Six hours after work in an empty, non-ventilated silo a 27-year-old Yugoslav worker suffered acutely from cough, dyspnea and general weakness. He was admitted to the hospital with severe partial respiratory insufficiency, and after emergency intubation artificial respiration had to be installed. X-ray showed a severe symmetrical alveolo-interstitial opacity. The heart configuration was normal. History revealed that the neighbouring silo had been filled with green corn the day before. Both silos were connected by a common drain-wall. Furthermore, a yellowish discolouration of the new paint in the empty silo was noted. Based on these facts silo-filler's disease was diagnosed. The patient recovered rapidly under high doses of steroids. Lung function was normalized within nine days, and the patient was released from the hospital. Steroid therapy was continued for six weeks.
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BMJ Open Respir Res
January 2025
Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Introduction: Patients recovering from severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a 30-day readmission rate of 20%. This study evaluated the feasibility of conducting a randomised controlled trial to evaluate clinical, patient-reported and physiological effects of home high-flow therapy (HFT) in addition to usual medical therapy, in eucapnic patients recovering from AECOPD to support the design of a phase 3 trial.
Methods: A mixed-methods feasibility randomised controlled trial (quantitative primacy, concurrently embedded qualitative evaluation) (ISRCTN15949009) recruiting consecutive non-obese patients hospitalised with AECOPD not requiring acute non-invasive ventilation.
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