Pleural effusion height measured by ultrasonography gives a reasonable estimate of effusion volume. Incorporating distance between lung base and diaphragm into estimation improves accuracy from 79% with the first method to 83% with the latter.
A 29 year-old previously healthy Egyptian male complained of a 4-day vague abdominal pain for which he underwent an abdominal ultrasound. An inferior vena cava (IVC) thrombus was suspected by the sonographer who recommended undergoing an abdominal computed tomography (CT) with intravenous contrast. The IVC thrombus was confirmed by CT, but the study did not delineate any cause for the thrombus or any additional abdominal pathology. The basal chest scans revealed multiple peripheral cavitary nodules in both lower lung lobes. The patient was referred to our institution for evaluation of the pulmonary lesions. At the time, the patient only complained of an occasional cough and a small amount of mucopurulent sputum, but no chest pain. He was moderate smoker and substance abuser (tramadol and cannabis). The patient strongly denied i.v. drug abuse as well as taking any medications.
Objectives
We aimed to compare the effects of different aerobic exercise training (ET) programs on respiratory performance, exercise capacity, and quality of life in fibrosing interstitial lung diseases (f-ILD).
Methods
A case-control study where 31 patients with f-ILD diagnosis based on chest high-resolution computed tomography were recruited from Main Alexandria University hospital-Egypt. Ten patients were randomly assigned for only lower limbs (LL) endurance training program, and 10 patients for upper limbs, lower limbs, and breathing exercises (ULB) program for consecutive 18 sessions (3 sessions/week for 6 consecutive weeks). Eleven patients who refused to participate in the ET program were considered as control. All patients were subjected for St George’s respiratory questionnaire (SGRQ), 6-minute walk test (6-MWT), forced spirometry and cardiopulmonary exercise testing (CPET) before and after ET programs.
Results
Fibrosing non-specific interstitial pneumonia (NSIP) and collagenic associated-ILD were the commonest pathologies among the ET groups (30% each) with mean age of 44.4±12.25 and 41.90±7.58 years for LL and ULB groups respectively and moderate-to-severe lung restriction. 6-MWT and SGRQ significantly improved after both ET programs (p<0.001). Peak oxygen consumption (VO2) improved significantly after both LL training (median of 22 (interquartile range (IQR) = 17.0–24.0) vs. 17.5 (IQR = 13.0–23.0) ml/kg/min, p = 0.032) and ULB training (median of 13.5 (IQR = 11.0–21.0) vs. 10.5 (IQR = 5.0–16.0) ml/kg/min, p = 0.018). Further, maximal work load and minute ventilation (VE) significantly improved after both types of ET training (p<0.05); however, neither ventilation equivalent (VE/VCO2) nor FVC% improved after ET (p = 0.052 and 0.259 respectively). There were no statistically significant important differences between LL and ULB training programs regarding 6-MWT, SGRQ or CPET parameters (p>0.05).
Conclusions
ET was associated with improvements in exercise capacity and quality of life in f-ILD patients irrespective of the type of ET program provided.
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