Obstructive Lung Disorder Research Articles

Telemedicine Management of COPD: Advancements in Chronic Disease Treatment and Implications for Medical Education

Social determinants of health are non-medical, social and economic factors that influence health. The practice of telemedicine enables physicians to virtually connect patients with healthcare resources. Throughout the COVID-19 pandemic, healthcare providers have increasingly utilized telemedicine as a method to provide appropriate care to patients with chronic diseases, including Chronic Obstructive Pulmonary Disease (COPD). COPD is a progressive obstructive lung disorder which is substantially impacted by social determinants of health including access to healthcare. The successful utilization of telemedicine in the care of patients with chronic diseases, including COPD, highlights its emerging importance in healthcare. However, many Canadian medical schools have yet to implement a formalized telemedicine curriculum, and most Canadian students do not feel adequately prepared for virtual healthcare delivery. Here, we outline the utilization of telemedicine in COPD management and advocate for the rapid introduction of a formalized telemedicine curriculum at the undergraduate and postgraduate levels.

Chest Dynamic-Ventilatory Digital Radiography in Chronic Obstructive or Restrictive Lung Disease.

ObjectiveThe aim of this study was to identify the relationships between parameters obtained from dynamic-ventilatory digital radiography (DR) and ventilatory disorders.MethodsThis study comprised 273 participants with respiratory diseases who underwent spirometry and functional residual capacity measurements (104 with normal findings on spirometry as controls, 139 with an obstructive lung disorder, 30 with a restrictive lung disorder) were assessed by dynamic-ventilatory DR. Sequential chest radiography images of the patient’s slow and maximum breathing were captured at 15 frames per second by a dynamic flat-panel imaging system. The system measured the following parameters: lung area at maximum inspiration divided by height (lung area_in/height), changes in tracheal diameter due to respiratory motions, rate of tracheal narrowing, diaphragmatic motion, and rate of change in lung area due to respiratory motion. Relationships between these parameters and ventilatory disorders were analyzed.ResultsLung area_in/height in patients with restrictive disorders showed significant decreases. Tracheal diameter change and tracheal narrowing rate in patients with obstructive disorders were significantly increased compared to both the control participants and patients with restrictive disorders. Patients with obstructive disorders and patients with restrictive disorders showed decreased diaphragmatic motion and lung area change rate. With the restrictive disorders as references, the area under the curve (AUC), sensitivity and specificity of lung area_in/height were 0.88, 0.77, and 0.88, respectively. With the obstructive disorders as references, the AUC, sensitivity and specificity of tracheal narrowing rate were 0.67, 0.53 and 0.81, respectively.ConclusionDynamic-ventilatory DR shows potential as a method for the detection and evaluation of ventilatory disorders in patients with respiratory diseases.

Indocyanine green imaging for pulmonary segmentectomy.

ObjectiveDelineation of the intersegmental plane during pulmonary segmentectomy by systemic injection of indocyanine green (ICG) has been rapidly emerging. We evaluated the feasibility of the use of ICG in a large-scale cohort according to the type of segmentectomy and the presence of obstructive lung disorder and compared the demarcation status with air injection.MethodsWe collected the data of 209 patients who underwent segmentectomy using ICG at National Cancer Center Hospital, Tokyo, Japan. Data of the operation including the demarcation status of the intersegmental plane were analyzed retrospectively.ResultsThe median operation duration and blood loss were 105 minutes (interquartile range, 94-118 minutes) and 12 mL (interquartile range, 5-24 mL), respectively. Good demarcation of the intersegmental plane by ICG was observed in 184 (88.0%) cases, with no correlation to the type of resected segments or the presence of obstructive lung disorder. Postoperative complications of Clavien–Dindo classification grade 3 or more were observed in 5 cases (2.4%), and no ICG-related adverse event was noted. High-frequency jet ventilation was also used in 160 cases (76.6%) to delineate the intersegmental inflation–deflation plane. The air injected by high-frequency jet ventilation tended to spread further beyond the intersegmental plane that was depicted by ICG.ConclusionsThe use of ICG might demarcate the intersegmental plane more restricted to the target segment compared with air injection. Delineation of the intersegmental plane by ICG is feasible regardless of the type of segmentectomy or the presence of obstructive lung disorder, and it can be commonly applicable in pulmonary segmentectomy.

