Bronchial anthracosis: a potent clue for diagnosis of pulmonary tuberculosis

Occupational exposure to carbon, silica, and quartz particles are predisposing factors for bronchial anthracosis. In some cases anthracosis may be associated with mycobacterium tuberculosis. This study aims to investigate the clinical, radiographic, and bacteriologic findings in bronchial anthracosis patients and its association with tuberculosis, This is a prospective study conducted between 1998 and 2001, A total of 919 patients underwent diagnostic bronchoscopy for pulmonary diseases. Of these, 71 patients showed evidence of bronchial anthracosis, 32 [45.8%] males and 39 [54.2%] females, age range, 30-92 years. The distinctive clinical features, nature of bronchoscopic lesions, and radiologic findings were analyzed prospectively and summarized, Bacteriologic studies and results of laboratory examinations were also assessed, Forty-one [57,8%] patients had positive smears or cultures for mycobacterium tuberculosis. Of 71 patients with bronchoscopic evidence of pulmonary diseases, 30 had previous occupational exposure, and 41 stated no previous exposure, Cavitary lesions on chest radiography, positive purified protein derivative tests and high ESR were more prevalent in tuberculous patients than the others. Bronchial anthracosis was caused by active or previous tuberculous infection. Detailed examinations for the presence of active tuberculosis should be performed in patients with such bronchoscopic findings in order to prevent the spread of tuberculosis and to avoid unnecessary invasive procedures

Pulmonary function test trend in adult bronchiolitis obliterans

Some histopathologic patterns of bronchiolar disease may be relatively unique to a specific clinical entity, such as respiratory bronchiolitis caused by cigarette smoking and toxic fumes i.e. sulfur mustard [SM]. The aim of this study was to determine the trend of pulmonary function indices in SM-exposed patients with the diagnosis of bronchiolitis obliterans. In this retrospective cohort study, 407 cases were evaluated. Patients were divided into 4 groups according to the time period from performing PFT: 1-3, 4-6, 7-10 and more than 10 years. The amounts of these changes amongst four PFT interval groups were compared by analysis of variance test. In addition, we used linear regression analysis to create a linear model of changes for each PFT index. The following equations imply a correlation between decrease in PFT indices and interval between the two tests plus index value of baseline PFT. 1: [FVC%]= -2.23 - [0.76 T]-[0.23 FVC1%], 2: [FEV1%]= -1.43 - [0.95 T]-[0.10 FEV11%], 3: [PEF%]= -0.91 - [1.07 T]-[0.14 PEF1%]. Better understanding of the nature of bronchiolitis obliterans, helps improve the treatment of this disease. Our study suggests a pattern of decline in pulmonary function indices directly proportional to the percentage of each index in the baseline PFT which was apparent during a 10-year observation period

Clinical differentiation between resistant asthma and chronic bronchiolitis: testing a practical approach

Intractable asthma is a challenging clinical problem. This study was conducted to determine whether a subset of patients with Intractable asthma may be misdiagnosed and have a form of bronchiolitis instead and also to determine the effectiveness of macrolide therapy in these patients. Seventy six patients with Intractable asthma were re-treated with recommended maximal doses of oral prednisolone for 5 days, beclomethasone, cromolyn sodium, salbutamol and ipratropium bromide for 30 days. Thirty five patients were considered as unresponsive and constituted the study group. They underwent high-resolution CT [HRCT] scan following which they were offered with video-assisted thoracoscopic surgical biopsy. Group 1 [n=27] refused biopsy and each was treated with macrolide therapy, while Group 2 [n=8] underwent biopsy, and then received macrolide therapy. The patients were treated and followed for three months. The study group consisted of 27 patients, with a mean age of 46.9 +/- 11.1 years. The mean duration of time between the onset of symptoms and the start of this study was 8.1 years. In group 2, no patient had pathologic findings of asthma, and 7/8 had a form of bronchiolitis. There was significant improvement in dyspnea, cough and pulmonary function indices at the end of the 3-month in both groups [p<0.001]. Our results suggest that patients with Intractable asthma could be misdiagnosed and some of them have some forms of chronic bronchiolitis. We believe that any patient who does not respond to standard treatments for Intractable asthma should be evaluated with expiratory HRCT; those with significant air trapping should be considered for a course of macrolide therapy or biopsy for better identification of the underlying disease