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PubMed2000

[The examinations for diffuse lung diseases].

Diffuse lung diseases show an abnormal shadow that is widely scattered on the bilateral lung fields in the chest X ray view and includes many respiratory diseases such as the infectious or the non-infectious disease; neoplasms. Among these, idiopathic pulmonary fibrosis(IPF) has been studied extensively because of its high frequency and difficulty of treatment. IPF is defined by the respiratory functions, the radiological findings, which depend on HRCT, and the histopathological evaluation by surgical lung biopsy. In particular, the histopathological appearance of usual interstitial pneumonia(UIP) is essential for the diagnosis of IPF. Most serum examinations such as angiotensin-converting enzyme, anti-nuclear antibodies are applied to rule out other diffuse lung diseases. SP-D or KL-6, which is the marker of the type II epithelial cells, is thought to be very useful for revealing the disease activity, but since it is not increased in the early stages of IPF, it is not applied in the diagnosis of IPF. The definitive serum examinations for the diagnosis or determinations of the therapeutic effect or prognosis of IPF have not been established. Easier, more useful and critical examinations including genetic diagnosis are required to manage patients with IPF.

Aged↗
PubMed2004

Resting and exercise physiology in interstitial lung diseases.

Interstitial lung diseases (ILDs) are a heterogeneous group of parenchymal pulmonary disorders with varying histologic appearances. Pulmonary function tests have gained a prominent role in the diagnosis and management of patients with these disorders. Although their role in the differential diagnosis of the various ILDs is limited, physiologic measurements are pivotal studies providing clues regarding disease severity, prognosis,and response to therapy.

Diagnosis, Differential↗
PubMed2004

Prior lung disease and risk of lung cancer in a large prospective study.

OBJECTIVES: While 75-90% of people who develop lung cancer are smokers, only a small proportion of smokers develop lung cancer. Identifying factors that increase a smoker's risk of developing lung cancer may help scientists to better understand the etiology of lung cancer and more effectively target high-risk groups for screening. METHODS: Information on physician-diagnosed non-malignant lung diseases [asbestosis, asthma, chronic bronchitis or emphysema (CB/E), pneumonia, and tuberculosis] was obtained at baseline from 17,698 men and women involved in CARET, a randomized lung cancer prevention trial of beta-carotene and vitamin A among heavy smokers and asbestos-exposed workers. Hazard ratios for lung cancer were estimated through Cox regression models, after controlling for potential confounding factors, included smoking. Analyses were restricted to former and current smokers. RESULTS: During a median follow up of 9.1 years, 1028 cases of lung cancer occurred. Those who developed lung cancer were more likely to report a history of CB/E than controls (adjusted HR = 1.29, 95% CI: 1.09-1.53). In subgroup analyses, the association between a history of CB/E and lung cancer was stronger for those who were younger at diagnosis/reference, men in the heavy smoker cohort, former smokers, and those with squamous cell carcinomas. There was little association between a history of other lung diseases and lung cancer. CONCLUSIONS: Smokers with a history of CB/E may be at higher risk of developing lung cancer, independent of their smoking history.

Adult↗
PubMed2003

Can mechanical ventilation strategies reduce chronic lung disease?

Chronic lung disease (CLD) continues to be a significant complication in newborn infants undergoing mechanical ventilation for respiratory failure. Although the aetiology of CLD is multifactorial, specific factors related to mechanical ventilation, including barotrauma, volutrauma and atelectrauma, have been implicated as important aetiologic mechanisms. This article discusses the ways in which these factors might be manipulated by various mechanical ventilatory strategies to reduce ventilator-induced lung injury. These include continuous positive airway pressure, permissive hypercapnia, patient-triggered ventilation, volume-targeted ventilation, proportional assist ventilation, high-frequency ventilation and real-time monitoring.

Bronchopulmonary Dysplasia↗
PubMed2005

[Interstitial lung disease related to systemic connective tissue diseases].

Interstitial lung disease (ILD) is one of the most frequent and most serious complications of connective tissue diseases such as systemic sclerosis, systemic lupus erythematosus, dermato- and polymyositis, Sjogren's syndrome, or mixed connective tissue disease. Diagnosis of ILD is often delayed in patients with connective tissue diseases because of the systemic character of the primary condition, restricted physical activity of the patient and insufficient awareness of the physycian. The aim of the current review is to present the up-to-date information on ethiopathology, classification, diagnosis and treatment of ILD in patients with connective tissue diseases.

Collagen Diseases↗
PubMed1998

Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin Lung Transplant Group.

OBJECTIVE: To determine the utility of CT-determined main pulmonary artery diameter (MPAD) for predicting pulmonary hypertension (PH) in patients with parenchymal lung disease. DESIGN: Retrospective review of right-heart hemodynamic data and chest CT scans in 45 patients. SETTING: Tertiary-referral teaching hospital and VA hospital. PATIENTS: Between October 1990 and December 1995, 36 patients referred for evaluation of parenchymal lung disease or possible pulmonary vascular disease were found to have PH, as defined by mean pulmonary artery pressure (mPAP) > or =20 mm Hg. Nine control patients (mPAP <20 mm Hg) were also identified (4 from hospital records search, 5 after evaluation for possible PH). RESULTS: CT-determined MPAD was 35+/-6 mm in patients with PH and 27+/-2 mm in control subjects. In our group of patients, MPAD > or =29 mm had a sensitivity of 87%, specificity of 89%, positive predictive value (PPV) of 0.97, and positive likelihood ratio (LR) of 7.91 for predicting PH; in the subgroup of patients with parenchymal lung disease (n=28, PH and control subjects), MPAD > or =29 mm had a sensitivity of 84%, specificity of 75%, PPV of 0.95, and positive LR of 3.36 for predicting PH. The most specific findings for the presence of PH were both MPAD > or =29 mm and segmental artery-to-bronchus ratio > 1:1 in three or four lobes (specificity, 100%). There was no linear correlation between the degree of PH and MPAD (r=0.124). CONCLUSIONS: CT-determined MPAD has excellent diagnostic value for detection of PH in patients with advanced lung disease. Therefore, standard chest CT scans can be used to screen for PH as a cause of exertional limitation in patients with parenchymal lung disease. Because CT is commonly used to evaluate parenchymal lung disease, this information is readily available.

