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Combined treatment with sustained-release theophylline and beta2-adrenoceptor-stimulating agents in chronic childhood asthma.

The effect of adding theophylline to treatment with a beta2-adrenoceptor stimulant was studied in 18 asthmatic children in a double-blind cross-over trial. Most patients were taking cromolyn sodium (cromoglycic acid) or beclomethasone aerosol, or both. A sustained-release preparation of theophylline was administered in individually titrated doses, producing a mean plasma theophylline concentration of about 8 micrograms/ml. Statistically significant improvements were found during the theophylline treatment in symptom score, consumption of beta2 stimulants in aerosol form, and morning peak expiratory flow rate and forced expiratory volume in one second. There was also a reduced need for emergency-room treatment during the theophylline period. Reported side effects were few and mild and were similar during the theophylline and placebo periods. Of the 17 patients who completed the trial, 14 preferred theophylline and three expressed no preference between theophylline and placebo. Adding submaximal doses of sustained-release theophylline to treatment with a beta2 stimulant gave further relief of asthmatic symptoms without appreciable side effects, suggesting that the drug combination has a favourable therapeutic index.

Adolescent↗

Fenoterol powder inhaler technique in children: influence of inspiratory flow rate and breath-holding.

The bronchodilator response after three different modes of inhalation of 0.2 mg fenoterol from a fenoterol powder inhaler was assessed in ten asthmatic children in a double-blind, placebo-controlled, cross-over study. There was a small, but statistically significant increase in response when the children inhaled as fast as possible, compared with very slow inhalations (16-19 l/min), but a breath-holding pause of 10 s after the inhalation had no significant effect on bronchodilation. Peak inspiratory flow through the inhaler, measured in 150 normal children aged 3.5-15 years, showed that all the children studied were able to generate a sufficient inspiratory flow to benefit from treatment with this inhaler. It is concluded that children using a fenoterol powder inhaler should be taught to inhale as fast as possible. They need not hold their breath after the inhalation.

Adolescent↗

A prospective study of chronic lung disease in cotton textile workers.

A cohort of both active and retired older cotton textile workers was examined prospectively over a 6-year period to establish the nature and extent of chronic lung disease. Respiratory symptoms and lung function were studied in these workers and in a group of similarly aged controls. The cotton textile workers had higher prevalence and attack rates of respiratory symptoms than did controls even with smoking habits taken into account. Chronic bronchitis developed in 16% of all cotton textile workers compared to 1% of controls over the follow-up period (p less than 0.001). The cotton workers suffered a larger loss of lung function over 6 years than did controls. Male workers lost 42 mL/yr of forced expiratory volume in 1 second, although male controls lost only 25 mL/yr (p = 0.001). Similar differences were seen in women, and in both men and women who were nonsmokers. Retired cotton textile workers had more symptoms and disability than active workers. We conclude that chronic lung disease is not only irreversible but may progress even after exposure to cotton dust has ended.

Byssinosis↗

The effect of inspiratory maneuvers on expiratory flow rates in health and asthma: influence of lung elastic recoil.

We studied the effect of breath holding and inspiratory speed on airflow during the FVC maneuver in seven healthy subjects and eight patients with asthma. The purpose of the study was to determine whether the effects of inspiratory speed and breath holding on expiratory flow were greater in patients with asthma than in healthy individuals; whether these effects were lessened by inhalation of aerosolized bronchodilator in the patients with asthma; and whether were was a relationship between the lung elastic recoil pressure and the expiratory flow achieved during four different maneuvers. We found that peak expiratory flow rate (PEFR) was significantly lower after both a slow inspiration and a breath hold than after a fast inspiration without a breath hold. In addition, a breath hold was associated with a significantly lower FEV1. The effects of inspiratory speed and breath holding in the patients with asthma were not significantly different from those observed in the healthy subjects. There was a significant relationship between lung elastic recoil pressure at the point of onset of the FVC maneuvers (Pel Blow) and expiratory flow in both healthy and asthmatic subjects. Also, the decrease in Pel Blow with equivalent breath-hold time was greater in asthmatic subjects, which is consistent with an increase in viscoelastic elements in the lung. These findings corroborate previous suggestions that inspiratory speed and the duration of breath holding have significant implications in the performance of spirometry and peak flow measurements, and indicate the importance of standardization of the preceding inspiration when determining FEV1 and PEFR.

Adult↗

O.35 ppm O3 exposure induces hyperresponsiveness on 24-h reexposure to 0.20 ppm O3.

