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Pulmonary reactions to chemotherapeutic agents: the ‘chemotherapy lung’
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Fabien Maldonado, Andrew H Limper
Radiographic findings rarely implicate a specific agent, except perhaps in the case of methotrexate-induced pneumonitis, in which typical hilar lymphadenopathy suggests reaction to this agent.7,8 However, in most cases of chemotherapy-associated lung disease the radiographic pattern is one of interstitial pneumonitis, which is impossible to distinguish from interstitial infiltrates related to common inflammatory or infectious aetiologies.9 Ground-glass and alveolar infiltrates are occasionally seen on the chest computed tomography (CT) scan. Pleural effusions and nodular tumour-like infiltrates are much less common, but have been classically described with certain agents (discussed below). A restrictive pattern is present on the pulmonary function studies of most patients with chemotherapy-induced lung disease.10 A decrease in diffusing capacity for carbon monoxide (DLCO), and in some situations in forced vital capacity and pulmonary capillary blood volume, may precede clinically overt interstitial lung disease. These parameters may prove to be valuable assets in screening for respiratory complications during the course of chemotherapy, although the evidence for supporting this practice remains scarce. As a result, screening pulmonary functions studies are not routinely indicated. Gallium-uptake scans are of limited value and rarely employed in recent years, except perhaps in the case of methotrexate-induced lung toxicity.11
Diffuse Lung Diseases (Emphysema, Airway and Interstitial Lung Diseases)
Published in de Azevedo-Marques Paulo Mazzoncini, Mencattini Arianna, Salmeri Marcello, Rangayyan Rangaraj M., Medical Image Analysis and Informatics: Computer-Aided Diagnosis and Therapy, 2018
Marcel Koenigkam Santos, Oliver Weinheimer
Diffuse pulmonary diseases may be classified into two large groups of conditions: obstructive and restrictive diseases. This classification is based mainly on clinical features (symptoms and physical examination) and pulmonary function testing. While patients with obstructive disease have airflow limitation/obstruction, patients with restrictive disease have pulmonary expansion limitation/restriction. The most common causes of obstructive disease are chronic obstructive pulmonary diseases (COPD), which includes emphysema and chronic bronchitis, asthma, bronchiectasis and cystic fibrosis (CF). Major conditions causing restrictive lung disease are represented by the interstitial lung diseases (ILD), such as idiopathic pulmonary fibrosis (IPF), pulmonary involvement by autoimmune diseases (systemic sclerosis, rheumatoid arthritis, lupus) and adverse drug reactions. Both groups share the same main symptoms of shortness of breath, cough and exertion. Pulmonary function tests (PFT), such as spirometry, plethysmography and diffusing capacity of the lung for carbon monoxide (DLCO) are used to differentiate obstructive from restrictive lung disease, as well as to assess disease severity and progression. But there are some conditions and situations that may challenge the correct diagnosis and also make adequate assessment of disease severity difficult, even with satisfactory clinical function tests. Some patients may present heterogeneous and mixed patterns of disease, showing restriction associated with obstruction at different degrees. Most clinical tests give only a global picture of the disease and cannot show a regional (right × left lung, basal × apical) or compartmentalized-based (airway, airspace, interstitial, vascular) analysis. For some diseases, PFT has a low sensitivity to detect initial alterations. Instead, pulmonary imaging can present morphological and function information, objectively and in a regional or compartmentalized fashion for the evaluation of diffuse lung diseases, being represented especially by the high resolution computed tomography (HRCT) (Maffessanti and Dalpiaz 2006, Webb and Higgins 2010).
