Introduction: Work-related asthma (WRA) is thought to be the most common occupational lung disease in the U.S., but there is no standard case definition of WRA. Most states, including Virginia, do not require WRA diagnoses to be reported to health departments. At present, there is too little epidemiological data on WRA in Virginia to direct public health planning efforts. Objectives: The first objective of this study was to estimate potential exposure to workplace asthma triggers in each of Virginia's 35 health districts. The second objective was to examine associations at the health district level between workplace asthma triggers, other asthma risk factors, and asthma prevalence in Virginia. The third objective was to identify the specific health districts in which workers face the highest risk of WRA. Methods: This ecological study required merging three datasets. Information on weight, age, race/ethnicity, income, gender, and histories of asthma diagnosis and smoking was obtained from the Behavioral Risk Factor Surveillance System (BRFSS) and aggregated at the health district level. Information from the Virginia Employment Commission on the location, industry, and number of employees of each business in the state was combined with data on the asthma triggers found nationwide in specific industries to calculate estimates of potential exposure to WRA triggers in each health district. Descriptive, correlational and multiple regression analyses were conducted, and health districts were sorted by asthma prevalence, or number of workplace triggers, or trigger-based multivariate models of WRA risk.Results: On average, there are 50,104 employees potentially exposed to five or more asthma triggers in workplaces per health district. The number of ever-diagnosed adult asthmatics was highly correlated with the number of workplace asthma triggers in a health district, as well as with all demographic and behavioral risk factors. A linear regression model including number of workplace triggers, number of obese adults, and number of adults with incomes below 200% of poverty accounted for 84% of the variance in health district asthma prevalence. There was little overlap (2 health districts) between the set of highest-risk health districts identified by this model and the set identified by a sort on asthma prevalence alone. Conclusion: The findings of this exploratory ecological analysis suggest that the number of asthma cases in a health district may be an insufficient indicator of health district risk of WRA. Additional WRA surveillance and epidemiological research on WRA may be warranted in the health districts shown in this study to be at highest risk of the disease.

Acute Respiratory Distress Syndrome (ARDS), an age-old clinical problem facing the Emergency Department and Intensive Care Units of all health systems, is a common debilitating lung condition consequent upon severe systemic inflammation. Although several studies have gone into understanding the epidemiology and pathogenesis of the disease thus making way for new advances in treatment strategies, there seems to be no known study tailored to its prevention. Neutrophil extravasation within the tissues during inflammation is the hallmark of this syndrome. Our study sought to block excessive neutrophil infiltration by inhibiting the biosynthesis of some essential proteins necessary for the process. In this initial study, neutrophil transmigration was successfully reduced by 66% using protein synthesis inhibitors, a combination of puromycin and anisomycin. Our strategy, if fine-tuned, could form the basis of a new clinical strategy for the prevention of ARDS.

