Impairment rating and disability evaluation of the pulmonary system.

An increasing number of patients are being seen by physicians for impairment and disability of the pulmonary system, partially because of the increasing prevalence of chronic obstructive pulmonary disease and increased awareness of industrial and environmental hazards to the respiratory system. As legislative efforts and social expectations towards entitlement and compensation become more permissive, an increasing number of individuals with respiratory impairment are claiming disability and seeking compensation. Consequently, the physician whose practice includes pulmonary rehabilitation may be expected to evaluate and rate impairment and disability of the pulmonary system. Fortunately, for respiratory disorders, excellent objective measures of pulmonary function exist that are readily applicable to the process of disability assessment. This article highlights the diagnostic procedures and assessment criteria of choice for pulmonary disability determination.

Endobronchial irradiation with 192Ir in the treatment of malignant endobronchial obstruction.

From Jan 1, 1983 to April 30, 1989, 32 patients underwent 38 endobronchial treatments with 192Ir, bronchoscopically inserted for treatment of endobronchial obstructions secondary to bronchogenic carcinoma. Thirty-four of the 38 treatments were far enough apart to allow separate response analysis. Thirty of the 34 patients were symptomatically improved or stable; 22 of 24 patients who could be evaluated roentgenographically showed improved or stable chest roentgenograms, and ten of 12 patients evaluated bronchoscopically demonstrated improved patency of bronchial lumen.

Effect of positive end-expiratory pressure and body position in unilateral lung injury.

Positive end-expiratory pressure (PEEP), by increasing lung volume in acute lung injury, may recruit terminal air spaces in the involved regions, but may also distend noninvolved regions increasing extravascular lung water and worsening gas exchange. We investigated the effect of increasing levels of PEEP on arterial oxygenation in 26 anesthesized dogs with unilateral acid pneumonitis and studied the influences of gravity and distribution of the injury on this effect. Arterial PO2 was consistently higher when the noninjured lung was dependent than in the supine or injured lung-dependent positions. Low levels of PEEP (5, 10 cmH2O) improved arterial oxygenation and reduced intrapulmonary physiological shunt. However, 15 cmH2O PEEP resulted in worsening of gas exchange, increased dead space ventilation, and diminished static compliance. The adverse effects of high levels of PEEP on arterial oxygenation were similar whether the injured lung was dependent or not and were evident a lower levels of PEEP in one group of dogs in which the unilateral injury was more diffuse and in which the upper and middle lobes were also involved. Thus, the compressive effects of high levels of PEEP on alveolar capillaries in the noninjured lung are influenced by the extent and distribution of injury in the injured lung, but not by local forces governing regional blood flow distribution.

Large airway obstruction secondary to endobronchial coccidioidomycosis.

When clinically apparent, coccidioidomycosis usually presents either as an interstitial pulmonary infiltrate or, later in its course, a parenchymal nodule often with cavitation. The present report concerns a young adult woman whose presentation was one of shortness of breath with wheezing and stridor, secondary to a localized endobronchial coccidiodal granuloma producing nearly complete obstruction of the right mainstem bronchus. Such a presentation has not been reported previously in an adult. The possible association of serious fungal disease with previous jejunoileal bypass surgery is discussed.