Pulmonary Function Tests
Published in Robert B. Northrop, Non-Invasive Instrumentation and Measurement in Medical Diagnosis, 2017
Spirometers basically measure the respiratory volumes, or in the case of modern units, respiratory volume flow rate which is integrated to determine the volume. Some of the common parameters used in spirometry are: FVC (forced vital capacity): This is the total volume of air a patient can exhale after a maximum effort inspiration. Patients with restrictive lung disease (RLD) have a lower FVC than do patients with obstructive lung disease (OLD).FEV1 (forced expiratory volume in 1 s) (also, FEV1/2): The volume of air expired in the first second following the beginning of maximum expiratory effort. FEV1 is reduced from normal in both OLDs and RLDs, but for different reasons; increased airway resistance in OLD, and decreased vital capacity in RLD.FEV1/FVC: This ratio is about 0.7 in healthy subjects. It can be as low as 0.2–0.3 in patients with OLD. Patients with RLD have near-normal ratios.FEF (25%–75%) (forced mid-expiratory flow rate): The average rate of flow during the middle of the FVC maneuver.Reduced in both OLD and RLD.DLCO (diffusion capacity of the lung for carbon monoxide): The poison gas, CO, can be used to measure the diffusion capacity of the alveoli. The diffusion capacity of the lung is decreased in parenchymal diseases, such as emphysema. It is normal in asthma. (Other gases can be used.)FRC (functional residual capacity): The volume of air remaining in the lungs and trachea after an exhale in normal breathing.RV (residual volume): The volume of air left in the lungs after a maximum FVC exhale. It is the “dead space” of the respiratory system; mostly combined trachea and bronchial tube volumes. It cannot be measured directly.TV (tidal volume): The volume exchanged in normal, relaxed breathing.AV (alveolar volume): Total volume of all the minute alveoli in the lung parenchyma.
Hypersensitivity pneumonitis in a slaughterhouse worker: A case report
Published in Archives of Environmental & Occupational Health, 2022
Elena Vasileiou, Paschalis Ntolios, Paschalis Steiropoulos, Theodoros Constantinidis, Evangelia Nena
Pulmonary Function Tests (PFTs) were performed according to the 2019 ATS/ERS statement on standardization of spirometry4 and revealed a restrictive respiratory disorder (Forced Vital Capacity – FVC: 60% predicted; Total Lung Capacity – TLC: 63% predicted; Diffusion Capacity for Carbon Monoxide – DLCO: 50% predicted). Six-minute walking test (6MWT) distance walked was 460 m (75.06% of predicted distance of 612.8 m). Chest High-Resolution Computed Tomography (HRCT) was typical for HP, demonstrating bilateral, sub-pleural reticular opacities, ground glass opacities and areas of decreased attenuation, representing air trapping. There was no zonal predominance of the distribution of these lesions.5 Honeycombing was absent. (Figure 1).6 All serologic tests were negative for auto-immune disorders. An extended panel for specific IgG antibody testing of most common antigens, including Aspergillus fumigatus, Micropolyspora faeni, Thermoactinomyces vulgaris was negative. A bronchoscopy with Bronchoalveolar Lavage (BAL) was performed and BAL fluid analysis demonstrated a lymphocyte predominance (60%).
Approaches to improving exercise capacity in patients with left ventricular assist devices: an area requiring further investigation
Published in Expert Review of Medical Devices, 2019
Richard Severin, Ahmad Sabbahi, Cemal Ozemek, Shane Phillips, Ross Arena
Post-LVAD implant, patients demonstrate improved ventilation-perfusion coupling and ventilatory efficiency evident by reductions in the minute ventilation/carbon dioxide production (VE/VCO2) slope [14,29]. Junget al.l reported reductions in the VE/VCO2 slope with increasing pump speed during maximal exercise (41 ± 14.9–36 ± 11.7, p = 0.005) [26]. Apostoloet al.l also demonstrated that increasing LVAD pump speed improved ventilatory efficiency (−1.9 ± 3.1, p = 0.031) [25]. However, further reductions in alveolar-capillary gas diffusion measured by the diffusing capacity of the lungs for carbon monoxide (DLCO) and lung diffusing capacity for nitric oxide (DLNO) 16 h after changing LVAD speed were also reported [25]. This deterioration of lung diffusion was thought to be a consequence of higher left atrial pressures and lung fluid content [25]. These findings warrant further caution when suggesting free application of pump speeds during exercise.
Chronic iliofemoral vein obstruction – an under-recognized cause of exercise limitation‡
Published in European Journal of Sport Science, 2018
Michael J. Segel, Ronen Reuveny, Jacob Luboshitz, Dekel Shlomi, Issahar Ben-Dov
IFVO patients performed pulmonary function tests (spirometry, body plethysmography and single breath carbon monoxide diffusing capacity (DLCO)), followed by two incremental symptom-limited exercise tests on cycle ergometers, with at least 2 hours rest between tests: a lower limb test and an upper limb test.