Restrictive Ventilatory Defect Research Articles

Incidental Finding to Diagnostic Dilemma

SESSION TITLE: Pulmonary Manifestations of Systemic Disease 2 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Lymphocytic Interstitial Pneumonitis (LIP) is a common manifestation of lung disease associated with Sjogren’s disease. We present a case fraught with diagnostic challenges. CASE PRESENTATION: A 59 year old man with history of Sjogren’s syndrome and asthma was referred to pulmonology after incidental X-ray finding of right lower lobe infiltrate. Review of systems revealed dry eyes, dry cough and dyspnea on exertion. He had a 25 pack-year smoking history. Medications were notable for saline eye drops and Albuterol inhaler. Physical examination revealed temperature 37 degrees Celsius; blood pressure 145/77; pulse 61; oxygen saturation 96% on room air. He was obese, with no lymphadenopathy and chest clear to auscultation. Initial Lab work was unremarkable. Serology was positive for antinuclear antibodies (ANA), anti Anti-Sjögren’s- syndrome-related antigen A and antigen B (SSa/SSb) antibodies. Pulmonary function tests revealed a mildly restrictive pattern. Initial CT scan showed right upper lobe infiltrate which worsened on 3 month follow up CT. Bronchoscopy with bronchoalveolar lavage (BAL) showed normal cell count and cytology, cultures grew beta streptococcus group B. After 2 weeks of antibiotics he developed night sweats and dyspnea on mild exertion. A third CT scan demonstrated dense right lower lobe consolidation, bilateral ground-glass opacities and enlarged sub-pleural nodules. Repeat BAL grew Cryptococcus. He received 7 weeks of fluconazole without improvement. Needle biopsy for sub-pleural nodule revealed multiple dense lymphoplasmacytic infiltrates. Ultimately, wedge biopsy confirmed dense lymphoplasmacytic infiltrate, lymphoid follicles, intra-alveolar macrophages and histiocytes. B-cell polyclonality was confirmed by PCR. He was diagnosed with focal lymphoid hyperplasia and lymphocytic interstitial pneumonia. Treatment with corticosteroids yielded transient resolution. Dramatic resolution was achieved with Rituximab (with azathioprine for maintenance). DISCUSSION: The pathogenesis of LIP is thought to be abnormal proliferation of indigenous cell lines and lung parenchymal infiltration with lymphoid cells. It may be a focal or diffuse, benign (monoclonal) or potentially malignant (polyclonal). It is most commonly seen in women in their 50s and is associated with autoimmune disease. Frequently, LIP presents with cough, chest pain and hemoptysis. There may be a restrictive ventilatory defect on PFTs. Imaging is variable and a lung biopsy required for diagnosis. CONCLUSIONS: Timely recognition of LIP prevents misdiagnosis. Treatment usually is with high dose corticosteroids. Alternative to steroid use may be immunosuppressant agents such as rituximab and azathioprine, however literature to support use of such agents is limited to case reports. Reference #1: Lymphocytic Interstitial Pneumonia, Tanmay S. Panchabhai MD, Carol Farver MD, Kristin B. Highland MD, MSCR Clinics in Chest Medicine, 2016-09-01 DISCLOSURE: The following authors have nothing to disclose: Reema Qureshi, Saira Imran No Product/Research Disclosure Information

Frequency of COPD in health care workers who smoke.

ABSTRACTObjective:COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. Methods:This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. Results:The study involved 305 subjects, and 47 (15.4%) were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%); restrictive ventilatory defect, in 5 (1.6%); and small airway disease, in 96 (31.5%). A diagnosis of COPD was made in 29 patients (9.5%), 25 (86.2%) of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both); 1 belonged to group D (3.6%); and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01). Conclusions:In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.

