Adalberto Pacheco

Irritant-Induced Asthma: Clinical and Functional Aspects

We report on three patients who experienced persistent asthma symptoms after repetitive irritant exposure which took place over a period from several days to months. Airway inflammation was assessed by induction of sputum and functional follow-up information was obtained from serial lung function tests. All patients had bronchial hyperresponsiveness to methacholine at the time of diagnosis. However, induced sputum samples did not show increased differential count of eosinophils. Treatment with inhaled corticosteroids was started in all of the patients and two of them were removed from work. In the two patients who left the workplace, methacholine inhalation test became negative when symptoms disappeared, whereas the patient who continued working had persistent asthma symptoms and a deterioration of bronchial hyperresponsiveness.

Allergic bronchopulmonary aspergillosis with low serum IgE levels in a child with cystic fibrosis

A five-year-old girl was diagnosed with cystic fibrosis (CF) at age 8 months on the basis of failure to thrive, steatorrhea, and a positive sweat chloride determination of 95 mEq/L. She was seen in our outpatient clinic four times per year. During the last 4 years she remained well with mild pulmonary symptoms and no evidence of asthma. She had experienced a few episodes of infectious bronchitis without wheezing, which improved with oral antibiotic therapy. There was no history of production of brown sputum plugs, and she had never been treated with bronchodilators or oral or inhaled corticosteroids. At age 1 year, Staphylococcus aureus was cultured from her sputum. At age 2 years, Pseudomonas aeruginosa grew on her sputum culture without pulmonary involvement, and a 3-week course of intravenous antibiotic was given. Over the next three years, S. aureus, and sometimes P. aeruginosa, were cultured from her sputum. AspergiUus fumigatus (Aft only grew twice at age 2 and 3 years. Her routine chest roentgenogram showed minor changes, such as increased lung markings and mild hyperinflation, without acute changes. On routine clinical examination, clear lung fields were heard. Routine laboratory evaluation always showed a peripheral eosinophil count less than 300 cells/mm 3. Since June 1995, as part of the Allergic Bronchopulmonary Aspergillosis (ABPA) screening study, the patient was evaluated every 4 months with total serum IgE and IgE against Af (IgE-Af) by CAP ftuoroenzymeimmunoassay (Pharmacia, Uppsala, Sweden); precipitins against Af by means of the Ouchterlony technique; IgG, IgA, and IgM antibodies against Af (IgG-Af, IgA-Af, IgM-Af) assessed by ELISA; peripheral eosinophil count; and immediate skin testing with Af. In February 1996, when the patient was free of symptoms laboratory data showed a blood eosinophil count of 300 cells/ram 3, a total serum IgE of 41 kU/L (normal value <84 kU/L) and a negative IgE-Af (<0.35 kU/L). In August 1996 a left upper lobe infiltrate was seen on a routine chest roentgenogram. She had no symptoms, and clinical examination was normal. Sputum

Bronchiolitis obliterans Organizing Pneumonia Associated with Evans Syndrome

The association of bronchiolitis obliterans organizing pneumonia (BOOP) with insulin-dependent diabetes mellitus (IDDM) and Evans syndrome (autoimmune pancytopenia) has not been reported previously. We describe the case of a 4-year-old child diagnosed with IDDM and Evans syndrome who presented malaise, fever and nonproductive cough for several months. The chest radiograph revealed several patchy alveolar opacities with peripheral and bilateral distribution and multiple hilar and mediastinal adenopathies. An open lung biopsy established the diagnosis of BOOP. During the follow-up over the next 7 years, the patient had chronic relapses in spite of corticosteroid treatment and developed restrictive lung disease.

Características asmáticas en pacientes fumadores con enfisema avanzado

Objetivos La mayoria de los neumologos asumen que el asma cronica y el enfisema asociado al fumar difieren tanto en su origen como en el tipo de inflamacion, pero es dificil que se estudie a individuos que presenten simultaneamente ambos procesos. Nosotros pretendemos averiguar mediante un analisis prospectivo si una porcion de pacientes fumadores con enfisema avanzado tienen un perfil asmatico, lo que supondria un solapamiento de ambas entidades Pacientes Y Metodo Se estudio a una poblacion de 23 fumadores afectados de obstruccion moderada a grave al flujo aereo y con criterios radiologicos de enfisema avanzado. Se analizo en todos los pacientes el perfil asmatico definido mediante 5 caracteristicas: respuesta aguda positiva a broncodilatadores, eosinofilia en sangre periferica, eosinofilos en esputo significativos, IgE serica total significativa e IgE especifica positiva a alergenos comunes y hongos. Se considero presente el perfil asmatico si se daban en un paciente tres o mas de las caracteristicas citadas. El analisis estadistico se hizo construyendo intervalos de confianza sobre los casos positivos totales para estimar la proporcion poblacional Resultados De los 23 pacientes, en 21 se pudo analizar al menos 4 de las caracteristicas. De los 21 pacientes, 10 (48%) presentaban un perfil asmatico, es decir, tenian tres o mas de las caracteristicas antes senaladas. Este dato supone una proporcion positiva de la presencia de caracteristicas asmaticas de entre el 17,6 y el 79,6% de la poblacion analizada con enfisema avanzado, con un intervalo de confianza del 99,9% de probabilidad Conclusiones En el enfisema asociado en principio al habito de fumar se podria admitir que al menos un 17,6% de los pacientes presentan un perfil asmatico evidente, lo que supone un alto grado de solapamiento entre asma y enfisema del fumador, y por eso no se desmiente la teoria holandesa sobre el origen comun de las enfermedades obstructivas cronicas que sostiene una base inicial de sensibilizacion alergica e hiperreactividad bronquial e influencias diversas, como el humo de tabaco, en la evolucion final a largo plazo