Current opinion in pulmonary medicine
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Air pollution is associated with adverse health effects. Much of the recent literature, which is the focus of this review, has concentrated on identifying individuals at risk and on the health effects of mixed pollutants. For indoor air, new analyses continue to support the notion that the risk of residential radon exposure is low and that environmental tobacco smoke may cause respiratory symptoms and dysfunction in adults, especially asthmatic adults, as well as in children. ⋯ Ozone may increase the sensitivity of asthmatic patients to allergens. Increased morbidity in association with increasing particulate matter levels gives coherence to the argument that the relationship between particulate matter and mortality is causal. However, other investigators note the tight associations among outdoor pollutants and consider particulate matter a marker of air pollution levels.
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Bronchiolar lesions continue to be increasingly recognized as a cause of airflow obstruction. Thus, it is important to have a current update of the current clinical, radiographic, and immunologic perspective of these disorders. Diffuse panbronchiolitis has been reported to occur in the United States and Europe, and the anti-inflammatory action of erythromycin appears to be effective in management. ⋯ Lung transplantation bronchiolitis obliterans continues to be the major complication and cause of mortality in transplant recipients. Risk factors of this form of chronic rejection include more frequent and more severe acute rejection and the coexistence of organizing pneumonia. The recognition of the distinctive differences among the bronchiolar airflow disorders continues to be essential for improved patient care, greater understanding of the pathogenesis, and development of therapeutic advances.