A simple, noninvasive clinical predictive rule has been developed to guide clinical diagnosis for the difficult-to-assess disease called hypersensitivity pneumonitis. Canadian researchers presented data on 400 patients from seven clinical sites in different countries to develop a predictive rule that distinguishes those with the disease. Among the group, there were 116 patients with hypersensitivity pneumonitis (HP) and 284 without the disease. Of the 116 patients with HP, 71 had pigeon breeder's/bird fancier's disease and 25 had farmer's lung. The rule was tested on 261 additional patients to verify its accuracy. HP involves inflammation in the tiny air sacs of the lungs (alveoli) that is caused by an allergic reaction to inhaled organic dusts and occasionally, chemicals. After exposure, the lungs become inflamed and white blood cells accumulate in the walls of the alveoli. If a person has developed hypersensitivity to a specific organic dust, a fever, cough, chill, and shortness of breath typically appear 4 to 8 hours after exposure. The researchers point out that diagnosis of the disease is difficult and often relies on invasive tissue pathology. After identifying appropriate individual components of the history, physical examination, and basic laboratory results, the investigators said that the rule they developed could reduce the number of unnecessary invasive procedures, including surgical biopsy, in patients with typical characteristics of the disease. The study appears in the second issue for October 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
MANAGEMENT OF PULMONARY INFECTIONS IN CYSTIC FIBROSIS
Inhaled antibiotics are being used by over 60 percent of U.S. patients with cystic fibrosis (CF) who have tested positive to the most significant pathogen affecting those with CF. The advantages of the technique involve direct delivery of high-dose antibiotics to an individual's bronchial space and limited systemic absorption and toxicity. These details are part of a comprehensive "State of the Art" article on the "Pathophysiology and Management of Pulmonary Infections in Cystic Fibrosis." The report is published in the second issue for October 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine. CF is a hereditary disease that causes certain glands to produce abnormal secretions. The trait for the disease is recessive and requires two genes to produce illness. When two genes are abnormal, chloride and sodium transport across cell membranes is disrupted, leading to dehydration and increased stickiness of secretions. As part of the disease process, the mucus-producing glands in the lungs produce abnormal secretions that clog the airways and allow bacteria to grow. Across the U.S. population with CF, the average decline in lung function test scores is 2 percent per year. CF is the most common life-shortening genetic disorder in the white population. In the U.S. in 2001, the estimated median age to death for CF victims was 34.4 years, up six years from 1996. The authors point out that appropriate antibiotic therapy directed against bacterial pathogens isolated from the respiratory tract is an essential component of the management of CF lung disease. The articles notes that some initial studies with gene therapy have been encouraging, but significant barriers remain before efficient delivery and long-term expression of the transgene in the airway is achieved.
For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For either contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news e-mail list, contact Cathy Carlomagno at 212-315-6442, or by e-mail at ccarlomagno@thoracic.org
Journal
American Journal of Respiratory and Critical Care Medicine