Pulmonary Parenchymal Involvement Research Articles

Sarcoidosis: Childvs adult

To compare the features of sarcoidosis in children to those of adults. In spite of the fact that sarcoidosis is a disease frequently seen in adults of 30-40 years, pediatric cases have rarely been reported. The authors evaluated 17 (3.3%, 12 females, 5 males) of the 516 patients of sarcoidosis, aged 16 yr and diagnosed within a 36-year period. When the features of sarcoidosis subjects diagnosed during the childhood period were compared to those of subjects >16 years of age, it was seen that patients with advanced stage of the disease were more in the first group (41.2% vs 18%, p=0.02). In addition, children had more frequent extrapulmonary (64.7% vs 40.3%) and lacrimal gland involvement (p values, respectively, 0.044 and 0.003). When clinical data are relevant, sarcoidosis should be borne in mind. A child with sarcoidosis has more frequent pulmonary parenchymal and extrapulmonary involvement than in adults.

Surgical Treatment of Complex Malignant Anterior Mediastinal Tumors Invading the Superior Vena Cava

Determining the appropriate surgery-based treatment for complicated anterior mediastinal malignancies (CAMM), especially those invading the superior vena cava (SVC) and its branches, remains a challenge for general thoracic surgeons. In this report, we summarize our experience and lessons regarding this issue in order to discuss a reasonable strategy for diagnosis and treatment of CAMM. Between January 2001 and April 2003, 15 patients with CAMM invading the SVC and/or its branches with or without invasion of other neighboring organs were surgically treated in our institution by a single surgeon team. We collected clinical data from the medical charts and from surgeons' specific notes for complicated cases, and performed a comprehensive analysis. There were 9 patients with malignant thymoma. Thymic carcinoma, teratoma, embryonal carcinoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, and mixed teratoma with thymoma were diagnosed in 1 patient each. All procedures were performed via median sternotomy. Some angioplasty techniques were successfully used to resect and reconstruct the SVC. Ten of the 15 patients also underwent pulmonary resection due to involvement of pulmonary parenchyma. Four of the patients underwent perioperative chemotherapy. There were no perioperative deaths. Two patients suffered prolonged ventilation after surgery, and there were no other severe complications related to surgery. One patient died 10 months after surgery. The remaining 14 patients were still living and their progress is still monitored. As of August 2004, the median follow-up duration for all patients was 35 months, and the disease-free survival duration was 10-43 months. CAMM can be safely and completely resected via a median sternotomy, even if it has invaded other mediastinal structures. CAMM should be pathologically identified before initial treatment. A good outcome for patients with CAMM is possible if a suitable strategy combining accurate diagnosis and appropriate treatment, especially surgical resection, is established.

Shrinking lung syndrome as a presenting manifestation of systemic lupus erythematosus in a female Kuwaiti

The shrinking lung syndrome (SLS) is a rare manifestation in patients with established systemic lupus erythematosus (SLE). Only two cases have been reported in which this syndrome was the presenting manifestation of SLE. We describe a 21-year-old female Kuwaiti who presented with SLS. In addition to clinical and serological features of lupus, she had dyspnea, respiratory muscle dysfunction, characteristic chest radiographic findings of small lung volumes, elevated right hemidiaphragm, and basilar atelectasis. There was no pulmonary parenchymal or pulmonary vascular involvement. Nerve conduction study showed right phrenic nerve palsy. She responded well to treatment with corticosteroids.

Pleuropulmonary manifestations of systemic lupus erythematosus

To analyze the incidence, clinical features, and prognosis of pleuropulmonary involvement in patients with systemic lupus erythematosus (SLE). The medical records of 320 SLE inpatients hospitalized in Peking Union Medical College Hospital 2004, 50 males and 270 females, aged 33 +/- 14 (8-75), were retrospectively analyzed. Pleuropulmonary involvement occurred in 142 cases with an incidence rate of 44.4%. The incidence of pleural involvement was 25% (80/320) and the incidence of pulmonary parenchyma involvement was 33.8% (108/320). The mortality rate of the SLE patients with thoracic involvement was 7.0%, significantly higher than that of the SLE patients without thoracic involvement (1.0%, P = 0.006). The incidence of acute lupus pneumonitis (ALP) was 1.3% and the survival rate of ALP was 100%. The clinical manifestations of ALP included hypoxemia, dyspnea, fever, and cough and chest radiograph characteristically showed unilateral or bilateral patchy acinar infiltrates predominantly in the lower lung zone. The incidence of diffuse alveolar hemorrhage (DAH) was 1.9% with a mortality rate of 66.7%. The clinical manifestations of DAH included hemoptysis, hypoxemia, cough, anemia and bloody bronchoalveolar lavage and the chest radiographic findings included new acinar infiltrates that were typically diffuse and bilateral and might be patchy. The other common pleuropulmonary complications of SLE included pleural disease (25%), chronic interstitial pneumonitis (6.9%), pulmonary hypertension (15.3%), pulmonary embolism (1.9%), and pulmonary infection (19.1%). SLE may affect all components of the respiratory system. Thoracic involvement is an adverse prognostic sign. Life-threatening pulmonary involvement is not uncommon. The clinicoradiographic features of the SLE-associated pulmonary syndromes overlap. Aggressive diagnostic evaluations such as blood culture, sputum culture, fibreoptic bronchoscopy, and lung biopsy are very important.

