Unraveling disparities: Probing gender, race, and geographic inequities in pulmonary heart disease mortality in the United States: An extensive longitudinal examination (1999-2020) leveraging CDC WONDER data.

This comprehensive study delves into the epidemiological landscape of Pulmonary Heart Disease (PHD) mortality in the United States from 1999 to 2020, leveraging the extensive CDC WONDER database. PHD encompasses conditions affecting the right side of the heart due to lung disorders or elevated pressure in the pulmonary arteries, including pulmonary hypertension, pulmonary embolism, and chronic thromboembolic pulmonary hypertension (CTEPH). Analyzing data from death certificates, demographic characteristics, and geographical segmentation, significant trends emerge. The age-adjusted mortality rates (AAMRs) for PHD-related deaths show a fluctuating pattern, initially decreasing from 1999 to 2006, followed by a steady increase until 2020. Male patients consistently exhibit higher AAMRs than females, with notable disparities observed among racial/ethnic groups and geographic regions. Non-hispanic (NH) Black or African American individuals, residents of specific states like Colorado and the District of Columbia, and those in the Midwest region demonstrate elevated AAMRs. Furthermore, nonmetropolitan areas consistently manifest higher AAMRs than metropolitan areas. These findings underscore the urgent need for intensified prevention and treatment strategies to address the rising mortality associated with PHD, particularly among vulnerable populations. Insights from this study offer valuable guidance for public health initiatives aimed at reducing PHD-related mortality and improving outcomes nationwide.

Catheter-Directed Thrombolysis in Submassive Pulmonary Embolism and Acute Cor Pulmonale.

Treatment of submassive (intermediate-risk) pulmonary embolism (PE), defined as hemodynamically stable with right ventricular (RV) dysfunction, showed lower in-hospital all-cause mortality with intravenous thrombolytic therapy than with anticoagulants, but at an increased risk of major bleeding. The present investigation was performed to test whether catheter-directed thrombolysis reduces mortality without increasing bleeding in submassive PE. This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample. In 2016, 13,130 patients were hospitalized with PE and acute cor pulmonale, were stable, and treated with catheter-directed thrombolysis in 1,500 (11%) or anticoagulants alone in 11,630 (89%). Mortality was lower with catheter-directed thrombolysis than with anticoagulants in unmatched patients, 35 of 1,500 (2.3%) compared with 755 of 11,630 (6.5%; p <0.0001) and in matched patients, 30 of 1,260 (2.4%) compared with 440 of 6,910 (6.4%; p <0.0001). Time-dependent analysis showed catheter-directed thrombolysis reduced mortality if administered within the first 3 days. Patients with saddle PE treated with anticoagulants had lower mortality than non-saddle PE, 75 of 1,730 (4.3%) compared with 680 of 9,900 (6.9%; p < 0.0001) in unmatched patients and 45 of 1,305 (3.4%) compared with 395 of 5,605 (7.0%; p < 0.0001) in matched patients. Mortality was not lower with inferior vena cava filters either in those who received catheter-directed thrombolysis or those treated with anticoagulants. There were no fatal or nonfatal adverse events associated with catheter-directed thrombolysis. In conclusion, patients with submassive PE appear to have lower in-hospital all-cause mortality with catheter-directed thrombolysis administered within 3 days than with anticoagulants, and risks are low.

Associations between short-term exposure to gaseous pollutants and pulmonary heart disease-related mortality among elderly people in Chengdu, China.

