RESUMEN
OBJECTIVE: To compare TLC and RV values obtained by the single-breath helium dilution (SBHD) method with those obtained by whole-body plethysmography (WBP) in patients with normal lung function, patients with obstructive lung disease (OLD), and patients with restrictive lung disease (RLD), varying in severity, and to devise equations to estimate the SBHD results. METHODS: This was a retrospective cross-sectional study involving 169 individuals, of whom 93 and 49 presented with OLD and RLD, respectively, the remaining 27 having normal lung function. All patients underwent spirometry and lung volume measurement by both methods. RESULTS: TLC and RV were higher by WBP than by SBHD. The discrepancy between the methods was more pronounced in the OLD group, correlating with the severity of airflow obstruction. In the OLD group, the correlation coefficient of the comparison between the two methods was 0.57 and 0.56 for TLC and RV, respectively (p < 0.001 for both). We used regression equations, adjusted for the groups studied, in order to predict the WBP values of TLC and RV, using the corresponding SBHD values. It was possible to create regression equations to predict differences in TLC and RV between the two methods only for the OLD group. The TLC and RV equations were, respectively, ∆TLCWBP-SBHD in L = 5.264 − 0.060 × FEV1/FVC (r2 = 0.33; adjusted r2 = 0.32) and ∆RVWBP-SBHD in L = 4.862 − 0.055 × FEV1/FVC (r2 = 0.31; adjusted r2 = 0.30). CONCLUSIONS: The correction of TLC and RV results obtained by SBHD can improve the accuracy of this method for assessing lung volumes in patients with OLD. However, additional studies are needed in order to validate these equations. .
OBJETIVO: Comparar resultados de CPT e VR obtidos pelo método de diluição de hélio em respiração única (DHRU) com aqueles obtidos por pletismografia de corpo inteiro (PCI) em indivíduos com função pulmonar normal, portadores de distúrbio ventilatório obstrutivo (DVO) e portadores de distúrbio ventilatório restritivo (DVR) com diferentes níveis de gravidade e elaborar equações para estimar CPT e VR por DHRU. MÉTODOS: Estudo transversal retrospectivo com 169 indivíduos, dos quais, respectivamente, 93, 49 e 27 apresentavam DVO, DVR e espirometria normal. Todos realizaram espirometria e determinação de volumes pulmonares pelos dois métodos. RESULTADOS: Os valores de CPT e VR foram maiores por PCI que por DHRU. A discrepância entre os métodos foi mais acentuada no grupo com DVO e se relacionou com a gravidade da obstrução ao fluxo aéreo. No grupo com DVO, o coeficiente de correlação da comparação entre os dois métodos foi de 0,57 e 0,56 para CPT e VR, respectivamente (p < 0,001 para ambos). Para predizer os valores de CPT e VR por PCI utilizando os respectivos valores por DHRU foram utilizadas equações de regressão, corrigidas de acordo com os grupos estudados. Somente foi possível criar equações de regressão para predizer as diferenças de CPT e VR entre os dois métodos para pacientes com DVO. Essas equações foram, respectivamente, ∆CPTPCI-DHRU em L = 5,264 − 0,060 × VEF1/CVF (r2 = 0,33; r2 ajustado = 0,32) e ∆VRPCI-DHRU em L = 4,862 − 0,055 × VEF1/CVF (r2 = 0,31; r2 ajustado = 0,30). CONCLUSÕES: A correção de CPT e VR obtidos por DHRU pode melhorar a acurácia desse método para avaliar os volumes pulmonares em pacientes com DVO. Entretanto, estudos adicionais ...
