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Biomedical subjects

A Agusti-Vidal

Publications and source records attributed to A Agusti-Vidal.

At least 19 recordsLinked to original sources
PubMed1990

Respiratory and skeletal muscle function in steroid-dependent bronchial asthma.

Respiratory and skeletal (deltoid) muscle strength were evaluated in 34 oral steroid-dependent asthmatics by use of maximal inspiratory and expiratory pressures and a myometer. The patients were compared to age- and sex-matched asthmatics who had never been on continuous oral steroid treatment. Endurance time was also studied in ten steroid-dependent asthmatics and ten controls using a pressure threshold breathing device. Nutritional status was assessed from body weight, midarm circumference, triceps skinfold (TSF), prealbumin, albumin, and total protein. An open biopsy from deltoid muscle was taken from nine steroid-dependent asthmatics and the diameter of type 1 and type 2 fibers was measured by a morphometric study. No differences were found between study and control groups either in respiratory and skeletal muscle strength or in endurance time. Steroid-dependent asthmatics showed a decrease in TSF, total protein, albumin, and potassium serum levels when compared with the control group but differences were not statistically significant after Bonferroni's adjustment for multiple comparison studies. Transversal diameter of type 2 fibers was significantly correlated with the percentage of ideal weight (r = 0.75 p less than 0.05), but not with average daily dose of steroids nor with the length of steroid treatment. Our results support the clinical impression that steroids, at the doses usually administered in chronic severe asthma, do not cause muscular weakness. We also found that malnutrition rather than corticosteroids is the most important contributory factor to type 2 muscle fiber atrophy in steroid-dependent asthma.

Adult↗
PubMed1989

How many manoeuvres should be done to measure maximal inspiratory mouth pressure in patients with chronic airflow obstruction?

To determine the number of maximal mouth pressure manoeuvres needed to obtain a reproducible value of maximal inspiratory mouth pressure (MIP), we studied 44 patients with chronic airflow obstruction, with a mean (SD) % predicted FEV1 value of 53.9 (25), who were clinically stable. Maximal inspiratory mouth pressure was determined with an anaeroid manometer during maximal inspiratory efforts in a quasi static condition at residual volume. All patients performed 20 consecutive maximal inspiratory mouth manoeuvres, each one separated by 30-40 seconds. The mean (SD) values of MIP varied from 71.5 (25.5) cm H2O at the first measurement to 80.1 (27) cm H2O at the last measurement. Maximal values of MIP were usually achieved after nine determinations. It is concluded that to obtain a reproducible MIP value in patients with chronic airflow obstruction who are untrained and unexperienced in such manoeuvres a minimum of nine technically acceptable maximal mouth pressure manoeuvres should be performed.

Female↗
PubMed1989

Pulmonary infiltrates in immunocompromised patients. Diagnostic value of telescoping plugged catheter and bronchoalveolar lavage.

The usefulness of telescoping plugged catheter (TPC) together with bronchoalveolar lavage (BAL) in the same bronchoscopic act in the diagnosis of pulmonary infiltrates was studied in 113 fiberoptic bronchoscopic examinations performed on 96 immunocompromised patients. The TPC cultures detected pulmonary bacterial infections in 25 (22 percent) cases but showed a high frequency of false positive results (12 microorganisms, 27 percent). Bronchoalveolar lavage had an overall diagnostic yield of 49 percent (53 of 113 cases). Combining TPC and BAL diagnostic values, 78 of 113 pulmonary infiltrates (69 percent) were diagnosed. The results obtained by both techniques allowed us to modify the treatment in 35 (31 percent) cases. Combined, TPC and BAL show a good diagnostic yield in immunocompromised patients with pulmonary infiltrates. Both techniques should be performed as the first approach in the evaluation of these patients, and be done in the same bronchoscopic procedure.

Bacteria↗
PubMed1989

Predisposing factors to death after recovery from a life-threatening asthmatic attack.

