A Cross-sectional Survey of the Clinical Manifestations and Underlying Illness of Cough.

AIM: The aim of this study was to identify factors affecting the final diagnosis of cough. MATERIALS AND METHODS: This study recruited 463 consecutive patients who visited five Japanese general hospitals due to cough from October 2006 to September 2007. Of these, 418 patients (90%) who completed a questionnaire designed to acquire data regarding clinical manifestations of cough were included. RESULTS: Most patients with bronchial asthma had cough with seasonal variation and wheezing. Patients with gastro esophageal reflux disease suffered from heartburn and cough without daily or seasonal variation. Cough associated with sinobronchial syndrome was only observed in females and was linked to increased sputum. Patients with whooping cough were bothered by cough interrupting sleep and talking. Patients with cardiogenic cough had exertional dyspnea. CONCLUSION: The specific items on our questionnaire relating to patient characteristics, complications, and triggers of cough, represent useful tools for diagnosing the primary disease producing cough.

[HEART PAP (adapted-servo ventilation; ASV) is effective for the ventilation of chronic heart failure patient with Cheyne-Stokes respiration].

CASE REPORT: A 72-year-old man with chronic heart failure had received implantation with a pacemaker for type III sick sinus syndrome in 2002. Mixed type sleep apnea syndrome (SAS) was diagnosed in 2004, and continuous positive airway pressure (CPAP) treatment was started. However, CPAP use become gradually difficult over the following 2 years. Atrial flutter was detected in December, 2006 and his heart failure became exacerbated. Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) was additionally found by the examination of PSG at that time. It was thought that he could not adjust his breathing to CPAP ventilation, because of the heart failure exacerbation. We introduced the HEART PAP (Respironics Inc. Murrysville, PA, USA) which was an adaptive-servo ventilator (ASV) on March 9, 2007. Mask wearing improved, and Cheyne-Stokes respiration and night hypoxemia disappeared. He showed improvement in sleep parameters and did not show the heart failure exacerbation diminished. It was recognized that the ASV yielded not only improvement of the respiratory status of this patient with heart failure but also an improvement of the cardiac function. Therefore, we should consider ASV for CSR-CSA patient who does not respond well to CPAP.

[A case of rapid development of arc welder's lung during the course of a year].

A 57-year-old man who had worked as a welder for about 40 years was admitted to our hospital. Every year he had had medical examinations in his workplace. On March 17, 1999, there was no finding of pneumoconiosis, but he had worked in a tunnel on a special arc welding project from December 20, 1999 to January 10, 2000. On admission, chest radiography revealed reticular shadows in the middle and lower lung fields. CT scans showed ground-glass opacities in both lungs. Serum iron was high (231 micrograms/dl) and serum ferritin was extremely high (2,309 ng/ml). Many iron particles were detected in the alveoli of the transbronchial biopsy specimen, and also in the sputum. A pathological diagnosis of siderosis was therefore made, and, considering the patient's occupation, the condition was termed arc welder's lung. This rapidly developing case was characterized by reticular shadows on chest radiography.