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PubMed1998

Inhaled nitric oxide in patients with pulmonary hypertension due to valvular heart disease and chronic lung disease.

The objective of this study was to investigate the effects of inhaled nitric oxide (NO) on chronic pulmonary hypertension (PH). Thirty patients with valvular heart diseases (n=8, group A), chronic lung diseases (n=16, group B), primary PH or PH due to collagen disease (n=6, group C) were studied. NO was delivered for 20 min at concentration of 5, 10, and 20 ppm in spontaneous respiration. After inhalation, percentages of systolic pulmonary artery pressure (%SPAP) levels in group A were significantly decreased compared with those for pre-inhalation by 12%, 14%, and 14% at 5, 10 and 20 ppm, respectively (p<0.05). In group B, %SPAP also significantly decreased by 7, 10, and 14% at 5, 10, and 20 ppm, respectively (p<0.05). However, inhaled NO did not significantly affect %SPAP in group C (p=0.4). There was no significant difference in gas exchange in any of the groups. However, 4 out of 8 patients in group A and 10 out of 16 patients in group B showed decreased partial pressure of arterial oxygen in response to inhaled NO. This study demonstrated that inhaled NO is a selective pulmonary vasodilator in decreasing pulmonary artery pressure (PAP); however, the reaction was different in line with the background disease cause of PH. NO inhalation was most effective on patients with moderate PAP. Furthermore, higher concentrations of NO would be risky in some patients with chronic PH.

Administration, Inhalation↗

PubMed2003

Genetic influences and neonatal lung disease.

Neonatal lung diseases may have a genetic background. The available studies mainly concentrate on surfactant proteins (SP-A, SP-B) and respiratory distress syndrome. Specific alleles of the SP-A and SP-B genes associate interactively with susceptibility to respiratory distress syndrome. This genetic impact on the condition is influenced by environmental, acquired and inherited factors. Other alleles and genotypes of SP-A and SP-D associate with severe respiratory infections in early infancy. Rare mutations causing an absence of the SP-B protein result in progressive respiratory failure. Dominant mutations of SP-C associate with chronic lung disease, with variable manifestations. The first steps towards unraveling the genetic network influencing the susceptibility to neonatal lung diseases are now being taken. Genes encoding multifunctional proteins in the distal lung are prime candidates for causing susceptibility to neonatal lung disease, including bronchopulmonary dysplasia.

Genetic Predisposition to Disease↗

PubMed2006

Outcomes of patients with interstitial lung disease referred for lung transplant assessment.

BACKGROUND: Patients with interstitial lung disease (ILD) very frequently die before the opportunity to receive lung transplantation (LTx). This retrospective study describes the clinical course of 86 patients with ILD referred for LTx assessment between January 1999 and December 2002. AIMS: (i) To describe the outcomes, (ii) to identify reasons of delay to transplantation, (iii) to describe the causes of death/complications and (iv) to assess the pathological diagnosis and concordance with explanted lung pathology. METHODS: Data were collected from the case notes of all patients with ILD referred to the Alfred Hospital over a 4-year period. RESULTS: Twenty women and 66 men, mean age of 55 +/- 8 years, were referred for LTx assessment. Forty-five patients were deemed not suitable for LTx and 41 were listed. Twenty-two patients underwent transplantation, 16 died on the waiting list and 7 are still on the waiting list. Complications were frequent (e.g. pulmonary embolism, malignancy and infection) and carried high mortality. Patients dying on the waiting list appeared generally to be in accelerated decline, dying shortly after listing, with no evidence in their lung function test assessment predicting them as a poor prognosis group. CONCLUSIONS: Serious complications and death on the waiting list of patients with idiopathic pulmonary fibrosis are high, not apparently because of delayed referral but usually in patients undergoing very rapid decline.

Female↗

PubMed2000

A randomized, controlled trial comparing thoracoscopy and limited thoracotomy for lung biopsy in interstitial lung disease.

