Effects of sex on sleep-disordered breathing in adolescents.

This study was conducted to determine the influence of puberty on features of sleep-disordered breathing (SDB) in adolescents. The study was performed in a general population sample of 226 adolescents of both sexes (aged 11-19 yrs) recruited from the secondary school population of the city of Seville, Spain. Subjects were divided into two groups: 1) postpubertal, i.e. females who had undergone menarche and males in whom axillary hair development or peak height velocity had occurred > 1 yr before the study; and 2) peripubertal, i.e. females who had not undergone menarche and males who had not developed axillary hair nor reached peak height velocity, or subjects in whom these pubertal changes had appeared < 1 yr before the study. All subjects answered a questionnaire on SDB and underwent overnight cardiorespiratory polygraphy. There were 50 males and 40 females (mean +/- SD age 13.5 +/- 1.2 yrs) in the peripubertal group, and 54 males and 82 females (age 16.3 +/- 1.7 yrs) in the postpubertal group. Males exhibited significantly higher neck circumference/height index and waist/hip index than females in both the peripubertal and postpubertal groups. In the postpubertal group, snoring and polygraphic alterations (respiratory events and oximetric parameters) were significantly more frequent in males than in females. Postpubertal adolescents showed sex differences in clinical and polygraphic parameters that were not observed at earlier pubertal stages. These findings support the influence of sex hormones on sex differences in sleep-disordered breathing.

Sleep-related breathing disorders in adolescents aged 12 to 16 years : clinical and polygraphic findings.

STUDY OBJECTIVES: To determine the frequency, symptoms, and polygraphic features of sleep-related breathing disorders (SRBD) in adolescents aged 12 to 16 years. DESIGN: Cross-sectional study. SETTING: Randomly selected secondary schools in the city of Seville, SPAIN: PARTICIPANTS: A general population sample of adolescents (n = 101; mean [+/- SD] age, 13.2 +/- 0.8 years). INTERVENTIONS: An 82-item questionnaire regarding anthropometric data and nocturnal and daytime symptoms suggestive of SRBD was administered. Symptoms were evaluated according to a 4-point frequency scale. Snorers answered "sometimes" or "often" in the question about snoring, and nonsnorers answered "never" or "rarely." All subjects underwent an overnight cardiorespiratory polygraphy at home. RESULTS: Twenty-nine percent of the subjects were snorers. Excessive daytime sleepiness was present in 14% of subjects, and sleep apnea was present in 3%. Polygraphy showed a respiratory disturbance index > or = 10 in 18 subjects (17.8%), but concurrent symptoms highly suggestive of SRBD were found in only 2 subjects (1.9%). Snorers had higher waist-to-hip ratios and a higher frequency of witnessed apnea or labored breathing as well as higher values of respiratory events as compared with nonsnorers. However, oximetry data were similar in both groups. CONCLUSIONS: In a nonselected group of adolescents aged 12 to 16 years, the frequency of symptoms potentially associated with SRBD was similar to that reported for younger children. Snoring was associated with a higher occurrence of other nocturnal symptoms, a more central pattern of body fat distribution, and a higher respiratory disturbance index as compared with nonsnorers. Although polygraphic abnormalities were mild, two cases of probable SRBD were found with a prevalence rate of 1.9%.

[Assessment of excessive day-time sleepiness in professional drivers with suspected obstructive sleep apnea syndrome]. / Evaluación de la somnolencia diurna excesiva en conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño.

Excessive daytime sleepiness is a common symptom of obstructive sleep apnea syndrome (OSAS) and can be a cause of traffic accidents, creating a problem of particular importance for professional drivers given the associated death, disability and professional repercussions. We assessed whether the Epworth sleepiness scale (ESS), which is a subjective measure of daytime sleepiness, correlates well with multiple sleep latency (MSL) testing, which gives an objective measure of daytime sleepiness. We also compared each method with the results of polysomnography (apnea-hypopnea index, arousal index and minimum oxygen saturation). We studied 55 professional drivers suspected of OSAS. All answered the ESS questionnaire and underwent polysomnographic and MSL testing. We found a significant, though not relevant, correlation between the degree of excessive daytime sleepiness estimated by the ESS and by MSL testing (r = -0.41; p = 0.002). A significant, though weak, correlation was found between the ESS score and the arousal index (r = 0.26; p < 0.05). Our results do not clarify which method is best for measuring excessive daytime sleepiness in professional drivers suspected of OSAS.

