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Query: UMLS:C0392680 (shortness of breath)
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The prevalence of chronic lung disease was investigated in 1284 adult residents of 11 villages situated at 1800 m in the Highlands of Papua New Guinea. Chronic cough, shortness of breath on exertion, bronchial hypersecretion, and adventitious chest sounds were increasingly common in both sexes from middle life onwards, and were associated with an irreversible obstructive ventilatory defect. Over the age of 45 years, 20% of men and 10% of women had an FEV1/FVC % less than 60%. The prevalence of active asthma was 0.25%. The smoking of home-grown, air-cured tobacco was not associated with chronic respiratory symptoms or reduction of ventilatory capacity. Smoking was, however, associated with recent cough symptom, bronchial hypersecretion and adventitiae. Mortality over the subsequent 5 years was increased 2--3 fold in those with adventitiae, but was not related to smoking status. The aetiological relevance of wood smoke in the houses and acute chest infections remains to be clarified.
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PMID:Respiratory abnormalities, smoking habits and ventilatory capacity in a highland community in Papua New Guinea: prevalence and effect on mortality. 52 9

On Karkar Island, off the coast of Papua New Guinea, 87 per cent of the 1,026 resident adults of 3 villages were surveyed for respiratory abnormalities. The prevalence of abnormalities suggestive of chronic lung disease was similar for each sex and increased with age. After 35 years of age, the combined rates were: adventitious breath sounds, 29 per cent; positive loose cough sign, 33 per cent; chronic cough, 11 per cent; and shortness of breath on exertion, 12 per cent. All of these abnormalities were associated with an obstructive ventilatory defect. Smoking began in late adolescence and was established in more than 90 per cent of both sexes by 25 years of age. Most persons smoked a home-grown variety of Nicotiana tabacum. The nonsmoking group was too small to allow adequate comparison; but among smokers, inhalation was related to both respiratory abnormalities and reduced lung function. The prevalence of respiratory abnormalities appeared to be at least as high as in some developed western societies, despite the fact that smoking habits resembled those of cigar smokers elsewhere, and that atmospheric and occupational exposures were absent. Among persons more than 35 years of age, 4 per cent had a history of pulmonary tuberculosis, and 5 per cent showed evidence of localized lung disease in a 70-mm chest radiograph. The predominant condition resembled the chronic nonspecific lung disease of developed societies. Unless this population is unusually susceptible to the effect of cigar-type smoking, other etiologic factors must be considered. These might include repeated acute chest infections, the indirect effects of pulmonary tuberculosis, larval migrations of intestinal parasites, or impaired host response as a result of poor nutrition. A wide spectrum of severity coexisted with a uniform environment and smoking pattern, which suggests that individual susceptibility is important.
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PMID:Respiratory abnormalities and ventilatory capacity in a Papua New Guinea Island community. 97 Jul 35

Chest radiographs of 39 patients with ankylosing spondylitis were studied. Three showed apical pulmonary fibrosis, two with cavitary lesions. Other known causes of lung disease were excluded. Symptoms and roentgenographic evidence of spondylitis were present for many years prior to the onset of pulmonary symptoms, which variably included shortness of breath, cough, hemoptysis, pleuritic chest pain, fever, and chills. Apical pulmonary lesions of unknown cause were absent in 53 age, sex, and racematched osteoarthritis control patients. The findings suggest that apical pulmonary fibrosis may be an extra-skeletal manifestation of ankylosing spondylitis, the frequency of which approaches that of spondylitic heart disease.
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PMID:Pulmonary manifestations of ankylosing spondylitis. 120 76

