Prevalence and causes of chronic cough in Japan.

BACKGROUND: Chronic cough is one of the most common symptoms of respiratory diseases and can adversely affect patients' quality of life and interfere with social activities, resulting in a significant social burden. A survey is required to elucidate the frequency and treatment effect of chronic cough. However, clinical studies that cover all of Japan have not yet been conducted. METHODS: Patients who presented with a cough that lasted longer than 8 weeks and visited the respiratory clinics or hospitals affiliated with the Japan Cough Society during the 2-year study period were registered. RESULTS: A total of 379 patients were enrolled, and those who did not meet the definition of chronic cough were excluded. A total of 334 patients were analyzed: 201 patients had a single cause, and 113 patients had two or more causes. The main causative diseases were cough variant asthma in 92 patients, sinobronchial syndrome (SBS) in 36 patients, atopic cough in 31 patients, and gastroesophageal reflux (GER)-associated cough in 10 patients. The time required to treat undiagnosed patients and those with SBS was significantly longer and the treatment success rate for GER-associated cough was considerably poor. CONCLUSIONS: We confirmed that the main causes of chronic cough were cough variant asthma, SBS, atopic cough, and their complications. We also showed that complicated GER-associated cough was more likely to become refractory. This is the first nationwide study in Japan of the causes and treatment effects of chronic cough.

Bronchoscopic observation of endobronchial tumor cells.

A 68-year-old woman presented with cough and dyspnea. Chest x-ray film and computed tomography revealed atelectasis in the right upper lobe. She had a history of a bladder neoplasm, which was treated by cystectomy and chemotherapy. Flexible bronchoscopy revealed a polypoid tumor in the right upper lobe bronchus, protruding into the right main bronchus. Further, we observed the surface of the tumor by using the endocytoscopy system. The endocytoscopy system showed oval-shaped tumor cells with prominent nuclei on the surface of the tumor with a methylene blue dye staining. Biopsied specimen of the tumor demonstrated foci of metastatic urothelial carcinoma. These cancer cells were similar to the cell images of endocytoscopy system. This technology may have the potential to provide pathologic diagnosis during bronchoscopy.

Impulse oscillometry; therapeutic impacts of transdermal long-acting Beta-2 agonist patch in elderly asthma with inhaled corticosteroid alone.

Growing interest had been focused on the involvement of the small airways in asthma, and impulse oscillometry (IOS) has been utilized as pulmonary functions for detecting large and small airways diseases separately. IOS can measure respiratory resistance and reactance at multiple frequencies, not available by spirometry or body plethysmography, is non-invasive techniques and convenient for elderly patients with a low dependency on cooperation during tidal breathing. IOS indices were well correlated with not only predicted FEV1 but also FEF25-75, residual volume/total lung capacity, delta N2 of a single nitrogen washout test which representing air trapping and inhomogeneous ventilation in the distal lung. These parameters and QOL scores were improved by additional transdermal long-acting beta-2 agonist patch even in well-controlled elderly asthma treating with inhaled corticosteroids alone. IOS may have a complementary role of spirometry in detecting subtle airways changes in general practice. However, systemic studies are required to investigate the clinical implication of each IOS index.

[Further examination of COPD using spirometry, respiratory function test, and impulse oscillometry].

Spirometry is essential for diagnosis and staging of chronic obstructive pulmonary disease (COPD). Characteristic of physiological change of small airways in COPD is heterogeneous distribution of small airway narrowing, resulting in air-trapping and nonhomogeneous ventilation. FEF25-75, residual volume/total lung capacity, delta N2 in phase III slope of single breath N2 washout test, closing volume, static and dynamic compliance, and carbon monoxide diffusing capacity (transfer factor) are measured for detecting small airways disease. Impulse oscillometry is also useful for assessment of small airways disease, especially indices of frequent resonance (Fres) and frequent dependent of resistance change of R5-R20; resistance at 5 Hz minus resistance at 20 Hz. Impulse oscillometry seems to have a complemental role of spirometry in managing COPD.

A case of adult T cell leukemia/lymphoma presenting as severe tracheal stenosis.

A 57-year-old woman was referred to our hospital for further examination of a tracheal stenosis shown on computed tomography findings. Bronchoscopy revealed multiple protruding tumors in the lumen of the trachea. Cytological findings of the cell block material from pleural effusion indicated that the T-cell lymphoma was composed of pleomorphic lymphoid cells. Serum human T-cell leukemia virus type 1 antibody was positive and supported the clinical diagnosis of ATLL. Systemic chemotherapy induced the remarkable improvement of the lesions, the infiltrative lung shadow and the soft tissue neoplasm. We report a rare case of adult T cell leukemia/lymphoma (ATLL) with endobronchial involvement.

