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  • After the ATS/ERS 2000 joint statement (guidelines) for the idiopathic pulmonary fibrosis (IPF), a committee of international experts on IPF with professor Raghu Ganesh as chair and Jim Egan and Fernando Martinez as co-chairs, have been appointed by the American Thoracic Society (ATS), The European Respiratory Society (ERS) and the Japan Respiratory Society (JRS) to write evidence based guidelines for the management of IPF. Given the scope of the magnitude that the task has evolved, the committee has expanded to include members from most of the regions of the world actively involved in IPF studies. Therefore, 21 pneumonologists, 4 radiologists, and 4 pathologists are participating in this ongoing project (Table 1). The committee met in Dublin last year, this year in Toronto and last month in Modena (photo) to reach a final document.
     
  • Asthma is a serious global problem. People of all ages and medical services at many levels are affected by this chronic airway disorder. In 1993, the Global Initiative for Asthma (GINA) was initiated to develop a network of individuals, organizations and public health services for the dissemination of information regarding the pathophysiology, diagnostic procedures, classification of disease severity and treatment related to asthma1. The 2002 GINA report stated: “It is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained”. Four years later the GINA report of 2006, to meet this challenge, changed the approach to asthma management, replacing severity with control as the focus. The control-driven approach was also the central issue in the guidelines of the National Institutes of Health (NIH), released in 2007 in the USA2. The variables used for the classification of severity have now become the variables for assessing the control of the disease. How important have the above changes been? Which are the new control variables? How do they affect the perspective and the treatment rationale of patients?
     
  • Reduced oxygen delivery to the tissues (hypoxia) induces a variety of different rescue mechanisms during acute and chronic states of oxygen cell deprivation. Mitochondria are the site where major protective biochemical processes are orchestrated. The reduction in reactive oxygen species (ROS) formation and in the intracellular uptake of calcium is achieved through changes in the electron transport during oxidative phosphorylation. Chronic oxygen lack results in more permanent alterations of cellular metabolic functions through the regulation of different genetic elements affecting the activity of many enzymes via post-translational factors, such as hypoxia-inducible factor 1 (HIF-1). Different rescue mechanisms involved during chronic hypoxia are responsible to a greater or lesser degree for the majority of systemic manifestations of the ‘syndrome’ of chronic obstructive pulmonary disease (COPD). The modulation of vascular tone in both systemic and pulmonary circulation, the increased retention of sodium and water from the kidneys, the chronic muscular fatigue and cachexia, and the chronic subtle inflammatory reaction in patients suffering from COPD are related to a complex network of intracellular and systemic interactions, which has recently been the topic of intensive basic research. The aim of this review is to describe the different adaptative mechanisms engaged at the cellular micro-level during hypoxia and their interconnection with the major clinical manifestations of COPD at the macroorganism level. Pneumon 2008; 21(2):134–144
     
  • This review deals with the diagnosis and treatment of idiopathic eosinophilic lung diseases. The term ‘eosinophilic lung diseases’ refers to a number of heterogeneous diseases which share the presence of eosinophilic infiltrates in the pulmonary parenchyma and increased numbers of eosinophils in the bronchoalveolar lavage (BAL), and which may or may not be accompanied by peripheral eosinophilia (PE). The clinical symptomatology of these diseases can vary from mild to severe and potentially fatal. As most patients with eosinophilic lung disease can be treated effectively, detailed symptom assessment and correct diagnosis are of crucial importance. Pneumon 2008; 21(2):156–166
     
  • Cadmium (Cd) is a widely spread environmental contaminant that exerts varied toxicity, including established carcinogenetic activity. Due to its long biological half-life (more than 10 years), chronic exposure and accumulation of Cd can give rise to a variety of toxic phenomena in the bones, the urogenital system and in the lungs. This short review focuses on the data that document the carcinogenic properties of Cd correlated with the induction of lung cancer. Smoking and exposure to Cd compounds at work are the main sources of Cd inhalation. The mechanisms involved have not been completely elucidated, but the oxidative and deregulating actions of Cd on certain proteins and enzymes of the exposed lung cells are thought to play a major role. Pneumon 2008; 21(2):172–177
     
  • Waldenstrφm’s macroglobulinemia (WM) is a neoplastic lymphoproliferative disease, characterized by clonal expansion of B-lymphocytes, which produce monoclonal immunoglobulin of the IgM type. A 77 year-old female presented with shortness of breath and a dry cough. Physical examination revealed absence of breath sounds over the base of the right lung. Blood tests showed anaemia, raised ESR and a monoclonal IgM protein. On chest X-ray right pleural effusion was found, and chest CT scan revealed multiple nodules of about 1cm in diameter in the lung parenchyma, mediastinal lymph node enlargement, and right-sided pleural effusion. Examination of the pleural fluid showed lymphoplasmacytic infiltration. Bronchoscopy and bronchoalveolar lavage were normal. Investigation for autoimmune disease and specific bacterial and viral diseases was negative. The bone marrow aspirate (BMA) showed diffuse infiltration by lymphoplasmacytoid cells (45%-50%) expressing CD20, CD19 and IgM, consistent with a diagnosis of WM. The patient underwent chemotherapy, which produced complete haematological remission and normalization of the chest CT scan. There was no evidence of disease one year later. The lungs are affected only 3%-5% of cases of WM. Pleuropulmonary involvement as the first manifestation of WM is extremely rare and only few cases have been reported in the literature. Pneumon 2008; 21(2):181–184
     
  • We present a case of a 68 year-old man with a lung adenocarcinoma associated with cutaneous and buccal metastases, which regressed after a chemotherapy regime combining cisplatin and paclitaxel. At 5-month follow-up, after 6 cycles of chemotherapy, the patient’s clinical condition was satisfactory, with no new cutaneous metastases. Pneumon 2008; 21(2):189–191
     
  • The B-lymphocyte is the tuner of humoral immunity. Following recognition of the antigen, and with significant collaboration with T-cells, B-cells become activated and secrete immunoglobulins. The lung hosts a small number of B-lymphocytes, but their role in various lung diseases is not yet fully understood. In chronic obstructive pulmonary disease (COPD ) and bronchial asthma, there appears to be activation of B-cells, at least at the level of the bronchial mucosa. This may indicate an increased alarm mechanism in the immune system, possibly due to microbial colonization of the bronchial tree, or support the theory of development of an autoimmune mechanism in COPD . Pneumon 2008; 21(1):196–199
     
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