Two cases of farmer's lung disease in siblings are reported. A 54-year-old male farmer, who had been engaged in stock work for 20 years, presented to our clinic for the second episode of fever, productive cough and shortness of breath. Chest roentgenogram revealed diffuse micronodular pattern, and mild hypoxemia was recognized on arterial blood gas analysis. Cytology obtained from BALF showed lymphocytosis, with especially increased OKT3, OKT4 positive cells and OKT4/8 ratio. The diagnosis was confirmed by highly positive reaction of precipitins to Thermoactinomyces vulgaris and granulomatous interstitial pneumonitis on histopathological examination. The second case was a 51-year-old female patient, the sister of the first case, who also worked as a stock farmer of another farm for 20 years. She presented with an episode of similar symptoms to the first case, one and a half years after the onset of her brother's symptoms. The findings of roentgenogram, BALF analysis, precipitins to T. Vulgaris and pathology were similar to those of the first case. The finding of high OKT4/8 ratio on BALF analysis in both cases is characteristic of formers lung disease, in contrast to the summer-type hypersensitivity pneumonitis which usually shows low OKT4/8 ratio in BALF. To our knowledge, this is the first report of farmer's lung disease in an area other than the northern part of Japan. Thus we conclude that farmer's lung disease may occur in Japan under any environmental conditions, and that some genetic factor may take part in the onset of this disease.
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PMID:[Case report of Farmer's lung disease in siblings in Kagoshima Prefecture]. 146 85

Information gathered in the Zutphen Study, the Dutch contribution to the Seven Countries Study that started in the 1960s, was used for the present study. In 1960 878 men participated in the physical examination and they were followed for 25 years until 1 July 1985. During this follow-up, their morbidity status was verified regularly. With this information the occurrence of chronic non-specific lung disease (CNSLD) at a specific time was coded by one physician, using strict criteria. The CNSLD diagnosis was based on the following criteria: episodes of respiratory symptoms such as regular cough and phlegm for longer than three months or episodes of wheezing and shortness of breath reported to the survey physician, or: diagnosis of CNSLD, including chronic bronchitis or emphysema by a clinical specialist. Occupation in 1960 was coded and used to generate specific occupational exposures with a Job Exposure Matrix. Because the exact time of diagnosis of CNSLD was known, incidence densities could be calculated. For 804 men a complete set of data was available. A Poisson regression analysis was used to analyse the relationships between the incidence density and independent variables like age, calendar period, occupation and specific occupational exposures. Blue collar workers had a significantly elevated incidence density ratio (IDR) compared to white collar workers (1.82, 95% confidence limits (CL): 1.35, 2.46). Subgroups of blue collar workers, wood and paper workers, textile workers, and tailors, construction workers and transport workers had significantly elevated IDRs also. Of the specific exposures heavy metals, mineral dust and adhesives had a significantly elevated IDR.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Occupational exposure and 25-year incidence rate of non-specific lung disease: the Zutphen Study. 208 26

The International Union against Tuberculosis and Lung Disease (IUATLD) Bronchial Symptoms Questionnaire (1984) was developed for use in studies of asthma and its reliability measured in an earlier survey in England. The association of the symptoms elicited by this questionnaire to bronchial response to histamine has also been described. This paper presents the results of studies of the questionnaire in four clinical centres in Europe. The reliability of the questionnaire and its ability to predict the bronchial response to histamine were compared for English, Finnish, French and German translations of the questionnaire in samples of diagnosed asthmatics and controls in Nottingham, Berlin, Helsinki and Paris. The answers to questions showed good repeatability, especially in Finland and Germany, particularly those questions on asthma and wheeze. The most sensitive symptom for predicting hyperresponsiveness was the question on wheeze, the most specific questions were those on waking at night with shortness of breath (Paris and Nottingham) and morning tightness (Helsinki and Berlin). This study shows that the IUATLD (1984) questionnaire may provide useful, valid and comparable data even in translation but these studies will need to be repeated in representative samples before such a possibility is accepted as fully demonstrated.
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PMID:Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison. 260 94

A questionnaire developed by the International Union against Tuberculosis and Lung Disease (IUATLD) to assess bronchial symptoms has been tested for its ability to predict the bronchial response to histamine in adults aged 18-64 years living in two areas of southern England. A number of questions were found to be independently associated with increased reactivity in the first randomly selected half of the subjects. These symptoms included wheeze, waking at night with shortness of breath, tightness in the chest or shortness of breath when exposed to animals, dust or feathers and the non-specific symptom of persistent problems with breathing. A predictive score based on these symptoms was more sensitive and only slightly less specific than the question on wheeze alone in predicting the response to histamine in the second half of the subjects. Questions about asthma though more specific were considerably less sensitive than either. Symptoms did not differentiate between reactivity associated with positive skin tests and that associated with smoking.
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PMID:What symptoms predict the bronchial response to histamine? Evaluation in a community survey of the bronchial symptoms questionnaire (1984) of the International Union Against Tuberculosis and Lung Disease. 265 59

