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Pili were recently recognized in Streptococcus pneumoniae and implicated in the virulence of this bacterium, which led to the proposal of using these antigens in a future pneumococcal vaccine. However, pili were found to be encoded by the rlrA islet that was not universally distributed in the species.
Circulating levels of endothelin-1 are increased in sepsis and correlate with severity of disease. A rapid and easy immunoassay has been developed to measure the more stable ET-1 precursor peptides proET-1. The objective of this study was to assess the diagnostic and prognostic value of proET-1 in a prospective cohort of mainly septic patients with community-acquired pneumonia.
The Journal of Infectious Diseases 2008;197:676-680
To investigate associations of 2 vitamin D receptor (VDR) gene polymorphisms and acute lower respiratory tract infection (ALRI), we compared 56 young children hospitalized with ALRI and 64 children without a history of ALRI.
Methicillin-resistant Staphylococcus aureus bacteremia in patients in intensive care units is associated with significant morbidity and mortality. Prompt clinical attention is essential to ensure good outcomes, including identification and management of the source of infection and any associated complications.
In recent years evidence has accumulated indicating that airborne particles cause adverse health effects. To understand the underlying mechanisms, a multitude of in vitro studies have been performed focusing on inflammatory responses, especially cytokine production. However, the diversity of studies renders it difficult to determine which results are consistent and which exposures most effective.
Journal of Occupational Medicine and Toxicology 2008, 3:6
Numerous cross-sectional studies have reported reduced lung function among welders but limitations of exposure assessment and design preclude causal inference. The aim of this study was to investigate if long-term exposure to welding fume particulates accelerates the age-related decline in lung function.
American Journal of Epidemiology 2008 167(5):570-578
Recent data suggest beneficial effects of fiber intake on chronic respiratory symptoms in adults that are independent of antioxidant vitamin intake, but little is known about fiber consumption in relation to lung function and chronic obstructive pulmonary disease (COPD).
Current Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 2-5(4)
Respiratory drug particles aerosolized from Dry powder inhalers (DPIs) may charge electrostatically. Influence of electrostatic charge and aerodynamic size distributions on the regional deposition of inhaled aerosols in the lung has been acknowledged by the investigators of aerosol medicine research.
For patients with acute respiratory failure who have declined intubation and resuscitation or have chosen comfort measures only, noninvasive ventilation (NIV) may help them achieve important health or personal goals, or merely prolong the dying process.
Bronchial mucosal dendritic cells (DCs) initiate and regulate immune responses to inhaled antigens, viruses and bacteria. Currently, little is known of their numbers in patients with chronic obstructive pulmonary disease (COPD). While reductions in their numbers have been reported recently in smokers with asthma, nothing is known of the effects of cigarette smoking on bronchial DCs in COPD. The present study compares DC numbers in smokers and ex-smokers with COPD.
The combination of right lung agenesis and left pulmonary artery (LPA) sling is a rare entity that has been described only in the pediatric population.
To use Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II data to retrospectively determine sensitivity and specificity of ventilation-perfusion (V/Q) scintigraphic studies categorized as pulmonary embolism (PE) present or PE absent and the proportion of patients for whom these categories applied.
Systemic proinflammatory cytokines and oxidative stress have been described in association with peripheral muscle wasting and weakness of patients with severe chronic obstructive pulmonary disease (COPD), but their expression in skeletal muscle is unknown. The objectives of the present study were to determine muscle protein levels of selected cytokines in patients with COPD and to study their relationships with protein carbonylation as a marker of oxidative stress, quadriceps function and exercise capacity.
Current Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 35-39(5)
Despite efforts to quell the rising tide of antimicrobial resistance, national trends show disturbing increases in the rate of resistance of clinically relevant microorganisms. The primary basis for this trend is inappropriate or insufficient antimicrobial treatment, which is often due to a lack of rapid diagnostic tools and dependence on time-consuming culturebased approaches for pathogen detection and resistance profiling.
Lung clearance index (LCI) is a sensitive marker of early lung disease in children but has not been assessed in adults. Measurement is hindered by the complexity of the equipment required. The aims of this study were to assess performance of a novel gas analyser (Innocor) and to use it as a clinical tool for the measurement of LCI in cystic fibrosis (CF).
Current Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 69-76(8)
Extracorporeal membrane oxygenation (ECMO) is used for severe neonatal and pediatric respiratory failure that fails to respond to maximal therapy, including but not limited to high frequency oscillatory ventilation (HFOV), surfactant replacement, inhaled nitric oxide (NO) and prone positioning of the patient.
Current Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 19-22(4)
Chronic respiratory diseases are one of the leading causes of death and morbidity. Therefore the assessment of regional and global ventilation distribution together with pulmonary perfusion imaging becomes more and more important.
Current Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 29-34(6)
Respiratory syncytial virus (RSV) is an important pathogen affecting all age groups and has been implicated in the inception of asthma in a subpopulation of children.
Current Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 40-51(12)
Lung transplantation provides a successful therapy for end-stage lung disease. However, problems such as acute and chronic lung allograft rejection, the latter also known as bronchiolitis obliterans syndrome (BOS), remain obstacles to achieving better long term outcomes.
Current Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 23-28(6)
Upper Airway Resistance Syndrome (UARS) was initially used to describe a group of patients who were sleepy but did not meet the diagnostic criteria of obstructive sleep apnea syndrome (OSAS).
Airway obstruction in acute asthma is the result of airway smooth muscle contraction, inflammation and mucus plugging. Case reports suggest that mucolytic therapy might be beneficial in acute asthma. The aim of this study was to determine the efficacy of the mucolytic drug recombinant human deoxyribonuclease (rhDNase) in addition to standard treatment at the emergency department in children with an asthma exacerbation.
American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 486-490, (2008)
Smoking is a primary risk factor for chronic bronchitis, emphysema, and chronic obstructive pulmonary disease, but since not all smokers develop disease, it has been suggested that some individuals may be more susceptible to exogenous factors, such as smoking, and that this susceptibility could be genetically determined.
Although respiratory involvement has been described in patients with IBD, well-defined interstitial lung disease has not been reported, especially among children with ulcerative colitis.
