Dietary carbohydrate, alveolar gas, and chronic obstructive pulmonary disease.
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Dietary Carbohydrates↗
Biomedical subjects
T A Dillard
Publications and source records attributed to T A Dillard.
Hypoxemia during air travel in patients with chronic obstructive pulmonary disease.
STUDY OBJECTIVE: To quantitate and identify determinants of the severity of hypoxemia during air travel in patients with chronic obstructive pulmonary disease. DESIGN: Prospective study of physiologic variables before and during intervention. SETTING: Referral-based pulmonary disease clinic at a U.S. Army medical center. PATIENTS: Eighteen ambulatory retired servicemen (age 68 +/- 6 [SD] years) with severe chronic obstructive pulmonary disease (forced expiratory volume in the first second [FEV1] 31% +/- 10% of predicted). INTERVENTION: Altitude simulation equivalent to 2438 meters (8000 feet) above sea level in a hypobaric chamber. MEASUREMENTS AND MAIN RESULTS: Radial artery catheter blood oxygen tension in the patients declined from a ground value (PaO2G) at sea level of 72.4 +/- 9 mm Hg to an altitude value (PaO2Alt) of 47.4 +/- 6 mm Hg after 45 minutes of steady state hypobaric exposure. The PaO2G correlated with PaO2Alt (r = 0.587; P less than 0.01). Multiple regression analysis revealed that the preflight FEV1 reduced the variability in PaO2Alt not explained by PaO2G in the equation: PaO2Alt = 0.453 [PaO2G] + 0.386 [FEV1% predicted] + 2.440 (r = 0.847; P less than 0.001). Residuals from two previously published formulas using PaO2G also correlated with FEV1 (r greater than or equal to 0.765; P less than 0.001). CONCLUSIONS: Arterial blood oxygen tension declined to clinically significant levels in most patients during hypobaric exposure. When combined with the preflight arterial PO2 at ground level (PaO2G), the measurement of the preflight FEV1 improved prediction of PaO2 at altitude (PaO2Alt) in patients with severe chronic obstructive pulmonary disease.
Adult↗
Bronchoalveolar lavage in the diagnosis of lipoid pneumonia.
Lipoid pneumonia (LP) is an uncommon entity with the characteristic radiographic features and histologic findings of alveoli filled with vacuolated, lipid-laden histiocytes. We questioned whether bronchoalveolar lavage (BAL) could be useful in the confirmation of LP. We examined lipid stains (oil-red O) in BAL specimens from 18 cases, representing a variety of pulmonary disease states, and compared them with an index case of confirmed LP. The index case of LP had a history of chronic intranasal use of mentholated petrolatum with subsequent x-ray findings of progressive air bronchograms. Positive histochemical confirmation (oil-red O) performed on frozen sections of transbronchial lung biopsy was obtained. Eleven of the non-LP cases had no intracellular staining of BAL macrophages with oil-red O stain, whereas the index case of LP exhibited markedly positive intracytoplasmic staining of macrophages for lipid. The remaining seven cases showed minimal to mild lipid staining with only one other case having moderate staining. This study demonstrates that BAL macrophages from patients with a variety of pulmonary states and without suspected LP do not demonstrate significant staining for intracellular lipids, in contrast with the expected strong positivity of LP. Lipid staining of BAL specimens, although not entirely specific, may be a preferred method for confirming the diagnosis of LP, thereby avoiding more invasive procedures.
Adult↗
Determinants of maximum exercise capacity in patients with chronic airflow obstruction.
Patients with chronic airflow obstruction (CAO) often develop impairment of respiratory muscle function. We hypothesized that inspiratory muscle strength, as assessed by resting, peak inspiratory pressure (PIP) may be an important determinant of maximum exercise capacity in patients with CAO. Twenty ambulatory male patients (mean age, 56 +/- 3 years [+/- SE]) with CAO (FEV1, 1.72 +/- 0.21 L) comprised the studied population. Oxygen consumption at incremental cycle ergometry to tolerance (VO2max, 1.80 +/- 0.20 L/min) served as the dependent variable for regression vs measures of resting pulmonary function. Significant correlations with VO2max included power output in watts (r = 0.951), VEmax (r = 0.858), Dsb (r = 0.841), PIP (r = 0.816), age (r = -0.809), FEV1 (r = 0.763), and FVC (r = 0.663). The FEV1, Dsb, and PIP each entered into a multiple linear regression relationship describing VO2max. Also, when paired with VEmax as independent variables in multiple regression, PIP and Dsb each improved description of VO2max over VEmax alone (p less than 0.05), whereas FEV1 and FVC did not (p greater than 0.05). We conclude that factors other than ventilatory capacity also have a quantitative effect on VO2max and that PIP constitutes a determinant of maximum exercise capacity in patients with CAO.