BACKGROUND: Pulmonary heart disease (PHD) has become a global burden, especially in low- and middle-income countries. However, very few studies have assessed the influence of air pollution on PHD. This is the first study to explore the association between gaseous pollutants and PHD-related mortality in the central Sichuan Basin of southwestern China. METHODS: Data on PHD-related mortality among elderly people (aged 60 and older) from 2013 to 2017 were collected from the Population Death Information Registration and Management System (PDIRMS). Data on air pollutants were collected from all 24 Municipal Environmental Monitoring Sites in Chengdu, and data on daily temperature, relative humidity, and atmospheric pressure were collected from the Chengdu Municipal Meteorological Bureau. An epidemiological design of time-stratified case-crossover was conducted to assess the association between short-term exposure to ambient gaseous pollutants and PHD-related mortality among elderly people. RESULTS: About 54,920 PHD-related deaths among people aged 60 and older were reported. After controlling for daily temperature, relative humidity, and atmospheric pressure, an IQR concentration increase in levels of sulfur dioxide (SO2) (13 µg/m3), nitrogen dioxide (NO2) (17 µg/m3), and ozone (O3) (74 µg/m3) was associated with 7.8, 6.2, and 5.5% increases in PHD-related mortality in people aged 60 and older, respectively. People over age 70 might have even higher susceptibility to PHD-related mortality associated with SO2, NO2, and O3. Females and individuals with alternative marital statuses (widowed, divorced, or never married) had twice and more than twice the PHD-related mortality risk associated with SO2 and NO2 than males and married individuals, respectively. CONCLUSIONS: Increased concentrations of ambient SO2, NO2, and O3 were significantly and positively associated with PHD-related mortality in Chengdu, China. Sociodemographic factors - including gender, age, and marital status - may modify the acute health effects of gaseous pollutants.

Influences of socioeconomic vulnerability and intra-urban air pollution exposure on short-term mortality during extreme dust events.

Air pollution has been shown to be significantly associated with morbidity and mortality in urban areas, but there is lack of studies focused on extreme pollution events such as extreme dust episodes in high-density Asian cities. However, such cities have had extreme climate episodes that could have adverse health implications for downwind areas. More importantly, few studies have comprehensively investigated the mortality risks of extreme dust events for socioeconomically vulnerable populations. This paper examined the association between air pollutants and mortality risk in Hong Kong from 2006 to 2010, with a case-crossover analysis, to determine the elevated risk after an extreme dust event in a high-density city. The results indicate that PM10-2.5 dominated the all-cause mortality effect at the lag 0 day (OR: 1.074 [1.051, 1.098]). This study also found that people who were aged ≥ 65, economically inactive, or non-married had higher risks of all-cause mortality and cardiorespiratory mortality during days with extreme dust events. In addition, people who were in areas with higher air pollution had significantly higher risks of all-cause mortality and cardiorespiratory mortality. In conclusion, the results of this study can be used to target the vulnerable among a population or an area and the day(s) at risk to assist in health protocol development and emergency planning, as well as to develop early warnings for the general public in order to mitigate potential mortality risk for vulnerable population groups caused by extreme dust events.

Elevated tricuspid regurgitant jet velocity, reduced forced expiratory volume in 1 second, and mortality in adults with sickle cell disease.

Cardiopulmonary disease is the leading cause of mortality in adults with sickle cell disease (SCD). Elevated tricuspid regurgitant jet velocity (TRJV) and reduced forced expiratory volume in 1 second (FEV1 ) %predicted are associated with early mortality in SCD; however their relationship and combined effect on survival is unknown. We investigated the relationship between TRJV and FEV1 %predicted, and their combined effect on mortality, in a retrospective cohort of 189 adults with SCD who underwent both pulmonary function testing and echocardiography. Nineteen (9.9%) of 189 patients died over a median follow-up of 1.4 years; cardiopulmonary disease was the major cause of death in 52.6%. FEV1 %predicted was negatively associated with TRJV (Spearman rho, -0.34, P < 0.001). Individuals with FEV1 %predicted ≤70% were more likely to have an elevated TRJV ≥2.5 m/second, compared to those with FEV1 %predicted >70% [45.8% versus 17.1%; odds ratio (OR) 4.1 (95% Confidence interval ([CI] 2.1-8.0); P = 0.001]. In a multivariable cox regression model, the combination of TRJV ≥2.5 m/second and FEV1 %predicted ≤70% predicted earlier mortality [hazard ratio (HR) 4.97 (95% CI 1.30-18.91; P = 0.019)] after adjusting for age, sex, and nephropathy. Both FEV1 %predicted ≤70% and TRJV ≥2.5 m/second were independently associated with nephropathy [OR 4.48 (95% CI 1.51-13.31); P = 0.004] and [OR 3.27 (95% CI 1.19-9.00); P = 0.017], respectively. In conclusion, pulmonary and cardiac impairment are associated with, and contribute to mortality in SCD. Therapies aimed at improving reduced FEV1 %predicted and elevated TRJV could improve survival in patients with SCD. Am. J. Hematol. 92:125-130, 2017. © 2016 Wiley Periodicals, Inc.