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Helio , Enfermedades Pulmonares Obstructivas/diagnóstico , Índice de Masa Corporal , Pruebas Respiratorias/métodos , Estudios Transversales , Modelos Lineales , Enfermedades Pulmonares Obstructivas/fisiopatología , Mediciones del Volumen Pulmonar/métodos , Pletismografía Total , Estudios Retrospectivos , Volumen Residual/fisiología , Índice de Severidad de la Enfermedad , EspirometríaRESUMEN
OBJECTIVE: To compare TLC and RV values obtained by the single-breath helium dilution (SBHD) method with those obtained by whole-body plethysmography (WBP) in patients with normal lung function, patients with obstructive lung disease (OLD), and patients with restrictive lung disease (RLD), varying in severity, and to devise equations to estimate the SBHD results. METHODS: This was a retrospective cross-sectional study involving 169 individuals, of whom 93 and 49 presented with OLD and RLD, respectively, the remaining 27 having normal lung function. All patients underwent spirometry and lung volume measurement by both methods. RESULTS: TLC and RV were higher by WBP than by SBHD. The discrepancy between the methods was more pronounced in the OLD group, correlating with the severity of airflow obstruction. In the OLD group, the correlation coefficient of the comparison between the two methods was 0.57 and 0.56 for TLC and RV, respectively (p < 0.001 for both). We used regression equations, adjusted for the groups studied, in order to predict the WBP values of TLC and RV, using the corresponding SBHD values. It was possible to create regression equations to predict differences in TLC and RV between the two methods only for the OLD group. The TLC and RV equations were, respectively, ∆TLCWBP-SBHD in L = 5.264 - 0.060 × FEV1/FVC (r2 = 0.33; adjusted r2 = 0.32) and ∆RVWBP-SBHD in L = 4.862 - 0.055 × FEV1/FVC (r2 = 0.31; adjusted r2 = 0.30). CONCLUSIONS: The correction of TLC and RV results obtained by SBHD can improve the accuracy of this method for assessing lung volumes in patients with OLD. However, additional studies are needed in order to validate these equations.
Asunto(s)
Helio , Enfermedades Pulmonares Obstructivas/diagnóstico , Adulto , Anciano , Índice de Masa Corporal , Pruebas Respiratorias/métodos , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Enfermedades Pulmonares Obstructivas/fisiopatología , Mediciones del Volumen Pulmonar/métodos , Masculino , Persona de Mediana Edad , Pletismografía Total , Volumen Residual/fisiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , EspirometríaRESUMEN
The respiratory muscles can present fatigue and even chronic inability to generate force. So, reliable devices are necessary to their evaluation. The aim of this study is to evaluate the MEP (Maximal Expiratory Pressure) values of individuals between 20 and 25 years old and to validate a protocol using a pressure transducer and a signal conditioner comparing it with the digital manometer. We evaluated the MEP of 10 participants. They remained seated and made six respiratory maneuvers from Total Lung Capacity (TLC) to Residual Volume (RV). The results in the study showed no statistically significant differences when compared to values reported in the literature, and that the pressure transducer provides reliable values for MEP.
Asunto(s)
Volumen Espiratorio Forzado/fisiología , Volumen Residual/fisiología , Músculos Respiratorios/fisiología , Capacidad Pulmonar Total/fisiología , Transductores de Presión , Adulto , Humanos , Valores de ReferenciaRESUMEN
Introduction: Adenovirus infection is an important cause of pneumonia in Chilean children. Postinfectious Bronchiolitis Obliterans (PIBO) is the most important complication. There are few studies assessing pulmonary function and quality of life in PIBO patients. Objective: The aim of this study is to assess the pulmonary function and the quality of life of patients with PIBO and the correlation between both variables. Methods: 14 children with PIBO in follow up at the pediatric pulmonology outpatient clinic of a public children hospital were included in this study. Study period: April 2009 - April 2010. Pulmonary function was assessed in a medical visit by spirometry, flow/volume curve and intrathoracic gas volume measurement. The following indices were analyzed FVC, FEV1, FEV25-75, FEV1/FVC, RV, TLC, RV and RV/TLC. A survey of a self-administered Quality of Life (PedsQL, version 4.0, Spanish for Chile) was applied at the visit to investigate their global, physical and psychosocial quality of life. The Pearson linear correlation between quality of life and the pulmonary function test parameters was assessed, in the statistical analysis ap value < 0.05 was considered significant. Results: The mean age of our patients was 12.4 (range: 9-19 years-old). The functional alterations were characteristics of an obstructive respiratory disorder in 64.3 percent of the patients. Average pulmonary function test indices showed decreases in FEV1 (75 percent), FEV25-75 (48.8 percent), FEV1/FVC (67.6 percent) with normal value of FVC (93,7 percent) as well as pronounced increases in RV (333.5 percent), TLC (156 percent) and RV/TLC (51.8 percent). Mean change of FEV1 and FEV25-75post-bronchodilator was 11.3 percent and 26.4 percent respectively. Only 14.3 percent of our patients showed normal pulmonary function. The quality of life parameters were in average 58.2 percent of overall quality of life, 58.6 percent of physical quality of life and 57.9 percent of psychosocial ...
