Chronic obstructive pulmonary diseases in Thailand: incidence, prevalence, present status and future trends.

MATERIAL AND METHOD: Data on cases of COPD in 1999 were collected. RESULTS: [table in text] The mortality rate was 0.6-3.4 per cent in OPD cases and 11-17 per cent in IPD cases. The hospital stay was 2-90 days (mean 14 days). The cost per day in the ICU of government hospitals was Bht 7,000 and in private hospitals Bht 10,000.

Effects of antileukotriene among asthmatic patients.

STUDY OBJECTIVE: To determine the effect of antileukotriene (montelukast) 10 mg once daily for the treatment of mild to moderate asthma. DESIGN: Open label, prospective. PATIENTS: Thirty asthmatic patients > or = 18 years of age with baseline FEV1 > 60 per cent and < or = 80 per cent of predicted values and evidence of reversible airway obstruction, as defined by an increase in FEV1 of > or = 20 per cent. INTERVENTIONS: Montelukast 10 mg once daily orally for 12 weeks, back up beta-2 agonist inhaler was available. MEASUREMENT AND RESULTS: Spirometry was performed during the screening period, and every month after starting antileukotriene. Subjects recorded asthma-related symptoms and use of supplement beta-2 agonists daily on diary cards. Over 12 weeks of treatment, the FEV1 increased 10 per cent, 14 per cent and 19 per cent respectively, compared to the baseline (p < 0.05). The physician and patients evaluation scores were quite good in the study. CONCLUSION: Oral montelukast once daily gave a favorable effect in management of mild to moderate asthmatic patients.

Bronchial artery embolization for hemoptysis.

BACKGROUND: Massive hemoptysis is a life-threatening condition. Since treatment from surgery has high mortality, bronchial artery embolization (BAE) is now safer and may be good for chronic hemoptysis as well. MATERIAL AND METHOD: Ten patients (6 male, 4 female) with hemoptysis underwent BAE. Five patients had massive life-threatening hemoptysis (4 tuberculosis and 1 bronchogenic carcinoma) and 5 had chronic hemoptysis (4 tuberculosis and 1 bronchogenic carcinoma). All patients received BAE by transfemoral arterial approach using gelfoam particles and Ivalon as the embolized materials. Bronchial arteries were abnormal in all cases except one patient who had bronchogenic carcinoma supplied by the acromiothoracic artery to the left upper lobe. RESULTS AND CONCLUSION: Chest radiograph may correlate well with angiographic findings if there is one lobar lesion, but multiple lobar lesions showed no correlation between the two modalities. Hypervascularity was a universal findings in all patients. Other angiographic findings were enlarged bronchial or nonbronchial arteries, systemic to pulmonary anastomosis, pseudoaneurysm, and extravasation of contrast media. The immediate result of BAE achieved 100 per cent but follow-up showed only a 70 per cent success rate with one mortality from recurrent massive hemoptysis and two recurrent cases due to complications. Ivalon which is a permanent embolized material may be useful for recurrent hemoptysis.

Bronchodilatation effects of dry powder formoterol fumarate in asthmatic patients.

Ten asthmatic patients were enrolled in our study of the effects of dry powder formoterol fumarate. The onset was 2-5 minutes and a long duration of action (over 12 hours) appeared. The mean baseline FEV1 was 1.67 liters (49-74%). Mean reversibility was 17 per cent (range 15-19%). There was no adverse effect in this study.

Multidrug-resistant tuberculosis: response to treatment.

OBJECTIVE: We investigated clinical response and mortality rates in 18 HIV- negative patients with multidrug-resistant tuberculosis. METHOD: We obtained detailed data from our hospital on patients with multidrug - resistant tuberculosis defined as tuberculosis resistant at least to isoniazid and rifampicin. Therapeutic responses were evaluated by both microbiologic and clinical data. RESULTS: From January 1985 to December 1990, 18 HIV-negative patients were identified and treated. One patient committed suicide 1 week after receiving antituberculous drugs. Of the 17 patients, 10 (58.8%) had clinical response as well as microbiologic response, 6 (35.3%) were persisters during 24 months of follow-up, and 1 (5.8%) died after 30 months of treatment. The median follow-up for the patients was 87 weeks (range, 24 to 212). For those who responded well, there was no relapse.