Acute respiratory distress syndrome: the heart side of the moon.

PURPOSE OF REVIEW: Circulatory failure is a frequent complication during acute respiratory distress syndrome (ARDS) and is associated with a poor outcome. This review aims at clarifying the mechanisms of circulatory failure during ARDS. RECENT FINDINGS: For the past decades, the right ventricle (RV) has gained a crucial interest since many authors confirmed the high incidence of acute cor pulmonale during ARDS and showed a potential role of the acute cor pulmonale in the poor outcome of ARDS patients. The most important recent progress demonstrated in ARDS ventilatory strategy is represented by the prone position, which has a huge beneficial effect on RV afterload. This review will focus on the mechanisms responsible for the RV dysfunction/failure during ARDS and on the strategy, which allows improving the right ventricular function. SUMMARY: The RV has a pivotal role in the circulatory failure of ARDS patients. The ventilatory strategy during ARDS has to pay a peculiar attention to the RV to rigorously control its afterload.

One-year prognosis and the role of brain natriuretic peptide levels in patients with chronic cor pulmonale.

Data on the clinical outcomes and role of brain natriuretic peptide (BNP) levels in patients with chronic cor pulmonale are limited. A total of 69 patients with chronic cor pulmonale, admitted for dyspnea (January 2007 to September 2011) to three university hospitals, were retrospectively reviewed. All of the patients had right ventricular (RV) dysfunction on echocardiography. The median age was 70.0 yr, and chronic obstructive pulmonary disease (40.6%) and tuberculosis-destroyed lung (TDL, 27.5%) were the leading causes of chronic cor pulmonale. At the 1-yr follow-up, the mortality rate was 15.9%, and the readmission rate was 53.7%; patients with TDL had higher mortality (31.6% vs. 10.0%; P=0.059) and readmission rates (78.9% vs. 43.8%; P=0.009) than those with non-TDL diseases. The area under the receiver operating characteristic curve for admission BNP levels to predict readmission was 0.788 (95% confidence interval [CI], 0.673-0.904), and the sensitivity and specificity of the cut-off value were 80.6% and 77.4%, respectively. In multivariate analysis, high admission BNP levels were a significant risk factor for subsequent readmission (hazard ratio, 1.049; 95% CI, 1.005-1.094). Additionally, admission BNP levels were well correlated with cardiac troponin I (r=0.558), and delta BNP also correlated with delta RV systolic pressure (n=25; r=0.562). In conclusion, among hospitalized patients with chronic cor pulmonale, admission high BNP levels are a significant risk factor for subsequent readmission. Therefore, more intensive monitoring and treatment are needed in patients with higher BNP levels.

Echocardiographic predictors of mortality in patients with pulmonary hypertension and cardiopulmonary comorbidities.