A doença pulmonar obstrutiva crônica (DPOC) é uma doença progressiva e, que interfere na qualidade de vida (QV) de seus portadores. Foi identificado na literatura internacional um instrumento específico para medir a QV de pacientes com DPOC, o Seattle Obstructive Lung Disease Questionnaire (SOLDQ). É um instrumento com 29 itens que abordam quatro domínios: a função física, a função emocional, a habilidade de “coping" e a satisfação com o tratamento. Para o processo de tradução e validação do instrumento, foi utilizado o modelo proposto por GUILLEMIN (1995), que consiste das seguintes fases: tradução inicial do instrumento original; a retrotradução; revisão por comitê de juízes, pré teste e validação transcultural realizado por meio de análise da consistência interna e validação discriminante. O SOLDQ foi aplicado a 47 pacientes portadores de DPOC, assistidos no Ambulatório de Clínica Médica do HU-USP e em 48 indivíduos referidos como “sadios". Os resultados obtidos por meio do coeficiente alfa de Cronbach, para a verificação da consistência interna em cada domínio foram: função física = 0,94; função emocional = 0,64; habilidade de “coping" = 0,63 , nesse domínio foi excluída uma questão do instrumento original e satisfação com o tratamento = 0,72. O teste “t" de Student mostrou que há diferença estatiscamente significante entre as médias dos domínios: função física; função emocional e habilidade de “coping" entre os dois grupos estudados, definindo sua função discriminante em pacientes portadores de DPOC. O instrumento final SOLDQ validado para o português constitui-se de seis questões e 28 itens. / The chronic obstructive pulmonary disease (COPD) is a progressive disease and interferes in the quality of life (QoL) of the patients with disease. There is in the international literature a specific instrument to measure the patients' QoL. with COPD, the Seattle Obstructive Lung Disease Questionnaire (SOLDQ). It is an instrument with 29 items that approaches four domains: the physical function, the emotional function, the coping skills and treatment satisfaction. The model proposed by GUILLEMIN was used (1995) for the translation process and validation of the instrument. That consists of the following phases: translation of the original instrument, the back-translation, committee review, pre-testing and cross-cultural validity accomplished by means of analysis of the consistency interns and its validation discriminate. SOLDQ was applied to two different groups: 47 patient with COPD, attended in the out-standing patients of internal medicine of University Hospital, University of Sao Paulo and to 48 individuals referred as “healthy." The results obtained by means of the coefficient alpha of Cronbach, for the verification of the consistency intern in each domain were: physical function  = 0,94; emotional function = 0,64; coping skills = 0,63. In the domain coping skills were excluded one question of the original instrument and treatment satisfaction = 0,72. The test “t" of Student showed that there is a significant statistical difference in the averages of the domains: physical function, emotional function and coping skills between the two studied groups, defining its function discriminate in patients with COPD. The final instrument SOLDQ validity for the Portuguese idiomatic was of questions and 28 items.

Idiopathic pulmonary fibrosis (IPF) is an irreversible disease of unknown etiology that involves progressive scarring of the lung tissue, leading to respiratory failure and death.1 IPF is thought to develop from repetitive lung injury and aberrant wound healing that leads to the generation of fibrous tissue rather than restoration of normal tissue.2 It has been suggested in mice that vascular leak after lung injury contributes to the development of lung fibrosis.2,3 Gadofosveset is an intravascular enhancing, gadolinium-based contrast agent used with magnetic resonance imaging (MRI) to assess a variety of biological processes in vivo because it can reversibly bind to albumin.13-14 Gadofosveset has been used to assess endothelial permeability and function, as it diffuses through the vessel walls via leaky neovessels and damaged endothelium.15 Our research group has developed a new method to assess disease activity in IPF patients using gadofosveset-enhanced lung MRI. In unpublished work, we have demonstrated that this technique can be used to generate an albumin extravasation index (AEI), and we have found that this is significantly and diffusely increased in the lung of patients with idiopathic pulmonary fibrosis compared to healthy controls.16 The AEI is a measure of the change in signal intensity post-contrast minus pre-contrast in predefined regions of interest (ROIs) in the lung parenchyma divided by post- minus pre-contrast signal intensity in the ROI in the aorta. In this study, we compared the AEI in patients with IPF to healthy control (HC) subjects and evaluated the correlation between the AEI and high-resolution computed tomography (HRCT) and pulmonary function testing (PFT). We found that IPF subjects had increased AEI values compared with HC subjects. While not statistically significant, AEI was more strongly correlated with fibrosis (interstitial abnormalities) than ground-glass (alveolar abnormalities) on HRCT. Furthermore, there was a possible correlation between AEI and change in percent predicted forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and diffusion capacity of carbon monoxide adjusted for hemoglobin (DLCO) [Hb]. Our results demonstrate that AEI calculations from gadofosveset-enhanced lung MRI are a surrogate measure of vascular leak and can potentially serve as an alternative method for predicting the clinical course and severity of IPF through its correlation with fibrosis on HRCT and pulmonary function.

