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.

Resolution rate of pulmonary sarcoidosis and its related factors in a Japanese population.

BACKGROUND AND OBJECTIVE: A number of previous studies have reported on the rate of resolution of pulmonary sarcoidosis and its associated factors. However, most of the studies were conducted several decades ago and no similar surveys have been conducted in recent years. The aim of this study was to evaluate the rate of resolution of pulmonary sarcoidosis and its related factors in recently diagnosed patients, and to compare the results with those from previous studies. METHODS: This study included 306 patients who had been newly diagnosed with pulmonary sarcoidosis between 2000 and 2009 in Sapporo, Japan. Chest radiographical findings were assessed at the initial visit and at the 2- or 5-year observation points. The rates of resolution on chest radiographs and the association with clinical manifestations were evaluated. RESULTS: The resolution rates were 17.9% at the 2-year and 29.9% at the 5-year observation point. These rates were lower than those reported in the earlier surveys. Younger subjects (aged <40 years) showed resolution more often (P < 0.05). The absence of extra-pulmonary organ involvement was associated with resolution at 5 years (P < 0.05). CONCLUSION: The clinical course of pulmonary sarcoidosis may be changing, showing a tendency not to resolve. At least in part, this may be due to the ageing of the Japanese population.

Utility of a Sputum Antigen Detection Test in Pneumococcal Pneumonia and Lower Respiratory Infectious Disease in Adults.

OBJECTIVE: To compare the utility of Gram staining, a urinary antigen detection kit and a sputum antigen detection kit were examined for the rapid and early detection of pneumococcal pneumonia and lower respiratory infectious diseases. METHODS: A newly developed sputum pneumococcal antigen detection kit (RAPIRUN), Gram staining, and urinary antigen detection kit (BinaxNOW) were comparatively evaluated for their ability to detect Streptococcus pneumoniae in patients with pneumonia or lower respiratory tract infection. Sputum culture results were used as a standard for comparison. Furthermore, the pneumococcus-positive rates in culture and rapid tests were compared using polymerase chain reaction (PCR) as a reference. RESULTS: Of the 169 patients studied, 54 (32.0%) tested positive for S. pneumoniae in culture. S. pneumoniae detection sensitivities for Gram staining, RAPIRUN, and BinaxNOW were 75.9%, 90.7%, and 53.7%, respectively; thus, RAPIRUN had a significantly higher sensitivity than BinaxNOW (p<0.001). For patients with ≥10(5) copies/µg of pneumococcal surface protein A DNA PCR analysis, the detection rates of culture, Gram staining, and RAPIRUN were 85.2%, 72.1%, and 82.0%, respectively, however, the detection rate of BinaxNOW was only 47.5%. Comparisons among 45 patients with culture-positive pneumococcal pneumonia revealed that RAPIRUN had a significantly higher detection rate than BinaxNOW in the mild cases (p<0.006), regardless of the number of days from onset (p<0.03). CONCLUSION: RAPIRUN is a rapid testing kit that detects S. pneumoniae in sputum with a high sensitivity and specificity. It is a particularly more useful detection kit than BinaxNOW for early and mild community-acquired pneumonia in pre-treatment patients whose sputum specimens can be obtained.

A study on the management of acute respiratory tract infection in adults.

Antimicrobials are commonly used to treat acute respiratory tract infection in adults. Furthermore, their overuse has raised concern. We conducted a field survey study that included 170 medical institutions from January 2008 to June 2010. The purpose of this study was to clarify the relationship between the rate of antimicrobial use and patient outcomes with each indication. The study included 1753 patients diagnosed with acute respiratory tract infection. Antimicrobials were used for treatment of 1420 of these patients, whereas 333 cases were not treated with antimicrobials. After 3 days of treatment, patients administered antimicrobials experienced a higher improvement rate than those who did not receive antimicrobial treatment (92.2% vs. 83.3%, p < 0.0001). However, after 7 days of treatment, the rates of improvement for patients in both groups were similar (95.0% and 93.4%, respectively, p = 0.2391). In addition, according to the criteria for the usage of antimicrobials described in the Japanese Respiratory Society guidelines for the management of respiratory tract infection in adults, the patients were classified into the 3 categories (6 indication factors for antimicrobial use): Grade 1, ≤ 2 factors; Grade 2, 3-4 factors; Grade 3, 5-6 factors). The indication factors considered were the following: 1) temperature; 2) purulent sputum or nasal discharge; 3) tonsillar enlargement and tonsillolith/white puss; 4) middle otitis/sinusitis; 5) inflammatory reaction; and 6) high-risk patients. The results indicate that the improvement observed after 3 days of treatment in Grade 2 and Grade 3 patients was significantly higher with antimicrobial treatment than without antimicrobial treatment. In conclusion, the administration of antimicrobials is not recommended in younger patients with no underlying disease. However, the use of antimicrobials is required in patients with a higher relative risk that corresponds to the presence of ≥ 3 of the 6 indication factors for antimicrobial use.

