Clinical investigation of obstructive pneumonia with lung cancer

Nineteen episodes (18 patients) of obstructive pneumonia occurring in 247 patients with lung cancer were clinically examined, and the following findings were obtained. 1) All 18 patients were male smokers, with an average of 64 years. 2) Body temperatures stood above 37 degrees C in 95% of the 19 episodes. Leukocytosis was detected in 41%, and neutrophilia was observed in 69%. CRP values were positive in all episodes. 3) The frequency of obstructive pneumonia according to the site of lung cancer was 13.2% in proximal tumors and 1.7% in peripheral tumors. Pathologically, the frequency was 5.2% in adenocarcinomas 7.6% in squamous cell carcinomas, 15.6% in small cell carcinomas and 9.1% in large cell carcinomas. Squamous cell carcinomas even in Stage I led to obstructive pneumonia at the rate of 13.0%. In contrast, higher frequency was observed in adenocarcinomas in Stage II or later and small cell carcinomas in Stage IIIB or later. 4) Obstructive pneumonia was detected at the time of discovery of lung cancer in 48% of the 18 patients, and during treatment and in the terminal stage in 26% respectively. 5) Chest X-ray examinations showed that 42% of the pneumonia cases were lobar pneumonia and 11% had pleural effusion. 6) In expectorated sputum, 50% of bacteria isolated were gram-negative, 10% were gram-positive and 40% were unknown. 7) Most of the bacteria isolated from expectorated sputum showed a good susceptibility to antimicrobial agents, but those proved clinically ineffective. 8) The prognosis of obstructive pneumonia was significantly affected by performance status and levels of total protein and choline-esterase.