Riparin II potentials the effect of ephedrine on inflammation and remodelling in the airway of rats suffering from asthma by regulating transforming growth factor-β/Smad3 signalling pathway

Asthma is a chronic obstructive lung disorder involving hyperresponsive lung tissue. This study evaluated the protective effects of riparin II against asthma and determined the synergistic effects of riparin II with ephedrine in treatment of asthma. Asthma was induced by intraperitoneal injection of Al(OH)3 (100 mg) with ovalbumin 1 mg/kg and subsequent exposure to 2% ovalbumin aerosol for 1 week. All animals were treated with riparin II 50 mg/kg and ephedrine 25 mg/kg alone and in combination for the duration of the study. Interleukin levels were assessed in the serum and bronchoalveolar lavage fluid (BALF) of asthmatic rats, while inflammatory cell infiltration was determined in the lungs. Airway remodelling was determined by assessing the lung tissue expression levels of transforming growth factor beta 1 (TGF-β1), Smad, and collagen I in asthmatic rats. There were lower levels of cytokines in the serum and BALF in riparin II-treated rats than in negative control rats. Moreover, inflammatory cell and IgE levels were reduced while interferon level was enhanced in the lungs of riparin II-treated rats, compared to negative control rats. These data reveal that treatment with riparin II ameliorates the altered expression of TGF-β1, Smad, and collagen I in lung tissue of asthmatic rats. In conclusion, riparin II treatment alone and in combination with ephedrine ameliorated the hyperresponsiveness of lung tissue due to reductions in airway remodelling and inflammation in asthmatic rats.

TO ESTIMATE LIPID PROFILE IN PATIENTS WITH COPD

Background: Chronic Obstructive Pulmonary Disease (COPD) includes persistent bronchitis and emphysema, which is generally caused due to smoking of tobacco. (COPD) is an obstructive lung disorder characterized by airflow limitation that is progressive, associated with severe inflammatory response in the air passages and the lungs due to toxic particles. It interferes with normal breathing and is not fully reversible.
 Objectives: 1. To estimate lipid profile (Total cholesterol (TCH), Triglycerides (TG), High density lipoprotein (HDL), Low density lipoprotein (LDL), Very low-density lipoprotein (VLDL)) in patients with Chronic Obstructive Pulmonary.
 2. To find correlation of these parameters with severity of disease.
 Material and Method: The study was conducted in Department of Biochemistry in collaboration with Department of Respiratory Medicine at Jawaharlal Nehru Medical College and AVBRH, Sawangi (Meghe) Wardha, India. Thirty-two patients diagnosed with COPD were selected from OPD and ward of Respiratory Medicine and thirty-two age and sex matched controls were taken.
 Result: The analysis of total cholesterol, triglycerides, HDL, LDL, VLDL in cases and controls. Result was statistically significant in between cases and controls of total cholesterol (p<0.001), HDL (p<0.001) and LDL (p<0.001), and statistically not significant in between cases and controls of triglycerides (p=0.6) and VLDL (p=0.98).
 Conclusion: We conclude that smoking significantly affect lipid profile in COPD patients, as it increases LDL levels and decreases HDL levels. Hence all patients with COPD patients who are smoker’s needs to check their lipid profile. COPD is considered as systemic disease with various co morbidities, which may affect the lipid profile.
 Keywords: Lipid profile, COPD, AAT, CVD, TNF-α, CRP and GOLD.

LYMPHANGIOLEIOMYOMATOSIS: A CASE REPORT

We report anesthetic management of a patient with lymphangioleiomyomatosis. A 41-year-old woman underwent lung biopsy under video-assisted thoracoscopic surgery to confirm the presence of lymphangioleiomyomatosis. She had hypoxemia due to obstructive lung disorder. Anesthesia was maintained with epidural block and general anesthesia with sevoflurane. During the operation, there were repeated episodes of hypoxemia, which required manual ventilation of the independent lung. After the operation, the tracheal tube was replaced with a laryngeal mask airway to minimize the risk of pneumothorax. There was no postoperative anesthesia-related complication.

