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Oral Sessions: Session 17: Free Communications - COPD

Chest. 2017;151(5_S):A1. doi:10.1016/j.chest.2017.04.002

Introduction: The “European COPD Audit” initiated by the European Respiratory Society (ERS) evaluated the management of hospital admissions due to exacerbation of COPD in several European Countries. Data on the treatment of severe acute exacerbation of COPD (AECOPD) in Switzerland is scarce. In light of the current guidelines, this work aims to examine the quality of care for AECOPD and to provide specific recommendations for the management of severe AECOPD in Switzerland.

Chest. 2017;151(5_S):A2. doi:10.1016/j.chest.2017.04.003

Introduction: Many prognostic scores for various diseases and disease outcomes exist. The majority of prognostic scores have never been externally validated. This renders uncertain their accuracy in populations different from the one in which they were developed. Furthermore, the different scores are rarely compared against each other. Thus, practitioners cannot base their decisions on which prognostic score to use on firm evidence.

Chest. 2017;151(5_S):A3. doi:10.1016/j.chest.2017.04.004

Introduction: Gastroesophageal reflux disease (GERD) has been reported to be a risk factor for exacerbations of chronic obstructive pulmonary disease (COPD). Laryngopharyngeal reflux (LPR) is defined as the retrograde flow of gastric content into the larynx and pharynx which may cause respiratory symptoms such as hoarseness, dysphonia and globus. A laryngopharyngeal monitor has been validated to reliably detect LPR. We hypothesize, that LPR, even if silent, may be a contributing factor for the prognosis of, and clinical outcomes of COPD.

Chest. 2017;151(5_S):A4. doi:10.1016/j.chest.2017.04.005

Introduction: An estimated 25-45% of cases with chronic obstructive pulmonary disease (COPD) is due to non-smoking causes. Occupational exposure to vapours, gases, dusts and fumes (VGDF) has been described as a relevant risk factor for COPD and mortality. Up to now, studies investigating the effects of occupational exposures on the lung and on mortality are limited by their designs, options to account for confounding (e.g., smoking) or were underpowered to detect effects on mortality. Thus, the contribution of occupational exposures on the risk of COPD and mortality is still very much debated.

Chest. 2017;151(5_S):A5. doi:10.1016/j.chest.2017.04.006

Introduction: On-line breath analysis is a painless, non-invasive method to get insights into the metabolism of patients. Using real-time mass spectrometry, we investigated the profiles of volatile and semi-volatile organic compounds (VOC, sVOC) in exhaled breath of patients suffering from chronic obstructive pulmonary disease (COPD) with and without frequent exacerbations. The aim of the study was to discriminate between the two groups as well as to get insights into underlying metabolic differences and to better understand the pathogenesis of exacerbations.

Oral Sessions: Session 18: Free Communications - Sleep and breathing

Chest. 2017;151(5_S):A6. doi:10.1016/j.chest.2017.04.008

Introduction: Morbidity/mortality in severe COPD are comparable to that of lung cancer. Severe COPD has a profound impact on health-related quality of life (HRQL). End-of-life in COPD is often associated with repeated admissions to emergency wards, intensive care unit (ICU) and hospital stays, in spite of its' poor prognosis. However, palliative care is seldom proposed to severe COPD and very few palliative care intervention studies are available. This trial aimed to determine the effectiveness of introducing specialized palliative care on rate of hospital, ICU and emergency ward admissions of patients with severe or very severe COPD.

Chest. 2017;151(5_S):A7. doi:10.1016/j.chest.2017.04.009

Introduction: Practices regarding home non-invasive mechanical ventilation (HMV) (indications, mode of prescription, devices, settings) have evolved since the last study published in the Geneva area (Janssens, Chest 2003). This study describes HMV in the Canton of Geneva, with data obtained through all actors involved (public and private hospitals, private practicioners, home care providers).

Chest. 2017;151(5_S):A8-A9. doi:10.1016/j.chest.2017.04.010

Introduction: Care of aortic aneurysms (AA) consists of regular imaging follow-up and managing cardiovascular risk factors. OSA has been proposed to be associated with accelerated expansion of abdominal AA in observational studies. The purpose of this ongoing study is to evaluate whether OSA has an influence on the progression of thoracic aortic aneurysm (TAA).

Chest. 2017;151(5_S):A10-A11. doi:10.1016/j.chest.2017.04.011

Introduction: CPAP is the standard treatment for OSAS. Long term adherence is relatively low, many patients abscond in the first months of treatment. In a pilot study, we observed an improvement in 1-month adherence for patients supported with telemetrically triggered interventions. Therefore, a prospectively randomized trial was conducted.