OBJECTIVE: We aimed to identify the echocardiographic measures associated with survival in a patient population with a high prevalence of co-morbid cardiovascular and pulmonary disease that have significantly elevated estimated pulmonary artery systolic pressures (ePASP). BACKGROUND: Pulmonary hypertension (PH) is a clinical feature of several cardiopulmonary diseases that are prevalent among elderly. While certain echocardiographic parameters have been shown to be important in the prognosis in specific PH groups, the prognostic relevance of echocardiographic characteristics in a cohort with multiple cardiopulmonary comorbidities is unclear. METHODS: We retrospectively identified 152 patients with ePASP > 60 mmHg by echocardiography over a five year period (6/2006-11/2011) and followed until 4/2013. Candidate clinical and echocardiographic characteristics suggestive of PH severity were compared between deceased and surviving subpopulations. Cox proportional hazard modeling was used to identify echocardiographic predictors of death adjusted for age and clinical characteristics. RESULTS: This was a predominantly elderly (age 78.8 ± 10.2 years), male (98.7%) cohort with several cardiopulmonary comorbidities. Overall mortality was high (69.7%, median survival 129 days). After adjusting for age and clinical characteristics, decreased right ventricular (RV) systolic function assessed by tricuspid annular plane systolic excursion (HR 0.56, 95% CI 0.33-0.96, p = 0.034) and increased RV thickness (HR: 4.34, 95% CI: 1.49-12.59, p = 0.007) were independently associated with mortality. In contrast, left ventricular systolic function, left ventricular diastolic parameters, ePASP, or echo-derived pulmonary vascular resistance (PVR) were not associated with increased mortality. CONCLUSION: In a cohort of patients with PH and high prevalence of cardio-pulmonary comorbidities, RV systolic function and hypertrophy are associated with mortality and may be the most relevant echocardiographic markers for prognosis.

Low-income status is an important risk factor in North East Mexican patients with cystic fibrosis.

BACKGROUND. Factors such as environment, income status, as well as access to proper healthcare influence the survival and quality of life of people affected by chronic diseases including cystic fibrosis (CF). Survival factors in Mexican patients with CF have not been reported before, even when it has been estimated that this disease could not be negligible in the Mexican population. OBJECTIVE. To compare the influence of the mutant allele ΔF508 and environmental factors on the survival of Mexican CF patients. MATERIAL AND METHODS. We collected epidemiological data of 40 patients molecularly tested between 1987 and 2008 in the Clínica de Fibrosis Quística from the Hospital Universitario of the Universidad Autónoma de Nuevo León in Northeastern México. Kaplan-Meier plots and survival statistics were estimated and compared. RESULTS. Survival analysis revealed statistical significance for low-income status (p = 3.13 x 10-6), cor pulmonale (p = 0.00169), severe pulmonary disease (p = 0.00136), and BMI ≤15 kg/m2 (p = 0.00678). Statistical significance was not observed for the predominant allele ΔF508 considering two (p = 0.992), one (p = 0.503) or no (p = 0.403) mutant allele. CONCLUSIONS. Low income status was the most detrimental factor; followed by cor pulmonale, severe pulmonary disease and BMI ≤ 15 kg/m2 for the survival in North East Mexican patients with CF. Carrying the ΔF508 allele did not influence survival.

Basic critical care echocardiography by pulmonary fellows: learning trajectory and prognostic impact using a minimally resourced training model*.

OBJECTIVES: The spread of basic critical care echocardiography may be limited by training resources. Another barrier is the lack of information about the learning trajectory and prognostic impact of individual basic critical care echocardiography domains like acute cor pulmonale determination and left ventricular function estimation. We thus developed a minimally resourced training model and studied the latter outcomes. DESIGN: Prospective observational study. SETTING: Twenty-bed medical ICU. SUBJECTS: Echocardiography-naive trainees enrolled in the first year of our Pulmonary Medicine Fellowship Program from September 2012 to September 2013. INTERVENTIONS: We described the learning trajectory in six basic critical care echocardiography domains (adequate views, pericardial effusion, acute cor pulmonale, left ventricular ejection fraction, mitral regurgitation, and inferior vena cava variability) and correlated abnormalities in selected basic critical care echocardiography domains with clinical outcomes (mortality and length of stay). MEASUREMENTS AND MAIN RESULTS: Three-hundred forty-three basic critical care echocardiography scans were done for 318 patients by seven fellows (median of 40 scans per fellow; range, 34-105). Only one-third patients had normal basic critical care echocardiography studies. Accuracy in various basic critical care echocardiography domains was high (> 90%), especially beyond the first 30 examinations. Acute cor pulmonale was associated with ICU mortality when adjusted for Acute Physiology and Chronic Health Evaluation II score and presence of sepsis, whereas mitral regurgitation was associated with longer hospitalization only on univariate analysis. CONCLUSIONS: Basic critical care echocardiography training using minimal resources is feasible. New trainees can achieve reasonable competency in most basic critical care echocardiography domains after performing about 30 examinations within the first year. The relatively high prevalence of abnormalities and the significant association of acute cor pulmonale with ICU mortality support the need for basic critical care echocardiography training.