Lung disease affects tens of millions of Americans, making it one of the most common medical conditions in the United States. Many of these lung diseases are classified as chronic airway disease. Because of this, it is important to be able to catch the development early so as to begin treatment as soon as possible to delay the progression and subsequently monitor that progression. One method of doing so is the use of quantitative computed tomography (CT). Study of the airway anatomy can be quantified using such measures as minor inner diameter (MinD), major inner diameter (MajD), wall thickness (WT), inner area (IA), and outer area (OA). Changes in these measures can then be tracked over time to determine how the airways are being affected by disease. The challenge with the desired longitudinal imaging is that prolonged radiation exposure can be dangerous to the patient. In order to make longitudinal imaging more feasible, it is important to determine what quantitative measures can reliably be made at different radiations doses so as to optimize radiation dose and quantitative assessment. Working to make this determination, three different radiation doses were tested to evaluate their quantitative outputs. A high dose (14.98 mGy), medium dose (6.00), and low dose (0.74 mGy) were used to image six different porcine subjects. Images were collected at these doses both while the lungs were in-vivo and once the lungs had been fixed and excised ex-vivo. All of the scans were then processed using APOLLO (VIDA Diagnostics). From the complete airway trees, quantitative measures were collected from thirty-five airways. For the whole lung analysis, the medium and low dose in-vivo scans and the high dose ex-vivo scans were compared to the high dose in-vivo scans to compare assess MinD, MajD, WT, IA, and OA. Then, in order to determine how well the CT measures represent the actual anatomy, a total of thirteen cube samples containing airways were segmented from one of the lungs (based on volume analysis of the lung pre- and post-fixation and visual inspection). The cubes were imaged in CT, for the purpose of aiding in the establishment of original location and studying the effect of a narrowed imaging window, and microscopic CT (μCT). Since μCT can have a resolution on the scale of microns, the values measured in these images were considered ground-truth. The CT and μCT cubes were then registered to the high dose ex-vivo scan so as to compare the cube values with the ex-vivo values from each of the three doses. The same five measures were collected and analyzed. The MinD, MajD, WT, IA, OA were statistically analyzed between the three in-vivo radiation dose scan sets, the high dose in- and ex-vivo scans, and the µCT cube, CT cube, and the three ex-vivo radiation dose sets. Preliminary results for the in-vivo scans show that the low dose and medium dose scans can reliably (< 5% error) be used to evaluate airways with minor diameters between 3.42 mm and 10.34 mm and major diameters between 3.98 mm and 12.06 mm. Comparison of the high-dose in-vivo and ex-vivo scans showed that the fixation and excision of the lungs did not significantly affect the ex-vivo lungs' ability to be used as a model for the in-vivo lungs. Finally, analysis of the various forms of the ex-vivo airways showed that there were few statistically significant differences between the datasets. These results support the use of using the low (0.74 mGy) radiation dose when studying airway disease affecting airways with minor diameters between 3.42 mm and 10.34 mm and major diameters between 3.98 mm and 12.06 mm. They also show that the quantitative measures from CT are representative of the true measures of the airways.