Shrinking lung syndrome in systemic lupus erythematosus: a single-centre experience

Introduction Shrinking lung syndrome (SLS) is a rare manifestation of systemic lupus erythematosus (SLE), characterized by decreased lung volumes and extra-pulmonary restriction. The aim of this study was to describe the characteristics of SLS in our lupus cohort with emphasis on prevalence, presentation, treatment and outcomes. Patients and methods Patients attending the Toronto Lupus Clinic since 1980 ( n = 1439) and who had pulmonary function tests (PFTs) performed during follow-up were enrolled ( n = 278). PFT records were reviewed to characterize the pattern of pulmonary disease. SLS definition was based on a restrictive ventilatory defect with normal or slightly reduced corrected diffusing lung capacity for carbon monoxide (DLCO) in the presence of suggestive clinical (dyspnea, chest pain) and radiological (elevated diaphragm) manifestations. Data on clinical symptoms, functional abnormalities, imaging, treatment and outcomes were extracted in a dedicated data retrieval form. Results Twenty-two patients (20 females) were identified with SLS for a prevalence of 1.53%. Their mean age was 29.5 ± 13.3 years at SLE and 35.7 ± 14.6 years at SLS diagnosis. Main clinical manifestations included dyspnea (21/22, 95.5%) and pleuritic chest pain (20/22, 90.9%). PFTs were available in 20 patients; 16 (80%) had decreased maximal inspiratory (MIP) and/or expiratory pressure (MEP). Elevated hemidiaphragm was demonstrated in 12 patients (60%). Treatment with prednisone and/or immunosuppressives led to clinical improvement in 19/20 cases (95%), while spirometrical improvement was observed in 14/16 patients and was mostly partial. Conclusions SLS prevalence in SLE was 1.53%. Treatment with glucocorticosteroids and immunosuppressives was generally effective. However, a chronic restrictive ventilatory defect usually persisted.

Familial pulmonary fibrosis: Clinical and radiological characteristics and progression analysis in different high resolution-CT patterns

BackgroundFamilial pulmonary fibrosis (FPF) is defined as an idiopathic diffuse parenchymal lung disease affecting two or more members of the same primary biological family. The aim of the present study was to contribute to the clinical, functional and radiological characterisation of FPF with particular regards to disease progression and survival. MethodsBaseline clinical, functional and radiological data of a FPF population (n = 46 patients) were retrospectively collected and analysed according to the 2011 IPF guidelines HRCT classification. A PFT follow-up after 1-year and survival analysis was conducted among to different HRCT patterns. Results22 female and 24 male patients (age at diagnosis 58.5 ± 9.7 years-old), belonging to 30 families, were included in this study. Radiological analysis demonstrated the presence of a UIP pattern at HRCT in 54.3% of patients, Poss-UIP in 21.8% and Incon-UIP in 23.9%. Incon-UIP patients were younger and more frequently female. Pulmonary function tests showed a restrictive ventilatory defect in patients with UIP and Incon-UIP patterns, while Poss-UIP patients had normal volumes with only a mild reduction of DLCO. BAL composition revealed increased lymphocytes percentage in Incon-UIP patients. Respiratory functional 1-year follow-up showed a significant worsening in UIP patients only. HRCT pattern progression was only demonstrated from Poss-UIP to UIP (18% of patients). Median survival was not statistically different among the 3 HRCT groups, although Poss-UIP patients presented a better outcome. ConclusionsFPF has been confirmed to be a complex condition with poor prognosis. The present study firstly analysed functional and radiological follow-up data of patients with FPF, showing that it may manifests with several HRCT patterns with different rates of progression, in which Possible UIP and UIP could be considered phases of the same disease and Inconsistent UIP patients may represent a different clinical and radiological condition.

CD16-positive circulating monocytes and fibrotic manifestations of systemic sclerosis.

The objective of this study is to assess the association of clinical manifestations of systemic sclerosis (SSc) with the absolute count of circulating blood monocyte subpopulations according to their membrane expression of CD16. Forty-eight consecutive patients fulfilling the 2013 ACR/EULAR classification criteria for SSc were included in this cross-sectional study. CD16+ monocyte absolute count was defined by flow cytometry and confronted to the clinical characteristics of SSc patients. Twenty-three healthy donors (HD) were randomly selected for comparison. SSc patients had an increased number of total circulating blood monocytes compared to HD (p<0.001). The CD16- subpopulation absolute count was increased in SSc patients compared to HD (p<0.001) but was similar in limited SSc (lSSc) and diffuse SSc (dSSc). On the contrary, the CD16+ population absolute count was increased in dSSc compared to both HD and lSSc patients (dSSc 0.071Giga/L (±0.034) vs HD 0.039Giga/L (±0.030), p<0.01, and dSSc 0.071Giga/L (±0.034) vs lSSc 0.048Giga/L (±0.024), p<0.05). The CD16+ monocyte subpopulation absolute count was significantly correlated with the severity of skin fibrosis evaluated by the modified Rodnan skin score (p<0.001). The CD16+ monocyte subpopulation was also associated with pulmonary fibrosis (p<0.05), with the severity of the restrictive ventilatory defect evaluated by total lung capacity (p<0.05) and with the pulmonary function impairment reflected by diffusing capacity of the lungs for carbon monoxyde measures (p<0.01). These results suggest that CD16+ monocytes are associated with the main fibrotic manifestations of SSc and their role in the pathogenesis of fibrosis in this autoimmune disorder should therefore be further considered.

