Persistent Pulmonary Atelectasis in Patient with Rheumatoid Arthritis Treated with High-Flow Therapy and High-Frequency Chest Wall Oscillation
American Journal of Internal Medicine
Volume 7, Issue 1, January 2019, Pages: 9-11
Received: Nov. 14, 2018; Accepted: Jan. 31, 2019; Published: Feb. 22, 2019
Views 728      Downloads 148
Anna Annunziata, Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy
Elena Sciarrillo, Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy
Maurizia Lanza, Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy
Giuseppe Fiorentino, Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy
Article Tools
Follow on us
Rheumatoid arthritis is a systemic inflammatory disorder that affects ∼1-2% of the population. Although a progressive destruction of cartilage and bone is the main presentation, extra-articular manifestations can occur in about 40% of patients during the course of their disease and are associated with significant morbidity and increased mortality. Pulmonary complications can frequently occur in these patients, although not always clinically recognized. We present a case of 60-year-old woman suffering from rheumatoid arthritis came to our department for the presence of exertional dyspnea, cough with poor mucous expectoration, chest pain and worsening of daytime asthenia. At a chest x-ray, evidence of right basal pulmonary atelectasis, for which she had practiced antibiotic therapy with persistence of symptomatology and pulmonary atelectasis. Chest CT showed parenchymal consolidation. The patient was treated with antibiotics and rehabilitation therapy, bronchial endoscopy, with persistence of pulmonary atelectasis. She started nasal high-flow therapy but in the seventh day appears epistaxis. For this reason, she suspended treatment with NHF. At the next rehabilitation session, for the recurrence of epistaxis, an otorhinolaryngology visit was performed that confirms the presence of nasal varices. Therefore, the patient started high-flow therapy with a mouthpiece with the use of High Frequency Chest Wall Oscillation. At the end of rehabilitative treatment we observed clinical and radiological improvement.
Atelectasis, Rheumatoid Arthritis, Pulmonary Rehabilitation, Nasal High-Flow Therapy (NHF)
To cite this article
Anna Annunziata, Elena Sciarrillo, Maurizia Lanza, Giuseppe Fiorentino, Persistent Pulmonary Atelectasis in Patient with Rheumatoid Arthritis Treated with High-Flow Therapy and High-Frequency Chest Wall Oscillation, American Journal of Internal Medicine. Vol. 7, No. 1, 2019, pp. 9-11. doi: 10.11648/j.ajim.20190701.13
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
T. Gono, H. Tokuda, F. Sakai, T. Takemura (Eds) (2018) Lung disease associated with rheumatoid arthritis. Springer Nature Singapore Pte Ltd., Singapore.
Spoletini G, Alotaibi M, Blasi F, Hill NS, (2015). Heated Humidified High Flow Nasal Oxygen in Adults: Mechanisms of Action and Clinical Implications, Chest. Jul; 148 (1): 253-261.
Hasani A, Chapman TH, McCool D, Smith RE, Dilworth JP, Agnew JE. (2008) Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chronic Respir Dis: 5 (2): 81-86.
Groves N, Tobin A. (2007) High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care 20: 126-131.
Braunlich J, Beyer D, Mai D, Hammerschmidt S, Seyfarth HJ, Wirtz H. (2012). Effects of nasal high flow on ventilation in volunteers, COPD and idiopathic pulmonary fibrosis patients. Respiration.
Parke R, McGuinness S, Eccleston M. (2009). Nasal high-flow therapy delivers low level positive airway pressure. Br J Anasesth. 103 (6): 886-890.
Nicolini A., Grecchi B. , Ferrari-Bravo M. , Barlascini C. (2018) Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 16; 13: 617-625.
Chakravorty I, Chahal K, Austin G (2011) A pilot study of the impact of high frequency chest wall oscillation in chronic obstructive pulmonary disease patients with mucus hypersecretion. Int J Chron Obstruct Pulmon Dis. 6: 693- 699.
Chaisson KM, Walsh S, Simmons Z, Vender RL (2006) A clinical pilot study: high frequency chest wall oscillation airway clearance in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler 7: 107-111.
Lechtzin N., Wolfe LF, Frick KD (2016). The Impact of High-Frequency Chest Wall Oscillation on Healthcare Use in Patients with Neuromuscular Diseases. Ann Am Thorac Soc. 13 (6): 904-9.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186