Chronic obstructive pulmonary disease and asthma in ICU

Chronic obstructive pulmonary disease and asthma are common chronic respiratory diseases. Both cause expiratory airflow limitation, are a result of chronic airway inflammation and can produce episodes of life-threatening respiratory failure. In the acute situation, clinical presentation of these conditions can be very similar, with symptoms of breathlessness, cough and wheeze predominating. This article will focus on the critical care aspects of both conditions and will discuss both pre- and peri-ICU management.     

Lower respiratory tract symptoms in Queensland schoolchildren: risk factors for wheeze, cough and diminished ventilatory function.

BACKGROUND--The occurrence of respiratory symptoms and abnormal lung function in children is known to be influenced by genetic and many environmental factors. The association between specific respiratory symptoms in children of school age and their parents has been examined. METHODS--Respiratory symptoms and ventilatory function were recorded for 4549 schoolchildren in Queensland, Australia. RESULTS--The cumulative prevalence of wheezing was 23.1% of 8 year olds and 20.8% of 12 year olds, and the prevalence of wheezing within the previous 12 months was 13.9% and 10.5% respectively. A parental history of asthma or wheeze and hayfever was associated with wheeze in the child, but did not affect either the age of onset or frequency of episodes. A history of frequent cough in children who had never wheezed was associated with a parental history of frequent bronchitis, but less strongly with parental wheeze. These familial aggregations were not mediated by common exposure to cigarette smoke. Both a history of parental wheeze and maternal cigarette use were associated with a decrease in FEF25-75 in the child and these effects were additive. CONCLUSIONS--The association of specific symptoms (wheeze and cough without wheeze) in parent and offspring is interpreted as evidence for different mechanisms of familial transmission, which may be genetic.     

Patient weighting of importance of asthma symptoms

BACKGROUND: Quality of life measures are increasingly important in evaluating outcomes in asthma. If some asthma symptoms are more troublesome to patients than others, this may affect their contribution to outcome measures. This study was designed to assess the relative importance of common symptoms in adults with asthma. METHODS: A postal survey using conjoint analysis was performed in 272 adults attending hospital outpatient clinics with moderately severe asthma. Patients were asked to chose between "symptom scenarios" offering different combinations of levels of five common asthma symptoms over one week. Two versions of the questionnaire were used with identical scenarios presenting symptoms in different orders. Different patients answered the two versions. Regression analysis was used to calculate symptom weights for daytime cough, breathlessness, wheeze and chest tightness, and sleep disturbance. RESULTS: Symptom order, percentage predicted peak expiratory flow (PEF), and symptoms in the week before the survey did not influence the choice of scenario. In both questionnaires patients were more likely to choose scenarios with low levels of cough and breathlessness than low sleep disturbance, wheeze or chest tightness. Regression weights for cough (-0.52) and breathlessness (-0.49) were twice those of wheeze (-0.25), chest tightness (-0.27), and sleep disturbance (-0.25). For 12% of patients cough dominated patient preferences, regardless of all other symptoms. Age was inversely related to weight given by patients to breathlessness. CONCLUSIONS: The prominence of cough among other asthma symptoms was unexpected. Daytime cough and breathlessness had greater impact for patients than wheeze or sleep disturbance. Age influenced symptom burden, with younger patients giving greater weight to breathlessness than older patients. Conjoint analysis appears to be a useful method for establishing the relative importance of common symptoms.     

Relationship of respiratory symptoms with smoking status and pulmonary function in chronic spinal cord injury

