非结核分枝杆菌肺病需要更多关注

非结核分枝杆菌肺病(NTM-PD)是最常见的非结核分枝杆菌感染性疾病,但误诊率高.近年来的研究报道显示,NTM-PD发病率和患病率都呈现逐渐上升趋势.NTM-PD症状和体征无特异性.CT检查主要表现肺部支气管扩张、结节、空洞和实变,常常多种CT表现形式同时存在.由于非结核分枝杆菌在自然界中普遍存在,易污染标本和定植在人...     

Nontuberculous Mycobacterial Lung Infections in Ontario, Canada: Clinical and Microbiological Characteristics

Study Objectives The aim of this study was to determine gender and clinical phenotype frequencies in pulmonary nontuberculous mycobacterial (NTM) infection and the frequency of disease in NTM isolates. Design The study is a retrospective observational cohort study of two overlapping cohorts: population cohort and clinical cohort. Setting The study was conducted at the University Health Network and Ontario Mycobacteriology Laboratory in Toronto, Ontario, Canada. Patients or Participants The population cohort consisted of all patients with one or more pulmonary NTM isolates in Ontario in 2003. The clinical cohort consisted of all patients with one or more pulmonary NTM isolates at our hospital in 2002–2003. Interventions The study entailed the review of laboratory records and demographics (both cohorts) and detailed clinical records (clinical cohort). Measurements and Results In the population cohort (N = 1651), females comprised 48% overall and 51% with microbiological disease criteria. In the clinical cohort (N = 552), females comprised 48% overall and 55% with NTM disease. In the population cohort, 45% fulfilled microbiological disease criteria, and in the clinical cohort 46% of patients had disease. Patients with MAC isolates fulfilled microbiological disease criteria in 51% of population cohort cases and all disease criteria in 52% of clinical cohort cases. Women more commonly fulfilled microbiological disease criteria in the population cohort (51 vs. 45%, P = 0.02) and all disease criteria in the clinical cohort (53 vs. 40%, P = 0.03). Among clinical cohort patients, 26% (13 women, 44 men) had fibrocavitation, while 62% (101 women, 37 men) had nodular bronchiectasis. Conclusions Women comprised a small majority with disease. Nodular bronchiectasis in women was most common, but significant proportions of each gender with each radiographic type were observed. NTM isolation, particularly MAC, was frequently associated with disease.     

Nontuberculous mycobacterial lung disease in patients without HIV infection: a retrospective analysis over 3 years

Introduction: Nontuberculous mycobacterial lung infections are relatively common in immunocompromised patients but are now increasingly being diagnosed in immunocompetent individuals. These organisms are not always pathogenic bacteria when isolated from human samples. The identification of which isolates are contaminants or colonizers is based on internationally accepted criteria. The clinical significance of the isolation of nontuberculous mycobacteria (NTM) from respiratory specimens in Italy is unknown. Objective: study was performed to evaluate the local epidemiology of NTM pulmonary infection in Naples in patients with positive respiratory specimens, and also to describe the clinical and radiological features of NTM pulmonary disease in immunocompetent patients with or without pre‐existing lung disease. Methods: Between December 2006 and September 2009, the clinical records and radiological examinations of 39 patients with 55 positive cultures for NTM species by sputum or bronchial wash or lavage were reviewed. Results: According to microbiological, clinical and radiological criteria, our study identified 16 patients with NTM lung infection as a ‘disease’ group and 23 patients in a ‘contamination’ group but without disease. M. intracellulare (n = 7, 41.2%), followed by M. kansasii (n = 5, 29.4%) were the most common NTM found in the ‘disease’ group. We detected a high number of M. gordonae isolates in respiratory samples obtained by fibrobronchoscopy. Conclusions: We evaluated the clinical significance of isolations in our reference centre in Naples. Forty‐one of all patients have ‘disease’, M. intracellulare and M. kansasii are mainly responsible. NTM species were analyzed in relation to their frequency. Assumptions were made about low pathogenic NTM isolations. Please cite this paper as: Del Giudice G, Iadevaia C, Santoro G, Moscariello E, Smeraglia R and Marzo C. Nontuberculous mycobacterial lung disease in patients without HIV infection: a retrospective analysis over 3 years. Clin Respir J 2011; 5:203–210.     

