ISRN Pulmonology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Lung Volume Reduction Surgery for Emphysema Treatment: State-of-the-Art and Perspectives Sun, 09 Mar 2014 09:51:06 +0000 Lung volume reduction surgery (LVRS) has shown an improve for up to several years respiratory function, exercise capacity, and quality of life in selected patients with severe emphysema and low exercise capacity, particularly if upper-lobe predominance of disease is radiologically recognized. However, mortality and morbidity rates of LVRS have been not negligible leading to raising question as to the cost-effectiveness of the procedure and resulting in a progressive decline in its use although a considerable number of patients meet selection criteria and could potentially benefit of this treatment modality. In recent years, an active investigation aimed at developing less invasive strategies that might allow us to achieve long-term results as satisfactory as those of the standard LVRS method but with fewer adverse effects has been undertaken. So far, novel options including nonresectional surgical and endoscopic LVRS methods hold promise but results from large studies with long follow-up are awaited to help define the most effective interventional treatment options for patients with severe emphysema. In this literature review an analysis of the main issues related to LVRS including selection criteria, mechanisms of action, results of currently available surgical and endoscopic methods, and some potential future perspectives is provided. Eugenio Pompeo Copyright © 2014 Eugenio Pompeo. All rights reserved. Carinal Resection and Reconstruction for Locally Advanced Primary Lung Cancer: Institutional Report Thu, 06 Mar 2014 07:46:01 +0000 Carinal resection and reconstruction for lung cancer, termed carinaplasty, is a rare operation, and the procedure remains challenging and few reports have been presented. We analyzed complications, local control, and manner of recurrence in patients who underwent a carinaplasty and compared the results to those who underwent an ordinary bronchoplasty. Among 766 patients who underwent surgery for primary lung cancer at our institutions, 82 bronchoplasty procedures were performed, while 6 of those who received a bronchoplasty underwent a carinaplasty. Three of 6 patients who received a carinaplasty underwent the montage method, and other 3 patients underwent the one-stoma method. There were no operative deaths in patients who underwent a carinaplasty, while there was 1 operative death in the group of patients who underwent an ordinary bronchoplasty. Complications in the anastomotic site were observed in 33% in the carinaplasty group and 5.3% in the ordinary bronchoplasty group . There was no significant difference in regard to local recurrence between the groups . In conclusion, our results show that a carinaplasty is a technically demanding but useful procedure to avoid a pneumonectomy in patients with locally advanced lung cancer. Yuji Matsumura, Muneo Minowa, Osamu Araki, Yoko Karube, and Masayuki Chida Copyright © 2014 Yuji Matsumura et al. All rights reserved. Tobacco Smoking Habits, Attitudes, and Beliefs among Albanian Nurse Students Tue, 24 Dec 2013 09:54:25 +0000 Background. Available information about tobacco smoking habits, attitudes, and beliefs among Albanian nurse students shows some discrepancies and requires further investigation. Material and Methods. Cross-sectional school-based survey using a self-administered anonymous questionnaire in the Tirana Nurse University in December 2012 about tobacco smoking habits, attitudes, and beliefs. Results. Sixty hundred fifty one students (mean age 20.0 years; males 19%, females 81%) completed the questionnaire with an overall response rate of 87%. Current smokers were 19%; of this group, 37% of males and 49% of females were occasional smokers. Among current smokers, males smoked more than females (46% versus 13%; ). The knowledge about smoking was generic; only a part (24%) of students reported having received a formal specific training on smoking related issues. The percentage of current smokers who reported at least one serious attempt to quit was 64%. Most students (78%) reported recent exposure to second hand smoke at home. Most students (84%) were felt to be a model of healthy lifestyle, but only a part (42% of the total) was recognized to have a role in advising smokers to quit. Conclusions. Smoking habits of Albanian nurse students are not higher than those of other European countries and Albanian population of similar age and gender. Our students showed many positive attitudes towards tobacco. Targeted training about smoking related issues should be mandatory in nursing schools. Ylli Vakeffliu, Silvana Bala, Rudina Pirushi, Kujtime Vakeffliu, Jul Bushati, and Andrea S. Melani Copyright © 2013 Ylli Vakeffliu et al. All rights reserved. First Report of FVC and FEV1 Reference Values for Beninese Children Aged 11–16 Years Tue, 13 Aug 2013 09:00:38 +0000 Background. The diagnosis of obstructive ventilatory disorders in children in Benin is not reliable despite the inclusion of ethnic correction factors for European standards (ERS-93) and the use of African-American standards (ITS-Black). Objectives. (1) Define standard values for forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) and (2) compare the FVC and FEV1 values observed in study subjects to those calculated by the ERS-93 and ITS-Black equations. Methods. FVC and FEV1 were measured using the MicroQuark Spirometer (Cosmed, Italy), and standing height was measured in 274 Beninese boys and 210 Beninese girls. The means and 95% confidence intervals for these values were calculated by univariate analysis. Results. FVC and FEV1 values calculated using the ERS-93 equations were significantly higher () than the measured values from our study. The percent change between the standard values in our study and the standards calculated using the ERS-93 and ITS-Black equations revealed