Serological Assessment of Activated Fibroblasts by alpha-Smooth Muscle Actin (α-SMA): A Noninvasive Biomarker of Activated Fibroblasts in Lung Disorders

OBJECTIVES: Remodeling of the extracellular matrix (ECM) is a key event in different lung disorders, such as fibrosis and cancer. The most common cell type in the connective tissue is fibroblasts, which transdifferentiate into myofibroblasts upon activation. All myofibroblasts express α-SMA, which has been found to be upregulated in lung fibrosis and cancer. We evaluated the potential of α-SMA as a noninvasive biomarker of activated fibroblasts in lung fibrosis and cancer. METHODS: A monoclonal antibody was raised against the N-terminal of α-SMA, and a novel competitive enzyme-linked immunosorbent assay (ELISA) measuring α-SMA was developed and technically characterized. Levels of α-SMA were measured in the fibroblast model, “scar-in-a-jar”, and in serum from patients with idiopathic pulmonary fibrosis (IPF), chronic obstructive lung disorder (COPD) and non–small cell lung cancer (NSCLC) belonging to two different cohorts. RESULTS: The novel α-SMA assay was developed and validated as technically robust. Based on the scar-in-a-jar results, α-SMA was only present in the fibroblasts activated by TGF-β. In cohort 1, levels of α-SMA were significantly higher in IPF, COPD and NSCLC patients compared to healthy controls (P = 0.04, P = 0.001 and P <0.0001, respectively). The area under the receiver operating characteristics (AUROC) for separation of healthy controls from IPF patients was 0.865, healthy controls from COPD patients was 0.892 and healthy controls from NSCLC patients was 0.983. In cohort 2, levels of α-SMA were also significantly higher in NSCLC patients compared to healthy controls (P = 0) and the AUROC for separating NSCLC and healthy controls was 0.715. CONCLUSIONS: In this study we developed and validated a robust competitive ELISA assay targeting the N-terminal of α-SMA. The level of α-SMA was upregulated when adding TGF-β, indicating that α-SMA is increased in activated fibroblasts. The level of α-SMA in circulation was significantly higher in patients with IPF, COPD and NSCLC compared to healthy controls. This assay could potentially be used as a novel noninvasive serological biomarker for lung disorders by providing a surrogate measure of activated fibroblasts.

Comorbidities of bullous pemphigoid in a Finnish cohort.

The incidence of bullous pemphigoid (BP) is increasing in Finland. To investigate the clinical presentation, comorbidities, and medications in a cohort of Finnish patients with confirmed BP managed in a university hospital setting. An observational retrospective study of all consecutive patients diagnosed with BP in 2012-2013 at the Department of dermatology, HUCH. The prevalence of the most common comorbidities was compared to that in a sample population aged over 30 years. Seventy patients were included (mean age: 77 years at diagnosis). The most common comorbidities were hypertension (44%), type 2 diabetes (34%), and ischaemic heart disease (26%). Almost half of the cohort had a neurological condition (46%). A statistically significant association was identified between BP and a past history of malignancies (17%; p<0.001), type 2 diabetes (24%; p<0.001), and chronic obstructive lung disorder (COPD) (10%; p=0.004), compared to an age-matched control group. The most common standard drugs were statins, beta-blockers, and diuretics. In total, 83% of the patients with type 2 diabetes took anti-diabetic treatments, mainly metformin (80%) and gliptins (55%). Significant associations were identified between BP and COPD, type 2 diabetes, and a past history of malignancy, compared to the general population. In this study, the specific role of some medications, such as gliptins, may account for the onset of BP in diabetic type 2 patients.

Intravenous superoxide dismutase as a protective agent to prevent impairment of lung function induced by high tidal volume ventilation

BackgroundPositive-pressure mechanical ventilation is essential in assisting patients with respiratory failure in the intensive care unit and facilitating oxygenation in the operating room. However, it was also recognized as a primary factor leading to hospital-acquired pulmonary dysfunction, in which pulmonary oxidative stress and lung inflammation had been known to play important roles. Cu/Zn superoxide dismutase (SOD) is an important antioxidant, and possesses anti-inflammatory capacity. In this study, we aimed to study the efficacy of Cu/Zn SOD, administered intravenously during high tidal volume (HTV) ventilation, to prevent impairment of lung function.MethodsThirty-eight male Sprague-Dawley rats were divided into 3 groups: 5 h ventilation with (A) low tidal volume (LTV; 8 mL/kg; n = 10), (B) high tidal volume (HTV; 18 mL/kg; n = 14), or (C) HTV and intravenous treatment of Cu/Zn SOD at a dose of 1000 U/kg/h (HTV + SOD; n = 14). Lung function was evaluated both at baseline and after 5-h ventilation. Lung injury was assessed by histological examination, lung water and protein contents in the bronchoalveolar lavage fluid (BALF). Pulmonary oxidative stress was examined by concentrations of methylguanidine (MG) and malondialdehyde (MDA) in BALF, and antioxidative activity by protein expression of glutathione peroxidase-1 (GPx-1) in the lung. Severity of lung inflammation was evaluated by white blood cell and differential count in BALF, and protein expression of inducible nitric oxide synthase (iNOS), intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor-α (TNF-α), matrix metalloproteinase-9 (MMP-9), and mRNA expression of nuclear factor-κB (NF-κB) in the lung. We also examined protein expression of surfactant protein (SP)-A and D and we measured hourly changes in serum nitric oxide (NO) level.ResultsFive hours of LTV ventilation did not induce a major change in lung function, whereas 5 h of HTV ventilation induced apparent combined restrictive and obstructive lung disorder, together with increased pulmonary oxidative stress, decreased anti-oxidative activity and increased lung inflammation (P < 0.05). HTV ventilation also decreased SP-A and SP-D expression and suppressed serum NO level during the time course of ventilation. Cu/Zn SOD administered intravenously during HTV ventilation effectively reversed associated pulmonary oxidative stress and lung inflammation (P < 0.05); moreover, it preserved SP-A and SP-D expressions in the lung and increased serum nitric oxide (NO) level, enhancing vascular NO bioavailability.ConclusionsHTV ventilation can induce combined restrictive and obstructive lung disorders. Intravenous administration of Cu/Zn SOD during HTV ventilation can prevent lung function impairment and lung injury via reducing pulmonary oxidative stress and lung inflammation, preserving pulmonary surfactant expression, and enhancing vascular NO bioavailability.

