Tanaffos Respiration Journal
Volume:11 Issue: 2, Spring 2012

Extracellular ATP is a signaling molecule which plays an important role in alerting the immune system in case of any tissue damage. Recent studies show that binding of ATP to the ionotropic P2X7 receptor of inflammatory cells (macrophages and monocytes) will induce caspase 1 activation. Stimulation of caspase 1 activity results in maturation and release of IL-1b in the inflammasome in Chronic Obstructive Pulmonary Disease (COPD) patients. COPD is an inflammatory disease characterized by emphysema and/or chronic bronchitis and is mostly associated with cigarette smoking. It is one of the leading causes of death in humans and there is currently no medication to stop the progression of disease. A deeper understanding of the mechanism by which the P2X7 receptor triggers IL-1b maturation and release, may open new opportunities for the treatment of inflammatory diseases such as COPD.

The present review discusses the role of tri-peptide Proline –Glycine -Proline (PGP) as a potential player, biomarker and therapeutic target in this process.

Due to current controversies regarding the effect of age on response to treatment in asthmatic patient, the present study was performed on patients referred with acute asthma attack for further evaluation of this matter. In this study 138 patients with severe persistent asthma were enrolled and divided into two categories of young (age ≤35 yrs; 82 cases, mean age = 25.2±7.3 years) and elderly subjects (≥50 yrs; 56 cases, mean age 57.4±6.4 years). Response to treatment was determined by pulmonary function tests. The mean percentage change of FEV1 from baseline in male and female patients of young and old age was 75.05±46.61 and 71.39±41.30%, (P=0.721) and 100.79±51.34% and 69±37.39% (P=0.015), respectively. The mean percentage of possible improvement of FEV1 among male and female patients of young and old age was 62.81±25.67% and 54.46±23.82% (P=0.148), and 78±24.04% and 63.58±41.24% (P=0.087); respectively. Response to treatment was significant in both young and old age groups suffering from acute asthmatic attack except for young female patients in which, percentage change of FEV1 increased compared to older patients. Among other patients this value and percentage of possible improvement of FEV1 between the 2 groups did not change significantly and age did not play a significant role in assessing the response to treatment in acute asthmatic attack.

COPD is a major cause of morbidity in smokers. The COPD assessment test (CAT) is a validated test for evaluation of COPD impact on health status. CAT is not a diagnostic test and pulmonary function test (PFT) still remains the most important diagnostic test. However, its predictive value for evaluation of disease impact is weak. The purpose of this study was to determine the relationship between CAT score and PFT in COPD patients. We evaluated 105 patients with stable COPD.Demographic data were obtained at baseline. Severity of airflow obstruction was assessed by standard spirometry and classified by the Global initiative for Obstructive Lung Disease (GOLD) criteria. Then, the impact of COPD on health status was assessed using CAT. The CAT scores were categorized into four groups. We statistically compared the relationship between CAT score, COPD stages, CAT groups and PFT. The mean age of patients and mean period of smoking (p/y) were 59.60±11.93SD and 35.43±15.33 SD yrs, respectively. The mean FEV1%predicted was 71.01±26.70SD.The mean CAT score was 19.61±8.07 SD. The correlation between the severity of smoking and GOLD classification was significant (p=0.006).There was a significant association between the FEV1%predicted and total CAT score (r= -0.55, p< 0.001). The correlation between mean FEV1%predicted and mean score of CAT groups 1,2, 3, and 4 was statistically significant (p<0.001). The relationship between CAT score and FEV1%predicted suggests that CAT is linked to severity of airflow limitation and GOLD classification in stable COPD patients. Health status as measured by CAT worsens with severity of airflow limitation.

This study aimed at evaluating the outcome of surgery for bullous lung disease by comparing the preoperative and postoperative subjective dyspnea score, pulmonary function and clinical features. This prospective study was conducted from May 2009 to October 2011, on 54 patients operated for bullous lung disease. Follow-up at 3-6 months consisted of taking a comprehensive history, physical examination, radiological work-up, and evaluation of changes in subjective dyspnea score, arterial blood gas analysis (ABG), and pulmonary function test (PFT). After comparison with preoperative values, the student’s paired t-test was used to calculate the statistical significance. With approximately 21.6 cases per year, the most common underlying lung pathology was primary bullous lung disease, followed by COPD. The most common presenting complaint was spontaneous pneumothorax in tall young adults in their fourth decade of life with a history of smoking. Bullectomy, with or without decortication, was done for all cases. Improvement in mean PaO2 (arterial partial pressure of oxygen), SaO2 (arterial oxygen saturation) and PaCO2 (arterial partial pressure of carbon dioxide) was seen in most cases but was statistically insignificant. Improvement in mean FEV1 (forced expiratory volume in 1st second), FVC (forced vital capacity) and FEV1 / FVC was statistically significant, with FEV1 being the most reliable indicator of postoperative progress. Improvement in subjective dyspnea score was statistically significant and showed an inverse correlation with FEV1. Those with diffuse pulmonary parenchymal involvement had poorer baseline values and less significant postoperative improvement. Complications occurred more commonly in those with diffuse disease. Mortality was seen exclusively in those with diffuse disease. We conclude that surgery is required for bullous lung disease more frequently in our community since we have a high number of young patients with primary bullous lung disease and localized parenchymal involvement and these patients have a good surgical outcome. Potentially fatal complications like pneumothorax and recurrent infections can therefore be prevented in them. Those with underlying diffuse disease and severely decreased FEV1 (especially below 1 L) also benefit from surgery but require careful patient selection.

