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Original papers

Conventional forceps or hot biopsy: comparative study of two methods in diagnosis of endobronchial lesions

Hamidreza Jabbari, MD(a), Mohammad Fakhri, MD (b, c), Mojtaba Lotfaliani, MD (b), Arda Kiani, MD (c)
a) Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran. (b) School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. (c) Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Background: It is suggested that hot electrocoagulation-enabled forceps (hot biopsy) may reduce hemorrhage risk after the biopsy in endobronchial tumors. The main concern in this method is possible reduction of the specimen's quality. Objectives: To compare the procedure related hemorrhage with hot biopsy and conventional forceps biopsy and the diagnostic quality of the obtained specimens with either technique. Methods: In this prospective study, assessment of the biopsy samples and quantity of hemorrhage were done in a blind fashion. At first, for each patient a definite clinical diagnosis was made based on pathologic examination of all available samples, clinical data, and imaging findings. Then, second pathologist reviewed all samples to evaluate the quality of the samples. Results: A total of 36 patients with endobronchial lesions were included in this study. Definite diagnosis was made in 83% of the patients. Diagnostic yield of the two methods were not statistically different, while the mean hemorrhage grades of all hot biopsy protocols were significantly lower as compared to that of conventional biopsy (p=0.003, p<0.001 and p<0.001 for 10, 20 and 40 voltages respectively). No significant difference was detected between the qualities of specimens obtained by hot biopsy methods in comparison with conventional biopsy (p>0.05 for all three voltages). Conclusions: Hot biopsy can be a valuable alternative to forceps biopsy in evaluating endobronchial lesions.
 
Keywords: hot biopsy, endobronchial tumors, forceps biopsy, bleeding

Article

application Conventional forceps or hot biopsy: comparative study of two methods in diagnosis of endobronchial lesions
2/2013

Estimation of direct medical costs of chronic obstructive pulmonary disease over 12 months

Irina Strâmbu, Ioan Paul Stoicescu
Universitatea de Medicină şi Farmacie „Carol Davila” Bucureşti

Estimation of direct medical costs of chronic obstructive pulmonary disease over 12 months. Chronic obstructive pulmonary disease (COPD) is a prevalent and expensive disease, the burden of disease involving the patient, the family and also the society. Aim. Estimation of direct medical costs of COPD in one patient, by adding the costs of all the medical events related to the disease over one year: exacerbations admitted to hospital or ambulatory, chronic treatments, follow-ups. Data were obtained using a questionnaire applied to 85 COPD patients approached in "Marius Nasta" Institute of Pulmonology in 2004. Results. 85 patients were questionned, mean age was 62.5 years, mean FEV1 was 36.65% predicted (72 patients were GOLD stages III and IV). In the previous year they had a mean of 2.2 exacerbations. They received various chronic treatments (bronchodilators, inhaled steroids, combination therapy) but not constant, between 3 and 8 months per year. The direct medical costs of COPD per patient in one year were estimated at 5243.4 lei (1456.5 €), 83% of costs represented the exacerbations (82.5% hospital admittances) and 17% the stable disease costs (16.5% chronic medication). Long term oxygen therapy, transportation, indirect costs were not included. Conclusions. Even if the costs are underestimated, COPD remains an expensive disease especially due to hospital exacerbations. Cost-effective interventions are needed for preventing exacerbations, redistributing resources and improving patients quality of life.

Keywords: COPD, burden of disease, direct medical costs, exacerbation

Article

application Estimation of direct medical costs of chronic obstructive pulmonary disease over 12 months
2/2013

Benefits of a 7-week outpatient pulmonary rehabilitation program in COPD patients

Alina Croitoru1, Diana Ioniţă2, Carmen Stroescu1, Irina Pele1, Daniela Gologanu3, Andreea Dumitrescu1, Lucia Marinescu1, Dana Anghelescu1, Miron Alexandru Bogdan1
Benefits of a 7-week outpatient pulmonary rehabilitation program in COPD patients

Respiratory rehabilitation programs (RR) are essential tools in the management of COPD. Aim: We present the results of a 7-week outpatient rehabilitation program in terms of dyspnea, exercise tolerance and quality of life. Material and method: The following parameters were evaluated before and after RR: dyspnea (mMRC scale), pulmonary function (FEV1, RV - residual volume), exercise tolerance (6MWT - 6 minutes walk test, CPET - cardiopulmonary exercise test), quality of life (SGRQ questionnaire). The RR program was outpatient, hospital based (7 weeks, 3 sessions/ week) and included: exercise training, therapeutic education, and psychological support. Results: 25 patients, COPD stage II-IV GOLD (mean FEV1 44.5 ± 13% predicted), mean age 60.4 ±12 years, 7 females, average BMI 27.14±4 kg/m2, average RV residual volume 221.55±86% predicted. Mean 6MWT distance: 407.48 ± 84 m and mean maximum power (Pmax) obtained on CPET: 75.67±30 Watts. All patients were symptomatic with significant dyspnea (3.06±0.7 on mMRC scale) and showed a significant impairment of quality of life: SGRQ score 46.23±14. At the end of RR program: dyspnea decreased with 0.67 points on mMRC scale (p = 0.000), 6MWT distance increased with 58.5 m (p = 0.001), Pmax obtained during CPET increased with 11.2 W, without reaching statistical significance (p> 0.05). SGRQ score decreased by 5.59 points (p = 0.02). There were no significant improvements in FEV1 and RV values (p> 0.05). Conclusion: In our COPD patients, the 7 week outpatient rehabilitation program was effective, leading to improvement of symptoms, exercise tolerance and quality of life.

Keywords: COPD, rehabilitation, exercise tolerance

Article

application Respiratory rehabilitation programs (RR) are essential tools in the management of COPD
2/2013