Poluição do ar relacionada ao tráfego urbano e carbono preto em macrófagos de escarro: uma doença pulmonar "silenciosa"?

AIMS: To describe two case reports with significant black carbon deposition in sputum macrophages in healthy young adults from an urban city, showing mild airway obstruction in lung function tests. The role of black carbon deposition by air pollution in the airways and the development of indolent chronic lung disease in populations living in larger cities is not clear and may be a potential world health problem. CASES DESCRIPTION: We report two cases of voluntary adults living in a South American large city who have undergone clinical examination, lung function and analysis of inflammation and black carbon deposition in macrophages from induced sputum. Two Caucasian, previously healthy, nonsmokers, male adults, living in the same city of southern Brazil, with no respiratory symptoms presented with normal physical exams, but with lung function demonstrating mild obstructive lung disorder, with no bronchodilator response. In particular, one of the subjects works daily in delivery services as a motorcycle driver. Induced sputum of both patients showed no signs of cellular inflammation. However, a large number of black carbon content was detected inside macrophages of the sputum sample in both patients. CONCLUSIONS: In summary, significant daily air pollution exposure may play a role in long-term silent disease in adults, potentially leading to clinically relevant chronic lung diseases later in life, particularly in populations of urbanized large cities from developing countries. The development of better, more directly and less invasive, methods for air pollution exposure are required, along with longitudinal studies, in order to measure the real impact of air pollution in chronic lung diseases of susceptible populations.

Severe, but manageable hypoxia caused by bronchospasm induced by bevacizumab.

Bevacizumab has a lower risk of treatment-related infusion reactions than other humanized monoclonal antibodies, and bronchospasm induced by bevacizumab has not been reported. We administered bevacizumab 15 mg/kg over 90 min infusion to a 34 year-old man with lung adenocarcinoma and childhood asthma. Then, grade 3 hypoxia developed and improved spontaneously. This reversible obstructive lung disorder was confirmed using a flow-volume loop, and the patient was diagnosed as having a bronchospasm due to infusion reaction of bevacizumab. This bronchospasm was easily manageable and preventable using an oral bronchodilator and an inhalant combination product, and the patient continued with bevacizumab therapy until the disease progression.

Cigarette smoking, cadmium exposure, and zinc intake on obstructive lung disorder.

Background and objectiveThis study examined whether zinc intake was associated with lower risk of smoking-induced obstructive lung disorder through interplay with cadmium, one of major toxicants in cigarette smoke.MethodsData were obtained from a sample of 6,726 subjects aged 40+ from the Third National Health and Nutrition Examination Survey. The forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured using spirometry. Gender-, ethnicity-, and age-specific equations were used to calculate the lower limit of normal (LLN) to define obstructive lung disorder as: observed FEV1/FVC ratio and FEV1 below respective LLN. Zinc intake was assessed by questionnaire. Logistic regression analysis was applied to investigate the associations of interest.ResultsThe analyses showed that an increased prevalence of obstructive lung disorder was observed among individuals with low zinc intake regardless of smoking status. The adjusted odds of lung disorder are approximately 1.9 times greater for subjects in the lowest zinc-intake tertile than those in the highest tertile (odds ratio = 1.89, 95% confidence interval = 1.22-2.93). The effect of smoking on lung function decreased considerably after adjusting for urinary cadmium. Protective association between the zinc-to-cadmium ratio (log-transformed) and respiratory risk suggests that zinc may play a role in smoking-associated lung disorder by modifying the influence of cadmium.ConclusionsWhile zinc intake is associated with lower risk of obstructive lung disorder, the role of smoking cession and/or prevention are likely to be more important given their far greater effect on respiratory risk. Future research is warranted to explore the mechanisms by which zinc could modify smoking-associated lung disease.