Recent regulations require commercial US aircraft to carry an enhanced medical kit. We reviewed kit use on United Airlines during the initial year of the regulations. We also surveyed passengers who became ill during flight and health care providers who used the new kit. The medical kit was used 362 times on 361 flights (once in every 1900 flights or one use for every 150,000 air travelers). Health care providers indicated that the kit was useful in more than 80% of emergencies and was occasionally lifesaving. In the emergencies in which the kit was used, 70% fell into one of seven major diagnostic groupings, including syncope/near syncope (29%), cardiac/chest pain (16%), asthma/lung disease/shortness of breath (10%), and allergic reactions (5%). With 450 million domestic air travelers per year, we would expect 3000 in-flight medical emergencies annually, and conclude that the enhanced medical kit is beneficial and propose that its effectiveness would be improved by the addition of a bronchodilator for inhalation.
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PMID:In-flight medical emergencies. One year of experience with the enhanced medical kit. 276 20

Pneumocystis carinii pneumonia occurs at some point in the course of disease in approximately 85 per cent of patients with AIDS. Because of the frequency of P. carinii pneumonia and because it is readily treatable, prompt, accurate, and efficient diagnostic schemes are of extreme importance. The clinical presentation is generally characterized by fever, nonproductive cough, and shortness of breath. Such symptoms in a patient from a recognized HIV transmission category should prompt a diagnostic evaluation to identify P. carinii or other opportunistic infections. A chest radiograph usually provides an objective indication of lung disease. Pulmonary function tests, particularly the DLCO and lung imaging using 67Ga-citrate, are useful screening tests in patients with normal chest films. Examination of sputum induced by inhalation of a mist of hypertonic saline is a very useful means of identifying P. carinii. Bronchoalveolar lavage is nearly 100 per cent sensitive to the presence of P. carinii and should be performed in patients who have a nondiagnostic sputum examination. Transbronchial biopsy increases the overall yield for diagnoses other than P. carinii and should be performed in patients in whom bronchoalveolar lavage does not provide a diagnosis. Because of the effectiveness of sputum examinations and bronchoscopic procedures, open lung biopsy is rarely necessary. Measurements of circulating P. carinii antigen and antibodies are of no help in diagnosis.
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PMID:Diagnosis of Pneumocystis carinii pneumonia. 306 May 25

Pneumocystis carinii pneumonia occurs at some point in the course of illness in approximately 85% of patients with AIDS. Because of the frequency of P. carinii pneumonia and because it is readily treatable, prompt, accurate, and efficient diagnostic schemes are extremely important. The clinical presentation is generally characterized by fever, nonproductive cough, and shortness of breath. Such symptoms in a patient from a recognized HIV transmission category should prompt a diagnostic evaluation to identify P. carinii or other opportunistic infections. A chest radiograph usually provides an objective indication of lung disease. Pulmonary function tests, particularly the DLCO and lung imaging using 67Ga-labeled citrate, are useful screening tests in patients with normal chest radiographs. Examination of sputum induced by inhalation of aerosolized hypertonic saline is a very useful means of identifying P. carinii. Bronchoalveolar lavage is nearly 100% sensitive to the presence of P. carinii and should be performed in patients who have a nondiagnostic sputum examination. Transbronchial biopsy increases the overall yield for diagnoses other than P. carinii and should be performed in patients in whom bronchoalveolar lavage does not provide a diagnosis. Because of the effectiveness of sputum examinations and bronchoscopic procedures, open lung biopsy is rarely necessary.
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PMID:Pneumocystis carinii pneumonia: diagnosis. 328 81


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