Pulmonary & Respiratory Medicine

Pulmonary alveolar proteinosis (PAP) is a rare lung disease in which macrophage dysfunction causes a nonproductive cough and progressive dyspnea. However, mortality in roughly 20% of these patients is due to opportunistic infections by fungal pathogens, Nocardia spp, and mycobacteria. In this case, we discuss a 52-year-old African American male who presented with a month-long history of progressively worsening dyspnea and frequent nonproductive cough. The patient’s medical history was significant for a diagnosis of cavitary pneumonia one year ago. He was treated for community acquired pneumonia. A week later, the patient presented back to the emergency room with seizures and an altered mental status with a lesion appearing on head CT. The brain lesion was removed and tested positive for Nocardia. However, the diagnosis of PAP was not considered at that time. This case is significant because PAP should be considered as a differential when a patient presents with dyspnea, cough, and opportunistic infection. If the patient was diagnosed with PAP at his initial visit, the Nocardia infection could have been found and treated conservatively before it progressed to seizures and an emergent surgery.

Background: Bronchial asthma is one of the most common diseases in Kuwait. Smoking also is on the rise in Kuwait. We therefore conducted this study to at prevalence of smoking among sample of Kuwaiti patients and the impact on asthma control. Methods: Descriptive study of 50 outpatients who were prospectively assessed from single center (Al-Jahra Hospital) that diagnosed recently as bronchial asthma using American Thoracic Society/European Respiratory Society (ATS/ERS) criteria definitions of asthma between the period of 1st of April and 20th may 2013. Patients were divided into two groups: Group A smokers and Group B non-smokers. Pulmonary function test using spirometer and asthma control test (ACT) was done for every patient at the time of visit and after 4 weeks to determine the effect of smoking on asthma control as a primary outcome using GINA guidelines definition for Asthma control and treatment. Results: At study entry 30% of sample size were smoker asthmatics. Smokers showed worse symptoms of wheezing, cough, and shortness of breath compared to non-smokers asthmatics whereas non-smokers asthmatics were more likely to have seasonal symptoms and use salbutamol MDI. Both groups showed similar spirometry findings at study entry. At 4 weeks from the first visit there was a significant difference in symptoms and signs of bronchial asthma between the 2 groups. Both measures of asthma control test and spirometer results favoured non-smokers. Smokers asthmatics were more likely to use rescue salbutamol MDI and non-compliant. No hospital admissions or acute exacerbations during the period of the study. Conclusion: Smoking was associated with worse asthma control and poor compliance among asthmatics.