Air pollution and weather as the determinants of acute attacks of asthma: Spatiotemporal approach.

BACKGROUND: Although air pollution and weather changes have been identified as putative risk factors that precipitate acute attacks of bronchial asthma, so far there have been no studies that could conclusively establisha clear association. OBJECTIVES: This study was carried out to investigate the effect of the concentrations of NO2, SO2, and particulate matter on exacerbation of bronchial asthma. METHODS: A longitudinal study was conducted during February 2014-January 2015. Sixty-one known cases of asthma were recruited from the outpatient department of a chest hospital. Data regarding weather parameter (temperature, rainfall, and relative humidity) and environmental pollution (SO2and NO2) and respirable suspended particulate matter were procured from the Indian Meteorological Department and Delhi Pollution Control Committee, respectively. Association was examined using the generalized estimation equation (GEE). RESULTS: Separate models were developed for weather parameter and pollution parameters. This study could not find a significant association between any of the weather parameters and occurrence of asthmatic attacks. In the GEE model, where average values of SO2, NO2, and PM were used, the PM was found to be significantly associated with asthmatic attacks. CONCLUSION: PM was found to increase the risk of exacerbation of asthma three folds.

Occupational emphysema following long-term exposure to metal fumes during electroplating in a non-smoker.

Exposure to cigarette smoke is by far the most common causative factor for chronic obstructive pulmonary disease. Occupational exposure to fumes, chemicals, dusts and environmental pollution is also an important cause of chronic productive cough. Emphysema developing as a consequence of an occupational exposure is extremely rare. We describe the rare occurrence of severe emphysema in a non-smoker male who had worked for nearly three decades in nickel electroplating industry.

Prediction equations for diffusing capacity (transfer factor) of lung for North Indians.

BACKGROUND: Prediction equations for diffusing capacity of lung for carbon monoxide (DLCO), alveolar volume (VA), and DLCO/VA using the current standardization guidelines are not available for Indian population. The present study was carried out to develop equations for these parameters for North Indian adults and examine the ethnic diversity in predictions. MATERIALS AND METHODS: DLCO was measured by single-breath technique and VA by single-breath helium dilution using standardized methodology in 357 (258 males, 99 females) normal nonsmoker adult North Indians and DLCO/VA was computed. The subjects were randomized into training and test datasets for development of prediction equations by multiple linear regressions and for validation, respectively. RESULTS: For males, the following equations were developed: DLCO, -7.813 + 0.318 × ht -0.624 × age + 0.00552 × age(2); VA, -8.152 + 0.087 × ht -0.019 × wt; DLCO/VA, 7.315 - 0.037 × age. For females, the equations were: DLCO, -44.15 + 0.449 × ht -0.099 × age; VA, -6.893 + 0.068 × ht. A statistically acceptable prediction equation was not obtained for DLCO/VA in females. It was therefore computed from predicted DLCO and predicted VA. All equations were internally valid. Predictions of DLCO by Indian equations were lower than most Caucasian predictions in both males and females and greater than the Chinese predictions for males. CONCLUSION: This study has developed validated prediction equations for DLCO, VA, and DLCO/VA in North Indians. Substantial ethnic diversity exists in predictions for DLCO and VA with Caucasian equations generally yielding higher values than the Indian or Chinese equations. However, DLCO/VA predicted by the Indian equations is slightly higher than that by other equations.

Increased oxidative stress and altered levels of antioxidants in chronic obstructive pulmonary disease.

An imbalance between oxidative stress and antioxidative capacity has been proposed to play an important role in the development and progression of chronic obstructive pulmonary disease. We carried out a study to assess the systemic oxidant-antioxidant status in patients with chronic obstructive pulmonary disease (COPD) and relate it to the severity of disease. We measured a wide range of parameters of oxidant-antioxidant balance in leukocytes, plasma and red cells of 82 patients with COPD and 22 healthy non-smoking controls (HNC). Lung function was measured by spirometry. Staging of COPD was done as per the recommended guidelines. Red cell antioxidative enzyme activities were altered, with glutathione peroxidase (GSH-Px) having lower, superoxide dismutase (SOD) having greater and catalase having similar activity in patients as compared to HNC. In plasma, ferric reducing antioxidant power (FRAP) and total protein sulfhydryls were lower and GSH-Px, lipid peroxides measured as MDA-TBA products, and protein carbonyls were higher in the patients as compared to HNC. Plasma total nitrates and nitrites (NO(x)) were similar in the two groups. Superoxide anion (O(2) (*-)) release from leukocytes upon stimulation with N-formyl-L-methionyl-L-leucyl-L-phenylalanine (fMLP) and total blood glutathione were also higher in patients as compared to HNC. Plasma FRAP had a positive whereas total blood glutathione had a significant negative correlation with the severity of airways obstruction (FEV(1)% predicted). Further, comparisons between clinical stages of severity of COPD revealed significant differences in plasma FRAP and total blood glutathione. Our observations suggest there is a systemic oxidant-antioxidant imbalance in the patients with COPD.

Preoperative diagnosis of allergic fungal sinusitis.

OBJECTIVES/HYPOTHESIS: Although the diagnosis of allergic fungal sinusitis is mainly based on characteristic histopathological findings, certain preoperative diagnostic criteria have been proposed. However, their usefulness in differentiating allergic fungal sinusitis from other sinus diseases is unknown. The objective of the study was to identify accurate preoperative diagnostic parameters for allergic fungal sinusitis. STUDY DESIGN: Prospective, comparative study. METHODS: Twenty consecutive cases of allergic fungal sinusitis were evaluated prospectively and compared with 16 cases of ethmoidal polyposis and 5 cases of invasive sinus aspergillosis, with regard to various clinical, radiological, and immunological parameters. All patients were categorized based on histopathological findings. RESULTS: Nasal polyps were seen in all 20 cases of allergic fungal sinusitis, all 16 cases of ethmoidal polyposis, and 2 of 5 cases of invasive sinus aspergillosis. Computed tomography (CT) scan hyper-attenuation was seen in all 20 cases of allergic fungal sinusitis but also in 2 (13%) cases of ethmoidal polyposis and 2 (40%) cases of invasive sinus aspergillosis. Serum levels of specific anti-Aspergillus immunoglobulin E were elevated in 14 (70%) cases of allergic fungal sinusitis, 2 (13%) cases of ethmoidal polyposis, and 3 (60%) cases of invasive sinus aspergillosis. The combination of all three (ie, nasal polyps, CT scan hyper-attenuation, and elevated titers of anti-Aspergillus immunoglobulin) was not found in any case of ethmoidal polyposis or invasive sinus aspergillosis. This triad demonstrated a sensitivity of 70% and a specificity of 100% for the preoperative diagnosis of allergic fungal sinusitis. CONCLUSIONS: Nasal polyps, CT scan, and specific immunoglobulin E titers, when considered in combination, have a high preoperative diagnostic value in allergic fungal sinusitis. However, they should not be considered in isolation because considerable overlap occurs with invasive sinus aspergillosis and ethmoidal polyposis.