Shingo Takata

Influence of age and disease severity on high resolution CT lung densitometry in asthma

BACKGROUND Low attenuation areas (LAA) on computed tomographic (CT) scans have been shown to represent emphysematous changes in patients with chronic obstructive pulmonary disease (COPD). However, the significance of LAA is still controversial in patients with asthma. This study was undertaken to assess the usefulness of lung CT densitometry in the detection of airspace enlargement in association with asthma severity. METHODS Forty five asthmatic subjects and 15 non-smoking controls were studied to determine the influence of age, pulmonary function, and asthma severity on mean lung density (MLD) and the relative area of the lung showing attenuation values less than –950 HU (RA950) on high resolution CT (HRCT) scans. RESULTS In asthmatic patients both MLD and RA950 correlated with parameters of airflow limitation (%FEV1, FEV1/FVC, %FEF25–75) and lung volume (%TLC, %FRC, %RV), but not with lung transfer factor (%Tlco, %Tlco/VA). The results of HRCT lung densitometry also correlated with patient age and severity of asthma. CONCLUSIONS Decreased CT lung density in non-smoking asthmatics is related to airflow limitation, hyperinflation and aging, but not with lung transfer factor.

Decreased computed tomographic lung density during exacerbation of asthma

Recently, it was shown that both mean lung density (MLD) and the relative lung area with an attenuation of <-950 HU (RA950) are related to severity of asthma in nonsmoking asthmatics. The aim of the present study was to examine whether reduced computed tomography (CT) lung density during exacerbation could change after treatment. A cross-sectional study was performed to compare CT lung density in 30 stable asthmatics, 30 unstable asthmatics and 25 control subjects. In order to investigate longitudinally the effect of treatment on decreased CT lung density, 17 asthmatics with an exacerbation were followed at the initiation of treatment and 2 months after relief. The MLD was significantly lower and the RA950 significantly higher in unstable asthmatics than in controls and stable asthmatics. Both MLD and RA950 changed significantly with administration of systemic glucocorticoid therapy. The changes in forced expiratory volume in one second correlated significantly with those in both MLD and RA950. The changes in residual volume also correlated significantly with those in both MLD and RA950. It was concluded that decreased computed tomographic lung density during an asthma exacerbation is at least partially reversible, and changes in mean lung density and the relative lung area with a radiation attenuation of <−950 HU are related to the change in forced expiratory volume in one second and residual volume.

Effect of repeated Waon therapy on exercise tolerance and pulmonary function in patients with chronic obstructive pulmonary disease: a pilot controlled clinical trial

Purpose Controlled clinical trials evaluating the efficacy of repeated Waon therapy for patients with chronic obstructive pulmonary disease (COPD) have yet to be conducted. The purpose of the present study was to evaluate whether repeated Waon therapy exhibits an adjuvant effect on conventional therapy for COPD patients. Patients and methods This prospective trial comprised 20 consecutive COPD patients who satisfied the criteria of the Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines, stages 1–4. They were assigned to either a Waon or control group. The patients in the Waon group received both repeated Waon therapy and conventional therapy, including medications, such as long-acting inhaled β2 agonists, long-acting anticholinergics and xanthine derivatives, and pulmonary rehabilitation. The Waon therapy consisted of sitting in a 60°C sauna room for 15 minutes, followed by 30 minutes of being warmed with blankets once a day, 5 days a week, for a total of 20 times. The patients in the control group received only conventional therapy. Pulmonary function and the 6-minute walk test were assessed before and at 4 weeks after the program. Results The change in vital capacity (0.30 ± 0.4 L) and in peak expiratory flow (0.48 ± 0.79 L/s) in the Waon group was larger than the change in the vital capacity (0.02 ± 0.21 L) (P=0.077) and peak expiratory flow (−0.11 ± 0.72 L/s) (P=0.095) in the control group. The change in forced expiratory flow after 50% of expired forced vital capacity in the Waon group, 0.08 (0.01–0.212 L/s), was larger than that in the control group, −0.01 (−0.075–0.04 L/s) (P=0.019). Significant differences were not observed in the change in any parameters in the 6-minute walk test. Data are presented as means ± standard deviation or median (25th–75th percentile). Conclusion The addition of repeated Waon therapy to conventional therapy for COPD patients can possibly improve airway obstruction.

Lung function and blood markers of nutritional status in non-COPD aging men with smoking history: A cross-sectional study

Purpose: Cigarette smoking and advanced age are well known as risk factors for chronic obstructive pulmonary disease (COPD), and nutritional abnormalities are important in patients with COPD. However, little is known about the nutritional status in non-COPD aging men with smoking history. We therefore investigated whether reduced lung function is associated with lower blood markers of nutritional status in those men. Subjects and methods: This association was examined in a cross-sectional study of 65 Japanese male current or former smokers aged 50 to 80 years: 48 without COPD (non-COPD group), divided into tertiles according to forced expiratory volume in one second as percent of forced vital capacity (FEV1/FVC), and 17 with COPD (COPD group). Results: After adjustment for potential confounders, lower FEV1/FVC was significantly associated with lower red blood cell count (RBCc), hemoglobin, and total protein (TP); not with total energy intake. The difference in adjusted RBCc and TP among the non-COPD group tertiles was greater than that between the bottom tertile in the non-COPD group and the COPD group. Conclusion: In non-COPD aging men with smoking history, trends toward reduced nutritional status and anemia may independently emerge in blood components along with decreased lung function even before COPD onset.

Assessment of etidronic acid plus alfacalcidol for the treatment of osteopenia in steroid-dependent asthmatics: A pilot study of five cases

ObjectiveOsteoporosis is generally known to be one of the most serious adverse effects of long-term corticosteroid administration. Recently it was discovered that corticosteroid-induced osteoporosis occurs not only in trabecular bone but also in cortical bone, leading to a reduction in cortical bone strength. To ameliorate corticosteroid-induced bone injury, we administered etidronic acid plus alfacalcidol to five steroid-dependent asthmatics for 4 years and monitored therapeutic responses in trabecular bone and cortical bone using peripheral quantitative computed tomography (pQCT).Patients and interventionsThe five steroid-dependent asthmatic patients included two males and three females, with a mean age 68.2 years, taking a mean daily dose of oral prednisolone of 7 mg/day. Etidronic acid 200 mg/day was administered for 14 consecutive days every 4 months for 4 years, while alfacalcidol 0.5μg was administered daily for 4 years.Main outcome measures and resultsEvery 4 months, the number of vertebral fractures was assessed by lateral vertebral radiographs, and the total radial bone mineral density (BMD), trabecular BMD, cortical BMD, Relative Cortical Volume (RCV) and Strength Strain Index (SSI) were assessed by pQCT (Stratec XCT-960). At follow-up, no new fractures had occurred, the trabecular BMD was found to be slightly increased (from 117.2 mg/cm3 at baseline to 121.6 mg/cm3 after 48 months), and no significant decreases were observed in the total BMD, cortical BMD, RCV or SSI.ConclusionBased on these findings, etidronic acid plus alfacalcidol seems to be effective in preventing steroid-induced bone injury, not only in terms of trabecular and cortical BMD, but also in terms of cortical bone volume and strength, which may lead to a decrease in non-vertebral fractures. However, further investigation is required with a larger sample size and a longer administration period to confirm these findings.