Introducción: La infección por adenovirus es una causa importante de neumonía en niños chilenos. La bronquiolitis obliterante (BOPI) es la complicación más importante. Existen pocos estudios donde evalúen la función pulmonar y la calidad de vida de los pacientes con BOPI. Objetivo: Evaluar la función pulmonar y la calidad de vida de los pacientes con BOPI y la correlación entre ambas variables. Métodos: Se incluyeron 14 niños con BOPI en el policlínico de la unidad de broncopulmonar de un hospital público de niños. Período de estudio: abril de 2009-abril de 2010. La función pulmonar se evaluó en una visita médica por espirometría, curva flujo / volumen y la determinación de volumen de gas intratorácico. Los índices analizados fueron los siguientes CVF, VEF1, FEV25-75, VEF1/CVF, VR,CPT, VR y VR / CPT. En la misma visita se realizó una encuesta auto-administrada de Calidad de Vida (PedsQL, versión 4.0, español de Chile) para investigar la calidad de vida global, física y psi-cosocial. Se aplicó la correlación lineal de Pearson entre calidad de vida y los parámetros de función pulmonar. Se consideró estadísticamente significativo unp <0,05. Resultados: La edad media de nuestros pacientes fue de 12,4 (rango: 9-19 años). La alteración funcional característica fue la obstructiva en el 64,3 por ciento de los pacientes. El promedio de los índices de pruebas de función pulmonar mostraron una disminución en VEF1 (75 por ciento), FEV25-75 (48,8 por ciento), VEF1/CVF (67,6 por ciento) con un valor normal de la CVF (93,7 por ciento), así como aumentos pronunciados en VR (333,5 por ciento), CPT (156 por ciento) y VR/CPT (51,8 por ciento). La media del cambio del VEF1 y FEV25-75post-broncodilatador fue 11,3 por ciento y 26,4 por ciento respectivamente. Sólo el 14,3 por ciento mostró una función pulmonar normal. Los parámetros de calidad de vida fueron en promedio 58,2 por ciento de calidad de vida general, 58,6 por ciento de calidad de vida física y el 57,9 por ciento...
Asunto(s)
Humanos , Masculino , Adolescente , Femenino , Niño , Pruebas Respiratorias , Bronquiolitis Obliterante/fisiopatología , Bronquiolitis Obliterante/psicología , Calidad de Vida , Infecciones por Adenovirus Humanos , Bronquiolitis Obliterante/virología , Capacidad Vital/fisiología , Flujo Espiratorio Forzado/fisiología , Espirometría , Encuestas y Cuestionarios , Volumen Espiratorio Forzado/fisiología , Volumen Residual/fisiologíaRESUMEN
The respiratory muscles can present fatigue and even chronic inability to generate force. So, reliable devices are necessary to their evaluation. The aim of this study is to evaluate the MEP (Maximal Expiratory Pressure) values of individuals between 20 and 25 years old and to validate a protocol using a pressure transducer and a signal conditioner comparing it with the digital manometer. We evaluated the MEP of 10 participants. They remained seated and made six respiratory maneuvers from Total Lung Capacity (TLC) to Residual Volume (RV). The results in the study showed no statistically significant differences when compared to values reported in the literature, and that the pressure transducer provides reliable values for MEP.
Os músculos respiratórios podem apresentar fadiga e até mesmo a incapacidade crônica na geração de força, sendo necessários dispositivos confiáveis para sua avaliação. O objetivo deste estudo foi avaliar a pressão expiratória máxima (PeMáx) de indivíduos entre 20 e 25 anos e validar um protocolo que utiliza um transdutor de pressão e um condicionador de sinais comparando-o com a manovacuometria. Foram avaliadas a PeMáx de 10 participantes. Estes permaneceram sentados e realizaram seis manobras respiratórias a partir da capacidade pulmonar total (CPT) até o volume residual (VR). Os resultados do estudo não apresentaram diferenças estatisticamente significativas quando comparados com os valores de normalidade descritos na literatura e mostraram que o transdutor de pressão fornece valores confiáveis para Pe máx.
