Subject(s)
Hemoptysis/etiology , Hypoxia/etiology , Pneumonia/chemically induced , Respiratory Insufficiency/etiology , Silicones/adverse effects , Biopsy , Bronchoscopy , Diagnosis, Differential , Female , Hemoptysis/diagnosis , Humans , Hypoxia/diagnosis , Pneumonia/diagnosis , Radiography, Thoracic , Respiratory Insufficiency/diagnosis , Tomography, X-Ray Computed , Young AdultABSTRACT
BACKGROUND: Capsaicin, the pungent extract of red peppers, has achieved widespread use in clinical research because it induces cough in a dose-dependent and reproducible manner. Although > 2 decades of experience has led investigators to consider capsaicin cough challenge testing a safe diagnostic modality, this issue has not been specifically addressed in the literature. STUDY OBJECTIVES: To review the published experience with capsaicin inhalation challenge testing in terms of safety. DESIGN: Literature review and personal communication with study authors. SETTING: Academic medical center. RESULTS: One hundred twenty-two published studies since 1984 described 4,833 subjects (4,374 adults, 459 children) undergoing capsaicin cough challenge, with no serious adverse events reported. Subjects included healthy volunteers as well as patients with asthma, COPD, pathologic cough, and other respiratory conditions. Minor complaints described in a small fraction of studies consisted mainly of transient throat irritation. Personal communication with the authors of > 90% of the studies confirmed an absence of any serious adverse events. Furthermore, these investigators have performed thousands of additional capsaicin challenge studies not reported in the literature, also without any associated serious adverse events. CONCLUSIONS: A review of the 20-year clinical experience has failed to uncover a single serious adverse event associated with capsaicin cough challenge testing in humans. Given the need for better antitussive therapies, capsaicin represents a vital component of future scientific inquiry in the field of cough.
Subject(s)
Bronchial Provocation Tests/methods , Capsaicin/pharmacology , Cough/chemically induced , Administration, Inhalation , Capsaicin/administration & dosage , Capsaicin/adverse effects , Dose-Response Relationship, Drug , HumansABSTRACT
BACKGROUND: The collapse of the World Trade Center (WTC) on September 11, 2001 created a large-scale disaster site in a dense urban environment. In the days and months thereafter, thousands of rescue/recovery workers, volunteers, and residents were exposed to a complex mixture of airborne pollutants. METHODS: We review current knowledge of aerodigestive inhalation lung injuries resulting from this complex exposure and present new data on the persistence of nonspecific bronchial hyperreactivity (methacholine PC20 < or =8 mg/mL) in a representative sample of 179 Fire Department of the City of New York (FDNY) rescue workers stratified by exposure intensity (according to arrival time) who underwent challenge testing at 1, 3, 6, and 12 months post-collapse. RESULTS: Aerodigestive tract inflammatory injuries, such as declines in pulmonary function, reactive airways dysfunction syndrome (RADS), asthma, reactive upper airways dysfunction syndrome (RUDS), gastroesophageal reflux disease (GERD), and rare cases of inflammatory pulmonary parenchymal diseases, have been documented in WTC rescue/recovery workers and volunteers. In FDNY rescue workers, we found persistent hyperreactivity associated with exposure intensity, independent of airflow obstruction. One year post-collapse, 23% of highly exposed subjects were hyperreactive as compared with only 11% of moderately exposed and 4% of controls. At 1 yr, 16% met the criteria for RADS. CONCLUSIONS: While it is too early to ascertain all of the long-term effects of WTC exposures, continued medical monitoring and treatment is needed to help those exposed and to improve our prevention, diagnosis, and treatment protocols for future disasters.
Subject(s)
Bronchial Hyperreactivity/etiology , Occupational Diseases/etiology , Rescue Work , Respiratory Distress Syndrome/etiology , September 11 Terrorist Attacks , Air Pollutants/adverse effects , Bronchial Hyperreactivity/epidemiology , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/etiology , Humans , New York City , Occupational Diseases/epidemiology , Occupational Exposure/adverse effects , Respiratory Distress Syndrome/epidemiology , VolunteersABSTRACT
An unusual endobronchial presentation of lymphoepithelial cysts (LECs) is described in a HIV-seropositive patient. The bilateral infrahilar cysts had followed an apparently benign course for 2 years. Bronchoscopy revealed an endobronchial mass occluding the anterior basilar segment of the left lower lobe. Biopsy resulted in emptying of the cyst and showed the typical pseudostratified columnar epithelium with intraepithelial lymphocytes of an LEC. This diagnosis should be considered in patients with HIV infection and pulmonary cysts on CT.