The common cold or upper respiratory infection (URI) is highly prevalent among young children and often results in otitis media (OM). The incidence and characteristics of OM complicating URI due to specific viruses have not been well studied.
Despite nearly complete vaccine coverage, a small number of fully vaccinated children in the Netherlands have experienced invasive disease caused by Haemophilus influenzae serotype b (Hib). This increase started in 2002, nine years after the introduction of nationwide vaccination in the Netherlands.
Secondary involvement of the thyroid gland by malignant metastases is uncommon. Acute respiratory crisis due to infiltration of the upper airways is a recognised complication of anaplastic thyroid carcinoma or thyroid lymphoma. Renal cell carcinoma is a tumour that metastasizes diffusely and in an unpredictable manner.
Clinical studies have shown that injurious mechanical ventilation is associated with increased airspace and plasma levels of interleukin-1beta (IL-1beta); however, the potential therapeutic value of IL-1 inhibition in acute lung injury has not been thoroughly investigated. A study was undertaken to determine if IL-1 signalling is a necessary early event in the pathogenesis of experimental ventilator-induced lung injury.
A 76-year-old male who was a previous smoker presented with symptoms suggestive of recurrent lower respiratory tract infections. There was no associated anorexia, weight loss or breathlessness. During one of these episodes he had haemoptysis which prompted further investigations with a CT scan of the chest as well as a flexible bronchoscopy.
The Journal of Infectious Diseases 2008;197:490-502
Advisory committees have cautioned that influenza vaccine-induced antibody declines more rapidly in the elderly, falling below seroprotective levels within 4 months. We conducted a literature review to assess this assertion.
The Journal of Infectious Diseases 2008;197:618-621
Toll-like receptors (TLRs) are important components of innate immunity. We investigated the association between polymorphisms in the TLR2, TLR4, and TLR9 genes and susceptibility to noninvasive forms of pulmonary aspergillosis.
The Journal of Infectious Diseases 2008;197:584-592
Recently identified human metapneumovirus (hMPV) is an important respiratory pathogen in children and adults worldwide. Little is known about cytotoxic T lymphocyte (CTL) responses that may control hMPV infection in humans.
Despite advances in the management of deep vein thrombosis (DVT) and pulmonary embolism (PE), relatively few contemporary data describe and compare outcomes in patients with these common conditions from a more generalizable community-based perspective.
The percentage of patients with community-acquired pneumonia (CAP) whose time to first antibiotic dose (TFAD) is less than 4 hours of presentation to the emergency department (ED) has been made a core quality measure, and public reporting has been instituted. We asked whether these time pressures might also have negative effects on the accuracy of diagnosis of pneumonia.
Sound data about the prevalence of acute renal failure (ARF) among patients with severe sepsis and septic shock are lacking. Further, it is not known whether ARF is an independent risk factor for mortality in septic patients or merely an indicator of disease severity.
High-mobility group box (HMGB) 1 is a recently discovered proinflammatory mediator that contributes to acute lung injury. We determined HMGB-1 levels in bronchoalveolar lavage fluid of patients during mechanical ventilation (MV) and ventilator-associated pneumonia (VAP).
Allergy, Volume 63, Number 3, March 2008 , pp. 292-298(7)
Allergic rhinitis (AR) and asthma are inflammatory conditions of the airways that often occur concomitantly. This observational, cross-sectional, national study was undertaken to describe the frequency and severity of AR in asthmatic patients. The impact of AR on the quality of life and the therapeutic management of patients in everyday general medical practice were also assessed.
Clinical trials measure exacerbations of chronic obstructive pulmonary disease (COPD) inconsistently. A study was undertaken to determine if different methods for ascertaining and analysing COPD exacerbations lead to biased estimates of treatment effects.
Emphysematous lung exhibits predominantly T helper type 1 (Th1) cells, but it remains unclear how tobacco induces Th1 immunity and the nature of relevant T cell antigens. This study explored the possibility that smoking induces an autoimmune response.
Nebulized bronchodilators are widely regarded as the optimal treatment for maintenance therapy in patients with severe chronic obstructive pulmonary disease (COPD). The aim of the study was to assess whether detailed physiological, functional and quality of life-related measurements can assist in determining the requirement for nebulized bronchodilator therapy in patients with moderate to severe COPD.
The optimal way of assessing the impact of pulmonary rehabilitation on functional status in chronic obstructive pulmonary disease (COPD) is currently unknown. The minimal clinically important difference for the constant work rate cycling exercise test also needs to be investigated to facilitate its interpretation.
Chronic cough is perhaps the commonest symptom of medical importance with some 12% of the general population having the symptom on a daily or weekly basis. Chronic cough causes a large degree of morbidity, with both the physical e.g. incontinence, and the psychological e.g. social isolation, domains.
Overweight and obesity have been associated with better survival in patients with chronic obstructive pulmonary disease (COPD). On the other hand, excess body weight is associated with abnormal metabolic and inflammatory profiles that define the metabolic syndrome and predispose to cardiovascular diseases.
Annals of Tropical Paediatrics: International Child Health, Volume 28, Number 1, March 2008 , pp. 71-78(8)
In Papua New Guinea (PNG), the most common cause of death among children under 5 years of age is pneumonia. Children with severe pneumonia need antibiotics and oxygen but oxygen shortages are common owing to the cost and complex logistics of transporting it in cylinders. Detection of hypoxaemia using clinical signs can be difficult, especially in highly pigmented children in whom cyanosis is difficult to recognise.
Major Vault Protein (MVP) is thought to be important for innate immunity and is found in antigen-presenting cells and epithelia throughout the respiratory system. This study investigated the role of MVP in human respiratory epithelium, particularly in response to infection with Pseudomonas aeruginosa.
The lung-protective strategy employs positive end-expiratory pressure to keep open otherwise collapsed lung regions (anatomical recruitment). Improvement in venous admixture with positive end-expiratory pressure indicates functional recruitment to better gas exchange, which is not necessarily related to anatomical recruitment, because of possible global/regional perfusion modifications.