Asunto(s)
Adulto , Humanos , Volumen Espiratorio Forzado/fisiología , Volumen Residual/fisiología , Músculos Respiratorios/fisiología , Transductores de Presión , Capacidad Pulmonar Total/fisiología , Valores de ReferenciaAsunto(s)
Fibrosis Quística/diagnóstico por imagen , Fibrosis Quística/prevención & control , Tomografía Computarizada por Rayos X/métodos , Bronquiectasia/diagnóstico por imagen , Niño , Fibrosis Quística/fisiopatología , Flujo Espiratorio Forzado/fisiología , Volumen Espiratorio Forzado/fisiología , Humanos , Volumen Residual/fisiología , Espirometría , Capacidad Vital/fisiologíaRESUMEN
OBJECTIVE: To assess pulmonary abnormalities detected by high-resolution computed tomography (HRCT) in young children with cystic fibrosis (CF) and mild to moderate lung disease. STUDY DESIGN: High-resolution computed tomography was performed in 60 children, 6 to 10 years old, with mild to moderate lung disease (forced expiratory volume in 1 minute [FEV(1)], 52-137; mean, 102; SD, 15% predicted). HRCTs were scored by using a system that evaluates each lobe for severity and extent of CF lung disease. Findings of CF lung disease were tabulated in all subjects and in a subgroup with normal pulmonary function tests. HRCT scores were correlated with FEV(1), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of expired vital capacity (FEF(25-75)) in 57 patients. RESULTS: Bronchiectasis was present in 35% of subjects, mucous plugging in 15%, and air trapping in 63%. No abnormality was detected in 25%. In 37 subjects with FEV(1), FVC, and FEF(25-75) >85% predicted, bronchiectasis was present in 30%. In 17% of these subjects, bronchiectasis was seen in > or =4 lobes. Correlations between HRCT scores and FEV(1) were significant and showed fair to moderate correlation (r=0.36-0.46). CONCLUSIONS: High-resolution computed tomography demonstrated a broad range of pulmonary abnormalities in young patients with CF with mild to moderate lung disease. In this study, abnormalities, including bronchiectasis, were common in young children with CF and normal pulmonary function tests.
Asunto(s)
Fibrosis Quística/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Bronquiectasia/diagnóstico por imagen , Niño , Fibrosis Quística/fisiopatología , Flujo Espiratorio Forzado/fisiología , Volumen Espiratorio Forzado/fisiología , Humanos , Volumen Residual/fisiología , Mucosa Respiratoria/patología , Espirometría , Capacidad Vital/fisiologíaRESUMEN
Se presentan 15 enfermos con bullas enfisematosas gigantes, tratados mediante lobectomía reglada en el Hospital Universitario Comandante Manuel Fajardo, en el período de 1995 a 2000; todos estos pacientes se abordaron mediante incisiones axilares y en el 100 (por ciento) eran del sexo masculino fumadores de 2 cajetillas de cigarros diarios. La mortalidad quirúrgica fue del 6,6 (por ciento) a causa de que uno de los pacientes falleció por trombolismo pulmonar. En los 14 enfermos restantes se valoraron las pruebas funcionales respiratorias y se observó un cambio del volumen espiratorio forzado de disminución del volumen residual. En la gasometría arterial, la presión de oxígeno (PO2) aumentó en todos los enfermos hasta valores entre 80 y 85 lo que les permitió incorporarse a su vida laboral activa(AU)
15 patients with giant emphysematous bullas treated by ruled lobectomy at Comandante Manuel Fajardo Teaching Hospital, from 1995 to 2000, were presented. All these patients were approached by axillary incisions. 100 percent were males who smoked 2 packages of cigarettes daily. Surgical mortality was 6.6 percent due to the fact that one of the patients died from pulmonary trombolism. In the other 14 patients the functional respiratory tests were made and it was observed a change of the forced expiratory volume in the reduction of the residual volume. In the arterial gasometry, the oxygen pressure (02P) increased in all patients, reaching values between 80 and 85, which allowed them to incorporate to their active working life(AU)
Asunto(s)
Humanos , Masculino , Enfisema Pulmonar/cirugía , Enfisema Pulmonar/diagnóstico , Pruebas de Función Respiratoria/métodos , Indicadores de Morbimortalidad , Volumen Residual/fisiología , Volumen Espiratorio ForzadoRESUMEN
Seventy-seven patients with morbid obesity, body mass index (BMI) 40-69.9 kg m(-2), who were candidates for gastroplasty, were studied in our laboratory as part of a pre-operative survey. They had no complaints other than obesity and were not cyanotic. A group of 28 lean subjects (BMI 20-29.8 kg m(-2)) who were candidates for abdominal surgery, without any respiratory complaint, were included as controls. For each patient a pulmonary function test was performed, measuring slow vital capacity with expiratory residual volume (ERV), forced vital capacity (flow/volume) and maximal voluntary ventilation (MVV). In obese patients the MVV is reduced as BMI increases. This results in the reduction of expiratory flows and volumes. Forced expiratory volume in 1 sec (FEV1) is reduced in proportion to the FVC reduction and is related to MVV. It is suggested that the main consequence of the burden of the chest wall by increased adipose mass is a reduction in its compliance, making inspiration increasingly difficult, and resulting in lower static volumes and flows.