Chest. 2017;151(5_S):A12. doi:10.1016/j.chest.2017.04.012

Introduction: Sleep related breathing disorders (SDB) in children are common. There is increasing awareness for symptoms as snoring or observed apnoea during sleep as possible indicators for airway obstruction, fatigue or irritability during daytime. SDB are associated with morbidities such as obesity or face abnormalities. In the presence of such symptoms, clinical examination including ENT exam will indicate further investigations for diagnosis and assessment of severity of SDB.

Oral Sessions: Session 19: Free Communications - Interstitial lung disease, translational research and pulmonary hypertension

Chest. 2017;151(5_S):A13. doi:10.1016/j.chest.2017.04.014

Introduction: The prevailing hypothesis on chronic thromboembolic pulmonary hypertension (CTEPH) is that pulmonary embolism (PE) is a necessary trigger for its pathogenesis. The true incidence of CTEPH after PE is actually not well known and has been found to vary almost ten-fold (0.57% to 4.7%) according to published studies. Therefore, the usefulness of a screening program after PE is uncertain. The aim of our study was to establish the 2-year incidence of CTEPH after PE in a large Swiss cohort. Additionally, we tested the performance of a 3 step screening algorithm based on an initial dyspnea questionnaire.

Chest. 2017;151(5_S):A14. doi:10.1016/j.chest.2017.04.015

Introduction: COPD is an inflammatory condition associated with disturbance of the homeostasis of extracellular matrix (ECM) molecules contributing to airway remodeling. In the lung, the ECM is subjected to a daily turnover of about 10%. Among other ECM molecules, glycosaminoglycans (GAGs) play a key role in airway remodeling in COPD. The aim of our study was to investigate whether serum levels of various GAGs are altered during acute exacerbation of COPD.

Chest. 2017;151(5_S):A15. doi:10.1016/j.chest.2017.04.016

Introduction: Idiopathic pulmonary fibrosis (IPF) is associated with damaged alveolar epithelial cells and an excessive proliferation and extracellular matrix deposition by fibroblasts. Stem cell-based therapy is a promising approach in the treatment of IPF. The therapeutic effects of stem cells are, at least in parts, mediated by the stem cell derived secretome through paracrine signaling. In this study we isolated mesenchymal stem cells (MSC) from fibrotic human lung tissue and investigated the anti-fibrotic properties of their secretome in vitro.

Chest. 2017;151(5_S):A16. doi:10.1016/j.chest.2017.04.017

Introduction: Idiopathic pulmonary fibrosis (IPF) is recognized as a distinct clinical disorder. However, despite major endeavors to understand the pathogenesis, the diagnosis of IPF remains elusive [1]. Metabolic profiling of biopsied tissue specimens has been shown promise to gain insights into IPF pathogenesis [2]. Thus we hypothesized that analysis of exhaled metabolites may also provide further insights.

Chest. 2017;151(5_S):A17. doi:10.1016/j.chest.2017.04.018

Introduction: High resolution computed tomography (HRCT) is an essential component of the diagnostic algorithm for idiopathic pulmonary fibrosis (IPF). In the absence of an identifiable cause of interstitial lung disease (ILD), an HRCT showing a typical usual interstitial pneumonia (UIP) pattern is diagnostic for IPF. However, it might be difficult to identify a typical UIP pattern, specifically if there is no access to a specialized thorax radiologist experienced in ILD. Here we report first experiences with a teleradiology-project that offers the possibility for second opinion HRCT read for patients with suspected IPF.

Oral Sessions: Session 20: Free Communications - Lung cancer and thoracic surgery

Chest. 2017;151(5_S):A18. doi:10.1016/j.chest.2017.04.020

Introduction: The availability of specialized pulmonary medicine differs considerably between geographical areas in Switzerland. Currently there are 6 tertiary centers supplying the broadest spectrum of pulmonary diagnostics and therapy. The diagnostic diversity is a marker of medical quality in terms of precision medicine. We hypothesize that diagnostic diversity could be lower in more isolated regions. Our aim was to investigate the relationship between the diversity of pulmonary diagnoses and the distance between patients' area of residence and the closest tertiary lung center.

Topics: lung
Chest. 2017;151(5_S):A19. doi:10.1016/j.chest.2017.04.021

Background: Pulmonary anatomical segmentectomies are increasingly performed by video-assisted thoracoscopic surgery (VATS). The aim of this study was to review the demographics, short term oncological outcome and define predictors of complications after anatomical VATS segmentectomies.

Chest. 2017;151(5_S):A20. doi:10.1016/j.chest.2017.04.022

Background: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is an accurate procedure to sample mediastinal lesions. Rapid on-site cytological evaluation (ROSE) has been advocated to improve the performance of this procedure, but its benefit remains controversial.

