relationship between diaphragmatic movements in sonographic assessment and disease severity in patients with stable chronic obstructive pulmonary disease [COPD]

Introduction: Pulmonary hyperinflation in patients with chronic obstructive pulmonary disease [COPD] can increase the breathing rate and reduce diaphragmatic movements by pushing the diaphragms downward and limiting their movements; this, in fact, can affect the breathing process. The purpose of this study was to compare diaphragmatic movements in COPD patients and healthy ones and to evaluate the relation of diaphragmatic movements and COPD severity in patients

Materials and Methods: This cross- sectional study was performed in Ghaem hospital, Mashhad Iran. Twenty-five COPD patients [case group] were selected, based on the inclusion and exclusion criteria. The patients' demographic and clinical characteristics along with factors related to pulmonary function were recorded. Patients were referred for sonography after pulmonary evaluation. The status of the left portal vein or one of its branches at the end of a deep expiration and a deep inspiration was considered as a marker. Twenty-five healthy non-smoker subjects, who were matched with the patients in terms of age and sex, were studied as the control group for the comparison of sonographic findings of the diaphragms

Results: The current study included 25 healthy subjects and 25 COPD patients, with the mean age of 59.2 +/- 12 years; approximately 84% of the subjects were males. Evaluation of the rate of diaphragmatic movements by sonography showed the mean of 42.08 +/- 12.15mm and 73.28 +/- 15.19mm in the case and control groups, respectively, which showed a statistically significant difference between them [P=0.02]. Statistical analysis indicated the relationship between the rate of diaphragmatic movements with factors related to airway obstruction. However, no relationship was observed between the rate of diaphragmatic movements and the factors associated with pulmonary hyperinflation or air retention

Conclusion: The rate of diaphragmatic movements as a parameter for determining exercise capacity in COPD patients could help with a better understanding of activity limitations in these patients

Role of Chlamydia pneumoniae infection in asthma in northeast on of Iran

The role of Chlamydia pneumoniae in asthma has drawn much attention in recent years. In this study we assessed the prevalence of C. pneumoniae infections in patients with chronic stable and acute exacerbation of asthma and compared it with normal population. Twenty adult patients with chronic stable asthma and 21 patients with acute exacerbations of asthma and 41 matched control subjects were studied for presence of C. pneumoniae using cell culture. This study suggests that positive results of C. pneumoniae culture are associated with both chronic stable and acute exacerbation of asthma. It could be concluded that C. pneumoniae is a risk factor for either development or exacerbation of asthma

Pulmonary complications of chemical warfare 15 years after exposure

Chemical weapons, [mainly mustard gas-MG] were heavily used by Iraq against Iranian soldiers between 1984-1986. It has acute effects on respiratory tract in the form of tracheobronchitis and ARDS, whereas chronic respiratory complications include chronic bronchitis, bronchiectasis, asthma and pulmonary fibrosis. There are few reports about human victims. Some of them describe acute effects while our purpose is to define chronic sequelae and their microbiologic, radiologic and physiologic behavior. Fourty four chemical weapon injured patients with moderate to severe disability were selected by AMA criteria [1]. All of them underwent history taking and physical examination, ABG, spirometry, CXR, HRCT, bronchoscopy and BAL for cytology and quantitative culture. Of fourty four patients; 29[66%] had diagnosis of chronic bronchitis by ATS criteria [2], 8 [18%] and 7 [16%] had diagnosis of bronchiectasis and asthma respectively. The most common HRCT finding was ground glass appearance. In one-fourth of patients BAL culture was positive and revealed unusual organisms [S.aureus, S.coagulase negative, E.coli]., BAL neutrophils were increased in bronchiectatic group [258 136 hpf] vs. [96 49 hpf], [148 133 hpf] [p<0.01 p]. Bronchiectatic patients were younger than the other groups [35.5 6.1 yr] vs. [43.5 5.2 yr], and [42.3 5.2 yr] [p<0.01]. The most common respiratory complication of MG is chronic bronchitis. Unusual microorganisms should be considered in the treatment of pulmonary infections. Persons who are exposed to mustard gas at younger age maybe more prone to development of bronchiectasis