The clinical significance of HRCT in evaluation of patients with rheumatoid arthritis-associated interstitial lung disease: a report from China

The objective of this study is to describe the interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients of China, and to study clinical significance of high-resolution computed tomography (HRCT) in evaluation and treatment. One hundred and ten Chinese patients (79 women and 31 man) diagnosed with RA between December 2008 to November 2009 were analyzed. According to the HRCT, 47 (42.73%) RA patients were diagnosed as ILD. Old age, smoking and pulmonary rales were closely related to ILD (P < 0.05). The main appearances of ILD were ground-glass (39.09%), honeycombing (4.55%), reticular patterns and consolidation (1.82%). Patients with reticular patterns and honeycombing were more likely to show the respiratory symptoms. It was also common to find other abnormal changes, such as fiber cord shadow (22.73%), lung markings fuzzy disorder (30%), pulmonary nodules (11.82%), emphysema (9.09%), bronchiectasis (3.64%), subpleural nodules (11.82%) and pleural thickening (24.55%). In treatment, honeycombing and subpleural nodules were more common in patients with methotrexate (MTX) and/or leflunomide treatment than without (P < 0.05). Other abnormal changes were no statistical significance (P > 0.05). Pulmonary involvement is common in RA patients, and it is suggested that HRCT could be a sensitive and useful way in evaluating the lung of RA patients.     

Yield of sputum microbiological examination in patients hospitalized for exacerbations of chronic obstructive pulmonary disease with purulent sputum

BACKGROUND: Whether sputum microbiological examination should be performed systematically in hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations remains unclear. OBJECTIVES: To assess the yield of sputum microbiological examination in COPD patients hospitalized in a medical ward for an acute exacerbation with purulent sputum. METHODS: Two hundred consecutive exacerbations in 118 patients were studied. Patients underwent sputum microbiological examination on admission and baseline lung function tests and CT scans were recorded. Factors associated with positive culture were analyzed. RESULTS: Sputum culture was positive (>or=10(7) CFU/ml) in 59% of samples, Haemophilus influenzae and Streptococcus pneumoniae being the most frequent pathogens. Factors associated with positive culture were bronchiectasis, long-term oxygen therapy and low FEV1. Pseudomonas spp. were found in 8.5% of all patients, who all had a FEV1<50% of predicted and were older. Only 25% of sputum samples satisfied all quality criteria. Sputum culture was positive in a high proportion of these samples (80.5%), but also in one half of samples with >25 leukocytes but >10 epithelial cells per field. Microbiological results induced a change in antibiotic therapy in 43.9% of cases with both quality criteria but also in 25.2% of cases with only one quality criterion. Finally, a predominant aspect after Gram stain was found in all positive samples. CONCLUSIONS: These data suggest that sputum microbiological examination with direct examination and leukocyte count should be performed routinely in patients hospitalized for COPD exacerbations with purulent sputum, especially when FEV1 is less than 50% predicted and in patients with bronchiectasis.     