Pulmonary outcome of esophageal atresia patients and its potential causes in early childhood

IntroductionThe aim of this study was to illustrate the pulmonary long term outcome of patients with repaired esophageal atresia and to further examine causes and correlations that might have led to this outcome. MethodsTwenty-seven of 62 possible patients (43%) aged 5–20years, with repaired esophageal atresia were recruited. Body plethysmography and spirometry were performed to evaluate lung function, and the Bruce protocol treadmill exercise test to assess physical fitness. Results were correlated to conditions such as interpouch distance, gastroesophageal reflux or duration of post-operative mechanical ventilation. ResultsSeventeen participants (63%) showed abnormal lung function at rest or after exercise. Restrictive ventilatory defects (solely restrictive or combined) were found in 11 participants (41%), and obstructive ventilatory defects (solely obstructive or combined) in 13 subjects (48%). Twenty-two participants (81%) performed the Bruce protocol treadmill exercise test to standard. The treadmill exercise results were expressed in z-score and revealed to be significantly below the standard population mean (z-score=−1.40). Moreover, significant correlations between restrictive ventilatory defects and the interpouch distance; duration of post-operative ventilation; gastroesophageal reflux disease; plus recurrent aspiration pneumonia during infancy; were described. ConclusionIt was shown that esophageal atresia and associated early complications have significant impact on pulmonary long term outcomes such as abnormal lung function and, in particular restrictive ventilatory defects. Long-running and regular follow-ups of patients with congenital esophageal atresia are necessary in order to detect and react to the development and progression of associated complications such as ventilation disorders or gastroesophageal reflux disease. Level of evidencePrognosis study, Level II.

Evaluation of lung function tests in rheumatoid arthritis patients

Background: Pulmonary manifestation is one of the most common extra-articular features in rheumatoid arthritis (RA) leading to significant morbidity. Lung function testing helps in identifying the type of respiratory defect. Early detection helps in effective management of the lung involvement in RA. Aims and Objectives: In this study, we compared the lung function of RA patient with the normal controls. Materials and Methods: Spirometry was performed in 100 participants (50 RA patients and 50 normal controls). Lung parameters such as forced vital capacity, forced expiratory volume in 1 s, forced expiratory flow in 25-75%, and peak expiratory flow rate were measured. Statistical analysis was performed, P < 0.05 was considered statistically significant. Result: In this study, restrictive ventilatory defect was seen in 64% of patients, and obstructive ventilatory defect was seen in 10% of patients. Pulmonary function abnormalities are common in asymptomatic rheumatoid patients which were found to be restrictive defect. Conclusion: Restrictive ventilatory defect may be due to idiopathic pulmonary fibrosis characterized by high levels of rheumatoid factor, antinuclear antibody and deposits of immunoglobulin A, and complement on the alveolar wall. Screening of RA patients with spirometer helps in early detection of pulmonary involvement.

Effect of changing from the National Health and Nutritional Examination Survey III spirometry reference range to that of the Global Lung Initiative 2012 at Gold Coast Hospital and Health Service.