Chest. 2017;151(5_S):A21. doi:10.1016/j.chest.2017.04.023

Introduction: Non-invasive diagnostic markers for patients with suspicious non-small cell lung cancer (NSCLC) may provide needed guidance on invasive diagnostic and therapeutic decisions. Thioredoxin reductase 1 (TrxR1) is a pivotal intracellular redox sensor and antioxidant enzyme, and plays an important part in tumor growth, progression, metastasis, and chemotherapy resistance. The goal of this study is to test the feasibility of developing plasma TrxR1 as a novel diagnostic marker for NSCLC.

Chest. 2017;151(5_S):A22. doi:10.1016/j.chest.2017.04.024

Background: Lung re-transplantation has been shown to be a valid option in selected patients with chronic lung graft dysfunction. While being listed and due to pulmonary function deterioration, a subgroup of patients may require extracorporeal membrane oxygenation (ECMO) before re-transplantation. The outcome of these patients, compared to primary transplantations (TX) with and without ECMO and to re-transplantations (re-TX) without ECMO is the subject of this report.

Poster Walks: Poster Walk 1: Airway disease I

Chest. 2017;151(5_S):A23. doi:10.1016/j.chest.2017.04.026

Introduction: The COPD assessment test (CAT) has been developed in 2009 with the input of COPD patients to provide an easy to use quantified measure of health-related quality of life. A systematic review supported the reliability and validity of the CAT and found that the tool is responsive to interventions, although the minimal clinically important difference is not well established. Regarding the course of the CAT over time, only few data is available. Our aim was to investigate the course of the CAT over one year in a telehealthcare (THC) cohort and to evaluate its potential to predict exacerbations.

Chest. 2017;151(5_S):A24. doi:10.1016/j.chest.2017.04.027

Introduction: Environmental conditions at high altitude reduce allergens and pollution. We thus investigated the additive effect of asthma rehabilitation at high altitude (Tuja Ashu, 3200m, HA) compared to the same rehabilitation at low altitude (Bishkek, 760m, LA) on asthma control.

Chest. 2017;151(5_S):A25. doi:10.1016/j.chest.2017.04.028

Bronchiectasis is one of the common chronic respiratory diseases. The diagnosis is established clinically on the basis of daily productive cough, and radiographically by the presence of bronchial wall thickening on CT scans.

Chest. 2017;151(5_S):A26. doi:10.1016/j.chest.2017.04.029

Introduction: First-line treatment for patients admitted for acute exacerbation of COPD (AECOPD) includes inhaled short-acting bronchodilators (beta-2 adrenergic agonists or anticholinergics), short course of systemic corticosteroids (SCS) and antibiotics (for patients with clinical symptoms of respiratory infection) to decrease hospital stay, early relapse and failure of treatment. The use of inhaled corticosteroids (ICS) alone for the treatment of exacerbations is not recommended. Electronic data collected by our pharmacy suggest an over-prescription of ICS for AECOPD.

Chest. 2017;151(5_S):A27. doi:10.1016/j.chest.2017.04.030

Background: Serum albumin level is one of the prgnostic factors in chronic respiratory diseases. Thus, we aimed to evaluate the usefulness and prognostic significance of serum albumin in patients with NCFB.

Chest. 2017;151(5_S):A28. doi:10.1016/j.chest.2017.04.031

Introduction: Cardiovascular disease is common comorbidity in COPD and associated with mortality. Prevalence of coronary artery diseases (CAD) in COPD with low risk of exacerbation and more symptoms (GOLD B) and the associations with serum N-terminal pro-B type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) were investigated in tertiary care center Thailand.

Chest. 2017;151(5_S):A29. doi:10.1016/j.chest.2017.04.032

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown etiology characterized by the formation of submucosal nodules affecting the lumen of large airways. A 31-year old female was referred to pulmonary clinic for recurrent hemoptysis. She had a history of latent TB diagnosed at age 28 treated with INH for 6 months. Following treatment, she complained of intermittent cough and hemoptysis. She had 2 episodes of pneumonia within the same year that were treated with oral antibiotics. Sputum cultures obtained grew Pseudomonas aeruginosa and Klebsiella pneumoniae- unusual organisms in an otherwise healthy individual. 3 sputum samples were negative on AFB culture. Bronchoscopy revealed an abnormal trachea with nodular mucosal lesions on the anterior and lateral walls with sparing of the posterior walls. Bronchial washings returned positive for Mycobacterium avium intracellulare, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Biopsies of the nodular lesions showed marked inflammation with squamous metaplasia and focal dystrophic ossification but were negative for granulomas or malignancy. AFB and PAS stains were negative. A CT scan revealed scattered areas of mucous plugging, middle lobe bronchiolitis, and tracheal mucosal irregularity characteristic of TO. She was treated with ethambutol, rifampin, and azithromycin for 6 months with resolution of symptoms. She did well for 14 months but then developed hemoptysis without any other symptom. A follow up CT scan showed a new nodule and increase in nodular infiltrates in the right middle lobe. 8 sputum samples were sent for AFB smear and culture. 1 grew Mycobacterium fortuitum and the rest were negative. Bronchoscopy was again performed. Bronchial washings grew Pseudomonas aeruginosa and Klebsiella pneumoniae. AFB cultures were negative. Given recurrent infections, a workup for immunosuppression including HIV screening, and immunoglobulin levels were obtained and found to be within normal limits. The patient has remained asymptomatic and no recurrence of hemoptysis has been noted. No infection outside of the lungs has been observed.

