Pulmonary Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Challenges in Endobronchial Tuberculosis: From Diagnosis to Management Thu, 14 Aug 2014 00:00:00 +0000 http://www.hindawi.com/journals/pm/2014/594806/ Despite the rapid advancement in diagnostic and therapeutic modalities, endobronchial tuberculosis (EBTB), defined as tuberculous infection of the tracheobronchial tree, continues to remain challenging for clinicians. Nonspecific respiratory symptoms along with normal chest radiograph in 10–20% of cases may be alleged for the diagnostic delay. Variable diagnostic yield with sputum microscopy might further compound the problem. In such cases, high resolution computed tomography (HRCT) works as a more sensitive tool and demonstrates involvement of tracheobronchial tree described classically as “tree-in-bud” appearance. Bronchoscopic biopsy is considered the most reliable method for confirmation of the diagnosis with 30% to 84% positivity in different series. Evolution of the disease is also unpredictable with frequent progression to bronchostenosis, therefore requiring regular follow-up and early intervention to halt the natural course. This review article elaborates various aspects of the disease with specific focus on diagnostic dilemma and recent advances in interventional bronchoscopy. In addition, this discussion evokes optimism for further research and introduction of innovative therapeutic modalities. Surender Kashyap and Anjali Solanki Copyright © 2014 Surender Kashyap and Anjali Solanki. All rights reserved. Fungal Exposure and Low Levels of IL-10 in Patients with Sarcoidosis Thu, 07 Aug 2014 09:09:48 +0000 http://www.hindawi.com/journals/pm/2014/164565/ Background and Objectives. Sarcoidosis is an inflammatory disease with increased levels of inflammatory cytokines. Previous studies have shown a relation between the degree of granuloma infiltration and serum cytokine levels, except for interleukin- (IL-) 10. The aim of the study was to further investigate the serum levels of IL-10 in patients with sarcoidosis and relate them to fungal exposure in terms of the amount of fungi in the air of their homes and β-glucan in bronchoalveolar lavage (BAL) fluid. Methods. Patients with sarcoidosis () and healthy controls () were enrolled. IL-10 was determined in serum. BAL was performed and the amount of β-glucan was measured. Domestic exposure to fungi was determined by measuring airborne β-N-acetylhexosaminidase (NAHA) in the bedrooms. Results. At high levels of fungal exposure (domestic fungal exposure and β-glucan in BAL), serum IL-10 values were lower than at low and intermediate exposure levels. Conclusion. The low serum IL-10 values at high fungal exposure suggest that fungal cell wall agents play a role in granuloma formation in sarcoidosis by inhibiting the secretion of the anti-inflammatory cytokine IL-10. Marjeta Terčelj, Sanja Stopinšek, Alojz Ihan, Barbara Salobir, Saša Simčič, and Ragnar Rylander Copyright © 2014 Marjeta Terčelj et al. All rights reserved. Effects of Inactivated Bordetella pertussis on Phosphodiesterase in the Lung of Ovalbumin Sensitized and Challenged Rats Wed, 09 Jul 2014 09:30:56 +0000 http://www.hindawi.com/journals/pm/2014/581738/ This paper indicated that inactivated Bordetella pertussis (iBp) can enhance the lung airway hyperreactivity of the rats sensitized and challenged with OVA. The mechanisms were involved in the upregulation of cAMP-PDE activity and PDE4A, PDE4D, and PDE3 gene expression in the lungs. But only PDE4 activity was different between the OVA and OVA+iBp groups, and PDE4D expression was significantly increased in iBp rats alone. So, our data suggested that cosensitization with OVA and iBp affects lung airway reactivity by modulating the lung cAMP-PDE activity and PDE4D gene expression. Ya-Juan Wang, Shun-De Song, Jun-Chun Chen, Xue-Feng Wang, Ya-Li Jiang, Qiang-Min Xie, Ji-Qiang Chen, Zi-Gang Li, and Hui-Fang Tang Copyright © 2014 Ya-Juan Wang et al. All rights reserved. The Epidemiology of Pulmonary Nontuberculous Mycobacteria: Data from a General Hospital in Athens, Greece, 2007–2013 Tue, 10 Jun 2014 05:55:28 +0000 http://www.hindawi.com/journals/pm/2014/894976/ Background. The epidemiology of pulmonary nontuberculous mycobacteria (NTM) in Greece is largely unknown. Objectives. To determine the incidence and the demographic, microbiological, and clinical characteristics of patients with pulmonary NTM infection and pulmonary NTM disease. Methods. A retrospective review of the demographic, microbiological, and clinical characteristics of patients with NTM culture-positive respiratory specimens from January 2007 to May 2013. Results. A total of 120 patients were identified with at least one respiratory NTM isolate and 56 patients (46%) fulfilled the microbiological ATS/IDSA criteria for NTM disease. Of patients with adequate data, 16% fulfilled the complete ATS/IDSA criteria for NTM disease. The incidence of pulmonary NTM infection and disease was 18.9 and 8.8 per 100.000 inpatients and outpatients, respectively. The spectrum of NTM species