Pulmonary Parenchymal Involvement of Low-Grade Lymphoproliferative Disorders

Lymphoid tissue is a normal component of the lung. The various lymphoproliferative diseases affect the lung parenchyma. The purpose of this article is to classify various lymphoproliferative diseases and to understand their computed tomography features of pulmonary involvement. The examples include follicular bronchiolitis, lymphocytic interstitial pneumonia, plasma cell granuloma, Castleman disease, lymphomatoid granulomatosis, and mucosa-associated lymphoid tissue lymphoma. Pathologic correlation is helpful for understanding imaging findings and their pathophysiology.

Experience with ARDS caused by tuberculosis in a respiratory intensive care unit

ObjectiveAcute respiratory distress syndrome (ARDS) is an important cause of morbidity and mortality in intensive care units. Tuberculosis (TB) commonly causes respiratory failure in patients with extensive pulmonary parenchymal involvement, but it is a rare cause of ARDS. We report our experience of TB presenting with ARDS.MethodsRetrospective analysis of 187 patients admitted with a diagnosis of ARDS over the previous 7 years. Data are presented in a descriptive fashion using mean±SD or median (range).ResultsNine (4.9%) of 187 patients had ARDS secondary to tuberculosis. All patients were mechanically ventilated. The diagnosis was made on clinico-radiological grounds and confirmed later using fiberoptic bronchoscopy and transbronchial biopsy in seven patients, and lymph node biopsy and examination of the joint aspirate in the remaining two. All patients were empirically started on anti-tubercular therapy with a median time to initiation of therapy being 3 days (range 2–8 days). Three patients had multi-organ dysfunction syndrome (MODS) without any evidence of bacterial infection. Seven of nine (77.8%) patients survived; two died because of severe ARDS, MODS, and respiratory failure.ConclusionsTuberculosis is an uncommon but definite cause of ARDS, and in patients with ARDS of obscure aetiology where the clinical features suggest tuberculosis as the inciting cause, antitubercular therapy should be started empirically and the diagnosis actively pursued later.

Early pulmonary involvement in Niemann‐Pick type B disease: Lung lavage is not useful

Niemann-Pick disease (NPD) is a rare, autosomal-recessively inherited lipid storage disease which is characterized by intracellular deposition of sphingomyelin in various body tissues. The disease is heterogeneous and classified into six groups. Pulmonary parenchymal involvement may be a feature of several subtypes of NPD, including type B. Progressive pulmonary involvement in NPD type B is a major cause of morbidity and mortality. It is usually diagnosed at older ages. Only a few cases with early pulmonary involvement have been reported. In this report, a patient with NPD type B, hospitalized with the diagnosis of pneumonia at age 3 months, is presented. Following treatment for pneumonia, she continued to have persistent respiratory symptoms and became oxygen-dependent. High-resolution computed tomography of the chest revealed diffuse interstitial changes. During follow-up, the patient developed hepatosplenomegaly. Lung, liver, and bone marrow biopsies showed characteristic findings for NPD. Biochemical studies also confirmed the diagnosis, and the sphingomyelinase enzyme level of the patient was low. Unilateral lung lavage was performed in order to decrease lipid storage as a treatment modality. However, there was no clinical or radiological improvement. The patient died at age 15 months due to progressive respiratory failure. Pulmonary involvement is a rare entity in early childhood in patients with NPD type B, but should be considered in the differential diagnosis of persistent interstitial lung disease. It may cause progressive respiratory failure, but the treatment options remain limited.