OBJECTIVE: The relationship of respiratory symptoms to pulmonary function parameters and smoking status was assessed in subjects with chronic (>1 year) spinal cord injury (SCI). METHODS AND PARTICIPANTS: As part of their annual physical examination, subjects were queried regarding respiratory symptoms and underwent pulmonary function studies. The 180 patients who successfully completed pulmonary function testing were evaluated, including 79 subjects with tetraplegia (56 nonsmokers and 23 smokers) and 101 subjects with paraplegia (78 nonsmokers and 23 smokers). FINDINGS: Logistic-regression analysis revealed the following independent predictors of breathlessness: level of injury (tetraplegia, paraplegia, odds ratio = 3.5, P < 0.0015), cough combined with phlegm and/or wheeze (CPWZ, odds ratio = 3.1, P < 0.015), total lung capacity percentage predicted (TLC <60%, odds ratio = 3.9, P < 0.02), and expiratory reserve volume (ERV < 0.6 L, odds ratio = 2.5, P < 0.05). Independent predictors of CPWZ were current smoking (odds ratio = 3.3, P < 0.004), breathlessness (odds ratio = 2.9, P < 0.03), and forced expiratory volume in 1 second (FEV1 <60%, odds ratio = 3.2, P < 0.01). CONCLUSION: Altered respiratory mechanics associated with tetraplegia contribute to breathlessness, restrictive ventilatory impairment (low TLC%), and reduced expiratory muscle strength (low ERV). These factors apparently overshadow adverse effects caused by smoking. Conversely, smoking and reduction of airflow (low FEV1%) were predictive of CPWZ, symptoms commonly associated with cigarette use.     

Reference values of interrupter respiratory resistance in healthy preschool white children

BACKGROUND: Interrupter respiratory resistance (Rint) is reported to be useful in evaluating lung function in poorly collaborating patients. However, no reference values are available from large samples of preschool children using the standard interrupter method. The aim of this study was to define reference Rint values in a population of healthy preschool children. METHODS: Rint was assessed without supporting the cheeks in children with no history of wheeze from six kindergartens. To evaluate the effects of upper airway compliance on Rint in healthy children, an additional group of preschool children with either no history of wheeze or no respiratory symptoms at the time of testing underwent Rint measurements in our lung function laboratory with and without supporting the cheeks. Short term (about 1 minute apart) and long term (mean 2.5 months apart) repeatability of Rint measurements (2 SDs of the mean paired difference between measurements) was also assessed in children referred for cough or wheeze. RESULTS: A total of 284 healthy white children (age range 3.0-6.4 years) were evaluated. Mean inspiratory and expiratory Rint (RintI and RintE) did not differ significantly in boys and girls. Age, height, and weight showed a significant inverse correlation with both RintI and RintE in the univariate analysis with linear regression. Multiple regression with age, height, and weight as the independent variables showed that all three variables were significantly and independently correlated with RintI, whereas only height was significantly and independently correlated with RintE. Supporting the cheeks had no significant effect on RintI (n=29, median 0.673 v 0.660 kPa/l.s, p=0.098) or RintE (n=39, median 0.702 v 0.713 kPa/l.s, p=0.126). Short term repeatability was 0.202 kPa/l.s for RintI (n=50) and 0.242 kPa/l.s for RintE (n=69). Long term repeatability was 0.208 kPa/l.s for RintE (n=26). CONCLUSIONS: We have reported reference Rint values in preschool white children and have demonstrated the usefulness of this technique in assessing lung function in this age group.     

Are reference equations for spirometry an appropriate criterion for diagnosing disease and predicting prognosis?

In the last few years, there has been considerable debate on the use of threshold criteria for the diagnosis of obstructive lung disease based on FEV(1) and FEV(1)/FVC ratio. It has been argued that a fixed ratio and fixed percentage criterion result in misclassification. The author argues that this critique is based on a false presumption about the validity of reference equations as a criterion for normality. The flaw lies in the methods used to derive reference equations, which involve arbitrary and circular criteria for exclusion of some members of the population, use potentially non-representative reference populations and include predictive variables that are really risk factors for disease or for adverse outcomes of disease. The author argues for a new interpretative approach for the use of lung function data in clinical practice based on prognostic equations analogous to the Framingham cardiovascular risk factor equations. These interpretative equations should be based on data from cohort studies and randomised controlled trials, rather than cross-sectional studies, and if properly formulated, will prove to be valuable aids to clinical decision making.     