Early and Intermediate Outcome of Emergency Endovascular Aneurysm Repair of Ruptured Infrarenal Aortic Aneurysm: A Single-Centre Experience of 90 Consecutive Patients

To evaluate the early and intermediate outcome of a consecutive series of emergency endovascular aneurysm repairs (eEVAR) of computed tomography (CT)-verified infrarenal ruptured abdominal aortic aneurysm (rAAA) at a single tertiary referral centre. Prospectively collected data of patients operated between April 2000 and October 2007 were retrospectively reviewed and all their pre-, intra- and postoperative imaging were re-evaluated. Patient and procedural data were analysed using a Cox multiregression model. Ninety patients (86% men, aged 76 (+/-7) years), were identified and included in the analysis. Symptom duration was <3h in 22% of patients, 3-24h in 39% and >24h in 39%. Mean aneurysmal diameter was 73 (+/-14)mm. All patients were treated with the COOK Zenith stent-graft (56% bi-iliac and 44% uni-iliac). Sixty-one percent were haemodynamically unstable on presentation, and 26% required an intra-operative aortic occlusion balloon to maintain haemodynamic stability. The 30-day and 1-year mortality rates were 27% and 37%, respectively. One-year aneurysm-related mortality was 33%. Twenty-eight percent of patients required re-interventions during the follow-up. The use of an aortic occlusion balloon and the presence of cerebrovascular disease or obstructive lung disorder correlated significantly with 30-day mortality in the multivariate analysis. EVAR is a valid treatment option for rAAA when used as a first-line method for all patients.

Cystic Fibrosis Case for First-Year Medical Students - Team-Based Learning Format

OPEN ACCESSNovember 24, 2008Cystic Fibrosis Case for First-Year Medical Students - Team-Based Learning Format Maria Sheakley, PhD, Sharma Davendranand, DM, DPS, Mary Moore, PhD, James Grogan, PhD, David Averill, PhD Maria Sheakley, PhD Ross University School of Medicine Google Scholar More articles by this author , Sharma Davendranand, DM, DPS Ross University of Medicine Google Scholar More articles by this author , Mary Moore, PhD Ross University School of Medicine Google Scholar More articles by this author , James Grogan, PhD Ross University School of Medicine Google Scholar More articles by this author , David Averill, PhD Ross University School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.809 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractUsing cases to expose medical students to clinical scenarios early in their education helps to put the basic science information into context. This increases retention of knowledge and creates a more enjoyable learning experience in the classroom. In addition, students have better attitudes toward the subject, develop better social skills, and become more articulate. Furthermore, the introduction of cases to first-year medical students is becoming more important as the NBME shelf exams and USMLE Step One exam are becoming more clinically oriented.This case on cystic fibrosis was written as a joint effort by faculty members from the departments of physiology, cell biology, and biochemistry genetics as an integrated case for first-year medical students in a team-based learning format. The case provides basic background clinical information covering material that students were introduced to in the first four weeks of the semester. The questions at the end of the case were written to stimulate group discussion. Overall, this small-group clinical case work promotes student interaction and discussion, as well as increased retention of knowledge and enhanced student interest. Educational Objectives By the end of this module, learners will be able to: Work in small groups effectively to solve a clinical problem.Describe the how cystic fibrosis is diagnosed using a sweat test.Describe the normal versus pathologic transport mechanisms of the cystic fibrosis transmembrane conductance regulator channel.Discuss the effect of an obstructive lung disorder on pulmonary mechanics.Discuss the ethical issues surrounding children in medical research.Describe how sodium dodecyl sulfate polyacrylamide gel works.Discuss the inheritance pattern for cystic fibrosis and the likelihood of passing the gene or disease from one generation to another. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Cystic Fibrosis Case Instructor's Version.pdf Cystic Fibrosis Case Student Version.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2008 Sheakley et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-Share Alike license.KeywordsTBLCFTR GeneSweat TestTeam-based LearningCystic Fibrosis Disclosures None to report. Funding/Support None to report. Loading ...