Bacterial colonisation of lower airways in health and chronic lung disease

Background: To evaluate the colonisation rate and type in different groups of patients with chronic lung diseases, bronchial lavage (BL) fluid was investigated for bacteria. Methods: All patients underwent fibre‐optic bronchoscopy as part of routine investigation for remote haemoptysis or nodule investigation. The standard procedure included BL and microbiological culture providing the total number of colony forming units (cfu)/mL and the number of potential pathogenic bacteria (ppb)/mL. Three groups of patients were included: 48 persons had a final diagnosis of no pathology, 53 patients with chronic obstructive pulmonary disease in a stable phase and 32 patients with a final diagnosis of bronchiectasis. Results: The median number of cfu cultured from patients with bronchiectasis was 10⁵ cfu/mL compared to 5 10³ cfu/mL in patients with COPD and 10⁴ cfu/mL in persons with no pathology. The ppb colonisation rate varied from 10% in persons with no pathology to 43% in patients diagnosed with chronic obstructive pulmonary disease (COPD) and 63% in patients with bronchiectasis. The most frequent bacteria isolated was Haemophilus influenzae. Colonisation rates were associated with frequencies of respiratory infections; patients with bronchiectasis reported a median of three infections per year, patients with COPD reported one infection per year, and persons without pathology reported 0 infections per year (P < 0.05). Within each group a large patient‐to‐patient variation was found. Conclusions: Different groups of patients with chronic pulmonary diseases have very different colonisation rates. Patients with bronchiectasis have the highest colonisation rate. This correlates to the reported frequency of lower respiratory tract infections. Please cite this paper as: Weinreich UM and Korsgaard J. Bacterial colonisation of lower airways in health and chronic lung disease. The Clinical Respiratory Journal 2008; 2: 116–122.     

Frequency of broncho-bronchiolar disease in rheumatoid arthritis: an examination by high-resolution computed tomography

 To assess the frequency of pulmonary changes in patients with rheumatoid arthritis (RA), we evaluated a subject group (all outpatients with RA visiting the hospital during a period of three consecutive days) by plain chest radiographs (CRs) and high-resolution computed tomography (HRCT). The study population consisted of 186 patients (32 men, 154 women; mean age 59.8 years), including 6 smokers or exsmokers. Chest radiography was performed on all patients. Seventy (Group A) patients demonstrated abnormal findings and 116 (Group B) did not. HRCT scans were performed on 69 of Group A and 54 of Group B. HRCT demonstrated centrilobular micronodules (n = 29; 23.6%), septal lines (n = 24; 19.5%), subpleural curvilinear shadows (n = 24; 19.5%), bronchiectasis (n = 21; 17.1%), dependent opacity (n = 14; 11.4%), nodules (n = 12; 9.8%), and honeycombing (n = 11; 8.9%). Ten (34%) of the patients with centrilobular micronodules also had bronchiectasis. The most frequent disorder was broncho-bronchiolar disease. Contrary to the CRs finding of no abnormality, HRCT detected pulmonary pathological findings in 40 of 54 patients (74.1%). Pulmonary diseases may be frequently latent, and HRCT is useful in evaluating them in patients with RA. Received: September 18, 2001 / Accepted: April 30, 2002 Correspondence to:T. Izumiyama     

Mycobacterium avium-intracellulare Pulmonary Infection in Patients Without Known Predisposing Lung Disease

We tried to characterize the clinical features and findings on chest high resolution computed tomography (HRCT) of patients with Mycobacterium avium-intracellulare (MAI) pulmonary infection without known predisposing lung disease and with no immunodeficiency. We also aimed to clarify the small airway and alveolar inflammation using bronchoalveolar lavage (BAL) from the affected regions. MAI infection was diagnosed in 53 patients from respiratory samples, including sputum and materials obtained using a fiberoptic bronchoscope. None had a predisposing lung disease or immunodeficiency, as assessed by medical history, routine laboratory data, and previously normal chest radiographs and/or CT scans. The mean age of the 53 patients was 60 ± 11 years, and 48 were nonsmoking females. They had few respiratory symptoms, although 42% had chronic paranasal sinusitis. Chest HRCT findings showed centrilobular small nodules and ectasia of small bronchi and/or bronchioles located mainly in segment (S) 2, 3, 4, and 5. S1, which is usually affected by pulmonary tuberculosis, was completely free of these opacities. The BAL study revealed that the predominant cells were activated T lymphocytes and neutrophils. The CD4⁺/CD8⁺ ratio increased significantly. Bacteriology was negative for other bacteria and fungi. Although our patients did not present with distinct respiratory symptoms, the regions affected by MAI showed a chronic inflammation of mainly neutrophils and activated T lymphocytes. The presence of chronic sinusitis may be merely coincidental. However, its high prevalence and the finding of bronchiectasis in chest HRCT raise the question of whether silent bronchiectasis may be a predisposition. Accepted for publication: 18 June 1998     