BACKGROUND: Lung biopsies are frequently needed to diagnose diffuse interstitial lung diseases. A prospective randomized, controlled trial comparing limited thoracotomy (open lung biopsy) and thoracoscopy for lung biopsy was done. METHODS: Ambulatory patients with a clinical diagnosis of diffuse interstitial lung disease were randomized to thoracoscopy or limited thoracotomy. Data on postoperative pain, narcotic requirements, operating room time, adequacy of biopsy, duration of chest tube drainage, length of hospital stay, spirometry, and complications were collected. RESULTS: A total of 42 randomized patients underwent lung biopsy (thoracoscopy 20, thoracotomy 22). The two study groups were comparable with respect to age, gender, corticosteroid use, and preoperative spirometry. Visual analog scale pain scores were nearly identical in the two groups (p = 0.397). Total morphine dose was 50.8 +/- 27.3 mg in the thoracoscopy group and 52.5 +/- 25.6 mg in the thoracotomy group (p = 0.86). Spirometry (FEV1) values in the two groups were not significantly different on postoperative days 1, 2, 14, and 28 (p = 0.665). Duration of operation was similar in both groups (thoracoscopy 40 +/- 30 minutes, thoracotomy 37 +/- 15 minutes; p = 0.67). The thoracoscopy and thoracotomy groups had equivalent duration of chest tube drainage (thoracoscopy 38 +/- 28 hours, thoracotomy 31 +/- 26 hours; p = 0.47) and length of hospital stay (thoracoscopy 77 +/- 82 hours, thoracotomy 69 +/- 55 hours; p = 0.72). Definitive pathologic diagnoses were made in all patients. CONCLUSIONS: There is no clinical or statistical difference in outcomes for thoracoscopic and thoracotomy approaches. Both thoracoscopy and thoracotomy are acceptable procedures for diagnostic lung biopsy in diffuse interstitial lung disease.

Biopsy↗

PubMed2004

Interstitial lung disease in the patient who has connective tissue disease.

Interstitial lung disease is a common complication of many of the connective tissue diseases. Because the prognosis, degree of reversibility, and optimal therapy differs for each disease presentation, a thorough knowledge of the pulmonary presentations of each connective tissue disease is important. Additionally, the challenge of finding the patient who has occult connective tissue disease in an interstitial lung disease clinic is discussed.

Arthritis, Rheumatoid↗

PubMed2000

Smoking-related interstitial lung diseases.

Interstitial lung diseases (ILDs) encompass diverse clinicopathological disease entities ranging from idiopathic interstitial pneumonia (IIP) to interstitial pneumonia accompanied by collagen vascular diseases and diseases related to smoking, drug reactions, occupational environments, infections, and malignancies. Our focus is on the smoking-related interstitial lung diseases. Specifically, we focus on reports suggesting that chronic smoking is deeply involved in the disease pathogenesis and on reports suggesting that chronic smoking may influence the clinical course in terms of either disease severity or progression. Pulmonary Langerhans' cell granulomatosis (PLCG), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis with interstitial lung diseases (RB-ILD), interstitial pneumonia associated with rheumatoid arthritis, acute respiratory distress syndrome (ARDS), and idiopathic pulmonary fibrosis (IPF) are covered.

Comorbidity↗

PubMed2005

Comparison of disease progression and mortality of connective tissue disease-related interstitial lung disease and idiopathic interstitial pneumonia.

OBJECTIVE: To compare disease progression and mortality between idiopathic interstitial pneumonia (IIP) and interstitial lung disease (ILD) due to connective tissue diseases (CTD) including scleroderma, rheumatoid arthritis, systemic lupus, polymyositis, dermatomyositis, Sjögren's syndrome, and mixed CTD. METHODS: A case-control study of patients with CTD-ILD (n = 46) and IIP controls (n = 51), seen at the University of Michigan between July 1,1998 and June 30,1999 and followed until March 30, 2002, was conducted. Survival analysis and Cox regression were performed to estimate survival, accounting for demographic and clinical parameters, including pulmonary function tests and high resolution computed tomography (HRCT) diagnosis and scoring. RESULTS: Median followup time was 4.4 person-years. Five-year survival in the IIP group was 51.9% (95% confidence interval [95% CI] 30.8-69.4) versus 43.4% (95% CI 21.1-63.9) in the CTD-ILD group. There were no significant differences among HRCT diagnostic categories between IIP and CTD-ILD. A fibrotic score > or = 2 was associated with decreased survival among the entire group. Age at diagnosis and most recent forced vital capacity were significant predictors of mortality when adjusted for IIP versus CTD-ILD diagnosis, sex, and interstitial score. CONCLUSION: Contrary to expectation, CTD-ILD compared with IIP appears to be associated with a worse prognosis when adjusted for age. A higher fibrotic score is suggestive of decreased survival.

Adult↗

PubMed2005

Histone deacetylation: an important mechanism in inflammatory lung diseases.

