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J Vestbo

Publications and source records attributed to J Vestbo.

At least 91 records · Page 5Linked to original sources
PubMed1997

Alveolar damage in AIDS-related Pneumocystis carinii pneumonia.

OBJECTIVE: Pneumocystis carinii pneumonia is the most common and serious of the pulmonary complications of AIDS. Despite this, many basic aspects in the pathogenesis of HIV-associated P carinii pneumonia are unknown. We therefore undertook a light and electron microscopic study of transbronchial biopsy specimens to compare pathologic features of P carinii pneumonia and other HIV-related lung diseases. DESIGN AND PATIENTS: Thirty-seven consecutive HIV-infected patients undergoing a diagnostic bronchoscopy. RESULTS: P carinii pneumonia was characterized by an increase in inflammation, edema, exudate, fibrosts, type II pneumocyte proliferation, and cellular infiltration of the alveolar wall when compared with other lung diseases (all p < 0.05). Electron microscopy showed apposition of the trophozoite to the type I pneumocyte. Erosion of type I pneumocytes was observed in 13 of 15 patients with P carinii pneumonia, whereas none without P carinii pneumonia had this finding (p < 0.05). Erosion of the type II pneumocyte was not observed. CONCLUSION: Inflammation, interstitial fibrosis, and alveolar epithelial erosion are characteristic features of P carinii pneumonia. The changes may form the pathologic basis for the respiratory failure seen in patients with P carinii pneumonia. Electron microscopy did not show any diagnostie advantage over conventional light microscopy using routine stains.

AIDS-Related Opportunistic Infections↗
PubMed1997

Gender difference in smoking effects on lung function and risk of hospitalization for COPD: results from a Danish longitudinal population study.

Recent findings suggest that females may be more susceptible than males to the deleterious influence of tobacco smoking in developing chronic obstructive pulmonary disease (COPD). This paper studies the interaction of gender and smoking on development of COPD as assessed by lung function and hospital admission. A total of 13,897 subjects, born after 1920, from two population studies, 9,083 from the Copenhagen City Heart Study (CCHS) and 4,814 from the Glostrup Population Studies (GPS), were followed for 7-16 yrs. Data were linked with information on hospital admissions caused by COPD. Based on cross-sectional data, in the CCHS the estimated excess loss of forced expiratory volume in one second (FEV1) per pack-year of smoking was 7.4 mL in female smokers who inhaled and 6.3 mL in male smokers who inhaled. In the GPS, the corresponding excess loss of FEV1 was 10.5 and 8.4 mL in females and males, respectively. Two hundred and eighteen subjects in the CCHS and 23 in the GPS were hospitalized during follow-up. Risk associated with pack-years was higher in females than in males (relative risks (RRs) for 1-20, 20-40 and >40 pack-years were 7.0 (3.5-14.1), 9.8 (4.9-19.6) and 23.3 (10.7-50.9) in females, and 3.2 (1.1-9.1), 5.7 (2.2-14.3) and 8.4 (3.3-21.6) in males) but the interaction term gender x pack-years did not reach significance (p=0.08). Results were similar in the GPS. After adjusting for smoking in more detail, females in both cohorts had an increased risk of hospitalization for COPD compared to males with a RR of 1.5 (1.2-2.1) in the CCHS and 3.6 (1.4-9.0) in the GPS. This was not likely to be caused by a generally increased rate of hospital admission for females. Results were similar when including deaths from COPD as endpoint. In two independent population samples, smoking had greater impact on the lung function of females than males, and after adjusting for smoking females subsequently suffered a higher risk of being admitted to hospital for COPD. Results suggest that adverse effects of smoking on lung function may be greater in females than in males.

Adult↗
PubMed1996

[Chronic expectoration and risk of death in chronic obstructive lung disease].