differences between Beninese children and children of European or African-American descent. Conclusion. The differences observed between study samples and those derived from the ITS-Black and the ERS-93 equations should be used as ethnic correction factors. Folly Messan, Pierre Dansou, Tanguy Marqueste, Patrick Decherchi, Richard Tossou, Toussaint Amoussou, and Bénoîte Sovi-Guidi Copyright © 2013 Folly Messan et al. All rights reserved. Factors Influencing Sputum Conversion among Smear-Positive Pulmonary Tuberculosis Patients in Morocco Thu, 27 Jun 2013 10:12:26 +0000 Background. Sputum smear-positive pulmonary tuberculosis patients expel infectious viable bacilli for a period following the commencement of treatment. Objective. To determine the time to sputum smear conversion and study the factors influencing it. Design. A prospective study was undertaken at our hospital in Rabat over a six-month period on a cohort of 119 sputum smear positive patients. Patients were followed up fortnightly. At each followup, specimens were collected and processed for microscopy using standard protocol. Results. 96.6% of our patients completed the study (4 deaths). Sputum conversion rate was 42% after two weeks, 73% after one month, and 95% after two months. Univariate and stepwise regression analysis showed that patients who had high smear grading, miliary, and bilateral radiologic lesions were more likely to undergo delayed sputum conversion (). Other factors were thought to influence sputum conversion but were not statistically proven in our study. Conclusion. Since viable bacilli continue to be expelled for up to two months, infection control measures should be maintained for such a time. Patients with high smear grading, miliary, and bilateral radiologic lesions need to be monitored more closely. Khalid Bouti, Mohammed Aharmim, Karima Marc, Mouna Soualhi, Rachida Zahraoui, Jouda Benamor, Jamal Eddine Bourkadi, and Ghali Iraqi Copyright © 2013 Khalid Bouti et al. All rights reserved. Lung Cancer Diagnosed More Than Five Years after the Development of Polymyositis/Dermatomyositis Sun, 23 Jun 2013 10:21:54 +0000 Background. The patients with polymyositis (PM) and dermatomyositis (DM) often develop the malignancies in their clinical course. The incidence of cancer is estimated at about 15%. The risk of cancer is the highest within the first year of myositis diagnosis and drops substantially thereafter. The patients with lung cancer diagnosed more than 5 years after the onset of PM or DM are the minority. Methods and Patients. We surveyed the medical records of patients with lung cancer over the period from 1995 to 2011. Results. We found five patients who developed lung cancer more than 5 years after the diagnosis of PM/DM. Three patients were male, and two were female. The median age was 61.2 (±11.7). Histological types were diverse. The clinical stages ranged from IA to IV. Three patients had smoking histories. Four patients suffered from DM, and one suffered from PM. All patients received oral corticosteroid therapy. Two patients also received ciclosporin, and another two received azathioprine. Anti-Jo-1 antibody was positive in one patient. Four patients were complicated with interstitial pneumonia (IP). Conclusion. These lung cancers diagnosed more than 5 years after the onset of PM/DM were probably related to IP or smoking but might not be comorbid with PM/DM. Ken Uchibori, Tomoyuki Ogata, Tuyoshi Shirai, Shuta Yamauchi, Masahiro Masuo, Sahoko Chiba, Haruhiko Furusawa, Kimitake Tsuchiya, Toshihide Fujie, Meiyo Tamaoka, Hiroyuki Sakashita, Yuki Sumi, Yasunari Miyazaki, and Naohiko Inase Copyright © 2013 Ken Uchibori et al. All rights reserved. The Effect of Ageing on Nasal Mucociliary Clearance in Women: A Pilot Study Sun, 07 Apr 2013 13:11:20 +0000 Introduction. Pneumonia is the leading infectious cause of death in the elderly. Impaired respiratory defences are one of the causes for increased susceptibility of the elderly to such infections. Nasal mucociliary clearance, the mirror image of bronchial clearance, is crucial in respiratory defence and is affected by various factors. Little is known about the effect of ageing on nasal respiratory epithelium. Aim. To evaluate the effect of ageing on nasal mucociliary clearance (NMC) in women. Materials and Methods. NMC was measured in 91 apparently healthy women of ages ranging from 20 to 80 years. The time taken to experience sweet taste at nasopharynx following the placement of saccharin pellet in the nostril was recorded as NMC time. Results and Discussion. NMC time was 10 min 36 secs in elderly women and it was significantly prolonged when compared to younger women (8 min 39 secs). The prolonged clearance may be due to altered cilia, slowed ciliary beating, or changes in the properties of mucus. Conclusion. NMC time clearly shows an increase with age signifying decreasing respiratory epithelium function. This study highlights an important cause of impaired respiratory health in older individuals and emphasises the need for preventive measures to be put in place. Preetha Paul, Priscilla Johnson, Padmavathi Ramaswamy, Sitalakshmi Ramadoss, Bagavad Geetha, and A. S. Subhashini Copyright Β© 2013 Preetha Paul et al. All rights reserved. Polymorphism of Beta2-Adrenoceptor and Regular Use of Formoterol in Asthma: Preliminary Results Sun, 31 Mar 2013 17:44:50 +0000 Polymorphism at codon 16 of the beta2-adrenoceptor (beta2-AR) affects the responsiveness to salmeterol in asthmatics. Data concerning formoterol are more controversial in the literature. The aim of this study was to verify whether homozygous for arginine-16 (ArgArg16) and homozygous for glycine-16 (GlyGly16) genotypes differently influence the long-term responsiveness to formoterol. Twenty-nine patients with mild-to-moderate asthma, in stable clinical conditions, underwent genotyping at codon 16 of the beta2-AR by RFLP-PCR assay. The effects of a 4-week monotherapy with formoterol (12 μg BID) were tested on the