Topics: lung infection
Chest. 2017;151(5_S):A30. doi:10.1016/j.chest.2017.04.033

Introduction: The aim of our study is to evaluate the potential correlation between oral health status and systemic inflammatory syndrome at COPD patients during exacerbation.

Chest. 2017;151(5_S):A31. doi:10.1016/j.chest.2017.04.034

Introduction: Severe COPD is associated with a high morbidity/mortality, with a major impact on quality of life. Prognosis is similar to that of lung cancer. Symptom control is often poor. Randomized controlled trials (RCT) are necessary to analyse the benefit provided by early intervention of palliative care specialists in this setting. An RCT was initiated in a tertiary center experienced with severe COPD, to determine the effectiveness of introducing specialized palliative care on hospital, iICU and emergency admissions in patients with severe or very severe COPD. Important difficulties were encountered during the inclusion process.

Chest. 2017;151(5_S):A32. doi:10.1016/j.chest.2017.04.035

Introduction: Asthmatics may benefit from the climate and reduced allergens at altitude. But the hypoxic environment may also be associated with adverse health effects, such as right heart strain due to increased pulmonary artery pressure (PAP), especially during the first days. We studied the right ventricular function (RVF) and SpO2 at lowland, immediately after arrival at 3200m and after 17 days at that altitude in asthmatics.

Chest. 2017;151(5_S):A33. doi:10.1016/j.chest.2017.04.036

Reactive airway dysfunction syndrome (RADS) is a severe form of irritant-induced occupational asthma with acute onset after a single exposure to high levels of a respiratory irritant without a latency period. The pathophysiology of RADS is not well understood but it is thought that high concentrations of an irritant substance may cause airway injury which leads to chronic airway inflammation, hyperresponsiveness and remodelling. Data on long term outcomes of RADS is limited.

Chest. 2017;151(5_S):A34. doi:10.1016/j.chest.2017.04.037
Abstract
Chest. 2017;151(5_S):A35. doi:10.1016/j.chest.2017.04.038

Introduction: Non cystic - fibrosis bronchiectasis (NCFBE) is a chronic heterogenous disease, with variety of predisposing factors and disease mechanism implicated in its pathogenesis. As a consequence the pathophysiologic processes are still not well defined.

Chest. 2017;151(5_S):A36. doi:10.1016/j.chest.2017.04.039

Introduction: Unilateral pulmonary artery agenesis (UPAA) is a rare congenital anomaly, with only 150 cases reported since its first description in 1868. 1 We present a case encountered in clinical practice.

Poster Walks: Poster Walk 2: Airway disease II

Chest. 2017;151(5_S):A37. doi:10.1016/j.chest.2017.04.041

Asthma is common in United Arab Emirates with an estimated prevalence of 10%. A significant area of country comprises of desert and dust storms are common. Weather is extremely hot/ humid and exposure to dust is a risk factor for air ways disease. There is no objective evidence to back up estimated prevalence of 10%. General practitioners have a tendency to over diagnose asthma without appropriate testing. A significant number of patients are wrongly diagnosed with Asthma in early childhood and they carry this diagnosis throughout their life.

Topics: asthma
Chest. 2017;151(5_S):A38. doi:10.1016/j.chest.2017.04.042

Introduction: Lung function tests with inert gas washout methods, such as nitrogen multiple breath washout (N2MBW), offer a great diagnostic tool in pulmonology since they have proven to be more sensitive than conventional lung function tests to detect ventilation heterogeneity. Data are scarce regarding the association between ventilation heterogeneity and the presence of bronchial hyperreactivity in patients with clinical suspicion of asthma and normal lung function.

Chest. 2017;151(5_S):A39. doi:10.1016/j.chest.2017.04.043

Introduction: Exacerbation of chronic obstructive pulmonary disease (COPD) is associated with high morbidity and mortality. Interferon lambda (IFNL) has an important anti-viral/bacterial and immunomodulatory function in the respiratory tract. However, the impact of IFNLs in the context of COPD and its exacerbations has not been explored yet.

