Arjan Rudolphus

Systemic Inflammation and Lung Function Impairment in Morbidly Obese Subjects with the Metabolic Syndrome

Background. Obesity and asthma are associated. There is a relationship between lung function impairment and the metabolic syndrome. Whether this relationship also exists in the morbidly obese patients is still unknown. Hypothesis. Low-grade systemic inflammation associated with the metabolic syndrome causes inflammation in the lungs and, hence, lung function impairment. Methods. This is cross-sectional study of morbidly obese patients undergoing preoperative screening for bariatric surgery. Metabolic syndrome was assessed according to the revised NCEP-ATP III criteria. Results. A total of 452 patients were included. Patients with the metabolic syndrome (n = 293) had significantly higher blood monocyte (mean 5.3 versus 4.9, P = 0.044) and eosinophil percentages (median 1.0 versus 0.8, P = 0.002), while the total leukocyte count did not differ between the groups. The FEV1/FVC ratio was significantly lower in patients with the metabolic syndrome (76.7% versus 78.2%, P = 0.032). Blood eosinophils were associated with FEV1/FVC ratio (adj. B −0.113, P = 0.018). Conclusion. Although the difference in FEV1/FVC ratio between the groups is relatively small, in this cross-sectional study, and its clinical relevance may be limited, these data indicate that the presence of the metabolic syndrome may influence lung function impairment, through the induction of relative eosinophilia.

Utility of nitric oxide for the diagnosis of asthma in an allergy clinic population.

Fractionated exhaled nitric oxide (FeNO) expression is increased in airway inflammation and several studies have suggested that FeNO measurement can be useful in patients with asthma. Atopic individuals have increased FeNO levels, indicating that atopy may be a codeterminant in FeNO production. The aim of this study was to determine the discriminative value of FeNO for asthma and other atopic conditions in the general allergy clinic. Patients referred to the outpatient allergy clinic were screened. A standardized questionnaire was taken and atopic status was assessed (skin-prick test or specific plasma IgE). FeNO level and spirometry were measured. If the patients history was suspect for asthma, a provocative concentration causing a 20% decrease in forced expiratory volume in 1 second (PC(20)) histamine challenge followed. One hundred fourteen steroid-naive patients were included. Forty-two subjects were diagnosed as asthmatic patients and 72 were diagnosed as nonasthmatic patients, comprising patients with allergic rhinitis (n = 32), nonallergic rhinitis (n = 11), urticaria (n = 11), eczema (n = 7), and other (n = 11). Asthmatic patients had a higher FeNO level than nonasthmatic patients (44 ppb versus 17 ppb; p < 0.001). Receiver operating characteristic curve analysis revealed the optimal FeNO level to distinguish asthma from nonasthma at 27 ppb, with a sensitivity of 78%, specificity of 92%, a positive predictive value of 86%, and a negative predictive value of 87%. Increased FeNO was positively correlated with the presence of respiratory symptoms (p < 0.01), airflow reversibility (p < 0.001), total IgE (p < 0.001), and negatively correlated with PC(20) histamine (p = 0.019). Multivariate analysis revealed that atopy was not a significant predictor of FeNO in asthmatic patients. Measuring FeNO is a simple and useful test to differentiate new asthma patients from those with other atopic conditions in a general allergy clinic.

Talcosis due to abundant use of cosmetic talcum powder.

To the Editor: A 36-yr-old, nonsmoking, Hindustan female presented with complaints of dyspnoea without coughing which had persisted for several months. The complaints started after a bout of pneumonia a few months previously. Her medical history was unremarkable. She did not suffer from asthma, nor did asthma run in the family. She worked at an administrative office. Physical examination showed no abnormalities; in particular, the auscultation of the lungs was normal. A screening laboratory examination, including complete blood count, renal function and liver function tests, was normal. A chest radiograph showed nodular lesions in both lungs (fig. 1a⇓). FIGURE 1. Radiodiagnostic imaging. a) A chest radiograph showing multiple nodular lesions in both lungs. b) A high-resolution computed tomography scan showing a diffuse nodular image in both lungs. Interlobular septa and pleura were normal. Because of the abnormal chest radiograph, a second patient history was carried out and revealed a remarkable twice daily bathing ritual where she used large amounts of cosmetic talcum powder. After bathing the patient powdered her whole body with talcum powder, a ritual she had carried out since her childhood. Ancillary laboratory investigations including angiotensin converting enzyme, total immunoglobulin E and anti-cyclic citrullinated peptide were all negative. A high-resolution computed tomography (CT) scan of the thorax showed a diffuse nodular image in both lungs. Interlobular septa and pleura showed a normal pattern (fig. 1b⇑). Pulmonary function tests showed a restrictive pattern, with a normal diffusion capacity. Bronchoscopy …