[Assessment with the Epworth scale of daytime somnolence in patients with suspected obstructive apnea syndrome during sleep. Differences between patients and their partners]. / Valoración mediante escala de Epworth de la somnolencia diurna en pacientes con sospecha de síndrome de apneas obstructivas durante el sueño. Diferencias entre los pacientes y sus parejas.

UNLABELLED: Daytime sleepiness is an important symptom in obstructive sleep apnea syndrome. The Epworth sleepiness scale gives a subjective estimate of the level of sleepiness by asking the patient to estimate the probability of falling asleep during each of eight activities of daily living. OBJECTIVE: We aimed to see whether patients suspected of sleep apnea and their partners or other living companions assessed daytime sleepiness differently. MATERIAL AND METHOD: One hundred fifty-nine consecutive patients referred for suspicion of sleep respiratory disorder were studied. Patients and their partners assessed sleepiness separately using the Epworth scale. RESULTS: One hundred forty subjects were men and 19 were women. The mean global Epworth score provided by the patients was significantly lower than that of their companions (10 +/- 0.37 versus 11 +/- 0.42; p < 0.001). However, the two were closely correlated (rho = 0.79). CONCLUSION: Our results indicate that living companions' subjective Epworth scale assessment of sleepiness is greater than is that of patients themselves.

[A comparative study of patients with chronic obstructive pulmonary disease with and without obstructive sleep apnea syndrome]. / Estudio comparativo de pacientes con enfermedad pulmonar obstructiva crónica con y sin síndrome de apneas obstructivas durante el sueño.

We aimed to study whether the presence of obstructive sleep apnea syndrome (OSAS) in patients with chronic obstructive pulmonary disease (COPD) led to differences in clinical picture, gas exchange during awake and sleep states and mechanical ventilation, in comparison with patients with COPD alone. We enrolled 48 COPD patients. In 26 (54.1%), OSAS was ruled out (non-OSAS COPD group) by polysomnography, and in 22 (45.8%) associated OSAS was diagnosed (OSAS COPD group). Patients in the OSAS COPD group experienced greater daytime sleepiness and less dyspnea. Body mass index was not significantly difference. The OSAS COPD group had significantly lower daytime PaO2 (66.4 +/- 10.4 mmHg in the OSAS COPD group and 75.5 +/- 11.2 mmHg in the non-OSAS COPD group; p = 0.01); there were no differences in PaCO2.Pimax in the OSAS-COPD group was 70.6 +/- 23.8 cmH2O, a level that was significantly lower than in the non-OSAS COPD group (Pimax 90.5 +/- 26.1 cmH2O; p = 0.04). Patients in the non-OSAS COPD group experienced longer periods of REM sleep. Nighttime saturation parameters were significantly different in the group with OSAS. We conclude that patients with both OSAS and COPD experience greater oximetric changes than those without OSAS, during both sleep and awake states. The deterioration of respiratory muscle pressures in such patients may play an important role in the changes. The groups also present differences in the intensity of some symptoms, such as degree of daytime sleepiness and dyspnea.

[Association of obstructive apnea syndrome during sleep and narcolepsy]. / Asociación del síndrome de apnea obstructiva durante el sueño y la narcolepsia.

Obstructive sleep apnea syndrome (OSAS) is highly prevalent. Daytime hypersomnolence (DHS) is among its symptoms, although other diseases, such as narcolepsy, can also give rise to DHS. We describe three men diagnosed of OSAS whose DHS persisted even after snoring disappeared following treatment with continuous positive airway pressure. We suspected associated narcolepsy, which was confirmed by multiple sleep latency testing. Narcolepsy, therefore, should be considered when DHS persists even after appropriate treatment of OSAS.

[Surgical treatment of adenotonsillar hypertrophy in children with sleep respiratory disorders: changes in polysomnographic patterns]. / Tratamiento quirúrgico de la hipertrofia adenoamigdalar en niños con trastornos respiratorios durante el sueño: cambio en el patrón polisomnográfico.