A Review of Respiratory Bronchiolitis and Respiratory Bronchiolitis-Associated Interstitial Lung Disease

In Brief Respiratory bronchiolitis (RB) and respiratory bronchiolitis–associated interstitial lung disease (RB-ILD) are 2 processes that lie along the continuum of probable smoking related lung diseases. The separation of the 2 is difficult and sometimes contentious; however, the combination of clinical symptoms and suggestive pathologic findings usually allows for a distinction and the subsequent diagnosis. RB in an asymptomatic smoker is considered an incidental histologic finding consistent with prior tobacco history. RB-ILD, although histopathologically similar to RB, is characterized by more extensive pulmonary parenchymal involvement and clinical expression as defined by dyspnea or other respiratory complaints. On pulmonary function testing, RB-ILD patients often demonstrate a mixed picture of obstructive or restrictive physiology, in combination with a reduced carbon monoxide diffusion capacity. Plain chest radiography is of limited utility and can be normal in many RB-ILD patients. High-resolution computer-assisted tomography scanning in the setting of RB-ILD correlates with the extent of bronchiolitis on pathologic analysis and offers a potential role for assessing response to therapy. Thus far, bronchoscopy has demonstrated a relatively limited capacity in diagnosing RB-ILD, necessitating surgical lung biopsy to arrive at a definitive diagnosis. Treatment of RB-ILD hinges upon smoking cessation maneuvers and consideration of immunosuppressive agents in recalcitrant cases. Respiratory bronchiolitis and respiratory bronchiolitis–associated interstitial lung disease are two processes that lie along the continuum of probable tobacco smoking–imparted changes on the lung. The separation of the 2 is difficult and sometimes contentious. The combination of the presence of clinical symptoms in conjunction with suggestive pathologic findings usually allows for a distinction and the subsequent diagnosis.

Diagnosis and management of pulmonary metastasis from recurrent respiratory papillomatosis

Objective We sought to review the current and proposed management, as well as bring about discussion, of managing the patient with distal tracheal and pulmonary parenchymal involvement by recurrent respiratory papillomatosis (RRP). Design, setting, and patients We conducted a review of 6 patients with pulmonary metastasis from RRP at 3 academic tertiary care hospitals. Interventions included surgical and medical management with antiviral, chemotherapeutic, and/or immune-modulating agents. Results Although treatment with α–2-β interferon, isotretinoin, and methotrexate have not proved to eradicate pulmonary involvement by RRP, possible epithelial stabilization and slowing of disease progression are noted. Conclusions The rates of distal tracheal and pulmonary metastasis as seen in our cohort were higher than previously reported. Approximately 12% of our patients with RRP have distal tracheal spread and as many as 7% of all patients with RRP at our institutions have pulmonary dissemination. Also, high suspicion for malignant conversion to squamous carcinoma in the patient with pulmonary spread should be maintained. In addition, aggressive treatment, although not proved to eradicate the pulmonary disease, should be undertaken due to the high morbidity and mortality associated with pulmonary dissemination of RRP in our cohort.

Pulmonary involvement in pediatric lymphoma.

The prevalence of pulmonary lymphoma in the pediatric age group is not documented in the literature. This study was designed to assess the prevalence of pulmonary parenchymal lymphoma in children with Hodgkin disease (HD), non-Hodgkin lymphoma (NHL) and post-transplant lymphoproliferative disorder (PTLD). A 10-year retrospective analysis of 161 lymphoma patients (62 girls and 99 boys), mean age of 12.4 years, was performed. The definition of pulmonary lymphoma excluded those with isolated pleural disease and/or mediastinal adenopathy. Eighty-two patients had HD, 65 had NHL, and 14 had PTLD. Overall prevalence of pulmonary parenchymal involvement was 13% (21/161), including 12% of patients with HD, 10% of patients with NHL, and 29% of patients with PTLD. CT findings included: pulmonary nodules (90%) or mass (38%); interstitial (9%) or alveolar (9%) disease; cavitation (9%); and pleural based mass (9%). Pulmonary parenchymal disease in our pediatric lymphoma population was more prevalent than expected (13%). This is significant for patient management. New pulmonary lesions in patients with known lymphoma should be regarded with suspicion. In the setting of immune suppression, pulmonary lesions treated as infection may actually represent lymphoma. Expeditious biopsy of lesions failing to respond promptly to antibiotic therapy should be considered.

Löfgren syndrome in Turkey.

