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CORRELATION OF CLINICAL FEATURES WITH PULMONARY FUNCTION TEST IN CASES OF TROPICAL PULMONARY EOSINOPHILIA
October 2008, Vol 134, No. 4_MeetingAbstracts Abstract: Poster Presentations | October 2008
CORRELATION OF CLINICAL FEATURES WITH PULMONARY FUNCTION TEST IN CASES OF TROPICAL PULMONARY EOSINOPHILIA Narayan Mishra, MBBS*; Prabhati Dutta, MBBS; Nirad K. Gacchayat, MBBS VSS Medical College, Burla, Sambalpur, India Chest Chest. 2008;134(4_MeetingAbstracts):p127002. doi:10.1378/chest.134.4_MeetingAbstracts.p127002
Abstract PURPOSE: Orissa being an endemic area for filariasis, Tropical Pulmonary Eosinophilia(TPE) is common, an effort was made to correlate the clinical features with pulmonary function test(PFT). METHODS: Of the 269 Consecutive TPE cases studied over 8 years 32 dropped out. Diagnosis was made basing on Symptoms, Absolute Eosinophil Count(AEC) more than 2000 per-cubicmillimeter and positive filarial compliment fixation test. PFT was done in all cases before and after treatment of four and eight weeks. In all cases with restrictive pattern, alternate cases were given Diethylcarbamazine (DEC) alone(Group-A) or DEC with oral-prednisolon(Group-B) and bronchodilator (Salmeterol inhelor) was added to cases of mixed pattern. In Group-A, DEC 6 to 8mg/kg body weight was given for four weeks and if AEC remained ≥800–2000, DEC was extended for 4 weeks more and if AEC remained more than 2000, oral- prednisolon 0.6mg/kg bodyweight was added to DEC and tapered every 5-days by 5mg. In the Group-B, DEC+prednisolon was started from day-one and similar protocol was followed as in Group-A. RESULTS: In majority(89.5%) cases restrictive pattern(Mild, Moderate and Severe) was observed followed by mixed pattern(10.5%). Greater percentage of Eosiniphil or Greater number of AEC had no definite relationship with PFT. With longer duration of symptoms more restriction was marked. Reduction in AEC in the Group-B(87.6%) than Group-A(47.7%) at the end of 4 weeks was significant. Though PFT became normal in 75.2% cases in Group-B compared to 47.7% in Group-A at the end of 8 weeks (significant), still then restrictive pattern persisted in 24.8% and 52.3% cases respectively. CONCLUSION: In TPE cases predominately restrictive pattern was observed in PFT which had no definite relationship with AEC but more restriction with longer duration of symptoms. After
treatment, restrictive pattern persisted in many cases but in steroid Group it was significantly reduced. CLINICAL IMPLICATIONS: Probably in filarial endemic areas TPE is one of the causes for interstitial pulmonary fibrosis which needs further investigation and in all cases of TPE initial institution of oral-steroid irrespective of PFT status will be beneficial. DISCLOSURE: Narayan Mishra, No Financial Disclosure Information; No Product/Research Disclosure Information Wednesday, October 29, 2008 1:00 PM - 2:15 PM
CORRELATION OF CLINICAL FEATURES WITH PULMONARY FUNCTION TEST IN CASES OF TROPICAL PULMONARY EOSINOPHILIA Narayan Mishra, MBBS*; Prabhati Dutta, MBBS; Nirad K. Gacchayat, MBBS VSS Medical College, Burla, Sambalpur, India Chest Chest. 2008;134(4_MeetingAbstracts):p127002. doi:10.1378/chest.134.4_MeetingAbstracts.p127002
Abstract PURPOSE: Orissa being an endemic area for filariasis, Tropical Pulmonary Eosinophilia(TPE) is common, an effort was made to correlate the clinical features with pulmonary function test(PFT). METHODS: Of the 269 Consecutive TPE cases studied over 8 years 32 dropped out. Diagnosis was made basing on Symptoms, Absolute Eosinophil Count(AEC) more than 2000 per-cubicmillimeter and positive filarial compliment fixation test. PFT was done in all cases before and after treatment of four and eight weeks. In all cases with restrictive pattern, alternate cases were given Diethylcarbamazine (DEC) alone(Group-A) or DEC with oral-prednisolon(Group-B) and bronchodilator (Salmeterol inhelor) was added to cases of mixed pattern. In Group-A, DEC 6 to 8mg/kg body weight was given for four weeks and if AEC remained ≥800–2000, DEC was extended for 4 weeks more and if AEC remained more than 2000, oral- prednisolon 0.6mg/kg bodyweight was added to DEC and tapered every 5-days by 5mg. In the Group-B, DEC+prednisolon was started from day-one and similar protocol was followed as in Group-A. RESULTS: In majority(89.5%) cases restrictive pattern(Mild, Moderate and Severe) was observed followed by mixed pattern(10.5%). Greater percentage of Eosiniphil or Greater number of AEC had no definite relationship with PFT. With longer duration of symptoms more restriction was marked. Reduction in AEC in the Group-B(87.6%) than Group-A(47.7%) at the end of 4 weeks was significant. Though PFT became normal in 75.2% cases in Group-B compared to 47.7% in Group-A at the end of 8 weeks (significant), still then restrictive pattern persisted in 24.8% and 52.3% cases respectively. CONCLUSION: In TPE cases predominately restrictive pattern was observed in PFT which had no definite relationship with AEC but more restriction with longer duration of symptoms. After
treatment, restrictive pattern persisted in many cases but in steroid Group it was significantly reduced. CLINICAL IMPLICATIONS: Probably in filarial endemic areas TPE is one of the causes for interstitial pulmonary fibrosis which needs further investigation and in all cases of TPE initial institution of oral-steroid irrespective of PFT status will be beneficial. DISCLOSURE: Narayan Mishra, No Financial Disclosure Information; No Product/Research Disclosure Information Wednesday, October 29, 2008 1:00 PM - 2:15 PM