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Lung cancer: practice and epidemiology

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1M. F. Biddiscombe, 2S. Meah, 2P. J. Barnes, 2O. S. Usmani. 1Nuclear Medicine Department, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK, 2Airways Disease Section, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK

Introduction Two-dimensional gamma scintigraphy (2DGS) is able to quantify the amount of drug delivered from a therapeutic inhaler device to the lungs. To obtain information on the regional lung deposition of inhaled drug, the lung image is divided into several “regions of interest (ROI)” that each represent airways of different sizes. Research groups tend to use their preferred method of ROI, which is often different from other centres. Presently, there is no standard method of defining ROI.

Objectives We compare different methods to determine ROI and ask whether the data generated are comparable.

Methods Using our own lung deposition data with 99mTc-labelled 3 μm particle size monodisperse aerosols1 and lung borders determined from a krypton-ventilation scan, we compared four reported methods of partitioning the lungs into ROI.2 3 4 5 Percentage lung area in the ROI and radioactive deposition counts for central (C), intermediate (I) and peripheral (P) regions were calculated. The C/P ratio and Penetration Index (PI) were determined (PI  =  ratio of P/C for the deposition aerosol normalised by P/C for krypton-ventilation gas).

Results Comparisons between the four methods of defining ROI are shown in table 1. All methods defined C as corresponding to central airways and P as peripheral/small airways. The proportionate lung areas of C and P regions and also the radioactive gamma counts varied greatly depending on the method used to define ROI. Only one method defined intermediate regions. However, there was good agreement of PI.

Abstract P183 Table 1

Conclusions PI, which is normalised to lung ventilation, is least affected by how the lung regions/ROI are drawn and analysed. PI should be the primary endpoint to compare results from different scintigraphic lung deposition studies. Care should be taken when comparing individual ROI between studies and attributing these 2DGS regions to specific three-dimensional anatomical airway structures.



1J. Rees, 2H. M. Tedd, 3A. De Soyza. 1Continence Care Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK, 2Adult Bronchiectasis Service, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK, 3Adult Bronchiectasis Service, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, University of Newcastle, Newcastle upon Tyne, UK

Introduction Urinary incontinence (UI) is common in patients with cystic fibrosis (CF)-associated bronchiectasis but limited data are available for patients with non-CF bronchiectasis.1 Patients suffering with UI are often embarrassed by symptoms and don’t seek medical attention,2 consequently remaining untreated. Department of Health guidelines3 state that primary and secondary care physicians should identify patients with incontinence problems, offer appropriate assessment and facilitate access to specialist services.

Setting In 2007 a new non-CF bronchiectasis service was started with patients referred from existing chest clinics and primary care. Patients attending were specifically asked about UI symptoms including duration of symptoms. If UI was reported, this prompted a nurse consultant review for UI management.

Results Of the 116 patients attending the bronchiectasis service to date, 76 were female; of these 55% (42 patients, mean age 62 years, range 27–82) had UI (UI-Br). 87.5% of UI-Br patients reported symptoms for over 5 years and 40% of patients described symptoms for over 10 years prior to intervention. 37% reported UI as having a “terrible” effect on quality of life. After assessment, a personalised UI management plan was formulated. All patients received education and patient literature regarding bladder health, training in pelvic floor strengthening, urge suppression and voiding techniques. Other treatments included bladder retraining (40%), toilet rescheduling (40%), bowel care (12.5%) and containment education (25%). A follow-up phone call was made at 4 weeks, providing motivation and support, followed by further clinic appointments linked to bronchiectasis clinic follow-up. Patients reported high compliance rates with treatment plans. A significant proportion of patients have already been discharged from the UI service following an improvement in symptoms.

Conclusion UI is common in patients with non-CF bronchiectasis. It has a significant psychosocial impact on patients’ lives and is rarely self-reported; patients suffer with symptoms for years without seeking medical assistance. Therefore it is important that respiratory physicians include UI as part of systematic care of these patients and that patients identified as suffering from symptoms of UI are referred on for specialist input in order to improve continence and quality of life.


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