was high (13 species) and predominated by M. avium-intracellulare complex (M. avium (13%), M. intracellulare (10%)), M. gordonae (14%), and M. fortuitum (12%). The ratio of isolation of NTM to M. tuberculosis in all hospitalized patients was 0.59. Conclusions. The first data on the epidemiology of pulmonary NTM in Athens, Greece, are presented. NTM infection is common in patients with chronic respiratory disease. However, only a significantly smaller proportion of patients fulfill the criteria for NTM disease. Marios Panagiotou, Andriana I. Papaioannou, Konstantinos Kostikas, Maria Paraskeua, Ekaterini Velentza, Maria Kanellopoulou, Vasiliki Filaditaki, and Napoleon Karagiannidis Copyright © 2014 Marios Panagiotou et al. All rights reserved. Retracted: Predictive Role of ADA in Bronchoalveolar Lavage Fluid in Making the Diagnosis of Pulmonary Tuberculosis Thu, 05 Jun 2014 09:20:39 +0000 http://www.hindawi.com/journals/pm/2014/426964/ Pulmonary Medicine Copyright © 2014 Pulmonary Medicine. All rights reserved. Trends in Pulmonary Hypertension Mortality and Morbidity Sun, 01 Jun 2014 00:00:00 +0000 http://www.hindawi.com/journals/pm/2014/105864/ Context. Few reports have been published regarding surveillance data for pulmonary hypertension, a debilitating and often fatal condition. Aims. We report trends in pulmonary hypertension. Settings and Design. United States of America; vital statistics, hospital data. Methods and Material. We used mortality data from the National Vital Statistics System (NVSS) for 1999–2008 and hospital discharge data from the National Hospital Discharge Survey (NHDS) for 1999–2009. Statistical Analysis Used. We present age-standardized rates. Results. Since 1999, the numbers of deaths and hospitalizations as well as death rates and hospitalization rates for pulmonary hypertension have increased. In 1999 death rates were higher for men than for women; however, by 2002, no differences by gender remained because of the increasing death rates among women and the declining death rates among men; after 2003 death rates for women were higher than for men. Death rates throughout the reporting period 1999–2008 were higher for blacks than for whites. Hospitalization rates in women were 1.3–1.6 times higher than in men. Conclusions. Pulmonary hypertension mortality and hospitalization numbers and rates increased from 1999 to 2008. Alem Mehari, Orlando Valle, and Richard F. Gillum Copyright © 2014 Alem Mehari et al. All rights reserved. Frequency and Intensive Care Related Risk Factors of Pneumothorax in Ventilated Neonates Mon, 28 Apr 2014 00:00:00 +0000 http://www.hindawi.com/journals/pm/2014/727323/ Objectives. Relationships of mechanical ventilation to pneumothorax in neonates and care procedures in particular are rarely studied. We aimed to evaluate the relationship of selected ventilator variables and risk events to pneumothorax. Methods. Pneumothorax was defined as accumulation of air in pleural cavity as confirmed by chest radiograph. Relationship of ventilator mode, selected settings, and risk procedures prior to detection of pneumothorax was studied using matched controls. Results. Of 540 neonates receiving mechanical ventilation, 10 (1.85%) were found to have pneumothorax. Respiratory distress syndrome, meconium aspiration syndrome, and pneumonia were the underlying lung pathology. Pneumothorax mostly (80%) occurred within 48 hours of life. Among ventilated neonates, significantly higher percentage with pneumothorax received mandatory ventilation than controls (70% versus 20%; ). Peak inspiratory pressure >20 cm and overventilation were not significantly associated with pneumothorax. More cases than controls underwent care procedures in the preceding 3 hours of pneumothorax event. Mean airway pressure change () and endotracheal suctioning () were not significantly associated with pneumothorax. Reintubation (), and bagging () were significantly associated with pneumothorax. Conclusion. Pneumothorax among ventilated neonates occurred at low frequency. Mandatory ventilation and selected care procedures in the preceding 3 hours had significant association. Ramesh Bhat Yellanthoor and Vidya Ramdas Copyright © 2014 Ramesh Bhat Yellanthoor and Vidya Ramdas. All rights reserved. Oscillatory Shear Stress-Induced Arginase Activity May Explain Reduced Exhaled Nitric Oxide Levels after Vest Chest Physiotherapy in Cystic Fibrosis Thu, 03 Apr 2014 11:46:07 +0000 http://www.hindawi.com/journals/pm/2014/725317/ Christoph Nowak Copyright © 2014 Christoph Nowak. All rights reserved. Practical Guidelines: Lung Transplantation in Patients with Cystic Fibrosis Sun, 30 Mar 2014 13:20:34 +0000 http://www.hindawi.com/journals/pm/2014/621342/ There are no European recommendations on issues specifically related to lung transplantation (LTX) in cystic fibrosis (CF). The main goal of this paper is to provide CF care team members with clinically relevant CF-specific information on all aspects of LTX, highlighting areas of consensus and controversy throughout Europe. Bilateral lung transplantation has been