The objective of this study was to discuss the spirometric characteristics of anthracofibrosis which is a from of bronchial anthracosis associated with deformity. Forty anthracofibrosis subjects who were diagnosed with bronchoscopy were enrolled in this prospective study. Static and dynamic spirometry plus lung volumes and diffusion capacity were measured in this group and compared to a healthy control group. Dyspnea (95%), cough (86%) and wheezing (68%) were the most frequent clinical findings. Spirometry showed significant decrease in all parameters including VC (FVC), FEV1, FEV1/FVC, FEF25-75 and FEF25-75 /FVC. The low value of FEV1/FVC and FEF25-75 and the increment of RV were in favor of obstructive patterns in 95% of subjects. Improving the obstruction with bronchodilator was not significant and diffusion capacity was mostly normal. Anthracofibrosis should be added to the list of chronic obstructive pulmonary diseases.

Production process of most factory-made products is harmful to our health and environment. Silica is the most important stone used in stone cutting factories. Numerous researches have reported respiratory diseases due to the inhalation of these particles in various occupations. Silicosis is a disease with typical radiographic pattern caused as the result of inhalation of silica particles. According to the intensity of exposures and onset of initiation of clinical symptoms silicosis is classified into three groups of acute, chronic and accelerated forms. The present study evaluated silicosis among stone cutter workers. This cross sectional study was performed on stone cutter workers in Malayer city (Azandarian) between 2008 and 2009. Respiratory data of our study participants were collected with a respiratory questionnaire and performing spirometry tests and chest radiography. Among our participants, 16 silicosis cases were diagnosed by radiographic changes. Among them, 10 workers had exposure for more than three years and 6 workers were smokers. Eleven workers had an abnormal radiographic pattern on their chest x-rays. Seven workers had obstructive and 4 workers had restrictive spirometric patterns. Prevalence of silicosis was high among our understudy workers and preventive strategies are required to control it.

Central airway stenosis may be a manifestation of benign or malignant lesions and can be a life threatening condition.There are different surgical and endoscopic modalities for treatment of these lesions. Balloon bronchoscopy is an interventional pulmonologic modality and can be performed under direct vision or fluoroscopic guidance. This technique can be used along with other interventional modalities for treatment of patients with tracheal stenosis.In this study we report balloon bronchoscopy as an interventional modality in a series of patients with tracheal stenosis and assess the outcome.

A 67- year old man presented with cough, weight loss and night sweats. Fiberoptic bronchoscopy did not show any abnormality. Chest computed tomography scan revealed peribronchovascular thickening, sheathing and narrowing of some bronchi. There were also mediastinal and interbronchial Lymphadenopathies. The patient became lost to follow-up. He presented 5 years later with pneumonia. Flexible bronchoscopy showed diffuse infiltration of the bronchi suggesting lung cancer. Histopathological study with histochemical staining revealed tracheobronchial tract AL amyloidosis. Chest CT-scan revealed extension of the broncho-vascular thickening and superimposed pulmonary calcified nodules and lymphadenopathies. Labial biopsy revealed AL amyloidosis. No specific treatment of amyloidosis was thought to be necessary for the patient. At 6 years follow-up the disease had not progressed. This case report highlights the fact that even very rarely, systemic AL amyloidosis can involve the tracheobronchial tract. Moreover, the lungs and the tracheobronchial tract can, although rarely, be affected in the same patient.

Celiac and splanchnic plexus blocks are considered as terminal approaches for pain control in end stage pancreatic cancer. It may be done temporarily (using local anesthetics) or as a permanent act (using alcohol and/or phenol). Like every other interventional procedure, celiac plexus block has its own potential complications and hazards among them pneumothorax and ARDS are very rare. In this case report we present an end stage patient with adenocarcinoma of ampulla of Vater with involvement of both abdomen and thorax who presented with severe intractable abdominal pain.Bilateral celiac plexus block in this patient resulted in left side pneumothorax and subsequent development of ARDS. We discuss the rare complications of celiac plexus block as well.

We report a case of a male child with a cystic mass in his left side of the neck with extension to the mediastinum. This article highlights the clinical and para-clinical findings and management of these cases.In conclusion, it is necessary to evaluate the mediastinum for extension of the cyst in cases with cystic hygromas of the neck. Surgical resection of the tumor through a cervical incision can be considered.

WHAT IS YOUR DIAGNOSIS?A man in his thirties was admitted due to new onset dyspnea, right-sided pleuritic chest pain and non-massive hemoptysis since 4 days before admission. On arrival, he was febrile and tachypneic with normal blood pressure. Bibasilar decreased breath sounds and vocal vibration, prominently in the right lung, and 2cm difference in diameter of the left leg were the remarkable findings. Blunting of the right costophrenic angle was prominent on chest x-ray. Laboratory analysis revealed normal blood cell count, elevated erythrocyte sedimentation rate (125 mm/hr.) and positive quantitative D-Dimer. Blood biochemistry and coagulation profile and urinalysis were normal.Anticoagulant was initiated with presumptive diagnosis of pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT). Doppler ultrasonography (DUS) and pulmonary computed tomographic angiography (CTA) were performed. DUS was normal, but right sided pulmonary artery embolus was confirmed with CTA (Figures 1 and 2). Interestingly, DUS revealed DVT in the right popliteal artery. Echocardiography was normal.Despite anticoagulative therapy, dyspnea progressed and the patient’s general condition deteriorated. Pleural fluid analysis showed lymphocyte dominant exudate.