Pediatric Infectious Disease Journal. 27(2):100-105, February 2008
Acute respiratory infections (ARI) are a major cause of morbidity in infancy worldwide, with cough and wheeze being alarming symptoms to parents. We aimed to analyze in detail the viral aetiology of ARI with such symptoms in otherwise healthy infants, including rhinoviruses and recently discovered viruses such as human metapneumovirus (HMPV), coronavirus NL63 and HKU1, and human bocavirus (HBoV).
Pediatric Infectious Disease Journal. 27(2):95-99, February 2008
Differentiating bacterial from nonbacterial community-acquired pneumonia in children is difficult. Although several studies have evaluated serum concentrations of C-reactive protein (CRP) as a predictor of bacterial pneumonia in this patient population, the utility of this test remains unclear.
Current Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 13-18(6)
Hematopoietic stem cell transplantation (HSCT) has been employed clinically for the therapy of a wide variety of acquired neoplastic and nonmalignant disorders. However, these immunocompromised patients remain at high risk of developing many serious and often life threatening complications.
Pulmonary exacerbations (P Exs) are important in cystic fibrosis (CF). They are very common, and are associated with poor quality of life. P Exs are regarded as an important end point in clinical trials. Risk factors associated with increase in P Exs have not been examined at a large scale.
Although global studies such as the International Study of Asthma and Allergies in Childhood (ISAAC) have provided valuable data on the prevalence of asthma in children in Latin America, there is little information on the relationship between asthma symptoms, pulmonary function, bronchial hyperresponsiveness (BHR) and atopy in the region.
Current Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 52-56(5)
Pulmonary thromboembolism (PTE) ranges from incidental, clinically unimportant thromboembolism to massive embolism with sudden death. Its treatment is well established in two groups of patients: heparin for those with normal systemic blood pressure without right ventricular dysfunction (RVD) and thrombolysis for those with RVD and circulatory shock.
Chronic obstructive pulmonary disease (COPD) is currently the fourth cause of mortality and morbility in the developed world. Patients with COPD experience a progressive deterioration of health-related quality of life (HRQOL). A new model of severity classification, the body mass index, bronchial obstruction, dyspnoea, exercise (BODE) index, has recently been proposed.
Endotoxin is a major cause of endotoxinemia, sepsis, and pneumonia due to gram-negative bacteria. Experimental endotoxin administration via the tracheal route has been extensively used to study the biological and pathophysiologic pathways of inflammation. In particular, experimental endotoxin instillation in the respiratory tree has allowed an extended research with regard to the local response of the lungs to the pathogenic stimulus.
urrent Respiratory Medicine Reviews, Volume 4, Number 1, February 2008 , pp. 57-68(12)
Chronic obstructive pulmonary disease (COPD) is a global health problem. COPD is associated with the progressive pulmonary inflammation and destruction of lung parenchyma (emphysema) that relate to disease severity.
There are increasing reports describing invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD) without the classic risk factors for this severe infection. The available literature on this association is based on case reports or small case series.
Exacerbations of pulmonary symptoms in patients with cystic fibrosis must be recognised early and treated vigorously in order to maintain pulmonary function and relieve symptoms. The aetiology of these exacerbations is discussed, together with the options for treatment and the evidence to support treatment choices.
Bronchiectasis unrelated to cystic fibrosis (CF) is increasingly recognised as an important and major primary respiratory disease in developing countries. In affluent countries, bronchiectasis is also increasingly recognised in subsections of communities (such as indigenous peoples) as well as a co-existent disease/co-morbidity and disease modifier in respiratory diseases such as chronic obstructive pulmonary disease.
The spectrum of diseases collectively known as pulmonary fibrosis does not have reliable therapeutic options. Many treatment protocols have been the subject of clinical trials, resulting in few significant improvements in outcome.
Improved survival from idiopathic pulmonary fibrosis (IPF) is dependent on better understanding of the epidemiology of the disease, its diagnostic spectrum in global terms and an analysis of outcomes from emerging therapies at a significant level.
Brain abscesses and ischaemic strokes complicate pulmonary arteriovenous malformations (PAVMs). At risk individuals are poorly recognised. Stroke/abscess risk factors have not been defined.
Asthma exacerbations are most commonly triggered by viruses, particularly rhinovirus. There is currently no biomarker that can be used to predict that a virus has triggered an exacerbation.
Airway wall thickening has been established as an important factor in airway obstruction in patients with COPD, and squamous metaplasia of columnar epithelium correlates with the severity of airway obstruction. Here, through a number of experiments, the authors provide evidence for a mechanistic link between these two processes.
Somatostatin analogues may have antifibrotic properties in the lung. The aim of this study was to evaluate the expression of the five somatostatin receptors sst1 to sst5 in normal and fibrotic mouse lung and the action of SOM230 (pasireotide), a new somatostatin analogue with a long half-life, in bleomycin induced lung fibrosis and in human lung fibroblasts in vitro.
Pleural haematoma secondary to spontaneous rupture of an intercostal artery aneurysm is extremely rare but can be life-threatening. Most documented cases have been associated with coarctation of the aorta or neurofibromatosis type 1,1 or occur following trauma2 or thoracic surgery.
Chronic obstructive pulmonary disease (COPD) is an insidiously starting disease. Early detection has high priority because of the possibility of early implementation of smoking cessation interventions. An evidence based model for case finding of COPD is not yet available.
Acute lung injury is a clinical syndrome of acute respiratory failure that is responsible for considerable morbidity and mortality in critically ill patients.
A reduced dietary intake of n-3 fatty acids, in association with increased n-6 fatty acid intake, has been proposed as a potential aetiological factor for chronic obstructive pulmonary disease (COPD) and asthma. However, the relative importance of individual fatty acids within the n-3 and n-6 categories on this effect has not been widely investigated.
To determine the effects of a nurse led intermediate care programme in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
The case history is presented of a patient who developed "popcorn worker's lung" following exposure to 2,3-butanedione
(diacetyl). Other similar cases are reviewed, and it is concluded that "food flavourer's lung" may be a more suitable diagnostic label.
