All posts in Pulmonary Disease

Low vitamin D common in lung disease

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Kinder and his colleagues assessed the prevalence of vitamin D deficiency in a cohort of patients with interstitial lung disease, who are often treated with corticosteroids. The detrimental effect of chronic use of corticosteroids on bone health has been well established, according to the researchers. Of the patients included in the study, 51 had interstitial lung disease and 67 had other forms of interstitial lung disease related to autoimmune connective tissue diseases.

A vitamin D insufficiency was defined as a serum level of less than 30 ng/mL. A level of less than 20 ng/mL was considered deficient. Both insufficient and deficient levels were prevalent in the study. In the overall sample, lower vitamin D levels were associated with reduced forced vital capacity (P=0.01). When the analysis was restricted to patients with connective tissue disease, both forced vital capacity and diffusing capacity of lung for carbon monoxide — a measure of the lung’s ability to transfer gases from the air to the blood — were significantly reduced (P<0.05 for both). After adjustment for several potential confounders — including age, corticosteroid use, race, and season, the presence of connective lung disease was a strong predictor of vitamin D insufficiency (OR 11.8, 95% CI 3.5 to 40.6).

According to the researchers, a pathogenic role of low vitamin D in the development of autoimmune diseases such as interstitial lung disease is plausible because of the immunoregulatory role of the biologically active form of vitamin D, 1,25-(OH)2D. “All cells of the adaptive immune system express vitamin D receptors and are sensitive to the action of 1,25-(OH)2D,” they wrote. “High levels of 1,25-(OH)2D are potent inhibitors of dendritic cell maturation with lower expression of major histocompatibility complex class II molecules, down-regulation of costimulatory molecules, and lower production of proinflammatory cytokines.” “A common theme in the immunomodulatory functions of vitamin D is that higher levels are immunosuppressive,” they continued, “which is consistent with a potential role for hypovitaminosis D in the pathogenesis of autoimmune disorders.”

In a statement, Len Horovitz, MD, a pulmonary specialist at Lenox Hill Hospital in New York City, commented that “vitamin D is known to promote wound healing, and to benefit the immune system. So it is not surprising to find that patients with immune lung disorders are vitamin D deficient.” He said that all of his patients are screened and treated for vitamin D deficiency with supplements. The study authors noted that further research is needed to determine whether supplementation is associated with improved outcomes. The study was limited, Kinder and his colleagues wrote, by its use of patients from a single center in Cincinnati.

In addition, the cross-sectional design of the study did not evaluate whether vitamin D supplementation is associated with any improved clinical outcomes. To examine that issue, the team called for prospective controlled interventional studies to determine whether vitamin D7 supplements can ameliorate symptoms and improve outcomes in connective tissue disease-related interstitial lung disease.

Source reference: Hagaman J, et al “Vitamin D deficiency and reduced lung function in connective tissue-associated interstitial lung diseases” Chest 2011; DOI: 10.1378/chest.10-0968.

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Eating a sensible diet improves lung health

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Steering clear of full-fat, fried, and processed foods is not just good for overall health, it could help prevent chronic lung conditions, a large UK study has revealed.

Led by Seif Shaheen, Professor of Respiratory Epidemiology at Barts and The London School of Medicine, the study – involving 1,551 men and 1,391 women with an average age of 66 – showed that those whose diet favoured fresh fruit and vegetables, oily fish and wholegrain products had far better lung function than those who chose a diet high in fat, sugar and processed food.

The diets of those involved were investigated to assess what kinds of food they consumed on a regular basis. Their lung function was also tested using a spirometer, a device which measures the amount of air that a person can blow out of their lungs in one second. This simple test illustrates how healthy the lungs are, and determines whether any blockage or obstruction exists in the airways. If the airways are obstructed, the person is diagnosed with Chronic Obstructive Pulmonary Disease (COPD).

The study also revealed that the beneficial effects of the sensible diet were particularly strong in men who smoked.

Lung health in particular may be positively affected by a sensible diet because of the antioxidants contained in fruit and wholegrains, and the omega-3 fatty acids found in oily fish – that protect the lungs against the adverse effects of smoking.