Exercise Test↗
Ventilatory limitation of exercise. Prediction in COPD.
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Exercise Test↗
Pulmonary function in sickle cell trait.
Pulmonary function abnormalities, which have been reported to occur in persons with sickle cell trait (hemoglobin AS), could intensify the hypoxic stimulus for the systemic formation of sickle cells at high altitude. We sought to determine whether pulmonary function abnormalities occur as a result of exposure to high altitudes in persons with hemoglobin AS. In a prospective study, 13 men with hemoglobin AS ("cases") and 13 controls (hemoglobin AA) matched by age, sex, and race were exposed to five to seven altitude simulations (ranging from 1524 to 7620 m [5000 to 25,000 ft]) in a hypobaric chamber. Measurements of diffusing capacity for carbon monoxide (DLco), forced vital capacity, forced expiratory volume in one second, and forced midexpiratory flow were obtained before and after each exposure. Data before exposures did not differ statistically between cases and controls. Altitude had no systematic effect on DLco or spirometric values in cases compared with values in controls (p greater than 0.05). Individual declines in forced vital capacity or DLco of more than 10% occurred with similar frequency in both groups. Measurements made after the series of exposures showed no change from those made before. We conclude that short serial exposures to hypoxia at high altitudes does not acutely or cumulatively alter DLco or spirometric values in healthy, nonexercising persons with sickle cell trait.
Adult↗
Overnight nasal CPAP improves hypersomnolence in sleep apnea.
Eleven adult men with sleep apnea underwent nocturnal polysomnography on two successive nights. The first study, done without NCPAP, served as the control. The second (treatment) was done with the application of 7.5 to 15 cm H2O nasal continuous positive airway pressure (NCPAP). A subjective sleepiness index (SSI) was noted upon awakening from each night of polygraphic recording. During the control night, the mean frequency of apnea episodes/sleep hr was 35.95 +/- 4.5 SE, and the mean duration was 28.68 +/- 2.7 sec. Mean frequency of disorder of breathing (DOB) episodes/sleep hr was 19.25 +/- 6.2 and mean duration of DOB episodes was 23.1 +/- 2.8 sec. During the treatment night, all obstructive apnea episodes were abolished. During the control night, the mean decrease in arterial oxygen saturation during obstructive apnea episodes was 11.2 +/- 1.9 percent and the mean lowest saturation was 67.6 +/- 4.0 percent. NCPAP eliminated arterial oxygen desaturation. While 44.5 +/- 5.7 percent of total sleep time was spent in either apnea or disordered breathing during the control night, NCPAP decreased this to 0.73 +/- 0.3 percent. In addition to the improvement in respiration during sleep, SSI decreased from a mean of 3.73 +/- 0.49 after the control night to 1.64 +/- 0.24 after treatment, reflecting an improvement in daytime hypersomnolence. We conclude that nasal CPAP is effective in eliminating obstructive apnea episodes, and results in a marked decrease in daytime hypersomnolence after one treatment night.
Adult↗
Prediction of ventilation at maximal exercise in chronic air-flow obstruction.
In chronic air-flow obstruction (CAO), inspiratory mechanics constitute a potential mechanism of compensation for limitation of expiratory air flow. We sought to determine whether assessment of inspiratory function could improve our ability to predict ventilation at maximal exercise (Ve max) in patients with CAO. Resting inspiratory and expiratory pulmonary function studies from 20 patients with ventilatory limitation of exercise due to CAO provided data for development of a new regression model for Ve max. Maximal exercise was quantitated from breath-by-breath analysis of exercise responses at cycle ergometry with work increments of 25 watts each min to tolerance. Multiple regression analysis by 3 methods gave identical results. A 2-variable formula containing peak inspiratory flow rate (PIFR) and the forced expiratory volume in one second (FEV1) correlated strongly with Ve max (r = 0.967) in the formula Ve max (L/min) = 21.34 FEV1 (L) + 6.28 PIFR (L/s) +3.94 (95% Cl = +/- 18 L/min). This model was significantly different from published models containing FEV1 alone (p = 0.0002) and was not improved by additional variables. Similar formulas derived for emphysematous and bronchitic clinical types of CAO did not exhibit significantly different slope and intercept coefficients. Both PIFR and FEV1 correlated strongly with tidal volume at maximal exercise. The PIFR also correlated well with resting peak inspiratory airway pressure (r = 0.775). We conclude that consideration of PIFR in addition to FEV1 can improve our clinical ability to predict Ve max in patients with CAO.
Adult↗