Lung Disorders:

Cystic Fibrosis

Two teams of medical scientists have identified what they believe is a simple, effective and inexpensive treatment to reduce lung problems associated with cystic fibrosis, the leading fatal genetic illness among whites. The new therapy, identified through studies supported chiefly by the Cystic Fibrosis Foundation and the National Heart, Lung and Blood Institute, also appears to be safe and easy to take.

By inhaling a saltwater aerosol solution almost twice as salty as the Atlantic Ocean for between 10 and 15 minutes at least twice a day, young patients should be able to avoid a significant part of the damage the disorder causes to their lungs, the researchers said. That's because the aerosolized saltwater restores the thin lubricant layer of water that normally coats airway surfaces. This water layer promotes the clearance of the naturally occurring mucus the body uses to trap harmful bacteria, viruses and other foreign particles.

In healthy people, a thin film of water only five-to-10 microns thick coats and lubricates the open areas of the lungs. "Studies demonstrate that CF lungs are missing this watery layer, and, hence, to treat the disorder effectively, you have to re-hydrate CF airway surfaces. This can be done with inhaled water solutions that are seven or eight times more salty than blood or about three-quarters as salty as the Dead Sea.

Cystic fibrosis appears on average in one of four children of parents who both carry a defective copy of a gene known as CFTR, Donaldson said. Children born with the disorder soon develop chronic lung damage, since their lungs cannot clear excessively sticky mucus by sweeping it to the mouth, where it is swallowed and eliminated. Respiratory failure is the leading cause of death in CF patients.


The Cornell and Stanford universities' statistical analysis of 22 trials with 15,276 participants found that common bronchodilators known as anticholinergics (generically named tiotropium and ipratropium) reduced severe respiratory events by 33 percent and respiratory-related deaths by 73 percent, compared with a placebo.

However, the same meta-analysis (which combines the results of the numerous studies) found that regularly inhaled beta-agonists (metaproterenol [Alupent], formoterol [Foradil], salmeterol [Serevent, Advair] and albuterol [Proventil, Ventolin, Volmax and others]) increased the risk of respiratory death more than twofold, compared with a placebo.

COPD is a progressive lung disease characterized by difficulty breathing, wheezing and a chronic cough. Complications include bronchitis and pneumonia. It is often associated with smoking.

Cobalt-Related Lung Disorder

Cobalt exposure occurs during the production of hard metal (cobalt and tungsten carbide) cutting tools and jet engine parts and during the polishing of diamonds with an abrasive grit of pure cobalt. Cobalt is highly soluble in lung tissue and may be absent in a lung biopsy analysis after exposure has ceased, but the biopsy specimen may show tungsten, which remains indefinitely. There are four types of cobalt disorders. First, asthma may occur. Second, an acute illness of fever, anorexia, malaise, and dyspnea resembling a viral illness may occur with crackles on examination, small nodules radiographically, and abnormal physiologic studies. The third disorder is interstitial pneumonitis of the usual interstitial pneumonia type, although this is rare. It is not responsive to cortico-steroid therapy and can be progressive. The fourth disorder, giant cell interstitial pneumonitis is slightly more responsive to corticosteroid therapy. A study of 513 employees indicated an increased frequency of cough and sputum, of abnormal vital capacity and diffusing capacity measurements, and of abnormal chest radiographs. Maintenance of strict dust level controls and regular supervision of workers must continue.

Manufactured Fibers

Manufactured vitreous fiber products include mineral wool, glass fiber and ceramic fiber. Mineral wool refers to slag wool and rock wool produced by melting and fiberizing iron ore furnace slag or siliceous limestone. Glass fiber includes glass wool such as the fiberglass used in home insulation, continuous glass filament, and special purpose glass fiber. Refractory ceramic fiber is characterized by the ability to resist very high temperatures and is produced from kaolin clay, alumina/silica, or alumina/silica/zirconia. The commonly used glass wool as in home insulation has the lowest health risk and may be a skin irritant. The potential risks associated with slag and rock wool are somewhat higher, and that associated with special purpose glass fiber and refractory ceramic fiber even higher. Extensive monitoring of individuals exposed to these agents continues to examine the carcinogenic risk, occurrence of airway dysfunction, and the presence of interstitial disorder and pleural effects.

Toxic Fume Exposures

Toxic fume exposures often result from accidents involving gas tanks, trucks or tank cars carrying ammonia, chlorine, or other toxic agents, or from explosions in chemical plants, pulp mills, or at missile sites. The first described accident involved broken nitric acid containers in 1804. Silo gas exposure may occur as a result of repairing the ventilation system or during the retrieval of a farmer's jacket. Mixing household substances such as four types of drain declogging agents can also be dangerous. The type of injury and eventual outcome is related to the nature of the fume and quantity of exposure. The amount of exposure is usually related to the distance from the source.

Hypersensitivity Pneumonia

Acute hypersensitivity pneumonitis begins with fever and chills in the form of a flu-like illness within 4 to 6 hours after exposure once sensitization has occurred and lasts for about 18 hours. The leukocyte count is often increased. The chest roentgenogram may show bilateral patchy infiltrates. The vital capacity and diffusing capacity are decreased. Usually, the illness responds quickly and completely to cessation of exposure or to a brief course of corticosteroid therapy. However, a study of acute-stage hypersensitivity pneumonitis in Finnish farmers showed an initial corticosteroid response but no influence on long-term results. The chronic form of disorder occurs in less than five percent of patients but is often characterized by irreversible pulmonary damage. Progressive dyspnea, crackles on examination, radiographic honeycombing, and abnormal diffusing capacity occur in this late stage. Some initial improvement may occur with corticosteroid therapy, but therapy or avoidance of antigen does not affect the permanent changes. With early recognition, the overall prognosis of hyper-sensitivity pneumonitis is excellent, but a fatal case has been reported from prolonged exposure to one parakeet kept in the home.

Occupational Pulmonary Infections

Occupational-related infections may develop in pet shop owners, abattoir workers, farmers, tannery workers, archaeologists, or health care workers. The microbial agents include bacteria causing disorders such as anthrax, brucel-losis, tularemia, or plague. Chlamydia produces pneumonia and psittacosis. The fungi include blastomycosis, coccidioidomycosis, and histoplasmosis. Myco-bacterial infections may occur in health care workers. Rickettsia can cause Q fever. Viruses such as adenovirus, influenza, rubeola, and varicella may be responsible for work-related or military infectious outbreaks. The symptoms and the radiographic findings reflect the causative agent. Treatment is directed toward the specific agent.

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