Bronchodilator premedication does not decrease respiratory adverse events in pediatric general anesthesia

PURPOSE: Upper respiratory infections (URI) presage perioperative respiratory complications, but thresholds to cancel surgery vary widely. We hypothesized that autonomically-mediated complications seen during emergence from anesthesia would be predicted by capnometry and reduced with preoperative bronchodilator administration. METHODS: Afebrile outpatient tertiary-care children (age two months to 18 yr, n = 109) without lung disease or findings, having non-cavitary, non-airway surgery for under three hours, were randomized to bronchodilator premedication vs placebo and had preoperative capnometry. After halothane via mask, laryngeal mask airway, or endotracheal tube, and regional anesthesia as appropriate, patients recovered breathing room air while cough, wheeze, stridor, laryngospasm, and cumulative desaturations were recorded for 15 min. RESULTS: In this specific population, there was no association between adverse events and either URI within six weeks (n = 76) or URI within seven days (n = 21). Neither albuterol nor ipratropium premedication decreased adverse events. Endotracheal intubation was associated with increased emergence desaturations and placebo nebulized saline increased emergence coughing. Neither anesthesiologists nor preoperative capnometry predicted adverse events. CONCLUSIONS: Adverse events were neither predicted nor prevented. In afebrile outpatient ASA I and II children with no lung disease or findings, having non-cavitary, non-airway surgery for under three hours, there was no association between either recent URI or active URI and desaturation, wheeze, cough, stridor, or laryngospasm causing desaturation (all P > 0.05). In this highly selected population of afebrile patients, the results suggest that anesthesiologists may proceed with surgery using specific criteria in the presence of a URI.     

Health effects of passive smoking. 3. Parental smoking and prevalence of respiratory symptoms and asthma in school age children

BACKGROUND: A systematic quantitative review of the evidence relating parental smoking to the prevalence of asthma and respiratory symptoms was conducted amongst school age children. METHODS: Sixty relevant studies were identified after consideration of 1593 articles selected by electronic search of the Embase and Medline databases using keywords relevant to passive smoking in children. The search was completed in April 1997 and identified 25 studies of asthma, 41 of wheeze, 34 of chronic cough, seven of chronic phlegm and six of breathlessness which were included in a quantitative overview. RESULTS: The pooled odds ratios for either parent smoking were 1.21 (95% CI 1.10 to 1.34) for asthma, 1.24 (95% CI 1.17 to 1.31) for wheeze, 1.40 (95% CI 1.27 to 1.53) for cough, 1.35 (95% CI 1.13 to 1.62) for phlegm, and 1.31 (95% CI 1.08 to 1.59) for breathlessness. Adjustment for confounding had little effect. Evidence of heterogeneity between studies appeared largely explicable by publication bias with a superfluity of small studies with large odds ratios. However, excluding these had little effect on the pooled odds ratios. The prevalence of all symptoms increased with the number of parents who smoked. While maternal smoking had a greater effect than paternal smoking, the effect of father only was clearly significant. CONCLUSIONS: The relationship between parental smoking and respiratory symptoms seems very likely to be causal given statistical significance, robustness to adjustment for confounding factors, consistency of the findings in different countries, and evidence of dose response. The raised risk in households where the father, but not the mother, smoked argues for a postnatal effect.


     

Prevalence of untreated asthma in a population sample of 6000 older adults in Bristol, UK

BACKGROUND: A study was undertaken to estimate the prevalence of untreated asthma in older adults. METHODS: A cross sectional population based survey of 6000 men and women aged 65 years and over was performed in 21 general practices in north Bristol, south west England. The main outcome measure was untreated asthma as defined by a two stage process comprising a respiratory questionnaire (symptoms suggestive of asthma or doctor diagnosed asthma not receiving respiratory treatment) followed by lung function tests (significant reversibility following bronchodilators or corticosteroids and/or significant within day variability in peak expiratory flow). RESULTS: 4792 of the 6000 participants (80%) completed the respiratory questionnaire and, of those not receiving respiratory treatment, 55 reported a previous doctor diagnosis of asthma and a further 696 had symptoms suggestive of asthma. Lung function testing in 280 of 501 randomly selected individuals from these groups resulted in 38 being defined as having asthma and an estimated population prevalence for untreated asthma of 2.4% (95% CI 1.6% to 3.6%) in men and 1.2% (95% CI 0.7% to 2.1%) in women. Most subjects (84%) with untreated asthma had moderate or severe disease. Untreated asthma was most common in individuals with doctor diagnosed asthma (21%) and those with breathlessness or wheeze (13-20%). CONCLUSION: Untreated asthma in the elderly is a common and important problem. Opportunistic use of appropriate lung function tests in older people with a history of doctor diagnosed asthma or wheeze or breathlessness at rest could identify untreated asthmatics who might benefit from treatment.     