Adult↗
PubMedDate not supplied

Pulmonary function testing in interstitial lung diseases.

Interstitial lung diseases (ILDs) are functionally characterized by a restrictive ventilatory defect due to a reduced distensibility of the lung parenchyma. ILD patients also show a reduced exercise tolerance, the main factors limiting exercise capacity being ventilatory and gas exchange abnormalities. Functional abnormalities in ILDs are typical, but not specific. Despite the fact that different lung function patterns have been described among ILDs, they overlap and their practical application to differentiate ILDs is poor. Resting pulmonary function and exercise-induced hypoxemia can aid in defining the prognosis of ILDs and in referring patients for lung transplantation. Additionally, spirometry and diffusing capacity are useful to monitor the response of patients to therapy.

Humans↗
PubMed2006

Nontuberculous mycobacterial disease and Aspergillus-related lung disease in bronchiectasis.

The aim of the present study was to determine whether patients with bronchiectasis and nontuberculous mycobacteria (NTM) have a higher prevalence of Aspergillus-related lung disease. A series of 30 consecutive patients with bronchiectasis and NTM (cases) were compared with 61 patients with bronchiectasis and no evidence of NTM (controls). Aspergillus serology and computerised tomography of the thorax were used to identify Aspergillus-related lung diseases, including aspergilloma, allergic bronchopulmonary aspergillosis and chronic necrotising pulmonary aspergillosis. The rate of positive Aspergillus serology was higher in cases with NTM disease compared with controls (10 out of 30 versus six out of 61). The radiological features of Aspergillus-related lung disease were also more common among patients with NTM disease than controls (six out of 30 versus none out of 61). This association between NTM disease and Aspergillus-related lung disease remained significant after adjustment for confounding effects of age and lung function (adjusted odds ratio 5.1, 95% confidence interval 1.5-17.0). Patients with bronchiectasis and nontuberculous mycobacterial disease have a higher prevalence of coexisting Aspergillus-related lung disease than patients with bronchiectasis and without nontuberculous mycobacteria. Identification of Aspergillus-related lung disease is important as prognosis amongst undetected cases is invariably poor.

Aged↗
PubMedDate not supplied

Interstitial lung disease.

Interstitial lung disease in children is a complex group of disorders whose etiology and pathogenesis is not entirely clear. Although the basic pathogenesis has been extrapolated from adult studies, its relevance in the pediatric population can be questioned. Several classifications of this condition have been put forward but Liebow's histologic classification is well accepted. Clinical manifestations are non-specific and can vary from no symptoms and a positive chest X-ray to more characteristic signs and symptoms. The triad of tachypnea, intercostal retractions and dry crackles is characteristic. Chest roentgenograms are a useful diagnostic tool and CT scans help to stage disease severity. Spirometry classically shows a restrictive pattern. Lung biopsy is the gold standard for establishing a diagnosis. Corticosteroids are the cornerstone of treatment in this condition. Thus, in view of the multifactorial nature of this disease, more extensive multi-centre prospective studies are required in order to better understand this rather complex group of disorders.

Adult↗
PubMed2006

Paediatric basis of adult lung disease.

Most lung disease throughout life is programmed in utero or early post-natal life. Factors in the fetal environment such as maternal smoking and diet can lead to reduced lung function, immunological modification or symptoms from birth. There are clear genetic components documented for cystic fibrosis, alpha1 anti-trypsin deficiency and asthma. In early life, the outcomes for those predisposed to asthma or allergy appear to be dependent on the relative timing of exposure to infective agents, allergens or helminths. Abnormal airway structure is present in both transient and persistent wheezers. New drugs and environmental manipulations will need to be developed with an understanding of the mechanisms associated with this early programming.

Adult↗
PubMed1993

Thoracoscopy for diagnosis of diffuse lung disease.

Diffuse lung diseases due to a wide variety of conditions are amenable to diagnosis by means of clinical evaluation, bronchoalveolar lavage, transbronchial biopsy, and lung biopsy. The recently introduced technique of thoracoscopic wedge biopsy provides the potential advantages of greater selection of biopsy sites and reduced postoperative pain compared with that associated with standard open lung biopsy. Its overall accuracy cited in initial reports has exceeded 90%. Although it is supplanting open lung biopsy as the most common operative technique for diagnosing diffuse pulmonary abnormalities, the availability of thoracoscopic lung biopsy should not alter the current indications for the initial use of bronchoscopic techniques in selected patients. In addition, because of the additional risk carried by thoracoscopic lung biopsy, open lung biopsy should still be used preferentially in patients suffering from acute decompensation, pulmonary hypertension, or coagulation disorders.

Biopsy↗
PubMedDate not supplied

Radiographic appearance of interstitial lung disease.

Interstitial lung disease has many forms, and its appearance can vary widely under radiographic imaging. This article reviews the anatomy and physiology of the lung, then describes the most common radiographic characteristics of ILD-the ground glass effect, consolidation, cysts, honey-combing, pulmonary nodules and interstitial thickening. Also included is a discussion of the advantages of using high-resolution computed tomography to image ILD.

Humans↗