Management of status asthmaticus requires more than guidelines-guided therapy. Occasionally, uncommon therapeutic interventions and procedures may provide significant benefits. The role of bronchoscopy in fatal asthma is still not clearly defined. We illustrate two cases of severe status asthmaticus on mechanical ventilation who showed remarkable improvement after therapeutic bronchoscopy.

Background: Obesity hypoventilation syndrome (OHS) can be complicated by several cardiovascular conditions. We assessed the prevalence and factors associated with left ventricular diastolic dysfunction (LVDD) in patients with OHS. Methods: In this prospective observational study, all consecutive OHS patients referred to the sleep disorders clinic between January 2002 to December 2016 were included (n=113). Demographic data, echocardiography, sleep parameters, arterial blood gases (ABGs), and lung functions were recorded. Results: Of 113 patients with OHS who participated, 76 patients (67%) had LVDD. More than twothirds had grade 1 LVDD. Median body mass index (BMI) was 42.8 kg/m 2 . Median PaCO 2 was 55.8 mmHg. Median apnea hypopnea index (AHI) was 52 (25-38.5). Eighty-four (75.7%) patients were hypertensive,and 60 (54.1%) were diabetic. To minimize the effect of fluctuations in intrathoracic pressure during the obstructive respiratory events on the cardiac function, 38 OHS patients with mild to moderate OSA (AHI <30) were identified. Twenty-seven (71%) had LVDD. When compared to OHS patients without LVDD, patients with LVDD had higher BMI (47.4±6.5 versus 41.5±4.5, P=0.009). Hypertension was more common in OHS patients with LVDD than without LVDD (89.3% versus 54.5%, P=0.03). Correlation analysis revealed that hypertension (r=−0.37, P=0.016) had significant correlations with LVDD.Conclusions: Diastolic left ventricular dysfunction is prevalent among OHS patients even in the absence of severe OSA. Hypertension and obesity were significantly more common in patients with LVDD.Assessment of diastolic dysfunction should be included in the initial evaluation of OHS patients to encourage the early institution of therapy.

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