Inflammatory lung diseases are characterised by increased expression of multiple inflammatory genes that are regulated by proinflammatory transcription factors, such as NF-kappaB. Gene expression is regulated by modifications such as acetylation of core histones through the concerted action of coactivators such as CBP (cAMP-response element binding protein (CREB)-binding protein) which have intrinsic histone acetyltransferase (HAT) activity and are able to recruit other HAT enzymes. Conversely gene repression is mediated via histone deacetylases (HDAC) and other corepressors. In biopsies from asthmatic subjects there is an increase in HAT activity and some reduction in HDAC activity. Both of these changes are partially reversed by corticosteroid therapy. Corticosteroids switch off inflammatory genes in asthma through a combination of a direct inhibition of HAT activity and by the recruitment of HDAC2 to the activated NF-kappaB-stimulated inflammatory gene complex. In chronic obstructive pulmonary disease (COPD), a corticosteroid insensitive disease, there is a reduction in HDAC activity and HDAC2 expression, which may account for the amplified inflammation and resistance to the actions of corticosteroids. The reduction in HDAC2 may be secondary to oxidative and nitrative stress as a result of cigarette smoking and severe inflammation. This may also occur to differing degrees in severe asthma, smoking asthmatic patients and cystic fibrosis. Similar mechanisms may also account for the steroid resistance seen within latent adenovirus infections. The reduction in HDAC activity induced by oxidative stress can be restored by theophylline, acting through specific kinases, which may be able to reverse steroid resistance in COPD and other inflammatory lung diseases. The modulation of HAT/HDAC activity may lead to the development of novel anti-inflammatory approaches to inflammatory lung diseases that are currently difficult to treat.

Acetylation↗

PubMed1994

Does every patient with enigmatic lung disease deserve a lung biopsy? The continuing dilemma.

STUDY OBJECTIVE: Define the negative predictive factors for survival in patients who undergo open-lung biopsy. DESIGN: Retrospective analysis from July 1988 through January 1992 (prior to widespread use of video-assisted techniques). Factors included in analysis were: oxygen therapy, requirement for intubation, and HIV status. Also analyzed were the accuracy of the preoperative presumptive diagnosis and the outcome of therapy. SETTING: University hospital in an urban area with active medical and surgical critical care services. PATIENTS: All patients who underwent open-lung biopsy during the study design period. Patients excluded were those with lung transplants and one patient who had a thoracoscopic biopsy. Forty-eight lung biopsies were performed and 31 patients without AIDS and 15 with AIDS. Twenty-four (16 without AIDS, 8 with AIDS) were receiving oxygen therapy, met intubation criteria, or were intubated and ventilated at the time of biopsy. The indications were undiagnosed nodular or interstitial lung disease. INTERVENTIONS: Presurgical evaluation included a preoperative diagnostic algorithm of transthoracic needle biopsy and nodular disease (9 patients) and at least one bronchoscopy with bronchoalveolar lavage and transbronchial biopsy in interstitial disease (22 patients). Seven patients with nodular disease and nine with infiltrate had no preoperative procedures. MEASUREMENTS AND RESULTS: Lung biopsy obtained at definitive diagnosis in 98 percent of patients. Biopsy significantly altered therapy in 79 percent (81 percent without AIDS, 73 percent with AIDS). Postoperatively, in-hospital mortality was 8 (17 percent): 5 (16 percent) without AIDS and 3 (20 percent) with AIDS p > 0.1. Mortality rates showed patients without respiratory compromise, 4.2 percent (7 percent without AIDS, 0 percent with AIDS); patients receiving oxygen therapy, 6 percent (10 percent without AIDS; 0 percent with AIDS); patients who met intubation criteria, 60 percent (33 percent without AIDS, 100 percent with AIDS); patients who were ventilated, 75 percent (66 percent without AIDS [p < 0.05], 100 percent with AIDS [p < 0.05]. CONCLUSION: We recommend that the decision for lung biopsy be individualized based on respiratory status.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Corticosteroids in infant chronic lung disease.

Chronic lung disease (CLD), defined as chronic oxygen dependency at 36 weeks postmenstrual age, is increasing and associated with chronic respiratory morbidity and high health care utilisation at follow up. Many strategies, tested in randomised trials, have failed to reduce CLD. In contrast, corticosteroids if given systemically within the first two weeks after birth reduce CLD and may also favourably influence survival. Unfortunately, systemically administered corticosteroids have many acute side-effects and adversely affect long term neurodevelopmental outcome. If given by inhalation, corticosteroids have fewer adverse effects, but are less efficacious. Further research is required to accurately identify infants at highest risk of developing CLD, the corticosteroid dosage associated with a positive risk: benefit ratio and preferably a safer and more effective alternative therapy.

