Quantitative CT analysis in patients with pulmonary emphysema: is lung function influenced by concomitant unspecific pulmonary fibrosis?

Purpose: Quantitative analysis of CT scans has proven to be a reproducible technique, which might help to understand the pathophysiology of chronic obstructive pulmonary disease (COPD) and combined pulmonary fibrosis and emphysema. The aim of this retrospective study was to find out if the lung function of patients with COPD with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III or IV and pulmonary emphysema is measurably influenced by high attenuation areas as a correlate of concomitant unspecific fibrotic changes of lung parenchyma. Patients and methods: Eighty-eight patients with COPD GOLD stage III or IV underwent CT and pulmonary function tests. Quantitative CT analysis was performed to determine low attenuation volume (LAV) and high attenuation volume (HAV), which are considered to be equivalents of fibrotic (HAV) and emphysematous (LAV) changes of lung parenchyma. Both parameters were determined for the whole lung, as well as peripheral and central lung areas only. Multivariate regression analysis was used to correlate HAV with different parameters of lung function. Results: Unlike LAV, HAV did not show significant correlation with parameters of lung function. Even in patients with a relatively high HAVof more than 10%, in contrast to HAV (p=0.786) only LAV showed a significantly negative correlation with forced expiratory volume in 1 second (r=−0.309, R2=0.096, p=0.003). A severe decrease of DLCO% was associated with both larger HAV (p=0.045) and larger LAV (p=0.001). Residual volume and FVC were not influenced by LAV or HAV. Conclusion: In patients with COPD GOLD stage III-IV, emphysematous changes of lung parenchyma seem to have such a strong influence on lung function, which is a possible effect of concomitant unspecific fibrosis is overwhelmed

Improvement of lung preservation - From experiment to clinical practice

Background. Reperfusion injury represents a severe early complication following lung transplantation. Among the pathogenetic factors, the high potassium content of Euro-Collins(R) solution is discussed. Material and Methods: In a pig model of orthotopic left-sided lung transplantation we investigated the effect of Euro-Collins solution (EC: n=6) versus low potassium dextran (LPD: Perfadex(R): n = 6). Sham-operated (n = 6) animals served as control. Transplant function, cellular energy metabolism and endothelial morphology served as parameters. In a clinical investigation, 124 patients were evaluated following single (EC: n = 31; LPD n = 37) or double (EC: n = 17; LPD n = 39) lung transplantation, whose organs where preserved with EC (n = 48) or LPD (n = 76). Duration of ischemia, duration of ventilation and stay on ICU were registered. Primary transplant function was evaluated according to AaDO(2) values. Cause of early death (30 days) was declared. Results: Experimental results: After flush with EC and 18 h ischemia, a reduction of tissue ATP content (p < 0.01 vs inital value and LPD) was noted. Endothelial damage after ischemia was severe (p < 0.05 vs control), paO(2) was significantly decreased. Clinical results: In the LPD group, duration of ischemia was longer for the grafts transplanted first (SLTx and DLTx: p = 0.0009) as well as second (2. organ DLTx: p = 0.045). Primary transplant function was improved (day 0: SLTx: p = 0.0015; DLTx: p = 0.0095, both vs EC). Duration of ventilation and stay on ICU were shorter (n.s.). Reperfusion injury-associated death was reduced from 8% (EC) to 0 (LPD). Conclusion: In experimental lung preservation, LPD lead to an improved graft function. These results were confirmed in clinical lung transplantation. Clinical lung preservation, therefore, should be carried out by use of LPD. Copyright (C) 2002 S. Karger AG, Basel

Absolute electrical impedance tomography (aEIT) guided ventilation therapy in critical care patients: simulations and future trends

Thoracic electrical impedance tomography (EIT) is a noninvasive, radiation-free monitoring technique whose aim is to reconstruct a cross-sectional image of the internal spatial distribution of conductivity from electrical measurements made by injecting small alternating currents via an electrode array placed on the surface of the thorax. The purpose of this paper is to discuss the fundamentals of EIT and demonstrate the principles of mechanical ventilation, lung recruitment, and EIT imaging on a comprehensive physiological model, which combines a model of respiratory mechanics, a model of the human lung absolute resistivity as a function of air content, and a 2-D finite-element mesh of the thorax to simulate EIT image reconstruction during mechanical ventilation. The overall model gives a good understanding of respiratory physiology and EIT monitoring techniques in mechanically ventilated patients. The model proposed here was able to reproduce consistent images of ventilation distribution in simulated acutely injured and collapsed lung conditions. A new advisory system architecture integrating a previously developed data-driven physiological model for continuous and noninvasive predictions of blood gas parameters with the regional lung function data/information generated from absolute EIT (aEIT) is proposed for monitoring and ventilator therapy management of critical care patients

