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Background: Objectives to assess the effectiveness of high frequency chest wall oscillation (HFCWO) vest system and Flutter devices in the treatment of patients with AECOPD, and to compare the efficacy of HFCWO vest system versus Flutter devices.Methods: We conducted an interventional study on 108 out of 129 patients presented with AECOPD, recruited from two-university hospitals. They were classified into three groups, HFCWO group (n=37), Flutter group (n=35), and control group (n=36). The HFCWO group and Flutter group were treated with AECOPD medications in addition to either HFCWO or Flutter physiotherapy, three sessions per week, for four weeks, while control group was treated by medications only. All patients were evaluated before and after treatment by spirometry, ABG, CAT score, and the BODE index.Results: Post treatment assessment for both HFCWO and Flutter groups demonstrated that most of spirometric indices (FEV1%, FVC%, FEV1/FVC %), oxygenations parameters (PaO2, SaO2 %) and CAT score, were significantly improved (p < 0.05). The level of perceived dyspnea decreased significantly, walking distance during 6-MWT was extended significantly, the BODE index and MMRC scale decreased significantly. While in control group only oxygenations parameters (PaO2, SaO2 %) was mildly improved. No statistical significant difference was found between vest HFCWO and Flutter device in all measured post treatment parameters (p > 0.05).Conclusions: Both vest HFCWO and Flutter device are highly effective in treatment of patients with AECOPD in terms of improvement in ventilatory function and oxygenation parameters with better exercise tolerance.

Background Mediastinal and/or hilar lymphadenopathy with or without parenchymal lesions are difficult in the diagnosis via noninvasive techniques. Objective To assess the role of flexible fiberoptic bronchoscopy (FOB), in particular, blind transbronchial needle aspiration (TBNA) in the diagnosis of mediastinal and/or hilar lymphadenopathies. Patients and methods A cross-sectional study was carried out on 42 out of 83 patients presented by chest radiography of hilar and/or mediastinal lymphadenopathies with or without parenchymal lesions. Contrast-enhanced computed tomography chest and FOB, TBNA, and bronchoalveolar lavage were done for all patients. Forceps biopsy and bronchial brushing were done for some patients with bronchoscopic airway abnormalities. Results A total of 52 patients underwent FOB procedures; among them 10 (19.2%) patients were excluded due to nonconclusive diagnosis for further evaluations; final histopathological and/or microbiological diagnosis was confirmed in 42 (80.8%) patients, and they were included in data analysis. Among them, 25 (59.5%) patients had malignant lymphadenopathies (five patients had small cell lung cancer, 18 patients had nonsmall cell lung cancer, and two patients had lymphoma) and 17 (40.5%) had benign lymphadenopathies (eight patients had sarcoidosis, three patients had tuberculosis, six patients had reactive lymphadenitis). The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of TBNA in the diagnosis of intrathoracic lymphadenopathies were 75.00, 54.50, 60.00, 70.60, and 64.29%, respectively. Conclusion Bronchoscopy with TBNA has good sensitivity and negative predictive value with fair specificity and positive predictive value in the diagnosis of intrathoracic lymphadenopathies. TBNA is a safe, effective procedure and can be performed easily during routine diagnostic bronchoscopy, and minimize the requirement for mediastinoscopy and thoracotomy.