Respiration; international review of thoracic diseases
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Comparative Study
Substance P-immunoreactive nerves in endobronchial biopsies in cough-variant asthma and classic asthma.
Unlike classic asthma, cough-variant asthma does not show any evidence of airway obstruction. The main symptom is a dry cough with little known pathophysiology. Hypersensitivity of the cough receptors in cough-variant asthma and an increase in the sensory nerve density of the airway epithelium in persistent dry cough patients have been reported. Therefore, it is possible that there is a higher sensory nerve density in cough-variant asthma patients than in classic asthma patients. ⋯ It is possible that a sensory nerve abnormality within the airway may be related to hypersensitivity of the cough receptor, and that this may be one of the pathophysiologies of cough-variant asthma.
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The new guidelines of the Global Initiative for Obstructive Lung Disease (GOLD) propose a novel staging system for COPD. This study describes the frequency distribution of GOLD stages in newly diagnosed COPD patients in a large city pulmonary practice. ⋯ The majority of COPD patients seek medical advice at advanced disease stages, and smoke actively despite severe symptoms and functional impairment. However, nearly every second patient presents at stages 0-1, thus opening a window for therapeutic or behavioral intervention. GOLD guidelines are a useful basis to reinforce screening programs aimed at early detection and prevention of progressive COPD in individuals at risk and smoking cessation.
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Following strenuous exercise, in vivo diaphragmatic strength has been reported to decrease. This decrease has been suggested to result from an increase in metabolic by-products of intense exercise. ⋯ This study suggests that physiological NH(3) concentrations do not adversely affect in vitro diaphragmatic contractility, fatigue, or recovery. These data are not consistent with diaphragmatic fatigue associated with exercise induced by arterial concentrations of NH(3) seen in humans, although further testing in situ or in vivo is needed.
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A case of a 30-year-old woman with a double-barrelled aorta misdiagnosed as asthma is presented. The patient was significantly improved after surgical treatment but a degree of airway symptoms persisted. ⋯ The paediatric experience with managing tracheomalacia is briefly reviewed and recommendations for the treatment of the rare adult cases are made. Our report emphasises the importance of early diagnosis and treatment of aortic arch abnormalities.