Aging is often viewed as a progressive decline in fitness due to cumulative deleterious alterations of biological functionsin the living system. Recently, our understanding of the molecular mechanisms underlying aging biology has significantlyadvanced. Interestingly, many of the pivotal molecular features of aging biology are also found to contribute to thepathogenesis of chronic lung disorders such as chronic obstructive pulmonary disease and idiopathic pulmonaryfibrosis, for which advanced age is the most crucial risk factor. Thus, an enhanced understanding of how molecularfeatures of aging biology are intertwined with the pathobiology of these aging-related lung disorders has paramountsignificance and may provide an opportunity for the development of novel therapeutics for these major unmet medicalneeds. To serve the purpose of integrating molecular understanding of aging biology with pulmonary medicine, in thisreview, recent findings obtained from the studies of aging-associated lung disorders are summarized and interpretedthrough the perspective of molecular biology of aging.
Particulate matter (PM) is suspended dust that has a diameter of <10 μm and can be inhaled by humans and depositedin the lungs, particularly the alveoli. Recent studies have shown that PM has an adverse effect on respiratory diseases. Theaim of this article is to review respiratory diseases associated with PM. According to existing studies, PM is associatedwith chronic obstructive pulmonary disease, bronchial asthma, and several other respiratory diseases and increasesthe mortality rates of these diseases. Moreover, increased exposure in the high concentration of atmospheric PM isassociated with the development of lung cancer. The most simple and common way to protect an individual fromairborne PM is to wear a face mask that filters out PM. In areas of high concentration PM, it is recommended to weara face mask to minimize the exposure to PM. However, the use of N95 or KF94 masks can interfere with respiration inpatients with chronic respiratory diseases who exhibit low pulmonary function, leading to an increased risk of respiratoryfailure. Conclusionally, reduction of the total amount of PM is considered to be important factor and strengthening thenational warning notification system to vulnerable patients and proper early management of exacerbated patients will beneeded in the future.
Hypersensitivity Pneumonitis (HP) one of the most common interstitial lung diseases (ILDs) is characterized byexposure to an inhaled inciting antigen that leads to a host immunologic reaction determining interstitial inflammationand architectural distortion. The underlying pathogenetic mechanisms are unclear. The absence of international shareddiagnostic guidelines and the lack of a “gold-standard” test for HP combined with the presence of several clinical andradiologic overlapping features makes it particularly challenging to differentiate HP from other ILDs, also in expertcontests. Radiology is playing a more crucial role in this process; recently the headcheese sign was recognized as a morespecific for chronic-HP than the extensive mosaic attenuation. Several classification proposals and diagnostic modelshave been advanced by different groups, with no prospective validation. Therapeutic options for HP have been limited toantigen avoidance and immunosuppressant drugs over the last decades. Several questions about this condition remainunanswered and there is a need for more studies.
In human immunodeficiency virus (HIV)-infected patients, Pneumocystis jirovecii pneumonia (PCP) is a wellknownopportunistic infection and its management has been established. However, PCP is an emerging threat toimmunocompromised patients without HIV infection, such as those receiving novel immunosuppressive therapeuticsfor malignancy, organ transplantation, or connective tissue diseases. Clinical manifestations of PCP are quite differentbetween patients with and without HIV infections. In patients without HIV infection, PCP rapidly progresses, is difficult todiagnose correctly, and causes severe respiratory failure with a poor prognosis. High-resolution computed tomographyfindings are different between PCP patients with HIV infection and those without. These differences in clinical andradiological features are due to severe or dysregulated inflammatory responses that are evoked by a relatively smallnumber of Pneumocystis organisms in patients without HIV infection. In recent years, the usefulness of polymerasechain reaction and serum β-D-glucan assay for rapid and non-invasive diagnosis of PCP has been revealed. Althoughcorticosteroid adjunctive to anti-Pneumocystis agents has been shown to be beneficial in some populations, theoptimal dose and duration remain to be determined. Recent investigations revealed that Pneumocystis colonization isprevalent and that asymptomatic carriers are at risk for developing PCP and can serve as the reservoir for the spread ofPneumocystis by airborne transmission. These findings suggest the need for chemoprophylaxis in immunocompromisedpatients as well as infection control measures, although the indications remain controversial. Because a variety of novelimmunosuppressive therapeutics have been emerging in medical practice, further innovations in the diagnosis andtreatment of PCP are needed.
