Pulmonary Function Impairment

Specific Clinicopathologic Forms of Diseases Involving the Small Conducting and/or Transitional Airways 

Connective tissue BO occurs most commonly in women with rheumatoid arthritis and has a particularly poor prognosis, often a fatal outcome within three years (23,24). This airflow lesion has also been reported in other connective tissue disorders (but less frequently) including lupus erythematosus, ankylosing spondyUtis, Sjogren s syndrome, and scleroderma. This topic is deeply discussed elsewhere in this book by Dr. Strange. 

Neuroendocrine Cell Hyperplasia with Bronchiolar Fibrosis 

When constrictive bronchiolitis occurs with no identifiable cause, it is referred to as cryptogenic constrictive bronchiolitis (36). It is rare and occurs mostly in women. Patients present with persistent cough and worsening dyspnea. Basilar inspiratory crackles may be heard on auscultation of the lungs in some patients. Progressive airway obstruction, often associated with air trapping, is seen by pulmonary function testing in the majority of affected patients. 

Practical Clinical Approach to Patients with Bronchiolitis 

---

Superinfection, hepatotoxicity, peripheral neuropathy (may be irreversible), Stevens-lohnson syndrome, permanent pulmonary function impairment, and anaphylaxis occur rarely... 

HEALTH SYMPTOMS inhalation (irritates upper respiratory tract, difficult breathing, pulmonary function impairment, coughing) contact (eye irritation) ingestion (no symptoms identified). 

ACUTE HEALTH RISKS pneumonitis fever tachypnea cough chest pain cyanosis diarrhea vomiting emphysema hemorrhage pneumothorax lethargy restlessness respiratory effects pulmonary function impairment kidney damage metallic taste in mouth death. 

No general consensus exists about what elements to include in medical evaluations for respirator use in general industry. Some institutions use only a questionnaire as a screening tool others routinely include a physical examination and spirometry and some include a chest x-ray. No generally accepted criteria exist for excluding workers from wearing respirators. Specifically, no spirometric criteria exist for exclusion. However, several studies have shown that most workers with mild pulmonary function impairment can safely wear respirators. There are some restrictions, such as the type of respirator or workload, for those with moderate impairment. There should be no respirator wear for individuals with severe impairment. Some respirators have a latex component and should not be worn by those who are allergic to latex. 

Given the imprecise correlations between CT and physiological parameters, direct measurement of PFTs is critical to assess the extent and degree of pulmonary functional impairment. 

CF is a relatively common, inherited, life-limiting disorder. The major clinical manifestations of CF respiratory disease are retention of sputum, reduced exercise capacity, pulmonary function impairment, and breathlessness (23). 

Forced expiration is commonly used to assess pulmonary function in both healthy and impaired individuals. Static measures of lung volumes (TLC, Vj, FRC) fail to detect dynamic changes in pulmonary function that are attributable to disease (e.g., asthmatic airway constriction). Obtaining maximum expiratory flow-volume (MEFV) curves (Fig. 5.21) permits derivation of key parameters in detecting changes in lung function. 

People at special risk from exposure to copper include those with impaired pulmonary function, especially those with obstructive airway diseases, because the breathing of copper fumes might cause exacerbation of pre-existing symptoms due to its irritant properties. 

Hard D, Roller B, Mehlhorn AT, Reinhardt D, Nicolai T, Schendel DJ, Griese M, Krauss-Etschmann S Quantitative and functional impairment of pulmonary CD4+CD25 regulatory T cells in pediatric asthma. J Allergy CUn Immunol 2007 119 1258-1266. 

The pulmonary fibrotic changes develop slowly over the years, often progressively even without further exposure, and their radiographic detection is a direct correlate of their extent and profusion. In some cases minor fibrosis with considerable respiratory impairment and disability can be present without equivalent x-ray changes. Conversely, extensive radiographic findings may be present with little functional impairment. 

Speciai risk Use with caution in patients with impaired pulmonary function, particularly those with obstructive pulmonary disease severely impaired cardiac function caused by myocardial disease history of previous liver disease or... 

Exposure around 0.1 ppm 03 for 10-30 minutes causes irritation and dryness of the throat above 0.1 ppm, one finds changes in visual acuity, substernal pain, and dyspnea. Pulmonary function is impaired at concentrations exceeding 0.8 ppm. Airway hyperresponsiveness and airway inflammation have been observed in humans. 

---