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Recently, the significance of anthracosis in the tracheobronchial tree, lung parenchyma, and even non-respiratory organs has been postulated and discussed in association with other diseases, especially tuberculosis. We reviewed the current literature by using the following key words in Medline/PubMed, Embase, and Google Scholar databases: anthracosis, anthracofibrosis, anthracotic bronchitis, biomass fuels, and mixed-dust pneumoconiosis. The bibliographies of eligible papers were also reviewed for further relevant articles. A total of 37 studies were assessed. The content of these studies was then divided into specific categories. Considering the pathogenesis, along with histopathological, radiological, and bronchoscopic results regarding anthracotic lesions, we suggest these findings be defined as "ANTHRACOSIS SYNDROME". For the first time, we describe a syndrome involving black pigmentation, which was previously thought to involve only the tracheobronchial tree. Until recently, it was not considered to be a single syndrome with different sites of involvement. [ABSTRACT FROM AUTHOR]

Objective. The potential role of central obesity in asthma outcomes has been examined in a few studies. The aim of this study was to examine the relationship between central obesity and asthma outcomes in a group of Iranian asthma patients. Methods. One hundred and forty-two outpatients with asthma were studied. Central obesity was defined according to National Institute of Health (NIH) and Asian waist circumference (WC) and waist-to-hip ratio (WHR) cut-offs. Asthma outcomes including asthma control, pulmonary function, and morbidity were evaluated. The association between central obesity and asthma outcomes was studied by linear and logistic regression analyses. Results. Linear regression analysis showed a significant association of WHR-based central obesity with forced expiratory volume in 1 s (FEV1) (β = −9.04; p-value = .044) and forced vital capacity (FVC) (β = −10.52; p-value = .012). Logistic regression analysis showed a significant increased risk of asthma attacks in 3 months with Asian WC-based central obesity [odds ratio (OR) = 6.31, 95% confidence interval (CI): 1.16-34.41]; emergency room (ER) visits with NIH WC-based (OR = 5.15, 95% CI: 1.36-19.55) and Asian WC-based (OR = 18.72, 95% CI: 1.92-182.63) central obesity; and hospitalization in 1 year with NIH WC-based (OR = 5.28, 95% CI: 1.28-21.84) and Asian WC-based (OR = 12.39, 95% CI: 1.29-119.53) central obesity. Conclusions. Our study shows that the Asian WC-based central obesity is a better predictor of asthma morbidity. The results of this study emphasize, when studying the relationship between asthma control and obesity, the importance of selecting the proper definitions for asthma control or central obesity and appropriate cutpoints. Further study in this field using other asthma control and quality of life questionnaires is warranted. [ABSTRACT FROM AUTHOR]

The article discusses the immunological features of chronic obstructive pulmonary disease (COPD) induced by indoor pollution and cigarette smoke. It provides a detailed account on the etiology, prevalence and types of COPD. Also discussed is COPD in never smokers with an unknown history of previous exposure to physicians and researchers, as well as autoimmunity and emphysema.

Bronchiectasis is a chronic debilitating condition characterized by abnormal dilated thickwalled bronchi. To investigate humoral immune function in bronchiectatic patients, this study was performed. Forty patients with established diagnosis of bronchiectasis, who were referred from two tertiary care pulmonology centers in Tehran, were investigated in this study. Immunoglobulin isotypes concentrations and IgG-subclasses were measured by nephelometry and enzymelinked immunosorbent assay (ELISA) methods, respectively. All patients received unconjugated pneumococcal vaccine, and blood samples were taken before and 21 days after vaccination. Specific antibodies against whole pneumococcal antigens were measured using the ELISA method. Fifteen (37.5%) out of 40 patients were diagnosed to have defects in antibody mediated immunity including 5 (12.5%) patients with immunoglobulin class deficiency (2 with common variable immunodeficiency and 3 with IgA deficiency), 3 (7.5%) with IgG subclass deficiency and 7 (17.5%) patients had Specific antibody deficiency (SAD) against polysaccharide antigen despite normal levels of serum immunoglobulins and IgG subclasses. Our study along with several other studies confirmed that all patients with bronchiectasis should undergo thorough immunological evaluation in order to identify the presence of the underlying immunologic defect. This evaluation should include serum immunoglobulins, IgG subclasses concentrations and also determination of serum antibodies against pneumococcal antigens. Early diagnosis and appropriate treatment will prevent the subsequent complications and improve quality of life of affected individuals. [ABSTRACT FROM AUTHOR]

Background: Chronic granulomatous disease (CGD) is a rare primary immunodeficiency (approximately 1 case in 200.000-250.000 newborns) caused by defect in one of the components of nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase enzyme (membrane-bound glycoproteins gp91, and cytosolic subunits p47-phox, p67-phox, p40-phox and p22-phox). This leads to defective intracellular killing by phagocyte cells. One of the components of NADPH-oxidase is p22-phox which is encoded by CYBA gene. In this study were identified new genetic changes of CYBA in 22 Iranian patients with autosomal recessive-CGD (AR-CGD). Methods: Twenty two CGD patients based on defect in NADPH oxidase activity (by NBT slide test and DHR-123 assay) and their demographic data and clinical histories were entered this study. They were referred to Immunology, Asthma and Allergy Research Institute (IAARI) for diagnosis and treatment. All patients had p22-phox deficiency based on western blotting. Genomic DNA was extracted from peripheral blood mononuclear cells (PBMCs) and PCR followed by direct sequencing to find p22-phox mutations. Results: Mutation analysis of CYBA revealed 12 different mutations, including three novel mutations: one deletion in exon 1, and two transitions in exon 3 [c.136G>A (p.Gly46Ser)], and exon 6 [c.388C>T (p.Gln130X)]. Conclusions: Three new mutations of CYBA gene in 4 of 22 Iranian patients with AR-CGD were found. These 3 novel mutations can partly complete the data base of Human Gene Mutation Database (HGMD). It can also be helpful for further prenatal diagnosis of next children in the affected families. Also it will be useful for timely decision making in bone marrow transplantation as treatment for CGD patients. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Asthma and Pregnancy: How We Can Improve the Outcome?" in the December 2007 issue.