UNLABELLED: We wished to determine whether excess COPD-related mortality in subjects with chronic mucus hypersecretion (CMH) could be explained by proneness to pulmonary infection. METHODS: 14,223 subjects of both sexes were followed for 10-12 years. Deaths with COPD as underlying or contributory cause (n = 214) were included and if death occurred in hospital, hospital records were obtained when possible (n = 101). From information regarding increased or purulent mucus, fever, leucocytosis and chest X-ray during hospital admission, death was classified as caused by pulmonary infection (n = 38), not caused by pulmonary infection (n = 51), or unclassifiable (n = 12). RESULTS: Of subjects reporting CMH, 54% died from pulmonary infection, whereas that was only the case for 28% of subjects without CMH (p < 0.01). Cox regression-analysis showed a strong inverse relationship between ventilatory function and COPD-related mortality. CMH was an independent predictor of death with pulmonary infection implicated (RR:3.5) but not of death without pulmonary infection (RR:0.9). CONCLUSION: COPD-patients with CMH are more likely to die from pulmonary infection than COPD-patients without CMH.

Adult↗
PubMed1996

[Isolated systolic hypertension: a significant risk factor of cerebral apoplexy and acute myocardial infarction. A prospective population based study].

The aim of this prospective population based study was to determine the prevalence of isolated systolic hypertension (ISH) and associated cardiovascular risk. ISH was defined as systolic blood pressure > or = 160 mmHg and diastolic blood pressure < 90 mmHg. The associated risk of stroke and myocardial infarction (MI) was assessed using a multivariate Cox regression model. Subjects (n = 6621) were included if aged 50 or older, without antihypertensive or cardiac medicine, and without a previous stroke or MI. The prevalence of ISH increased from 3% among fifty-year olds to 13% among seventy-year olds. No sex difference was found. Adjusted relative risk of stroke was 3.0 (95% CI 1.6-5.3) for women and 2.7 (1.8-4.3) for men when compared to normotensives. Adjusted relative risk of MI was 0.8 (0.3-2.0) for women and 1.6 (1.0-2.5) for men. Population attributable risk percent for stroke associated with ISH is up to 30%.

Aged↗
PubMed1996

Mortality in adults with self-reported asthma. Copenhagen City Heart Study Group.

BACKGROUND: On the question of whether asthma shortens survival the published work gives no clear answer. We have prospectively analysed overall and cause-specific mortality in persons with self-reported asthma. METHODS A sample of 13 540 individuals (6104 men) 20 years of age or older, randomly selected from the general population of the city of Copenhagen, was followed for 17 years. FINDINGS: Survival in participants with self-reported asthma was significantly poorer than in non-asthmatics, the excess mortality being limited to pulmonary mortality. After statistical adjustment for age, length of school education, and smoking, women with asthma had a 1.7 higher risk of dying than women without asthma (95% confidence interval 1.3--2.2). Although the relative risk (RR) of dying with asthma was slightly lower in men (RR = 1.5, 95% Cl 1.2-1.9) the difference between sexes was not significant. The results were similar within smoking groups and the highest risk of death associated with asthma was seen among never-smokers (RR = 2.1, 95% Cl 1.6-2.3). Inclusion of one-second forced expiratory volume, in % predicted, in the mortality analyses showed that the increased risk of death associated with asthma was mediated mainly through reduced lung function. INTERPRETATION: We conclude that, in the general population, self-reported asthma is associated with a slight excess of mortality, mainly from respiratory diseases.

Adult↗
PubMed1996

[Prognostic value of interleukin-8 in AIDS-related Pneumocystis carinii pneumonia].