Comparison of cardiac allograft vasculopathy in heart and heart-lung transplantations: a 15-year retrospective study.

BACKGROUND: Cardiac allograft vasculopathy (CAV) is a major factor limiting long-term survival after heart transplantation (HTx). Specific determinants of CAV and long-term outcome after CAV occurrence have been poorly investigated after heart-lung transplantation (HLTx). METHODS: Between January 1996 and December 2006, 79 patients underwent HLTx (36.3 ± 12.2 years old; 47% men) and 141 patients underwent HTx (49.2 ± 12.3 years old; 77% men) at two different institutions. CAV grading was reviewed in both groups according to the 2010 standardized nomenclature of the International Society for Heart and Lung Transplantation. The mean post-transplant follow-up was 94 (1 to 181) months. RESULTS: Overall 10-year survival rate was 58% after HTx and 43% after HLTx (p = 0.11). The Grade 1 (or higher) CAV-free survival rate was 95% at 4 years and 69% at 10 years after HLTx, and 77% and 39%, respectively, after HTx (p < 0.01). Mean cyclosporine blood levels were similar between the groups at 3, 6, 12, 24 and 36 months. The main causes of mortality beyond 5 years after HTx and HLTx were malignancies and bronchiolitis obliterans, respectively. By multivariate analysis, recipients who developed >3 acute myocardial rejections during the first year post-transplant were exposed to a higher risk of CAV (95% CI 1.065 to 2.33, p = 0.02). Episodes of acute pulmonary rejection and bronchiolitis obliterans were not associated with an increased risk of CAV (p = 0.52 and p = 0.30). CONCLUSION: HLTx recipients appeared protected from CAV compared with HTx patients in this retrospective study. Repeated acute cardiac rejections were independent predictors of CAV. Unlike bronchiolitis obliterans, CAV had a very low impact on long-term survival after HLTx.

Elevated C-reactive protein, depression, somatic diseases, and all-cause mortality: a mendelian randomization study.

BACKGROUND: Elevated levels of plasma C-reactive protein (CRP) have been associated with many diseases including depression, but it remains unclear whether this association is causal. We tested the hypothesis that CRP is causally associated with depression, and compared these results to those for cancer, ischemic heart disease, chronic obstructive pulmonary disease, and all-cause mortality. METHODS: We performed prospective and instrumental variable analyses using plasma CRP levels and four CRP genotypes on 78,809 randomly selected 20- to 100-year-old men and women from the Danish general population. End points included hospitalization or death with depression and somatic diseases, prescription antidepressant medication use, and all-cause mortality. RESULTS: A doubling in plasma CRP yielded an observed odds ratio (OR) of 1.28 (95% confidence interval [CI]: 1.23-1.33) for hospitalization or death with depression, whereas for genetically elevated CRP, the causal OR was .79 (95% CI: .51-1.22; observed vs. causal estimate, p = .03). For prescription antidepressant medication use, corresponding ORs were 1.12 (1.11-1.15) and .98 (.83-1.15; p = .08). These results were similar to those for risk of cancer (p = .002), ischemic heart disease (p = 4 × 10(-99)), chronic obstructive pulmonary disease (p = 6 × 10(-86)), and all-cause mortality (p = .001) examined in the same individuals. CONCLUSIONS: Elevated CRP was associated with increased risk of depression in individuals in the general population, but genetically elevated CRP was not. This indicates that CRP per se is not a causal risk factor for depression.

Relationships between cold-temperature indices and all causes and cardiopulmonary morbidity and mortality in a subtropical island.