Highly sensitive C-reactive protein levels in Iranian patients with pulmonary complication of sulfur mustard poisoning and its correlation with severity of airway diseases

Background: Sulfur mustard (SM) is a chemical warfare agent that can cause serious pulmonary complications. This study was designed to determine serum highly sensitive C-reactive protein (hs-CRP) and evaluate its correlation with lung function parameters in patients with chronic obstructive pulmonary disease (COPD) due to SM poisoning. Methods: Fifty consecutive SM patients with stable COPD and a mean age 46.3 + 9.18 years were enrolled in this cross sectional study. Thirty healthymen were selected as controls. Lung function parameters were evaluated. Serum hs-CRP by immunoturbidometry assay was measured in both the patients and controls. Results: In the case group, the mean forced expiratory volume in one second (FEV1) was 2.14 + 0.76 L (58.98%+17.51% predicted). The mean serum hs-CRP was 9.4+6.78 SD and 3.9+1.92 SDmg/L in the cases and controls, respectively, with significant statistical differences (p < .001). There was negative correlation between the serum hs-CRP and FEV1 levels (p ¼ .01). The serum hs-CRP levels were also correlated with Global Initiative for ChronicObstructive Lung disease (GOLD) stages (r ¼ .45, p < .001). Conclusions:Our findings suggest that the serum hs-CRP level is increased in SM patients with COPD and may have a direct correlation with disease severity. It may then be used as a marker for the severity of COPD in patients with SM poisoning

The EDD (exercise, DLco, dyspnea) index in diffuse systemic sclerosis with pulmonary fibrosis

Introduction: Pulmonary fibrosis secondary to systemic sclerosis (SSc) is the major cause of morbidity and mortality in these patients. The aim of this study was to determine the correlation of important lung function parameters with chest high resolution CT scan (HRCT). Methods and materials: Thirty–two consecutive diffuse SSc patients (according to the criteria of american college of rheumatology) with pulmonary involvement were enrolled in this cross-sectional study. Patients with pulmonary fibrosis secondary to other reasons, previous restrictive lung disease, and history of smoking were excluded. Complete lung function evaluation was performed. Also the severity of dyspnea was evaluated by Modified Medical Research Council (MMRC) scale.EDD index was calculated based on 6MWT, DLco, and MMRC. The EDD index in scleroderma lung fibrosis. The chest HRCT was performed and the Warrick score recorded in all patients. Results: The mean age of the patients was 39.18 years ±9.39 (SD).Seventeen (53%) of patients were in EDD stage 1 (score: 0_score_3), 9 patients (28%) in stage 2 (3<score _6), and 6patients (19%) in stage 3(6<score_9). The mean Warrick score was 10.84±6.94 (SD).There was statistically significant correlation between EDD index and Warrick score (p=0.001, r=0.72).Also there was statistically significant relation in EDD stages with Warrick scores (p=0.002). Conclusion: The EDD as a useful lung function index is completely related to chest HRCT findings in SSc pulmonary fibrosis and can be used in clinical practice

Current concepts on the role of inflammation in COPD and lung cancer

Chronic obstructive pulmonary disease (COPD) and lung cancer are leading cause of death, and both are associated with cigarette smoke exposure. It has been shown that 50–70% of patients diagnosed with lung cancer suffer from COPD, and reduced lung function is an important event in lung cancer suggesting an association between COPD and lung cancer. However, a causal relationship between COPD and lung tumorigenesis is not yet fully understood. Recent studies have suggested a central role of chronic inflammation in pathogenesis of both the diseases. For example, immune dysfunction, abnormal activation of NF-κB, epithelial-to-mesenchymal transition, altered adhesion signaling pathways, and extracellular matrix degradation/altered signaling are the key underlying mechanisms in both COPD and lung cancer. These parameters along with other processes, such as chromatin modifications/epigenetic changes, angiogenesis, and autophagy/apoptosis are altered by cigarette smoke, are crucial in the development of COPD and lung cancer. Understanding the cellular and molecular mechanisms underlying these processes will provide novel avenues for halting the chronic inflammation in COPD and devising therapeutic strategies against lung cancer