Adenotonsillar enlargement (ATE) can cause respiratory disorders during sleep in children. The treatment of choice for ATE is adenotonsillectomy and its efficacy must be assessed based on improvement in symptoms and polysomnographic patterns. We studied 11 children (7 boys and 4 girls, age 5.5 years) whose ATE symptoms were corrected by adenotonsillectomy. Two nighttime polysomnograms (SleepLab) were recorded, one at baseline and one 6 months after adenotonsillectomy. Polysomnographic recordings were analyzed by quantifying 1) only apneic or hypopneic events lasting > or = 10 sec and 2) all respiratory events > or = 5 sec. The most common symptoms were snoring, nocturnal dyspnea and sleep apnea. Symptoms resolved after adenotonsillectomy for most patients. Obstructive events, in particular shorter apneic events (> or = 5 sec) and instances of hypopnea, decreased after surgery. We found no changes in baseline SaO2, although the minimum SaO2 improved and the number of desaturations decreased, above all those stemming from respiratory events.

[Respiratory polygraphy in the diagnosis of obstructive sleep apnea syndrome]. / Poligrafía respiratoria en el diagnóstico del síndrome de apneas obstructivas durante el sueño.

The traditional way of diagnosing obstructive sleep apnea syndrome (OSAS) is all-night polysomnographic recording. A proposed alternative is respiratory polygraphy, a simplified procedure that consists in nighttime monitoring of oxygen saturation, oronasal flow and respiratory movements. Our aim was to evaluate the efficacy of respiratory polygraphy in diagnosing OSAS in comparison with conventional polysomnography. We studied 101 patients (92 men and 9 women) who had undergone polysomnography. An apnea-hypopnea index (AHI) > or = 10 was considered to be the diagnostic criterion for OSAS. To assess the diagnostic validity of respiratory polygraphy we considered that an AHI per hour of recording > or = 10 and a desaturation index per hour of recording > or = 10 were consistent with a diagnosis of OSAS. Sixty patients were diagnosed of OSAS. The AHI per hour of recording was > or = 10 in 56 patients, with 4 false negatives (sensitivity 93.3% and specificity 100%). The desaturation index per hour of recording was > or = 10 in 65 patients, with 7 false positives and 2 false negatives (sensitivity 96.6% and specificity 82.9%). We conclude that respiratory polysomnography is a specific, highly sensitive method for diagnosing OSAS.

[The detection of the sleep apnea syndrome in a population of professional drivers]. / Detección del síndrome de apnea obstructiva del sueño en una población de conductores profesionales.

The aim of this study was to reduce the risk of traffic accidents related to obstructive sleep apnea syndrome (OSAS) by means its detection and treatment in a group of 100 commercial drivers from Seville. Besides, to analyze which clinical findings could suggest OSAS. By means a questionnaire we selected subjects without (questionnaire score < 10 points) and with (questionnaire score > or = 10) clinical history of OSAS. In cases with score > or = 10, an overnight home polygraphy was carried out (Apnoescreen II, Jaeger), with measurement of oronasal airflow, chest and abdominal movements, oxygen saturation, electrocardiogram, body position and actimetry. We performed a manual analysis of recordings, and polygraphy was considered to be positive for OSAS if both AHI (respiratory events Index) or DI (desaturation Index) were > or = 10. In these positive cases, overnight conventional polysomnography was carried out (SleepLab, Jaeger), with therapeutic tests with CPAP if OSAS was diagnosed (AHI > or = 10). Average age and BMI (Body Mass Index) were 41.5 +/- 0.9 years and 28.2 +/- 0.4 kg/m2. Questionnaire was positive in 59 subjects, in 35 of whom home polysomnography was done. We did not find differences in age, BMI, neck circumference or symptomatology among these 35 drivers and the 24 remaining subjects in whom home polygraphy was not performed. Home polygraphy was positive in 10 subjects and negative In 25. Drivers in first group were older, heavier and complaint more frequently about snoring, sleep apnea and daytime sleepiness. We did not find differences in neck circumference, waist/hip ratio nor alcohol consumption between both groups. From the group with positive polygraphy, we performed conventional polysomnography in 8 cases and OSAS was diagnosed in 5 (in all cases, treatment with CPAP was started). This study does not provide data about prevalence, but it seems that the percentage of our drivers with OSAS could be lightly higher than the prevalence in general population. These subjects seem to be older, heavier and complaint more frequently about snoring, sleep apnea and daytime sleepiness.

[Hypercapnic stimulation and ventilation response in the syndrome of sleep obstructive apnea. Comparison of reinhalation and steady state]. / Estimulación hipercápnica y respuesta ventilatoria en el síndrome de apnea obstructiva del sueño. Comparación de reinhalación y estado-estable.