Effect of isoniazid prophylaxis on incidence of active tuberculosis among Thai HIV-infected individuals.

A prospective comparative study was conducted to determine the effect of isoniazid prophylaxis on the incidence of active tuberculosis among Thai HIV-infected patients for 1 year. Among those 36 HIV-infected patients without prophylaxis, the incidence of active tuberculosis was 2.7 per cent while in 10 HIV-infected patients with isoniazid prophylaxis, there was no incidence of active tuberculosis during the first year.

CD4 + T counts with a course of antituberculous therapy in healthy and HIV-infected patients.

A prospective study of CD4 + T lymphocytes with a course of treatment on 20 HIV-infected patients with active tuberculosis receiving antituberculous drugs was compared with 30 non HIV-infected patients with active tuberculosis. The CD4 + T cell counts among non HIV-infected patients were 510 +/- 409 and increased to 634 +/- 382 and 867 +/- 248 at the third and sixth month of therapy. Among HIV-infected patients, the CD4 + T cell counts were 64 +/- 42 and decreased to 40 +/- 23 and 35 +/- 16 in the third and sixth month of therapy (p < 0.05).

Abnormal pulmonary function among traffic policemen in Bangkok.

One hundred and seventy four traffic policemen's pulmonary functions were measured via vitalograph. Abnormal pulmonary functions occurred in 44 persons (25.29%). There was restrictive lung in 30, small airway obstruction in 11 and large airway obstruction in 3.

Cell analysis of bronchoalveolar lavage.

Ninety bronchoalveolar lavage (BAL) of Thai cancerous cases (28), tuberculous cases (24); non-tuberculous cases (17) and miscellaneous diseases cases (13) was performed for total and differential BAL cell count. This technique could be initially used as a guideline for suggestive diagnosis in some suspicious cases particularly cancer from tuberculous BAL. The combination in the ratio of macrophages to dusty and foamy macrophages below 1.25 and total BAL cell count lower than 0.85 x 10(3)/mm3 could suggest a diagnostic indication of cancerous BAL rather than tuberculous BAL or other diseases. Tuberculous BAL revealed a high percentage of macrophages, low level of dusty and foamy macrophages. Non-tuberculous BAL could be distinguished from other diseases by the higher percentage of neutrophil over 55% and lower percentage in every type of macrophages, whereas, a high level in every type of macrophages was found in miscellaneous BAL.

Trial of transdermal nicotine patch in smoking cessation.

In order to evaluate the efficacy of the transdermal nicotine patch, 37 persons who wore the patches (group 2) were compared with 40 persons who attended an organized smoking cessation program (group 1). At 1 month, 8 persons of group 2 (21.62%) and 22 persons of group 1 (55%) were able to stop smoking. At 3 months, 8 persons of group 2 (21.62%) and 17 persons of group 1 (42.5%) were still abstinent. At 6 months, 7 persons of group 2 (18.9%) and 14 persons of group 1 (35%) were able to stop smoking. At 12 months, 5 persons of group 2 (13.5%) were able to maintain their abstinence. Counselling and follow-up support are needed to maintain abstinence.

Nosocomial pneumonias in Thailand.

In order to compare the etiology, clinical manifestations, and prognosis of patients acquiring nosocomial pneumonia, we studied and compared sixty normal hosts who acquired nosocomial pneumonia during Jan 1, 1989-Dec 31, 1991 (group I) with seventy-two immunocompromised patients with nosocomial pneumonia who were admitted during 1984-1992 (group II). Both groups were similar in some patterns, eg gram-negative bacilli were common (80%, 50%), the chest roentgenogram showed initial localized lesions (74%, 72%), and there was a high mortality rate (46.7%, 54.2%). The differing findings were that the first group acquired pneumonia more often during the first 7 days after admission, transbronchial aspiration was believed to be the route of entry and most of the patients had productive coughs. Blood cultures rarely yielded the organisms (7%). The second group had pneumonia at a mean of 32 days after admission, hematogenous spread to the lungs was common and blood cultures more often yielded the etiologic organisms (41.7%).

The course of clinical COPD in Thailand.