Chest. 2017;151(5_S):A40. doi:10.1016/j.chest.2017.04.044

Introduction: The role of the extracellular matrix (ECM) molecules in lung disease is gaining in importance. Changes in turnover of these molecules result in changes in lung architecture. Degradation fragments of collagen type I (C1M), type IV (α1 chain, C4M2), type IV (α3 chain, C4Ma3), all degraded by metalloproteinases (MMPs) and the pro-form of collagen type V (Pro-C5) were investigated and associated with chronic obstructive pulmonary disease (COPD) severity and outcome.

Chest. 2017;151(5_S):A41. doi:10.1016/j.chest.2017.04.045
Abstract
Chest. 2017;151(5_S):A42. doi:10.1016/j.chest.2017.04.046

Introduction: 6-min walk tests (6MWT) are routinely performed in patients with chronic obstructive pulmonary diseases (COPD). Oxygen (VO2) kinetics during 6MWT can be modeled and derived parameters provide indicators of patients' exercise capacity. Post-exercise VO2 recovery has not been extensively investigated. A number of nonlinear regression models with partly different underlying biological assumptions and mechanisms may be suitable for describing recovery kinetics. Subsequently, model averaging can be used to capture the uncertainty in considering several models. We applied model averaging in the context of nonlinear mixed effects regression to describe and better understand the physiological underpinnings of the VO2 recovery after 6MWT in patients with COPD.

Chest. 2017;151(5_S):A43. doi:10.1016/j.chest.2017.04.047

Introduction To determine whether the patients with acute exacerbation of COPD benefit from noninvasive ventilation, which EPAP is required for a varying range rather than a fixed level.

Chest. 2017;151(5_S):A44. doi:10.1016/j.chest.2017.04.048

Background and Objective: Physical activity (PA) is an important outcome parameter in patients with COPD regarding hospitalizations and mortality. Both, objective assessment by accelerometers and self-evaluation by questionnaires were used in studies investigating PA in COPD. Whether self-reported questionnaires can adequately reflect PA and its changes over time compared to objective assessments has not been thoroughly investigated in COPD. In this COPD cohort study, we evaluated whether PA measured by accelerometer and its annual changes can also be assessed by self-reported questionnaires.

Chest. 2017;151(5_S):A45. doi:10.1016/j.chest.2017.04.049

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are clinically relevant events with therapeutic and prognostic implications. Up to 50% of the AECOPD are associated with bacterial infections, such as Hemophilus influenzae, Streptococcus pneumonia and Moraxella catarrhalis. The differences in risk factor exposure, ethno-geography, genetic background and antibiotic resistance in Asia results in distinct bacterial profiles and antibiotic response during AECOPD. Data on Asian COPD cohorts is essential for patient management and antibiotic choice during AECOPD.

Chest. 2017;151(5_S):A46-A47. doi:10.1016/j.chest.2017.04.050

*These authors contributed equally to this work

Chest. 2017;151(5_S):A48. doi:10.1016/j.chest.2017.04.051

Background: Insulin-like growth factor 1 (IGF-1) is mainly produced in the liver, leptin and adiponectin predominantly in adipose tissue. Production and serum levels are dependent, on nutritional status and insulin. IGF-1 and leptin decrease with fasting and low insulin activity while adiponectin increases in wasting, and insulin deficiency. Cystic fibrosis (CF), a multi-organ disease, is characterized by inflammation, malnutrition, wasting and impaired insulin production. We assessed IGF-1, leptin and adiponectin to evaluate potential relation with body mass index (BMI), insulin secretion, and insulin treatment in patients with CF.

Chest. 2017;151(5_S):A49. doi:10.1016/j.chest.2017.04.052

Introduction: Chronic obstructive pulmonary disease is significantly associated with extra-pulmonary comorbid conditions such as cardiovascular and peripheral vascular disease. It has been hypothesized that local airway inflammation may cause changes in systemic circulation which result in vascular changes, namely, endothelial dysfunction. The measurement of endothelial dysfunction using reactive hyperemia peripheral arterial tonometry (RH-PAT) is well documented in the field of cardiovascular research. There are no data available for COPD patients. We, therefore, investigated endothelial dysfunction in a cohort of COPD patients using RH-PAT to determine the importance of endothelial dysfunction in assessing disease severity and systemic burden in COPD.