This study aimed to identify optimal cold-temperature indices that are associated with the elevated risks of mortality from, and outpatient visits for all causes and cardiopulmonary diseases during the cold seasons (November to April) from 2000 to 2008 in Northern, Central and Southern Taiwan. Eight cold-temperature indices, average, maximum, and minimum temperatures, and the temperature humidity index, wind chill index, apparent temperature, effective temperature (ET), and net effective temperature and their standardized Z scores were applied to distributed lag non-linear models. Index-specific cumulative 26-day (lag 0-25) mortality risk, cumulative 8-day (lag 0-7) outpatient visit risk, and their 95% confidence intervals were estimated at 1 and 2 standardized deviations below the median temperature, comparing with the Z score of the lowest risks for mortality and outpatient visits. The average temperature was adequate to evaluate the mortality risk from all causes and circulatory diseases. Excess all-cause mortality increased for 17-24% when average temperature was at Z=-1, and for 27-41% at Z=-2 among study areas. The cold-temperature indices were inconsistent in estimating risk of outpatient visits. Average temperature and THI were appropriate indices for measuring risk for all-cause outpatient visits. Relative risk of all-cause outpatient visits increased slightly by 2-7% when average temperature was at Z=-1, but no significant risk at Z=-2. Minimum temperature estimated the strongest risk associated with outpatient visits of respiratory diseases. In conclusion, the relationships between cold temperatures and health varied among study areas, types of health event, and the cold-temperature indices applied. Mortality from all causes and circulatory diseases and outpatient visits of respiratory diseases has a strong association with cold temperatures in the subtropical island, Taiwan.

Estimates of global mortality attributable to particulate air pollution using satellite imagery.

BACKGROUND: Epidemiological studies of the health effects of air pollution have traditionally relied upon ground-monitoring stations to measure ambient concentrations. Satellite derived air pollution measures offer the advantage of providing global coverage. OBJECTIVE: To undertake a global assessment of mortality associated with long-term exposure to fine particulate air pollution using remote sensing data. METHODS: Global PM(2.5) exposure levels were derived from the MODIS and MISR satellite instruments. Relative risks and attributable fractions of mortality were modeled using previously developed concentration-response functions for the association between PM(2.5) and mortality. RESULTS: The global fraction of adult mortality attributable to the anthropogenic component of PM(2.5) (95% CI) was 8.0% (5.3-10.5) for cardiopulmonary disease, 12.8% (5.9-18.5) for lung cancer, and 9.4% (6.6-11.8) for ischemic heart disease. CONCLUSION: This study demonstrates the feasibility of using satellite derived pollution concentrations in assessing the population health impacts of air pollution at the global scale. This approach leads to global estimates of mortality attributable to PM(2.5) that are greater than those based on fixed site ground-level measures of urban PM(2.5), but more similar to estimates based on global chemical transport model simulations of anthropogenic PM(2.5).

Cause-specific mortality in a Chinese chrysotile textile worker cohort.

Chrysotile asbestos has continued to be mined and used in China, but its health effects on exposed workers have not been well documented. This study was conducted to give a complete picture about cause-specific mortality in Chinese asbestos workers. A cohort of 586 males and 279 females from a chrysotile textile factory were prospectively followed for 37 years. Their vital status was identified, and the date and underlying cause of death were verified from death registry. Cause-specific standardized mortality ratios by gender were computed with nationwide gender- and cause-specific mortality rates as reference. Male workers were 11 years older, and had 6 years longer exposure duration than females; 79% in males and 1% in females smoked. In males, the mortality rate of all cancers doubled; both larynx and lung cancer were four-fold, and mesothelioma was 33-fold. In females, there was slightly excess mortality from lung cancer and all cancers, and significant increase in mesothelioma and ovarian cancer. Other significantly increased mortality was seen from cancers of thymus, small intestine and penis in males, and cancers of bone and bladder in females. In addition to asbestosis, mortality from pulmonary heart disease was significantly elevated in both genders. The data confirmed significantly excess mortality from mesothelioma in either gender, lung and larynx cancers in males, and ovarian cancer in females. A gender difference in mortality from lung cancer and all cancers could be mainly due to the discrepancies in age, exposure duration and smoking between the male and female workers.

