BackgroundChronic cough is a common problem, frequently caused or exacerbated by acid reflux. Diagnosis of acid reflux cough is haphazard currently, often relying on long therapeutic trials of expensive medications. We tested the hypothesis that the most relevant mechanistic component of acid reflux in chronic cough is when it rises to the level of the airway where acid can potentially be aspirated. We further wished to determine if multi-sample exhaled breath condensate (EBC) pH profiles can identify chronic cough patients likely to respond to proton pump inhibitor therapy.Methods59 subjects were recruited for this study. Initially we examined EBC pH (gas-standardized with Argon) in the setting of 15 experimental pharyngeal acid challenges to determine duration of EBC acidification. Subsequently, we enrolled 22 healthy subjects to determine a normal multi-sample exhaled breath condensate pH profile over 1–3 days. We additionally obtained multi-sample EBC pH profiles in 22 patients with chronic cough. These samples were timed to occur after coughing episodes. Exhaled breath condensate pH was measured after gas standardization.ResultsWe found that exhaled breath condensate pH is substantially reduced for approximately 15 minutes after pharyngeal acid load. Healthy subjects rarely have any low EBC pH values (defined as < 7.4 based on a normative reference range from 404 healthy subjects). Patients with chronic cough who subsequently responded well to proton pump inhibition (n = 8) invariably had one or more cough episodes associated with EBC acidification. No patient who had normal EBC pH with each of their cough episodes reported a clinically relevant response to proton-pump inhibition.ConclusionPatients whose cough responds to proton pump inhibition have transient exhaled breath condensate acidification with coughing episodes, supporting the role of airway acidification in reflux-triggered cough. Multi-sample EBC pH profiles, involving samples collected immediately subsequent to a coughing episode, may be useful appropriately to direct therapy to those patients with cough who have relevant acid reflux.

Exhaled breath condensate acidification reflects the presence of airway acidification. Mycobacterium tuberculosis is an organism particularly sensitive to acidity. We aimed to determine if there is evidence of airway acidification in a cross section of patients with active tuberculosis.We enrolled 51 subjects with active tuberculosis in Ghana and Thailand, and compared them to control subjects. We collected exhaled breath condensate, and assayed for pH after gas standardization.Exhaled breath condensate pH from the control group revealed a median of 7.9 (7.7 -8.0, n = 21), significantly higher than the active pulmonary tuberculosis patients who had a median pH of 7.4 (7.0 -7.7; n = 51; p=0.002). Presence or absence of antibiotic therapy did not affect EBC pH values.These exhaled breath condensate data support the theory that airways become acidic in active tuberculosis infection. This may be a mechanism of immune response and pathology not previously considered.

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Background. Patients with cholangiocarcinoma (CCA) have poor prognosis and high mortality. Therefore, early detection and early diagnosis are extremely important to control the development of CCA. This study aims to explore the diagnostic effect in patients with CCA and imaging characteristics of MRI combined with CT. Methods. 109 patients with suspected CCA underwent CT and MRI before diagnosis. The examination results were compared with the “gold standard.” ROC curve was drawn to analyze the diagnostic efficacy of MRI combined with CT for CCA patients. Results. The diagnosis rate of suspected CCA patients was 95.41%. The diagnostic coincidence rate of CT and MRI examination was 89.42% and 92.31%, respectively. The diagnostic coincidence rate of MRI combined with CT examination was 100.00%. The number of CT delayed enhancement, peripheral bile duct dilatation, and hepatic capsular depression were more than those of MRI. The number of circular enhancement cases in the CT group was less than that in the MRI group. ROC curve results showed that the sensitivity and specificity of MRI combined with CT for the diagnosis of CCA patients were higher than those of MRI or CT alone. Conclusion. MRI combined with CT has high diagnostic sensitivity and specificity and can provide imaging evidence for the clinical diagnosis and treatment of CCA.