Chest. 2017;151(5_S):A50. doi:10.1016/j.chest.2017.04.053

Introduction: Lung transplant recipients (LTR) have an increased risk of complications from influenza virus infection. Early treatment with neuraminidase inhibitors is recommended for LTR with suspected influenza virus infection. Standard multiplex polymerase chain reaction (PCR) testing for influenza virus takes 36-48 hours. LTR with suspected influenza are treated empirically with oseltamivir pending the results of the nasopharyngeal swab (NPS). In the influenza season 2016/2017 a rapid test for influenza virus A and B was introduced with PCR-based test results available in 2 hours. The objective of this audit was to compare results obtained with the two different tests in order to detect possible diagnostic discrepancies.

Chest. 2017;151(5_S):A51. doi:10.1016/j.chest.2017.04.054
Abstract

Poster Walks: Poster Walk 3: Sleep/Breathing

Chest. 2017;151(5_S):A52. doi:10.1016/j.chest.2017.04.056

Background and aims: Obstructive sleep apnea (OSA) is frequent in ischemic stroke/TIA patients and may negatively affect functional outcome. Little is known about the effect of OSA treatment on the long-term outcome following ischemic stroke/TIA. We aimed to assess prospectively the effect of CPAP treatment for moderate to severe OSA on long-term stroke outcome.

Chest. 2017;151(5_S):A53. doi:10.1016/j.chest.2017.04.057

Introduction: A strong association between obstructive sleep apnea (OSA) and atrial fibrillation/atrial flutter (AF) has been consistently observed in both epidemiological and clinical cohort studies. The effect of treatment with positive airway pressure (PAP) on AF recurrence is not conclusive. This study aims to evaluate the effect of treatment of sleep apnea with PAP on AF recurrence.

Chest. 2017;151(5_S):A54. doi:10.1016/j.chest.2017.04.058

Background COPD is associated with impaired pulmonary gas exchange and cardiovascular disease. Travelling to high altitude may increase the risk of cardiac arrhythmia due to hypoxemia and central sleep apnea in COPD patients as previously shown in patients with obstructive sleep apnea syndrome. The current study investigates whether staying at moderate altitude increases markers of cardiovascular risk and arrhythmias in lowlanders with COPD and whether this can be prevented by nocturnal oxygen therapy.

Chest. 2017;151(5_S):A55. doi:10.1016/j.chest.2017.04.059

Objective: To evaluate the effect of acute exposure, acclimatization and re-exposure to very high altitude on nocturnal breathing and subjective sleep quality in lowlanders.

Chest. 2017;151(5_S):A56. doi:10.1016/j.chest.2017.04.060

Introduction: Continuous Positive Airway Pressure (CPAP) treats Obstructive Sleep Apnea (OSA) effectively but compliance is poor. Interface type may impact long term compliance, with oronasal (ON) being associated with adverse effects and reduced compliance. Extended trial of interface before deciding on a preferred interface may improve compliance.

Chest. 2017;151(5_S):A57. doi:10.1016/j.chest.2017.04.061

Introduction: Respiratory - especially diaphragmatic - muscle function is of utmost importance in the context of hypoxia of any type to compensate for the increased ventilatory demand. Data from short-term exposure to moderate hypoxia suggest a decrease in respiratory muscle strength and increased fatigability during exercise. This study examined the effects of severe and prolonged hypobaric hypoxia on respiratory muscle strength in addition to diaphragmatic function and morphology during a high altitude expedition.

Chest. 2017;151(5_S):A58. doi:10.1016/j.chest.2017.04.062

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease leading to progressive loss of motor function and muscular mass and respiratory failure. Indices commonly used to predict occurrence of respiratory failure include clinical symptoms, daytime arterial blood gases, vital capacity seated and supine, sleep oximetry, and strength of inspiratory muscles assessed by Mouth Maximal Inspiratory Pressure (MIP) and Sniff Nasal Inspiratory Pressure (SNIP). This study aims 1/ to measure agreement between MIP and SNIP in bulbar and non-bulbar ALS patients at diagnosis and 2/ to analyze correlation between MIP, SNIP and anthropometric variables in this population.

Chest. 2017;151(5_S):A59. doi:10.1016/j.chest.2017.04.063

Background. Patients with Fabry disease (FD) often suffer from impaired quality of life and excessive daytime sleepiness. Obstructive sleep apnoea (OSA) is frequently reported among patients with FD, however, its prevalence and its effect on quality of life in this population is unclear.

Chest. 2017;151(5_S):A60. doi:10.1016/j.chest.2017.04.064

Introduction: Heart failure patients with central sleep apnoea/Cheyne Stokes Respiration (CSA/CSR) have a unfavourable prognosis. Both continuous positive airway pressure (CPAP) and assisted servo-ventilation (ASV) are accepted treatment modalities for CSA/CSR. Nocturnal oxygen (O2) is a treatment alternative. Whether treatment of CSA/CSR by these modalities is beneficial for cardiac function is controversial.