Pulmonary computed tomography scan findings in chronic granulomatous disease

BackgroundChronic granulomatous disease is a phagocyte defect, characterised by recurrent infections in different organs due to a defect in NADPH oxidase complex. This study was performed to investigate pulmonary problems of CGD in a group of patients who underwent computed tomography (CT) scan.MethodsComputed tomography scan was performed in 24 patients with CGD. The findings of the CT scan were documented in all of these patients.ResultsAreas of consolidation and scan formation were the most common findings, which were detected in 79% of the patients. Other abnormalities in order of frequencies were as follows: small pulmonary nodules (58%); mediastinal lymphadenopathy (38%); pleural thickening (25%); unilateral hilar lymphadenopathy (25%); axillary lymphadenopathy (21%); bronchiectasis (17%); abscess formation (17%); pulmonary large nodules or masses (8%); and free pleural effusion (8%).ConclusionThe pulmonary CT scans of the patients with CGD demonstrated a variety of respiratory abnormalities in the majority of the patients. While recurrent respiratory infections and abscesses are considered as prominent features of CGD, early diagnosis and precise check-up of the respiratory systems are needed to prevent further pulmonary complications.     

New diagnostic criteria for nutcracker esophagus using conventional water‐perfused manometry: A comparison between nutcracker esophagus with and without gastroesophageal reflux disease

Background and Aim: Controversy continues as to whether nutcracker esophagus (NE) is a ‘real’ manometric disease due to its poor correlation with clinical symptoms such as chest pain or dysphagia. While new NE criteria were proposed in a recent study, that study included NE patients both with and without gastroesophageal reflux disease (GERD). We aimed to analyze both general NE (with or without GERD) and pure NE (without GERD) patients in terms of distal esophageal amplitude (DEA) and its correlation with symptoms. Methods: Using previously known normal DEA values (mean and SD), patients were stratified into three different groups: group A (DEA 180 to 220 mmHg, 2 to 3 SD), B (DEA 220 to 260 mmHg, 3 to 4 SD), and C (DEA > 260 mmHg, > 4 SD). Results: A total of 72 patients who simultaneously underwent esophageal manometry and 24‐h pH monitoring were diagnosed with NE. They were separated into groups A (n = 43), B (n = 18), and C (n = 11). Although the proportion of general NE patients with symptoms appeared to be greater in group A (65.6%) than in group C (90.9%), statistical analysis showed that this was not a significant correlation (P = 0.07). Pure NE patients were defined as those returning negative findings after 24‐h pH monitoring. These patients were separated into three groups based on the same DEA criteria as above: group A‐1 (n = 33), B‐1 (n = 11), C‐1 (n = 8). The proportion of patients with symptoms increased from 54.5% in group A‐1 to 87.5% in group C‐1, and this correlation was found to be significant (P < 0.05). Conclusions: There exists in the general NE population a subset with pure NE. DEA values correlated with symptoms in this subset.     

Prevalence and characteristics of anxiety in patients with unconfirmed pulmonary nodules