peak expiratory flow (PEF) variability and the forced expiratory volume in 1 sec (FEV1) slope of the dose-response curve to salbutamol. Variability in PEF significantly increased during the 4-week treatment period in 14 patients with GlyGly16, but not in 15 patients with ArgArg16 and ArgGly16 . The FEV1 slope of the dose-response curve to salbutamol decreased after the 4-week treatment period in GlyGly16, but not in pooled ArgArg16 and ArgGly16 patients. This study provides preliminary evidence that tolerance to formoterol develops more frequently in asthmatics with GlyGly16 genotype. If confirmed in a larger population, this finding might be useful in choosing the bronchodilator therapy on the basis of genetic polymorphism of the beta2-AR. Leonello Fuso, Alessandra Di Perna, Anna Longobardi, Andrea Trové, Michela Bisceglia, Benedetta F. Bibi, Carla Angelozzi, Francesco D. Tiziano, and Raffaele Antonelli Incalzi Copyright © 2013 Leonello Fuso et al. All rights reserved. Respiratory Gating for Radiotherapy: Main Technical Aspects and Clinical Benefits Tue, 19 Mar 2013 10:55:56 +0000 Respiratory-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast, and liver tumors. An increased conformality of irradiation fields leading to decreased complication rates of organs at risk is expected. Five main strategies are used to reduce respiratory motion effects: integration of respiratory movements into treatment planning, forced shallow breathing with abdominal compression, breath-hold techniques, respiratory gating techniques, and tracking techniques. Measurements of respiratory movements can be performed either in a representative sample of the general population, or directly on the patient before irradiation. Reduction of breathing motion can be achieved by using either abdominal compression, breath-hold techniques, or respiratory gating techniques. Abdominal compression can be used to reduce diaphragmatic excursions. Breath-hold can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily breath-holds. Respiratory gating techniques use external devices to predict the phase of the breathing cycle while the patient breathes freely. Another approach is tumor-tracking technique, which consists of a real-time localization of a constantly moving tumor. This work describes these different strategies and gives an overview of the literature. Philippe Giraud and Annie Houle Copyright © 2013 Philippe Giraud and Annie Houle. All rights reserved. Pharmacotherapy of Chronic Obstructive Pulmonary Disease: A Clinical Review Wed, 13 Mar 2013 08:07:37 +0000 Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity worldwide. In addition to generating high healthcare costs, COPD imposes a significant burden in terms of disability and impaired quality of life. Unlike many leading causes of death and disability, COPD is projected to increase in many regions of the world as the frequency of smoking is rising and the population is aging. The pharmacological treatment of COPD includes bronchodilators to relax smooth muscle, such as β2-agonists (salbutamol, terbutaline, and fenoterol, short-acting β2-agonists as well as salmeterol, formoterol, and indacaterol, and long-acting β2-agonists) and anticholinergics, such as ipratropium, oxitropium (short-acting anticholinergic), and tiotropium (long-acting anticholinergic). Although airway inflammation in COPD poorly responds to steroids, several inhaled corticosteroids (fluticasone, budesonide, and beclomethasone) are in use in combination with long-acting β2-agonists. Other medications include theophylline (both a bronchodilator and a phosphodiesterase inhibitor) and the phosphodiesterase-4 antagonists, such as roflumilast. Finally, a number of novel long-acting anticholinergics and β2-agonists with once- or twice-daily profiles are in development and clinical testing. Balazs Antus Copyright © 2013 Balazs Antus. All rights reserved. Assessment of Pulmonary Artery Pulsatility by Multidetector Computed Tomography in Patients Affected by Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension: Preliminary Data Thu, 07 Mar 2013 15:23:52 +0000 The aim was to assess if computed tomography is able to measure pulmonary artery pulsatility in patients affected by chronic obstructive pulmonary disease and to ascertain whether pulsatility is different in patients with and without pulmonary hypertension and whether it is related to haemodynamics. We selected two groups of patients, the first one with pulmonary hypertension and the second one without. In patient with hypertension, pulmonary artery pressure and resistance were increased with the increased diameters (transverse 36 ± 5 mm and axial 38 ± 4 mm versus 22 ± 3 and 25 ± 5, resp.), the increased cross-sectional area (10 ± 08 versus 4 ± 1 cm2), and the reduced pulsatility (21 ± 7 versus 10% ± 5%). Arterial stretching was decreased in patients with hypertension (10 ± 5 versus 21% ± 7%) and significantly related to pulmonary vascular resistances and pressure. Cardiac output measured by tomography was significantly related to that obtained by Fick method and was not different in the two groups. The diameters allow to identify patients with PH, assuming a cut-off of 28 mm and assuming a pulsatility of right branch of 26% as well. These preliminary observations indicate tomography as a suitable technique, being able to measure the pulsatility and the dimensions of the arteries and the right ventricular functional parameters. Anna Grazia D'Agostino, Giuseppe Valerio, Pierluigi Bracciale, and Fabio Valerio Copyright © 2013 Anna Grazia D'Agostino et al. All rights reserved. Effect of Physical Exercise on the Level of DNA Damage in Chronic Obstructive Pulmonary Disease Patients Tue, 05 Feb 2013 16:35:04 +0000 This study assessed the chronic effects of physical exercise on the level of DNA damage and the susceptibility to exogenous mutagens in peripheral blood cells of chronic obstructive pulmonary disease (COPD) patients. The case-control study enrolled COPD