Occupational asthma remains a common disease in the UK with up to 3000 new cases diagnosed each year. The Health and Safety Executive
(HSE) estimates the cost to our society to be over £1.1 billion for each 10-year period.1 In October 2001 the Health and Safety Commission agreed a package of measures aimed at reducing the incidence of asthma caused by exposure to substances in the workplace by 30% by 2010. Key to this aim are primary prevention by proper risk assessment and exposure control, together with secondary prevention to ensure reduction in the delay between the development of allergic symptoms at work (normally nasal or respiratory) and appropriate advice to the affected worker and workplace.
A study was undertaken to examine factors that might influence lung function during infancy and to test the hypothesis that change in weight during infancy is negatively associated with change in lung function.
As pointed out in the introduction to this document, occupational asthma remains a common disease in the UK, with up to 3000 new cases diagnosed each year. It is also estimated that one in 10 cases of adult onset asthma relate to sensitisation in the workplace. This is an important document for all respiratory clinicians. I also recommend the editorial by Tarlo in which she discusses the significance of occupational asthma and also "work-related asthma" when asthma worsens at work but is not in fact occupational asthma caused by workplace sensitisers.
Acute lung injury is an important cause of respiratory failure in the critically ill patient. It is caused by damage to the alveolar barrier with subsequent alveolar flooding leading to the development of refractory hypoxaemia. - Agonists stimulate alveolar fluid clearance in animal models of lung injury. In a clinical trial (BALTI-1), intravenous beta agonists reduced extravascular lung water, an effect that took 72 h in contrast with what animal studies suggest. One possible explanation for the delay in change in extravascular lung water is the time required for salbutamol to stimulate alveolar epithelial repair.
Sex differences have been described in a number of pulmonary diseases. However, the impact of ozone exposure followed by pneumonia infection on sex-related survival and macrophage function have not been reported. The purpose of this study was to determine whether ozone exposure differentially affects: 1) survival of male and female mice infected with Klebsiella pneumoniae, and 2) the phagocytic ability of macrophages from these mice.
Deep inspirations (DI) have bronchodilatory and bronchoprotective effects in healthy human subjects, but these effects appear to be absent in asthmatic lungs. We have characterized the effects of DI on lung mechanics during mechanical ventilation in healthy mice and in a murine model of acute and chronic airway inflammation.
Clinical and Experimental Hypertension, Volume 30, Issue 2 February 2008 , pages 143 - 150
Sleep apnea is a very common condition, particularly in patients with arterial hypertension. A precise diagnosis, however, requires the performance of a sleep study. Clinical surrogate markers for significant apnea could be useful in guiding decisions to perform sleep studies.
The Journal of Infectious Diseases 2008;197:465-473
Pseudomonas aeruginosa undergoes phase variation in the expression of the phosphorylcholine (ChoP) epitope, a structure crucial for the virulence of several respiratory pathogens.
Indian Journal of Critical Care Medicine Year : 2007 Volume : 11 Issue : 4 Page : 176-181
We investigated the reasons for intensive care unit (ICU) readmission of patients with acute respiratory failure. Of 88 patients re-admitted to our ICU over a 15-month period, 16 were suffering from acute respiratory failure.
Journal of Cardiopulmonary Rehabilitation & Prevention. 28(1):12-16, January/February 2008
Pulmonary arterial hypertension is a group of disorders defined by a progressive elevation of pulmonary vascular resistance in the small pulmonary arteries and arterioles. In its untreated form, the disease causes progressive dyspnea and severe activity limitation resulting in premature death due to right ventricular failure.
American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 473-478, (2008)
Hispanics are individuals whose ancestry can be traced to Spain and/or areas previously under Spanish control (e.g., Mexico, Puerto Rico). They are a rapidly growing subset of the population of the United States and are quite diverse in their racial ancestry, country of origin, area of residence, socioeconomic status, tobacco use, and access to health care.
Allergy, Volume 63, Number 3, March 2008 , pp. 261-267(7)
In contrast to the epidemiological and clinical association between allergic rhinitis and asthma, upper airway inflammation is less characterized in patients with nonatopic asthma and virtually unexplored in chronic obstructive pulmonary disease (COPD). Here, sinonasal pathology is studied in patients with allergic asthma, nonallergic asthma and COPD.
Pneumothorax, one type of lung disorder in the air leak syndrome spectrum, is defined as the presence of air between the visceral and parietal pleura that leads to lung collapse. Air leaks through holes in the lung tissue into the spaces outside the lung airways.
Journal of the Canadian Thoracic Society January/February 2008, Volume 15 Issue 1: 20-26
Acute asthma is a common emergency department (ED) presentation and variation in its management is well recognized. The present study examined the use of an asthma care map (ACM) in one Canadian ED to improve adherence to acute asthma guidelines, emphasizing the use of systemic corticosteroids (SCSs) and inhaled corticosteroids (ICSs).
American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 544-554, (2008)
Obstructive sleep apnea (OSA), characterized by intermittent hypoxia/reoxygenation (IHR), is associated with atherosclerosis. Polymorphonuclear leukocytes (PMNs) are implicated in atherogenesis by producing oxidizing radicals and proteolytic enzymes during PMN-endothelium interactions. PMN apoptosis is a fundamental, injury-limiting mechanism, which prevents their destructive potential.
Journal of the Canadian Thoracic Society January/February 2008, Volume 15 Issue 1: 41-44
Fibrosing mediastinitis is a rare benign condition, which can cause compression of the pulmonary or systemic vessels, tracheobronchial tree, coronary arteries or esophagus, leading to disabling clinical symptoms and even death. The case of a 26-year-old woman who presented with dyspnea is described. She was found to have 80% stenosis of the right pulmonary artery secondary to fibrosing mediastinitis. The stenosis was managed successfully with an endovascular Palmaz- Schatz stent, and the patient remains symptom-free 10 years later.
American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 506-515, (2008)
Sildenafil has been implicated in the activation of cystic fibrosis transmembrane conductance regulator (CFTR) protein. The effect was observed in vitro and in the presence of doses roughly 300 times larger than those commonly used for treating erectile dysfunction.
