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BACKGROUND: Bronchial asthma is a chronic inflammatory disease that has a severe impact on health worldwide. METHODS: A survey of 10,771 patients with bronchial asthma in the Tama region, Tokyo was conducted for 5 years to examine treatment and quality of life (QOL). Subjects were patients aged ≥ 16 years and their physicians who replied to a questionnaire sent in November from 2002 to 2006. Symptoms of bronchial asthma, visits to an emergency room, use of drugs, and severity of asthma were investigated. RESULTS: Asthmatic symptoms improved over the 5 years, with a reduction in the number of emergency room visits. Since inhaled corticosteroids (ICS) were used by >80% of patients in 2002, we suspected that increased use of concomitant leukotriene receptor antagonists (LTRA) and long-acting ß(2) agonists (LABA) might have contributed to these findings. The effects of these drugs were compared between ICS + LTRA (n = 45) and ICS + LABA (n = 54) groups of patients. There was no significant difference in the ICS dose between these groups. In the ICS + LABA group, 18.5% and 22.2% of patients visited an emergency room before and after initiation of combination therapy, respectively, with no statistically significant difference. In contrast, the rate of emergency room visits in the ICS + LTRA group decreased from 24.4% to 6.6% after addition of LTRA. CONCLUSIONS: These results suggest that the frequency of visits to an emergency room was decreased by complementing the anti-inflammatory effect of ICS with further treatment of inflammation, particularly with LTRA.

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Pyothorax-associated lymphoma (PAL) is a unique and rare non-Hodgkin's lymphoma developing in the pleural cavity following a long-standing history of chronic pyothorax (CP). The development of F-18 2'-deoxy-2fluoro-D-glucose (FDG) positron emission tomography combined with computed tomography (PET/CT) has contributed to the evaluation of lymphoma staging. However, only a few studies describing FDG-PET/CT findings in PAL have been published. This study reported three cases of PAL; all 3 patients had previously undergone artificial collapse therapy for pulmonary tuberculosis. Both the first case (an 84-year-old male) and second case (an 83-year-old male) complained of abdominal pain. An ultrasound scan revealed a mass shadow in the left chest wall without abnormal findings in the abdomen, and the CT and magnetic resonance imaging scans suggested malignant lymphoma of the left chest. FDG-PET/CT imaging showed extremely intense FDG uptake only in the left pleura and chest wall. Diagnosis was CP in the two patients, showing a high maximum standardized uptake value (SUVmax: early, 14.8 and delayed, 19.4 in the first case; early, 20.8 and delayed, 27.3 in the second case, respectively). Histopathological analysis of the specimens obtained by biopsy of the PET/CT-positive pleural mass showed non-Hodgkin's, diffuse large B cell lymphoma in the two cases. The third case was a 79-year-old male with relapse after right pleuropneumonectomy for PAL (diffuse large B cell lymphoma) 4 years earlier. PET/CT showed intense FDG uptake (SUVmax: early, 19.9 and delayed, 35.7) in the right pleura and chest wall. Diagnosis was CP, suggesting the recurrence of PAL. Furthermore, abnormal intense FDG uptake was noted in the hilar, mediastinal and supraclavicular lymph nodes, as well as in the spleen. In conclusion, FDG-PET/CT imaging is useful in the evaluation of the area of invasion in PAL.

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BACKGROUND: The impulse oscillation system (IOS) measures respiratory impedance (Zrs) in terms of resistance (Rrs) and reactance (Xrs) at multiples of 5 Hz. These measurements can be used clinically to help diagnose and monitor respiratory disorders, independent of effort. METHODOLOGY: The predictive equation for resistance at 5 and 20 Hz and impedance at 5 Hz (R5, R20, X5), for the first time, in 299 Japanese adult subjects was determined. In addition, the within single day variation and between day variation were determined. RESULTS: The predictive equation for R5, R20 and X5 revealed a clear difference with respect to the subject's smoking history (lifelong non-smoker, n = 166, adjusted r = 0.55, 0.46 and 0.57, respectively, vs. smoker, n = 133, adjusted r = 0.47, 0.42 and 0.47, respectively). This difference was less obvious with respect to gender (female, n = 120, adjusted r = 0.42, 0.20 and 0.47, respectively, vs. male, n = 179, adjusted r = 0.46, 0.37 and 0.47, respectively). The predictive equations were dependent on the log of height (H) for both R5 and R20, and on age and log of height for X5. The equations were: R5 (KPa/L/s) = -3.841167 x logH + 8.671580; R20 (KPa/L/s) = -2.546561 x logH + 5.841867; and X5 (KPa/L/s) = -0.000097 x Age + 1.018597 x logH - 2.343672. For these parameters there were no statistically significant differences for within day repeatability or between day variations (P > 0.05), suggesting a high degree of reproducibility for IOS measurements. CONCLUSION: It was possible to determine a predictive equation and confirm a high degree of reliability of IOS parameters in Japanese adult subjects.

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