shown to be an important therapeutic option for end-stage CF pulmonary disease. Transplant function and patient survival after transplantation are better than in most other indications for this procedure. Attention though has to be paid to pretransplant morbidity, time for referral, evaluation, indication, and contraindication in children and in adults. This review makes extensive use of specific evidence in the field of lung transplantation in CF patients and addresses all issues of practical importance. The requirements of pre-, peri-, and postoperative management are discussed in detail including bridging to transplant and postoperative complications, immune suppression, chronic allograft dysfunction, infection, and malignancies being the most important. Among the contributors to this guiding information are 19 members of the ECORN-CF project and other experts. The document is endorsed by the European Cystic Fibrosis Society and sponsored by the Christiane Herzog Foundation. T. O. Hirche, C. Knoop, H. Hebestreit, D. Shimmin, A. Solé, J. S. Elborn, H. Ellemunter, P. Aurora, M. Hogardt, T. O. F. Wagner, and ECORN-CF Study Group Copyright © 2014 T. O. Hirche et al. All rights reserved. Factors Influencing Early Health Facility Contact and Low Default Rate among New Sputum Smear Positive Tuberculosis Patients, India Thu, 06 Mar 2014 15:56:00 +0000 http://www.hindawi.com/journals/pm/2014/132047/ Early case identification and prompt treatment of new sputum smear positive case are important to reduce the spread of tuberculosis (TB). Present study was planned to study the associated factors for duration to contact the health facility since appearance of symptoms and treatment default. Methodology. It was prospective cohort study of TB patients already registered for treatment in randomly selected TB units (TUs) in Himachal Pradesh, India. Relative risk (RR) was calculated as risk estimate to find out the explanatory variables for early contact and default. Results. Total 1607 patients were recruited and 25 (1.5%) defaulted treatment. Patients from nuclear family (aRR: 1.37; 1.09–1.73), ashamed of TB (aRR: 1.32; 1.03–1.70), wishing to disclose disease status (aRR: 1.79; 1.43–2.24), but aware of curable nature (aRR: 1.67; 1.17–2.39) and preventable (aRR: 1.35; 1.07–1.70) nature of disease, contacted health facility early since appearance of symptoms. Conclusion. Better awareness and less misconceptions about disease influences the early contact of health facility and low default rate in North India. Ashok Kumar Bhardwaj, Surender Kashyap, Pradeep Bansal, Dinesh Kumar, Sunil Kumar Raina, Vishav Chander, and Sushant Sharma Copyright © 2014 Ashok Kumar Bhardwaj et al. All rights reserved. Retrospective Observations on the Ability to Diagnose and Manage Patients with Asthma through the Use of Impulse Oscillometry: Comparison with Spirometry and Overview of the Literature Sun, 09 Feb 2014 07:45:32 +0000 http://www.hindawi.com/journals/pm/2014/376890/ Objective. Impulse oscillometry (IOS) is an evolving technology for the diagnosis and followup of patients with asthma. Our objective is to review the findings on patients who underwent both spirometry and IOS during clinical evaluations of their asthma. The goal was to retrospectively evaluate IOS during the initial diagnosis and followup of patients with asthma in comparison with spirometry. Methods. We routinely perform IOS and spirometry evaluation in patients with suspected asthma during baseline visits and at followup. We reviewed the data on 39 patients over the age of 13 with asthma at baseline and following treatment with inhaled corticosteroids. IOS and spirometry were both done at baseline, following short acting bronchodilator administration, and at followup after at least three months of inhaled corticosteroid treatment. Results. IOS showed improvement in airway function both initially, following short acting bronchodilator introduction, and later after initiation of long term inhaled corticosteroid treatment, even when the spirometry did not reveal improvement. We noted the IOS improvement in the reactance or AX as well as the resistance in smaller airways or R5. Conclusion. IOS may provide a useful measure towards identifying an asthma diagnosis and followup without inducing the extra respiratory effort spirometry requires. Constantine Saadeh, Blake Cross, Charles Saadeh, and Michael Gaylor Copyright © 2014 Constantine Saadeh et al. All rights reserved. Sleep Apnea and Cardiovascular Diseases Wed, 05 Feb 2014 13:50:03 +0000 http://www.hindawi.com/journals/pm/2014/690273/ Rodolfo Álvarez-Sala, Francisco García-Río, Félix Del Campo, Carlos Zamarrón, and Nikolaus C. Netzer Copyright © 2014 Rodolfo Álvarez-Sala et al. All rights reserved. A Simple Clinical Measure of Quadriceps Muscle Strength Identifies Responders to Pulmonary Rehabilitation Thu, 30 Jan 2014 07:15:07 +0000 http://www.hindawi.com/journals/pm/2014/782702/ The aim was to determine if baseline measures can predict response to pulmonary rehabilitation in terms of six-minute walk distance (6MWD) or