This study focuses on the prevalence and characteristics of anxiety in patients with pulmonary nodules that was assessed by Hamilton Anxiety Scale (HAMA) scores. A total of 890 patients were enrolled in this study, including incidence of absence of anxiety n = 343 (38.54%), mild or probable anxiety n = 459 (51.57%) and moderate or definite anxiety n = 79 (8.88%) and obvious anxiety n = 9 (1.01%), respectively. According to the definition of anxiety, 88 (9.89%) patients were enrolled in anxiety group. The incidence of anxiety in females was significantly higher than male (11.98% vs. 7.20%, p = 0.018), patients with respiratory symptoms were significantly higher than without respiratory symptoms (13.33% vs. 8.50%, p = 0.029) and diameter of pulmonary nodules >8 mm is significantly higher than ≤8 mm (13.35% vs. 7.10%, p = 0.002). Regression analysis showed that female (OR = 0.548, 95% CI: 0.340–0.884), family history of malignant tumour (OR = 1.691, 95% CI: 1.067–2.678), respiratory symptoms (OR = 1.713, 95% CI: 1.073–2.733) and diameter >8 mm (OR = 2.135, 95% CI: 1.350–3.375) were independent risk factors of anxiety. Further analysis of 88 patients with anxiety showed the sum of psychic anxiety was significantly higher than somatic anxiety (16.66 ± 2.46 vs. 0.97 ± 1.10, p < 0.0001). Hence, vast majority of patients with unconfirmed pulmonary nodules suffered various severity of anxiety and manifested as psychic anxiety. And gender, respiratory symptoms, family history of malignant tumour and diameter of pulmonary nodules were independent influencing factors of anxiety. Effective strategies urgently need exploring and providing for improving the mental health.     

Bronchodilator reversibility in Australian adults with chronic obstructive pulmonary disease

Abstract Background and aims: Bronchodilator reversibility (BDR) and inhaled corticosteroid (ICS) use were assessed for volunteers who responded to an advertisement requesting current or ex‐smokers who were experiencing breathlessness to attend for lung function testing. Methods: One hundred and fifty‐four volunteers responded. Forced expiratory volume (FEV₁) was measured before and after 400 µg of salbutamol. Significant BDR was assessed according to guidelines of: (i) the American Thoracic Society (≥12% plus 200 mL of baseline FEV₁ or forced vital capacity), (ii) the British ­Thoracic Society (BTS) (≥15% plus 200 mL of baseline FEV₁), (iii) the European Thoracic Society (≥10% predicted FEV₁), and (iv) the most commonly used criteria in Australia and New Zealand (≥15% of baseline FEV₁). Results: One hundred and twenty‐three subjects (33 female; 40 current smokers; median pack years 48 (range 5?144)) were suitable for analysis (i.e. had no history of asthma, demonstrable airflow limitation and a forced expiratory ratio (FER) of <70%). Twenty (16%) patients had an FEV₁ within the normal range but FER of <70%, 24 (20%) patients had mild disease (FEV₁ 60?80% predicted), 31 (24%) patients had moderate disease (FEV₁ 40?59% predicted), and 48 (39%) patients had severe disease (FEV₁ <40% predicted), according to BTS criteria. Significant BDR was evident in: (i) 58 (47%) subjects by American criteria, (ii) 26 (21%) subjects by British criteria, (iii) 19 (15%) subjects by European criteria and (iv) 36 (29%) subjects by Australasian criteria. ICS use was reported by 71 (58%) subjects overall and was weakly, but significantly, related to poorer FEV₁ (r = ?0.2; P < 0.01), and greater BDR (r = 0.3; P < 0.005). Conclusion: Chronic obstructive pulmonary disease in Australian volunteers with no history of asthma encompasses many individuals with significant BDR. Interestingly, most volunteers reported ICS use and this was related to poorer spirometry and greater BDR. However, until the underlying immuno­pathology has been determined they cannot be assumed to have ‘asthma’ or even an ‘asthmatic element’. (Intern Med J 2003; 33: 572?577)     

Lung structure abnormalities, but normal lung function in pediatric bronchiectasis

