Respiration; international review of thoracic diseases
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Although restriction is considered the classic pulmonary function profile of asbestosis, studies suggest that obstruction of the peripheral airways not revealed by standard spirometry is equally frequent and indicative of peribronchiolar fibrosis. We recorded flows and volumes from maximal expiratory flow volume (MEFV) curves, closing volume data and the phase III slope of the alveolar plateau for 610 litigants, 575 men and 35 women, exposed to asbestos for varying periods in a single workplace in northern New Jersey. Smokers (260) included current smokers and subjects who had stopped within the previous 10 years; nonsmokers (350) had either never smoked or had given up for more than 10 years. ⋯ Compared to predicted, smokers and nonsmokers had significantly higher closing capacities (p less than 0.01) and delta N2% (p less than 0.001) means, and lower forced vital capacity (FVC), forced expiratory volume for the first second (FEV1.0, maximal expiratory flow rate (MEFR) and peak expiratory flow rate (PEFR) functions (p less than 0.05); the flow rate after 75% of the FVC had been exhaled (FEF75%) values were significantly reduced (p less than 0.01) only for workers exposed for more than 30 years. The change from predicted was significantly more rapid for smokers, compared with nonsmokers, for FVC, FEV1.0, PEFR, MEFR and FEF75% means, while the increase in closing capacity (CC) was twice as rapid for nonsmokers and the two groups did not differ in their mean rates of rise for delta N2%. CC and the slope of the alveolar plateau appeared to be the measures best able to discriminate between the data for both smoking and nonsmoking asbestos workers and their lung function prediction means.(ABSTRACT TRUNCATED AT 250 WORDS)
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The applicability of nasal challenge for etiologic diagnosis of extrinsic asthma was evaluated by assessing easiness of performance, precision, and cost of a standardized test by metered nebulizer in 20 asthmatics with and without concurrent rhinitis submitted also to skin prick tests and RAST. Although less sensitive than in the group with rhinitis (where precision was 90.4%), the nasal provocation test proved to be an easy, inexpensive, and specific (82.3%) means for contributing to the identification of allergic sensitization in patients affected by asthma alone.
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The cough reflex in anaesthetized rabbits was elicited by irritation of the larynx with ammonia, inhalation of ammonia into the lungs, and mechanical stimulation of the tracheobronchial tree with a catheter. After block of lung stretch receptors with sulphur dioxide and virtual abolition of the Breuer-Hering inflation reflex, the cough response to all three stimuli was far less frequent and, when it occurred, was weaker especially with respect to the expiratory efforts. It is concluded that the Breuer-Hering reflex enhances the cough reflex, although modification of the sensitivity of tracheobronchial cough and irritant receptors by sulphur dioxide may also influence the cough.
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Case Reports
Uncontrollable life-threatening status asthmaticus--an indicator for termination of pregnancy by cesarean section.
Two pregnant women with severe status asthmaticus unresponsive to intensive medical treatment are reported. Termination of pregnancies by cesarean section was followed by a dramatic improvement within 24 h. Termination of pregnancy is indicated in life-threatening status asthmaticus.
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Case Reports
Hypersensitivity pneumonitis concomitant with acute airway obstruction after exposure to hay dust.
The case of a non-atopic farmer who had developed severe respiratory as well as systemic symptoms upon exposure to hay dust during the past several years is presented. Inhalation challenge by his own hay induced an unusual association of peripheral and central airway obstruction beginning immediately, and hardly susceptible to therapeutic control, as well as the typical hypersensitivity pneumonitis reaction several hours later. ⋯ Only minimal aspergillus-specific IgE antibodies were found in the patient's serum. This case demonstrates that hay dust can cause bronchial obstruction as well as hypersensitivity pneumonitis in the same individual, with symptoms beginning immediately and lasting up to 2 days.