European journal of respiratory diseases最新文献

The relationship between smoking habits, respiratory symptoms and lung function at the start of the study and mortality during a follow-up period of 11 years was studied in 607 men, aged 50 and 60 years at entry and sampled from the general population. The overall mortality rate in the sample was 18%. In a logistic multiple regression model, mortality rate was significantly related to age, smoking habits, dyspnea and one of the lung function variables FEV1, VC or the slope of phase III. Smokers had a double mortality rate compared to non-smokers (22 versus 10%) after allowing for age, dyspnea and lung function. Similarly, in subjects with abnormal FEV1, VC or slope of phase III, the mortality rate was almost doubled compared to subjects with normal lung function, other factors being equal. Thus, impaired lung function is an important factor to be considered in the assessment of mortality risk, besides smoking and dyspnea.

The aim of this study was to discover the subsequent histories and ultimate diagnoses in 182 patients studied in a chest clinic because of unexplained cough. Twenty-nine patients (16%) developed asthma during the mean follow-up time of 4.4 years. Chronic bronchitis was diagnosed in 18 patients (10%) and sporadic instances of some other diseases were also seen. The development of asthma was studied both by calculating simple relative risks and using a multiple logistic model. Circadian changes in peak expiratory flow (PEF)-values and total blood eosinophil count were found to be the best variables for predicting the risk of developing asthma in a patient with unexplained cough, whereas mild bronchial hyperreactivity had only a low predictive value. If the risk of developing asthma in a patient presenting with unexplained cough is to be estimated, attention should be paid simultaneously to a number of variables. Even mild abnormalities in several variables can be significant when they occur together.

Non-smoking patients (n:25) with stable symptomatic asthma were investigated with regard to the pulmonary effects of N-acetylcysteine (NAC), peroral dose 200 mg three times daily, in a crossover double-blind study. They were studied once a week for 9 weeks, with a run-in period and periods with NAC and placebo (3 weeks each). Functional residual capacity and specific airway resistance were 19 and 53% larger, respectively, and forced expiratory variables (FEV%, MEF25) were 20 and 53% lower than reference values. Distribution of ventilation-perfusion ratios (VA/Q), assessed by multiple inert gas elimination technique with peripheral venous sampling, was abnormal, although arterial PO2 and PCO2 were within normal limits. NAC medication had no effect on any spirometric, lung mechanic or gas exchange variable, nor on the frequency of pulmonary symptoms.

The sera from 26 patients with serological evidence of infection with Mycoplasma pneumoniae and 23 patients with influenza virus A infection were examined for autoantibodies to smooth muscle, cell nuclei and 'reticulin'. There is an increased incidence of autoantibodies to smooth muscle (46%) in the serum of patients infected with M. pneumoniae. There is no increase in autoantibodies to cell nuclei or 'reticulin' in these patients. There is no increased incidence of autoantibodies in patients infected with influenza virus A. The possible aetiology of the raised incidence of smooth muscle autoantibodies in the patients with M. pneumoniae is discussed.

Sera from patients with active pulmonary tuberculosis and sera from appropriate control individuals were assayed for IgG, IgA and IgM antibodies against glycoprotein from tubercle bacilli by an enzyme-linked immunosorbent assay. The mean antibody levels in IgG and IgA were significantly higher in the tuberculosis patients than in the controls. By measuring IgG antibody, this assay may provide a diagnostic tool to distinguish patients with active pulmonary tuberculosis from patients with other pulmonary disease.

Increasing dose of budesonide, each dose given for a minimum of 1 month, were administered via a Nebuhaler to 14 patients. Two consecutive abnormally low fasting morning plasma cortisol values, taken 2 weeks apart, were accepted as evidence of hypothalamo-pituitary-adrenal (HPA) hypofunction. Data from nine of the 14 patients entering the study were available for analysis. One patient developed HPA hypofunction while inhaling 2.4 mg budesonide per day and another retained normal HPA function on a dose of 12 mg. In the remaining patients, intermediate doses resulted in suppression, or the patients were withdrawn unsuppressed for other reasons (n = 3). The results in this small patient sample suggest that budesonide administered via the Nebuhaler in doses up to 1.6 mg daily does not significantly affect plasma cortisol.

A well-recognized complication of ethambutol use is optic neuropathy, but the potential ocular toxicity of isoniazid is often overlooked. A patient developed optic neuropathy while being treated with isoniazid and ethambutol. The optic neuropathy subsided only when both drugs were discontinued, suggesting an additive toxic effect.

Hyaluronate is a potential marker of activated pulmonary fibroblasts and appears in increased amounts in bronchoalveolar lavage fluid from patients with sarcoidosis. This study was performed to investigate a possible link between the local immune response and pulmonary fibroblast proliferation. The median hyaluronate concentration in the lavage fluid from 23 sarcoid patients was 12.0 (interquartile range 7.5-28.5) micrograms/l. The hyaluronate concentration was positively correlated to the concentration and proportion of lymphocytes (p less than 0.001 and p less than 0.01, respectively) as well as to the concentrations of T lymphocyte subsets (OKT4+ p less than 0.01, OKT8+ p less than 0.05). No correlation was found between the hyaluronate concentration and the OKT4+/OKT8+ ratio. Furthermore, a significant correlation was observed in the lavage fluid between hyaluronate and angiotensin-converting enzyme, a marker of monocyte/macrophage activity (p less than 0.01). Thus, the intensity of the sarcoid alveolitis was associated with biochemical signs of pulmonary fibroblast proliferation/activation in sarcoidosis.