BACKGROUND: Bronchiectasis is not considered to be uncommon in children anymore. The relationship between pulmonary function and severity of bronchiectasis is still controversial. STUDY OBJECTIVES: To assess the extent and severity of bronchiectasis through high-resolution CT (HRCT) scan score, and to correlate it with clinical, microbiological, and functional data. PATIENTS AND METHODS: Forty-three white children with HRCT-diagnosed bronchiectasis were studied. Bronchiectasis extent, bronchial wall thickening severity, and bronchial wall dilatation severity were evaluated using the Reiff score. Clinical, microbiological, and spirometry results were related to total HRCT scan score and to subscores as well. RESULTS: The percentages of affected lobes were as follows: right lower lobe, 65%; middle lobe, 56%; left lower lobe, 51%; right upper lobe, 37%; lingula, 30%; and left upper lobe, 30% (chi(2) = 18.4; p = 0.002). The mean (+/- SEM) HRCT score was 20 +/- 2.6. Total score or subscores of bronchiectasis extent, bronchial wall thickening severity, and bronchial wall dilatation severity were not significantly related to FEV(1) and FVC. Seventy-four percent of patients had asthma. The age at the onset of cough correlated with age at the time of the HRCT scan (p = 0.004) and with the presence of asthma (p = 0.01). Positive findings of deep throat or sputum cultures were found more frequently in atopic patients (p = 0.02) and asthmatic (p < 0.01) patients, and in children who were < 2 years of age at the onset of cough (p < 0.01). CONCLUSIONS: Normal lung function may coexist with HRCT scan abnormalities and does not exclude damage to the bronchial structure. Pulmonary function is not an accurate method for assessing the severity of lung disease in children with bronchiectasis.     

Correlation of spirometry indices to chest radiology in the diagnosis of chronic airway disease among regional and rural Indigenous Australians

Background

The majority of Indigenous Australians reside in non-urban locations, with reduced access to chest radiology such as computed tomography (CT). Spirometry and chest X-ray (CXR) may be used in the absence of CT; however, the correlation of spirometry indices to CT-defined chronic airway diseases (i.e. chronic obstructive pulmonary disease (COPD) and bronchiectasis) compared with CXR among Indigenous people is sparsely reported.

Aim

To evaluate spirometry indices against CXR and CT findings among adult Indigenous Australians.

Methods

Indigenous patients who had undergone a spirometry test between 2012 and 2020 and had a CXR or chest CT scan assessed for the presence (⁺)/absence (⁻) of airway diseases were included in this study.

Results

Of 643 patients (57% female, 31% remote/very remote), 364 (57%) had CT and CXR available. Patients who were ‘CT⁻ and CXR⁻’ for airway diseases (48%) recorded a mean FVC, FEV₁ and FEV₁/FVC of 61%, 59% and 0.76 compared to 57%, 49% and 0.66 in the ‘CT⁺ and CXR⁻’ group and 53%, 39% and 0.58 in the ‘CT⁺ and CXR⁺’ group. CXR showed sensitivity (44%) and specificity (88%), while spirometry showed 62% and 77% compared to CT. Spirometry demonstrated predominately restrictive impairment among ‘CT⁻ and CXR⁻’ and mixed/obstructive impairment among ‘CT⁺ and CXR⁻’ and ‘CT⁺ and CXR⁺’ groups.

Conclusion

Indigenous Australians tend to demonstrate restrictive impairment in the absence of radiological evidence of airway disease. However, in the presence of airway disease, combinations of mixed and obstructive impairments were common. Obstructive impairment shows greater sensitivity for identifying COPD than that shown by CXR; however, CXR shows greater specificity. Hence, spirometry in conjunction with chest radiology should be utilised to aid in the assessment of airway diseases in this population.     

Multislice CT pulmonary findings in Behçet’s disease (Report of 16 cases)