patients separated into two groups (group of physical exercise (PE-COPD; ); group of nonphysical exercise (COPD; )) and 51 controls. Peripheral blood was used to evaluate DNA damage by comet assay and lipid peroxidation by measurement of thiobarbituric acid reactive species (TBARS). The cytogenetic damage was evaluated by the buccal micronucleus cytome assay. The results showed that the TBARS values were significantly lower in PE-COPD than in COPD group. The residual DNA damage (induced by methyl methanesulphonate alkylating agent) in PE-COPD was similar to the controls group, in contrast to COPD group where it was significantly elevated. COPD group showed elevated frequency of nuclear buds (BUD) and condensed chromatin (CC) in relation to PE-COPD and control groups, which could indicate a deficiency in DNA repair and early apoptosis of the damaged cells. We concluded that the physical exercise for COPD patients leads to significant decrease of lipid peroxidation in blood plasma, decrease of susceptibility to exogenous mutagenic, and better efficiency in DNA repair. Andréa Lúcia G. da Silva, Helen T. da Rosa, Eduarda Bender, Paulo Ricardo da Rosa, Mirian Salvador, Clara F. Charlier, Dinara Jaqueline Moura, Andréia R. de Moura Valim, Temenouga N. Guecheva, and João Antônio Pegas Henriques Copyright © 2013 Andréa Lúcia G. da Silva et al. All rights reserved. Blood Cells and Interferon-Gamma Levels Correlation in Latent Tuberculosis Infection Mon, 21 Jan 2013 07:52:16 +0000 The Mycobacterium tuberculosis (M. tb) infection is largely spread in world's population. Most infected individuals develop latent tuberculosis infection (LTBI). Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are the available tests to detect the infection. It has been reported that some individuals take a longer period of time to develop the infection than others with the same exposure level. It is suggested that the innate immunity, in which neutrophils have an important protective role, is responsible for this. Many hematologic abnormalities have been described as common findings during severe disease. To investigate if these changes are related to LTBI development and if they interfere in TST and IFN-γ production, we recruited 88 household contacts of tuberculosis (TB) pulmonary patients and compared blood cell counts with these tests' results. There were no statistically significant changes in hemoglobin, hematocrit, platelets, global leukocyte, neutrophils, basophils, eosinophils, typical lymphocytes, atypical lymphocytes, and monocytes counts between infected and noninfected individuals. Also, there was no correlation between TST or IGRA and blood cell counts. These results suggest that blood cell counts are not LTBI markers and do not interfere in TST results or IFN-γ levels obtained by IGRA. Iukary Takenami, Camila Loureiro, Almério Machado Jr., Krisztina Emodi, Lee W. Riley, and Sérgio Arruda Copyright © 2013 Iukary Takenami et al. All rights reserved. Characteristics of COPD Patients Enrolled into Rehabilitation Programme in Copenhagen Sun, 13 Jan 2013 16:18:18 +0000 Pulmonary rehabilitation (PR) is a recommended standard of care for patients with chronic obstructive pulmonary disease (COPD), as it improves exercise capacity and health-related quality of life (HRQOL), attenuates perceived dyspnoea, and decreases the need for hospitalisation. The objective of this study was to compare medical and sociodemographic characteristics of COPD patients who were enrolled and completed the PR with those of COPD patients who were resident in the same municipality but were not enrolled into this PR. The data used for comparison came from the Danish National Registers. The COPD patients who were enrolled and completed the rehabilitation differed from COPD patients who were not enrolled into the rehabilitation in the following: (1) there were more women than men among those who were enrolled; (2) those who were enrolled had higher socioeconomic status compared to those who were not enrolled; and (3) those who were enrolled into the rehabilitation used more COPD-specific medication compared to those who were not enrolled. In conclusion, to enrol more COPD patients into PR, special attention needs to be paid to COPD patients from lower socioeconomic status groups as well as male patients. Ramune Jacobsen, Ea Rusch, Anne Frølich, Per Kragh Andersen, and Nina Godftredsen Copyright © 2013 Ramune Jacobsen et al. All rights reserved. Implication of DNA Methylation Profiling in Oral Epithelium for Lung Cancer Screening Mon, 26 Nov 2012 11:57:53 +0000 In lung cancer, the roles of molecular alterations in blood, sputum, bronchial brushing, and exhaled gas samples, which are relatively easy to obtain, have been evaluated for clinical availability. This study was based on the hypothesis that similar molecular alterations occur in the lung and oral cavity because both are exposed to the same environmental or tobacco-derived carcinogens. Because epigenetic alterations due to exposure to carcinogens are thought to play a major role in the development of lung cancer, the DNA methylation status of 11 genes in the oral epithelium was analyzed in lung cancer patients () and control individuals without lung cancer (). DNA methylation profiling revealed that GDNF, RARB, and HS3ST2 were methylated more frequently in cancer patients than in the control participants (, 0.0062, and 0.0193, resp.). Combined analysesindicatedthat 6 of 16 cancer patients (37.5%), but only 1 of 32 control individuals (3.1%) showed DNA methylation in 2-3 of these 3 genes (). These combined analyses showed the high specificity and positive predictive value in total and subgroup analyses. Our data suggest that DNA methylation profiling using oral epithelium may help in the identification of individuals with a high risk of lung cancer. Hiroaki Harada, Kazuaki Miyamoto, Yoshinori Yamashita, Kikuo Nakano, Kiyomi Taniyama, Masami Kimura, Yoshihiro Miyata, Hideki Ohdan, and Morihito Okada