quality of life. Participants with COPD who attended pulmonary rehabilitation between 2010 and 2012 were recruited. Baseline measures evaluated included physical activity, quadriceps strength, comorbidities, inflammatory markers, and self-efficacy. Participants were classified as a responder with improvement in 6MWD (criteria of ≥25 m or ≥2SD) and Chronic Respiratory Questionnaire (CRQ; ≥0.5 points/question). Eighty-five participants with a mean (SD) age of 67(9) years and a mean forced expiratory volume in one second of 55(22)% were studied. Forty-nine and 19 participants were responders when using the 6MWD criteria of ≥25 m and ≥61.9 m, respectively, with forty-four participants improving in CRQ. In a regression model, responders in 6MWD (≥25 m criteria) had lower baseline quadriceps strength () and higher baseline self-efficacy scores (). Independent predictors of 6MWD response (≥61.9 m criteria) were participants with metabolic disease () and lower baseline quadriceps strength (). Lower baseline CRQ was the only independent predictor of CRQ response. A participant with relatively lower baseline quadriceps strength was the strongest independent predictor of 6MWD response. Metabolic disease may predict 6MWD response, but predictors of CRQ response remain unclear. James R. Walsh, Norman R. Morris, Zoe J. McKeough, Stephanie T. Yerkovich, and Jenny D. Paratz Copyright © 2014 James R. Walsh et al. All rights reserved. Predictive Role of ADA in Bronchoalveolar Lavage Fluid in Making the Diagnosis of Pulmonary Tuberculosis Tue, 24 Dec 2013 09:24:51 +0000 http://www.hindawi.com/journals/pm/2013/851518/ Current diagnostic tests for tuberculosis (TB) are time-consuming. The aim of this study was to evaluate the diagnostic usefulness of ADA in bronchoalveolar lavage fluid in patients with pulmonary TB. A cross-sectional study was performed in Yazd, Iran, between 2009 and 2010. Patients suspected of pulmonary TB with negative sputum smear for AFB were included in the study. Mean ADA levels in BAL fluids were measured and compared between study groups. Sixty-three patients were enrolled in the study among which 15 cases had pulmonary TB, 33 had pulmonary diseases other than TB, and 15 subjects with normal bronchoscopy results were considered as controls. Mean ADA levels in BAL fluid were , , and , respectively. This rate was significantly higher in the pulmonary TB group compared to the other two groups (). Using ROC curve with a cut-off value of 3.5 IU/L, the highest sensitivity (57%) and specificity (84%) were obtained in diagnosis of TB. The results showed that although ADA activity in BAL fluid of pulmonary TB patients was higher than those seen in other diseases, a negative test does not rule out pulmonary TB. Fariba Binesh and Abolhassan Halvani Copyright © 2013 Fariba Binesh and Abolhassan Halvani. All rights reserved. The Pattern of Respiratory Disease Morbidity and Mortality in a Tertiary Hospital in Southern-Eastern Nigeria Tue, 17 Dec 2013 11:35:34 +0000 http://www.hindawi.com/journals/pm/2013/581973/ Background. Respiratory complaints are commonly encountered in medicine and respiratory diseases place a high burden on healthcare infrastructure. Healthcare planning should be based on adequate information: this study will help us to analyze the pattern of respiratory disease admissions in the medical wards in a developing country. Methods. The medical records of patients admitted into the medical wards over a 5-year period were retrieved and reviewed. Information obtained included demography, diagnosis, comorbid conditions, and risk factors for respiratory disease. Results. Three thousand four hundred and ninety patients were admitted into the medical wards with 325 (9.3%) of them diagnosed with a respiratory condition. There were 121 females and 204 males. The average age of the patients was 40.7 ± 14.7 years. Only 7% of the patients smoked cigarette. The commonest respiratory conditions were tuberculosis (66.8%) and pneumonia (24.9%). The commonest comorbidity was HIV infection (39.7%). Tuberculosis/HIV coinfection rate was 50.7%. HIV infection was the single most important predictor of an adverse outcome (OR 5.1, 95% CI 2.05–12.7, ). Conclusion. Infective conditions make up a large percentage of respiratory diseases in low income countries with HIV infection constituting a significant risk factor for a poor disease outcome. Victor Aniedi Umoh, Akaninyene Otu, Henry Okpa, and Emmanuel Effa Copyright © 2013 Victor Aniedi Umoh et al. All rights reserved. Evaluating the Ameliorative Potential of Quercetin against the Bleomycin-Induced Pulmonary Fibrosis in Wistar Rats Thu, 12 Dec 2013 10:46:35 +0000 http://www.hindawi.com/journals/pm/2013/921724/ The current study deals with the effect of a dietary flavanoid quercetin on fibrotic lung tissue in rats. Bleomycin was administered by single intratracheal instillation to Wistar rats to induce lung fibrosis. The pathologies associated with this included significantly reduced antioxidant capacity, ultimately leading to protracted inflammation of the