In the 36-year period between 1966 and 2002, 514 patients were diagnosed with sarcoidosis at Cerrahpaşa Medical Faculty, Istanbul, Turkey, and of these 98 (19.1%) had Löfgren syndrome. The frequency of female patients with Löfgren was higher than the frequency among other sarcoidosis patients (female:male ratio 4.8 vs. 1.64; P < 0.001). Erythema nodosum was diagnosed in 72.4% of the subjects and arthritis or arthralgia was diagnosed in 51%. Erythema nodosum and arthritis or arthralgia were more frequent in Löfgren; however, pulmonary parenchymal involvement was more frequent in other sarcoidosis patients (all P-values < 0.001).

Cutaneous involvement in sarcoidosis: analysis of the features in 170 patients

In our study, we retrospectively evaluated the clinical features of patients diagnosed as sarcoidosis at our center within the last 36 years and who had skin involvement. Cutaneous involvement was observed in 170 patients (32.9%, 136 females, 34 males). The most frequent skin lesion was erythema nodosum (EN) (106 subjects, 20.5%). In addition, skin plaques and subcutaneous nodules were observed in 22 cases (4.3%), maculopapular eruptions in 19 cases (3.7%), scar lesions in 15 cases (2.9%), lupus pernio (LP) in 14 cases (2.7%) and psoriasiform plaques in five cases (0.9%). Among patients with LP (64.3%) and scar lesions (40%), pulmonary parenchymal involvement was more frequent than patients with other skin lesions. Parenchymal involvement present in 10.4% of patients with EN was significantly less than in patients with LP and scar lesions ( P values, respectively, <0.001, 0.002). When patients with skin involvement were compared to other sarcoidosis patients, it was seen that the frequency of females among those with skin involvement was significantly higher than the frequency among other sarcoidosis patients ( P<0.001). Parenchymal involvement in sarcoidosis patients without skin involvement was less frequent than in patients with LP; however, more frequent than in patients with EN (both P values=0.002). As a conclusion, skin involvement was diagnosed in approximately one-third of our sarcoidosis patients with a generally female predominance. EN was the most frequent skin lesion encountered. Parenchymal involvement was more frequent in patients with LP and scar lesions and less frequent in patients with EN.

The Diagnostic Pathway to Sarcoidosis

To examine the time from the first physician visit to the diagnosis of sarcoidosis. The time required to diagnose sarcoidosis is dependent on the initial symptoms, socioeconomic status, referral to a specialist, race, and severity of pulmonary involvement. Patients were recruited from the Case Control Etiology of Sarcoidosis Study (ACCESS) and had biopsy-confirmed sarcoidosis. Subjects were asked to recall the date of onset of symptoms of sarcoidosis, their first physician visit, number of physician visits, and types of physicians seen. One hundred eighty-nine patients were enrolled. The diagnosis of sarcoidosis was made on the first physician visit in only 15.3% of cases. The presence of pulmonary symptoms was associated with prolonged time (> 6 months vs < or = 6 months, p = 0.02) until diagnosis, and the presence of skin symptoms with a shorter time (< or = 6 months vs > 6 months, p = 0.02) until diagnosis. Patients with pulmonary symptoms had more physician visits (mean +/- SEM) until the diagnosis was made compared to those without pulmonary symptoms (4.84 +/- 0.38 visits vs 3.15 +/- 0.24 visits, p = 0.0002). The mean baseline FEV(1) was greater in those diagnosed < or = 6 months from the first physician visit than those diagnosed > 6 months (87.3 +/- 1.52% predicted vs 81.2 +/- 2.5% predicted, p = 0.04). There was a significant delay in diagnosis (> 6 months vs < or = 6 months) from first physician visit with higher Scadding stages (stage 4 vs stage 2, or stage 3 vs stage 0 or 1, p = 0.04). The diagnosis of sarcoidosis is often delayed and seems to be more a factor of disease presentation than patient or physician characteristics. The presence of pulmonary symptoms or higher radiographic stages is associated with a prolonged time until diagnosis. The presence of skin symptoms is associated with less delay in diagnosis. It is likely that the delay in diagnosis of pulmonary sarcoidosis relates to the fact that pulmonary symptoms and parenchymal involvement are nonspecific and are often regarded as manifestations of other pulmonary diseases.