Chronic pulmonary diseases include a wide range of illnesses that differ in etiology, prevalence, symptomatology and available therapy. A common link among these illnesses is their impact on patients’ vital function of breathing, high symptom burden and significantly impaired quality of life. This dissertation research evaluates disease severity, symptom burden and health behaviors of patients with three different chronic pulmonary conditions. First, alpha-1 antitrypsin deficiency (AATD) is an inherited condition that typically is associated with an increased risk of early onset pulmonary emphysema. This study examines differences in demographic, health, and behavioral characteristics and compares clinical outcomes and health related behaviors and attitudes between two severe genotypes of AATD - ZZ and SZ. The findings of the study suggest that patients with SZ genotype and less severe form of deficiency report higher number of exacerbations, comorbidities, as well as unhealthy behaviors such as lack of exercise and current smoking. In addition, individuals with the more severely deficient ZZ genotype are more adherent to disease management and prevention program recommendations and maintain a healthier lifestyle than individuals with SZ genotype. Second chronic lung disease examined in this research was chronic obstructive pulmonary disease (COPD), the fourth leading cause of death and second leading cause of disability in the United States. Prevalence and burden of cough and phlegm, two of the most common symptoms of the COPD, were assessed among participants of the COPD Foundation’s Patient-Powered Research Network (COPD PPRN). In addition, association between patient-reported levels of phlegm and cough, clinical outcomes and patients’ quality of life were evaluated. Participants’ quality of life was assessed using Patient Reported Outcome Measurement Information System instrument PROMIS-29. Association between changes in symptom severity over time and patient-reported quality of life were examined. Findings of this study indicated that severity of cough and phlegm were associated with higher number of exacerbations, greater dyspnea, and worsened patient-reported quality of life including physical and social functioning. Improvement in cough and phlegm severity over time was associated with better patient-reported quality of life. Third pulmonary illness described in this dissertation is non-cystic fibrosis bronchiectasis (NCFB), a rare and etiologically diverse condition characterized by dilated bronchi, poor mucus clearance and susceptibility to bacterial infection. Association between presence of Pseudomonas aeruginosa (PA), one of the most frequently isolated pathogens in patients with NCFFB, and disease severity was assessed utilizing enrollment data from the Bronchiectasis and NTM Research Registry (BRR). NCFB disease severity was evaluated using modified versions of validated in large international cohorts instruments, the Bronchiectasis Severity Index (BSI) and FACED. The findings of this study indicate that PA infection is common in NCFB patients, and presence of PA in patients’ sputum is associated with having moderate and high severity of bronchiectasis. In addition, the results of this study suggest that the two severity assessment instruments classify patients with NCFB differently which may be attributed to a greater number of severity markers utilized in the calculation of the BSI compared to FACED. In conclusion, the proposed dissertation aims to enhance understanding of differences in health outcomes between genotypes of AATD within AlphaNet registry, and to guide future health-promoting behaviors. It highlights the burden of common symptoms such as cough and phlegm in patients with COPD within COPD PPRN and their association with patients’ quality of life. In addition, it introduces modified indices of NCFB severity and emphasizes high burden of the disease in patients with presence of PA within the US BRR.

An estimated 14 million people in the United States currently have chronic obstructive pulmonary disease (COPD). This nonreversible illness causes progressively decreasing airflow and is manifested by frequent episodes of acute and chronic dyspnea. The purposes of this study were: 1) to examine the relationships between mastery (MS), negative affectivity trait (NA), perceptions of patient dyspnea severity (DSI), and perceptions of which dyspnea interventions are effective (DE) among family caregiver-COPD patient dyads and 2) to examine the degree of agreement between the dyad members regarding dyspnea assessment and management. The study subjects were elderly (patients = 71.6 years, caregivers = 63.4 years), mostly women (patients = 60%, caregivers = 63.3%), Caucasian (96.7%), and patients had severe/very severe COPD (80%). No significant differences were found between family caregivers' and patients' ratings of MS, NA, DSI, or DE. The most effective dyspnea management strategies identified by both dyad members included changing activity, relaxation, inhaled medication use, and altering breathing pattern. The study conceptual model was tested to identify the interrelationships between the study variables. Significant effects in the patient model were between DSI and NA (p = 0.04), DE and gender (p = 0.04), DE and education (p = 0.015), and between DE and disease severity (p = -0.026). The caregiver model demonstrated no significant effects between the study variables. Significant effects in the dyad model were between DSI and the length of time caregiving had been provided (LOT, mean = 25.2 years) (p = 0.013), DE and DSI (p = 0.004), and between DE and LOT (p = 0.03). Gender, education, disease severity, LOT, and DSI influenced DE. Negative affectivity and LOT (mean = 25.2 years) influenced DSI. The findings of this study indicate that when the family caregiver of a patient with COPD is present, he or she is able to provide valid and reliable assessments of the patient's dyspnea severity. During acute exacerbations of dyspnea, persons with COPD are often unable to speak for themselves and these experienced family caregivers may be valuable partners with nurses and other healthcare providers to represent the patient's responses and needs.