Background: Infectious conditions may increase the risk of venous thromboembolism. The purpose of this study wasto evaluate the risk factor for combined infectious disease and its influence on mortality in patients with pulmonaryembolism (PE). Methods: Patients with PE diagnosed based on spiral computed tomography findings of the chest were retrospectivelyanalyzed. They were classified into two groups: patients who developed PE in the setting of infectious disease or thosewith PE without infection based on review of their medical charts. Results: Of 258 patients with PE, 67 (25.9%) were considered as having PE combined with infectious disease. The sites ofinfections were the respiratory tract in 52 patients (77.6%), genitourinary tract in three patients (4.5%), and hepatobiliarytract in three patients (4.5%). Underlying lung disease (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.926–7.081;p<0.001), bed-ridden state (OR, 2.84; 95% CI, 1.390–5.811; p=0.004), and malignant disease (OR, 1.867; 95% CI, 1.017–3.425; p=0.044) were associated with combined infectious disease in patients with PE. In-hospital mortality was higher inpatients with PE combined with infectious disease than in those with PE without infection (24.6% vs. 11.0%, p=0.006). Inthe multivariate analysis, combined infectious disease (OR, 4.189; 95% CI, 1.692–10.372; p=0.002) were associated withnon-survivors in patients with PE. Conclusion: A substantial portion of patients with PE has concomitant infectious disease and it may contribute amortality in patients with PE.
Background: Limited studies have been performed to assess readmission following hospitalization for communityacquiredpneumonia (CAP) in an Asian population. We evaluated the rates, reasons, and risk factors for 30‑dayreadmission following hospitalization for CAP in the general adult population of Korea. Methods: We performed a retrospective observational study of 1,021 patients with CAP hospitalized at YeungnamUniversity from March 2012 to February 2014. The primary end point was all-cause hospital readmission within 30days following discharge after the initial hospitalization. Hospital readmission was classified as pneumonia-related orpneumonia-unrelated readmission. Results: During the study period, 862 patients who survived to hospital discharge were eligible for inclusion and amongthem 72 (8.4%) were rehospitalized within 30 days. In the multivariable analysis, pneumonia‑related readmissionwas associated with para/hemiplegia, malignancy, pneumonia severity index class ≥4 and clinical instability ≥1 athospital discharge. Comorbidities such as chronic lung disease and chronic kidney disease, treatment failure, anddecompensation of comorbidities were associated with the pneumonia-unrelated 30-day readmission rate. Conclusion: Rehospitalizations within 30 days following discharge were frequent among patients with CAP. The riskfactors for pneumonia-related and -unrelated readmission were different. Aspiration prevention, discharge at the optimaltime, and close monitoring of comorbidities may reduce the frequency of readmission among patients with CAP.
Background: Infectious conditions may increase the risk of venous thromboembolism. The purpose of this study wasto evaluate the risk factor for combined infectious disease and its influence on mortality in patients with pulmonaryembolism (PE). Methods: Patients with PE diagnosed based on spiral computed tomography findings of the chest were retrospectivelyanalyzed. They were classified into two groups: patients who developed PE in the setting of infectious disease or thosewith PE without infection based on review of their medical charts. Results: Of 258 patients with PE, 67 (25.9%) were considered as having PE combined with infectious disease. The sites ofinfections were the respiratory tract in 52 patients (77.6%), genitourinary tract in three patients (4.5%), and hepatobiliarytract in three patients (4.5%). Underlying lung disease (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.926–7.081;p<0.001), bed-ridden state (OR, 2.84; 95% CI, 1.390–5.811; p=0.004), and malignant disease (OR, 1.867; 95% CI, 1.017–3.425; p=0.044) were associated with combined infectious disease in patients with PE. In-hospital mortality was higher inpatients with PE combined with infectious disease than in those with PE without infection (24.6% vs. 11.0%, p=0.006). Inthe multivariate analysis, combined infectious disease (OR, 4.189; 95% CI, 1.692–10.372; p=0.002) were associated withnon-survivors in patients with PE. Conclusion: A substantial portion of patients with PE has concomitant infectious disease and it may contribute amortality in patients with PE.
Background: The purpose of this study was to investigate the effect of early tracheostomy on clinical outcomes inpatients requiring prolonged acute mechanical ventilation (≥96 hours). Methods: Data from 575 patients (69.4% male; median age, 68 years), hospitalized in the medical intensive care unit(ICU) of a university-affiliated tertiary care hospital March 2008–February 2017, were retrospectively evaluated. Earlyand late tracheostomy were designated as 2–10 days and >10 days after translaryngeal intubation, respectively. Results: The 90-day cumulative mortality rate was 47.5% (n=273) and 258 patients (44.9%) underwent tracheostomy. Incomparison with the late group (n=115), the early group (n=125) had lower 90-day mortality (31.2% vs. 47.8%, p=0.012),shorter stays in hospital and ICU, shorter ventilator length of stay (median, 43 vs. 54; 24 vs. 33; 23 vs. 28 days; all p<0.001),and a higher rate of transfer to secondary care hospitals with post-intensive care settings (67.2% vs. 43.5% p<0.001). Also,the total medical costs of the early group were lower during hospital stays than those of the late group (26,609 vs. 36,973USD, p<0.001). Conclusion: Early tracheostomy was associated with lower 90-day mortality, shorter ventilator length of stay and shorterlengths of stays in hospital and ICU, as well as lower hospital costs than late tracheostomy.