A Case of Primary BALT Lymphoma Limited to the Trachea

Primary pulmonary lymphoma is rare, especially lymphomas arising in and limited to the tracheal wall without pulmonary parenchymal involvement are extremely rare. Bronchus-associated lymphoid tissue (BALT) lymphoma accounts for the majority of tracheal lymphomas. BALT lymphoma reveals distinct clinicopathologic features and remains localized for prolonged periods. The diagnosis is made histopathologically. Optimal management of these rare lesions has not been established. But, chemotherapy and radiation therapy all have been tried with favorable short-term results. The prognosis of BALT lymphoma is relatively good. We present here a case of BALT lymphoma of the tracheal wall which had responded to bronchoscopic ND-YAG laser therapy and local radiation therapy. (Tuberculosis and Respiratory Diseases 2003, 55:198-205)

Matrix metalloproteinases and tissue inhibitor of metalloproteinase-1 in sarcoidosis and IPF

The purpose of this study was to examine the role of interstitial collagenases, members of the family of matrix metalloproteinases, in the development of pulmonary fibrosis. The activity, levels and molecular forms of collagenases (matrix metalloproteinases (MMP)-1, -8 and -13), gelatinase B (MM P-9) and its main endogenous inhibitor, tissue inhibitor of metalloproteinase-1 (TIMP-1) were assessed in bronchoalveolar lavage fluid (BALF) from patients with idiopathic pulmonary fibrosis (IPF) and sarcoidosis patients with varying degrees of pulmonary parenchymal involvement. Collagenase activity was elevated in IPF and group 3 sarcoidosis patients. A positive correlation between BALF collagenase activity and MMP-8 levels was also observed. Western immunoblotting revealed the presence of two isoforms of MMP-8 in patient samples; an 80 kD form representing latent enzyme from polymorphonuclear neutrophils and a 55 kD form representing the fibroblast-type proform. MMP-9 levels were also elevated in both IPF and group 3 sarcoidosis patients, while TIMP-1 levels remained normal, indicating a shift in the balance between the enzyme and inhibitor, favouring MMP-9. Matrix metalloproteinase-8 is the major contributor to the bronchoalveolar lavage fluid collagenase activity in the airways of patients with idiopathic pulmonary fibrosis and sarcoidosis and may initiate collagen destruction and remodelling leading to the development of pulmonary fibrosis.

Is it possible to detect ulcerative colitis-related respiratory syndrome early?

Obstructive airway disease, bronchiectasis, non-specific parenchymal infiltration and bronchiolitis obliterans organizing pneumonia are seen occasionally in patients with inflammatory bowel disease. In the present study, we evaluated ulcerative colitis (UC) patients for latent pulmonary involvement. Fifteen patients (nine females, six males, mean age 44 years) were admitted into the study. All patients were free of respiratory symptoms. Ulcerative colitis was active in nine patients and all patients were using anti-inflammatory treatment. Pulmonary function tests (PFT), high resolution computed tomography of thorax (HRCT) and bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBLB) were carried out in all subjects. Mild airways obstruction was found in 1 of 13 patients. High resolution CT was abnormal in 4 of 15 patients. Ground glass appearance suggestive of an interstitial lung disease was present in three patients. Radiolucency and pneumocysts were present in the fourth patient suggesting obstructive small airway disease. High resolution CT findings correlated with disease activity (P < 0.05). Fiberoptic bronchoscopy was performed in 10 patients. A mixed type alveolitis was detected in BAL fluid in five patients. In eight patients, TBLB showed alveolar septal thickening by connective tissue, lymphocytic accumulation in the septal area and minimal septal fibrosis, suggesting subclinical pulmonary parenchymal involvement linked to UC. Our data suggest that latent interstitial pulmonary involvement may occur during the course of UC, despite an absence of symptoms of lung disease.

Hypercalcaemia in Greek patients with tuberculosis before the initiation of anti-tuberculosis treatment

Hypercalcaemia has been known to occur in association with granulomatous diseases. The aim of this study was to ascertain the incidence of hypercalcaemia and determine the prevalence of symptoms associated with it in Greek patients with newly-diagnosed tuberculosis (TB), before the initiation of anti-tuberculosis treatment. We prospectively evaluated all patients with newly-diagnosed TB presenting, either as inpatients or as outpatients, to our hospital, during a 3-year period. We evaluated 88 patients with TB (50 males and 38 females), aged between 23 and 89 years (mean age±SD: 46·4±19 years), and 65 age- and sex-matched controls with chronic obstructive pulmonary disease (36 males and 29 females), aged between 28 and 88 years (mean age±SD: 47·2±18 years). Among TB patients, 56 had pulmonary TB, 20 had pleural TB without evidence of pulmonary parenchyma involvement, eight had pulmonary and pleural TB, and four had disseminated disease.The mean (±SD) albumin–adjusted serum calcium concentration and the mean ionized calcium concentration were significantly higher in the TB group (2·49±0·21 mmol l−1and 1·27±0·02 mmol l−1respectively) than in the control group (2·36±0·11 mmol l−1and 1·19±0·02 mmol l−1, P<0·05). In the TB group no correlation between type of disease and albumin-adjusted or ionized calcium concentration was seen. Hypercalcaemia was detected in 22 patients with TB (25%) but only three showed symptoms associated with it. We conclude that, although hypercalcaemia is a common laboratory finding among Greek patients with TB before anti-TB chemotherapy, it is usually asymtomatic.

