Cause and evaluation of chronic dyspnea in a pulmonary disease clinic

Article Abstract:

Labored breathing, or dyspnea, is a common disorder often resulting from respiratory or cardiovascular problems and is characterized by coughing or wheezing. Physicians lack diagnostic information concerning chronic dyspnea. Researchers postulated that with more accurate diagnostic information pertaining to chronic dyspnea, specific therapy that would result in more effective treatment could be formulated. To test this hypothesis, 100 patients in a pulmonary outpatient clinic, diagnosed as having chronic dyspnea, were examined. The researchers concluded that the most accurate means of determining the cause of chronic dyspnea is the use of objective tests in conjunction with clinical impressions. Such an approach was diagnostically successful in 100 percent of the cases studied, compared with only a 66 percent diagnostic success rate when clinical impressions were the sole means of evaluation. It was also shown that a broad range of conditions, such as asthma and chronic obstructive pulmonary disease (COPD), were linked with chronic dyspnea. One of the best treatments is to direct therapy specifically toward the underlying cause. Such an approach accounted for an improvement in 76 percent of the patients. COPD, asthma, ILD (interstitial lung disease), and cardiomyopathy (diseases of the heart muscle) were responsible for two thirds of the cases of chronic dyspnea. Testing for these conditions should be performed initially unless evidence of other underlying conditions exists. ILD, which may indicate the cellular breakdown of lung tissue, is indicated by a crackling sound heard on lung examination using a stethoscope. Evidence of ILD may also be present on a chest X-ray. In general, when patients are seen for difficulty breathing spirometry, to measure air capacity of the lungs, should be the first diagnostic test performed, followed by a physical exam and an X-ray of the chest. Patients who lack a conclusive diagnosis after lung function tests and chest X-rays should undergo an exercise test to provide information concerning the pattern of physiologic lung impairment. An exercise test may differentiate between a respiratory and a cardiovascular cause of dyspnea. Researchers caution that determining the cause of dyspnea or measuring the response to treatment remains difficult to achieve.

Comparative analysis, Lung diseases, Pulmonary function tests, Respiratory tract diseases, Diagnosis

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Zirconium compound-induced pulmonary fibrosis

Article Abstract:

Pneumoconioses are chronic and progressive lung diseases that are caused by toxic substances. Some of the more well known causes of these types of lung diseases are asbestos and silica. Zirconium, a heavy metal used in making certain bricks and textiles, as well as in grinding optical lenses, has not previously been described as a cause of pneumoconiosis. A case of presumed zirconium-induced lung disease is described. A 62-year-old man complained of 25 years of progressive shortness of breath. He had been told in the past that he had emphysema, and had never received any treatment for his shortness of breath. In obtaining an occupational history from the patient, it was discovered that he had worked in the optical industry for nearly 40 years, grinding lenses. Lung function tests showed severe lung disease. A biopsy of his lungs revealed severe fibrosis, in which scar tissue had replaced normal lung tissue with a fibrous material, impairing his lungs' ability to expand and relax properly with each breath, and interfering with oxygen absorption. A large number of foreign particles were seen, which proved to be various zirconium compounds. The likeliest explanation for the patient's lung disease was a zirconium-induced pneumoconiosis, based on the slowly progressive course of the illness, the history of zirconium exposure, the biopsy of his lung, and the absence of any other identifiable reason for his lung disease. The case demonstrates the need for further research into the toxic effects of zirconium, and to determine what steps would be appropriate to protect other patients from excessive exposure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Glass industry, Zirconium, Pulmonary fibrosis

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Complications associated with thoracentesis

Article Abstract:

Thoracentesis is the surgical puncture of the chest wall to remove fluid accumulated within the chest. The complications associated with different sampling methods used in thoracentesis were evaluated in 52 co-operative patients, who were spontaneously breathing or breathing without assistance. The thoracentesis sampling methods consisted of needle-only; needle with catheter, a tube-like structure; and needle with sonographic or sound wave-directed guidance. In all patients, effusions or fluid secretions were detected by chest X-ray and extended over more than half of the hemidiaphragm, which is half of the diaphragm, a muscle separating the chest and abdominal cavities. Potential complications of thoracentesis include pneumothorax, the collection of air or gas in the pleural or lung cavity; dry tap, the complete drainage of fluid from the chest cavity; and inadequate tap, the insufficient drainage of fluid from the chest cavity. Serious complications occurred in none of the 19 patients who underwent the sonography-guided method, 9 of 18 patients subjected to the needle-catheter method, and 5 of 15 patients subjected to the needle-only method. Pneumothoraces developed in none of 19 sonography-guided, 7 of 18 needle-guided, and 3 of 15 needle-only procedures. These results demonstrate that the sonography-guided method of thoracentesis is the safest procedure for thoracentesis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Pneumothorax, Chest, Pleural effusions, Pleural effusion, Thoracentesis

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