lung tissue. The hallmark of this induced fibrosis condition was an excessive collagen deposition in peribronchial and perialveolar regions of the lung. Oral quercetin treatment over a period of twenty days resulted in significant reversal of the pathologies. The antioxidant defense in lung tissue was revived. Moreover, activity of the collagenase MMP-7, which was high in fibrotic tissue, was seen restored after quercetin administration. Trichome staining of lung tissue sections showed high collagen deposition in fibrotic rats, which may be a direct result of increased mobilization of collagen by MMP-7. This was appreciably reduced in quercetin treated animals. These results point towards an important protective role of quercetin against idiopathic lung fibrosis, which remains a widely prevalent yet incurable condition in the present times. Ramesh Verma, Lokendra Kushwah, Darpesh Gohel, Manish Patel, Tulsi Marvania, and Suresh Balakrishnan Copyright © 2013 Ramesh Verma et al. All rights reserved. The Immediate Pulmonary Disease Pattern following Exposure to High Concentrations of Chlorine Gas Mon, 09 Dec 2013 11:56:42 +0000 http://www.hindawi.com/journals/pm/2013/325869/ Background. Classification of pulmonary disease into obstructive, restrictive, and mixed patterns is based on 2005 ATS/ERS guidelines and modified GOLD criteria by Mannino et al. (2003), but these guidelines are of limited use for simple spirometry in situations involving mass casualties. Aim. The purpose of this study was to apply these guidelines to patients who underwent simple spirometry following high concentration of chlorine gas inhalation after a train derailment in Graniteville, South Carolina. Methods. We retrospectively investigated lung functions in ten patients. In order to classify pulmonary disease pattern, we used 2005 ATS/ERS guidelines and modified GOLD criteria along with our own criteria developed using available simple spirometry data. Results. We found predominant restrictive pattern in our patients with both modified GOLD and our criteria, which is in contrast to other chlorine exposure studies where obstructive pattern was more common. When compared to modified GOLD and our criteria, 2005 ATS/ERS guidelines underestimated the frequency of restrictive disease. Conclusion. Diagnosis of pulmonary disease patterns is of importance after irritant gas inhalation. Acceptable criteria need to be developed to evaluate pulmonary disease through simple spirometry in events leading to mass casualty and patient surge in hospitals. Pallavi P. Balte, Kathleen A. Clark, Lawrence C. Mohr, Wilfried J. Karmaus, David Van Sickle, and Erik R. Svendsen Copyright © 2013 Pallavi P. Balte et al. All rights reserved. The Role of the High-Sensitivity C-Reactive Protein in Patients with Stable Non-Cystic Fibrosis Bronchiectasis Sat, 07 Dec 2013 11:03:00 +0000 http://www.hindawi.com/journals/pm/2013/795140/ Study Objectives. The aim of this study is to investigate the correlation between serum high-sensitivity C-reactive protein (hs-CRP) and other clinical tools including high-resolution computed tomography (HRCT) in patients with stable non-CF bronchiectasis. Design. A within-subject correlational study of a group of patients with stable non-CF bronchiectasis, who were recruited from our outpatient clinic, was done over a two-year period. Measurements. Sixty-nine stable non-CF bronchiectasis patients were evaluated in terms of hs-CRP, 6-minute walk test, pulmonary function tests, and HRCT. Results. Circulating hs-CRP levels were significantly correlated with HRCT scores (, , ) and resting oxygenation saturation (, ). HRCT severity scores significantly increased in patients with hs-CRP level of 4.26 mg/L or higher (mean ± SD ) compared to those with hs-CRP level less than 4.26 mg/L (, ). Oxygenation saturation at rest was lower in those with hs-CRP level of 4.26 mg/L or higher () compared to those with hs-CRP level less than 4.26 mg/L (, ). Conclusion. There was a good correlation between serum hs-CRP and HRCT scores in the patients with stable non-CF bronchiectasis. Meng-Heng Hsieh, Yueh-Fu Fang, Guan-Yuan Chen, Fu-Tsai Chung, Yuan-Chang Liu, Cheng-Hsien Wu, Yu-Chen Chang, and Horng-Chyuan Lin Copyright © 2013 Meng-Heng Hsieh et al. All rights reserved. Vest Chest Physiotherapy Airway Clearance is Associated with Nitric Oxide Metabolism Thu, 21 Nov 2013 11:27:56 +0000 http://www.hindawi.com/journals/pm/2013/291375/ Background. Vest chest physiotherapy (VCPT) enhances airway clearance in cystic fibrosis (CF) by an unknown mechanism. Because cilia are sensitive to nitric oxide (NO), we hypothesized that VCPT enhances clearance by changing NO metabolism. Methods. Both normal subjects and stable CF subjects had pre- and post-VCPT airway clearance assessed using nasal saccharin transit time (NSTT) followed by a collection of exhaled breath condensate (EBC) analyzed for NO metabolites (). Results. VCPT shorted NSTT by 35% in normal and stable CF subjects with no difference observed between the groups. EBC concentrations decreased 68% in control