Pulmonary & Critical Care Medicine: Pulmonary Manifestations of Systemic Diseases Surinder K Jindal, Shankar S Patil
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1World Clinics: Pulmonary & Critical Care Medicine: Pulmonary Manifestations of Systemic Diseases2
3World Clinics: Pulmonary & Critical Care Medicine: Pulmonary Manifestations of Systemic Diseases
Editor-in-Chief Surinder K Jindal MD FCCP Guest Editor Shankar S Patil MD FRCP FAMS DSc (Gul) Dsc (NTR) DSc (RGUHS)
July 2013 Volume 2 Number 2
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Cover images: (Left) Contrast-enhanced computed tomography of the lungs: mediastinal window. Courtesy: Aman Sharma, Puneet Chhabra. (Middle) Photograph of lower limbs showing palpable purpura. Courtesy: Amita Aggarwal, Anuj Shukla. (Right) X-ray of paranasal sinuses showing bilateral maxillary sinusitus in a patient with Wegener's granulomatosis. Courtesy: Amita Aggarwal, Anuj Shukla.
The editors hereby declare/certify that they have no financial or non-financial interest in regard to the subject matter discussed in the manuscript.
WORLD CLINICS Pulmonary and Critical Care Medicine: Pulmonary Manifestations of Systemic Diseases
July 2013, Volume 2, Number 2
ISSN: 2319-1260
9789351520054
Printed in India
5Contributors
Editor-in-Chief
Guest Editor
Contributing Authors
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11Editorial
Surinder K Jindal md fccp
Editor-in-Chief
There has been an apparent disconnection between the pulmonary and the general medical practice in this country in the past. This is so despite an increased recognition of the pulmonary manifestations of systemic illnesses and vice versa. Every lung disease can have one or more systemic feature/s; similarly, pulmonary manifestations are present in about a third of most systemic illnesses. Obviously, pulmonology is incomplete without an in-depth knowledge and comprehension of different aspects of systemic-pulmonary diseases.
The third issue of the World Clinics in Pulmonary and Critical Care Medicine particularly focuses on the above cited issues. We have attempted to discuss the developments in this subject for a comprehensive exposure of our readers, and also to formulate a systemic approach for the diagnosis and management of the problems. Each subject has been discussed by expert/s engaged in that area in his/her long clinical practice.
Of the several systemic-pulmonary problems, the connective tissue disorders and vasculitides form one specific group which overlaps the boundaries of different specialties and subspecialties. Interstitial lung diseases and pulmonary vasculitis in particular bring a pulmonologist in close collaboration with internists. Systemic diseases as causes of interstitial lung involvement require multiple investigations and specialty expertise for their interpretation.
The pulmonary involvement in specific-organ syndromes, such as those of the cardiovascular, cerebrovascular, gastrointestinal, hepatic, and renal systems constitutes the other major group of problems. The assessment and management of these problems requires awareness and algorithmic approach for rationale decisions. Drug-induced pulmonary problems have become an important issue of concern which frequently requires a general medicine approach for the diagnosis and management. We have also included articles on subjects which are relatively uncommonly discussed in today's clinical practice. For example, the parasitic lung diseases and menstrual cycle-related pulmonary problems are important to recognize and discuss, but generally pushed under the carpet.
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It is never possible to include each and every subject in a volume limited in size and scope. The respiratory involvement in various infections and malignancies are also common. Lungs are important sites for localization of systemic infections including those caused by bacteria, fungi and viruses. They are also the preferred sites for metastases of various malignancies including those of breasts, gastrointestinal tract, genitourinary system, and other organs. Further, both the metastatic and nonmetastatic manifestations of lung tumors include a wide arena of systemic organ involvement. The introductory articles on “Pulmonary Manifestations of Systemic Diseases” and “Approach to Systemic Manifestations of Pulmonary Diseases” should serve the purpose of an overall assessment and comprehension.
We sincerely hope that the readers shall benefit from the subjects discussed in this issue. Each article has been appropriately referenced to help the readers for an in-depth search of an issue of interest. Finally, the abstract and editorial comments on each article shall serve to provide the brief overview at a glance for quick browsing.