Relation of lung function and exercise capacity to mood and attitudes to health.

Results of psychometric tests were obtained on 161 male welders and other tradesmen in heavy industry who had recently been made redundant. Anxiety and depression were scored on the Hospital Anxiety and Depression Scale, and negative attitudes and beliefs regarding breathlessness and related aspects of respiratory health on a semantic differential scale. Scores for attitudes and beliefs about health and personal disability were pooled to give a general attitude score. Personality was rated on a standard scale. Subjects completed a questionnaire on respiratory symptoms and underwent routine spirometry, measurement of carbon monoxide transfer factor for the lung, and a progressive exercise test on a cycle ergometer. Scores for anxiety, depression, and negative mental attitudes were significantly intercorrelated; subjects with disordered personality profiles had above average scores for anxiety and depression. The psychometric scores were associated with clinical grade of breathlessness, lung function, and the physiological response to exercise. The general attitude score could be predicted from the anxiety and depression scores and from lung function expressed relative to age and stature, the combination of mood score and FEV1 explaining 38% of the variance in general attitude score. The general attitude score accounted for more than half the explained variance in the clinical grade of breathlessness and contributed more to the variance in maximal oxygen uptake (R2 = 0.11) than FEV1. It was associated with the level of habitual activity but not with smoking category, wheeze, chronic cough or phlegm. Thus attitude to disability reflected the subject's assessment of his exercise capacity and was closely related to the clinical grade of breathlessness.     

Respiratory symptoms in patients with treated hypothyroidism and inflammatory bowel disease

BACKGROUND: Patients with idiopathic chronic cough and unexplained airflow obstruction in non-smokers have been shown to have an increased prevalence of hypothyroidism and other organ specific autoimmune disorders. Whether patients with hypothyroidism have an increased prevalence of respiratory symptoms is unknown. METHODS: The prevalence of respiratory symptoms was assessed in 124 patients with treated hypothyroidism recruited from primary and secondary care, 64 outpatients with inflammatory bowel disease, and 1346 control adults recruited randomly from the electoral register in a case-control study. Respiratory symptoms and smoking history were assessed by a respiratory symptom questionnaire. RESULTS: After adjustment for age, sex and smoking, symptoms of breathlessness and sputum production were more prevalent in both patient populations than in controls (odds ratios for hypothyroidism and inflammatory bowel disease; breathlessness: 3.1 (95% CI 2.1 to 4.6) and 3.4 (95% CI 2.0 to 6.0), respectively; sputum production: 2.7 (95% CI 1.6 to 4.5) and 2.5 (95% CI 1.2 to 5.0), respectively). Cough during the day and night was significantly more prevalent in patients with hypothyroidism (1.8 (95% CI 1.2 to 2.9)) and approached significance in those with inflammatory bowel disease (1.8 (95% CI 1.0 to 3.4)). Wheeze and nocturnal cough were no more prevalent in either disease population than in controls. CONCLUSION: There is a significantly increased prevalence of respiratory symptoms in patients with hypothyroidism or inflammatory bowel disease compared with controls recruited from the general population. Further work is required to determine whether similar differences are seen in comparison with hospital based controls. These findings support the hypothesis that there is a link between autoimmune hypothyroidism and respiratory disease.     

Locally generated particulate pollution and respiratory symptoms in young children

BACKGROUND: Particulate matter <10 mum (PM(10)) from fossil fuel combustion is associated with an increased prevalence of respiratory symptoms in children and adolescents. However, the effect of PM(10) on respiratory symptoms in young children is unclear. METHODS: The association between primary PM(10) (particles directly emitted from local sources) and the prevalence and incidence of respiratory symptoms was studied in a random sample cohort of 4400 Leicestershire children aged 1-5 years surveyed in 1998 and again in 2001. Annual exposure to primary PM(10) was calculated for the home address using the Airviro dispersion model and adjusted odds ratios (ORS) and 95% confidence intervals were calculated for each microg/m(3) increase. RESULTS: Exposure to primary PM(10) was associated with the prevalence of cough without a cold in both 1998 and 2001, with adjusted ORs of 1.21 (1.07 to 1.38) and 1.56 (1.32 to 1.84) respectively. For night time cough the ORs were 1.06 (0.94 to 1.19) and 1.25 (1.06 to 1.47), and for current wheeze 0.99 (0.88 to 1.12) and 1.28 (1.04 to 1.58), respectively. There was also an association between primary PM(10) and new onset symptoms. The ORs for incident symptoms were 1.62 (1.31 to 2.00) for cough without a cold and 1.42 (1.02 to 1.97) for wheeze. CONCLUSION: In young children there was a consistent association between locally generated primary PM(10) and the prevalence and incidence of cough without a cold and the incidence of wheeze which was independent of potential confounders.     