Asunto(s)
Inhalación/fisiología , Obesidad Mórbida/fisiopatología , Adulto , Análisis de Varianza , Fenómenos Biomecánicos , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Volumen Espiratorio Forzado/fisiología , Humanos , Masculino , Ventilación Voluntaria Máxima/fisiología , Persona de Mediana Edad , Volumen Residual/fisiología , Capacidad Vital/fisiologíaRESUMEN
Progressive restrictive defect with increasing age, obstructive lung disease, and bronchodilator responsiveness have been reported in sickle cell disease (SCD). Because airway hyperreactivity (AHR) can be underestimated when assessed by bronchodilator responsiveness in patients with normal baseline lung function, the aim of this study was to investigate the prevalence of AHR in SCD by cold-air bronchial provocation testing, and to assess whether AHR can be present in symptom-free patients with SCD. Forty patients aged 6 to 19 years (mean, 10.7 years +/- 3.5 SD) performed pulmonary function tests. Eighteen were known to have a history of reactive airway disease (RAD group), and 22 had no known history of RAD (non-RAD group). A control group, aged 6 to 7 years (mean, 10.5 +/- 3.1 years), consisted of 10 siblings of the non-RAD SCD group. There were no significant differences in age and height among the groups. If the forced expiratory volume in 1 second (FEV1) was greater than 70%, cold air challenge (CACh) was performed; if the FEV1 was less than 70%, aerosolized bronchodilator therapy was given. A decrease in FEV1 of more than 10% after CACh or an increase in FEV1 of 12% or greater after bronchodilator inhalation was considered evidence of AHR. In the RAD group, the total lung capacity was 88.9% +/- 14.0% of race-corrected predicted values, the forced vital capacity was 91.2% +/- 12.6%, and FEV1 was 85.3% +/- 16.2%. The mean maximal percent fall in FEV1 after CACh (n = 13) was 18.5% +/- 9.6% and was greater than 10% in 11 of 13 patients. The mean increase in FEV1 after bronchodilator therapy (n = 5) was 11.5% +/- 8.3%, and it was greater than 12% in 4 of 5 patients. In the non-RAD group the baseline total lung capacity was 101.6% +/- 11.7%, forced vital capacity was 95.5% +/- 10.2%, and FEV1 was 93.3% +/- 13.2%. The mean maximal percent fall in FEV1 after CACh (n = 19) was 14.1% +/- 8.8% and was greater than 10% in 13 of 19 patients. The mean increase in FEV1 after bronchodilator therapy (n = 3) was 14.7% +/- 11.3%, and was 12% of greater in 1 of 3 patients. In the control group the baseline total lung capacity was 105.7% +/- 12.1%, forced vital capacity was 96.2% +/- 11.1%, and FEV1 was 92.9% +/- 10.3%. The mean maximal percent fall in FEV1 was 5.0% +/- 2.5%, and was greater than 10% in none of 10 patients. The prevalence of AHR in the control group, the RAD group, and the non-RAD group was zero, 83%, and 64%, respectively (p < 0.0001). The overall prevalence in the SCD group was 73%. We conclude that there is a high prevalence of AHR in children with SCD and that airway hyperreactivity may exist in patients with SCD even in the absence of the clinical symptoms of RAD. AHR may be a significant component of sickle cell lung disease.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Hiperreactividad Bronquial/etiología , Administración por Inhalación , Adolescente , Adulto , Aerosoles , Factores de Edad , Aire , Estatura , Hiperreactividad Bronquial/fisiopatología , Pruebas de Provocación Bronquial/métodos , Broncodilatadores/uso terapéutico , Niño , Frío , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Volumen Espiratorio Forzado/fisiología , Predicción , Humanos , Pulmón/fisiopatología , Enfermedades Pulmonares Obstructivas/etiología , Enfermedades Pulmonares Obstructivas/fisiopatología , Masculino , Flujo Espiratorio Medio Máximo/fisiología , Prevalencia , Volumen Residual/fisiología , Capacidad Pulmonar Total/fisiología , Capacidad Vital/fisiologíaRESUMEN