The outcome of 49 asthmatics (20 men and 29 women) who had suffered a severe exacerbation of asthma requiring mechanical ventilation was investigated in a follow-up study ranging from 23 weeks to 10 years. Over this time, there were 6 fatalities, all female chronic asthmatics requiring treatment with bronchodilators, beclomethasone, and short courses of oral steroids. Three died at home as a consequence of a sudden attack. Another patient developed a cardiorespiratory arrest immediately after having received a sedative. In the remaining two cases, death occurred within hours or days of progressive deterioration. Four of the six women had required psychiatric treatment for an anxiety-depression syndrome. These findings support previous studies suggesting that psychological disturbances may be predisposing factors to death in bronchial asthma.

Aged↗
PubMed1989

Aspirin-intolerance as a precipitating factor of life-threatening attacks of asthma requiring mechanical ventilation.

The records of 92 asthmatics who underwent mechanical ventilation were reviewed. In seven patients (8%) the severe attack was precipitated by a non-steroidal anti-inflammatory drug (NSAID); one of these patients died. Five of the cases had a history of asthmatic attacks provoked by NSAIDs; whilst in two the severe attack requiring mechanical ventilation was the first manifestation of NSAID-intolerance. In two patients the NSAID had been prescribed by their physicians. Another aspirin-intolerant patient, a general practitioner, self-administered a NSAID. The sudden attack in another patient was precipitated by a preparation which contains aspirin and is usually recommended for indigestion. In the fatal case the attack was provoked by a capsule containing aspirin, which had been given by a herbalist. Unlike other reports, we found that NSAID-intolerance is a frequent provoking factor in severe acute asthma requiring mechanical ventilation. Inadequate investigation of precipitating factors in asthmatics with severe sudden attacks is a possible reason why this phenomenon is underreported.

Adolescent↗
PubMed1988

Effects of a fish oil enriched diet on aspirin intolerant asthmatic patients: a pilot study.

The effect of a fish oil enriched diet containing about 3 g of eicosapentaenoic acid was studied in 10 patients with aspirin intolerant asthma. Subjects were studied during six weeks on a control diet followed by six weeks on the fish oil diet in a single blind study design. They were asked to record their peak expiratory flow (PEF) twice daily, bronchodilator and steroid doses, and subjective ratings of pulmonary symptoms on diary cards. There were no significant changes in symptom scores over the six weeks of either the control diet or the fish oil diet. PEF values, however, were significantly lower during the fifth and sixth week of the fish oil diet than during the control diet (308 v 262 l/min week 5 and 306 v 256 l/min week 6). Bronchodilator usage was also greater during the fifth and sixth week of the fish oil diet than during the control period (12.0 v 7.4 and 13.0 v 7.4 puffs a day in weeks 5 and 6). This pilot study suggests that fish diets may have a deleterious effect on patients with aspirin intolerant asthma.

Adult↗
PubMed1988

Muscle atrophy in severe exacerbation of asthma requiring mechanical ventilation.

An unusual case of acute muscular atrophy in a patient with a severe exacerbation of asthma requiring mechanical ventilation is reported. High doses of pancuronium bromide and 6-methylprednisolone were administered. It is suggested that the conditions of mechanical ventilation increase in some way the potential of corticosteroids to cause myopathy. The possible implication of myorelaxant drugs in the development of this complication is also suggested.

Albuterol↗
PubMed1988

Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the Metras catheter.

A new guiding technique, Metras catheter (MC), for blindly introducing a telescoping plugged catheter (TPC) was applied to 25 mechanically ventilated patients with suspected bacterial pneumonia (BPN). Results obtained with TPC-MC were compared with those obtained with TPC using a conventional fiberoptic bronchoscope (FB) in random order. The diagnosis of BPN was definitely confirmed in 18 patients. In 7 patients, all TPC samples (MC and FB) were sterile, and a diagnosis other than BPN was proved. In the former group, colony-forming units equal to or greater than 10(3)/ml of one or more microorganisms were obtained in 61% of TPC-MC and in 66% of TPC-FB samples. These percentages increased to 64 and 71%, respectively, when 4 patients with previous antibiotic treatment were excluded from the study group. Agreement was observed between microorganisms cultured from both TPC samples in 11 of 18 patients with proved BPN (61%). Complete disparity was seen only in 2 patients (11%). Two patients developed a self-limiting hemoptysis after the TPC procedure (MC and FB, respectively). We conclude that TPC-MC is both a sensitive and specific technique for the diagnosis of BPN in mechanically ventilated patients. Because the diagnostic value of TPC-MC is similar to that of TPC-FB, we propose that the MC be used in patients receiving mechanical ventilation when the FB is not available. The simplicity and lower cost of this new system are important advantages to be considered over the fiberoptic bronchoscope.