Copyright © 2012 Hiroaki Harada et al. All rights reserved. A Model Simulation for Decreased Left Ventricular Stroke Volume in Obstructive Sleep-Disordered Breathing Mon, 22 Oct 2012 11:06:19 +0000 Background. Increased negative intrathoracic pressures are recognized to exacerbate left ventricular dysfunction in obstructive sleep-disordered breathing. Reportedly left ventricular stroke volume (LVSV) decline appeared greater than predicted by the obstruction alone. Objectives. Whether this effect is more dependent on biventricular elasticity and fluid shifts than on breathing-related transmural pressures could be inferred from a mathematical model simulation. Design. A previously validated cardiopulmonary model in healthy subjects during inspiratory loading was modified by parameter adjustments to fit its ventricular volumes output to published clinical data of decreased LVSV in obstructed breathing. Results. Reduced left ventricular end-diastolic compliance and increased central blood volume from baseline each simulated a 20% drop in LVSV whereas twice as much change was the result of increasing a mere 400 mL to the unstressed volume of systemic veins. An intermediate value was obtained by decreasing right ventricular end-diastolic compliance and higher systemic venous compliance. Conclusions. Simulations encompassing a wide range of decreased stroke volume at comparable intrathoracic pressures suggested a prominent role of decreased myocardial distensibility (possibly coupled to fluid migration) in the stroke volume fall. Ernesto Goldman Copyright © 2012 Ernesto Goldman. All rights reserved. Aberrant Methylation in Promoters of GSTP1, p16, p14, and RASSF1A Genes in Smokers of North India Thu, 18 Oct 2012 14:21:01 +0000 Promoter hypermethylation plays an important role in the inactivation of tumor suppressor/metabolic genes during tumorigenesis. The screening of high-risk population (smokers) for hypermethylation pattern in tumor suppressor/metabolic genes can be a good noninvasive biomarker tool, which should be included in prognosis so that therapeutic measures can be initiated at an early stage. The purpose of this study was to determine the prevalence of aberrant promoter methylation of GSTP1, p16, p14, and RASSF1A genes in smokers and nonsmokers of North India. Our study showed that compared with nonsmokers, smokers have an increased risk of hypermethylation in these genes. We found that 57.3% of the smokers samples showed methylation for GSTP1, 38% for p16, 18% for p14, and 32% for RASSF1A. Our population study allowed us to reveal the relationship between smoking and the subsequent appearance of an epigenetic change. Smoking speeds up the hypermethylation of these genes, which are thus unable to express, making the person more susceptible to the risk of lung and other solid carcinomas. Hypermethylation studies on DNA from two lung cancer cell lines (A549 and H460) were also done to compare the results, and the results are similar to samples of smokers. Jagdeep S. Deep, Sukhjeet Sidhu, Avinash Chandel, Shruti Thapliyal, and Charu Garg Copyright © 2012 Jagdeep S. Deep et al. All rights reserved. FEV1/FEV6: A Reliable, Easy-to-Use, and Cheaper Alternative to FEV1/FVC in Diagnosing Airway Obstruction in Indian Population Sun, 14 Oct 2012 18:33:58 +0000 Background. FEV1/FEV6 has been proposed as a cheap, reproducible and valid alternative to FEV1/FVC in spirometry. No Indian data exists on its utility to diagnose airway obstruction. Aim. we sought to determine a fixed cut off of FEV1/FEV6 to diagnose obstruction corresponding to FEV1/FVC < 0.70 proposed by GOLD guidelines. Method. Spirometry was done on patient referred to a tertiary centre in India. Age, sex, height weight were recorded in addition to spirometric variables like FEV1, FVC, FEV6. The sensitivity, specificity, positive and negative predictive values of FEV1/FEV6 were determined with respect to gold standard of FEV1/FVC < 0.70. Results. 467 spirometries were analysed after meeting the ATS acceptability criteria. Considering FEV1/FVC < 0.7 as being the gold standard for obstruction, ROC curve was used to determine the best corresponding cut-off for FEV1/FEV6. The area under the curve was 99.3% (95% CI: 98.1–99.8%), and the FEV1/FEV6 cut-off, corresponding to the greatest sum of sensitivity and specificity, was 73%. For the total population, the FEV1/FEV6 sensitivity, specificity, PPV, NPV were was 95.7 %, 94.2 %, 87.5 % and 97.9 % respectively. Agreement by Kappa value between two cut offs was excellent 0.89 (0.87–0.91). Conclusion. FEV1/FEV6 < 73% is a new reliable spirometry index to diagnose airway obstruction in Indian population. Anupam Kumar Singh and Amit Lohia Copyright © 2012 Anupam Kumar Singh and Amit Lohia. All rights reserved. Sex Differences in the Effects of Inhaled Corticosteroids on Weight Gain among Patients with Asthma Sun, 16 Sep 2012 08:39:09 +0000 Background. Studies have shown that asthma and asthma exacerbations are related to body weight and that this relationship might be sex-specific. While oral corticosteroids have been associated with weight gain, little is known about the effect of inhaled corticosteroid (ICS) use on short-term weight gain. The purpose of the present study was to examine whether ICSs would be associated with weight gain among asthmatic patients. Methods. A total of 180 adult patients with physician-diagnosed asthma provided details of their medical history and demographic information, along with height and weight at baseline and at one year. Weight change was defined as follow-up minus baseline weight. General linear models were used to assess the relationship between ICS dose (fluticasone propionate equivalent) and sex. Results. Significant main effects of sex (𝑃=.005) and ICS dose (𝑃=.036) and an interaction effect of sex and ICS dose (𝑃=.003) on weight change were observed. Further analysis of the interaction indicated that women had greater weight gain, while men had decreased weight with