Increased prevalence of cigarette smoking in Japanese patients with sarcoidosis.

BACKGROUND AND OBJECTIVE: Several studies have shown that individuals with sarcoidosis in Western populations are less likely to have smoked before diagnosis. Epidemiological characteristics of sarcoidosis are known to differ between Japanese and Westerners. Therefore, the relationship between cigarette smoking and sarcoidosis in a Japanese population was investigated. METHODS: Three hundred eighty-eight patients newly diagnosed with sarcoidosis between 2000 and 2008 were retrospectively identified. The results of two large surveys of smoking prevalence in Japan provided reference data. Specific clinical manifestations of sarcoidosis were compared between current smokers and never-smokers, after excluding former smokers. RESULTS: The prevalence of current smokers at the time of the diagnosis of sarcoidosis was 59.6% in men and 27.9% in women. With the exception of men in their 30s, the prevalence was higher in all age groups compared with the general Japanese population. The prevalence of lung parenchymal involvement tended to be higher in current smokers than in never-smokers (odds ratio = 1.33 (0.99-1.77), P = 0.054). CONCLUSIONS: This retrospective cohort study suggests that smoking prevalence is higher in Japanese sarcoidosis patients than that reported in Western sarcoidosis patients and that there could be different relationships between smoking and the development of sarcoidosis in these populations.

[Examination of the inspiratory flow rates of COPD patients in Japanese medical facilities].

UNLABELLED: Chronic obstructive pulmonary disease (COPD) is treated primarily with inhalation therapy. However, as many COPD patients are elderly, whether or not patients inhale dry powder at an adequate inspiratory flow rate requires investigation. We therefore conducted a multicenter investigation of the effects of height, body weight, age, disease severity, and other factors on inspiratory flow rate in COPD patients. METHODS: We measured inspiratory flow rates and forced expiratory volume in the first second (FEV1) with the In-Check Dial (Clement Clarke) fitted with a discus adapter in 175 COPD patients of 40 years old and over (mean age 71.3, men 89.1%, women 10.9%). RESULTS: A total of 98.9% of the patients had an inspiratory flow rate exceeding 30L/minute. Two patients had a rate of 30L/minute or less. The mean inspiratory flow rate was 98 +/- 30L/minute overall, 104 +/- 27L/minute in mild COPD, 109 +/- 28L/minute in moderate COPD, 91 +/- 26L/minute in severe COPD, 71 +/- 24L/minute in very severe COPD, and 83 +/- 28L/minute in patients 75 years and older. Inspiratory flow rates significantly correlated with body mass index and FEV1. CONCLUSION: Most elderly patients with COPD maintained a sufficient inspiratory flow rate when inhaling dry powder.

Current situation of asthma therapy by allergists in primary medical facilities in Japan.

BACKGROUND: To reduce deaths from asthma, further use of inhaled corticosteroids (ICS) in accordance with the guidelines is required. The present study was conducted because specialists are responsible for increasing the use of guidelines, but the current state of asthma care provided by specialists in primary clinical settings has not been clarified. METHODS: In collaboration with five primary medical facilities throughout Japan, severity of asthma, contents of asthma therapy, and the implementation rate of pulmonary function testing and peak flow measurements were analyzed for 1007 outpatients ≥40 years old with stable bronchial asthma. In all patients, peak inspiratory flow (PIF) was measured during examination. RESULTS: Either ICS or ICS/long-acting beta 2 agonist (LABA) was used in almost all patients with at least mild persistent asthma. Although treatments adhered to the guidelines, therapeutic steps did not match asthma severity in many patients with mild intermittent asthma. Large gaps existed between facilities that measure pulmonary function and PEF in daily clinical practice and those that do not. While mean PIF value for all subjects was well maintained at 102.0 ± 29.1L/min, some patients may not have been able to inhale efficiently in terms of PIF (5.1% of Turbuhaler® users and 5.7% of Diskhaler® users). CONCLUSIONS: When stepping down asthma therapy, some confusion in policy may exist, leading to guideline mismatches. Differences in the implementation of pulmonary function and PEF measurements, as indicators for long-term management, need to be minimized among specialists. For maintaining effective inhalation, inspiratory flow should be periodically checked.

