1/13. Mucoepidermoid carcinoma of the trachea with airway hyperresponsiveness.We report a case of mucoepidermoid carcinoma of the trachea in a 23-year-old pregnant female in her 39th week. The patient had cough and wheezing in the early morning for 9 months before admission. No abnormalities were detected on a chest roentgenogram. At Caesarean section, fiberscopy revealed a polypoid lesion narrowing the trachea. The pathologic diagnosis made from the biopsy specimen obtained was low-grade mucoepidermoid carcinoma and the lesion was resected. Airway hyperresponsiveness was shown before resection with airflow limitation, however, airway reactivity and airflow limitation improved 1 year after resection.- - - - - - - - - - ranking = 1keywords = cough (Clic here for more details about this article) |
2/13. Reactive airways dysfunction syndrome following metal fume fever.Metal fume fever (MFF) is an acute response to the inhalation of heavy metals used in industry. The patient typically experiences symptoms of cough, fever, chills, malaise, and myalgia that are self-limited and of short duration. Wheezing may occur and pulmonary function may be acutely impaired with a decrease in lung volumes and diffusing capacity of carbon monoxide. Nevertheless, respiratory function quickly returns to normal, and persistent pulmonary insufficiency is unusual. Irritant-induced asthma is a non-immunogenic form of airway injury that may be associated with industrial inhalation exposure. In this situation, the direct toxic effect on the airways causes persistent airway inflammation and bronchial hyperreactivity. The two conditions are considered distinct entities, but we report a previously healthy worker who had classic MFF and was left with irritant-induced asthma or reactive airways dysfunction syndrome (RADS).- - - - - - - - - - ranking = 1keywords = cough (Clic here for more details about this article) |
3/13. pressure support ventilation with the laryngeal mask airway: a method to manage severe reactive airway disease postoperatively.The use of a laryngeal mask airway (LMA) and a bi-level positive airway pressure (BiPAP) machine is described in a post-operative thoracotomy patient with reactive airway disease. The LMA was placed to avoid reintubation of the trachea after a double lumen tube was no longer necessary. Placement in an awakening patient and positive-pressure ventilatory support were well tolerated and did not trigger a bronchospastic response. The patient was able to cough and breathe deeply with the LMA while receiving ventilatory assistance in the post-anaesthesia care unit (PACU). The LMA is a therapeutic option to tracheal reintubation in patients who need postoperative ventilatory support after one-lung anaesthesia.- - - - - - - - - - ranking = 1keywords = cough (Clic here for more details about this article) |
4/13. Occupational asthma due to heated polypropylene.A 35 year-old nonatopic woman was referred to the hospital for possible work-related asthma. She had worked as an operator, at a plant producing polypropylene bags, for the previous four yrs. Her main complaint was a productive cough with dyspnoea and wheezing, as well as rhinitis over the past 3 yrs. She had been absent from work for 6 months on maternity leave, and had improved greatly. She was on a beta 2-adrenergic agent and had to take it at least four times daily. Baseline spirometry whilst at work showed marked airflow obstruction (forced expiratory volume in one second (FEV1) of 43% predicted (pred). After two months away from work FEV1 improved to 89% pred; provocative concentration of histamine causing a 25% fall in FEV1 (PC20) was 3.6 mg.ml-1 (mild airway hyperresponsiveness). return to work resulted in a marked deterioration in FEV1, and serial peak expiratory flow (PEFR) values. PC20 was 0.11 mg.ml-1 (severe airway hyperresponsiveness) one week after she had returned to work. Specific inhalation challenges with polypropylene heated to 250 degrees C resulted in a late asthmatic reaction. As formaldehyde is one of the degradation products of heating polypropylene, we exposed her to it for up to 2 h, but we elicited no bronchospastic reaction. We conclude that heated polypropylene should be listed as one of the agents that causes occupational asthma.- - - - - - - - - - ranking = 1keywords = cough (Clic here for more details about this article) |
5/13. Occupational asthma caused by pectin inhalation during the manufacture of jam.We report a case of pectin-induced occupational asthma in a 35-year-old man. His job involved mixing powdered pectin into a fruit puree during the manufacture of jam. Within minutes of adding pectin, he developed coryza, rhinorrhea, coughing, and wheezing. His symptoms cleared during weekends while away from work and improved with the use of a protective face mask at work. Peak flow rates were significantly lower while at work compared with those at home, and a prick skin test with the pectin powder was positive. We conclude that pectin should be added to the list of the substances known to induce occupational asthma.- - - - - - - - - - ranking = 1keywords = cough (Clic here for more details about this article) |