increased ICS dose. Conclusions. Findings suggest that ICSs may trigger weight gain in females and highlight the need for studies to confirm this relationship and examine the potential underlying mechanisms. Amanda K. Rizk, Kim L. Lavoie, Véronique Pepin, Alicia Wright, and Simon L. Bacon Copyright © 2012 Amanda K. Rizk et al. All rights reserved. An Assessment of Epithelial and Mesenchymal Phenotypes in Experimental and Clinical Pulmonary Fibrosis Mon, 13 Aug 2012 12:52:09 +0000 Epithelial injury has been implicated as a driving factor for the pathogenesis of idiopathic pulmonary fibrosis (IPF). In this study we investigated changes in epithelial and mesenchymal markers in experimental models of fibrosis and associated this with IPF. TGFβ1 induced an epithelial to mesenchymal transition (EMT) phenotype in A549 cells and normal human bronchial epithelial cells, with A549 cells exhibiting a more profound transition to a mesenchymal phenotype. TGFβ1 overexpression in the lungs of mice resulted in an early increase in mesenchymal cell markers and apoptotic genes that preceded collagen deposition, suggesting an early epithelial injury triggers the downstream fibrotic response. In contrast, bleomycin had a gradual increase in mesenchymal cell marker and a decrease in E-cadherin expression that correlated with collagen protein deposition. Finally, we compared normal healthy lung tissue with surgical lung biopsies from IPF patients and observed alterations in epithelial and mesenchymal cell markers, as well as an increase in the apoptotic marker GSK3β. Interestingly, the mesenchymal changes were more profound in rapidly progressive patients in comparison to IPF patients with slowing progressing disease. In summary, this study provides evidence of alterations in epithelial and mesenchymal markers in experimental models of lung fibrosis and how these findings are relevant to clinical disease. Rebecca Dunmore, Alan M. Carruthers, Matthew J. Bell, Huilan Zhang, Cory M. Hogaboam, Xueyang Peng, Erica L. Herzog, Darryl A. Knight, Fernando J. Martinez, Matthew A. Sleeman, and Lynne A. Murray Copyright © 2012 Rebecca Dunmore et al. All rights reserved. Effect of Salt-Bromide-Iodine Thermal Water Inhalation on Functional and Biochemical Lung Parameters Wed, 25 Jul 2012 14:26:58 +0000 Background. Inhalation of thermal water has been used empirically in the treatment of chronic diseases of upper and lower respiratory tract. This study investigates biomarkers of effect in exhaled breath (nitric oxide (NO)) and in exhaled breath condensate (EBC) (hydrogen peroxide (H2O2), anions, toxic heavy metals of tobacco smoke) for patients with lung diseases inhaling salt-bromide-iodine thermal water. Methods. This study enrolled two groups of patients, twenty with alveolar pulmonary diseases—pneumoconiosis—twenty-two with bronchial diseases. Patients received 12 days inhalation treatment with thermal water in Terme of Monticelli (Parma), Italy. Results. No statistically significant differences were found for NO at different flow rates in both groups of patients before and after thermal water inhalation. Also in EBC no statistically significant differences were present for H2O2 concentrations, toxic heavy metals concentrations, and anion concentrations before and after treatment. Nitrates in EBC were found to be significantly higher in patients before inhalation than in controls as well as in patients after inhalation versus controls. Conclusions. This study contributes to better quantify functional and biochemical changes in airways before and after thermal water treatment. Massimo Corradi, Giuseppina Folesani, Petra Gergelova, Matteo Goldoni, Silvana Pinelli, Gianfranco Gainotti, Giuseppe De Palma, and Antonio Mutti Copyright © 2012 Massimo Corradi et al. All rights reserved. Lung Function Tests in Sickle-Cell Patients in Benin City Tue, 26 Jun 2012 17:07:08 +0000 Background. Sickle-cell disease (SCD) is a life-long haematological disorder characterized by red blood cells that assume an abnormal, rigid, sickle shape and with high prevalence in West Africa. Sickle cell disease (SCD) is one of the most common genetic disorders among Africans as indicated in Akinyanju (1989). 61.4% of the children born annually with haemoglobinopathies worldwide have been reported to have SCD and they are from Africa as shown in World Health Organization Report (1987). Hypoxaemia is the hallmark of pulmonary abnormality in SCD patients of all age groups. This was first documented by Klinefelter (1942), and has since been corroborated by other workers. The hypoxaemia of stable SCD patients is said to result from the combined effects of perfusion and diffusion defect. Materials and Methods. This study was carried out to determine the changes in lung functions in relation to gender, age, and body mass index (BMI) of sickle-cell patients in a stable state. 60 subjects made up of 30 patients and 30 control groups were used in this study. Both test and control groups were 13 men and 17 women, aged 19–35 years. Lung Function Test was done with the aid of a digital spirometer (Spirolab II, Italy). Weight was measured using Avery scales (Avery Berkel, 2003, UK). Height was measured using a wall-mounted stadiometer. Data were collected and analyzed using Student's t-test and Pearson correlation. 