High intensity training in obesity: a Meta‐analysis

High Intensity training (HIT) is a time‐effective alternative to traditional exercise programs in adults with obesity, but the superiority in terms of improving cardiopulmonary fitness and weight loss has not been demonstrated.

Effect of an Outpatient Pulmonary Rehabilitation Program on Exercise Tolerance and Asthma Control in Obese Asthma Patients

PURPOSE: To compare the effects of an outpatient pulmonary rehabilitation (PR) program on exercise tolerance and asthma control in obese and nonobese patients with asthma. METHODS: Nonobese (body mass index [BMI] <30 kg/m2) and obese (BMI ≥ 30 kg/m2) patients with asthma who participated in a local multidisciplinary 12-week PR program were analyzed retrospectively. Effects of PR were assessed by changes in 6-minute walking distance (6MWD) and Asthma Control Questionnaire (ACQ). RESULTS: A total of 138 asthma patients were included: 53 (38.4%) obese and 85 (61.6%) nonobese. At baseline, obese patients with asthma had a lower level of exercise tolerance reflected by a lower 6MWD (525 m vs 621 m; P < .001). After PR, the 6MWD improved significantly in both groups (≥50 m in nonobese vs ≥45 m in obese; P < .001 in both groups). The improvement in 6MWD was clinically relevant in 71% of the nonobese and 60% of the obese patients. These patients had lower 6MWD (P = .024), higher usage of long-acting &bgr;-agonist (P = .034) and oral corticosteroids (P = .033). Asthma control also improved in both groups (&Dgr;ACQ −0.3 in nonobese vs &Dgr;ACQ −0.4 in obese; P = .021 and P = .019, respectively). Clinically relevant improvement was achieved by 46.5% of nonobese and 51.9% of obese patients with asthma. The improvements between the groups were not statistically different. CONCLUSIONS: A standardized PR program is feasible in obese patients with asthma and they benefit as much as nonobese patients with asthma. However, there are still a large number of patients who show no clinically significant improvement. Patients with more severe asthma seem to benefit the most from PR.

Afwijkingen van het respiratoire systeem

Samenvatting Respiratoire afwijkingen komen zeer frequent voor als primaire aandoening of secundair aan een maligniteit, infectie of systeemziekte. Zoals voor veel inwendige aandoeningen geldt, is een goede anamnese en lichamelijk onderzoek onontbeerlijk bij de analyse van pulmonale aandoeningen. De eerste paragrafen van dit hoofdstuk zullen hier dieper op ingaan. Helaas zijn de klachten vaak weinig specifiek en noodzaken dikwijls tot verder beeldvormend onderzoek. De X-thorax is vaak het beginpunt van een dergelijk diagnostisch traject. In de latere paragrafen zullen specifieke bevindingen op de X-thorax verder worden uitgediept. In veel gevallen is naast laboratoriumonderzoek ook functieonderzoek en computertomografie van de thorax noodzakelijk om de differentiële diagnose verder te versmallen. Het verkrijgen van weefsel is bij interstitiële longaandoeningen, tuberculose en maligniteit vaak het sluitstuk van de diagnostiek. Nieuwe endoscopische echogeleide technieken komen steeds meer in de plaats van invasief onderzoek zoals mediastinoscopie of thoracotomie. Ook kan met behulp van PCR-technieken sneller en meer specifiek een juiste diagnose worden verkregen.