Chest. 2017;151(5_S):A61. doi:10.1016/j.chest.2017.04.065

Introduction: This study describes technical aspects of home non-invasive mechanical ventilation (HMV) in the Canton of Geneva, based on data obtained through all actors involved (public and private hospitals, private practicioners, home care providers). Population, ABG and modalities of medical follow-up are reported in another abstract.

Chest. 2017;151(5_S):A62. doi:10.1016/j.chest.2017.04.066

Introduction: To detect clinical, functional respiratory and nocturnal complete cardio-respiratory data in adult PWS patients and in obese subjects matched for sex, age and BMI.

Chest. 2017;151(5_S):A63. doi:10.1016/j.chest.2017.04.067

Introduction: Magnetic Resonance Imaging (MRI) of the chest has long suffered from its sensitivity to respiratory and cardiac motion with an intrinsically low signal to noise ratio and a limited spatial resolution. The purpose of this study was to perform chest MRI under an adapted non invasive high frequency ventilation system allowing 10 to 15 times longer breath hold durations than other existing systems.

Chest. 2017;151(5_S):A64. doi:10.1016/j.chest.2017.04.068

Introduction: High Flow Nasal Cannula (HFNC) is an oxygen delivery modality that has been increasing in popularity over the past few years as trials have shown it to be a non-inferior option in patients with acute hypoxic respiratory failure. At UC Davis, a recent retrospective study for failure rates (defined as need for transfer to the ICU, initiation of non-invasive ventilation or endotracheal intubation) in floor patients placed on HFNC was undertaken and demonstrated that 25/66 patients analyzed (38%) failed HNFC therapy. The mortality of patients who failed HFNC was also higher (48%) than the non-failure group (39%). It is unclear why this occurred, but there seems to be a lack of knowledge regarding when HFNC should be initiated and who should be involved in the decision to utilize it. Thus, the decision was made to create a protocol for the initiation and use of HFNC in floor patients and to study its effect on failure rates.

Chest. 2017;151(5_S):A65. doi:10.1016/j.chest.2017.04.069

A short, valid and reliable tool is needed in daily practice to assess the burden of home non-invasive ventilation (NIV) on specific domains of health-related quality (HRQoL) of life such as respiratory symptoms (rS), sleep quality & attendant symptoms (Ss) and side-effects (Se) related to mechanical ventilation. Available questionnaires provide valid assessment of HRQoL, but are long and complex which limit their everyday use. The aim of this study was to develop and validate a short self-administered questionnaire, the “S3-NIV questionnaire” to assess key domains related to NIV treatment.

Chest. 2017;151(5_S):A66. doi:10.1016/j.chest.2017.04.070

Introduction: Muscle weakness and diaphragmatic dysfunction are risk factors for readmissions following an acute hypercapnic respiratory failure (AHRF). Sniff Nasal Inspiratory Pressure (SNIP) and Mouth Maximal Inspiratory Pressure (MIP) are easy-to-perform, non-invasive tests that assess inspiratory muscle strength. Little is known about inspiratory muscle function in COPD and OHS surviving an AHRF. This study aims 1/ at reporting SNIP and MIP values 15 days after ICU discharge in a cohort of patients surviving AHRF 2/measuring agreement between SNIP and MIP in this population.

Chest. 2017;151(5_S):A67. doi:10.1016/j.chest.2017.04.071

Introduction: Increased neck circumference is a recognized risk factor for obstructive sleep apnea. For men, the cutoff is 43 cm and for women it is 37 cm. We are investigating a novel method in measuring the neck circumference via the chest x-ray. Since a chest-x ray is a 2 dimensional image, measuring the circumference will be an indirect method “π × D”. We wanted to compare this to the clinical method and investigate how reliable would it be to depend on the chest x-ray alone.

Chest. 2017;151(5_S):A68. doi:10.1016/j.chest.2017.04.072

Background: Central sleep apnea (CSA) is a common comorbidity in heart failure and also seen in lung transplant recipients. If positional sleep apnea is present, the lateral position often leads to an improvement of the apnea-hypopnea-index (AHI) and oxygenation. Single-lung transplantation (sLTX) results in changes in pulmonary hemodynamics and ventilation. We present a case of posture dependent aggravation of CSA in single-lung transplant recipient.

