ObjectiveTo explore the cytologic profile of induced sputum and its relationship with the treatment response in patients with chronic obstructive pulmonary disease (COPD). MethodsSixty-five treatment-naive patients with COPD and 26 normal subjects were recruited for the study. Sputums induced by the inhalation of hypertonic saline were collected, and the associations of differential cell counting were analyzed with pulmonary function, modified Medical Research Council dyspnea scale, St. George's Respiratory Questionnaire score (SGRQ) before and after the treatment with inhaled corticosteroid and long-acting β2-agonist. ResultsThe cell percentages of neutrophil (Neu), macrophage, eosinophil (Eos) and lymphocyte in induced sputum of the COPD patients were (86.24±15.04)%, (5.75±6.96)%, (4.71±4.79)%, and (1.30±1.09)%, respectively. The eosinophil percentage (Eos%) was≥3% in 31 patients (60.78%). The neutrophil percentage (Neu%) was inversely correlated with forced expiratory volume in 1 second (FEV1), percent of predicted value of FEV1 (FEV1% pred), forced vital capacity (FVC), and percent of predicted value of FVC (FVC% pred) (P < 0.01, respectively), and positively correlated with the SGRQ symptom score (r=0.304, P=0.034). The Eos% was inversely correlated with FEV1/FVC ratio (r=-0.399, P=0.004). The patients with Eos%≥3% improved significantly in FEV1 and symptom score (P < 0.05, respectively) than the patients with Eos% < 3%. ConclusionsAn eosinophilic airway inflammation is present in a subgroup of COPD. The Eos% is inversely correlated with pulmonary function and may be a predictive indicator of response to treatment with inhaled corticosteroids and long-acting β2-agonists.
ObjectiveTo improve the knowledge of clinical features,image and pathology of Behcet's disease with the pulmonary artery aneurysm. MethodsOne typical female patient aged 40 years with recurrent pulmonary artery aneurysm caused by Behcet's disease was analyzed including clinical data,image and pathological features.The Pubmed (1967.1 to 2013.10) and Wanfang database (1982.1 to 2013.10) were searched with "Behcet's disease","pulmonary artery aneurysm" as search terms. ResultsRecurrent hemoptysis was major clinical manifestation of pulmonary artery aneurysm caused by Behcet's disease.Features of image including hilar enlargement,pulmonary artery aneurysm and primary thrombus.During the first hospitalization,the patient was diagnosed as pulmonary artery aneurysm.Then pulmonary lobectomy was performed and pathology examination revealed artery aneurysm and primary thrombus.During the second hospitalization,she was diagnosed as pulmonary thromboembolism and it was considered as failure of treatment of anticoagulant therapy.During the third hospitalization,she was diagnosed as pulmonary artery aneurysm of Behcet's disease,and recurrent hemoptysis was fully ameliorated by the combination treatment of glucocorticoid and immunodepressant. ConclusionPulmonary artery aneurysm is the typical feature of pulmonary vascular lesions of Behcet's disease,and recurrent hemoptysis is major clinical manifestation.CT angiography can identify location of pulmonary artery aneurysm.The key drugs of therapy are imunosuppressive drugs in combination with steroids.
ObjectiveTo evaluate the effectiveness of different biopsy methods in the diagnosis of idiopathic interstitial pneumonia (IIP). MethodsA retrospective analysis was performed in patients hospitalized and diagnosed as IIP between January 2010 to December 2013 in the Department of Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University. The patients were divided based on initial diagnoses. The performance of invasive examinations including both transbronchoscopic lung biopsy (TBLB) and surgical lung biopsy (SLB) and final diagnoses were recorded. ResultsThree hundred and ninety-one patients were included in the study with mean age of 62.5±11.9 years. There were 299 patients receiving TBLB, 43 patients receiving SLB, and 49 patients receiving non-invasive examinations. Among 299 patients who underwent TBLB, parenchymal tissue was not obtained in 132 (44.1%) but successfully obtained in 167 (55.9%) patients, with 79 (47.3% out of 167) clinically helpful. TBLB-based specific diagnoses were as follows:30 cases of non-specific interstitial pneumonia (NSIP), 22 cases of cryptogenic organizing pneumonia (COP), 18 cases of idiopathic pulmonary fibrosis (IPF), 4 cases of acute interstitial pneumonia (AIP), 2 cases of respiratory bronchiolitis-interstitial lung disease (RB-ILD) and lymphocytic interstitial pneumonia (LIP) for each, 1 case of desquamative interstitial pneumonia (DIP), respectively. Among 43 patients who underwent SLB, parenchymal tissue was obtained in all cases with 40(93.0% out of 43) pathologically diagnostic, including 20 cases of NSIP, 12 cases of IPF, 3 cases of COP and LIP for each, and 2 cases of RB-ILD and DIP for each. Finally, among 181 patients who failed to obtain parenchymal tissue or did not undergo invasive examination, specific diagnoses could be established in 40 patients with all finally diagnosed as IPF. ConclusionsThe pathological diagnosis, either based on TBLB or SLB, is very important in the diagnostic procedure of IIP. The biopsy technique of hospital and patient conditions should be considered when making the decision of biopsy method.
ObjectiveTo analyze misdiagnosis of other lung diseases as asthma to avoid medical error. MethodsSixty-nine cases who were misdiagnosed as asthma between February 2012 and February 2014 were recruited. Clinical data was collected and analyzed including characteristics of symptoms, induced sputum, pulmonary function and blood tests. ResultsThere were 13 diseases misdiagnosed as asthma, and eosinophilic bronchitis(21.74%), upper airway cough syndrome(20.29%), chronic obstructive pulmonary disease(13.04%), allergic bronchopulmonary aspergillosis(7.25%) and hyperventilation syndrome (7.25%) were the top five diseases in these cases. Some rare diseases were also found such as idiopathic hypereosinophilic syndrome and vocal cord dysfunction. ConclusionsA variety of diseases have the similar clinical symptoms with asthma. The key to avoid and reduce misdiagnosis is to strengthen the understanding of asthma and similar diseases.