Adult↗
PubMed1988

Ability of asthmatics with and without respiratory arrest to detect added resistive loads.

Asthmatics who sometimes experience respiratory arrest during an exacerbation are a particular concern. To date no adequate explanation exists for this phenomenon. Impaired perception of resistive loads is considered a factor in the development of hypercapnic respiratory failure, especially during exacerbation in patients with chronic obstructive pulmonary disease. We analyzed the perception of resistive loads in 10 asthmatics who had suffered two or more respiratory arrests during an acute exacerbation. A group of eight asthmatics (same mean age and basal bronchial obstruction) who had never developed respiratory arrest or acidosis during their exacerbations was also studied. No statistically significant differences were found between the two groups in the perception of resistive loads. This negative result seems to exclude a deficiency in the ability to detect resistive loads as a cause of respiratory arrest in asthmatic patients.

Adult↗
PubMed1988

Effect of three different bronchodilators during an exacerbation of chronic obstructive pulmonary disease.

This study evaluates the effect of three different bronchodilators (beta 2-adrenergic, anticholinergic and methylxanthine) alone and in randomized sequence, during an exacerbation in thirteen patients with chronic obstructive pulmonary disease. Dose-response curves were obtained for inhaled salbutamol and inhaled ipratropium bromide. The bronchodilator effect of a perfusion of aminophylline was also assessed. When a plateau of bronchodilatation was achieved with one agent, one dose of a second bronchodilator was administered to see whether additional bronchodilation could be achieved. The increments in FEV1 and FVC were similar with the three agents. The addition of a second bronchodilator did not result in significant increments in most of the patients. In at least half of the patients the doses of salbutamol and ipratropium that produced the maximal bronchodilatation were twice that currently employed.

Aged↗
PubMed1988

Different patterns of gas exchange response to exercise in asbestosis and idiopathic pulmonary fibrosis.

To analyse the pattern of pulmonary gas exchange during maximal exercise (Emax) in asbestosis, we compared nine subjects with this disease (1 female/8 male), aged 54 +/- 11 yrs (mean +/- SD), to nine patients (1 female/8 male) with idiopathic pulmonary fibrosis (IPF) of a similar age, height, weight and smoking history, both at rest and during Emax. No differences were observed in dynamic and static lung volumes between the groups. However, patients with IPF had a lower DLCOsb and KCO (p less than 0.005 and 0.05, respectively). At rest, both groups showed mild arterial hypoxaemia (76 +/- 11, asbestosis, vs 77 +/- 11 mmHg, IPF), widened AaPO2 (32 +/- 14 vs 31 +/- 13 mmHg) and slight increases in VD/VT (47 +/- 12 vs 46 +/- 11%), respectively. During Emax, PaO2 fell to 51 +/- 7 mmHg in patients with IPF whereas those with asbestosis had PaO2 of 73 +/- 21 mmHg (p less than 0.05). Conversely, those with asbestosis were able to reduce VD/VT (from 47 +/- 12 to 39 +/- 10%, p = 0.01) as opposed to those with IPF (from 46 +/- 11 to 47 +/- 13%). Furthermore, DLCOsb and AaPO2 during Emax were highly correlated only in IPF (r: -0.84, p less than 0.01). Despite the finding that both diseases represent a diffuse pulmonary fibrosis with a similar degree of resting ventilatory impairment, the pattern of gas exchange during exercise is different in each. These differences may be related to the underlying morphology of each process, which probably includes more airway disease and less pulmonary vascular involvement and/or a different degree of interstitial fibrotic change in asbestosis.

Asbestosis↗
PubMed1988

Lung function changes following Legionnaires' disease.