6/13. Reactive airways dysfunction syndrome induced by exposure to a mixture containing isocyanate: functional and histopathologic behaviour.A 31-year-old machinist experienced acute symptoms of rhinoconjunctivitis, coughing, shortness of breath, and wheezing after sudden exposure to fumes containing isocyanates and solvents. Lung function tests carried out 11 days after the event showed reduced flow rates. Forty days after the acute inhalational injury, expiratory flows improved, and the PC20 was 0.8 mg/ml, showing moderate bronchial hyperresponsiveness. Six days later, the subject underwent bronchoscopy. Bronchial biopsies showed a marked loss of epithelial cells, severe subepithelial oedema, and inflammatory cells infiltrate (mainly lymphocytes). The subject was given inhaled steroids. The PC20 was back to normal 42 days later. Bronchial biopsies then showed incomplete regeneration of the epithelial layer with few ciliated cells and persistence of inflammation (lymphocyte infiltrate) in epithelia and connective tissue. We conclude that irritant exposure to a mixture of isocyanates and solvents can cause occupational asthma without a latency period, i.e., reactive airways dysfunction syndrome.- - - - - - - - - - ranking = 1keywords = cough (Clic here for more details about this article) |
7/13. Persistent cough: causes and cures.Refractory cough in a patient with a normal chest X-ray usually falls into one of five categories: drug-induced (especially by ACE inhibitors), secondary to postnasal discharge, gastroesophageal reflux, or hyperactive airway disease, and idiopathic but responsive to nebulized lidocaine. The history may point to the most likely cause, and empiric therapy may confirm the diagnosis.- - - - - - - - - - ranking = 5keywords = cough (Clic here for more details about this article) |
8/13. Bronchial mucoid impaction due to the monokaryotic mycelium of schizophyllum commune.We report, to our knowledge, the first case of mucoid impaction of the bronchi due to a hypersensitivity reaction to the monokaryotic mycelium of schizophyllum commune. The patient was hospitalized because of mild asthma attacks, persistent cough, peripheral eosinophilia, and "gloved finger" shadows on a chest roentgenogram. Bronchoscopic examination disclosed mucoid impactions that consisted of accumulations of eosinophils, Charcot-Leyden crystals, and nondichotomously branched hyphae in B3, B9, and B10 of the left lung. Cultures of the mucous plugs and sputum samples yielded white, felt-like mycelial colonies that were later identified as the monokaryotic mycelium of S. commune by use of mating tests with established monokaryotic and dikaryotic strains of S. commune. The results of tests for serum antibody to S. commune cytosol antigen were positive. Repeated bronchoscopies for performing bronchial toilet were effective in removing the mucous plugs and relieving the patient's symptoms. We suggest that the monokaryotic mycelium of S. commune should be considered as one of the fungi that can cause hypersensitivity-related lung diseases.- - - - - - - - - - ranking = 1keywords = cough (Clic here for more details about this article) |
9/13. hypersensitivity pneumonitis-like reaction and occupational asthma associated with 1,3-bis(isocyanatomethyl) cyclohexane pre-polymer.Twenty-three of 34 workers who had worked in the injection molding operation making polyurethane foam parts at an automobile parts manufacturing plant developed respiratory symptoms and/or systemic symptoms over a 2-month period following the full production use of a new diisocyanate paint that contained 1,3-bis(isocyanatomethyl)cyclohexane pre-polymer (BIC)(CAS #75138-76-0, 38661-72-2). At 3 months, all subjects underwent an interview, physical examination, pre- and post-shift pulmonary function tests, and either methacholine challenge test or bronchodilator challenge at an occupational health clinic. The most frequently cited symptoms were dyspnea (65%), cough (61%), chest tightness (57%), chills (57%), wheezing (30%), and myalgias, arthralgias, and nausea (26%). Thirteen subjects had either a positive methacholine challenge test or a positive response to bronchodilator challenge, making the overall prevalence of airway hyperresponsiveness 38%. The overall prevalence of hypersensitivity pneumonitis-like reactions among line operators in the injection molding process was 27%. This disease outbreak suggests that 1,3-bis(isocyanatomethyl)cyclohexane pre-polymer may cause asthma and hypersensitivity pneumonitis-like reactions. The use of BIC was discontinued 6 months after the first workers developed symptoms.- - - - - - - - - - ranking = 1keywords = cough (Clic here for more details about this article) |
10/13. A case for serial examination of sputum inflammatory cells.In the case reported, serial evaluation of sputum inflammatory cell counts made it possible to identify an unusual series of events in a man with eosinophilic bronchitis. The patient initially presented with a productive cough, which did not respond to treatment with antibiotics or high-dose inhaled corticosteroids. A diagnosis of eosinophilic bronchitis was made after demonstration of intense sputum eosinophilia. When inhaled corticosteroids were stopped, symptoms and sputum eosinophilia became worse and airway hyperresponsiveness developed. Both abnormalities were reversed by a course of prednisone. When the prednisone was stopped the productive cough recurred but on this occasion sputum examination suggested a different disease process and the symptoms resolved after a course of co-trimoxazole. The patient has subsequently remained well on no treatment with little or no sputum eosinophilia.- - - - - - - - - - ranking = 2keywords = cough (Clic here for more details about this article) |
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