Background: Physiological studies have shown that many preterm infants and infants with chronic lung disease may suffer chronic hypoxaemia, which possibly leads to poor growth and development. Anecdotal reports indicate that there is a drive to increase the oxygen saturation target range to a higher level in these infants due primarily to perceived benefits derived from clinical experience and from uncontrolled observational studies of babies discharged on home oxygen. Objective The BOOST (Benefits Of Oxygen Saturation Targeting) trial is the first randomised trial to assess the long-term benefits and harms of two different oxygen saturation target ranges. Methods: BOOST was a multicentre, double blinded, randomised controlled trial that enrolled 358 infants born at less than 30 weeks� gestation who remained oxygen-dependent at 32 weeks postmenstrual age. They were randomly assigned to target either a functional oxygen saturation range of 91-94% (standard or control group) or 95-98% (higher or treatment group). The primary outcomes were growth and neurodevelopmental measures at 12 months corrected age. Secondary outcomes included length of hospital stay, retinopathy of prematurity, health service utilisation, parental stress, and infant temperament. Results: Prognostic baseline characteristics did not differ between the two groups. Mean birth weight and gestational age of enrolled infants was 917g and 26.5 weeks respectively. The rate of antenatal corticosteroid use was 83%.

Bronchoalveolar lavage (BAL) is an established method providing diagnostic support and evaluation of disease activity in interstitial lung disease (ILD). The aims of the present investigation were 1) to study the inflammatory response in pneumonitis evoked by irradiation. 2) to evaluate how well lung tissue inflammation is reflected in BAL findings. 3) to study the effect of smoking on radiation-induced pneumonitis. BAL was performed in 21 patients (11 smokers, 10 non-smokers) who were treated for breast cancer, stage 1 (TjMaNq) by post-surgery irradiation to an accumulated target dose of 56 Gy. It was founa that irradiation induced an alveolitis in the non-smoking patient group while the smoking patients did not differ from their smoking controls. The alveolitis in non-smokers was characterized by an increase in lymphocytes, mast cells and elevated concentrations of hyaluronan (HA), and fibronectin (FN). Three of the non-smoking patients had chest X-ray infiltrates indicating the presence of pneumonitis. An animal experimental model for radiation-induced pneumonitis and fibrosis was established in rats, allowing comparative analysis of BAL fluid and morphology. In the rat model a divergence was noted between the differential cell counts in BAL and cells observed in the interstitial tissue, which was most notable for neutrophils (PMN) and mast cells whereas there was a good correlation between HA content in BAL and HA deposition in the lung tissue. A marked infiltration of intraseptally-located mast cells occurred during the pneumonitis-phase, and this increase was paralleled by a deposition of HA in the interstitial tissue. Histochemical fixation and staining properties of the mast cells revealed that the majority of these cells were of connective tissue mast cell type (CTMC). Compound 48/80, a mast cell secretagogue, significantly altered the HA content both in BAL and in lung tissue in the irradiated animals. Regular treatment throughout the whole experimental period induced depletion of mast cell granules and a decrease in HA deposition whereas 48/80 treatment during the pneumonitis phase enhanced HA deposition. A rat model with smoke exposure was developed, and the effect of cigarette smoke on radiation-induced inflammation was studied. Rats that smoked 3 weeks prior to irradiation and continued to smoke throughout