Lung function in former intravenous drug abusers: the effect of ubiquitous cigarette smoking
Article Abstract:
Lung function is often decreased in former intravenous drug abusers (IVDAs). Lung damage can be caused by the agents used to cut the drugs, the drug themselves and by using unsterile techniques. More recently, the high incidence of human immunodeficiency virus (HIV) infection among IVDAs has also been a source for lung problems, such as pulmonary infection or lymphocytic alveolitis, in this population. A number of studies have shown that the lungs of people in this group have a reduced capacity to diffuse (reduce the blood concentration of) carbon monoxide (DLco). The problem with the studies to date is that almost all IVDAs also smoke. DLco values in those studies were compared with general values derived from nonsmokers. This study examined the contribution smoking had on the decreased DLco values seen in this population and assessed the relationship between HIV infection and DLco values. DLco and other tests of lung functioning were performed on 98 patients in a methadone clinic for former IVDAs. HIV status was also noted. Findings were compared with those from smokers in the general population. Results showed that 94 of the 98 patients currently smoked and 2 of the 98 were former smokers. Asthma had been diagnosed in 17 (17 percent) of the subjects, which was much higher than the 3.5 percent prevalence of asthma in the general smoking population. Average values for DLco and other lung function tests were significantly lower than predicted on the basis of findings in the nonsmoking general population. When adjustments were made for smoking, there were no significant differences in DLco, forced expiratory volume (FEV1; the amount of air that can be forcibly expelled from the lungs in one second), and forced vital capacity (FVC; the maximal capacity of the lungs upon forced inhalation) between the study subjects and the general population of smokers. HIV status was available in 13 subjects, with 6 testing positive for the virus. DLco values were lower in the positive subjects, but the differences did not reach statistical significance, probably because the number of subjects was too low. These results indicate that former IVDAs have normal DLco and other lung function test values when the values are adjusted for the effects of smoking. Decreased values may indicate infection with HIV. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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What lies ahead? Future research and treatment for chronic obstructive pulmonary disease
Article Abstract:
Over the last two decades, the incidence of chronic obstructive pulmonary disease (COPD) has been increasing. COPD is a major cause of mortality and new methods of preventing and treating COPD are needed. Cigarette smoking is the leading known cause of COPD. The physiological changes that occur in the lungs of patients with COPD include lung tissue inflammation, destruction of the elastic fibers that allow the lungs to expand, fibrosis (the formation of dense, nonelastic tissue), excessive growth of smooth muscle cells, and excessive mucus production. Emphysema is the most serious form of COPD, which occurs when enzymes called proteases, such as elastase, destroy the lung tissue. Cigarette smoking causes emphysema by causing inflammation in the lungs, which increases the amount of proteases and tissue damage. Under normal circumstances, the lung tissue makes a substance called alpha-1 proteinase inhibitor (alpha1-PI), which inactivates proteases so that they do not damage the lung tissue. However, during chronic cigarette smoking large amounts of proteases are made and there is not enough alpha1-PI to prevent tissue damage. Emphysema can also be caused by an inherited deficiency of alpha1-PI. Infusions of alpha1-PI have been used to treat patients with alpha1-PI deficiency, but this form of treatment is very expensive. Corticosteroids reduce tissue inflammation and may be effective in slowing the progression of COPD. Clinical studies are needed to determine if drugs such as ipratropium, which that dilate the lung air passages, can help slow the progression of COPD in cigarette smokers. At the present time, the best method of preventing COPD is preventing or stopping cigarette smoking. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Respiratory dysfunction due to L-dopa therapy for Parkinsonism: diagnosis using serial pulmonary function tests and respiratory
Article Abstract:
Tardive dyskinesias are defects in voluntary movement that are drug-induced, and dysfunction of respiratory muscles may occur. Dyskinesias initially affect the face and mouth, followed by involvement of the limbs and trunk; the lungs may also be affected in patients receiving L-dopa or neuroleptic therapy. Impaired respiratory function has been reported in patients after treatment with L-dopa for Parkinson's disease, a chronic nervous system disease. Cases are described of two patients with respiratory dyskinesias resulting from L-dopa treatment. The respiratory dyskinesias were associated with choreiform movements, involuntary muscle twitches of the limbs and face muscles. Lung function of these patients was assessed by taking various pressure and volume measurements within the airways during respiration. Dyskinesias associated with L-dopa treatment resemble muscle disorders associated with chronic degenerative diseases of the nervous system, such as Huntington's chorea. L-dopa-induced dyskinesias occur in 50 percent of patients treated with L-dopa, and are related to both the dose and the duration of the drug therapy. The signs and symptoms, possible mechanisms, and treatment of respiratory dyskinesias associated with L-dopa treatment are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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