Carbonaceous aerosol, a major component of particulate matter (PM), gases, and vapors in the atmosphere, has been associated with natural and anthropogenic air pollution, reduced visibility, climate modulation, material and ecosystem damage, and adverse health effects.
American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 491-497, (2008)
Whether the airway and systemic inflammatory profile in bacterial exacerbations of chronic obstructive pulmonary disease (COPD) is distinct from nonbacterial exacerbations is unclear. Previous studies have not used molecular typing of bacterial pathogens, which is required to accurately define bacterial infection in COPD. The relationship between clinical severity and course of exacerbation and inflammation is also not fully understood.
Allergy, Volume 63, Number 3, March 2008 , pp. 327-332(6)
Although the prevalence of allergic asthma increased quickly in the past decade, the diagnostic criteria have not been well established. The aim of the present study was to explore whether stem cell factor (SCF), B cell-activating factor (BAFF), and cytokines interleukin (IL)-17 and IL-31 are usable parameters for the diagnosis of allergic asthmatics.
Clinical Nuclear Medicine. 33(3):236-239, March 2008
A 63-year-old man previously treated with a subtotal laryngectomy, presented with a 4 month history of severe dysphagia and intractable aspiration. On the last follow-up he underwent a scintigraphic swallowing procedure that showed severe tracheopulmonary aspiration with visualization of the trachea, of the right and left bronchi, and evidence of good airway clearance on the follow-up scan obtained 15 minutes later.
Journal of the Canadian Thoracic Society January/February 2008, Volume 15 Issue 1: 39-40
Thoracoscopy is being increasingly utilized in stable patients to manage both blunt and penetrating injuries. The case of a patient who presented with a knife impaled in the chest is reported. The knife was able to be removed under thoracoscopic guidance, avoiding thoracotomy.
Journal of the Canadian Thoracic Society January/February 2008, Volume 15 Issue 1: 45-47
Intracerebral abscess is an uncommon complication of severe cystic fibrosis lung disease. The present report describes a case of fatal multiple intracerebral abscesses in a patient with a severely bronchiectatic, nonfunctioning right lung and chronic low-grade infection. The patient was previously turned down for pneumonectomy. Intracerebral abscess in cystic fibrosis and the potential role of pneumonectomy in the present patient are discussed.
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia (CAP). Early diagnosis would allow more directed therapy and confidence in appropriate treatment for a majority of patients.
Journal of the Canadian Thoracic Society January/February 2008, Volume 15 Issue 1: 33-38
To create and evaluate the efficacy of a short individualized educational intervention program, based on Prochaska's transtheoretical model, for a six-month period in a population of adult asthma patients living with domestic animals but sensitized to these pets.
Journal of the Canadian Thoracic Society January/February 2008, Volume 15 Issue 1: 27-32
Oropharyngeal (OP) symptoms are common in asthma patients using inhaled corticosteroids (ICSs) alone and in combination with a long-acting beta2-agonist (LABA). Patterns of medication use, level of asthma control and association with OP symptoms are not often reported in a nonstudy setting.
American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 486-490, (2008)
Smoking is a primary risk factor for chronic bronchitis, emphysema, and chronic obstructive pulmonary disease, but since not all smokers develop disease, it has been suggested that some individuals may be more susceptible to exogenous factors, such as smoking, and that this susceptibility could be genetically determined.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 5, Issue 1 February 2008 , pages 5 - 11
The CXC chemokines, IP-10/CXCL10 and IL-8/CXCL8, play a role in obstructive lung disease by attracting Th1/Tc1 lymphocytes and neutrophils, respectively. Inhaled corticosteroids (ICS) and long acting beta2-agonists (LABA) are widely used.
Clinical studies suggest that acute respiratory tract infection (ARTI) may be a risk factor for the acute coronary syndrome (ACS). ARTI is associated with an increased risk for ACS up to 2 weeks prior to a cardiac event.
The purpose of our study was to determine the attenuation threshold value for the detection and quantification of air trapping using paired inspiratory and expiratory volumetric MDCT scans and to assess whether the densitometric parameter can be used for the quantification of airway dysfunction in chronic obstructive pulmonary disease (COPD) regardless of the degree of emphysema.
Canadian Journal of Infectious Diseases & Infectious Microbiology January/February 2008, Volume 19 Issue 1: 19-53
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are important causes of morbidity and mortality, with mortality rates approaching 62%. HAP and VAP are the second most common cause of nosocomial infection overall, but are the most common cause documented in the intensive care unit setting. In addition, HAP and VAP produce the highest mortality associated with nosocomial infection. As a result, evidence-based guidelines were prepared detailing the epidemiology, microbial etiology, risk factors and clinical manifestations of HAP and VAP.
This article recounts the story of the dietary hypothesis for the rise in asthma and allergies from the first idea to publication of papers showing an association of maternal diet during pregnancy with rise of asthma in the offspring at 2 and 5 years. The nutrient most consistently associated with this endpoint is vitamin E, and it is suggested that reductions in the intake of this vitamin during pregnancy over past decades could explain up to a third of the excess cases of childhood asthma.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 5, Issue 1 February 2008 , pages 25 - 34
Arformoterol, a single isomer long-acting beta2-agonist, was developed as an inhalation solution for the maintenance treatment of bronchoconstriction in COPD.
We would like to make it clear that part of the cohort of patients used in our study [Respir Res 2007, 8:61] was also analysed in Clinical Neurophysiology [Neurophysiol Clin 2007, 37:29-33]. Although this study was cited in the original version of our article as reference 15, we feel that the overlap between the two studies should be made plain.
Future Microbiology, Volume 3, Number 1, February 2008 , pp. 97-106(10)
Pseudomonas aeruginosa is an important opportunistic human pathogen, causing various infections that are often very persistent. P. aeruginosa infections are the major cause of death in cystic fibrosis patients.
American Journal of the Medical Sciences. 335(2):141-144, February 2008
Fluoroquinolones are increasingly used for the treatment of community-acquired pneumonia. However, their use has been associated with a delay in the diagnosis and treatment of pulmonary tuberculosis.