Total lung capacity (TLC) and its components, including residual volume (RV) and vital capacity (VC), are described in a sample of 164 male and 143 female youths of Aymara ancestry (10.0-19.9 years) who were born and raised at high altitudes (> 2,500 m) and who were residing in La Paz, Bolivia (average altitude of about 3,600 m). The hypothesis was tested that the enhanced lung volumes of adult highlanders are attained during the period of growth and development. As found in adult male highlanders, TLC in young highlanders was significantly larger than in lowlanders of the same sex and body size, primarily as a result of increases in RV and secondarily through increases in VC. In addition, estimates of the magnitude of the effect of chronic hypobaric hypoxia on all of the measures of pulmonary function, including TLC, RV, and VC, were positively related to age. This finding suggests that growth and development at high altitude is associated with a constant increase in TLC and other measures of pulmonary function relative to those of lowlanders, a finding which is consistent with the expectations of the developmental adaptation hypothesis. However, although these relationships were statistically significant in males, they were not significant in females. Thus, although the magnitude of the estimated effects of chronic hypobaric hypoxia on TLC, RV, and VC were similar in males and females, the developmental pattern by which these enhanced volumes are achieved may differ between sexes.
Asunto(s)
Altitud , Indígenas Sudamericanos , Capacidad Pulmonar Total/fisiología , Adolescente , Adulto , Estatura/fisiología , Bolivia , Niño , Europa (Continente)/etnología , Volumen de Reserva Espiratoria/fisiología , Femenino , Volumen Espiratorio Forzado/fisiología , Capacidad Residual Funcional/fisiología , Humanos , Hipoxia/fisiopatología , Capacidad Inspiratoria/fisiología , Pulmón/crecimiento & desarrollo , Pulmón/fisiología , Masculino , Volumen Residual/fisiología , Factores Sexuales , Tórax/anatomía & histología , Capacidad Vital/fisiologíaRESUMEN
We describe the clinical, radiologic, functional, and pulmonary hemodynamic characteristics of a group of 30 nonsmoking patients with a lung disease that may be related to intense, long-standing indoor wood-smoke exposure. The endoscopic and some of the pathologic findings are also presented. Intense and prolonged wood-smoke inhalation may produce a chronic pulmonary disease that is similar in many aspects to other forms of inorganic dust-exposure interstitial lung disease. It affects mostly country women in their 60s, and severe dyspnea and cough are the outstanding complaints. The chest roentgenograms show a diffuse, bilateral, reticulonodular pattern, combined with normalized or hyperinflated lungs, as well as indirect signs of pulmonary arterial hypertension (PAH). On the pulmonary function test the patients show a mixed restrictive-obstructive pattern with severe hypoxemia and variable degrees of hypercapnia. Endoscopic findings are those of acute and chronic bronchitis and intense anthracotic staining of the airways appears to be quite characteristic. Fibrous and inflammatory focal thickening of the alveolar septa as well as diffuse parenchymal anthracotic deposits are the most prominent pathologic findings, although inflammatory changes of the bronchial epithelium are also present. The patients had severe PAH in which, as in other chronic lung diseases, chronic alveolar hypoxia may play the main pathogenetic role. However, PAH in wood-smoke inhalation-associated lung disease (WSIALD) appears to be more severe than in other forms of interstitial lung disease and tobacco-related COPD. The patients we studied are a selected group and they may represent one end of the spectrum of the WSIALD.