Chest
Clinical InvestigationsPulmonary Arterial Hypertension and Cor Pulmonale Associated with Chronic Domestic Woodsmoke Inhalation
Section snippets
Study Population
In the last 2 years we have consecutively studied a group of 30 patients (63.3 ± 1.76 years old). The patients were identified as possible candidates at our outpatient clinic on the basis of the following: (1) clinical, radiologic, and electrocardiographic evidence of PAH and CP;8 and (2) the antecedent of long-standing (at least 10 years) domestic wood-smoke exposure. They had to be nonsmokers, defined as those who have never smoked or have smoked less than one cigarette or equivalent a day
RESULTS
The mean age of the patients was 63.3 ± 1.76 years and the mean time of exposure was 51.9 ± 2.8 years. The clinical features as well as the radiologic, electrocardiographic, and perfusion lung scan findings are shown in Table 1. Dyspnea and cough were the main complaints. In most of the patients, dyspnea was related to mild and minimal physical activity (97 percent). Cough was mostly productive of hyaline sputum except during exacerbations when it was purulent. On physical examination,
DISCUSSION
Wood smoke is a complex mixture of compounds, including the following: (1) suspended particles of respirable size; (2) gases, such as carbon monoxide, sulfur oxides, nitrous oxides, and aldehydes; and (3) polyorganic matter, including polycyclic aromatic hydrocarbons.1, 2, 26 There is in vitro evidence that many of these compounds are mutagenic,27 and they also contain irritants, cilia-toxic fractions, and coagulating agents1, 26 that can compromise respiratory system defenses and increase the
ACKNOWLEDGMENTS
The authors are indebted to Dr. Donald Greenberg and Dr. Armando Fraire for their review of the manuscript and their constructive suggestions.
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Manuscript received September 10; revision accepted May 5.