𝑃<0.05 was statistically significant. Results. The results revealed that adults with SCD had a significantly lower mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) compared to the control. The lung function indices were lower in females than males in the sickle cell patients. The FVC, FEV1, and FEV1/FVC correlated positively with BMI statistically in the patients. The lung function declined with age. This work has also shown that the most common pulmonary function test (PFT) abnormality was restrictive disease pattern (76.7%). Conclusion. The result of this work suggested that lung function differs significantly in subjects with SCD compared with matched controls of a similar age and gender. J. N. Oko-Ose, V. Iyawe, E. Egbagbe, and M. Ebomoyi Copyright © 2012 J. N. Oko-Ose et al. All rights reserved. Exercise Capacity in Prepubertal Children with Cystic Fibrosis Sun, 24 Jun 2012 11:29:13 +0000 Background. Patients with cystic fibrosis (CF) are observed to have diminished lung function, nutritional status, and aerobic exercise capacity. All three parameters are related to prognosis and survival. However, there is little information regarding these parameters in prepubertal patients. Methods. Our study groups consisted of sixteen patients with CF (7 girls) and 99 healthy volunteers (52 girls). Subjects performed spirometry and a progressive exercise test to exhaustion on a cycle ergometer. Leg muscle strength was measured using an isokinetic dynamometer. Physical activity was examined using the modifiable activity questionnaire and accelerometer. Results. Nutritional status was similar between groups (BMI—boys control versus CF 18.5 versus 17.9, girls control versus CF 19.5 versus 17.4). Girls with CF were significantly smaller and lighter than controls. Lung function was significantly reduced in CF groups (FEV1—boys control versus CF 91% versus 84%, girls control versus CF 90% versus 82%). Patients with CF were as active and as fit as their healthy controls. Conclusion. In this group of prepubertal children with CF, nutritional status was comparable to healthy children of the same age. Their aerobic exercise tolerance and peripheral muscle strength were also relatively well preserved despite significantly lower lung function. Emma Kilbride, John Widger, Juliette Hussey, Basil El Nazir, and Peter Greally Copyright © 2012 Emma Kilbride et al. All rights reserved. Variations in Draining Patterns of Right Pulmonary Veins at the Hilum and an Anatomical Classification Tue, 19 Jun 2012 09:03:38 +0000 Pulmonary veins carry oxygenated blood from the lungs to the left atrium. Variations are quite common in the pattern of drainage. The present study was undertaken to evaluate the incidence of different draining patterns of the right pulmonary veins at the hilum by dissecting the human fixed cadaveric lungs. Clinically, pulmonary veins have been demonstrated to often play an important role in generating atrial fibrillation. Hence, it is important to look into the anatomy of the veins during MR imaging and CT angiography. In 53.8% of cases, the right superior lobar vein and right middle lobar vein were found to be united together to form the right superior pulmonary vein. In contrast to this, in 11.53% of cases, right middle lobar vein united with the right inferior lobar vein to form the right inferior pulmonary vein, while in 26.9% of cases, the right superior lobar vein, right middle lobar vein, and right inferior lobar vein drained separately. M. S. Rajeshwari and Priya Ranganath Copyright © 2012 M. S. Rajeshwari and Priya Ranganath. All rights reserved. A Study of Community-Acquired Pneumonias in Elderly Individuals in Bijapur, India Sun, 13 May 2012 18:52:46 +0000 Community-acquired pneumonia (CAP) in elderly has different clinical presentation and higher mortality than CAP in other age group. Clinical presentation may vary from mere presence of fever to altered sensorium. The incomplete clinical picture of CAP in the elderly may be associated with a delay in establishing the diagnosis and, consequently, in starting adequate antibiotic therapy. Delay in diagnosis and treatment may contribute to the higher observed death rate in the elderly population with CAP. Hence the following study was undertaken to study the clinical, radiological, and bacteriological profile of community-acquired pneumonia in elderly. A total of 50 patients were studied. Age group varied from 66 years to 88 years. Presentation varied from typical symptoms to altered sensorium. Smoking and COPD were most common predisposing conditions. Most common organisms responsible were Streptococcus pneumonia, Klebsiella pneumonia, Pseudomonas, H. influenza, and Staphylococcus aureus. Etiological agents could not be identified in many cases because of difficulty in collecting sputum in elderly patients, lower yield of culture, and various atypical and difficult to isolate causative organisms. Hence there is need for an empirical therapy covering both typical and atypical organisms. Better understanding of these aspects may help a long way in managing elderly patients with pneumonia. Bilal Bin Abdullah, Mohammed Zoheb, Syed Mustafa Ashraf, Sharafath Ali, and Nida Nausheen Copyright © 2012 Bilal Bin Abdullah et al. All rights reserved. Environmental Exposure and Nonadherence with Medicines Directly Correlate with Exacerbations and Hospitalization for Asthma: A Population-Based Survey from UAE Thu, 29 Mar 2012 10:36:04 +0000 Acute severe exacerbation of asthma is directly related with the uncontrolled asthma including noncompliance with the medicines and exposure to the environmental factors. To our knowledge, none of the community-based study has explored the prevalence of asthma and other factors (namely, pattern of symptoms, environmental/occupational/housing/behavioral pattern/misperception about asthma, and educational factors) contributing to the exacerbation of asthma. We also studied the nonadherence issues related to the management of asthma in the United Arab Emirates (UAE). By using European Community Respiratory Health Survey (ECRHS) questionnaires and pooled data from AIRGNE (UAE) study, we aimed to determine the above-mentioned factors in the general population by means of a cross-sectional assessment of a random sample of 1,229 participants of which 62.97% were male and 20.01% were UAE nationals, with a mean age (±SD) of 32.9 (±14.1) years. Prevalence of individual respiratory symptoms from the ECRHS questionnaire in all participants ranged from 8 to 10%, while those participants aged 20–44 years presented a lower prevalence in all symptoms (𝑃<0.05). Conclusion. Certain specific persistent environmental