Nutrition and respiratory health in children in six Central and Eastern European countries

BACKGROUND: The results of studies on the effect of nutrition on respiratory diseases are inconsistent. The role of nutrition in children's respiratory health was therefore analysed within the cross sectional Central European Study on Air Pollution and Respiratory Health (CESAR). METHOD: A total of 20 271 children aged 7-11 were surveyed in six European countries. Respiratory health and food intake were assessed using questionnaires. Associations between four symptoms and nutritional factors were evaluated using logistic regression, controlling for area plus other potential confounders. RESULTS: All symptoms showed initial associations with nutritional factors. Low consumption of fish and of summer and winter fruit were the most consistent predictors. In a fully adjusted model low fish intake remained a significant independent predictor of persistent cough (OR=1.18; 95% CI 1.04 to 1.34), wheeze ever (OR=1.14; 95% CI 1.03 to 1.25) and current wheeze (OR=1.21; 95% CI 1.06 to 1.39) and a weaker predictor of winter cough (OR=1.10; 95% CI 0.99 to 1.23). Low summer fruit intake was a predictor of winter cough (OR=1.40; 95% CI 1.10 to 1.79) and persistent cough (OR=1.35; 95% CI 1.01 to 1.82). Low winter fruit intake was associated with winter cough (OR=1.28; 95% CI 1.09 to 1.51). Associations between symptoms and vegetable intake were inconsistent. Low summer intake was significantly associated with winter cough (OR=1.23; 95% CI 1.03 to 1.47) but, overall, winter intake had inverse associations with both coughs. Associations between winter vegetable intake and wheeze varied considerably between countries. CONCLUSION: A number of associations were found between respiratory symptoms and low intake of fish, fruit and vegetables in children. Low fish intake was the most consistent predictor of poor respiratory health. Fruit and vegetable intake showed stronger associations with cough than with wheeze.     

Prevalence and incidence of respiratory symptoms in relation to indoor dampness: the RHINE study

BACKGROUND: An association between indoor dampness and respiratory symptoms has been reported, but dampness as a risk factor for the onset or remission of respiratory symptoms and asthma is not well documented. METHOD: This follow up study included 16 190 subjects from Iceland, Norway, Sweden, Denmark, and Estonia who had participated in the European Community Respiratory Health Survey (ECRHS I). Eight years later the same subjects answered a postal questionnaire that included questions on respiratory symptoms and indicators of indoor dampness. RESULTS: Subjects living in damp housing (18%) had a significantly (p<0.001) higher prevalence of wheeze (19.1% v 26.0%), nocturnal breathlessness (4.4% v 8.4%), nocturnal cough (27.2% v 36.5%), productive cough (16.6% v 22.3%) and asthma (6.0% v 7.7%). These associations remained significant after adjusting for possible confounders. Indoor dampness was a risk factor for onset of respiratory symptoms but not for asthma onset in the longitudinal analysis (OR 1.13, 95% CI 0.92 to 1.40). Remission of nocturnal symptoms was less common in damp homes (OR 0.84, 95% CI 0.73 to 0.97). CONCLUSIONS: Subjects living in damp housing had a higher prevalence of respiratory symptoms and asthma. Onset of respiratory symptoms was more common and remission of nocturnal respiratory symptoms was less common in subjects living in damp housing.     

Descriptive study of cough, wheeze and school absence in childhood.