Evaluation of a rapid immunochromatographic ODK0501 assay for detecting Streptococcus pneumoniae antigen in sputum samples from patients with lower respiratory tract infection.

A novel, rapid, and noninvasive test (ODK0501) to detect Streptococcus pneumoniae antigen was evaluated in a Japanese multicenter study. ODK0501 uses polyclonal antibodies to detect C polysaccharide of S. pneumoniae from sputum samples by an immunochromatographic assay. The utility of ODK0501 was evaluated for 161 adult patients with lower respiratory tract infection between March 2006 and March 2007. Bacterial culture and identification, real-time PCR, and ODK0501 assays were performed on sputum samples, and the Binax Now Streptococcus pneumoniae antigen test was performed using urine samples obtained from the same patients. The performances of all tests were compared based on the results of bacterial culture and identification. The sensitivity and specificity of ODK0501 were 89.1% (49/55 samples) and 95.3% (101/106 samples), respectively. We then compared the Binax Now Streptococcus pneumoniae antigen test with ODK0501 using samples from 142 patients. The sensitivities of ODK0501 and the Binax Now S. pneumoniae antigen test were 90.0% (45/50 samples) and 62.0% (31/50 samples), respectively (P = 0.002). The relative quantity of S. pneumoniae in expectorated sputum was calculated using real-time PCR and indicated that the possibility of false-positive results for ODK0501 due to indigenous S. pneumoniae was low. The positive and negative concordance rates of ODK0501 and Binax Now were 96.8% (30/31 samples) and 21.1% (4/19 samples), respectively. Binax Now was less capable of detecting S. pneumoniae antigen among patients with underlying chronic obstructive pulmonary disease. In conclusion, ODK0501 is noninvasive, rapid, and an accurate tool for diagnosing respiratory infection caused by S. pneumoniae.

[Histologic diagnosis of sarcoidosis].

In Japan, elderly patients with sarcoidosis, cardiac sarcoidosis and severe pulmonary sarcoidosis patients have been increased. The patients with ocular manifestations without intrathoracic involvement have been also increased and it is, however, difficult to establish the diagnosis and to confirm such patients as sarcoidosis. To detect the histological findings such as epithelioid cell granuloma is gold standard in diagnosis. Transbronchial lung biopsy, scalene node biopsy, muscle biopsy and video-assisted thoracoscopic surgery are useful procedure for getting the tissue samples. We performed TBLB in 655 patients with clinical features of sarcoidosis. In 125 out of 293 patients with stage 0, 229 out of 272 with stage I, 66 out of 70 with stage II and 19 out of 20 with stage III patients, epithelioid cell granuloma was found. The effort to getting proper tissue samples of suspected sarcoidosis is important.

[A case of nonspecific interstitial pneumonia associated with amyopathic dermatomyositis efficiently treated with a combination of cyclosporin A and prednisolone].

A 36-year-old man was admitted to our hospital complaining of cough, dyspnea on exertion, skin eruptions, and joint pain. Characteristic skin lesions such as erythema around the nails, telangiectasis, and edema of the eyelids were observed in this patient. He had never complained of muscle symptoms, and his laboratory examinations showed no elevation of either CPK or aldolase. From several lines of evidence including the skin biopsy findings, amyopathic dermatomyositis was diagnosed. Chest X-ray films showed subpleural funicular opacities and consolidation in both lower lung fields. Lung biopsy specimens taken under video-assisted thoracoscopic surgery revealed nonspecific interstitial pneumonia, group II. Oral prednisolone treatment was initiated at 60 mg daily together with oral cyclosporin A (100-150 mg daily). The minimum serum concentration of cyclosporin A was maintained between 100 and 200 ng/ml. Respiratory symptoms gradually improved, and the oral prednisolone dose was tapered off. Pulmonary function and chest CT findings showed marked improvement.