Pulmonary artery aneurysm is the best-defined type of pulmonary disease in Behçet’s disease (BD) with an important morbidity and mortality. The objective of this study was to assess the contribution of high-resolution dynamic chest CT imaging for one of the most serious aspects of BD: pulmonary artery aneurysm and other pulmonary parenchymal involvement. Sixteen BD patients were recruited for this study, (14 men, 87.5%, and 2 women, 12.5%). All patients fulfilled the 1990 American College of Rheumatology criteria for classification of BD [International Study Group for Behçet’s Disease, Lancet 335:1078–1080, (1990)]. All patients underwent thorough history taking, full clinical examination, and routine laboratory investigations. Plain chest X-rays and pulmonary CT angiography were performed on all patients in an attempt to assess the pulmonary vasculature and lung parenchyma. Pulmonary vascular abnormalities were as follows: pulmonary artery aneurysms of varying sizes in nine patients (56.3%%), main pulmonary artery ectasia in two patients (12.5%), pulmonary artery embolism in two patients (12.5%), venacaval thrombosis in seven patients (43.8%), and pulmonary venous varices in four patients (25%). Pulmonary parenchymal abnormalities were as follows: three patients (18.8%) with mild central bronchiectasis, one patient (6.3%) with atelectasis, one patient (6.3%) with subpleural nodule, and four patients (25%) with interstitial lung disease. Eight of the male patients were smokers. Multislice CT is useful in demonstrating the entire spectrum of thoracic manifestations of BD. Multislice CT is noninvasive and provides excellent delineation of the vessel lumen and wall and perivascular tissues, as well as detailed information concerning the lung parenchyma, pleura, and mediastinal structures.     

Pulmonary involvement in mixed connective tissue disease: high-resolution CT findings in 41 patients

The objective of this study was to describe the pulmonary abnormalities on high-resolution computed tomography (CT) in patients with mixed connective tissue disease (MCTD). The study included 41 patients who met the diagnostic criteria for MCTD and showed abnormal findings on high-resolution CT. The presence, extent, and distribution of various high-resolution CT findings were evaluated. The predominant abnormalities included areas of ground-glass attenuation (n = 41), subpleural micronodules (n = 40), and nonseptal linear opacities (n = 32). Other common findings included peripheral predominance (n = 40), lower lobe predominance (n = 39), intralobular reticular opacities (n = 25), architectural distortion (n = 20), and traction bronchiectasis (n = 18). Less common findings included honeycombing, ill-defined centrilobular nodules, airspace consolidation, interlobular septal thickening, thickening of bronchovascular bundles, bronchial wall thickening, bronchiectasis, and emphysema. Pulmonary involvement of MCTD is characterized by the presence of ground-glass attenuation, nonseptal linear opacities, and peripheral and lower lobe predominance. Ill-defined centrilobular opacities were uncommonly seen.     

Prognostic Significance of Cavitary Lung Nodules in Granulomatosis With Polyangiitis (Wegener's): A Clinical Imaging Study of 225 Patients

Objective

Granulomatosis with polyangiitis (Wegener's) (GPA) is a systemic necrotizing vasculitis in which pulmonary nodules are a common manifestation. Our study examined whether pulmonary nodules, and nodule type (solid versus cavitary), are associated with different disease manifestations and outcomes.

Methods

Demographic, clinical, biologic, and radiologic data at diagnosis and during followup and treatments of GPA patients followed at the Mount Sinai Hospital (Canada) Vasculitis Clinic were analyzed. Patients were separated by the absence of lung nodules, presence of solid nodules only, and presence of cavitary nodules (+/? solid nodules). The study outcomes included followup lung imaging, relapses, and deaths.

Results

Of 225 patients with GPA, 46 had solid nodules only and 44 had cavitary nodules at diagnosis. Demographic and clinical manifestations were similar in the patient subgroups at diagnosis. Cyclophosphamide (CYC) was used for induction after diagnosis in 76.7% of patients with cavitary nodules, compared with 64.7% of patients without nodules and 51.1% of patients with solid nodules (P = 0.04). The mean ± SD followup after diagnosis was 106.6 ± 92.6 months, and 6 of the patients died. In multivariable analysis, diagnosis before 2000 or pulmonary nodule cavitation at diagnosis were associated with relapse, with a hazard ratio of 0.38 (95% confidence interval [95% CI] 0.22–0.65; P < 0.001) and 1.53 (95% CI 1.00–2.33; P = 0.05), respectively, after adjustment for CYC use.

Conclusion

The presence of cavitary nodules led to increased use of CYC but had no impact on survival. Relapse occurred more often, however, in patients with cavitary nodules than in those with solid nodules or no nodules, and should be studied in other cohorts.