UNLABELLED: We evaluated the significance of interleukin-8 (IL-8) in Pneumocystis carinii pneumonia (PCP). Bronchoalveolar lavage (BAL) fluid and serum was prospectively collected in 76 consecutive HIV-infected patients with a primary episode of PCP, as well as in ten healthy control subjects. Patients were found to have elevated levels of IL-8 in BAL fluid compared to control subjects (p < 0.01). Nine patients died during the course of PCP. Non-survivors had significantly higher IL-8 levels in BAL fluid than survivors (p < 0.05). Furthermore patients with levels of IL-8 in BAL greater then 90 pg/ml (i.e. greater than control subjects) had significantly worse vital prognosis (log rank test, p < 0.05). Thirteen patients required mechanical ventilation (MV), and these patients had significantly elevated levels of IL-8 compared with patients not requiring MV (p < 0.05). IN CONCLUSION: i) IL-8 in BAL fluid correlates to the clinical severity of the pneumonia, and ii) is a predictor of mortality and severe respiratory compromise.

AIDS-Related Opportunistic Infections↗
PubMed1996

Association of chronic mucus hypersecretion with FEV1 decline and chronic obstructive pulmonary disease morbidity. Copenhagen City Heart Study Group.

The aim of this study was to examine the association between chronic mucus hypersecretion, and FEV1 decline, and subsequent hospitalization from chronic obstructive pulmonary disease (COPD). We used data from The Copenhagen City Heart Study on 5,354 women and 4,081 men 30 to 79 yr of age with assessment of smoking habits, respiratory symptoms, and spirometry at two surveys 5 yr apart. Information on COPD hospitalization during 8 to 10 yr of subsequent follow-up was obtained from a nationwide register. Chronic mucus hypersecretion was significantly associated with FEV1 decline; the effect was most prominent among men, where chronic mucus hypersecretion at both surveys was associated with an excess FEV1 decline of 22.8 ml/yr (95% confidence interval, 8.2 to 37.4) compared with men without mucus hypersecretion, after adjusting for age, height, weight change, and smoking; in women, the excess decline was 12.6 ml/yr (0.7-24.6). Chronic mucus hypersecretion was associated with subsequent hospitalization due to COPD after adjusting for age and smoking; relative risk was 5.3 (2.9 to 9.6) among men and 5.1 (2.5 to 10.3) among women. After further adjusting for FEV1 at the second survey, the relative risk was reduced to 2.4 (1.3 to 4.5) for men and 2.6 (1.2 to 5.3) for women. Chronic mucus hypersecretion was significantly and consistently associated with both an excess FEV1 decline and an increased risk of subsequent hospitalization because of COPD.

Adult↗
PubMed1995

[Sarcoidosis. Dependence of life expectancy on lung function, respiratory symptoms, roentgenologic stage and age at diagnosis and significance of extrapulmonary manifestations].

Patients with intrathoracic sarcoidosis have - during prolonged observation (27 years) - the same survival as the general population. A higher mortality from sarcoidosis as well as from diseases not related to sarcoidosis is found among persons who at the time of diagnosis of sarcoidosis had respiratory symptoms and a low FEV1, TLC and Tiffeneau. Our knowledge of the prognosis for extrapulmonary manifestations and their influence on survival is sporadic. Symptoms from heart and CNS have in studies of selected patients been connected with an elevated mortality.

Adolescent↗
PubMed1995

[Long-term prognosis of pulmonary sarcoidosis. 1. Prognostic value of lung function and symptoms].

A follow-up of 254 patients with intrathoracic sarcoidosis has been carried out after a median of 27 years from diagnosis. All patients could be traced. No excess mortality was found (80 deaths observed versus 66 expected). The causes of death were related to sarcoidosis in 41%. X-ray stage was related to survival with a significant excess mortality for stage 3. Early clearing of X-ray changes gave a favourable vital prognosis. Survival was related to lung function, especially forced expiratory volume in 1 second (FEV1) and total lung capacity (TLC). All deaths from sarcoidosis were seen among patients with respiratory symptoms at presentation. For sarcoidosis & sarcoidosis-related deaths (N = 33), presence of one or more of the respiratory symptoms increased the risk significantly. For overall mortality respiratory symptoms were also significant predictors; this was the case even after adjusting for age, sex, x-ray stage and lung function (FEV1 & TLC) at presentation. In conclusion, no excess mortality was observed after a median of 27 years follow-up. Lung function, respiratory symptoms and to some extent X-ray stage at time of diagnosis influenced long-term mortality in patients with intrathoracic sarcoidosis.