BACKGROUND: Respiratory symptoms such as cough and wheeze are associated with significant morbidity, including school absenteeism. METHODS: A respiratory questionnaire was sent to the parents of all 5727 children aged 7-9 years of age registered with 95 general practitioners in the Southampton area to determine (a) the prevalence of asthma, cough and wheeze, (b) the effects of respiratory symptoms on school absenteeism, and (c) the use of anti-asthma medication. RESULTS: A total of 4830 parents replied (response rate 86%). The 12 month prevalence of wheeze in the absence of cough was 5.5%, cough in the absence of wheeze was 10.0%, and 7.6% reported cough and wheeze; 15.2% of children had been diagnosed. Of the 4830 who replied, 12.7% were receiving bronchodilators, 0.6% xanthine derivatives, 1.7% sodium cromoglycate, and 4.1% inhaled corticosteroids. In all, 348 (7.2%) children had missed more than five days of schooling in the preceding year for respiratory symptoms, while 43 children (0.9%) had missed more than 20 days of schooling in the preceding year. Of the children who had missed more than five days of schooling, 43% reported cough and wheeze, 33% cough alone, and 16% wheeze alone in the preceding year. Compared with children who coughed, those who wheezed were significantly more likely to be diagnosed as asthmatic and to be receiving bronchodilators or inhaled corticosteroids. CONCLUSIONS: In this study, cough was the most frequently reported symptom amongst children missing more than five days of schooling per year.     

Exhaled nitric oxide levels in atopic children: relation to specific allergic sensitisation,AHR, and respiratory symptoms

BACKGROUND: Exhaled nitric oxide (eNO), which has been proposed as a measure of airway inflammation, is increased in atopic subjects. This raises the question of whether eNO provides any additional information about airway inflammation in asthmatic subjects, other than as a marker for atopy. A study was undertaken to determine whether eNO levels in a population of atopic children are associated with sensitisation or natural exposure to specific allergens, and to examine the relationship between eNO, airway responsiveness, and current respiratory symptoms. METHODS: Exhaled NO and airway responsiveness to histamine were measured in winter and in summer in 235 children aged 8-14 years who had been classified as atopic by skin prick testing. Current respiratory symptoms, defined as wheeze or cough during the month preceding the test, were measured by a parent completed questionnaire. Airway hyperresponsiveness (AHR) was defined as a dose response ratio (DRR) of >8.1 (% fall in forced expiratory volume in 1 second (FEV(1))/micromol + 3). RESULTS: Sensitisation to house dust mite was associated with raised eNO levels in winter while sensitisation to Cladosporium was associated with raised eNO levels in both winter and summer. Grass pollen sensitisation was not associated with raised eNO levels in either season. Exhaled NO correlated significantly with DRR histamine (r=0.43, p<0.001) independently of whether the children had current symptoms or not. In children with current wheeze, those with AHR had eNO levels 1.53 (95% CI 1.41 to 1.66) times higher than those without AHR (p=0.006). Neither DRR (p=1.0) nor eNO levels (p=0.92) differed significantly between children with or without persistent dry cough in the absence of wheeze. CONCLUSIONS: In atopic children, raised eNO levels are associated with sensitisation to perennial allergens, but not to seasonal allergens such as grass pollen. In this population, an increase in eNO is associated with AHR and current wheezing, suggesting that eNO is more than just a marker for atopy.     

Lung function in healthy never smoking adults: reference values and lower limits of normal of a Swiss population.

BACKGROUND: Reference values and definitions of "normal" are prerequisites for population screening and classification of lung diseases. The aim of this study was to calculate reference values for never smoking Caucasian adults. METHODS: In the SAPALDIA cross sectional study respiratory health was assessed in a random sample of 9651 subjects, aged 18-60 years, from eight areas of Switzerland. Lung function was measured according to ATS criteria including quality control. In 3157 healthy never smoking adults without respiratory symptoms the mean values and fifth percentiles of lung function variables were calculated. For each sex, logarithms of lung function were regressed against age, age squared, and the logarithm of height. Residuals were used to estimate fifth percentiles across the age range using a technique not requiring normality or homoscedasticity of residuals. RESULTS: Most lung function variables were non-linear with age and showed an increase in early adulthood and an accelerated decline thereafter. The reference values for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were higher than those of the European Community for Coal and Steel and those from North America. The prediction equations for lower fifth percentile values defined a stable proportion of subjects outside this limit whereas alternative methods for estimating the fifth percentile showed a loss of sensitivity with age. CONCLUSIONS: The reference equations for mean values of spirometric indices and their lower fifth percentiles gave an improved and unbiased lower limit of normal. The higher mean values may in part be due to the strictly selected population, quality control procedures, cohort effects, and altitude, and are not explained by the statistical model used.     

