Early detection of pulmonary emphysema in smokers by spiral chest CT

This study was carried out to assess the occurrence of pulmonary emphysema early among smokers [symptomatizing and non symptomatizing] by hellical chest CT and relating this finding to pulmonary function. In order to achieve this purpose 55 smokers [25 asymptomatic and 30 symptomatic] and 10 apparently healthy non smokers control subjects were in vestigated through: I. Full detailed medical history with particular attention to smoking habits. II. Full clinical examination comprising both general and local chest examination. Ill. Plain chest X-ray, posterio-anterior [P A] and lateral views. IV. Pulmonary function tests, using computerized sensor medics 2450. [1] flow volume loop data, before and 20 minutes after inhalation of 4 puffs [400 micro g] of salbutamol using MDI to exclude asthmatic. [2] functional residual capacity [FRC] helium equilibration test. [3] pulmonary diffusing capacity [DL[co]] and pulmonary diffusing coefficient [DL[co]/VA] [alveolar volume VA]. V. High resolution chest CT [HRCT] .Analysis of the computed tomograms was performed visually according to Goddard et al. [5]. VI. Subjects proved to have other concomitant disease or known COPD were excluded from this study in asymptomatic smokers 16 out of 25 [64%] have emphysema by HRCT. Plain chest x-ray of those 16 smokers having emphysema by HRCT were normal in all [100%] and 9 of them [56.3%] have normal pulmonary functions in symptomatic smokers 27 out of 30 [90%] were having emphysema by HRCT. Twenty six percent of those symptomatic smokers having emphysema by HRCT showed normal plain chest x-ray. On comparing the validity of plain x-ray versus HRCT in the diagnosis of pulmonary emphysema plain x-ray has 35.5% sensitivity, 95.4% specificity, 95.0% predicted value positive, 46.7 predicted value negative and 61.5% accuracy. Correlation between pulmonary functions and emphysema score by HRCT in both asymptomatic and symptomatic smokers showed that there was only significant negative correlation between emphysema score and DL[co]/VA in asymptomatic smokers [P < 0.05] but in symptomatic smokers there is highly significant negative correlation with all parameters of pulmonary functions except total lung capacity [TLC]. residual volume [RV] RV/TLC and FRC [I] HRCT is the best mean for early detection of pulmonary emphysematous changes among smokers as it is better in this respect than pulmonary functions. [2] Plain chest X-ray is less sensitive than pulmonary functions in early detection of pulmonary emphysema. [3] DL[co]/V A is the most sensitive pulmonary function test to be affected early in pulmonary emphysema

Short form - 36 questionnaire for assessing quality of life in bronchial asthma patients

This aim of the present study was to apply the short form -36 [SF- 36]questionnaire in patients with bronchial asthma and to assess the relationship between symptom score and ventilatory pulmonary function, with the scores of the nine component of the SF-36. This study was carried out on one hundred and forty two patients with stable bronchial asthma of variable severity [forced expiratory volume in 1[st] second FEV[1] ranged from 55 to 73% of predicted], they were 60 males and 82 females with their ages ranged from 16 to 49 years. All patients were subjected to: ventilatory pulmonary function measurements using computerized sensor medics 2450 apparatus before and 20 minutes after inhalation of 200 micro g of salbutamol using metered dose inhaler. The clinical severity of asthma was assessed according to the symptom frequency score of Reddel et al., [15]. Every patient completed SF-36 questionnaire which is composed of 36 items, measuring three major health attributes and nine health concepts. The result of this study showed that the older patients had the severe asthma score. Most SF-36 scores were significantly higher in men than in women. The symptom score showed significantly negative correlation with all items of SF-36 scores. While the FEV[1]% predicted was significantly positively correlated with five of the nine health components of the SF-36 questionnaire, the forced expiratory flow at 25-75% of vital capacity% predicted [FEF[25-75%]] and the forced expiratory flow at 75-85% of vital capacity% predicted [FEF[75-85%]] showed only significantly positive correlation with three of the nine health component of the questionnaire. In conclusion, the SF-36 questionnaire can be used as a tool to measure health related quality of life [HQL] in asthmatics. The severity of symptom score but not the ventilatory pulmonary function was a significant predictor of various component of HQL [SF-36]