteria could be established using local epidemiological data.

The combined mechanical effects of obesity and COPD reduced operating lung volumes at rest and throughout exercise with favorable influences on dyspnea perception and peak oxygen uptake during cycle ergometry.