Tracheobronchial Amyloidosis

To evaluate the presentation and clinical course of patients with tracheobronchial amyloidosis. We retrospectively reviewed the records of all patients with biopsy-proven tracheobronchial amyloidosis who were evaluated at the Mayo Clinic in Rochester, Minn, between 1973 and 1999. All relevant information, such as clinical, historical, demographic, laboratory, and histological data, was examined. Tracheobronchial amyloidosis was diagnosed in 17 patients (9 women and 8 men), with a mean age of 56.6 years. The most common symptoms at presentation were dyspnea, cough, hemoptysis, and hoarseness. None of the 14 patients who underwent investigation for systemic amyloidosis had any evidence of disease outside the tracheobronchial system except for a man in whom multiple myeloma had been diagnosed 3 years before the development of respiratory disease. Treatment of tracheobronchial amyloidosis consisted of laser or forceps resection, external radiation, systemic therapy, or observation. Two patients died of complications directly related to their disease. Patients presenting with tracheobronchial amyloidosis have symptoms similar to those caused by various airway disorders. Tracheobronchial amyloidosis is not typically associated with systemic amyloidosis or pulmonary parenchymal involvement. It often recurs and despite repeated attempts with bronchoscopic techniques, airway compromise remains a major problem.

Pulmonary Cryptosporidiosis in Simian Immunodeficiency Virus—infected Rhesus Macaques

Cryptosporidiosis is a common opportunistic infection in the gastrointestinal tract of human and nonhuman primates with AIDS. Pulmonary infection associated with Cryptosporidium spp. has not been previously reported in monkeys. Two macaques experimentally infected with simian immunodeficiency virus (SIV) had lesions containing cryptosporidial organisms involving the trachea, lungs, bile ducts, pancreas, and intestine. The pulmonary sections revealed moderate to severe bronchopneumonia associated with cryptosporidiosis. Numerous 2-4 microm oval Cryptosporidium spp. organisms were present in the cytoplasm of alveolar macrophages, multinucleated giant cells, and intestinal epithelial cells. Giant cells were positive for SIV by in situ hybridization. These are the first reported cases of cryptosporidiosis with involvement of pulmonary parenchyma in SIV-infected macaques.

Influence of antimicrobial chemotherapy on spirometric parameters and pro-inflammatory indices in severe pulmonary tuberculosis

Patients who have completed a treatment for severe pulmonary tuberculosis (TB) are often left with severe respiratory disability. There have been few prospective studies assessing the effect of treatment on lung function in such patients. The influence of antimicrobial chemotherapy on lung function was investigated over a six month period in patients with newly diagnosed pulmonary TB to test the hypothesis that treatment improves lung function, as well as to identify factors that may influence lung function outcome. Seventy-six patients were recruited into the study, of whom 74 completed the treatment programme. Forty-two were current smokers and 13 seropositive for the human immunodeficiency virus. Improvement in lung function occurred in 54% of patients, but residual airflow limitation or a restrictive pattern was evident in 28% and 24% of patients, respectively. The extent of lung infiltration (radiographic score) both at the outset and after chemotherapy was significantly and negatively related to forced expiratory volume in one second (FEV1) (% pred) (r=-0.41, and r=-0.46, respectively). The post-treatment serum C-reactive protein and alpha1-protease inhibitor levels were negatively associated with FEV1 (% pred) (r=-0.30 and r=-0.35, respectively). These findings demonstrate that, while antimicrobial chemotherapy may lead to improved lung function in patients with pulmonary tuberculosis, a large proportion of patients has residual impairment. The most significant factor influencing post-treatment lung function status, as measured by forced expiratory volume in one second (% predicted), is the pretreatment and post-treatment radiographic score, which acts as a marker of the extent of pulmonary parenchymal involvement in tuberculosis.