American Journal of the Medical Sciences. 335(2):163-169, February 2008
Plastic bronchitis is an uncommon and underdiagnosed entity, characterized by recurrent expectoration of large, branching bronchial casts. We describe a 39-year-woman with no prior lung disease who had episodic wheezing, severe dyspnea with expectoration of large and thick secretions, branching in appearance, which she described as resembling squid.
American Journal of Industrial Medicine Volume 51, Issue 3 , Pages 186 - 194
Asbestosis is associated with lung cellular and immunological abnormalities. Induced sputum cytology and local and systemic markers of inflammation may be helpful to characterize disease status and progression in these patients.
Allergy and Asthma Proceedings, Volume 29, Number 1, 1/2 2008 , pp. 55-61(7)
Asthma is a clinical problem with social, psychological, and economic burdens. To improve patient disease management and quality of life (QOL), different education programs have been developed. The purpose of this study is to adapt and implement a community-based educational program for patients with asthma.
Allergy and Asthma Proceedings, Volume 29, Number 1, 1/2 2008 , pp. 51-54(4)
As a marker of inflammation, exhaled breath condensate (EBC) pH may be a useful screening tool in the evaluation of asthma, especially in a military recruit population.
Different host genetic factors causes imbalance in the immune response. The purpose of this study was to establish whether pathological findings in chest radiography are related to the various host-related immunological factors in nephropathia epidemica (NE).
Annals of Internal Medicine 19 February 2008 Volume 148 Issue 4 Pages 278-283
Pulmonary arterial hypertension (PAH) occurs as an idiopathic disease (formerly called primary pulmonary hypertension) and as a consequence of other illnesses. These illnesses include connective tissue diseases, portal hypertension, diet and stimulant drug use, HIV infection, and congenital heart disease. Inherited susceptibility to PAH occurs in families and is almost always due to mutations in genes of the TGF-beta family of receptors
International Journal of Clinical Practice doi:10.1111/j.1742-1241.2008.01624.x
Pulmonary hypertension (PH) may complicate the course of many forms of advanced interstitial lung disease (ILD) and has been shown to portend a worse outcome.
Metastasizing pleomorphic adenoma is a rare condition of metastasis from a histologically benign salivary gland tumor. We report a case of metastasizing pleomorphic adenoma presenting with multiple bilateral lung metastases, and discuss the clinical aspects of this disease.
Complete rupture of the main bronchus after blunt thoracic trauma is rare. Most patients with blunt traumatic injury to the trachea or bronchus die before arriving at hospital. A 26-year-old man with complete right main bronchus rupture was successfully treated by urgent surgical intervention and postoperative fiberoptic bronchoscopy for bronchial toilet.
Clinical Nuclear Medicine. 33(2):144-145, February 2008
A 63-year-old woman with dyspnea and hypoxia had ventilation-perfusion (V/Q) imaging for possible pulmonary embolism. Prominent focal deposition of Technegas was noted in the region of the carina on the ventilation scan.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 371-376, 2008
The role of macrophages in the clearance of particles with diameters less than 100 nm (ultrafine or nanoparticles) is not well established, although these particles deposit highly efficiently in peripheral lungs, where particle phagocytosis by macrophages is the primary clearance mechanism.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 251-255, 2008
In aerobic organisms, all cells have the capacity to respond to changes in oxygenation through the stabilization and transcriptional activation of hypoxia-inducible factor (HIF).
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 293-299, 2008
Nasal epithelial cells form the outermost protective layer against environmental factors. However, this defense is not just physical; it has been shown that epithelial cells respond by the production of inflammatory mediators that may affect local immune responses.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 318-323, 2008
Ozone is known to produce an acute influx of neutrophils, and alveolar epithelial cells can secrete chemokines and modulate inflammatory processes. However, direct exposure of alveolar epithelial cells and macrophages to ozone (O3) produces little chemokine response. To determine if cell–cell interactions might be responsible, we investigated the effect of alveolar macrophage–conditioned media after ozone exposure (MO3CM) on alveolar epithelial cell chemokine production.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 354-361, 2008
Responses to exchange transfusion using red blood cells (RBCs) with modified hemoglobin (Hb) oxygen (O2) affinity were studied in the hamster window chamber model during acute anemia to determine its role on microvascular perfusion and tissue oxygenation.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 283-292, 2008
The mechanisms used by alveolar type I pneumocytes for maintenance of the lipid homeostasis necessary to sustain these large squamous cells are unknown. The processes may involve the ATP-binding cassette transporter A1 (ABCA1), a transport protein shown to be crucial in apolipoprotein A-I (apoA-I)-mediated mobilization of cellular cholesterol and phospholipid. Immunohistochemical data demonstrated the presence of ABCA1 in lung type I and type II cells and in cultured pneumocytes.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 276-282, 2008
Abnormal epithelial repair to damage participates in airway remodeling in asthma by the paracrine regulation of mesenchymal cell functions. Retinoids control epithelial functions through nuclear retinoic acid receptor (RAR) and retinoid X receptor (RXR) activation, yet their expression and contribution to epithelial repair and to airway remodeling in asthma are unknown.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 269-275, 2008
The formation of neural tissue, in association with airway smooth muscle (ASM), is a feature of normal lung development and function. Intrinsic neuronal tissue has recently been shown, in animal models, to be derived from neural crest cells (NCC).
The tuberculin skin test is limited by its inability to distinguish between infection with Mycobacterium tuberculosis and non-tuberculous mycobacteria (NTM).
Clinical Microbiology and Infection doi:10.1111/j.1469-0691.2007.01946.x
Associated resistance to four to six related and unrelated antimicrobial agents was investigated in consecutive non-duplicate isolates of Escherichia coli (n = 39 425), Pseudomonas aeruginosa (n = 1070), Staphylococcus aureus (n = 7489), Streptococcus pneumoniae (n = 1604) and Streptococcus pyogenes (n = 2531).