The categorisation of lung disease into obstructive ventilatory defect (OVD) and tendency to a restrictive ventilatory defect (TRVD) patterns using spirometry is used to guide both prognostication and treatment. The effectiveness of categorisation depends upon having reference ranges that accurately represent the population they describe. The Global Lung Initiative 2012 (GLI 2012) has spirometry reference ranges drawn from the largest sample size to date. This study aimed to determine whether using spirometry reference ranges from the new GLI 2012 dataset, compared to the previously used National Health and Nutritional Examination Survey III (NHANES III) dataset, resulted in a change in diagnosis between OVD, TRVD and normal ventilatory pattern (NVP). Spirometry data were collected from 301 patients, aged 18-80 years, undergoing investigation at the Gold Coast Hospital and Health Service (GCHHS) throughout February and March 2014. OVD was defined as a forced expiratory volume in 1 second (FEV1) divided by forced vital capacity (FVC) less than lower limit of normal (LLN). TRVD was defined as FEV1/FVC ≥ LLN, FEV1 < LLN, and FVC < LLN. The LLN values were determined by equations from the GLI and NHANES datasets. Spirometry interpreted using the NHANES III equations showed: 102 individuals (33.9%) with normal spirometry, 136 (45.2%) with an OVD pattern, 52 (17.3%) with a TRVD pattern, and 11 (3.7%) with a mixed pattern. When the spirometry data were interpreted using the GLI 2012 equations 2 (0.7%) individuals changed from OVD to NVP, 2 (0.7%) changed from NVP to OVD and 14 (4.7%) changed from TRVD to NVP. Using the GLI 2012 reference range resulted in a change in diagnosis of lung disease in 5.9% of the individuals included in this study. This variance in diagnosis when changing reference ranges should be taken into account by clinicians as it may affect patient management.

Does normal spirometry rule out an obstructive or restrictive ventilatory defect?

Does normal spirometry rule out an obstructive or restrictive ventilatory defect?

Idiopathic Pulmonary Fibrosis: Epidemiology, Clinical Features, Prognosis, and Management.

Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic interstitial lung pneumonia associated with the histologic pattern of usual interstitial pneumonia (UIP). Although UIP is a distinct histologic lesion, this histologic pattern is not specific for IPF and can also be found in other diseases (e.g., connective tissue disease and asbestosis). Clinical features of IPF include progressive cough, dyspnea, restrictive ventilatory defect, and progressive fibrosis and destruction of the lung parenchyma. IPF is rare (13-42 cases/100,000), and primarily affects older adults (>50 years of age). The diagnosis of IPF often requires surgical lung biopsy, but the diagnosis can be affirmed with confidence in some patients provided the results of computed tomographic (CT) scans and clinical features are consistent. The clinical course is variable, but inexorable progression (typically over months to years) is typical. Mean survival from the onset of symptoms approximates 3 to 5 years. Medical treatment is only modestly effective, primarily by slowing the rate of disease progression. Lung transplantation is the best therapeutic option.

Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction.

Health-care providers often diagnose and empirically treat COPD without a confirmative pulmonary function test (PFT) or even despite a PFT that is not diagnostic of obstructive lung disease. We hypothesized that a portion of patients continue to carry a persistent empiric COPD diagnosis and receive treatment with bronchodilators and inhaled steroids after a PFT shows no obstruction. We retrospectively reviewed single PFT sessions with both spirometry and plethysmography in 1,805 subjects. We included subjects who had a normal PFT or a restrictive ventilatory defect. Persistent empiric COPD diagnosis and treatment were defined when subjects with normal PFTs or a restrictive ventilatory defect continued to carry a health-care provider COPD diagnosis or receive treatment with bronchodilators and/or inhaled glucocorticoids, respectively, after a PFT showed no obstruction. One quarter of subjects with FEV1/FVC ≥ lower limit of the normal range had nonspecific PFT abnormalities. We included 473 subjects with normal PFTs and 382 with a restrictive ventilatory defect (n = 855). Persistent empiric COPD diagnosis (60 of 855, 7% prevalence) was associated with current (odds ratio [OR] = 44.7, P < .001) and former smoking (OR = 17.3, P < .001) and older age (OR = 1.03/y, P = .005). Persistent empiric treatment (208 of 855, 24%) was associated with empiric COPD diagnosis (OR = 24.6, P < .001), female sex (OR = 1.75, P = .002), current (OR = 2.04, P = 0.040) and former smoking (OR = 1.53, P = 0.029), interstitial lung disease (OR = 2.09, P = .001), other respiratory diagnosis (OR = 3.17, P < .001), and obstructive sleep apnea (OR = 1.79, P = .006). Persistent empiric COPD diagnosis was 7%, but persistent empiric treatment was common.

