American Thoracic Society News Tips for June

AMERICAN THORACIC SOCIETY NEWS TIPS FOR JUNE

STUDY SHOWS INCREASED BRONCHITIS RISK FROM OCCUPATIONAL POLLUTANTS

Using data from a general population survey of 14 industrialized countries, researchers studied airway exposure to occupational pollutants, the amount of chronic bronchitis, and lung function results in 13,253 men and women ages 20 to 49. Their results show an increased risk for bronchitis in agricultural sector workers who are both smokers and nonsmokers. Elevated risk for bronchitis was also shown for textile, wood, paper, and chemical industry workers, especially among those who were smokers.

The Spanish investigators found that industrial bronchitis occurred without pronounced airflow limitation, probably because of the younger ages of the study population. Among nonasthmatics in the study, chronic bronchitis was present in 1 to 3 percent of never-smokers, and 5 to 9 percent of current smokers. Males had a greater occupational exposure to vapors, gas, dust, and fumes than did females. For the 14 countries, self-reported occupational exposure rates varied between 30 and 58 percent. The study appears in the June issue of the American Journal of Respiratory and Critical Care Medicine.

END-STAGE EMPHYSEMA PATIENTS SHOW SIGNIFICANT FIVE-YEAR IMPROVEMENT FROM LUNG VOLUME REDUCTION SURGERY

Results from one of the first five-year studies to be completed on lung volume reduction surgery (LVRS) in both lungs, research that involved 26 patients with end-stage emphysema, showed that nine individuals had durable clinical and significant physiologic improvement after 3 years, seven after 4 years, and two after 5 years. Since the participants average age was 67, an estimated 60 percent of the severely ill study patients would have died from respiratory failure within one year had they not had the surgery. All patients prior to their operation could walk less than 100 yards and had exhausted the best medical therapy available.

Prior to their operation, 18 were on full or partial oxygen therapy. The 18 men and eight women participants had a smoking history of 52 pack years (meaning they had smoked at least 20 cigarettes every day, per year). Since lungs damaged by changes caused by emphysema gradually lose their elasticity, surgeons removed the diseased portion of the lung during the operation which leads to improved functioning for the remaining lung tissue. The research appears in the June issue of the American Journal of Respiratory and Critical Care Medicine.

NEW ATS GUIDELINES FOR COMMUNITY-ACQUIRED PNEUMONIA

The latest ATS "Guidelines for the Management of Adults with Community-acquired Pneumonia," last published in 1993, have incorporated the latest disease management techniques for this potentially fatal illness. In the United States, pneumonia is the sixth leading cause of death, and the number one cause of mortality from infectious diseases. Because pneumonia is not a reportable illness, information on the incidence has resulted in crude estimates. However, it appears that 5.6 million cases occur annually, and 1.1 million persons are hospitalized. According to the Guidelines, the single most important decision a physician can make during the course of treatment for community-acquired pneumonia is the selection of the initial site of care.

The experts said that the estimated cost of hospital inpatient care in the U.S., is $7,500, as compared with $150 to $300 for outpatient care. The expert panel suggested that physicians should strongly consider hospitalization when multiple risk factors exist in their patients. These include age over 65 and the presence of other chronic diseases such as diabetes and congestive heart failure. The Guidelines recommend that patients at risk for pneumonia be vaccinated with both pneumococcal and influenza vaccines. They also advocate smoking cessation as an important preventive strategy against the disease. The Guidelines are published in the June issue of the American Journal of Respiratory and Critical Care Medicine.

For the complete text of the articles, please see the ATS Journal Online Website at http://www.atsjournals.org For the contact information on a specific investigator, to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the monthly postal or e-mail address list for journalists, contact Cathy Carlomagno at212) 315-6442, by fax at (212) 315-6456, or by e-mail at [email protected]

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