acyclovir and Bronchiolitis

Cigarette smoking is the leading cause of preventable death in the United States. Smoking adversely affects many organ systems, but especially the lung. Carcinoma of the lung and chronic obstructive pulmonary disease account for most smoking-associated respiratory morbidity and mortality, and their association with smoking is both well established and widely recognized. Cigarette smoking also is associated with differences in the incidence, severity, or natural history of a broad array of other respiratory illnesses, ranging from the common cold to pneumothorax, pulmonary hemorrhage, and various interstitial lung diseases. Interestingly, while the general effect of smoking on respiratory diseases is adverse, in the cases of sarcoidosis and hypersensitivity pneumonitis smoking may actually be associated with a decrease in the incidence of disease. In this article, the author briefly discusses some of the pulmonary and systemic effects of smoking that might mediate its effects on an array of lung diseases, then comprehensively reviews less common or less well-recognized smoking-affected lung diseases such as pulmonary infections, spontaneous pneumothorax, Goodpasture's syndrome, eosinophilic granuloma and other interstitial lung diseases, and pulmonary metastatic disease.

Topics: Acyclovir; Alveolitis, Extrinsic Allergic; Antiviral Agents; Arthritis, Rheumatoid; Asbestosis; Bronchiolitis; Chickenpox; Eosinophilic Granuloma; Humans; Lung Diseases; Lung Neoplasms; Pneumonia, Bacterial; Pneumonia, Viral; Pneumothorax; Pulmonary Fibrosis; Respiratory Tract Infections; Risk Factors; Smoking

Guidelines for the diagnosis and grading of lymphocytic bronchiolitis (LB) have been available for more than a decade, but agreement is lacking concerning the clinical implications of this histologic finding.. Study goals were to describe the overall prevalence and incidence of LB in a consecutive cohort of lung transplant recipients and identify risk factors for the onset, frequency, and severity of LB.. A retrospective analysis was done of 2,697 transbronchial biopsy (TBB) specimens obtained during the first 2 years after transplantation from 299 consecutive patients who underwent transplantation between 1996 and 2006.. Full diameter membranous bronchioli were missing in approximately 30% of TBB specimens. The proportion of patients demonstrating LB remained constant during follow-up (trend test, p = 0.2). The cumulative incidence of LB (>or=B2) was 33%, 53%, 62%, and 68% at 1-, 3-, 6-, and 12-months, respectively. Approximately one-quarter and one-half of the patients had a second episode of >or=B2 within 3 months and 2-years of transplantation, respectively. Exposure to LB during the first 2 years after transplantation was independently associated with the frequency and/or severity of acute cellular rejection (p < 0.0001). The choice between anti-thymocyte globulin or daclizumab induction did not alter the overall frequency and/or severity of LB (p = 0.7). LB grade B2 or higher was associated with increased histologic bronchiolitis obliterans (odds ratio, 3.3, 95% confidence interval, 1.5-6.9, p = 0.001).. The frequency and severity of LB was associated with the occurrence and severity of acute cellular rejection.

Topics: Acyclovir; Antiviral Agents; Biomarkers; Biopsy; Body Mass Index; Bronchiolitis; Follow-Up Studies; Graft Rejection; Humans; Lung Diseases; Lung Transplantation; Middle Aged; Recurrence; Retrospective Studies; Time Factors