Plethysmography and its relationship with biochemical parameters in the Maltese population

Plethysmography is an ever increasing test being performed at Mater Dei Hospital. The aim of the study was to obtain descriptive data regarding plethysmography in the Maltese population as well as to investigate the association of these lung function tests to various biochemical parameters. 282 patients who had plethysmography between June 2015 and March 2016 at Mater Dei Hospital were enrolled in the study. The indications for referral, demographic data, lung function parameters, white cell count (WCC), urea, potassium and fasting blood glucose were noted. The mean BMI of the population cohort was 29.06. BMI was found to be negatively correlated to serum potassium levels (r value: -0.14) and residual volume (r value: -0.2). DLCO, total lung capacity and forced expiratory flow in one second were negatively correlated to the WCC (r value: -0.2, -0.17 and -0.12 respectively) in the population. The current study confirms a significant association between lung function testing, diabetes, BMI and total serum white cell count after correcting for confounding factors. This highlights the need for clinicians to be more aware of the possibility of underlying lung disease in these patients. A good clinical evaluation using history and examination of such patients is essential so as to identify which patients should be referred for lung function testing. Such early referrals could potentially avoid progression of undiagnosed lung disease thus reducing the burden on the health care service with particular emphasis on acute hospital admissions and respiratory outpatient clinics.peer-reviewe

Lung Function Status of Workers Exposed to Welding Fume: a Preliminary Study

BACKGROUND: Exposure to welding fume in the workplace was associated with lung function disorders and occupational asthma. In this study, we determined lung function parameters in men workers exposed to welding fumes from heavy equipment manufacturer. This study is a preliminary study of biomonitoring program in worker exposed to welding fume as our main study. METHODS: A study with case-control design, random study, was conducted among welder (59 subjects) and non-welder (34 subjects) with more than one year experience in the same job task in a heavy equipment manufacturer. All subjects completed physical examination, informed consent, questionnaire and lung function status. Lung function status was measured by spirometer with vital capacity (VC), forced vital capacity (FCV), forced expiratory volume in one second (FEV1) and ratio of FEV1/FVC as test parameters. Linear regression model was developed to identify the risk factor of lung function parameter status using age, working period and smoking status as variables. RESULTS: This study showed that there were significant lower VC, FVC and FEV1 in welder than non-welder, but not difference in ratio of FEV1/FVC. However, there was no significant difference among welder from foundry and fabrication plan. By multivariate analysis, working period was found as a risk factor for lower parameters in lung function among welder. CONCLUSION: Lung function parameters status were significantly lower in welder than non-welder, and working period was the most important indicator for lung function status evaluation among welder

Ergonomic Consideration of the Effect of Flour Dust on Peak Expiratory Flow Rate of Bakers in Abeokuta, Ogun State

Flour dusts are one of the most harmful chemicals in the bakery industries which could lead to serious heart and lung diseases. This study investigated the effect of flour dust on Peak Expiratory Flow Rate of male bakers in Abeokuta, Ogun State, Nigeria with the relationship to the anthropometrical parameters. A total of One hundred Eighty (180) male participants were investigated, where ninety (90) participants were bakers and ninety (90) individuals as control group. The Peak expiratory flow rate (PEFR) and anthropometrical parameters of the participant were measured using mini-Wright peak flow meter (PFM 20, OMRON) and Detecto PD300MDHR (Cardinal Scale manufacturing company, USA) column scale with digital height rod was used to measure body mass [kg] and height (cm) respectively. The PEFR and anthropometrical parameters of the bakers and control groups were analysed using descriptive statistics and T-test with SPSS. The results showed that lower PEFR, 182.67 ± 16.34 L/min existed in bakers compared to 287.67 ± 17.02 L/min in the control study. The result also showed that a significant correlation exist between body mass, height and age (P < 0.01), PEFR, height (P < 0.05) and years of exposure (P < 0.01) of the bakers respectively. Furthermore, the results also showed that workers in the dusting and mixing of flour are at a risk of developing related pulmonary function impairment such as asthma. The study concluded that there is need to develop an effective intervention strategy, treatment seeking behaviour through awareness programs to prevent lung impairment diseases among the bakery workers