American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Feb 1996
Early detection of lung involvement in lysinuric protein intolerance: role of high-resolution computed tomography and radioisotopic methods.
Pulmonary disease of unknown etiology is a potentially fatal complication in patients with lysinuric protein intolerance (LPI), an autosomal recessive disorder caused by the defective transport of cationic amino acids. Lung involvement was investigated in nine Italian LPI patients through pulmonary function tests and lung imaging studies consisting of conventional chest radiography, high-resolution computed tomography (HRCT), and perfusion and ventilation scintigraphy. One 10-yr-old patient died of severe respiratory insufficiency from alveolar proteinosis. ⋯ Radioisotope studies showed an uneven distribution of perfusion and ventilation, and confirmed the presence of segmental and/or diffuse pulmonary functional defects. No abnormalities of pulmonary function were evident, and answers to a questionnaire excluded primary coexisting lung disease. In patients with LPI, including those without clinical and functional impairment, HRCT and radioisotopic studies appear to be the most sensitive methods for the early diagnosis of lung disease and correct assessment of its progression.
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Am. J. Respir. Crit. Care Med. · Feb 1996
Comparative StudyDifferences in interleukin-8 and tumor necrosis factor-alpha in induced sputum from patients with chronic obstructive pulmonary disease or asthma.
Asthma and chronic obstructive pulmonary disease are characterized by chronic airway inflammation. Studies using bronchoalveolar lavage (BAL) have shown an increased proportion of eosinophils in the BAL fluid from asthmatics compared with that from normal subjects, whereas studies of chronic obstructive pulmonary disease (COPD) have shown increased numbers of neutrophils. Induced sputum allows sampling of respiratory tract secretions from patients and control subjects, providing a noninvasive method of studying airway secretions and allowing characterization of cells and measurement of soluble markers. ⋯ We found a significant increase in neutrophils and increased concentrations of tumor necrosis factor-alpha (TNF alpha) and interleukin-8 (IL-8) in the patients with COPD compared with the smoking and nonsmoking control subjects. Interleukin-8, but not TNF alpha, was significantly higher in the COPD group than in the asthmatic group. We conclude that the cytokines TNF alpha and IL-8 may be involved in the inflammation in COPD.
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Am. J. Respir. Crit. Care Med. · Jan 1996
Comparative StudyResource use implications of do not resuscitate orders for intensive care unit patients.
This study describes the use of do not resuscitate (DNR) orders for ICU patients in four northeastern U. S. teaching hospitals and investigates the relationship between DNR orders and length of stay. The use of detailed data from the mortality probability model (MPM II) study on 6,290 consecutive ICU admissions to general adult medical and surgical ICUs during 1989 through 1991 allows us to control for severity of illness and the time during the ICU stay at which the DNR order was entered. ⋯ Nonsurvivors with early (first 24 h) DNR had shorter mean and median ICU and hospital stays than the comparison group of non-DNR patients. The percentage of patients with very long ICU (> 30 d) and hospital (> 60 d) stays was smaller among DNR patients. The use of DNR orders, particularly early in the ICU stay, may be associated with significant resource use reduction for an identifiable group of patients.
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Am. J. Respir. Crit. Care Med. · Jan 1996
Comparative StudyNocturnal saturation improves by target-flow inspiratory muscle training in patients with COPD.
Nocturnal desaturations during rapid eye movement (REM) sleep, caused by nonobstructive hypoventilation, occur frequently in patients with chronic obstructive pulmonary disease (COPD). This is partly caused by decreased activity of the intercostal and accessory muscles due to a lower motor command. The diaphragm has to compensate for the diminished activity of these muscles during REM sleep. ⋯ PImax, Pdi, SIPmax, and the endurance time as well as the nocturnal saturation improved significantly in the 60% training group (by 3.0 +/- 1.5 kPa, 3.4 +/- 1.9 kPa, 1.5 +/- 1.4 kPa, 189 +/- 149 s, and 1.9 +/- 2.2%, respectively), whereas no changes occurred in the sham training group. Also, significant correlations were observed between the changes in Pdi, SIPmax, and endurance time on the one hand and the change in nocturnal saturation on the other. We conclude that TF-IMT improves the nocturnal saturation in patients with severe COPD by increasing respiratory muscle strength and endurance.
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Am. J. Respir. Crit. Care Med. · Jan 1996
Comparative StudyEnvironmental tobacco smoke, wheezing, and asthma in children in 24 communities.
The association of exposure to environmental tobacco smoke (ETS) at home with asthma and several measures of wheeze was examined among 11,534 children aged 8 to 11 yr in 24 communities in the United States and Canada in 1988 through 1990. Information on the child's respiratory symptoms in the past year and history of exposure to ETS was provided by the child's mother on a questionnaire. After adjusting for potential confounders, children currently exposed to ETS were at greater risk of wheezing with colds (odds ratio [OR] = 1.7; 95% confidence interval [95% CI], 1.4 to 1.9), going to a hospital emergency room for wheeze (OR = 1.6; 95% CI, 1.2 to 2.2), and having persistent wheeze (OR = 1.4; 95% CI, 1.1 to 1.8). ⋯ In contrast to wheeze symptoms, active doctor-diagnosed asthma and asthma medication use were not significantly associated with ETS exposure at home, possibly reflecting underdiagnosis of asthma, reporting bias, or smoking cessation by parents whose child is labeled asthmatic. We conclude that exposure to ETS is associated with wheezing symptoms, medical therapy for wheezing, and wheezing-related emergency department visits in U. S. and Canadian children.