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 5, Issue 1 February 2008 , pages 53 - 67
Chronic obstructive pulmonary disease (COPD) is conventionally thought of as a disease of adult smokers, related to airway inflammation and structural airway changes (remodeling). However, there is important epidemiological evidence, from a series of studies with overlapping age groups from birth to late middle age that early life events, including antenatal influences on lung growth, program the child to be at increased risk for future COPD.
Allergy, Volume 63, Number 3, March 2008 , pp. 255-260(6)
Close association exists between allergic rhinitis and asthma. Moreover, allergic rhinitis is a strong risk factor for the onset of asthma in adults. This study was aimed at evaluating a large group of patients with moderate-to-severe and persistent allergic rhinitis alone for investigating the presence of spirometric abnormalities and possible risk factors related to it.
Annals of Cardiac Anaesthesia Year : 2008 Volume : 11 Issue : 1 Page : 6-14
Pulmonary arterial hypertension (PAH) is a debilitating disease associated with significant morbidity and a high mortality if left untreated. Over the past 5 years, there have been significant advances with regard to the understanding of the pathogenesis, diagnosis and classification of PAH.
The laboratory diagnosis of invasive pneumococcal disease (IPD) continues to rely on culture-based methods that have been used for many decades. The most significant recent developments have occurred with antigen detection assays, whereas the role of nucleic acid amplification tests has yet to be fully clarified.
Until recently, cytomegalovirus (CMV) infection represented a major threat to lung transplant recipients. Preliminary studies have shown that antiviral prophylaxis might improve the outcome for these patients.
Annals of Clinical Microbiology and Antimicrobials 2008, 7:5
Recent studies have described a number of fatalities due to methicillin-resistant Staphylococcus aureus (MRSA) and influenza virus co-infection. MRSA isolates provide a challenge to caregivers due to inherent wide range antibiotic resistance. Many facilities have instituted screening methods, based on the presence of antibiotic resistance genes, to identify MRSA positive patients upon admission.
Atherosclerosis is still the leading cause of death in the western world. Besides known risk factors studies demonstrating Chlamydophila pneumoniae (C. pneumoniae) to be implicated in the progression of the disease, little is known about C. pneumoniae infection dynamics. We investigated whether C. pneumoniae induce cell death of human aortic endothelial cells, a cell type involved in the initiation of atherosclerosis, and whether chlamydial spots derive from inclusions.
Mucosal pH (pHi) is influenced by local perfusion and metabolism (mucosal-arterial Pco2 gradient, [DELTA]Pco2), systemic metabolic acidosis (arterial bicarbonate), and respiration (arterial Pco2).
American Journal of Industrial Medicine Volume 51, Issue 3 , Pages 161 - 165
Vocal cord dysfunction (VCD) is a condition characterized by paradoxical partial adduction of the vocal cords on inspiration. It has been associated with exposures to irritants, as well as with psychological illnesses and conditions. Workers who participated in the recovery of the WTC disaster site were exposed to a large amount of irritants as well as considerable psychological stressors.
The aim of the current study was to investigate the contribution of various strategies to increase influenza vaccine uptake among health care workers (HCWs) working in hospitals in Greece during the 2005-2006 season.
Simkania negevensis, a recently found Chlamydia-like organism, has been associated with respiratory infections in children and adults with pneumonia, but S. negevensis findings have been common also without any infection.
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 5, Issue 1 February 2008 , pages 13 - 23
An abnormal increase in proteolytic enzymes is thought to play a key role in pulmonary emphysema. Alveolar macrophage proteolytic enzymes include cathepsin L, cathepsin S, matrix metalloproteinase 1, 9, and 12, and a number of studies have implicated these proteinases in the alveolar destruction that characterizes emphysema.
Clinical Microbiology and Infection doi:10.1111/j.1469-0691.2007.01944.x
Pneumonia caused by the opportunistic organism Pneumocystis jirovecii is a clinically important infection affecting AIDS and other immunocompromised patients.
This retrospective study was conducted to review the complications of lung radiofrequency (RF) ablation and to clarify the effects of inflammation after lung RF ablation on mortality and morbidity. Complications were evaluated by reviewing medical records on an RF session basis
COPD: Journal of Chronic Obstructive Pulmonary Disease, Volume 5, Issue 1 February 2008 , pages 43 - 51
Chronic obstructive pulmonary disease (COPD) results in significant morbidity and mortality. Smoking has long been recognized as the primary risk factor for development of COPD, but factors determining the severity or pattern of disease in smokers are largely unknown. Recent interest has focused on the potential role of infectious agents and the associated host response in accelerating progression of airway obstruction or in perpetuating its progression following discontinuation of tobacco exposure.
American Journal of Industrial Medicine Volume 51, Issue 3 , Pages 186 - 194
Asbestosis is associated with lung cellular and immunological abnormalities. Induced sputum cytology and local and systemic markers of inflammation may be helpful to characterize disease status and progression in these patients.
American Journal of the Medical Sciences. 335(2):163-169, February 2008
Plastic bronchitis is an uncommon and underdiagnosed entity, characterized by recurrent expectoration of large, branching bronchial casts. We describe a 39-year-woman with no prior lung disease who had episodic wheezing, severe dyspnea with expectoration of large and thick secretions, branching in appearance, which she described as resembling squid.
American Journal of the Medical Sciences. 335(2):141-144, February 2008
Fluoroquinolones are increasingly used for the treatment of community-acquired pneumonia. However, their use has been associated with a delay in the diagnosis and treatment of pulmonary tuberculosis.
Allergy and Asthma Proceedings, Volume 29, Number 1, 1/2 2008 , pp. 55-61(7)
Asthma is a clinical problem with social, psychological, and economic burdens. To improve patient disease management and quality of life (QOL), different education programs have been developed. The purpose of this study is to adapt and implement a community-based educational program for patients with asthma.
Allergy and Asthma Proceedings, Volume 29, Number 1, 1/2 2008 , pp. 51-54(4)
As a marker of inflammation, exhaled breath condensate (EBC) pH may be a useful screening tool in the evaluation of asthma, especially in a military recruit population. To evaluate the utility of EBC pH in the diagnosis of asthma, EBC pH levels were determined in basic military trainees prior to an evaluation for asthma that included a history, physical exam, baseline spirometry, and a methacholine or exercise challenge.
