Gold J A, Jagirdar J, Hay J G, Addrizzo-Harris D J, Naidich D P, Rom W N
Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, Bellevue Chest Service, New York 10016, USA.
Medicine (Baltimore). 2000 Sep;79(5):310-7. doi: 10.1097/00005792-200009000-00004.
We report an illustrative case of advanced "hut lung," or domestically acquired particulate lung disease (DAPLD), in a recently emigrated nonsmoking Bangladeshi woman with a history of 171 hour-years of exposure to biomass smoke. She presented with symptoms of chronic cough, dyspnea, and early parenchymal lung disease. High-resolution computed tomography (CT) of the chest demonstrated numerous 2- to 3-mm nodules, sparing the pleural surface. To our knowledge, this is the first such report of CT findings in the literature. Bronchoscopy yielded typical anthracotic plaques and diffuse anthracosis with interstitial inflammation on histopathologic examination of biopsy specimens. DAPLD is potentially the largest environmentally attributable disorder in the world, with an estimated 3 billion people at risk. Caused by the inhalation of particles liberated from the combustion of biomass fuel, DAPLD results in significant morbidity from infancy to adulthood. Clinically, DAPLD manifests a broad range of disorders from chronic bronchitis and dyspnea to advanced interstitial lung disease and malignancy. While a detailed environmental history is essential for making the diagnosis in most individuals, for patients with advanced DAPLD, invasive modalities such as bronchoscopy with transbronchial biopsy and examination of bronchoalveolar lavage fluid help differentiate it from other diseases. Recognition of this syndrome and removal of the patient from the environment is the only treatment. The development of well-controlled interventional trials and the commitment of sufficient resources to educate local populaces and develop alternative fuel sources, stove designs, and ventilation are essential toward reducing the magnitude of DAPLD.
我们报告了一例典型的晚期“茅屋肺”，即家庭获得性颗粒性肺病（DAPLD），患者为一名新近移民的不吸烟孟加拉国女性，有171小时年的生物质烟雾暴露史。她出现慢性咳嗽、呼吸困难和早期实质性肺病症状。胸部高分辨率计算机断层扫描（CT）显示有许多2至3毫米的结节，胸膜表面未受累。据我们所知，这是文献中首次关于CT表现的此类报告。支气管镜检查在活检标本的组织病理学检查中发现典型的煤尘斑和弥漫性煤尘沉着伴间质性炎症。DAPLD可能是世界上最大的环境所致疾病，估计有30亿人面临风险。DAPLD由吸入生物质燃料燃烧释放的颗粒引起，从婴儿期到成年期都会导致严重发病。临床上，DAPLD表现出从慢性支气管炎和呼吸困难到晚期间质性肺病和恶性肿瘤等广泛的疾病。虽然详细的环境史对大多数个体的诊断至关重要，但对于晚期DAPLD患者，诸如支气管镜检查加经支气管活检和支气管肺泡灌洗液体检查等侵入性手段有助于将其与其他疾病区分开来。认识到这种综合征并让患者脱离该环境是唯一的治疗方法。开展严格控制的干预试验以及投入足够资源对当地民众进行教育并开发替代燃料来源、炉灶设计和通风设施对于减少DAPLD的影响至关重要。