Methods for Measuring Lung Volumes: Is There a Better One?

Background: Accurate measurement of lung volumes is of paramount importance to establish the presence of ventilatory defects and give insights for diagnostic and/or therapeutic purposes. Objectives: It was the aim of this study to measure lung volumes in subjects with respiratory disorders and in normal controls by 3 different techniques (plethysmographic, dilutional and radiographic methods), in an attempt to clarify the role of each of them in performing such a task, without any presumptive ‘a priori' superiority of one method above others. Patients andMethods: In different groups of subjects with obstructive and restrictive ventilatory defects and in a normal control group, total lung capacity, functional residual capacity (FRC) and residual volume were measured by body plethysmography, multi-breath helium (He) dilution and radiographic CT scan method with spirometric gating. Results: The 3 methods gave comparable results in normal subjects and in patients with a restrictive defect. In patients with an obstructive defect, CT scan and plethysmography showed similar lung volumes, while on average significantly lower lung volumes were obtained with the He dilution technique. Taking into account that the He dilution technique does primarily measure FRC during tidal breathing, our data suggest that in some patients with an obstructive defect, a number of small airways can be functionally closed at end-expiratory lung volume, preventing He to reach the lung regions subserved by these airways. Conclusion: In all circumstances, both CT scan with spirometric gating and plethysmographic methods provide similar values of lung volumes. In contrast, the He dilution method can measure lower lung volumes in some patients with chronic airflow obstruction.

Pulmonary alveolar microlithiasis with finger clubbing: A case report and literature review.

Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive and slowly progressive disease. Mutations of the solute carrier family 34, member 2 gene are considered to be the cause of the disease. The present study reported the case of a 35-year-old female patient who was diagnosed with PAM. The parents of the patient were reported to be blood-related (cousins). The clinical manifestations and radiological and pathological characteristics of the patient are reported. A pulmonary function examination detected restrictive ventilatory and diffusion defects, and a high-resolution computed tomography scan showed multiple bilateral diffuse ground-glass opacifications and subpleural linear calcifications. A bronchoalveolar lavage fluid (BALF) examination detected a calcified body in the lavage fluid and a transbronchial biopsy showed numerous calcified bodies, concentrically laminated with an onion skin-like appearance in the alveolar spaces. Based on the aforementioned observations, the patient was diagnosed with PAM. Following administration of inhaled corticosteroid treatment, the symptoms were improved and the patient was discharged. After 1 year, the patient was lost to follow-up. The present study presents and reviews the typical radiological appearance, clinical presentation, pathological characteristics and treatments of PAM, and suggests that, often, the parents of the patients are blood-related and typically cousins. In addition, the present study proposes that a BALF examination may be considered an alternative method for the pathological diagnosis of PAM.

Tuberculous pyopneumothorax: about 18 cases

Le pyo-pneumothorax tuberculeux est une complication rare mais grave de la tuberculose pulmonaire évolutive. Nous rapportons une série de 18 cas de pyo-pneumothorax tuberculeux colligés au service de Pneumo-Phtisiologie de l'Hôpital Militaire d'Instruction Mohammed V de Rabat entre janvier 2005 et décembre 2009. Il s'agit de 15 hommes et 3 femmes d’âge moyen de 35 ans ±7 ans. 4 patients étaient diabétiques. Le tabagisme était retrouvé chez 9 cas. Le pyo-pneumothorax était du coté droit dans 13 cas. La radiographie thoracique avait montré des lésions cavitaires chez 15 patients et des lésions étendues et bilatérales chez 8 cas. La recherche de BK dans le liquide de tubage gastrique était positive chez 16 cas. Un drainage thoracique associé à un traitement antituberculeux selon le régime 2SRHZ/7RH et une kinésithérapie respiratoire ont été instaurés chez tous les cas. La durée moyenne de drainage pleural était de 4 semaines. Chez 3 cas on avait noté la persistance de la suppuration pleurale ayant nécessité une toilette pleurale sous thoracoscopie avec pleurectomie et exérèse pulmonaire limitée emportant la lésion parenchymateuse tuberculeuse et la persistance d'une volumineuse poche pleurale avec trouble ventilatoire restrictif ayant nécessité une décortication pleurale chirurgicale chez deux cas. L’évolution était favorable avec pachypleurite séquellaire minime chez le reste des cas. Le pyo-pneumothorax tuberculeux est une forme grave, qui est souvent en rapport avec une tuberculose cavitaire active. L’évolution est généralement trainante malgré le traitement antituberculeux et le drainage thoracique, d'où la nécessité d'un diagnostic et un traitement précoce de toute forme de tuberculose.