Eleven out of thirteen patients hospitalized because of severe pneumonia caused by Legionella Pneumophila were evaluated over a period of 53 months. During the acute phase, all but one patient manifested severe hypoxaemia, needing either supplementary oxygen or, in the case of three, mechanical ventilation and one died. Following recovery, two patients complained of mild shortness of breath alone. However, most of the individuals showed subclinical mild to moderate ventilatory and/or gas exchange abnormalities a few months after discharge (less than 6 months). Despite the fact that some of these functional findings in part persisted at long-term (6-33 months), a significant overall improvement in lung function was noticed. The main pulmonary functional sequelae following Legionnaires' Disease might include a restrictive ventilatory defect, a low transfer factor and hypoxaemia.

Acute Disease↗
PubMed1987

Neuronal antinuclear antibody (anti-Hu) in paraneoplastic encephalomyelitis simulating acute polyneuritis.

A patient with paraneoplastic encephalomyelitis (PEM) and small cell lung cancer had a clinical presentation of acute polyneuritis. The patient had an antibody (anti-Hu) restricted to nuclei of neurons identical to that reported in patients with subacute sensory neuronopathy and lung cancer. This finding further supports the hypothesis that PEM and subacute sensory neuronopathy are closely related disorders of autoimmune origin. PEM should be considered in patients with small cell lung cancer and clinical features limited to the peripheral nervous system.

Antibodies, Antinuclear↗
PubMed1986

Oxyhemoglobin affinity in patients with chronic obstructive pulmonary disease and acute respiratory failure: role of mechanical ventilation.

Oxyhemoglobin affinity was assessed in 20 subjects with chronic obstructive pulmonary disease, all of whom experienced acute respiratory failure. PaCO2, pH, and 2,3-diphosphoglycerate (2,3-DPG) were measured 24 and 48 h after admission, and then during weaning (for the ten patients on mechanical ventilation) or on discharge (for the ten nonventilated patients). At 24 h, nonventilated patients had a lower pH (p less than .001) and 2,3-DPG concentration (p less than .05) and a higher PaCO2 (p less than .01) than ventilated patients; 48 h later only PaCO2 was higher (p less than .01) in the former, and there were no differences between the two groups in the final set of measurements. There was a persistent left shift in the oxyhemoglobin dissociation curve (P50 at pH 7.4) in both groups throughout the study period. In contrast, the in vivo P50 was significantly lower in ventilated patients only at 24 h (22.7 +/- 2.2 vs. 25.8 +/- 1.5 torr, respectively, p less than .005). Our results suggest that changes of in vivo P50 in ventilated patients are probably related to the Bohr effect induced by mechanical ventilation. The latter swiftly corrects severe respiratory acidosis, causing an intra-erythrocytic alkalotic pH and raising the levels of 2,3-DPG.

2,3-Diphosphoglycerate↗
PubMed1986

Effect of nifedipine on arterial hypoxaemia occurring after methacholine challenge in asthma.

To investigate whether the effects of nifedipine on methacholine induced broncho-constriction could impair pulmonary gas exchange in bronchial asthma a randomised, double blind, crossover study in 13 symptom free asthmatic subjects was designed. Each patient underwent a methacholine bronchial challenge test on two separate days one week apart, after having either oral nifedipine (20 mg thrice daily) or placebo for three days. Arterial blood gases were measured before and after methacholine challenge in nine subjects. Prechallenge values of forced expiratory volume in one second (FEV1) and arterial oxygen tension (Pao2) were similar after nifedipine and after placebo. After challenge, the cumulative doses of methacholine required to produce a 20% fall in FEV1 (PD20 FEV1) were significantly larger after nifedipine (280 (SD 347)) cumulative breath units (CBU) than after placebo (120 (183) CBU; p less than 0.01). After challenge the fall in Pao2 values (17.1 (1.6) mm Hg; (2.28 (0.21) kPa)) was significantly greater than after placebo (11.7 (2.4) mm Hg; (1.56 (0.32) kPa) p less than 0.03). Our data show that although oral nifedipine significantly reduces airway reactivity in patients with mild bronchial asthma, it also adversely affects pulmonary gas exchange, resulting in a lowered postchallenge Pao2, probably because of worsening ventilation-perfusion relationships.

Adult↗