factor along with nonadherence to the controller medicines is a significant factor leading to uncontrolled asthma with consequent exacerbations, morbidity/mortality, and health care cost in UAE. Bassam Mahboub, Mayank Vats, Shahid Afzal, Walid Sharif, and Mohammed Nizam Iqbal Copyright © 2012 Bassam Mahboub et al. All rights reserved. Exercise-Induced Bronchospasm Diagnosis in Sportsmen and Sedentary Thu, 22 Mar 2012 14:30:45 +0000 This paper aims to identify factors that may account for the high values and varied prevalence of exercise-induced bronchospasm (EIB), which occur in the population of athletes. Journal articles, indexed and peer reviewed, published in the MEDLINE and SPORTDiscus database were screened using a computer search. Keywords as “prevalence,” “exercise,” “bronchospasm,” and “athletes” were crossed. The diagnosis of EIB based on the questionnaire or maximal decrease of ventilatory parameters was considered as inclusion criteria and selection of articles. Analysis of selected articles reveals higher values and varied prevalence of EIB (11–55%) compared to those in the general population (4–20%). Evaluation criteria of EIB are those based on the characteristics of sedentary subjects. Criteria sometimes do not seem adapted to specific sports. This paper suggests a differential diagnostic approach which takes account of both the EIB characteristics of sedentary and those of sportsmen. Folly Messan, Tanguy Marqueste, BarnabΓ© Akplogan, Patrick Decherchi, and Laurent GrΓ©lot Copyright © 2012 Folly Messan et al. All rights reserved. Mathematical Behavior of MEFV Curves in Childhood Asthma and the Role of Curvature in Quantifying Flow Obstruction Sun, 18 Mar 2012 13:13:55 +0000 Maximal expiratory flow-volume (MEFV) curves of pediatric patients are investigated using differentiation schemes and by computing their second derivative, 𝑑2̇𝑉/𝑑𝑉2. Results show that spirometric tracings illustrate a characteristic well-defined behavior, where two distinct regions of the MEFV curve may be identified: (1) a concave profile during the initial expiratory maneuver, and (2) a convex profile over the greater lower region of the descending phase of the MEFV curve; this latter region is characterized by an approximately constant positive value of 𝑑2̇𝑉/𝑑𝑉2 such that the descending MEFV limb may be captured by a quadratic function. Based on simple expiratory flow modeling, we show that 𝑑2̇𝑉/𝑑𝑉2, and alternatively the local geometrical curvature πœ…(𝑉), yield a measure of the relative degree of flow obstruction. In view of future clinical applications, we make use of an “average curvature index”, to assist clinician’s assessment of asthma severity, by quantifying curvature and summarizing global information in MEFV curves. Ben Spycher, Urs Frey, Johannes H. Wildhaber, and JosuΓ© Sznitman Copyright © 2012 Ben Spycher et al. All rights reserved. The Pattern of Presentation and Prevalence of Tuberculosis in HIV-Seropositive Patients Seen at Benin City, Nigeria Mon, 12 Mar 2012 14:19:02 +0000 Background. The emergence of Human immunodeficiency virus (HIV), led to the rise in the incidence and prevalence of tuberculosis (TB) worldwide. However, the trend is being reversed recently due to the widespread use of effective Anti-Retrovirals. Immunosuppression induced by HIV infection modified the clinical presentation of TB, resulting in atypical signs and symptoms, and a more frequent extrapulmonary presentation. This study was undertaken to determine the pattern of presentation and prevalence of TB in HIV seropositive patients seen in Benin City, Nigeria, from January to April, 2007. Method. The study was done using 330 HIV positive patients (123 males and 207 females). A designed questionnaire was used as a diagnostic instrument. Results. The prevalence of TB HIV was found to be 33.9%. It was found to be commoner in females, commonest in the age group 30–39 years. Pulmonary TB was the commonest type of TB found (78.6%). This was followed by TB adenitis (12.5%). The incidence of extrapulmonary TB was 21.4%. There was a high incidence of atypical chest X-ray features and high frequency of negative sputum smears. Conclusions. The overall prevalence rate of TB in HIV (33.9%), and the extrapulmonary presentation of TB are high. Some investigation results were found to be atypical in those with both infections. Physicians should be aware of this pattern of presentation and the atypical findings on investigation for early diagnosis and treatment. Christopher C. Affusim, Emeka Kesieme, and Vivien O. Abah Copyright © 2012 Christopher C. Affusim et al. All rights reserved. Controversies Surrounding the Potential Use of Histone Deacetylase Inhibitors for the Treatment of Asthma Thu, 01 Mar 2012 13:10:19 +0000 Management of asthma with long-acting 𝛽2-adrenergic receptor agonists and corticosteroids is exceptionally effective for the majority of asthma patients. However, corticosteroid insensitivity or resistance remains a significant clinical problem for a significant proportion of patients, requiring the investigation of new potential therapeutics for asthma. Histone deacetylase inhibitors represent a different class of compounds that have been evaluated for their potential antiasthmatic effects. Although accumulating evidence is indicating beneficial effects in rodent models of allergic airways disease, the potential use of histone deacetylase inhibitors in asthma remains controversial given their mechanisms of action. The aim of this paper is to provide an overview of histone deacetylases and pharmacological modifiers of these enzymes. The discussion represents a balanced account of the emerging evidence indicating the beneficial effects of histone deacetylase inhibitors in inflammatory lung diseases. The potential problems associated with the use of this class of compounds in asthma are also carefully considered. Simon G. Royce, Katherine Ververis, and Tom C. Karagiannis Copyright Β© 2012 Simon G. Royce et al. All rights reserved.