subjects after VCPT (before = 115 ± 32 μM versus after = 37 ± 17 μM; ). CF subjects had a trend toward lower EBC . Conclusion. We found an association between VCPT-stimulated clearance and exhaled levels in human subjects. We speculate that VCPT stimulates clearance via increased NO metabolism. Joseph H. Sisson, Todd A. Wyatt, Jacqueline A. Pavlik, Pawanjit S. Sarna, and Peter J. Murphy Copyright © 2013 Joseph H. Sisson et al. All rights reserved. The Role of Cardiopulmonary Exercise Test in IPF Prognosis Thu, 31 Oct 2013 16:42:07 +0000 http://www.hindawi.com/journals/pm/2013/514817/ Background. In IPF, defects in lung mechanics and gas exchange manifest with exercise limitation due to dyspnea, the most prominent and disabling symptom. Aim. To evaluate the role of exercise testing through the 6MWT (6-minute walk test) and CPET (cardiopulmonary exercise testing) in the survival of patients with IPF. Methods. This is a prospective, observational study evaluating in 25 patients the relationship between exercise variables through both the 6MWT and CPET and survival. Results. By the end of the observational period 17 patients were alive (33% mortality). Observation ranged from 9 to 64 months. VE/VCO2 slope (slope of relation between minute ventilation and CO2 production), VO2 peak/kg (peak oxygen consumption/kg), VE/VCO2 ratio at anaerobic threshold, 6MWT distance, desaturation, and DLCO% were significant predictors of survival while VE/VCO2 slope and VO2 peak/kg had the strongest correlation with outcome. The optimal model for mortality risk estimation was VO2 peak/kg + DLCO% combined. Furthermore, VE/VCO2 slope and VO2 peak/kg were correlated with distance and desaturation during the 6MWT. Conclusion. The integration of oxygen consumption and diffusing capacity proved to be a reliable predictor of survival because both variables reflect major underlying physiologic determinants of exercise limitation. Christina Triantafillidou, Effrosyni Manali, Panagiotis Lyberopoulos, Likourgos Kolilekas, Konstantinos Kagouridis, Sotirios Gyftopoulos, Konstantinos Vougas, Anastasia Kotanidou, Manos Alchanatis, Anna Karakatsani, and Spyros A. Papiris Copyright © 2013 Christina Triantafillidou et al. All rights reserved. Prevalence of Occupational Asthma and Respiratory Symptoms in Foundry Workers Sun, 22 Sep 2013 11:17:46 +0000 http://www.hindawi.com/journals/pm/2013/370138/ This cross-sectional study was conducted in a foundry factory to assess the prevalence of respiratory symptoms and occupational asthma in foundry workers. Physical examination, spirometric evaluation, chest radiograph, and a questionnaire related to respiratory symptoms were performed. Monitoring of peak expiratory flow rates, spirometric reversibility test, and high-resolution computed tomographies were performed for the participants having respiratory symptoms and/or impaired respiratory function test. A total of 347 participants including 286 workers from production department and 61 subjects who worked in nonproduction departments were enrolled in this study. It is found that phlegm (: 71, 20.46%) and cough (: 52, 14.98%) were the most frequent symptoms. The other symptoms were breathlessness (: 28, 8.06%), chest tightness (: 14, 4.03%), and wheezing (: 7, 2.01%) . The prevalence of occupational asthma was found to be more frequent among the subjects who worked in the production department (: 48, 16.78% ) than the other persons who worked in the nonproduction department (: 3, 4.91%) by chi-square test (: 0.001). To prevent hazardous respiratory effects of the foundry production, an early diagnosis of occupational asthma is very important. Cessation of cigarette smoking and using of protective masks during the working time should be encouraged. Servet Kayhan, Umit Tutar, Halit Cinarka, Aziz Gumus, and Nurhan Koksal Copyright © 2013 Servet Kayhan et al. All rights reserved. Utilization of CT Pulmonary Angiography in Suspected Pulmonary Embolism in a Major Urban Emergency Department Thu, 29 Aug 2013 08:23:37 +0000 http://www.hindawi.com/journals/pm/2013/915213/ Objectives. We conducted a study to answer 3 questions: (1) is CT pulmonary angiography (CTPA) overutilized in suspected pulmonary embolism (PE)? (2) What alternative diagnoses are provided by CTPA? (3) Can CTPA be used to evaluate right ventricular dilatation (RVD)? Methods. We retrospectively reviewed the clinical information of 231 consecutive emergency department patients who underwent CTPA for suspected PE over a one-year period. Results. The mean age of our patients was 53 years, and 58.4% were women. The prevalence of PE was 20.7%. Among the 136 patients with low clinical probability of PE, a d-dimer test was done in 54.4%, and it was normal in 24.3%; none of these patients had PE. The most common alternative findings on CTPA were emphysema (7.6%), pneumonia (7%), atelectasis (5.5%), bronchiectasis (3.8%), and congestive heart failure (3.3%). The sensitivity and negative predictive value of CTPA for (RVD) was 92% and 80%, respectively. Conclusions. PE could have been excluded without