Donald P. Schlueter

The Clinical Spectrum of Primary Tuberculosis in Adults: Confusion with Reinfection in the Pathogenesis of Chronic Tuberculosis

Abstract Thirty-seven adults with tuberculosis are reported, in whom there was evidence (usually tuberculin conversion) that infection was of primary type. The clinical spectrum of primary tubercul...

Hypersensitivity to Wood Dust

Abstract Respiratory disease resulting from prolonged exposure to wood dusts may be due to a hypersensitivity reaction in addition to the nonspecific toxic or irritant effects of the inhaled materials. In four patients the hypersensitivity response was manifested by two clinical patterns, one characterized by immediate onset and rapid reversibility of asthmatic symptoms, and the other by a more delayed onset and more gradual reversibility. In this disease the clinical history and challenge with the suspected offending dust proved to be of greater diagnostic importance than skin testing.

Chronic lung disease secondary to ammonia inhalation injury: A report on three cases

Inhalation of highly hydrosoluble toxicants, like ammonia, can be associated with chronic lung diseases, which have been partially characterized. We present the case of three patients who were evaluated 2 years after massive exposure to ammonia in occupational settings. They presented with chronic dyspnea, and clinical pictures consistent with restrictive lung dysfunction, obstructive lung disease, and bronchial hyper-reactivity and small airways disease, respectively. The findings in 94 reported cases of inhalation injury due to massive exposure to ammonia are reviewed; in 35 cases follow-up for at least 1 year was available. The range of chronic pulmonary diseases associated with ammonia inhalation injury is reviewed, and suggestions for appropriate diagnostic evaluation are made.

THE PATHOPHYSIOLOGIC AND ROENTGENOLOGIC EFFECTS OF CHEST IRRADIATION IN BREAST CARCINOMA

We studied the effects of radiation therapy on lung function in 21 patients who underwent modified radical mastectomy and radiotherapy for breast carcinoma. The patients had pulmonary function studies and chest X rays prior to radiation therapy and at six weeks, and three, six, and twelve months following radiation therapy. All pulmonary function studies showed a small but statistically significant decline within the first three months following radiation therapy. Changes in the moderate and large airways continued to occur after three months. None of the changes in pulmonary function were reversible. Radiographic changes occurred in 12 patients. These changes occurred later than the lung function changes (median time for the changes was twelve months) and were unrelated to changes in lung function.

Respiratory Stimulation with Intravenous Doxapram in Respiratory Failure

Abstract The ability of a respiratory stimulant (doxapram) to maintain arterial carbon dioxide tension and pH within narrow limits during oxygen administration was assessed in a double-blind study of 78 patients with chronic obstructive lung disease admitted to hospitals for management of acute respiratory failure. The first two hours after admission constituted the study period, with either doxapram or placebo being given intravenously (2 to 3 mg per minute). During the two-hour period, oxygen administration was associated with elevation of carbon dioxide tension or decline in pH (or both) beyond the desired range in 36.8 per cent of the patients receiving placebo, but in only 17.5 per cent of those receiving doxapram. The results suggest that doxapram may prove a useful adjunct in the management of patients in whom oxygen therapy may be expected to exaggerate hypercapnia and acidosis.

The spectrum of respiratory disease associated with exposure to metal working fluids

Occupational respiratory diseases have been reported following exposure to metal working fluids. We report a spectrum of respiratory illnesses occurring in an outbreak in 30 workers of an automobile parts engine manufacturing plant. Workers presented with respiratory complaints and, after clinical and laboratory evaluations, were classified as those having hypersensitivity pneumonitis, occupational asthma, or industrial bronchitis, or those without occupational lung disease. Hypersensitivity pneumonitis affected seven workers, with six exhibiting serum precipitins to Acinetobacter Iwoffii. Occupational asthma and industrial bronchitis affected 12 and six workers, respectively. Oil-mist exposures were below current recommendations. Gram-negative bacteria, but no fungi, Thermophiles, or Legionella, were identified. Although specific agents responsible for each individual case could not be identified, probably both specific sensitizing agents and non-specific irritants from metal working fluids, additives, or contaminants contributed to this spectrum of occupational respiratory illness.

Asthma Caused by Nickel Sensitivity

Abstract This report presents a case of asthma associated with the inhalation of nickel salts. Immunologic studies showed circulating antibodies to the salt, and controlled inhalation exposure to a...

The long-term outcome in acute, subacute, and chronic forms of pigeon breeder's disease hypersensitivity pneumonitis

BACKGROUND Pigeon breeders disease (PBD) is an avian-induced hypersensitivity pneumonitis. The limited data that exist on the long-term outcome for the disease are conflicting. OBJECTIVE We sought to determine the long-term outcome of patients with PBD to evaluate the course of the disease. METHODS Review a case series of 18 pigeon breeders that were followed from 4 to 26 years after initial diagnosis. RESULTS Fourteen breeders reduced their bird contact significantly; four kept their birds. In eight patients with the acute form of the disease, pulmonary function either did not change from normal or improved to normal. Of five patients with subacute disease, four had persistent symptoms. All had mildly abnormal spirometry with either restrictive or obstructive changes which persisted. Five patients with chronic disease exhibited daily dyspnea. They had severe abnormalities of lung function at diagnosis. Of these patients, three improved and two deteriorated. Chest radiographs were of little value in predicting outcome. CONCLUSIONS Patients with the acute form of PBD have the best prognosis, compared with those with subacute and chronic forms. Although some improvement could be seen in most individuals, recovery may still not be complete. Those with the chronic form are at particular risk for morbidity.

Interstitial Lung Disease Due to Contamination of Forced Air Systems

Eight patients had hypersensitivity pneumonitis due to contaminated home or office forced-air heating or air-conditioning systems. We studied their clinical and laboratory features, and the results indicated that this disease may occur as an acute or insidious form differing in type and intensity of respiratory and systemic symptoms. Thermophilic actinomycetes contaminatinf the forced air systems were identified as the sensitizing agents in most cases. Precipitating antibodies to the organisms could be shown in the serums of the patients and the antigen identified by immunofluorescent studies in the three lung biopsies examined by this method. Inhalation challenge studies with the cultured organism or other materials obtained from the forced air systems reproduced the clinical syndrome in the four patients tested. Avoidance of the contaminated system, and the use of corticosteroids in more severe cases,seems to be appropriate therapy for patients with this disease.

Response of the lung to inhaled antigens

Abstract The lung serves as the main route by which extrinsic antigens gain access to the body. Reviewed here are the various types of immunologic reactions and the antigenic agents that have been implicated in producing a wide spectrum of respiratory diseases. Two major types of response to inhaled antigens are discussed, namely, asthma and hypersensitivity pneumonitis (extrinsic alveolitis). Inhaled antigens include organic dusts, molds, chemicals and metal salts. Clinical and physiologic response patterns are emphasized to aid in early recognition of these diseases. At this stage, the majority of patients will recover merely by avoiding exposure to the offending antigen.