Annals of Internal Medicine 19 February 2008 Volume 148 Issue 4 Pages 278-283
Pulmonary arterial hypertension (PAH) occurs as an idiopathic disease (formerly called primary pulmonary hypertension) and as a consequence of other illnesses. These illnesses include connective tissue diseases, portal hypertension, diet and stimulant drug use, HIV infection, and congenital heart disease.
International Journal of Clinical Practice doi:10.1111/j.1742-1241.2008.01624.x
Pulmonary hypertension (PH) may complicate the course of many forms of advanced interstitial lung disease (ILD) and has been shown to portend a worse outcome.
Metastasizing pleomorphic adenoma is a rare condition of metastasis from a histologically benign salivary gland tumor. We report a case of metastasizing pleomorphic adenoma presenting with multiple bilateral lung metastases, and discuss the clinical aspects of this disease.
Complete rupture of the main bronchus after blunt thoracic trauma is rare. Most patients with blunt traumatic injury to the trachea or bronchus die before arriving at hospital. A 26-year-old man with complete right main bronchus rupture was successfully treated by urgent surgical intervention and postoperative fiberoptic bronchoscopy for bronchial toilet.
Clinical Nuclear Medicine. 33(2):144-145, February 2008
A 63-year-old woman with dyspnea and hypoxia had ventilation-perfusion (V/Q) imaging for possible pulmonary embolism. Prominent focal deposition of Technegas was noted in the region of the carina on the ventilation scan.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 251-255, 2008
In aerobic organisms, all cells have the capacity to respond to changes in oxygenation through the stabilization and transcriptional activation of hypoxia-inducible factor (HIF).
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 293-299, 2008
Nasal epithelial cells form the outermost protective layer against environmental factors. However, this defense is not just physical; it has been shown that epithelial cells respond by the production of inflammatory mediators that may affect local immune responses.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 318-323, 2008
Ozone is known to produce an acute influx of neutrophils, and alveolar epithelial cells can secrete chemokines and modulate inflammatory processes. However, direct exposure of alveolar epithelial cells and macrophages to ozone (O3) produces little chemokine response. To determine if cell-cell interactions might be responsible, we investigated the effect of alveolar macrophage-conditioned media after ozone exposure (MO3CM) on alveolar epithelial cell chemokine production.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 283-292, 2008
The mechanisms used by alveolar type I pneumocytes for maintenance of the lipid homeostasis necessary to sustain these large squamous cells are unknown. The processes may involve the ATP-binding cassette transporter A1 (ABCA1), a transport protein shown to be crucial in apolipoprotein A-I (apoA-I)-mediated mobilization of cellular cholesterol and phospholipid. Immunohistochemical data demonstrated the presence of ABCA1 in lung type I and type II cells and in cultured pneumocytes.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 276-282, 2008
Abnormal epithelial repair to damage participates in airway remodeling in asthma by the paracrine regulation of mesenchymal cell functions. Retinoids control epithelial functions through nuclear retinoic acid receptor (RAR) and retinoid X receptor (RXR) activation, yet their expression and contribution to epithelial repair and to airway remodeling in asthma are unknown.
American Journal of Respiratory Cell and Molecular Biology. Vol. 38, pp. 269-275, 2008
The formation of neural tissue, in association with airway smooth muscle (ASM), is a feature of normal lung development and function. Intrinsic neuronal tissue has recently been shown, in animal models, to be derived from neural crest cells (NCC).
Am J Physiol Lung Cell Mol Physiol 294: L190-L195, 2008
beta2-Adrenergic receptors (beta2-AR) expressed on airway epithelial and smooth muscle cells regulate mucociliary clearance and relaxation and are the targets for beta-agonists in the treatment of obstructive lung disease.
Am J Physiol Lung Cell Mol Physiol 294: L378-L385, 2008
The ectoenzyme CD38 catalyzes synthesis and degradation of cyclic ADP ribose in airway smooth muscle (ASM). The proinflammatory cytokine TNF{alpha}, which enhances agonist-induced intracellular Ca2+ ([Ca2+]i) responses, has been previously shown to increases CD38 expression.
Am J Physiol Lung Cell Mol Physiol 294: L214-L224, 2008
The ontogeny of the C-C chemokines eotaxin-1, eotaxin-2, and eotaxin-3 has not been fully elucidated in human lung. We explored a possible role for eotaxin in developing lung by determining the ontogeny of eotaxin-1 (CCL11), eotaxin-2 (CCL24), eotaxin-3 (CCL26), and the eotaxin receptor, CCR3.
Am J Physiol Lung Cell Mol Physiol 294: L358-L367, 2008
Treatment of lung epithelial cells with different kinds of nano-sized particles leads to cell proliferation. Because bigger particles fail to induce this reaction, it is suggested that the special surface properties, due to the extremely small size of these kinds of materials, is the common principle responsible for this specific cell reaction.
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Am J Physiol Lung Cell Mol Physiol 294: L309-L318, 2008
Prolonged exposure to decreased oxygen tension causes contraction and proliferation of pulmonary arterial smooth muscle cells (PASMCs) and pulmonary hypertension.
New England Journal of Medicine Volume 358:700-708 February 14, 2008 Number 7
Bronchopulmonary dysplasia is associated with ventilation and oxygen treatment. This randomized trial investigated whether nasal continuous positive airway pressure (CPAP), rather than intubation and ventilation, shortly after birth would reduce the rate of death or bronchopulmonary dysplasia in very preterm infants.
International Journal of Clinical Practice doi:10.1111/j.1742-1241.2007.01641.x
To determine the effectiveness of influenza vaccination on acute respiratory illness (ARI) and on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) during a 2-year study conducted prior to and after influenza vaccination in patients with chronic obstructive pulmonary disease (COPD).
New England Journal of Medicine Volume 358:716-727 February 14, 2008 Number 7
Acute lower respiratory tract infections are a persistent and pervasive public health problem. They cause a greater burden of disease worldwide than human immunodeficiency virus infection, malaria, cancer, or heart attacks.
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