Surinder K Jindal md fccp
Professor and Head
Department of Pulmonary Medicine
Postgraduate Institute of Medical Education and Research
Chandigarh 160 012, India
13Abbreviations 6MWD
Six-minute walk distance
6MWT
Six-minute walk test
6MWTD
6MWT distance
AAT
Alpha-1-antitrypsin
AAV
ANCA-associated vasculitis
ABG
Arterial blood gas
ACE
Angiotensin converting enzyme
ACEI
Angiotensin converting enzyme inhibitor
AFB
Acid-fast bacilli
AKI
Acute kidney injury
ALS
Amyotrophic lateral sclerosis
AMI
Acute myocardial infarction
ANA
Antinuclear antibody
ANCA
Antineutrophil cytoplasmic antibody
APS
Antiphospholipid syndrome
AR
Androgen receptor
ARDS
Acute respiratory distress syndrome
ASL
Airway surface liquid
ATS
American Thoracic Society
BAL
Bronchoalveolar lavage
BALT
Bronchus associated lymphoid tissue
BD
Behçet's disease
BHR
Bronchial hyper-reactivity
BiPAP
Bilevel positive airway pressure
BNP
Brain natriuretic peptide
BOOP
Bronchiolitis obliterans organizing pneumonia
BUN
Blood urea nitrogen
CABG
Coronary artery bypass graft
cANCA
Cytoplasmic ANCA
CBF
Cilia beat frequency
CD
Cluster of differentiation
CF
Cystic fibrosis
CFTR
Cystic fibrosis transmembrane conductase regulator
cGMP
Cyclic guanosine monophosphate
CH
Catamenial hemoptysis
CHCC
The Chapel Hill Consensus Conference
CMAP
Compound muscle action potential
CNS
Central nervous system
COPD
Chronic obstructive pulmonary disease
CP
Catamenial pneumothorax
CPAP
Continuous positive airway pressure
CPC
Chronic persistent cough
CPE
Cardiogenic pulmonary edema
CREST
Calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly and telangiectasia
CSS
Churg-Strauss syndrome
CT
Computed tomography
CTD
Connective tissue disease
CXR
Chest X-ray
DAH
Diffuse alveolar hemorrhage
DILD
Drug-induced interstitial lung disease
DIPD
Drug-induced pulmonary disease
DLCO
Diffusing capacity of the lungs for carbon monoxide
DMD
Duchenne muscular dystrophy
dsDNA
Double-stranded deoxyribonucleic acid
Echo
Echocardiography
ED
Emergency department
ELISA
Enzyme-linked immunosorbent assay
EMG
Electromyography
ER
Estrogen receptor
ERA
Endothelins receptor antagonist
ERS
European Respiratory Society
ERV
Expiratory reserve volume
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ESLD
End-stage liver disease
ET
Endothelin
EUVAS
European Vasculitis Study Group
FDG
F-fluorodeoxyglucose
FEF
Forced expiratory flow
FEV1
Forced expiratory volume in the first second
FiO 2
Fraction of inspired oxygen
FOB
Fiberoptic bronchoscopy
FRC
Functional residual capacity
FVC
Forced vital capacity
GBM
Glomerular basement membrane
GBS
Guillain-Barré syndrome
GERD
Gastroesophageal reflux disease
GGOs
Ground-glass opacities
GI
Gastrointestinal
GN
Glomerulonephritis
GP1
Glycoprotein 1
GPA
Granulomatosis with Polyangiitis
HCV
Hepatitis C virus
HIV
Human immunodeficiency virus
HLA
Human leukocyte antigen
HP
Hypersensitivity pneumonitis
HPS
Hepatopulmonary syndrome
HRCT
High resolution computed tomography
HSP
Henoch-Schönlein purpura
IBD
Inflammatory bowel disease
ICU
Intensive care unit
IFN-γ
Interferon-gamma
Ig
Immunoglobulin
IL
Interleukin
ILD
Interstitial lung disease
IMA
Internal mammary artery
IPF
Idiopathic pulmonary fibrosis