Spirometry and outcome of 96 cases who were clinically diagnosed as having COPD were studied. Ninety-two cases had significant airway obstruction. Of these 92 cases, initial bronchodilator responses were evaluated in 73 cases. Twenty-six cases were responders (CRAO), while 47 cases were nonresponders (COPD). The average median survival of the whole group was 4 years and 5-year survival was 30 per cent. The annual change in FEV1 in both COPD and CRAO group were fluctuating, with a tendency to decrease in the former and increase in the latter. Spirometric parameters were found to be different between the survivors and nonsurvivors, these included initial PFEV1, PFVC, PFEF 25-75 per cent and postbronchodilator FEV1 and FEF 25-75 per cent. Inspite of the differences, an initial response to bronchodilator could not predict a better outcome for CRAO as compared to COPD. It was concluded that most clinical COPD who had progressive symptoms had significant airway obstruction and shorter survival. Due to fluctuating FEV1 during the course, the initial spirometry and degree of bronchodilator response were not accurate enough to predict subsequent outcome. Long-term follow-up on spirometry and response to bronchodilator should be individually evaluated.

Stair climbing, pre- and post-exercise arterial blood gases, and pulmonary function for pre-operative evaluation.

In order to determine the relationship between pulmonary function, performance on stair climbing, pre- and post-exercise arterial blood gases and post thoracotomy complications, we performed a prospective study on 19 patients. Sixteen of seventeen patients could accomplish a five flight stair climb. All of the seventeen patients survived and could be weaned off the respirator. Four developed postoperative complications. MMEFP (per cent mid maximum expiratory flow) showed statistically significant differences between patients with and without complications.

Nosocomial pneumonias-a comparison among normal and compromised hosts in Thailand.

In order to compare the etiology, clinical manifestation, and prognosis of patients acquiring nosocomial pneumonia, we studied and compared twenty normal hosts who acquired nosocomial pneumonia from Jan 1, 1989 to Dec 31, 1989 (group 1) with fifty-four immunocompromised patients with nosocomial pneumonia who were admitted between 1984 and 1990 (group 2). Both groups were similar in some patterns such as: gram-negative bacilli were common (75%, 60%), the chest roentgenogram showed initial localized lesions (75%, 73%), there was a history of prolonged hospitalization (27, 33 days) and a high mortality rate (60%, 50%). The differing findings were that the first group acquired pneumonia more often during the first 7 days after admission; transbronchial aspiration was believed to be the route of entry and most of the patients had productive cough. Blood cultures rarely yielded the organisms (5%). The second group had pneumonia at a mean of 33 days after admission, hematogenous spread to the lungs was common and blood cultures yielded the etiologic organisms more often (40.7%).

The compromised host and pulmonary infiltration: a prospective study.

If immediate sputum examination does not result in a diagnosis, broad spectrum antibiotics should be administered while awaiting cultures. Three days later, if the patient deteriorates and has a negative hemoculture, bronchoalveolar lavage should be done before open lung biopsy or antifungal drugs are considered. We have demonstrated that rational empiric therapy in immunosuppressed patients with pneumonia is beneficial. Diagnostic tests must be performed so that treatment can be modified later when the etiological agent has been identified.

Silicosis in ceramic-industry workers with particular reference to the diagnostic value of bronchoalveolar lavage.

We could identify, via bronchoalveolar lavage, crystals in the lavage fluid and in the alveolar macrophages. Thus, BAL could be another method for diagnosing silicosis patients.

Final diagnosis of "suspicious for malignancy" from bronchial washing cytology.

Our study showed that patients whose first bronchial washing cytology was reported "suspicious for malignancy" had 82 per cent positive predictive value for malignancy. Repeat bronchoscopy should be offered to those with a visible endobronchial mass, and transthoracic needle aspiration should be performed in patients with peripheral lesions.

Oxygen desaturation induced by bronchoalveolar lavage.

Our study demonstrates that bronchoalveolar lavage can induce significant desaturation in patients with a resting PaO2 of below 70 torr, and that supplemental oxygen at 5 L/min through a nasal cannula may not prevent a marked drop in the oxygen saturation during this procedure. Therefore, measures to provide higher FiO2 should be offered to assure adequate oxygenation in severely ill patients requiring bronchoalveolar lavage.

Use of bronchoalveolar lavage to diagnose pulmonary infiltrates in immunocompromised hosts.

Bronchoalveolar lavage is a simple and safe technique that aids in making the diagnosis of pulmonary infiltrates in immunosuppressed patients. The procedure can be done even in thrombocytopenic patients and those requiring ventilatory support.