Association between celiac disease and lung disease.

An association has been suggested between celiac disease and diffuse interstitial lung disease of the hypersensitivity pneumonitis type in several reports from Europe. The present report consists of a study of 18 North American, biopsy-proved celiac patients, who were compared with an equal number of control subjects balanced for age, sex, and smoking. The celiac patients showed no evidence of interstitial lung disease as assessed by chest roentgenograms and pulmonary function tests. However, a history of asthma or chronic cough was present in a higher proportion of the celiac than control subjects. Also the celiac patients showed objective evidence of airway obstruction, as demonstrated by differences between the two groups in FEV1 (P less than 0.05) and Vmax 50% and Vmax 25% (P less than 0.01 and less than 0.05, respectively). These results confirm a recent report questioning whether there is truly a relationship between celiac disease and interstitial lung disease. Nevertheless, our findings suggest an association between celiac disease and airway obstruction.

Further manifestations of Behçet's syndrome.

Behçet originally described a syndrome of iritis and anal and vaginal ulcerations. Many other manifestations of this disease have since been added, including rarely esophageal and bronchial ulceration. The authors report the case of a 65-year-old woman who had a 40-year history of oral and genital ulcers associated with arthritis, thrombosis of the left subclavian artery, asthma and esophageal ulceration. Her esophageal and respiratory symptoms were dominant. In the esophagus, despite effective control of reflux, she continues to have ulceration and secondary stricture requiring intermittent dilatation. When the stricture is tight, aspiration of food occurs, aggravating her asthma. The radiologic, endoscopic and manometric features of her esophageal disorder are described.

Comparison of respiratory variables in grain elevator workers and civic outside workers of Thunder Bay, Canada.

We compared respiratory variables in 441 grain elevator workers with 180 civic outside laborers in Thunder Bay. The grain handlers had a lower frequency of both positive skin reactions to pollens and molds and a family history of asthma, which suggests that they may have been self-selected for a decreased tendency to develop allergic respiratory disease. There was a higher frequency of cough and rales and a small decrease in forced vital capacity and forced expiratory volume in one sec among the grain handlers, as compared to the civic workers matched for smoking. However, these differences between grain and nongrain workers were small in comparison to those between smokers and nonsmokers. There was no clear indication of a worsening of respiratory functions that could be attributed specifically to duration of employment as a grain elevator worker.

The mechanism of increase in total lung capacity during acute asthma.

In order to investigate the mechanism underlying the increased total lung capacity (TLC) observed during an acute asthmatic attack, we measured respiratory mechanics in a specially trained, exercise-induced, asthmatic. During the acute attack his TLC (determined plethysmographically) increased from 7.8 to 9.2 liters. The static pressure-volume curve of the lung shifted to the left and expiratory compliance increased from 0.24 to 0.55 liter/cm H2O. There was a parallel shift of the static pressure-volume curve of the chest wall resulting in an increase in the outward recoil of this structure. The maximum inspiratory pressure-volume curve of the total respiratory system was shifted so that the inspiratory muscles were able to generate greater pressures at any given lung volume during the attack. The findings indicate that the increase in TLC during acute bronchospasm results from the combination of loss of lung recoil, increased outward recoil of the chest wall and increased strength of contraction of the inspiratory muscles.