Respiration; international review of thoracic diseases
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We report 7 patients with severe acute asthma unresponsive to standard medication, including sympathomimetic agents, aminophylline and corticosteroids, who responded to inhaled frusemide. All were hypercapneic with a mean PaCO2 of 7.7 kPa (57.7 mm Hg) [range 6.2-8.8 kPa (46.2-66.3 mm Hg)]. ⋯ No adverse effect was recognized. Inhaled frusemide should be considered for treatment of acute asthma refractory to conventional therapy.
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Comparative Study
Features of idiopathic pulmonary fibrosis with organizing pneumonia.
To characterize the clinical features of patients with idiopathic pulmonary fibrosis (IPF) having organizing pneumonia (OP), we retrospectively reviewed the clinical charts, chest X-rays, CT scans, and transbronchial lung biopsy (TBLB) specimens of patients with IPF. Patients with IPF and OP had a subacute onset of symptoms (within 2 months) (87.5%), leukocytosis (> 10,000/mm3) (62.5%), and a strong C-reactive protein (CRP) reaction (> 3+) (75%). Some of these features were distinctly different from those of IPF patients without OP (subacute onset of symptoms 0%, leukocytosis 0%, strong CRP reaction 16.7%). ⋯ Clinical features of IPF patients with OP differed from those of patients with IPF without OP. IPF patients with OP showed good clinical response to corticosteroid therapy. These findings warrant further study of the presence of OP in TBLB specimens in predicting corticosteroid responsiveness and prognosis of patients with IPF.
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The clinical utility of the newly developed pressure swing adsorption (PSA)-type oxygen concentrator with a membrane humidifier that does not require added water for humidification was evaluated in 13 patients with chronic pulmonary disease who were receiving long-term oxygen therapy. PaO2 and the relative humidity were measured when the patient breathed air and oxygen from the new device via a nasal cannula. After using the new concentrator for 5 h, the patients were asked whether they experienced dry nasal passages or a dry throat. ⋯ A significant difference was observed between the relative humidity of room air (44.7 +/- 18.6%) and that of the oxygen flow (72.7 +/- 14.8%) from the new device. None of the patients experienced dry nasal passages, dry throat, or any other adverse effects. Since this new PSA-type oxygen concentrator with a membrane humidifier supplies well-humidified nasal oxygen without water, laborious cleaning of the container and changing of the water are not necessary, and may help to improve the patient's quality of life.
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Streptococcus milleri mediastinitis had resolved in a 44-year-old male after 3 weeks of combined parenteral antibiotic therapy including clindamycin, which showed the greatest in vitro activity against S. milleri isolated from this patient, and surgical drainage. This case demonstrates that primary purulent mediastinitis may be caused by a strain of S. milleri with or without other bacterial species, and suggests that S. milleri should be added to the list of causative organisms of purulent mediastinitis even when the patient has not undergone a surgical procedure.
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Comparative Study
Lack of ventilatory threshold in patients with chronic obstructive pulmonary disease.
We investigated whether the ventilatory threshold (VET) could be detected in 25 patients with severe chronic obstructive pulmonary disease (COPD). Exercise on a treadmill was performed until symptom-limited maximum oxygen uptake (VO2SL) was obtained. VET was absent in 14 patients (56%, VET(-) group) and present in the others (44%, VET(+) group). ⋯ The changes in PaO2 and PaCO2 were not different between the two groups, but changes in pH and HCO3- in VET(+) were greater than those in VET(-). These results suggest that the absence of VET in some COPD patients indicates a lower exercise capacity without producing metabolic acidosis. This may be caused by rapidly developing dyspnea.