[Small (<2.5 micron) particulate matter concentration of ambient air and early death in Hungary]. / A levego 2,5 mikron alatti részecskeméretu szállópor-tartalma és a korai halálozás Magyarországon.

The small (<2.5 micron) particulate matter concentration of ambient air is constantly measured and estimated over Europe, based on the recommendations of the WHO and the Council of Europe. Concentration of small size particulate matter has been found to be very high in Central and Eastern Europe, including central and eastern regions of Hungary. Epidemiologic evidence indicates strong direct correlation between small size particulate matter pollution and incidences of cardiopulmonary disease and lung cancer. As compared to Slovakia or the Czech Republic and after correction for population size, Hungary has the highest number of years of life lost due to small size particulate matter pollution related cardiopulmonary disease and lung cancer.

[Mortality and comorbidity in hospitalized chronic obstructive pulmonary disease patients]. / Analiza przyczyn zgonów i chorób wspólistniejacych u hospitalizowanych chorych na przewlekla obturacyjna chorobe pluc.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a fourth cause of death in USA and is expected to be the third cause of death by year 2020. It is believed that some diseases like cardiovascular diseases, osteoporosis, cachexia, anaemia are systemic consequences of COPD. Some data show that the co-morbidities are more frequent in severe COPD patients than in control groups and are associated with the serious health outcomes. It is debated whether extra pulmonary comorbidities or pulmonary complications are the main reason of death in COPD. The aim of the study was to analyze the mortality and comorbidity in COPD patients who died during hospitalization in the Department of Pneumonology and Allergology in WMU from 2004 to 2008. MATERIAL AND METHODS: We analyzed 266 records of patients who had diagnosis of COPD and died during hospitalization (179 [67%] M and 87 [33%] F). The mean age at death was 73 ± 8 years (M 73 ± 8 years, F 74 ± 9 years). RESULTS: The most frequent cause of death were: COPD exacerbation (n = 81 [30%], F = 32, M = 49), pneumonia (n = 67 [25%], F = 17, M = 50), lung cancer (n = 50 [19%], F = 18, M = 32), ischemic heart disease (n = 20 [7%], F = 5, M = 15), cardiovascular insufficiency (n = 14 [5%], F = 6, M = 8) and other (n = 34 [14%]). The lung cancer was more frequent cause of death in younger patients (p = 0.002), and pneumonia in older (p = 0.02). In COPD patients the following comorbidities were diagnosed: chronic heart failure (n = 169), hypertension (n = 103), ischaemic heart disease (n = 102), diabetes mellitus type 2 (n = 55), renal insufficiency (n = 43), hypertrophy of prostate (n = 36), arteriosclerosis obliterans (n = 28), osteoporosis (n = 19), anaemia (n = 14) and others. CONCLUSIONS: 1. The most frequent reasons of death were related to respiratory system: COPD exacerbation, pneumonia and lung cancer. 2. The most frequent diseases coexisting with COPD were cardiovascular disease, respiratory insufficiency and diabetes mellitus.

Long-term complications and prognosis of chronic beryllium disease.

BACKGROUND: Chronic beryllium disease (CBD) is a rare disease, and there are no previous reports that have followed CBD patients over several decades. Thus, the long-term complications and prognosis of this illness still remain unclear. OBJECTIVE: The aim of this study was to investigate long-term complications and prognosis of CBD patients. STUDY DESIGN AND METHODS: This was a retrospective study based on the medical records of all CBD patients diagnosed at Kyoto University Hospital between the period 1973 to the present day. Ultimately, ten patients whose diagnoses had been made during the period 1973 to 1977 were included. Long-term physiological and radiological change, complications and prognosis of these patients were investigated. RESULTS: Three patients completely remitted, and one died of cor-pulmonale. Among the remaining six patients, four have been followed up for more than thirty years in our institute. The majority developed mixed patterns of lung function impairment, cavity lesions of the lung, pneumothorax, and respiratory infections. CONCLUSIONS: Long-term prognosis of CBD was poor with several complications due to chronic parenchymal and airway lesions.