Current opinion in pulmonary medicine
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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.
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Bronchiolar lesions are becoming increasingly recognized as an important cause of airflow obstruction. For this reason, it is helpful to have an update of the current clinical, radiographic, and immunologic perspective. Among the bronchiolar airflow disorders, diffuse panbronchiolitis is related to HLA antigen Bw54, and low-dose, long-term erythromycin appears to be effective therapy. ⋯ Bronchiolitis obliterans associated with lung transplantation is undergoing intensive investigation with regard to pathogenesis, immunologic study, early detection, and treatment. The lesion appears to be a form of chronic organ rejection. The recognition of the distinctive differences among the bronchiolar airflow disorders by clinicians and clinical investigators is essential for improved patient care, for a greater understanding of the pathogenesis of the disorder, and for development of new therapeutic advances.