Administration, Inhalation↗

PubMed2001

[A case of rheumatoid lung disease in which lung involvement preceded arthritis].

A 75-year-old man was admitted because of dyspnea on exertion and diffuse pulmonary interstitial shadows. An open lung biopsy revealed unclassified interstitial pneumonia. The abnormal shadow subsided spontaneously. Three years later, however, rheumatoid arthritis developed with a simultaneous relapse of interstitial pneumonitis, which was alleviated by steroid therapy. We report here the rheumatoid lung disease that preceded the onset of arthritis, together with a review of the literature.

Aged↗

PubMed2003

Evaluation and development of potentially better practices to prevent chronic lung disease and reduce lung injury in neonates.

OBJECTIVE: Despite increased knowledge and improving technology, chronic lung disease (CLD) rates in extremely low birth weight infants have remained constant for 20 years. One reason for this is an ineffective translation of research-proven improvements into practice. The Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was created to provide participating nurseries the tools necessary to effect change. The objective of this study was to develop and implement a process that uses quality improvement techniques to collaboratively improve CLD rates. METHODS: Nine member hospitals of the NIC/Q 2000 collaborative formed a focus group aiming to decrease CLD rates. The focus group established goals and outcome measures, created a list of potentially better practices (PBPs) based on available literature, benchmarked and performed site visits, encouraged individual site implementation of PBPs, developed a database, and measured outcomes. RESULTS: The goal "decrease CLD rates in extremely low birth weight infants" was established. Nine PBPs were identified, and 57 PBPs were implemented by the 9 participating sites. Twelve site visits were conducted, and a 435-patient database of infants with a mean birth weight of 789 g was established. CONCLUSIONS: Collaborative use of quality improvement techniques resulted in creation of a logical, efficient, and effective process to improve CLD rates. Group creation of PBPs, based on literature review and reinforced with site visits, internal data analysis, and improved individual site outcomes, resulted in accelerated and effective change, unlikely to occur if attempted outside of the collaborative.

Benchmarking↗

PubMedDate not supplied

Computed tomography appearances of bronchogenic carcinoma associated with bullous lung disease.

Bullous lung disease is known to be a risk factor for developing a bronchogenic carcinoma. In this article, computed tomography appearances of 20 patients with histologically proven bronchogenic carcinoma were reviewed retrospectively. On the basis of the previous literatures and our findings, the computed tomography appearances of bronchogenic carcinoma associated with bullous lung disease could be classified into 3 types; nodule or mass extruding from the bullous wall, nodule or mass confined within the bullous lumen, and soft-tissue density extending along the bullous wall. Attention should be paid in the interpretations for mass or nodule in the wall of the bulla because they frequently lack the characteristic appearances of bronchogenic carcinoma.

Adult↗

PubMed1992

Thoracoscopic lung biopsy in interstitial lung disease.

Thoracoscopic lung biopsy has been proposed as an alternative to open lung biopsy for the diagnosis of interstitial lung disease. We performed thoracoscopic lung biopsy under local anesthesia and diathermic coagulation in 33 non-immunocompromised patients with interstitial lung disease. A diagnosis was obtained in all patients. No severe complication was observed. The average time of drainage was 4 days. We confirm that this technique has advantages compared to open lung biopsy.

Adult↗

PubMed2004

Chemotherapy-induced lung disease.

The lung has significant susceptibility to injury from a variety of chemotherapeutic agents. The clinician must be familiar with classic chemotherapeutic agents with well-described pulmonary toxicities and must also be vigilant about a host of new agents that may exert adverse effects on lung function. The diagnosis of chemotherapy-associated lung disease remains an exclusionary process, particularly with respect to considering usual and atypical infections, as well as recurrence of the underlying neoplastic process in these immune compromised patients. In many instances, chemotherapy-associated lung disease may respond to withdrawal of the offending agent and to the judicious application of corticosteroid therapy.

Antibiotics, Antineoplastic↗

PubMed1992

Fibroblast growth factors in connective tissue disease associated interstitial lung disease.