Background: Worldwide, numerous people of all ages and ethnicities experience asthma. The achievements of current medical regimens for patients frequently depend on three factors: 1) knowledge of patients regarding this disease, 2) patient's attitude about asthma, including willingness to collaborate with the therapeutic group for disease control, and 3) patient's self-efficacy for controlling asthma. Therefore, this study examined the relationship between knowledge, attitudes, and self-efficacy with socio-economic factors in Iranian asthmatic patients during 2006 - 2008. Methods: Participants consisted of 120 adults referred to Milad Hospital, Tehran, Iran during 2006 to 2008 whose physicians diagnosed their asthma. Socio-demographic factors such as sex, age, education level, occupation, marital status, family history of asthma, disease costs, and period of sickness were reviewed. Assessments of knowledge, attitudes and self-efficacy were performed by the Persian version of an international standard questionnaire (KASE-AQ). Data were analyzed by SPSS version 14. Results: Among respondents, only 9 (7.5%) patients had good knowledge about asthma, 108 (90%) patients had a suitable attitude about their asthma and 103 (85.3%) patients had proper self-efficacy. We found a significant association between self-efficacy and attitude in asthmatic patients (P<0.05). Conclusion: Although specific knowledge about asthma is low, however, favorable attitudes toward asthma create opportunities to intervene and improve asthma management among patients. However, the use of educational tools depends on patients' educational levels. Therefore, we recommend elevating asthma knowledge. [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) is a public health problem worldwide. Increased energy and protein needs, decreased energy and protein intake are common in COPD patients. Adequate intake is essential to improve pulmonary function and immune system, prevention of weight loss and maintaining muscle mass and strength. Assessment of energy and protein intake and its relationship with pulmonary function in COPD patients was performed in this study. The study group included 63 COPD patients. For all subjects, evaluation of energy and protein intake by Food Frequency Questionnaire (FFQ) and 24-hour recall, spirometry for measuring pulmonary function and determining disease severity were performed. The subjects were divided into three groups based on disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. Relationship between energy and protein intake with pulmonary function was assessed. Energy and protein intake were lower than the calculated energy and protein demand for all groups. Significant relationship was found between the amount of protein intake extrapolated from food frequency questionnaire with Forced Vital Capacity (FVC) (r=0.2, P=0.02) and Vital Capacity (VC) (r=0.3, P=0.008). The results of the study suggest that accurate evaluation of protein and energy intake and requirements should be included in the goals of medical treatment of COPD patients.

Asthma affects an estimated 300 million people worldwide. Poor compliance with the prescribed medication leads to increased mortality and morbidity. Various determinants of compliance have been described. The purpose of this study was to determine factors that can influence patients' compliance with prescribed Metered Dose Inhaler drugs.179 patients with diagnosis of asthma were selected from two asthma clinics in Tehran. 160 of them met the inclusion criteria. Collected data consisted of patients' demographic data, asthma symptoms and severity, medical history of patients and their attitude towards asthma control and using drugs. Compliance was assessed by four questions regarding using Metered Dose Inhaler drugs. There was a significant correlation between compliance and patient's literacy level, attitude about using drugs, and their knowledge about asthma (p=0.012, p=0.0001, p=0.001 respectively). However there was significant negative correlation between symptom control score and compliance (r =-0.270, p=0.004). Other factors including sex, patients' attitude about asthma control and severity of asthma did not show any significant relation. There are four major factors influencing the patients' compliance: level of literacy, attitude towards asthma management, knowledge about asthma, and symptom control. The negative relation between compliance and symptom control may be caused by patients' inadequate knowledge towards continuing treatment after improvement in their conditions. The study emphasizes on the importance of enhancing the patients' compliance. This could be done by providing patients with adequate information about their disease and treatment.

The prevalence of both obesity and asthma has increased in recent years. Thus we decided to investigate the relation between obesity and asthma severity. We undertook a cross-sectional study in outpatient asthma clinics of 2 tertiary hospitals in Tehran. Obesity was defined as a body mass index greater than 30. Asthma severity was defined by using the Guide for Asthma Management and Prevention 2004 guidelines, according to patients' clinical and/or spirometerical parameters. Active cigarette smoking patients and patients with a history of other lung diseases were excluded.A total of 116 individuals, aged 16-83 years with a mean age of 46.57+/-15.05 years, met the entry criteria. There were 73 females and 43 males. The prevalence of obesity in our study population was 29.3%. The Spearman correlation coefficient between asthma severity and body mass index was r= 0.275 (p= 0.001). Mean body mass index of females and males were 28.95+/-5.41 and 25.17+/-4.17, respectively. Mean body mass index of females with asthma was significantly higher than males (p< 0.0001). The odds ratios for obesity were 8.650, 8.746, and 22.491 for mild, moderate and severe persistent asthma, respectively, compared to patients with mild intermittent asthma.With increasing asthma severity, we observed higher occurrence of obesity in adults. The association of asthma severity with obesity suggests that obesity may be a potentially modifiable risk factor for asthma or asthma exacerbation.