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Drug-Induced Interstitial Pneumonitis In Children
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Marina I. Liscano, Lawrence J. Ettinger
Chronic toxicity is insidious in onset and is associated with the chronic use of nitrofurantoin. The insidious onset of malaise, dyspnea on exertion, and cough are common manifestations. Pulmonary function studies reveal a restrictive pattern and a decrease in DLCO. A diffuse interstitial pattern is seen on a radiograph of the chest. Pathologically, nonspecific interstitial pneumonitis and/or fibrosis is common.28,29 If nitrofurantoin is promptly with drawn after the first clinical signs of pulmonary toxicity appear, the chances for recovery are good. However, pulmonary function may be permanently impaired even after cessation of nitrofurantoin, especially if its use is not discontinued early.
Respiratory Symptoms
Published in James M. Rippe, Lifestyle Medicine, 2019
Jeremy B. Richards, Richard M. Schwartzstein
Pulmonary function testing refers to maneuvers in which spirometry, lung volumes, inspiratory and expiratory pressures, and/or diffusion limitation of carbon monoxide (DLCO) are measured. Confusion regarding PFTs arises from imprecise use of the term “pulmonary function tests” in clinical practice to refer to measurements of spirometry alone. It is more precise to consider PFTs to include spirometry, lung volume, and DLCO measurements.
The thorax
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The diffusion capacity (DLCO) is a measurement of the lung’s ability to transfer gases and is often referred to as the ‘transfer factor’. It cannot be performed at the bedside, requires the patient’s current haemoglobin level and is a test of the integrity of the lung’s alveolar–capillary surface area for gas exchange. In lung diseases that damage the alveolar walls, such as emphysema, or that thicken the alveolar membrane, such as lung fibrosis, it may be reduced. In patients who require surgery to remove part of their lung, for example for lung cancer, measurement of DLCO is an important determitant of ‘fitness’ for surgery and it should be measured formally as part of a lung function test.
Pulmonary function tests reveal unrecognised lung dysfunction and have independent prognostic significance in patients with systemic AL amyloidosis
Published in Amyloid, 2023
Georgia Trakada, Despina Fotiou, Anastasios Kallianos, Foteini Theodorakakou, Magdalini Migkou, Maria Gavriatopoulou, Nikolaos Kanellias, Panagiotis Malandrakis, Ioannis Ntanasis-Stathopoulos, Evangelos Eleutherakis-Papaiakovou, Ioanna Dialoupi, Evangelos Terpos, Meletios A. Dimopoulos, Efstathios Kastritis
The pulmonary function test indices measured in our patient population can be seen in Table 2. The breathing physiology was normal in 68% of patients, restrictive in 23%, and obstructive in 9% (Figure 1(a,b)). DLCO% was normal in 43%, decreased in 44% and increased in 13% of patients. Maximal inspiratory and expiratory pressures were affected in most patients: Pi% was normal in just 7% and decreased in 93% of patients and Pe% normal in 30%, and decreased in 70%. A restrictive physiology correlated strongly with Pe% (p < 0.001) and DLCO% (p = 0.003). It was also associated with higher Mayo stage at baseline (p = 0.034). In univariate analysis, a restrictive physiology was associated with worse survival (35.9 months vs not reached for obstructive/normal physiology, p = 0.002) (Figure 2). The one-year mortality for patients with a normal physiology was 14% versus 18% for obstructive versus 38% for restrictive physiology. The association of a restrictive breathing physiology with worse survival remained significant (HR: 2.01, p = 0.034) even after adjustment for Mayo stage and for abnormal chest CT (HR: 2.23, p = 0.016) or parenchymal abnormalities specifically (HR: 2.49, p = 0.007) (all HRs for restrictive physiology). A restrictive physiology was less common in patients with renal (p = 0.034), liver (p = 0.024) and soft tissue involvement (p = 0.023) and there was no association with nerve or soft tissue involvement or free light chain (FLC) levels.
Advances in predicting patient survival in pulmonary sarcoidosis
Published in Expert Opinion on Orphan Drugs, 2021
Gamze Kirkil, Elyse Lower, Robert Baughman
Since not all fibrotic sarcoidosis patients progress over time, identification of those patients at risk is important. Testing such as HRCT and pulmonary function tests, especially the DLCO, should allow for enrichment of patients with worse outcome. Validation of these screening tests over a wider range of patients may help clarify which features are most important in the individual patient. Also, evaluating whether these tests could be used to identify increased risk for other outcomes besides mortality will be useful as clinical trials move forward. The ultimate goal would be to integrate these tests into routine management of sarcoidosis patients. One can envision that HRCT and pulmonary function testing will become an important routine assessment in advanced sarcoidosis patients.
Lung volume reduction with endobronchial valves in patients with emphysema
Published in Expert Review of Medical Devices, 2018
Marieke C. Van Der Molen, Karin Klooster, Jorine E. Hartman, Dirk-Jan Slebos
Since treatment with endobronchial valves should only be considered in highly symptomatic emphysema, only patients with a post-bronchodilator forced expiratory volume in 1 s (FEV1) of less than 50% of predicted are considered. A minimum of 20% is usually maintained in line with findings in LVRS, where a FEV1 of <20% predicted and a diffusion capacity (DLCO) of <20% were predictive of a higher 90-day mortality [8]. In contrast, a DLCO of <20% predicted is not an absolute contraindication. DLCO can be considered as a representation of the emphysematous destruction of the lungs and the inability to perform this test correctly is not uncommon in patients with hyperinflation. In these patients, individual functional reserves should be considered [33,34]. However, patients with severe hypercapnia (>8.0 kPa) or hypoxemia (<6.5 kPa) are excluded from EBV treatment. In these cases, underlying pulmonary diseases other than emphysema should be considered, and BLVR would reasonably lead to increased oxygenation problems since a sufficient amount of remaining lung tissue is needed for proper gas exchange.