A 49 year old previously healthy smoker was diagnosed with a giant bulla in his right lung, following a history of dry cough, repeated upper airway infections and increasing dyspnea for several years. Computed tomography (CT) confirmed the presence of a giant bulla in the right inferior lobe and several smaller bullae in the right superior lobe. The giant bulla was 17 cm in diameter, occupying more than half of the right hemithorax. On spirometry a moderate restrictive and a mild obstructive pattern was observed. Lung volume was measured with two different techniques, nitrogen washout and plethysmography, with volume of the bullae estimated at 2.9 L, similar to the 3.2 L determined by CT. The patient underwent thoracotomy, where the giant bulla together with the inferior lobe were removed with lobectomy and the small bullae in the superior lobe with wedge resection. Five months postoperatively the patient is in good health and is back at work. Postoperatively significant improvements in spirometry values and lung volume measurements have been documented. This case demonstrates that giant bullae can be successfully managed with surgical resection and their size can be determined by different techniques, including lung volume measurements and chest CT.
To determine the current management of acute asthma in the emergency department and to evaluate outcome we reviewed the charts of 99 patients aged 15 to 55 years who presented to the emergency department of a tertiary referral, university-affiliated hospital and were subsequently discharged with a diagnosis of acute asthma. Outcome was evaluated prospectively, with a structured questionnaire, by telephone. During the visit pulsus paradoxus was documented in four patients. Spirometry was done in 63 patients; postbronchodilator values ranged from 0.9 to 4.1 L. A total of 92 patients received inhaled bronchodilator therapy, most by wet nebulization. Sixteen patients received anticholinergic agents and three received theophylline. Ingested corticosteroids were given to 27 patients. Of the 71 patients contacted, a mean of 12 days after the visit, 26 (37%) had sought further medical attention, 19 at the emergency department; 9 had required admission. Forty-six patients reported that their condition had improved, but over 60% continued to have cough, sputum production, nocturnal waking and early-morning chest tightness. The results indicate that asthma continues to be undertreated in the emergency department and highlight the importance of routine spirometry in all patients and the need for systemic corticosteroid therapy.
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Studies covered changes in external respiration system of young able-bodied males and females exposed to ambient air of negative temperature in natural climate of European North. Findings are that breathing cold air causes significant changes in static respiratory volumes and capacities, so vital lung capacity, inspiratory reserve volume and expiratory reserve volume were decreased, respiratory capacity was increased, respiratory level was decreased. Changes in the females appeared to be more than those in the males.
Lifetime respiratory function after extremely preterm birth (gestational age=28 wk or birth weight=1,000 g) is unknown.
To compare changes from 18-25 years of age in respiratory health, lung function, and airway responsiveness in young adults born extremely prematurely to that of term-born control subjects.
Comprehensive lung function investigations and interviews were conducted in a population-based sample of 25-year-old subjects born extremely prematurely in western Norway in 1982-1985, and in matched term-born control subjects. Comparison was made to similar data collected at 18 years of age.
At 25 years of age, 46/51 (90%) eligible subjects born extremely prematurely and 39/46 (85%) control subjects participated. z-Scores for FEV1, forced expiratory flow at 25-75% of vital capacity, and FEV1/FVC were significantly reduced in subjects born extremely prematurely by 1.02, 1.26, and 0.88, respectively, and airway resistance (kPa/L/s) was increased (0.23 versus 0.18). Residual volume to total lung capacity increased with severity of neonatal bronchopulmonary dysplasia. Responsiveness to methacholine (dose-response slope; 3.16 versus 0.85) and bronchial lability index (7.5 versus 4.8%) were increased in subjects born extremely prematurely. Lung function changes from 18 to 25 years and respiratory symptoms were similar in the prematurely born and term-born groups.
Lung function in early adult life was in the normal range in the majority of subjects born extremely prematurely, but methacholine responsiveness was more pronounced than in term-born young adults, suggesting a need for ongoing pulmonary monitoring in this population.
This study investigated whether chronic airflow limitation and rapid decline in pulmonary function were associated with peak exposures to ozone and other irritant gases in pulp mills. Bleachery workers potentially exposed to irritant gassings (n = 178) from three Swedish pulp mills, and a comparison group of workers not exposed to irritant gassings (n = 54) from two paper mills, were studied. Baseline surveys occurred in 1995-1996, with follow-up surveys in 1998-1999. Participants performed spirometry and answered questions regarding ozone, chlorine dioxide (ClO2), and sulphur dioxide (SO2) gassings. From regression models controlling for potential confounders, declines in both the forced expiratory volume in one second (FEV1) (-24 mL x yr(-1)) and the forced vital capacity (FVC) (-19 mL x yr(-1)) were associated with ClO2/SO2 gassings. At follow-up, the prevalence of chronic airflow limitation (i.e. FEV1/FVC less than the lower limit of normal) was elevated for participants with only pre-baseline ozone gassings and with both pre-baseline and interval ozone gassings, after controlling for potential confounders. These findings suggest that obstructive effects among bleachery workers are associated with ozone gassings, and that adverse effects on spirometry might also accompany chlorine dioxide/sulphur dioxide gassings. Peak exposures to irritant gases in pulp mills should be prevented.