The objective of this study was to assess ventilatory response to stimulation with CO2 in patients suffering obstructive sleep apnea syndrome (OSAS) but without chronic obstructive pulmonary disease (COPD), by examining differences between hyper- and normocapnic patients and comparing the results obtained with the usual techniques used to stimulate hypercapnia (rebreathing and stable-state). To this end, we studied 15 obese patients, all with an apnea-hypopnea index greater than 10 from a polysomnograph lasting a full night. The following lung function tests were performed: spirometry, air way resistance measures and static lung volumes by plethysmograph and arterial gasometry. We later analyzed ventilatory response by the stable-state method, with increasing CO2 concentrations (from 1 to 9%) and by the rebreathing method. Results from the two methods were similar for all patients: delta VE/delta PCO2 (0.64 +/- 0.35 vs 0.67 +/- 0.48 l/min/mmHg; p = 0.59), delta Vt/delta PCO2 (28.33 +/- 16.23 vs 26.42 +/- 16.94 ml/mmHg; p = 0.9), delta Vt/Ti/delta PCO2 (28.82 +/- 20.9 vs 29.41 +/- 23.78 ml/s/mmHg; p = 0.89) y delta P0.1/delta PCO2 (0.11 +/- 0.07 vs 0.117 +/- 0.05 cmH2O/mmHg; p = 0.58). We compared the results obtained by the two techniques by dividing the sample into two groups of 7 and 8 patients, respectively, depending on whether PaCO2 level before stimulation was higher or lower than 45 mmHg. The hypercapnic patients (group I) were older (61 +/- 3.5 vs 50 +/- 9 years; p = 0.04) but were not different with respect to body mass from the normocapnic patients (group II) (37.59 +/- 6.4 vs 34.56 +/- 4.75 kg/m2; p = 0.33). The results from the two techniques for stimulating hypercapnia were similar within each group, with a statistically significant decrease (p < 0.03) in patients with daytime hypercapnia in delta VE/delta PCO2 delta Vt/delta PCO2, delta Vt/Ti/delta PCO2 and delta P0.1/delta PCO2. We conclude that there are no differences in the results obtained with the rebreathing and stable state techniques. Likewise, ventilatory response to stimulation with CO2 in individuals with OSAS and daytime hypoventilation is less than of normocapnic patients.

Polysomnographic studies in children with adenotonsillar hypertrophy and suspected obstructive sleep apnea.

Upper airway obstruction causes many sleep-related respiratory disorders that can culminate in obstructive sleep apnea syndrome (OSAS). Polysomnography is routinely used to define OSAS in adults, but problems remain in diagnosing children by this method. The current study was designed to analyze the polysomnographic patterns in children with symptomatic adenotonsillar hypertrophy and to determine whether obstructive respiratory events shorter than 10 sec could have pathophysiological significance. Furthermore, we analyzed the correlation between clinical data on children with adenotonsillar hypertrophy and polysomnographic findings. Twelve children (mean age, 4.5 +/- 1.5 years) with airflow obstruction due to adenotonsillar hypertrophy were observed in our Sleep Laboratory. Prior to study, a questionnaire was used to score symptom severity. Overnight polysomnography was then performed to measure total sleep time, sleep efficiency, desaturation index, minimal arterial oxygen saturation (SaO2), apneahypopnea (AH) episodes < or = 5 sec and those > or = 10 sec, and AH index, AH percentage of total test time, and number of spontaneous and respiratory event-associated desaturations were recorded. Respiratory events of 5 sec or longer resulted in increases in the AH index and an increase in the number of oxyhemoglobin desaturations due to respiratory events. A significant relationship was found between the AH index and AH episodes > or = 5 sec and > or = 10 sec. There was, however, no association between polysomnographic parameters and symptom severity scores. An appraisal of AH recordings > or = 10 sec showed that desaturation episodes were more frequent than respiratory events, and the desaturation index was closely related to spontaneous and respiratory event-associated desaturations. When considering all obstructive episodes > or = 5 sec, the number of desaturations did not exceed the number of respiratory events. The correlation between the desaturation index and spontaneous or respiratory event associated desaturations was similar. The occurrence of short AH episodes that lead to hemoglobin desaturation are important in the evaluation of OSAS in children.

