US EPA

5472132 

Journal Article 

Letter 

Chlorinated solvents, welding and pulmonary edema 

Seldén, A; Sundell, L 

1991 

Yes 

Chest
ISSN: 0012-3692
EISSN: 1931-3543 

99 

1 

263-264 

English 

1984976 

10.1378/chest.99.1.263b 

WOS:A1991EQ85300065 

To the Editor:

The mortality rate in patients with cor pulmonale secondary to chronic obstructive pulmonary disease (COPD) is well documented. The 6 months-1 year survival rate (despite intensive medical treatment) is generally very poor: approximately 30 to 35 percent.

To our knowledge, there is very little information on the mortality rate of patients with cor pulmonale secondary to pulmonary fibrosis (PF) alone or in association with COPD. Pulmonary fibrosis is a common sequela of repeated and improperly treated lower respiratory bacterial, viral, protozoal, and mycobacterial infections during childhood and early adulthood, especially in developing countries with inadequate medical facilities; it usually culminates in poor respiratory function and cor pulmonale.

Exposure to mining dusts such as asbestos and other inorganic particulate matter is also a common cause of chronic lung injury resulting in pulmonary fibrosis with or without obstructive airway disease5,6 and in cor pulmonale later in life.

The mortality rate in patients with cor pulmonale secondary to PF is not exceptionally good; the prognosis is as poor and sobering as that in cor pulmonale secondary to COPD. We have followed up 21 patients (mean age, 47 years) with cor pulmonale secondary to extensive PF postpulmonary tuberculosis for a year. All the patients were maintained on the following conventional treatment: bronchodilators, diuretics and/or veno-vasodilators; oxygen as required; and broad-spectrum antibiotic therapy when respiratory infection was suspected. None of the patients received steroid therapy, and none was on a mechanical ventilator. After a follow-up period of 1 year, only 13 patients (62 percent) had survived. The predicting factor for early deaths was recurrent lower respiratory tract infections, possibly due to impaired respiratory defense mechanisms or undernutrition concurrent with cor pulmonale. Other bad prognostic factors were persistent dyspnea despite adequate bronchodilator therapy, edema resistant to diuretic therapy, central cyanosis, male sex, and coexisting COPD. The patient with extensive PF on chest radiograph also had the poorest prognosis.

Although several authors have indicated malnutrition as one of the poor prognostic factors in patients with cor pulmonale secondary to COPD,7, 8, 9 malnutrition was not one of the predictors of survival among our patients because most of our patients were extremely malnourished due to old pulmonary tuberculosis and cor pulmonale secondary to postpulmonary tuberculosis fibrosis.