Adult↗
PubMed1995

[Long-term prognosis of pulmonary sarcoidosis. 2. Cardiac sarcoidosis and other extrapulmonary manifestations].

Frequency and prognostic importance of extrapulmonary manifestations have been examined in 254 patients with intrathoracic sarcoidosis. A follow-up was carried out after a median of 27 years from diagnosis. All patients could be traced. Extrapulmonary manifestations were found in 119 patients (47%), mostly occurring within the first years after diagnosis of intrathoracic sarcoidosis; skin manifestations were most frequently seen. ECG-abnormalities were found in 35 patients (14%); in 17 cases in the form of sinus tachycardia. No excess mortality was found (80 deaths observed versus 66 expected). The causes of death were related to sarcoidosis in 41%. Only tachycardia was associated with an unfavourable prognosis and this association vanished after adjusting for decreased lung function. None of the other extrapulmonary manifestations were associated with an unfavourable vital prognosis. Erythema nodosum was of no prognostic significance concerning survival. In conclusion, extrapulmonary manifestations are frequent in patients with intrathoracic sarcoidosis but do not influence vital prognosis.

Aged↗
PubMed1995

Prognostic value of interleukin-8 in AIDS-associated Pneumocystis carinii pneumonia.

UNLABELLED: Interleukin-8 (IL-8) is a potent neutrophil chemoattractant and activator. Pneumocystis carinii pneumonia is associated with an accumulation of neutrophils in bronchoalveolar lavage (BAL) fluid. Thus, we hypothesized that IL-8 is involved in the pathogenesis of P. carinii pneumonia. BAL fluid and serum were prospectively collected in 76 consecutive HIV-infected patients with a primary episode of P. carinii pneumonia, as well as in 10 healthy control subjects. Patients were found to have elevated levels of IL-8 in BAL fluid compared with control subjects (p < 0.01). Nine patients died during the course of P. carinii pneumonia. Comparing survivors with nonsurvivors, the median IL-8 level in BAL fluid was 127 (0 to 3,900) versus 584 (127 to 6,100) pg/ml (p < 0.05). Furthermore, patients with levels of IL-8 in BAL fluid greater than 90 pg/ml (i.e., greater than control subjects) had significantly worse vital prognosis (log rank test, p < 0.05). Thirteen percent required mechanical ventilation (MV). Patients requiring MV had a median IL-8 level of 396 (25 to 6,100) versus 129 (0 to 3,900) pg/ml for patients not requiring MV (p < 0.05). IN CONCLUSION: i) IL-8 in BAL fluid correlates to the clinical severity of the pneumonia, and ii) is a predictor of mortality and severe respiratory compromise.

AIDS-Related Opportunistic Infections↗
PubMed1995

Chronic mucus hypersecretion in COPD and death from pulmonary infection.

The association of chronic mucus hypersecretion and mortality is a matter of debate. We wished to determine whether the relationship between chronic mucus hypersecretion and chronic obstructive pulmonary disease (COPD)-related mortality could be explained by proneness to pulmonary infection. We followed 14,223 subjects of both sexes for 10-12 yrs. Cases where COPD was an underlying or contributory cause of death (n = 214) were included, and hospital records were obtained when possible (n = 101). From the presence of increased mucus, purulent mucus, fever, leucocytosis and infiltration on chest radiography, death was classified as either due to pulmonary infection (n = 38), other causes (n = 51), or unclassifiable (n = 12). Of subjects reporting chronic mucus hypersecretion at the initial examination, pulmonary infection was implicated in 54% of deaths, whereas this only occurred in 28% of subjects without chronic mucus hypersecretion. Controlling for covariates, in particular smoking habits, a Cox analysis showed a strong inverse relationship between ventilatory function and COPD-related mortality. Chronic mucus hypersecretion was found to be a significant predictor of COPD-related death with pulmonary infection implicated (relative risk (RR) 3.5) but not of death without pulmonary infection (RR 0.9). We consider that subjects with COPD and chronic mucus hypersecretion are more likely to die from pulmonary infections than subjects without chronic mucus hypersecretion. This may explain the excess mortality in subjects with COPD and chronic mucus hypersecretion found in previous studies.