Poster Walks: Poster Walk 4: Interventional pneumology/Thoracic surgery

Chest. 2017;151(5_S):A69. doi:10.1016/j.chest.2017.04.074

Introduction: End-stage emphysema is associated with severe dyspnoea, limitation of activities, recurrent lung infection and, ultimately, respiratory failure. The PneumRx Endobronchial Coil System is a minimally invasive treatment option for severe emphysema. At the individual patient level Health Related Quality of Life (HRQoL) is important in assessment of limitations, disease course over time, and the effects of interventions. The RENEW study was a randomised controlled study with lung volume reduction coils in patients with severe emphysema (NCT01608490). Quality-Adjusted Life Years (QALYs) a metric that combines quality and quantity of life is an important measure of patient benefit. The reported mean 1-year QALY difference in another coil RCT [REVOLENS] was 0.06. The purposes of this analysis were to: i) map available SGRQ data onto EQ5D preference (utility) values; ii) generate prognostic statistical models to quantify the impact of coils treatment on HRQoL; iii) generate indicative estimates of long-term QALY gains over a range of clinically plausible scenarios.

Chest. 2017;151(5_S):A70. doi:10.1016/j.chest.2017.04.075

Background: Endoscopic lung volume reduction by coils (LVRC) is a recent treatment approach of severe emphysema. Furthermore, dual-energy computed-tomography (DECT) now offers a combined assessment of lung morphology and pulmonary perfusion. The aim of our study was to simply assess the impact of LVRC on pulmonary perfusion with a qualitative analysis by DECT.

Chest. 2017;151(5_S):A71. doi:10.1016/j.chest.2017.04.076

Introduction: Flexible bronchoscopy (FB) is a recognized safe diagnostic and therapeutic procedure, useful in the assessment of lower respiratory tract and lung parenchyma. However, few data with conflicting results is available on the impact of age on indications and complications associated with FB, namely in the very elderly population, usually a minor sample. This study retrospectively compares the indications and complications of FB in very elderly patients (≥85 years old) with younger ones.

Chest. 2017;151(5_S):A72. doi:10.1016/j.chest.2017.04.077

Introduction: Ventilated patients do not cough and are suctioned to clear secretions. Current endotracheal suction catheters pass into the right main stem exclusively. Secretions accumulate in the left side and may lead to resistance. This problem has been addressed many times over thirty years. Several devices developed to access the left main met with no real success. We tested a patented device (The Bronchial Vacuum) that accesses the desired main stem bronchi consistently.

Chest. 2017;151(5_S):A73. doi:10.1016/j.chest.2017.04.078

Introduction: Endobronchial coils for treatment of severe emphysema have been demonstrated in two randomized, controlled trials to improve quality of life, exercise tolerance, and lung function in bilaterally treated patients. In Switzerland, patients undergoing coil treatment have been followed in a post-market Registry; preliminary results are presented here.

Chest. 2017;151(5_S):A74. doi:10.1016/j.chest.2017.04.079

Introduction: Tracheal or bronchial fistulae seem to be a very rare complication only reported in a few cases. Recently Wong et al published the case of a bronchomediastinal fistula (BMF) that occurred in the context of bevacizumab treatment.

Chest. 2017;151(5_S):A75. doi:10.1016/j.chest.2017.04.080

Combination of sedatives such as fentanyl and midazolam during bronchoscopy is recommended by American College of Chest Physician due to its favourable drug profile. It improves patient comfort and tolerance, and is commonly given unless contraindicated. We describe a rare case of fentanyl-induced chest wall rigidity syndrome during a routine bronchoscopy with endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA) in a 55 year old male presenting with a lung mass and mediastinal lymphadenopathy. This was effectively managed with neuromuscular blockade, intubation and reversal agents including naloxone. This rare complication should be effectively managed by all bronchoscopist as it carries significant mortality and morbidity if not recognised early. We review the literature on the occurrence of fentanyl-induced chest wall rigidity and its predisposing risk factors.

Chest. 2017;151(5_S):A76. doi:10.1016/j.chest.2017.04.081

Introduction: Smoking history has been correlated to the development of atrial fibrillation (AFib) after noncardiac thoracic surgery, increasing hospital length of stay, post-operative mortality, and costs. This study sought to determine the effects of smoking history and pulmonary function on the development of AFib following robotic-assisted pulmonary lobectomy to allow for more targeted dispositioning of post-lobectomy patients.

Chest. 2017;151(5_S):A77. doi:10.1016/j.chest.2017.04.082

Introduction: In this study, we examined asymmetry of lung malignancies and outcomes in patients (pts) undergoing pulmonary lobectomy.

Chest. 2017;151(5_S):A78. doi:10.1016/j.chest.2017.04.083

Introduction: Pulmonary sequestration (PS) is a congenital lung defect rarely diagnosed in adults. PS is often misdiagnosed or not recognized early, delaying surgical management. The aim of this case series analysis was to determine the characteristics of all PS patients with surgical resections occurring over an 8-year period in a single tertiary centre.

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  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543