[Inflammation mediators (eosinophilic cationic protein, ECP) in a normal population and in patients with bronchial asthma or allergic rhinitis]. / Mediadores de la inflamación (proteína catiónica del eosinófilo, ECP) en población normal y pacientes con asma bronquial o rinitis alérgica.

We analyzed serum levels of eosinophilic cationic protein (ECP), one of the 4 main eosinophilic proteins; ECP is released from an activated cell and acts as a mediator of inflammation. Serum samples from 139 persons were studied prospectively. Fifty-three individuals from the general population provided the control group. Eighty-six consecutive patients were also studied: 69 with bronchial asthma and 17 with allergic rhinitis and no signs of asthma. The level of severity of disease was established in the asthmatics by the method proposed by Aas (Aas score), based on symptoms and medications received within the last year. We also classified these patients as having mild, moderate or severe asthma according to the latest criteria issued by the International Consensus for Diagnosis and Treatment of Asthma. Atopic status was estimated by skin Prick tests. ECP levels in the control group (9.34 +/- 5.76 micrograms/l) were significantly lower (p < 0.001) than those of the total population of patients (17.59 +/- 16.85 micrograms/l). The mean for patients with rhinitis was 14.76 +/- 10.94 micrograms/l, whereas it was 18.29 +/- 18 micrograms/l in the asthmatics; the levels for both groups were statistically different from that of the control group (p < 0.03 and p < 0.001, respectively). Levels by degrees of severity established at the time of revision and by sensitivity to allergens were also significantly different from the level of the control group, although the mean levels were low in the group of severely affected patients who had received treatment with inhaled corticoids.(ABSTRACT TRUNCATED AT 250 WORDS)

[An analysis of the prevalence of respiratory symptomatology in the general population]. / Análisis de la prevalencia de sintomatología respiratoria en la población general.

This paper is a report of a cross-sectional epidemiological study that formed part of multicenter European project; the aim was to estimate the prevalence of respiratory symptoms and signs related to asthma over a period of 12 months in the city of Seville. A sample of 4,000 persons of both sexes, aged between 20 and 44 years old, was surveyed first by mail questionnaire and later by telephone interview. We analyzed the response index obtained with the mail survey for the epidemiological study of asthma in the area and for the frequency of respiratory symptoms and their distribution by age and sex. The response index was 53.36% and was similar for men and for women. Forty-nine percent reported at least one respiratory symptom, with nocturnal coughing attacks (27.7%) and wheezing (22.2%) being the most frequent. The frequency of these symptoms was different by sex, however, with the former more often reported by women (p < 0.02) and the latter by men (p < 0.001). We found that 14.9% of the population had rhinitis and that women reported this symptom more often (p < 0.02). Symptoms related to asthma were nocturnal attacks of breathlessness, the use of asthma medication and an asthma attack diagnosed by a physician within the last 12 months. With these criteria the estimated prevalence of asthma was 11.72%, a proportion that held steady for all age groups except the middle-aged and for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of nasal continuous positive airway pressure on lung function in patients with sleep obstructive apnea syndrome]. / Efectos de la presión positiva continua nasal (CPAPn) sobre la función pulmonar en pacientes con síndrome de apnea obstructiva del sueño (SAOS).

Sixty-one patients with obstructive sleep apnea syndrome (OSAS), 26 of whom also had chronic obstructive pulmonary disease (COPD), received treatment by nasal continuous positive airways pressure (nCPAP). To evaluate the effects of this device on daytime lung function, we analyzed pulmonary function tests before treatment with nCPAP and after a mean follow-up period of 12 months (range: 2-22 months). In patients with both OSAS and COPD, we observed a significant decrease in PaCO2 (p < 0.007), in airways resistance (p < 0.002) and in residual volume (p < 0.01); for these same patients we recorded increases in forced vital capacity (p < 0.04) and maximum inspiratory pressure (p < 0.02). We saw no change in lung function in patients with OSAS only. PaO2 increased after treatment in the 15 patients who were initially hypoxemic (p < 0.001). We conclude that after treatment with nCPAP, the greatest changes in respiratory function occur in patients with both OSAS and COPD, who also experience slight decrease in body weight. These changes may be explained by a decrease in auto-PEEP and weight loss.

[Brief polysomnographic studies in the diagnosis of the obstructive sleep apnea syndrome]. / Estudios polisomnográficos cortos en el diagnóstico del síndrome de apnea obstructiva del sueño.

