Chest
Volume 103, Issue 1, January 1993, Pages 12-20
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Clinical Investigations
Pulmonary Arterial Hypertension and Cor Pulmonale Associated with Chronic Domestic Woodsmoke Inhalation

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We describe the clinical, radiologic, functional, and pulmonary hemodynamic characteristics of a group of 30 nonsmoking patients with a lung disease that may be related to intense, long-standing indoor wood-smoke exposure. The endoscopic and some of the pathologic findings are also presented. Intense and prolonged wood-smoke inhalation may produce a chronic pulmonary disease that is similar in many aspects to other forms of inorganic dust-exposure interstitial lung disease. It affects mostly country women in their 60s, and severe dyspnea and cough are the outstanding complaints. The chest roentgenograms show a diffuse, bilateral, reticulonodular pattern, combined with normal-sized or hyperinflated lungs, as well as indirect signs of pulmonary arterial hypertension (PAH). On the pulmonary function test the patients show a mixed restrictive-obstructive pattern with severe hypoxemia and variable degrees of hypercapnia. Endoscopic findings are those of acute and chronic bronchitis and intense anthracotic staining of the airways appears to be quite characteristic. Fibrous and inflammatory focal thickening of the alveolar septa as well as diffuse parenchymal anthracotic deposits are the most prominent pathologic findings, although inflammatory changes of the bronchial epithelium are also present. The patients had severe PAH in which, as in other chronic lung diseases, chronic alveolar hypoxia may play the main pathogenetic role. However, PAH in wood-smoke inhalation-associated lung disease (WSIALD) appears to be more severe than in other forms of interstitial lung disease and tobacco-related COPD. The patients we studied are a selected group and they may represent one end of the spectrum of the WSIALD.

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.

REFERENCES (46)

  • MR Pandey

    Prevalence of chronic bronchitis in a rural community of the hill region of Nepal

    Thorax

    (1984)
  • MR Pandey

    Domestic smoke pollution and chronic bronchitis in a rural community of the hill region of Nepal

    Thorax

    (1984)
  • HR Anderson

    Respiratory abnormalities in Papua New Guinea children: the effects of locality and domestic wood smoke pollution

    Int J Epidemiol

    (1978)
  • LM Melchum et al.

    Factores de riesgo asociados a la bronquitis cronica

    Neumol Cir Torax

    (1989)
  • World Health Organization Technical Report Series No. 213

    Circulation

    (1963)
  • JH Comroe et al.
    (1962)
  • E Baldwin et al.

    Pulmonary insufficiency: I. Physiologic classification, clinical methods of analysis, standard values in normal subjects

    Medicine

    (1948)
  • JF Morris et al.

    Spirometric standards for healthy nonsmoking adults

    Am Rev Respir Dis

    (1971)
  • E Lupi-Herrera et al.

    Extrinsic allergic alveolitis caused by pigeon breeding at a high altitude (2,240 meters)

    Am Rev Respir Dis

    (1981)
  • E Lupi Herrera et al.

    The role of hydralazine therapy for pulmonary arterial hypertension of unknown cause

    Circulation

    (1982)
  • ML Martinez-Guerra et al.

    Valores normales de algunas medidas de la función respiratoria en la Ciudad de México

    Prensa Med Mex

    (1973)
  • A De Micheli et al.

    Observaciones sobre los valores hemodinàmicos y respiratorios obtenidos en sujetos normales

    Arch Inst Cardiol Mex

    (1960)
  • S. Berggren

    The oxygen deficit of arterial blood caused by nonventilating parts of the lung

    Acta Physiol Scand

    (1942)
  • Cited by (0)

    Manuscript received September 10; revision accepted May 5.

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