Pulmonary function in uncomplicated influenza.

Pulmonary function of 10 patients who had serologically confirmed, uncomplicated A2 influenza was studied during the acute illness and at two- and six-week follow-up periods. Six patients had significant but reversible decreases in pulmonary function manifested by restrictive ventilatory defects and increased alveolar-arterial oxygen tension gradients. Evidence of airway obstruction was found in only one patient. Administration of a bronchodilator aerosol produced no significant change in ventilatory function or arterial blood gas measurements. These data indicate that apparently uncomplicated influenza is frequently accompanied by abnormalities in pulmonary function that are probably related to viral invasion of the lower respiratory tract despite normal chest radiographs.

Early bronchiolitis obliterans syndrome shows an abnormality of perfusion not ventilation in lung transplant recipients

Long-term survival of lung transplant patients is limited, principally because of Bronchiolitis Obliterans Syndrome (BOS). BOS is primarily classified based on airflow obstruction however there is recent data to suggest that the rejection process can lead to a restrictive ventilatory defect with involvement of the pulmonary vasculature. This study evaluates perfusion heterogeneity in different BOS stages by measuring the relative dispersion (RD) of an arterial spin labelling MRI blood flow image. Acinar ventilation heterogeneity (Sacin) was determined using the Multiple Breath Nitrogen Washout technique. In 24 post transplant patients with a range of severity in BOS status, Sacin increased as BOS level rose from stage 0 to stage 3. In contrast, RD-perfusion was not elevated at BOS 1 and 2 combined compared to BOS 0 and becoming elevated only at BOS-3. However, RD-perfusion in BOS-0p was elevated compared to BOS-0, without an increase in Sacin. These results suggest that BOS-0p is different in nature from other BOS stages.

Lung function in poorly controlled type 1 North African diabetic patients: A case-control study

AimTo compare the lung function parameters of poorly controlled type-1-diabetes-mellitus (T1DM) patients with age-; height and sex-matched healthy-non-smokers (HNS). Population and methodsSubjects aged 35–60Yrs who have a poorly controlled T1DM (glycated-Haemoglobin level >7%) with a disease history of more than 10Yrs (n=14) and HNS subjects (n=14) were recruited. Clinical, anthropometric and fasting biological data were collected. Plethysmographic data (flows, volumes, estimated-lung-age (ELA), lung-capacity-to-transfer-carbon-monoxide (DLCO)) were measured. Large-airway-obstructive-ventilatory-defect (LAOVD) was defined as first–second-forced-expiratory-volume (FEV1)/forced-vital-capacity (FVC) below the lower-limit-of-normal (LLN). Restrictive-ventilatory-defect (RVD) was defined as total-lung-capacity (TLC)<LLN. Lung-hyperinflation was defined as residual-volume (RV)>upper-limit-of-normal. Student t-test and chi-2 test were used to compare plethysmographic data and profiles of the two groups. ResultsThe two groups were matched in chronological-lung-age (CLA) (respectively 47±7 vs. 50±8Yrs) and sex (7 males and 7 females in each group) and height. Compared to the HNS group, the T1DM one had significantly lower FEV1, FVC, slow-vital-capacity and maximal-mid-expiratory-flow (respectively 99±11% vs. 83±11%, 99±9% vs. 86±11%, 80±8% vs. 67±15% and 98±23% vs. 72±23%), had significantly higher TLC and RV (respectively, 105±20% vs. 123±24% and 108±22% vs. 131±24%) and had significantly higher percentage of subjects with lung-hyperinflation (7.1% vs. 43.0%). Both groups had similar percentages of LAOVD and RVD and similar corrected DLCO values. ELA of the T1DM group (57±10Yrs) was significantly higher than CLA. ConclusionPoorly controlled T1DM seems to alter ventilatory mechanics without effect on the alveolo-capillary-membrane. In addition, it accelerates the respiratory ageing.