the observation period (7 weeks) had a significantly reduced inflammatory response compared to irradiated non-smoking rats. The most prominent BAL findings in the smoke-exposed rats were a decrease in PMN, mast cells and a decrease in HA. In conclusion, irradiation induces an alveolitis characterized mainly by mononuclear cells. Mast cells seem to be of importance in the remodelling of the connective tissue in the radiation-induced inflammatory response. Hyaluronan is an important component in the early connective tissue response preceding later collagen deposition, and its interstitial deposition is very well reflected in BAL. Moreover, tobacco-smoke suppresses the radiation-induced inflammation with a decreased recruitment of effector cells including mast cells. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1992, härtill 5 uppsatser.</p> / digitalisering@umu

Lėtinė obstrukcinė plaučių liga pasireiškia nevisiškai išnykstančia kvėpavimo takų obstrukcija, kuri įprastai progresuoja ir sutrikdo kvėpavimo takų pralaidumą bei dujų apykaitą plaučiuose ir audiniuose. Pasaulinės sveikatos organizacijos (PSO) duomenimis lėtine obstrukcine plaučių liga serga apie 600 mln. žmonių. Lietuvoje statistikos duomenimis 2012 metais sirgo apie 60 tūkstančių žmonių. Šie skaičiai verčia jieškoti lėtinės obstrukcinės plaučių ligos problemų sprendimo būdų. Vienas iš tokių būdų yra plaučių ligomis sergančiųjų reabilitacija. Moksliniais tyrimais įrodyta, kad efektyviausia reabilitacija yra tuomet , kai ji pradedama iš karto po ligos paūmėjimo. Garsų mankšta mažina bronchų reaktyvumą ir bronchospazmą, aktyvūs kvėpavimo pratimai stiprina kvėpavimo raumenis, gerina atsikosėjimą, stiprina kvėpavimo raumenis bei skatina širdies ir kraujagyslių veiklą, o tuo pačiu ir plaučių kraujotaką. Tyrimo tikslas : Įvertinti skirtingų kineziterapijos metodų efektyvumą gydant sergančiuosius lėtine obstrukcine plaučių liga ūmiu ligos laikotarpiu. Uždaviniai : 1. Išanalizuoti tiriamųjų rizikos veiksnius, būdingus lėtinei obstrukcinei plaučių ligai. 2. Įvertinti tiriamųjų dusulio laipsnį. 3. Nustatyti tiriamųjų plaučių ventiliacijos rodiklius, kraujo spaudimo bei krūtinės ląstos ekskursiją prieš ir po kineziterapijos. 4. Palyginti tiriamųjų, kuriems buvo taikyta garsų mankšta ir tiriamųjų, kuriems buvo taikyti aktyvūs kvėpavimo pratimai, visus... [toliau žr. visą tekstą] / The chronic obstructive lung disease is characterized by presence of airways obstruction which, as a rule, would be progressing and disturbing airflow passing and gas exchange in lungs and tissues. According to the World Health Organisation (WHO) data approximately 600 million people suffer from chronic obstructive lung disease. The Lithuanian statistic data show that in 2012 about 60 thousand Lithuanian residents had this disease. The above figures make us look for solutions to the problems created by chronic obstructive lung disease. One of the ways is rehabilitation of patients with lung diseases. The scientific research proved that the rehabilitation was most efficient when commenced immediately following exacerbation of the disease. Speech-language exercises reduce bronchi reactivity and bronchospasm, active breathing exercises strengthen the breathing muscles, improve expectoration, strengthen breathing muscles and stimulate better heart and blood vessels performance at the same time resulting in better blood circulation in lungs. Goal of the study: to assess the effectiveness of different physiotherapy methods in treatment of chronic obstructive lung disease in the acute stage. Objectives: 1. to analyse the risk factors in patients under study typical of the chronic obstructive lung disease; 2. to evaluate the degree of dyspnoea in patients under study; 3. to establish lung ventilation, blood pressure and thorax excursion values in patients... [to full text]