Fibrosis is a major cause of morbidity and mortality in chronic inflammatory diseases, especially interstitial pulmonary disorders. Fibroproliferation is an important part of this fibrotic response, and is mediated largely through growth factors such as platelet-derived growth factor (PDGF), insulin-like growth factor (IGF) I and tumour necrosis factor-alpha (TNF-alpha). Although there is some evidence implicating these cytokines in fibrotic disorders, strong evidence in vivo is almost nonexistent. In order to ascertain the role that these factors play in inflammatory lung disorders associated with connective tissue diseases, alveolar mononuclear cells have been obtained from subjects by bronchoalveolar lavage and assessed for the spontaneous release of fibroblast growth factors. The study population consisted of subjects with a variety of different connective tissue disorders, both with and without inflammatory pulmonary complications. It was found that lavage cells spontaneously secreted fibroblast growth factor activity over 24 h with maximum activity detected at 6 to 12 h. Growth factor activity could be detected in most subjects with connective tissue disease-associated inflammatory lung disease and some normal subjects, but the amount of growth factor activity was much higher in the former than in the latter. By means of antibody depletion experiments all growth factor activity from lavage cells of normal patients was attributable to TNF-alpha while patients with interstitial lung disease secreted large amounts of PDGF and fibronectin in addition to TNF-alpha. Approximately 40-50% of the total released growth factor activity could be accounted for by PDGF, and 100% by the combination of PDGF, TNF-alpha and fibronectin. While TNF-alpha is released from the bronchoalveolar lavage cells of many subjects, in addition, many patients with interstitial lung disease also release spontaneously, large amounts of fibroblast growth factor activity attributable to PDGF and fibronectin.

Bronchoalveolar Lavage Fluid↗

PubMed1997

Prognostic value of pulmonary hypertension in patients with chronic interstitial lung disease referred for lung or heart-lung transplantation.

BACKGROUND: The purpose of this study was to identify precise and reliable prognostic parameters in patients affected by serious chronic interstitial lung disease, who were undergoing screening for lung or heart-lung transplantation. METHODS: Hemodynamic and respiratory function parameters of 67 patients (43 with idiopathic pulmonary fibrosis, 18 with histiocytosis X, and 6 with lymphangioleiomyomatosis) undergoing clinical screening for lung transplantation. RESULTS: Statistical analysis showed that hemodynamic and respiratory function parameters in patients affected by histiocytosis X and idiopathic pulmonary fibrosis were not related to survival time. Moreover, the degree of pulmonary hypertension showed no correlation between respiratory function parameters in all the groups of diseases examined. Patients affected with histiocytosis X, even with higher degrees of pulmonary hypertension, had a better survival rate (p < 0.0005) compared with patients with idiopathic pulmonary fibrosis. CONCLUSIONS: Hemodynamic and respiratory parameters obtained during the clinical screening for lung transplantation do not predict survival and cannot be used as prognostic indicators.

Adult↗

PubMed1984

The diseased lung and drugs.

Among the numerous ways by which drug-lung relationships can be discussed we chose to examine three questions: Is the lung capable of directly modulating drug pharmacokinetics? Knowing that the pulmonary circulation can exert very selective and efficient clearance and catabolism of biogenic molecules such as serotonin (5-HT), norepinephrine (N.E.), prostaglandins PGE2 and PGF2 alpha, and bradykinin, as well as activation of angiotensin (A)I to AII, a similar behavior has been sought for drugs. Uptake of circulating drugs occurs clearance of biogenic amines, the significance of which remains to be fully evaluated, and iatrogenic phospholipidosis localization of which in the lung might result from the elevated drug concentration in the tissue. Lung cells contain enzymes, among them mixed function oxidases (MFO), which enables them to metabolize xenobiotics even in the intact organ. Although blood supply to the lung is higher than that to the liver, the comparatively low MFO content of the former organ predicts only a marginal pulmonary metabolic contribution in vivo. On the otherhand, enzymatic activity upon drugs can generate instable reactive metabolites which, even in minute amounts are toxic and can damage cells; furthermore, it is hypothesized that the relatively high bronchiolar Clara cell MFO content explains the striking susceptibility of the long to xenobiotics. Do lung diseases indirectly influence drug pharmacokinetics? Hindrance to blood flow is common in respiratory failure (R.F.), from both reduced area and hypoxic vasoconstriction, resulting in altered flow distribution to the liver and kidney.

Drug-Related Side Effects and Adverse Reactions↗