Chronic obstructive pulmonary disease in treated pulmonary tuberculous patients

Abstract Background/Aim To detect the prevalence of chronic obstructive pulmonary disease (COPD) as a sequel of treated pulmonary tuberculosis (PTB). Materials and methods A total of 50 adults, 28 men and 22 women, with a definite diagnosis of PTB and complete antituberculous therapy, with subsequent presentation of exertional dyspnea and/or cough, and expectorations for which no other alternative cause was found, were included in our study. All the patients underwent full history taking, full clinical examination, chest radiography, erythrocyte sedimentation rate, prebronchodilator and postbronchodilator forced vital capacity (FVC%), and forced expiratory volume (FEV1%) in the first second of FEV1/FVC%. Results Pulmonary function testing showed 22 patients (44%) with irreversible obstructive pattern denoting chronic obstructive pulmonary disease (COPD), seven patients had restrictive ventilatory defect, and three patients had mixed obstructive and restrictive pattern. Of those 22 patients with irreversible obstructive pattern (COPD), 11 patients (50%) had mild obstruction, nine patients (40.9%) had moderate obstruction, and two patients (9.1%) had severe obstruction. There is a positive correlation between dyspnea and post-tuberculous COPD patients, and a negative correlation between cough and post-tuberculous COPD patients. There is no correlation between the duration since the completion of antituberculous therapy and development of COPD. Conclusion COPD can be a sequel of PTB and should be overlooked, especially in those patients complaining of dyspnea even in the absence of any history of smoking. Post-tuberculous COPD as a cause of COPD in nonsmokers should be now more recognized in countries where the prevalence of PTB is still high.

Six cases of silicosis: implications for health surveillance of stonemasons.

Silicosis is one of the oldest occupational lung diseases, but it continues to cause significant morbidity and mortality worldwide. To report cases of silicosis presenting to two specialist respiratory clinics. A retrospective analysis of prospectively collected data of cases of silicosis in workers referred to specialist respiratory clinics. Over the course of 6 years, six cases were identified. The patients were all male with an age range between 24 and 39 years. The duration of silica exposure ranged between 7 and 20 years (mean 13 years). Four cases were entirely asymptomatic at presentation, and two cases described minimal shortness of breath on exertion. Pulmonary function tests were normal in three cases, and a mild restrictive ventilatory defect was documented in the other cases. All had a low apparent predicted probability of pneumoconiosis based on health questionnaires, spirometry and duration of silica exposure. The initial chest X-ray was abnormal in all six cases with radiological evidence of silicosis (International Labour Office profusion category ≥1/1) on imaging, and all had evidence of silicosis on high-resolution computed tomography (HRCT). Three patients had already progressed to progressive massive fibrosis on HRCT scanning at the time of referral to specialist respiratory services. The appearances of these six cases of silicosis in young, asymptomatic construction workers emphasizes the importance of enforcing effective exposure control and comprehensive surveillance programmes. Our observations highlight the importance of having a low threshold for early radiological screening to promote early and effective detection of this disease.

Rheumatoid lung sine arthritis – An unusual case mimicking idiopathic pulmonary fibrosis

We present the case of a 72-year-old male, with no history of connective tissue disease or musculoskeletal symptoms, who presented to our pulmonary clinic with five years of worsening dyspnea and presyncope with exertion. Pertinent findings on evaluation were computerized tomography of the chest showing diffuse honeycombing, pulmonary function tests demonstrating an intrinsic restrictive ventilatory defect, labs significant for an elevated C-reactive protein and erythrocyte sedimentation rate, and serologies remarkable for positive rheumatoid factor, positive anti-cyclic citrullinated peptide antibodies, and positive anti-nuclear antibody. Despite never having articular or other systemic manifestations of rheumatoid arthritis (RA), the patient was diagnosed with rheumatoid lung disease, started on definitive therapy and referred to rheumatology. An awareness of this unusual presentation of connective tissue related lung disease is critical to prevent misdiagnosis as idiopathic pulmonary fibrosis, so proper management and optimal patient outcomes are ensured.