IPV
Intrapulmonary percussive ventilation
IV
Intravenous
IVIG
Intravenous immunoglobulin
LAM
Lymphangioleiomyomatosis
LDH
Lactate dehydrogenase
LES
Lower esophageal sphincter
LPM
Liters per minute
LTRA
Leukotriene receptor antagonist
LVEDP
Left ventricular end-diastolic pressure
MDCT
Multidetector computed tomographic
MEFV
Maximal expiratory flow volume
MEP
Maximum expiratory pressure
MG
Myasthenia gravis
MI-E
Mechanical insufflation-exsufflation
MIP
Maximum inspiratory pressure
MMF
Mycophenolate mofetil
MP
Methylprednisolone
MPA
Microscopic polyangiitis
MPO
Myeloperoxidase
NCPE
Noncardiogenic pulmonary edema
NIPPV
Nasal intermittent positive pressure ventilation
NIV
Noninvasive ventilation
NMD
Neuromuscular disease
NO
Nitric oxide
NSAID
Nonsteroid anti-inflammatory drug
NSIP
Nonspecific interstitial pneumonia
OC
Oral contraceptive
OLD
Obstructive lung disease
OSA
Obstructive sleep apnea
PaCO2
Partial pressure of carbon dioxide in the arterial blood
PAH
Pulmonary arterial hypertension
p-ANCA
Perinuclear antineutrophil cytoplasmic antibody
PaO2
Partial pressure of oxygen in arterial blood
PAP
Pulmonary artery pressure
PAPO
Pulmonary artery occlusion pressure
PASP
Pulmonary artery systolic pressure
PBC
Primary biliary cirrhosis
PCIS
Postcardiac injury syndrome
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PCL
Pericilliary liquid layer
PCWP
Pulmonary capillary wedge pressure
PDE
Phosphodiesterase
PEEP
Positive-end expiratory pressure
PEF
Peak expiratory flow
PFT
Pulmonary function test
PIE
Pulmonary infiltrates with eosinophilia
PImax
Pressure to maximal inspiratory pressure
PLCH
Pulmonary Langerhans cell histiocytosis
PMA
Premenstrual asthma
POPH
Portopulmonary hypertension
PPH
Primary pulmonary hypertension
PPI
Proton pump inhibitor
PR
Progesterone receptor
PR3
Proteinase 3
PRS
Pulmonary-renal syndrome
PTU
Propylthiouracil
PVR
Pulmonary vascular resistance
QOL
Quality of life
RA
Rheumatoid arthritis
RANTES
Regulated upon activation normal T cell expressed and presumably secreted
RAVE
Rituximab for ANCA-associated vasculitis
RBC
Red blood cell
RCT
Randomized controlled trial
REM
Rapid eye movement
RF
Rheumatoid factor
RITUXVAS
Rituximab versus Cyclophosphamide in ANCA-Associated Renal Vasculitis
RNP
Ribonucleoprotein
ROS
Reactive oxygen species
RP
Raynaud's phenomenon
RPGN
Rapidly progressive glomerulonephritis
RV
Residual volume
RVSP
Right ventricular systolic pressure
SDB
Sleep-disordered breathing
SHBG
Sex hormone-binding globulin
SLE
Systemic lupus erythematosus
SMA
Spinal muscular atrophy
SMARD
Spinal muscular atrophy with respiratory distress
SNIP
Sniff nasal inspiratory pressure
SRC
Scleroderma renal crisis
SS
Sjogren's syndrome
SSc
Systemic sclerosis
SSc-RLD
SSc-related lung disease
TA
Takayasu's arteritis
TB
Tuberculosis
TES
Thoracic endometriosis syndrome
TLC
Total lung capacity
TNF
Tumor necrosis factor
TTP
Thrombotic thrombocytopenic purpura
UC
Ulcerative colitis
UIP
Usual interstitial pneumonia
ULN
Upper limit of normal
VATS
Video-assisted thoracoscopic surgery
VC
Vital capacity
VMR
Vagus-mediated reflex
VTE
Venous thromboembolism
VTR
Velocity of tricuspid regurgitation
WHO
World Health Organization