Professor Shaheen said: “Whilst cessation of smoking is still the number one way to improve lung health, this study is important because it suggests that cases of COPD might be prevented if people, especially male smokers, ate more fruit and vegetables, oily fish and wholegrain cereals, and less white bread, sugar, full fat dairy products, fried food and processed meat. However, the only way to confirm this would be to carry out a randomised controlled trial.”

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Iranian scholars share Avicenna’s mediaeval medical wisdom

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For pulmonary ailments, certain mediaeval physicians had a useful medical textbook on hand offering detailed information remarkably similar to those a modern doctor might use today. One of the fathers of medicine, the great Persian scholar Avicenna left a wealth of information in his many works. Iranian academics dust off one of these in an article published today in the SAGE journal Therapeutic Advances in Respiratory Disease, sharing in English details of Avicenna's work that still fascinate both physicians and historians of medicine alike.

Seyyed Mehdi Hashemi and Mohsen Raza dug deep into Avicenna's original ancient text, housed in the Central Library of the Tehran University of Medical Sciences in Iran, where they both work. In particular, they aimed to highlight Avicenna's work on respiratory diseases, which may be informative or interesting to physicians and pulmonologists today.

Avicenna discusses respiratory diseases in volume three of the Canon of Medicine, covering the functional anatomy and physiopathology of the pulmonary diseases that were known in his time in detail. His descriptions of the signs and symptoms of various respiratory diseases and conditions are remarkably similar to those found in modern pulmonary medicine. The topic is covered under five chapters: breathing, voice, cough and haemoptysis, internal wounds and inflammations and principles of treatments.

The authors also highlight both herbal and non-herbal treatments Avicenna recommends for respiratory diseases, and their signs and symptoms from the second volume of the Canon of Medicine. Avicenna suggested 21 herbs to treat respiratory disorders, and today we know that several of these herbs contain bioactive compounds with analgesic, antispasmodic, bronchodilatory or antimicrobial activities. For instance, Avicenna would have prescribed opium at that time for cough and haemoptysis, a practice which today has an established therapeutic basis.

“In the time of Avicenna, the presentation of respiratory diseases, their treatment and their prognosis was much different than in modern times,” says Hashemi. Mediaeval physicians had a greater reliance on history, physical examination (which was mostly based on visual observation), individual variation, environmental factors, diet, and so on, for diagnosis and treatment.

Even so, several of Avicenna's observations related to signs and symptoms, aggravating and relieving factors and the treatment of pulmonary disorders are still valid and can be explained by modern science. For example, one of the important symptoms in the diagnosis of asthma that Avicenna discusses is dyspnea during sleep that leads to awakening. Avicenna also observed plaster-like material in tuberculosis patients' sputum, which is now known as lithoptysis (stone spitting), where a patient coughs up calcified material due to perforated bronchial lymph node.

Despite many limitations and the lack of modern instruments in his day, Avicenna adopted a scientific approach to the diagnosis and treatment, not only of respiratory disorders, but also more generally to illnesses he treated and mentioned throughout the Canon of Medicine.

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Vitamin E May Decrease Pulmonary Disease

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Ms. Agler and colleagues reviewed data compiled by the Women's Health Study, a multi-year, long-term effort ending in 2004 that focused on the effects of aspirin and vitamin E in the prevention of cardiovascular disease and cancer in nearly 40,000 women aged 45 years and older. Study participants were randomized to receive either 600 mg of vitamin E or a placebo every other day during the course of the research.

Although fewer women taking vitamin E developed COPD, Ms. Agler noted the supplements appeared to have no effect on asthma, and women taking vitamin E supplements were diagnosed with asthma at about the same rate as women taking placebo pills. Importantly, Ms. Agler noted the decreased risk of COPD in women who were given vitamin E was the same for smokers as for non-smokers.

Ms. Agler said further research will explore the way vitamin E affects the lung tissue and function, and will assess the effects of vitamin E supplements on lung diseases in men. “If results of this study are borne out by further research, clinicians may recommend that women take vitamin E supplements to prevent COPD,” Ms. Agler noted. “Remember that vitamin E supplements are known to have detrimental effects in some people; for example vitamin E supplementation increased risk of congestive heart failure in cardiovascular disease patients. Broader recommendations would need to balance both benefits and risks. “

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