CTPA in ~1 out of 4 patients with low clinical probability of PE, if a formal assessment of probability and d-dimer test had been done. In patients without PE, CTPA did not provide an alternative diagnosis in 65%. In patients with PE, CTPA showed the potential to evaluate RVD. Adil Shujaat, Janet M. Shapiro, and Edward Eden Copyright © 2013 Adil Shujaat et al. All rights reserved. Drug Resistance among Pulmonary Tuberculosis Patients in Calabar, Nigeria Mon, 26 Aug 2013 09:28:52 +0000 http://www.hindawi.com/journals/pm/2013/235190/ Background. This study aimed to determine the pattern of drug susceptibility to first-line drugs among pulmonary TB patients in two hospitals in Calabar, Nigeria. Methods. This was a descriptive cross-sectional study carried out between February 2011 and April 2012. Sputum samples from consecutive TB patients in Calabar were subjected to culture on Lowenstein-Jensen (LJ) slopes followed by drug susceptibility testing (DST). The DST was performed on LJ medium by the proportion method. Results. Forty-two of the 100 Mycobacterium tuberculosis strains were found to be resistant to at least one drug. Resistance to only one drug (monoresistance) was found in 17 patients. No strains with monoresistance to rifampicin were found. Resistance to two drugs was found in 22 patients, while one patient was resistant to both three and four drugs. MDR TB was seen in 4% (4/100). The independent variables of HIV serology and sex were not significantly associated with resistance (). Conclusion. There was a high prevalence of anti-TB drug resistance in Calabar. Akaninyene Otu, Victor Umoh, Abdulrazak Habib, Soter Ameh, Lovett Lawson, and Victor Ansa Copyright © 2013 Akaninyene Otu et al. All rights reserved. Pathophysiologic Mechanisms of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome Thu, 27 Jun 2013 15:03:47 +0000 http://www.hindawi.com/journals/pm/2013/521087/ Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. This disease has many potential consequences including excessive daytime sleepiness, neurocognitive deterioration, endocrinologic and metabolic effects, and decreased quality of life. Patients with OSAS experience repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing that provoke systemic effects. Furthermore, there may be increased levels of biomarkers linked to endocrine-metabolic and cardiovascular alterations. Epidemiological studies have identified OSAS as an independent comorbid factor in cardiovascular and cerebrovascular diseases, and physiopathological links may exist with onset and progression of heart failure. In addition, OSAS is associated with other disorders and comorbidities which worsen cardiovascular consequences, such as obesity, diabetes, and metabolic syndrome. Metabolic syndrome is an emerging public health problem that represents a constellation of cardiovascular risk factors. Both OSAS and metabolic syndrome may exert negative synergistic effects on the cardiovascular system through multiple mechanisms (e.g., hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory activation). It has been found that CPAP therapy for OSAS provides an objective improvement in symptoms and cardiac function, decreases cardiovascular risk, improves insulin sensitivity, and normalises biomarkers. OSAS contributes to the pathogenesis of cardiovascular disease independently and by interaction with comorbidities. The present review focuses on indirect and direct evidence regarding mechanisms implicated in cardiovascular disease among OSAS patients. Carlos Zamarrón, Luis Valdés Cuadrado, and Rodolfo Álvarez-Sala Copyright © 2013 Carlos Zamarrón et al. All rights reserved. Epidemiological and Pathogenic Relationship between Sleep Apnea and Ischemic Heart Disease Tue, 18 Jun 2013 09:28:24 +0000 http://www.hindawi.com/journals/pm/2013/405827/ Obstructive sleep apnea is recognized as having high prevalence and causing remarkable cardiovascular risk. Coronary artery disease has been associated with obstructive sleep apnea in many reports. The pathophysiology of coronary artery disease in obstructive sleep apnea patients probably includes the activation of multiple mechanisms, as the sympathetic activity, endothelial dysfunction, atherosclerosis, and systemic hypertension. Moreover, chronic intermittent hypoxia and oxidative stress have an important role in the pathogenesis of coronary disease and are also fundamental to the development of atherosclerosis and other comorbidities present in coronary artery diseases such as lipid metabolic disorders. Interestingly, the prognosis of patients with coronary artery disease has been associated with obstructive sleep apnea and the severity of sleep disordered breathing may have a direct relationship with the morbidity and mortality of patients with coronary diseases. Nevertheless, treatment with CPAP may have important effects, and recent reports have described the benefits of obstructive sleep apnea treatment on the recurrence of acute heart ischaemic events in patients with coronary artery disease. Carlos Carpio, Rodolfo