Increased microcirculation in subepithelial invasion of lung cancer.

BACKGROUND AND OBJECTIVE: Mucosal irregularity and hypervascularity associated with primary lung cancer in large airways are observed by bronchoscopy. The aim of this study was to evaluate microcirculation at subepithelial invasion sites of lung cancer. METHODS AND PATIENTS: Between July 2001 and June 2007, 12 patients who had subepithelial invasion sites of lung cancer in the large airways (aged 52 to 74 years, 12 males) were enrolled into this study. They were 6 patients with adenocarcinoma, 4 patients with squamous cell carcinoma, and 2 patients with small cell carcinoma. We compared 12 control subjects without endobronchial abnormality (aged 51 to 83 years, 9 males and 3 females). The patients underwent conventional bronchoscopy and subsequent high magnification bronchovideoscopy with the conventional imaging and the narrow band imaging (NBI). For evaluating microcirculation of subepithelial invasion, hemoglobin index was calculated. RESULTS: In high magnification view, aberrant microvessels and/or irregular mucosal thickening were observed at subepithelial invasion sites of lung cancer. Irregularly enlarged microvessels were increased and formed an aberrant microvessel network on the surface of irregular mucosa. The diameter of aberrant microvessels was significantly increased compared to normal microvessels. By switching to NBI, the aberrant microvessels were more clearly visualized. The levels of hemoglobin index were significantly higher in subepithelial invasion sites of lung cancer compared to normal mucosa. CONCLUSION: In subepithelial invasion of lung cancer, aberrant microvessels are thought to be characteristic and subepithelial microcirculation may be increased.

[Primary Sjögren's syndrome with lymphocytic interstitial pneumonia, autoimmune hemolytic anemia and an endobronchial amyloid nodule].

A 73-year-old woman was admitted to our hospital for examination of anemia, dry feeling of oral and eyes with chest abnormal shadow in October, 1999. Chest radiograph showed interstitial shadows difference and CT showed small nodular opacities in both lung fields. Laboratory examination showed direct Coombs test was positive, and the serum levels of indirect bilirubin and haptoglobin were elevated. Anti-SS-A antibody and anti-SS-B antibody were positive with hypergammaglobulinemia. The serum levels of SP-D and KL-6 were elevated. Lip biopsy showed atrophy and lymphocyte infiltration of the salivary glands. According to these findings, she was diagnosed as primary Sjögren's syndrome with autoimmune hemolytic anemia. In addition, bronchoscopic examination showed an endobronchial polyp in the right B8, and the biopsy specimen showed AL type amyloid deposits. In order to obtain pathological diagnosis of lung lesions, we performed lung biopsy by video-assisted thoracoscopic surgery. The biopsy specimen showed severe infiltration of lymphocytes and the plasma cells around peribronchiole with lymphoepithelial lesions, suggesting malignant lymphoma. However, immunohistochemistry did not show monoclonal profile and Southern blot hybridization assay demonstrated no rearrangement of JH gene. Lung lesions were diagnosed as lymphocytic interstitial pneumonia due to Sjögren's syndrome. Steroid therapy was performed and followed by improvement of anemia and pulmonary lesions. Malignant lymphoma has not been involved for eight years after a diagnosis.

Decreased subepithelial microvasculature observed by high magnification bronchovideoscope in the large airways of smokers.

OBJECTIVE: A fine vascular network is developed in the subepithelial layer of bronchial mucosa. Cigarette smoking is thought to influence angiogenesis. However, the bronchial microvasculature in smokers has not been fully investigated. The aim of this study was to determine the characteristics of the subepithelial microvessels in the large airways of smokers. METHODS: Between August 2000 and July 2004, 12 current smokers and 12 nonsmokers were enrolled in this study. The nonsmokers had no abnormal findings in the large airways in the examination of conventional bronchoscopy. Smoking histories varied from 20 to 50 years. The average smoking index was 31.3+/-19.9 (mean+/-SD) pack-years. High magnification bronchovideoscopy was used in this study, which provides information on bronchial mucosa with a maximum magnification of 110 times. To evaluate the characteristics of subepithelial microvessels, 4 parameters were compared between the two groups: 1) vessel area ratio, 2) vessel length ratio, 3) vessel area to length ratio, and 4) hemoglobin index. RESULTS: Subepithelial microvessels of large airways were narrow and sparsely distributed in smokers. Vessel area ratio, vessel length ratio, vessel area to length ratio and hemoglobin index were significantly lower in the smokers than in the nonsmokers (p<0.0001, p<0.0001, p<0.0001, p=0.0002, respectively). CONCLUSION: Subepithelial microvessels of smokers were decreased and narrow, which suggested a decrease in microcirculation in the subepithelial layer of the large airway.