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Original papers

Iatrogenic tracheal stenosis in COPD patients: a medical-surgery challenge

This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe.
Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting.
The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy.
In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.
Keywords: tracheal stenosis, interventional bronchoscopy, COPD

Main bronchial stenosis - sequel of delayed diagnosis after posttraumatic bronchial injury

Bronchial ruptures due to blunt chest traumas are rarely encountered injuries and frequently late diagnosed. Once the diagnostic is established by bronchoscopy surgical treatment is mandatory and usually, the results are very good. In order to conserve as much as possible lung parenchyma minimal possible resection is required. We present four cases managed in our department by means of main bronchial sleeve resection - two on the right side and two on the left side - with good outcome. We were able to save the entire lung in all four cases despite long-term atelectasis.
Keywords: posttraumatic bronchial stenosis; delayed diagnosis bronchial injury; main bronchial resection

Ventilatory defects in patients with pulmonary tuberculosis

Objectives: The main objective of the study is to identify changes that occur in lung function in patients with pulmonary TB. The secondary objective is to determine the characteristics of bronchial obstruction associated with pulmonary TB.
Methods: There were included in the study patients with pulmonary TB diagnosed in Bacau Pneumology Hospital between January 2011 and March 2012. Data was collected on gender, age, origin, education, occupation, smoking, and TB case category. Expansion of lung lesions was assessed on chest radiographs. Lung function was measured by spirometry and bronchodilatator test.
Results: The study group included 84 patients with a mean age of 44.9 years, predominantly male (86.9%) and rural (61.9%). Investigation revealed that smoking status was 23.81% non-smoking, 22.62% former smokers and 53.57% smokers. 64.29% of patients were new cases of pulmonary TB, 15.47% relapse and 20.24% patients with chronic pulmonary TB. Assessment of ventilatory function found 58.33% of patients with respiratory defects. These were mainly restrictive (33.33%), mixed (17.86%) and obstructive (7.14%). Obstructive and mixed ventilatory defects are significantly associated with age over 40 years (χ2 =4.70, r=0.419, p=0.036, 95% CI), male gender (χ2=8.14, r= -0.688, p=0.027, 95% CI), smoking (χ2=11.251, r= 0.758, p=0.032, 95% CI), category of chronic case of TB (χ2=11.25, r= 0.475, p=0.0008, 95% CI) and radiological lung lesions extension (χ2=8.128, r= 0.658, p=0.01293, 95% CI).
Conclusions: Pulmonary TB is often associated with significant functional changes, present since the early stages of the disease and which are often ignored. Early detection and proper treatment of TB could contribute to reducing the incidence of ventilatory defects associated with TB, and their rapid detection would allow better monitoring and thus improved quality of life of these patients. Extensive, multicenter, longitudinal studies are necessary to investigate and deepen knowledge of the functional consequences of tuberculosis.

Keywords: tuberculosis, ventilatory defects, bronchial obstruction

Romanian Echoes of European COPD Audit

Florin Mihălțan
Romanian Echoes of European COPD Audit


ERS COPD Audit's mission was to draw attention to the many problems that practitioners raised by the chronic obstructive pulmonary disease (COPD) exacerbations, by the comorbidites and impact of exacerbation on the patient destiny and practitioner reaction. In this Romanian article I draw attention to specific issues that arise when addressing these exacerbations to our hospitals.


Keywords: COPD, exacerbation, comorbidities