Álvarez-Sala, and Francisco García-Río Copyright © 2013 Carlos Carpio et al. All rights reserved. Flow-Volume Parameters in COPD Related to Extended Measurements of Lung Volume, Diffusion, and Resistance Thu, 13 Jun 2013 10:39:29 +0000 http://www.hindawi.com/journals/pm/2013/782052/ Classification of COPD into different GOLD stages is based on forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) but has shown to be of limited value. The aim of the study was to relate spirometry values to more advanced measures of lung function in COPD patients compared to healthy smokers. The lung function of 65 COPD patients and 34 healthy smokers was investigated using flow-volume spirometry, body plethysmography, single breath helium dilution with CO-diffusion, and impulse oscillometry. All lung function parameters, measured by body plethysmography, CO-diffusion, and impulse oscillometry, were increasingly affected through increasing GOLD stage but did not correlate with FEV1 within any GOLD stage. In contrast, they correlated fairly well with FVC%p, FEV1/FVC, and inspiratory capacity. Residual volume (RV) measured by body plethysmography increased through GOLD stages, while RV measured by helium dilution decreased. The difference between these RV provided valuable additional information and correlated with most other lung function parameters measured by body plethysmography and CO-diffusion. Airway resistance measured by body plethysmography and impulse oscillometry correlated within COPD stages. Different lung function parameters are of importance in COPD, and a thorough patient characterization is important to understand the disease. Linnea Jarenbäck, Jaro Ankerst, Leif Bjermer, and Ellen Tufvesson Copyright © 2013 Linnea Jarenbäck et al. All rights reserved. Cardiopulmonary Exercise Testing Sun, 09 Jun 2013 13:20:55 +0000 http://www.hindawi.com/journals/pm/2013/686104/ Darcy D. Marciniuk, Bruce D. Johnson, J. Alberto Neder, and Denis E. O'Donnell Copyright © 2013 Darcy D. Marciniuk et al. All rights reserved. Clinical Usefulness of Response Profiles to Rapidly Incremental Cardiopulmonary Exercise Testing Sun, 12 May 2013 13:36:49 +0000 http://www.hindawi.com/journals/pm/2013/359021/ The advent of microprocessed “metabolic carts” and rapidly incremental protocols greatly expanded the clinical applications of cardiopulmonary exercise testing (CPET). The response normalcy to CPET is more commonly appreciated at discrete time points, for example, at the estimated lactate threshold and at peak exercise. Analysis of the response profiles of cardiopulmonary responses at submaximal exercise and recovery, however, might show abnormal physiologic functioning which would not be otherwise unraveled. Although this approach has long been advocated as a key element of the investigational strategy, it remains largely neglected in practice. The purpose of this paper, therefore, is to highlight the usefulness of selected submaximal metabolic, ventilatory, and cardiovascular variables in different clinical scenarios and patient populations. Special care is taken to physiologically justify their use to answer pertinent clinical questions and to the technical aspects that should be observed to improve responses’ reproducibility and reliability. The most recent evidence in favor of (and against) these variables for diagnosis, impairment evaluation, and prognosis in systemic diseases is also critically discussed. Roberta P. Ramos, Maria Clara N. Alencar, Erika Treptow, Flávio Arbex, Eloara M. V. Ferreira, and J. Alberto Neder Copyright © 2013 Roberta P. Ramos et al. All rights reserved. Obstructive Sleep Apnea and Coronary Artery Disease: From Pathophysiology to Clinical Implications Mon, 15 Apr 2013 10:15:30 +0000 http://www.hindawi.com/journals/pm/2013/768064/ Coronary artery disease (CAD) and obstructive sleep apnea (OSA) are both complex and significant clinical problems. The pathophysiological mechanisms that link OSA with CAD are complex and can influence the broad spectrum of conditions caused by CAD, from subclinical atherosclerosis to myocardial infarction. OSA remains a significant clinical problem among patients with CAD, and evidence suggesting its role as a risk factor for CAD is growing. Furthermore, increasing data support that CAD prognosis may be influenced by OSA and its treatment by continuous positive airway pressure (CPAP) therapy. However, stronger evidence is needed to definitely answer these questions. This paper focuses on the relationship between OSA and CAD from the pathophysiological effects of OSA in CAD, to the clinical implications of OSA and its treatment in CAD patients. Fernando De Torres-Alba, Daniele Gemma, Eduardo Armada-Romero, Juan Ramón Rey-Blas, Esteban López-de-Sá, and José Luis López-Sendon Copyright © 2013 Fernando De Torres-Alba et al. All rights reserved. Pulmonary Tuberculosis Sun, 14 Apr 2013 11:17:26 +0000 http://www.hindawi.com/journals/pm/2013/645747/ Anete Trajman, José R. Lapa e Silva, Margareth Dalcolmo, and Jonathan E. Golub Copyright © 2013 Anete Trajman et al. All rights reserved.