A study was undertaken in a number of rowhouses, some of which had had previous problems related to dampness and water leakage. The aim of the study was to assess the relation between exposure to airborne (1--> 3)-beta-D-glucan, a cell-wall substance in molds, and airways inflammation. The study involved 75 houses with indoor (1--> 3)-beta-D-glucan levels ranging from 0 to 19 ng/m3. Of 170 invited tenants, 129 (76%) participated in the study. A questionnaire relating to symptoms was used, and measurements were made of lung function and airway responsiveness. Myeloperoxidase (MPO), eosinophilic cationic protein (ECP), and C-reactive protein (CRP) were measured in serum. Atopy was determined with the Phadiatop test. The major findings were a relation between exposure to (1--> 3)- beta-D-glucan and an increased prevalence of atopy, a slightly increased amount of MPO, and a decrease in FEV1 over the number of years lived in the house. The results suggests the hypothesis that exposure to (1--> 3)-beta-D-glucan or molds indoors could be associated with signs of a non-specific inflammation.
Oil tanks containing a mixture of hydrocarbons, including sulphuric compounds, exploded and caught fire in an industrial harbour. This study assesses airway symptoms and lung function in the nearby population 1½ years after the explosion.
A cross-sectional study included individuals =18 years old. Individuals living 20 km away formed a control group. A questionnaire and spirometry tests were completed by 223 exposed individuals (response rate men 70%, women 75%) and 179 control individuals (response rate men 51%, women 65%). Regression analyses included adjustment for smoking, occupational exposure, atopy, infection in the preceding month and age. Analyses of symptoms were also adjusted for stress reactions related to the accident.
Exposed individuals experienced significantly more blocked nose (odds ratio 1.7 [95% confidence interval 1.0, 2.8]), rhinorrhoea (1.6 [1.1, 3.3]), nose irritation (3.4 [2.0, 5.9]), sore throat (3.1 [1.8, 5.5]), morning cough (3.5 [2.0, 5.5]), daily cough (2.2 [1.4, 3.7]), cough >3 months a year (2.9 [1.5, 5.3]) and cough with phlegm (1.9 [1.2, 3.1]) than control individuals. A significantly increasing trend was found for nose symptoms and cough, depending on the proximity of home address to explosion site (daily cough, 3-6km 1.8 [1.0, 3.1],
BACKGROUND: Up to 5% of patients with dermatitis who are consecutively patch tested are allergic to one or more corticosteroids. However, few reports of allergic mucosal and skin symptoms in patients with asthma and rhinitis caused by inhaled corticosteroids exist. OBJECTIVE: Our purpose was to determine whether inhalation of budesonide would result in reactivation of patch test reactions caused by budesonide. METHODS: The study, which was randomized, double-blind, and placebo-controlled, was ethically reviewed by the Medical Faculty, University of Lund, Sweden. Fifteen nonasthmatic patients who were initially given a diagnosis of budesonide hypersensitivity on patch testing from less than 1 up to 8 years before the study were provoked with budesonide or placebo by inhalation 6 weeks after they had been patch tested with budesonide, its R and S diastereomers, and potentially cross-reacting substances. Lung function was studied by using spirometry and repeated peak expiratory flow measurements. RESULTS: In 4 of 7 patients who inhaled budesonide, reactivation of previously positive patch test reactions was noted within 24 hours, in contrast to 0 of 8 patients who inhaled placebo (P =.026). No adverse pulmonary responses could be detected. CONCLUSION: This study shows that allergic skin reactions may occur in patients with contact allergy to budesonide when inhaled forms of the drug are used.
In a community survey in Oslo, Norway, comprising 1268 persons, alpha 1-antitrypsin concentration in serum (AT) and protease-inhibitor (Pi) phenotypes were examined in 1258 subjects. Estimated percentage distribution of Pi-phenotypes in the target population aged 15--70 years was M 87.30%, MS 4.65%, MZ 4.73%, FM 2.69%, SZ 0.13%, IM 0.20%, FZ 0.07%, S 0.06%, FS 0.07% and Z 0.06%. The distribution curve of AT had a normal (Gaussian) shape and the ranges of AT demonstrated great overlap of types MS and MZ with type M. In subjects with phenotype MZ neither respiratory symptoms nor physicians' diagnoses of chronic obstructive lung disease (COLD) were more frequent than in M subjects. Physicians' diagnoses of COLD were slightly more frequent (0.06 greater than P greater than 0.01) in subjects with phenotype MS than M, probably due to there being more smokers in the MS group. Spirometric variables given as per-cent of predicted values yielded large differences between smokers and non-smokers but no differences among phenotypes M, MS and MZ. Radiologic signs of hypertransradiancy and/or emphysema were evently distributed in M, MS and MZ subjects. The only subject observed with Pi-type Z and one out of three subjects with type SZ had COLD. In neither smokers nor non-smokers is phenotype MZ a risk factor of clinical importance for development of obstructive lung disease.