Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974± 1998. A. Debeljak, J. S AE orli, E. MusAEicAE, P. Kecelj. #ERS Journals Ltd 1999. ABSTRACT: The authors reviewed their experience with therapeutic bronchoscopy for removal of tracheobronchial foreign bodies in the adult.Bronchoscopy records and collection of foreign bodies in the endoscopic department were retrospectively examined. Among 37,466 bronchoscopies performed between 1974±1998, 62 (0.2%) were performed for the removal of tracheobronchial foreign bodies.Medical history was suggestive of foreign body aspiration in 33 patients and the chest radiograph was suggestive in 10 patients. The procedure was performed with the flexible bronchoscope in 42 patients (68%), rigid bronchoscope in 4 (6%), and with both in 16 (26%) patients. Foreign bodies were found in the right bronchial tree on 42 occasions, in the left on 20 and in the trachea once. In 39 patients, inflammatory granulations were found around the foreign body. The origins of the foreign bodies included: bone fragments (n=31), vegetable (n=10), broncholith (n=8), a part of dental prosthesis (n=7), endodontic needle (n=2), a metallic (n=2), or plastic (n=1) particle, a tracheostomy tube (n=1) and a match (n=1). In one patient, 2 foreign bodies were found. The foreign bodies were successfully removed in all but 2 patients (3%). The most useful instruments for removal were alligator forceps and the wire basket.Foreign bodies in the tracheobronchial system are rare in adults. Aspiration of foreign bodies can occur in children [1], as well as in adults or elderly people [2]. Therapeutic bronchoscopy for foreign bodies removal was introduced into clinical practice 100 yrs ago by the German otolaryngologist G. Killian [3]. Currently both, rigid and flexible bronchoscopies are utilized for this indication [4].In the present study, the authors reviewed their experience with therapeutic bronchoscopy for the removal of foreign bodies from 1974±1998. More specifically, diagnosis, techniques of removal and types of foreign bodies present in the tracheobronchial tree were investigated. Patients and methodsThe authors' Clinical Department for Respiratory Diseases and Allergy covers a population of one million inhabitants in Slovenia. Bronchoscopic records and the collection of foreign bodies in the endoscopic department were retrospectively examined. If possible, hospital documen-tation of the patients with foreign bodies aspiration was reviewed. Between 1974±1998, 37,466 bronchoscopies were performed, 33,716 (90%) with the flexible and 3,750 (10%) with the rigid bronchoscope. Sixty-two bronchoscopies (i.e. 0.2%) were performed in an attempt to remove foreign bodies.There were 42 male and 20 female patients ranging in age 18±86 yrs (meanSD 5514 yrs). Prior to bronchoscopy, a complete medical history, physical examination and chest radiograph at full inspiration were obtained. Premedication included 1 mg of atropine. Topical anaesthesia (nose, pharynx and larynx) was performed wi...

Chronic obstructive pulmonary disease (COPD) represents a major health problem in Central and Eastern European (CEE) countries; however, there are no data regarding clinical phenotypes of these patients in this region.Participation in the Phenotypes of COPD in Central and Eastern Europe (POPE) study was offered to stable patients with COPD in a real-life setting. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analysis of differences in symptom load, comorbidities and pharmacological treatment.3362 patients with COPD were recruited in 10 CEE countries. 63% of the population were nonexacerbators, 20.4% frequent exacerbators with chronic bronchitis, 9.5% frequent exacerbators without chronic bronchitis and 6.9% were classified as asthma–COPD overlap. Differences in the distribution of phenotypes between countries were observed, with the highest heterogeneity observed in the nonexacerbator cohort and the lowest heterogeneity observed in the asthma–COPD cohort. There were statistically significant differences in symptom load, lung function, comorbidities and treatment between these phenotypes.The majority of patients with stable COPD in CEE are nonexacerbators; however, there are distinct differences in surrogates of disease severity and therapy between predefined COPD phenotypes.

1. Using the mouth occlusion pressure technique, we have studied the control of breathing in seven hypercapnic and eight non-hypercapnic patients with chronic obstructive lung disease. 2. When breathing room air, pulmonary ventilation, mean inspiratory flow and P0.1 (mouth occlusion pressure developed 0.1 s after the onset of occluded inspiration at functional residual capacity) were not significantly different between the two groups of patients. Tidal volume, however, was significantly lower in the hypercapnic than in the non-hypercapnic patients, as a result of a significantly lower duration of inspiration. 3. The lower tidal volume in the hypercapnic patients leads to decreased alveolar ventilation, and appears to be the main cause of retention of carbon dioxide.