Chronic productive cough in young adults is very often due to chronic rhino-sinusitis

Background. Chronic productive cough is a common clinical problem; often potential causes outside the lower respiratory tract are forgotten or ignored. The aim of this study was to make a precise etiopathogenetic diagnosis of chronic productive cough in young adults. Methods. In a clinical setting, 212 subjects (mean age 41±5 years) who had reported chronic productive cough in a previous postal survey of a young adult population underwent within two years clinical and functional investigations following a rational diagnostic approach. Two pulmonologists independently established the diagnosis using a clinically structured interview on nasal and respiratory symptoms, spirometry and other tests when appropriate (bronchodilator test or methacholine bronchial challenge, chest radiography); if rhino-sinusitis was suspected, subjects underwent an ENT examination with nasal endoscopy and/or sinus computed tomography. Results. At the end of the diagnostic procedure, 87 subjects (41%) no longer had chronic productive cough and had normal function. Fifty-eight subjects (27%) had chronic rhino-sinusitis; seventeen subjects (8%) had asthma, and of these fourteen also had chronic rhino-sinusitis; 50 subjects (24%) had COPD stage 0+, of these seven also had chronic rhino-sinusitis. Chronic rhino-sinusitis was more frequent in females than in males (p<0.05). Conclusions. Both in clinical practice and in epidemiological studies, it is important to consider that the origin of chronic productive cough could be frequently outside the lower respiratory tract; a consistent percentage of young adults with persistent productive cough has indeed chronic rhino-sinusitis

Prevalence rate of Metabolic Syndrome in a group of light and heavy smokers

Background: Smoking is an important cause of morbidity and mortality worldwide. It is widely accepted as a majorrisk factor for metabolic and cardiovascular disease. Smoking reduces insulin sensitivity or induces insulin resistanceand enhances cardiovascular risk factors such as elevated plasma triglycerides, decreases high-density lipoproteincholesterol and causes hyperglycemia. Several studies show that smoking is associated with metabolicabnormalities and increases the risk of Metabolic Syndrome. The aim of this study was to estimate the prevalenceof the metabolic syndrome in a group of light and heavy smokers, wishing to give up smoking.Methods: In this cross-sectional study all the enrolled subjects voluntary joined the smoking cessation programheld by the Respiratory Pathophysiology Unit of San Matteo Hospital, Pavia, Northern Italy.All the subjects enrolled were former smokers from at least 10 years and had no cancer or psychiatric disorders, norhistory of diabetes or CVD or coronary artery disease and were not on any medication.Results: The subjects smoke 32.3 ± 16.5 mean Pack Years. The prevalence of the metabolic syndrome is 52.1%:57.3% and 44.9% for males and females respectively. Analysing the smoking habit influence on the IDF criteria forthe metabolic syndrome diagnosis we found that all the variables show an increasing trend from light to heavysmokers, except for HDL cholesterol. A statistical significant correlation among Pack Years and waist circumference(R = 0.48, p < 0.0001), Systolic Blood Pressure (R = 0.18, p < 0.05), fasting plasma glucose (R = 0.19, p < 0.005) and HDLcholesterol (R = −0.26, p = 0.0005) has been observed.Conclusions: Currently smoking subjects are at high risk of developing the metabolic syndrome.Therapeutic lifestyle changes, including smoking cessation are a desirable Public health goal and should successfullybe implemented in clinical practice at any age

"Nonobstructive" emphysema of the lung

An unusual case of smoking-related centrilobular emphysema with normal spirometry. A 64-year-old man presented with severe dyspnoea and respiratory failure. Pulmonary function and mechanics were normal except for a marked reduction in diffusing capacity of the lung. High-resolution CT scan showed diffuse centrilobular emphysema also involving lower lobes. Pulmonary embolism, cardiac or pulmonary shunt and immunopathologically based vasculitis were excluded. Pulmonary pressure was at the upper limit of normality but within few months he developed a severe pulmonary hypertension. Although spirometry is the only physiologic measure recommended by the updated Global Initiative for Chronic Obstructive Lung Disease guidelines for confirming the diagnosis it should be recognized that diffuse emphysema may occur with only abnormalities in gas exchange without airflow obstruction. The identification of different phenotypes within COPD is important for understanding disease heterogeneity and progression

Long-term outcome after pulmonary endarterectomy

Rationale: There are few follow-up studies on long-term cardiopulmonary function after pulmonary endarterectomy (PEA), the operation of choice for chronic thromboembolic pulmonary hypertension (CTEPH). Objectives: To prospectively evaluate long-term outcome of patients with CTEPH treated with PEA. Methods: Between 1994 and 2006, 157 patients (mean age 55 yr) weretreated withPEAat Pavia University Hospital.Thepatientswere evaluated before PEA and at 3 months (n 5 132), 1 year (n 5 110), 2 years (n 5 86), 3 years (n 5 69), and 4 years (n 5 49) afterward by NYHA class, right heart hemodynamic, spirometry, carbon monoxide transfer factor (TLCO), arterial blood gas, and treadmill incremental exercise test. Measurements and Main Results: Cumulative survival was 84%. Within 3 months, 18 patients died in-hospital and 2 had lung transplantation; during long-term follow-up, 6 died, 1 had lung transplantation, and 3 had a second PEA (2.5 events per 100 person-years). NYHA class III–IV was the most important predictor of late death, lung transplant, or PEA redo (hazard ratio, 3.94). Extraordinary improvement in NYHA class, hemodynamic, and PaO2 were achieved in the first 3 months (P , 0.001) and persisted during follow-up; exercise tolerance progressively increased over time (P , 0.001). At 4 years, although 74% of the patients were in NYHA class I and none was in class IV, 24% had pulmonary vascular resistance greater than 500 dyne.s/cm5 or PaO2 less than 60 mm Hg; they were significantly older and were more frequently in NYHA class III–IV 3 months after surgery than the others. Conclusions: After PEA, long-term survival and cardiopulmonary function recovery is excellent in most patients