Rehabilitation bei berufsbedingten Atemwegs- und Lungenerkrankungen

Background

Pulmonary rehabilitation is a well-recognized treatment option in chronic obstructive lung disease improving exercise performance, respiratory symptoms and quality of life. In occupational respiratory diseases very little information is available.

Objectives

The goal of this study was to evaluate the usefulness and sustainability of pulmonary rehabilitation in patients with occupational respiratory diseases, partly involving complex alterations of lung function.

Methods

We studied 263 patients (asthma, silicosis, asbestosis, chronic obstructive pulmonary disease) using a 4-week inpatient rehabilitation program and follow-up examinations 3 and 12 months later. The outcomes evaluated were lung function, 6-min walking distance (6MWD), maximum exercise capacity (W_max), skeletal muscle strength, respiratory symptoms, exacerbations and associated medical consultations, quality of life [Short Form, 36 items (SF-36), Saint George’s Respiratory Questionnaire (SGRQ)], anxiety/depression [Hospital Anxiety and Depression Scale (HADS)] and breathlessness [Medical Research Council (MRC) dyspnea scale, Baseline/Transition Dyspnea Index (BDI/TDI)].

Results

Compared to baseline, there were significant (p?<?0.05) improvements in 6MWD, W_max and muscle strength immediately after rehabilitation, and these were maintained over 12 months (p?<?0.05). Effects were less pronounced in asbestosis. Overall, significant reductions in the rate of exacerbations by 35?%, antibiotic therapy by 27?% and use of health care services by 17?% were observed compared to the previous year. No changes were seen in the questionnaire outcomes.

Conclusion

Pulmonary rehabilitation is effective even in the complex settings of occupational respiratory diseases, providing sustained improvement of functional capacity and reducing health care utilization.     

Respiratory symptoms and pulmonary function of welders in the engineering industry

We have studied respiratory symptoms, smoking habits, chest radiographs, sickness absence, and pulmonary function among 258 welders and an equal number of matched control subjects in three engineering factories. Welders who smoked had a higher frequency of chronic phlegm production than control subjects but there was no difference in cough or dyspnoea. The frequency of abnormality on chest radiographs was low and similar in welders and controls. Upper respiratory infections were a more frequent cause of sickness absence in welders than in controls but no difference was found in other respiratory diseases. FEV1 and peak expiratory flow rate were similar in welders and controls. In a subset of 186 subjects the maximum expiratory flow rate at low lung volumes was significantly less in welders who smoked than in control subjects who smoked, but there was no difference in non-smokers. Welders working under these conditions in the engineering industry appear to have no increased risk of chronic obstructive lung disease.     

Long-term effects of mustard gas on respiratory system of Iranian veterans after Iraq-lran war： a review

To review long-term respiratory effects of mustard gas on Iranian veterans having undergone Iraq-Iran war. Electronic databases of Scopus, Medline, ISI, IranMedex, and Irandoc sites were searched. We accepted articles published in scientific journals as a quality criterion. The main pathogenic factors are free radical mediators. Prevalence of pulmonary involvement is approximately 42.5%. The most common complaints are cough and dyspnea. Major respiratory complications are chronic obstructive pulmonary disease, bronchiectasis, and asthma. Spirometry results can reveal restrictive and obstructive pulmonary disease. Plain chest X-ray does not help in about 50% of lung diseases. High-resolution CT of the lung is the best modality for diagnostic assessment of parenchymal lung and bronchi. There is no definite curative treatment for mustard lung. The effective treatment regimens consist of oxygen administration, use of vaporized moist air, respiratory physiotherapy, administration of mucolytic agents, bronchodilators, corticosteroids, and long-acting beta-2 agonists, antioxidants, surfactant, magnesium ions, therapeutic bronchoscopy, laser therapy, placement of respiratory stents, early tracheostomy in laryngospasm, and ultimately lung transplantation. High-resolution CT of the lung is the most accurate modality for the evaluation of the lung parenchyma and bronchi. The treatment efficacy of patients exposed to mustard gas depends on patient conditions (acute or chronic, upper or lower respiratory tract involvement). There are various treatment protocols, but unfortunately none of them is definitely curable.