Current opinion in pulmonary medicine
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Despite being a treatable and preventable disease, tuberculosis will kill an estimated 30 million people during the current decade. Tuberculosis is a global problem, and increases in case rates are occurring not only in the developing countries of the world but also in several industrialized nations, such as the United States. Coincident with the resurgence of tuberculosis in the United States, there has also been an alarming increase in the number and proportion of cases caused by strains of Mycobacterium tuberculosis that are resistant to multiple first-line drugs. ⋯ The HIV epidemic is playing a pivotal and permissive role in the resurgence of tuberculosis morbidity and mortality in those populations where tuberculosis and HIV are prevalent and overlap. Co-infection with HIV distorts the natural history and clinical expression of tuberculosis. Molecular biology has yielded important insights into the mechanisms of drug resistance and provided powerful tools for the rapid diagnosis and epidemiologic study of this disease.
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Infection with HIV was first recognized through a clustering of unusual respiratory infections. The lung has been a major target manifesting many of the infectious complications of the immunodeficiency. Noninfectious pulmonary complications in HIV-infected individuals are also common and have been recognized since the advent of the AIDS epidemic. ⋯ Bronchoscopists have accumulated a collection of endobronchial lesions uncommonly seen in non-HIV-related pulmonary consultation. In the following review, we discuss the epidemiology, pathology, pathogenesis, clinical features, diagnostic findings, prognosis, and therapeutic options available for each noninfectious pulmonary complication. As the life expectancy for HIV-infected patients increases, the incidence of noninfectious pulmonary complications will rise.
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This gathering of new observations about chronic obstructive pulmonary disease, collected under the loosely defined heading of "pathology," creates a certain air of excitement. Vascular engorgement in concert with muscle contraction produces small airways narrowing in asthma, but not in chronic obstructive pulmonary disease. Stenotic small airways can be visualized in three dimensions. ⋯ Microvascular injury seems to produce emphysema. The protease-antiprotease theory of emphysema has competition from the inflammation-repair-fibrosis sequence seen in other organs. The mystery of why some smoker's lungs remain unaffected by tobacco smoke is further documented but unsolved; neuroendocrine cells and their neuropeptides may be important.
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Asthma and chronic obstructive pulmonary disease are both common diseases, which together afflict approximately 25 million Americans. Although expiratory airflow obstruction is the common physiologic abnormality, asthma and chronic obstructive pulmonary disease are characterized by unique pathologic findings, clues from clinical histories, and laboratory test results. Despite some overlap in these characteristics, it is usually possible to differentiate these two conditions. This distinction is important for the healthcare provider to communicate a realistic prognosis to the patient and the patient's family, and to institute appropriate therapy.
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Smoke inhalation injury affects nearly one third of all major burn victims. Significant inhalation exposures must be suspected in persons who were entrapped in a closed space or who became unconscious during a fire. ⋯ In addition to variable amounts of thermal loads, firesmoke may contain mixtures of carbon monoxide, hydrogen cyanide, nitrogen oxides, and other highly irritating gases. Each constituent of firesmoke may potentially create pulmonary and systemic toxicities and must be considered in every victim of smoke inhalation.