     

Six‐minute walk test in pulmonary rehabilitation: Do all patients need a practice test?

Background and objective: The six‐minute walk test (6MWT) is widely used as an outcome measure in pulmonary rehabilitation programs (PRP). A learning effect for the test has been reported in COPD; however, limited data exist in patients with other respiratory diagnoses. The objectives of this study were to: (i) report the magnitude of change in 6MWD with test repetition in patients referred to an outpatient PRP, and (ii) compare the magnitude of change in 6MWD with test repetition in patients with COPD, interstitial lung disease (ILD), bronchiectasis and asthma. Methods: Retrospective study of 349 patients with stable COPD (n = 245), ILD (n = 21), bronchiectasis (n = 33) or asthma (n = 50) who performed two 6MWT at enrolment into a PRP. Results: 6MWD increased in all groups on the second test (all P < 0.001). At least 80% of patients in each diagnostic group walked further on their second 6MWT. The magnitude of change (mean, 95% CI) was greater (P < 0.05) in the COPD (37 m, 95% CI: 33–41 m) and ILD (41 m, 95% CI: 27–55 m) cohorts compared with the bronchiectasis (22 m, 95% CI: 14–31 m) and asthma (19 m, 95% CI: 11–27 m) cohorts. Conclusions: Respiratory diagnosis influences the magnitude of the learning effect for the 6MWT. The findings support the recommendation of a practice 6MWT at baseline assessment in order to provide an accurate measure of the effects of rehabilitation on 6MWD.     

Pulmonary manifestations in inflammatory bowel disease: a prospective study

Background

Although pulmonary abnormalities have been recognized in patients with inflammatory bowel diseases (IBD), their prevalence and clinical significance are not known.

Aim

To study the prevalence and clinical significance of pulmonary abnormalities in patients with IBD.

Methods

Ninety-five non-consecutive patients with IBD (12 Crohn’s disease, 83 ulcerative colitis; mean age 41.9 [SD 13] years; 47 women) were prospectively studied from January 2007 to March 2010. Pulmonary function tests (PFT) and high-resolution CT (HRCT) chest were performed in them. PFT were compared to those in 270 healthy (control) subjects matched for age, sex and smoking status.

Results

Twenty-seven (28.5%) patients and 11 (4%) control subjects had abnormal PFT (p?Conclusion PFT and HRCT chest showed abnormality in about one-quarter of patients with IBD. A majority of patients with these abnormalities were asymptomatic.     

Socioeconomic deprivation, readmissions, mortality and acute exacerbations of bronchiectasis

Background: Bronchiectasis is known to cause significant morbidity in children in New Zealand. Little is known of the disease in adults. Aim: Our objective was to characterise a cohort of adults who presented to hospital with acute exacerbations of the disease. Methods: We retrospectively collected information on all exacerbations treated as inpatients from a single hospital in South Auckland, New Zealand during 2002. Results: We collected information on 307 exacerbations in 152 patients. Twenty‐seven per cent were of Maaori ethnic origin, and 44% Pacific. Seventy per cent lived in areas categorised as the 20% most deprived in New Zealand. Comorbid conditions were present in 80% of patients – most commonly chronic obstructive pulmonary disease, asthma, diabetes and cardiac disease. Seventy (46%) patients had at least one readmission and 32 patients (21%) died within 12 months of admission to hospital. Greater deprivation was associated with increased mortality at 12 months after admission after adjusting for other factors (OR 11, 95% CI 2.0–61, P= 0.006). In the subgroup who underwent high‐resolution computed tomographic scanning (93), increasing severity of bronchiectasis (modified Bhalla score) was associated with readmission within 12 months (P= 0.004), but not mortality (P= 0.419). Conclusions: We have shown that exacerbations of bronchiectasis in South Auckland are more common in patients who are predominantly of Maaori or Pacific descent and are socioeconomically deprived. Admission to hospital for an exacerbation is associated with high readmission and mortality rates.