The role of N-acetylcysteine (NAC) in the treatment of chronic bronchitis is unclear. Since a number of studies have been published on this topic, a systematic review of published studies seems justified.A systematic search (Medline, Embase, Cochrane Library, bibliographies, no language restriction) for published randomized trials comparing oral NAC with placebo in patients with chronic bronchitis was performed. Dichotomous data on prevention of exacerbation, improvement of symptoms and adverse effects were extracted from original reports. The relative benefit and number-needed-to-treat were calculated for both individual trials and combined data.Thirty-nine trials were retrieved; eleven (2,011 analysed patients), published 1976± 1994, were regarded as relevant and valid according to preset criteria. In nine studies, 351 of 723 (48.5%) patients receiving NAC had no exacerbation compared with 229 of 733 (31.2%) patients receiving placebo (relative benefit 1.56 (95% confidence interval (CI) 1.37±1.77), number-needed-to-treat 5.8 (95% CI 4.5±8.1). There was no evidence of any effect of study period (12±24 weeks) or cumulative dose of NAC on efficacy. In five trials, 286 of 466 (61.4%) patients receiving NAC reported improvement of their symptoms compared with 160 of 462 (34.6%) patients receiving placebo (relative benefit 1.78 (95% CI 1.54±2.05), number-needed-to-treat 3.7 (95% CI 3.0±4.9)). With NAC, 68 of 666 (10.2%) patients reported gastrointestinal adverse effects compared with 73 of 671 (10.9%) taking placebo. With NAC, 79 of 1,207 (6.5%) patients withdrew from the study due to adverse effects, compared with 87 of 1,234 (7.1%) receiving placebo.In conclusion, with treatment periods of~12±24 weeks, oral N-acetylcysteine reduces the risk of exacerbations and improves symptoms in patients with chronic bronchitis compared with placebo, without increasing the risk of adverse effects. Whether this benefit is sufficient to justify the routine and long-term use of Nacetylcysteine in all patients with chronic bronchitis should be addressed in further studies and cost-effectiveness analyses. Eur Respir J 2000; 16: 253±262.

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The association of bronchiolitis obliterans organizing pneumonia (BOOP) with polymyalgia rheumatica is rare, and only one case has previously been described. This study reports on the case of an 80 yr-old male who presented with malaise, nonproductive cough and exertional dyspnoea for several weeks, along with a history of bilateral shoulder and pelvic girdle pain of several months' duration. The chest radiograph revealed a pneumonic infiltrate in the right lower lobe, which was unresponsive to antibiotics. Bronchoscopy, bronchoalveolar lavage and a transbronchial lung biopsy established the diagnosis of BOOP. The patient improved consistantly on steroids. As in other connective diseases, organizing pneumonia may be one of the early manifestations of polymyalgia rheumatica. Eur Respir J 1999; 13: 926±929. Polymyalgia rheumatica is a frequent clinical syndrome seen mainly in elderly patients. It often presents a diagnostic challenge, because of a large differential diagnosis including malignant neoplasms or connective tissue diseases [1]. The estimated prevalence in persons older than 50 yrs is 0.5% in the USA [1,2]. Lung involvement in polymyalgia rheumatica is rare and has been observed in the form of respiratory symptoms such as cough due to upper airway inflammation or vasculitis, pulmonary nodules and infiltrates or vasculitis of the pulmonary arteries or smaller pulmonary blood vessels [3±6]. Organizing pneumonia is a common pattern of injury and repair seen in a number of different clinical settings, mainly connective tissue disease or exposure to drugs [7,8]. The association of organizing pneumonia with polymyalgia rheumatica has been reported only once [9], hence the present report. Case reportA 80 yr-old white male presented at the outpatient clinic because of a history of several months of bilateral aches and stiffness involving the shoulders and pelvic girdle. Subsequently, he developed a nonproductive cough and slight dyspnoea on exertion. He complained of malaise, fatigue, depression, and 4 kg of weight loss in the last 2 months. The patient was a retired mason, with no history of recent respiratory tract infection. He had never smoked and had had no dermatoses or allergies. He had taken hydrocodeine for 1 month because of the cough. He denied taking any other drugs, even in the past few years.At admission, he had no fever. Physical examination of the heart and lungs was normal. The temporal arteries were neither tender nor pulseless, and he had no pain or swelling of the peripheral joints. A slight rigour of both forearms and reduced sensitivity in his lower legs were noticed. The white blood cell count (WBC), including eosinophils, was normal. The haemoglobin was 12.4 g . dL -1 (normal =14.4± 17.5 g . dL -1 ) with a normal mean corpuscular volume. The erythrocyte sedimentation rate (ESR) was 46 mm in 1 h (normal <20) and the C-reactive protein (CRP) 62 mg . L -1 (normal <10 mg . L -1 ). Serum electrophoresis showed a normal pattern. Creatine phosphokinase and levels of vitamin B12 and fo...

BackgroundTakayasu's arteritis is a chronic systemic inflammatory disease that usually affects the aorta, its primary branches and occasionally the pulmonary and coronary arteries. Female gender in reproductive age and Asian origin are known factors associated with higher disease prevalence. The clinical manifestations vary considerably and are typically caused by limb or organ ischemia illness and fever. The estimated incidence rate in the western world is 2.6 cases per million persons per year. Occasionally, exertional dyspnea can be the sole primary clinical manifestation of Takayasu's arteritis.Case presentationWe report the case of a 57-year-old woman who was referred to our institution with increasing exertional dyspnea caused by pulmonary artery involvement in Takayasu's arteritis. In a review of the literature we discuss demographic data, clinical and radiographic findings and available therapeutic options.ConclusionsDyspnea due to pulmonary artery involvement can be the initial symptom of Takayasu's arteritis. Simple clinical tests, including a complete pulse-status and blood pressure measuring at both arms can lead to the right diagnosis and should always be done beyond the auscultation of the heart and lungs in patients with dyspnea.

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