Cause of Death↗
PubMed1995

Risk factors for death and hospitalization from pneumonia. A prospective study of a general population.

The aim of this study was to identify possible risk indicators for pneumonia leading to death and hospitalization in the general population. We followed 6,158 men and 7,265 women aged 30-70 years, who participated in the Copenhagen City Heart Study, a prospective population study, for 12 years with regard to mortality and hospital admissions for pneumonia. A total of 260 deaths with pneumonia as main or contributory death cause had occurred, and 405 subjects had been admitted to hospital at least once because of pneumonia. Mortality and hospitalization were analysed by multivariate Cox regression models. In addition to increasing age, forced expiratory volume in one second (FEV1) was strongly and consistently related to both pneumonia related mortality and hospitalization. Women with FEV1 < 60% predicted had a relative risk of 5.7 (95% confidence interval: 2.9-11) and 3.6 (2.1-6.4) for death and hospitalization, respectively, when compared with women with FEV1 > or = 100% predicted. Similar, although lower, relative risks were observed in men. Other significant risk indicators for hospitalization were: self-reported asthma (women), mucus hypersecretion (women and men), history of stroke (men) and smoking (women). We conclude that, in addition to age, reduced FEV1 is the most important risk indicator for severe pneumonia.

Adult↗
PubMed1995

Does cytomegalovirus predict a poor prognosis in Pneumocystis carinii pneumonia treated with corticosteroids? A note for caution.

OBJECTIVE: To examine the importance of cytomegalovirus (CMV) in bronchoalveolar lavage (BAL) fluid of patients with HIV-associated Pneumocystis carinii pneumonia (PCP) treated with adjunctive corticosteroids (CS). DESIGN: Analysis of clinical data during a 5-year period. SETTING: Department of infectious diseases where clinical and paraclinical data on patients suspected of having PCP have been sampled prospectively. PATIENTS: 148 consecutive patients with a first episode of PCP in a 5-year period. MAIN OUTCOME MEASURE: Vital status 3 months after diagnosis of PCP. RESULTS: Patients with PCP treated with adjunctive CS who had CMV cultured from BAL fluid had a two times higher mortality within 3 months from bronchoscopy than others (p = 0.08). This difference could not be explained by differences in CD4 count, PO2 or PCO2 at time of bronchoscopy. CONCLUSION: With the accepted usage of adjunctive CS in severe PCP, the role of CMV as a pulmonary copathogen may have changed. Active CMV infection may be an important cause of failing treatment of severe PCP in those treated with adjunctive CS.

AIDS-Related Opportunistic Infections↗
PubMed1995

Electrocardiographic changes in patients with intrathoracic sarcoidosis: influence on prognosis.

A retrospective evaluation of 244 electrocardiograms obtained at rest at time of diagnosis from a population of 254 patients with intrathoracic sarcoidosis was carried out. Thirty-five (14%) were abnormal. Sinus tachycardia was present in 17 (7%), the rest encompassing various degrees of right-sided bundle branch, atrioventricular first degree block, ventricular extrasystolia and ST-depression. At follow-up after a median time of 27 years we found a significantly higher mortality risk in the group with ECG-changes compared to those without. Excess mortality was increased when comparing patients with tachycardia to those without. However, when adjusted for FEV1, the risk of death was not significantly different between the two groups.

Adolescent↗