Using risk analysis in Health Impact Assessment: the impact of different relative risks for men and women in different socio-economic groups

The aim of this study is to contribute to the emerging field of quantification of Health Impact Assessment (HIA), by analysing how different relative risks affect the burden of disease for various socio-economic groups (SES). Risk analysis, utilising attributable and impact fraction, raises several methodological considerations. The present study illustrates this by measuring the impact of changed distribution levels of smoking on lung cancer, ischemic heart disease (IHD), chronic obstructive lung disorder (COLD) and stroke for the highest and lowest socio-economic groups measured in disability adjusted life years (DALY). The material is based on relative risks obtained from various international studies, smoking prevalence (SP) data and the number of DALY based on data available for Sweden. The results show that if smoking would have been eliminated (attributable fraction, AF), the inequality between the highest and lowest socio-economic groups may decrease by 75% or increase by 21% depending on the size of the relative risk. Assuming the same smoking prevalence for the lowest socio-economic group as for the highest (impact fraction), then the inequality may decrease by 7–26%. Consequently, the size of the relative risk used may have a significant impact, leading to substantial biases and therefore should be taken into serious consideration in HIA.

The burden of COPD in France: results from the confronting COPD survey

Chronic obstructive pulmonary disease (COPD) is an obstructive lung disorder characterized by progressive airflow limitation that is not reversible or only partially reversible, including chronic bronchitis and emphysema. Confronting COPD in North America and Europe was the first large-scale international survey to attempt to quantify the country-specific burden of the disease, collecting data on clinical outcomes, healthcare resource utilization, and lost productivity, from patients and physicians in France and seven other countries.The economic analysis of the French survey results showed that patients with COPD required considerable utilization of healthcare resources, with annual direct costs estimated at €530 per patient. In addition, COPD-related illness or disability prevented many patients from working, with an estimated annual indirect cost of €1078 per patient. The survey suggested underdiagnosis and undertreatment of COPD by healthcare professionals, and patients reported poor symptom control. The cost of unscheduled care (€15 I) was almost double the cost of scheduled visits to healthcare professionals (€82). This suggests that improving the long-term management of chronic symptoms by healthcare professionals could reduce the burden of disease. As in other countries, the clinical management of COPD in France may be improved by following guideline recommendations for COPD treatment. These include smoking cessation at all stages of the disease, regular treatment of chronic symptoms with bronchodilators in dyspnoeic patients, and pulmonary rehabilitation. The results of the survey also showed that the societal cost of COPD was considerably greater in patients with severe disease (€2882) compared with mild COPD (€289). This suggests that interventions that could help delay the progression of COPD to the advanced stages of the disease (such as smoking cessation) could be of economic benefit.

Buspirone safely relieves anxiety in patients with obstructive lung disorder

Buspirone safely relieves anxiety in patients with obstructive lung disorder

Determinants of chronic bronchitis and lung dysfunction in Western Australian gold miners.

The relation of chronic bronchitis and respiratory dysfunction to age, tobacco smoking, and occupational exposure to surface and underground mining operations were examined in a cross sectional survey of 1363 men employed in the Kalgoorlie mining industry in 1985. Overall, the prevalence of chronic bronchitis was 14%. Eleven per cent of the workers had obstructive lung disorder (FEV1/FVC less than 0.70) and 9% had restrictive lung disorder (FVC less than 0.80 of predicted for height and age). There was little change in the prevalence of chronic bronchitis from that observed in a survey of the same industry in 1961-2. Only 1% of the workers in 1985 had radiographic signs of silicosis compared with 22% in 1961-2. Age, smoking, and underground mining experience all exerted strong effects on the development of chronic bronchitis with or without associated respiratory function abnormalities. After control of confounding by age and smoking, it was estimated that compared with a lifetime non-miner, the odds ratio (OR) of chronic bronchitis was 1.8 (95% confidence interval, 1.0-3.3) for one to nine years underground mining gold, 2.5 (1.2-5.2) for 10-19 years, and 5.1 (2.4-10.9) for 20 or more years. Underground mining of minerals other than gold was also associated with chronic bronchitis (OR = 5.1; 95% CI, 1.1-25.0) whereas exclusive surface mining had only a small empirical effect (OR = 1.3; 95% CI, 0.6-2.5). It is estimated that the proportion of cases of chronic bronchitis in working underground miners due to occupational factors is 50%. The results support the existence of an industrial cause of chronic bronchitis, although caution must be exercised in generalising the results to miners with progressive and sever respiratory impairment.