Firm diagnosis of obstructive sleep apnea syndrome (OSAS) is normally based on all-night-long polysomnograms, at considerable expenditure of time and money. Shorter studies have been proposed as an alternative. We have assessed the efficacy of polysomnograms recorded over the first three hours of nocturnal sleep (SN) for diagnosing OSAS and the results have been compared with those of polysomnograms recorded throughout the entire night (EN). Twenty-five male patients suspected of having OSAS were enrolled; 19 were diagnosed for OSAS by EN and 16 were diagnosed by SN, indicating 3 false negatives and a sensitivity of 84% for SS. No false positives were obtained by studying only the first three hours of sleep, indicating a specificity of 100%. Significant differences were found in minimum oxygen saturation (SatO2) and percent of total sleep time with intervals of SatO2 below 80%. We conclude that polysomnography during the first part of nocturnal sleep is a specific method for screening for OSAS and that, although this method's sensitivity is high, study should be continued throughout an entire night when results are negative. Desaturation levels may be underestimated in recordings lasting only the first half of the night.

[Usefulness of dehumidifiers in the reduction of acari concentrations]. / Utilidad de los dispositivos deshumidificadores en la reducción de la concentración de ácaros.

This study analyzes the role of dehumidifiers in asthma prophylaxis. The efficacy of dehumidifiers in the reduction of Dermatophagoides in the bedrooms of 9 patients with specific allergies was evaluated, along with success in reducing in high concentrations of mite allergens (D. pteronissinus I). Results were compared with those for a control group of 8 patients with the same allergy. In the group in whose homes a dehumidifier was installed, there was a significant reduction in relative humidity in the bedroom (54.84 +/- 4.33% and 45.23 +/- 4.92%; p < 0.05) as well as a significant decreased in concentrations of D. pteronissinus I (2.313 +/- 1.831 to 0.42 +/- 0.44 microgram/g; p < 0.05). This was not the case of patients in the control group (51.15 +/- 7.38% to 60.5 +/- 6.15%; p < 0.05 and 3.28 micrograms/g +/- 4.46 to 4.24 +/- 5.10; p = NS).

[An association of lymphoid interstitial pneumonia, common variable immunodeficiency and non-Hodgkin's lymphoma]. / Asociación de neumonía intersticial linfoide, inmunodeficiencia común variable y linfoma no hodgkiniano.

We describe a woman with lymphoid interstitial pneumonia diagnosed by open lung biopsy following a profile of unproductive cough, weakness and bilateral lung infiltrates. The patient was also diagnosed as having common variable immunodeficiency based on hypogammaglobulinemia, repeated sinusitis and persistent diarrhea. Exfoliative cytology of pleural effusion revealed the development of non-Hodgkin's lymphoma. We review the associations among these processes and consider the suggestion made by other authors that lymphoid interstitial pneumonia be considered a prelymphomatous process.

[Pulmonary infection in patients with lung cancer]. / Infección pulmonar en pacientes con cáncer de pulmón.

BACKGROUND: To determine the frequency of pneumonia in patients with primary lung cancer requiring hospital admission, the etiologic diagnosis, probable production mechanisms, and the factors which may condition the evolution. METHODS: A prospective study was carried out in patients with primary lung cancer requiring hospital admission between 1986-1990. The diagnosis of pneumonia was performed by clinical and radiologic criteria and the etiology, in all cases, by hemocultures, pulmonary aspiration puncture, transtracheal aspiration and bronchoscopic techniques. RESULTS: The frequency of pneumonia was 12%. Etiologic diagnosis of the pulmonary infection was achieved in 16 patients and the most frequent etiologic agents were Gram negative (56%), anaerobic (31%) and Pneumocystis carinii (31%). Mortality was 16%. Community or nosocomial infection was not related with the evolution of the lung infection. Neither did diagnosis of the etiologic agent condition mortality attributable to the pneumonia but facilitated treatment. CONCLUSIONS: Pulmonary infection is a frequent and severe disease in patients with primary lung cancer. Bronchial obstruction may be the related pathogenic mechanism in the greatest number of cases with pneumonia. Due to the etiologic spectrum of these infections the practice of reliable diagnostic techniques is recommended to obtain etiologic diagnosis in addition to the administration of initial wide spectrum empiric antibiotherapy against the mentioned germs.