Pulmonary function hyperresponsiveness, defined as enhanced response on reexposure to O3, compared with initial O3 exposure, has been previously noted in consecutive day exposures to high ambient O3 concentrations (i.e., 0.32-0.42 ppm). Effects of consecutive-day exposure to lower O3 concentrations (0.20-0.25 ppm) have yielded equivocal results. To examine the occurrence of hyperresponsiveness at two levels of O3 exposure, 15 aerobically trained males completed seven 1-h exposures of continuous exercise at work rates eliciting a mean minute ventilation of 60 1/min. Three sets of consecutive-day exposures, involving day 1/day 2 exposures to 0.20/0.20 ppm O3, 0.35/0.20 ppm O3, and 0.35/0.35 ppm O3, were randomly delivered via an obligatory mouthpiece inhalation system. A filtered-air exposure was randomly placed 24 h before one of the three sets. Treatment effects were assessed by standard pulmonary function tests, exercise ventilatory pattern (i.e., respiratory frequency, f; and tidal volume, VT) changes and subjective symptom (SS) response. Initial O3 exposures to 0.35 and 0.20 ppm had a statistically significant effect, compared with filtered air, on all measurements. On reexposure to 0.35 ppm O3 24 h after an initial 0.35 ppm O3 exposure, significant hyperresponsiveness was demonstrated for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), f, VT, and total SS score. Exposure to 0.20 ppm O3 24 h after 0.35 ppm O3 exposure, however, resulted in significantly enhanced responses (compared with initial 0.20 ppm O3 exposure) only for FEV1, f, and VT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Cardiopulmonary exercise capacity in adult patients with atrial septal defect].

UNLABELLED: The aim of the study was to evaluate cardiopulmonary exercise capacity (WTS) in adult patients with atrial septal defect (ASD). After excluding 10 patients with additional cardiac, pulmonary or muscle diseases, 53 patients with ASD (Gr-ASD; mean age 37.8 +/- 14.9 years; 35 women, 19 men) were enrolled in our study. In addition, we evaluated 22 healthy age and gender matched control subjects (Gr-K; mean age 36.6 +/- 14.9 years; 13 women, 9 men). First, all subjects underwent resting spirometry and forced vital capacity--(FVC; % of predicted value), one-second forced expiratory volume--(FEV1; % of predicted value) and FEV1/FVC (%) were determined. Then each subject performed a symptom-limited, incremental exercise test (modo Bruce). We evaluated the following parameters of resting metabolism: respiratory rate--(RR; L/min), minute ventilation--(VE; L/min), tidal volume--(Vt; L), oxygen uptake--(VO2; ml/kg/min), end-tidal carbon dioxide pressure--(PET CO2; mmHg), end tidal oxygen pressure--(PET O2; mmHg), ventilatory equivalent for carbon dioxide--(VE/VCO2) and ventilatory equivalent for oxygen--(VE/VO2). The following exercise parameters were analysed: peak oxygen uptake--(VO2 peak; ml/kg/min), VO2 peak expressed as % of predicted value--(VO2 %N), anaerobic threshold--(AT; % VO2 max), ventilatory equivalent for carbon dioxide--(VE/VCO2), end-tidal carbon dioxide pressure--(PET CO2; mmHg), O2 pulse, time of exercise--(T; min) and time to AT--(TAT; min). In addition, we performed a subgroup analysis for ASD patients below and > or = 40 years of age. All values were expressed as mean +/- SD. RESULTS: Although there was no significant difference in FVC, FEV1, FEV1/FVC, VO2, VE, Vt, RR between ASD patients and controls, the ASD patients aged 40 or older showed significantly lower FEV1/FVC and significantly higher RR. Expiratory gas exchange analysis showed significant differences between the ASD patients and controls (higher VE/VCO2, VE/VO2, PET CO2, and lower PET O2 respectively). Moreover, VO2 peak, VO2%N, AT, PET CO2 and O2 pulse were significantly lower while VE/VCO2 was significantly higher in ASD patients than in normal subjects. On average, VO2%N in ASD patients was only 61% of the predicted value for age and sex. Total time of exercise and time to AT were significantly shorter in ASD patients as well. CONCLUSIONS: WTS allows appropriate evaluation of cardiopulmonary capacity in ASD patients, though the mechanisms underlying ventilatory and hemodynamic abnormalities are still not fully understood. Adult patients with ASD reveal ventilatory abnormalities with an age-related trend towards deterioration. Cardiopulmonary exercise capacity in adults with ASD is markedly reduced in comparison with healthy population and deteriorates with age. WTS complements echocardiographic and hemodynamic evaluation of patients with ASD, and is helpful in indicating patients for ASD closure and their follow up.

Adult↗

Adult-type pulmonary function tests in infants without respiratory disease.

A new method that permits the measurement of adult-type maximal expiratory flow-volume curves and fractional lung volumes in sedated infants was recently described. The purpose of this study was to define the normal range for these new measures of pulmonary function in infants and young children. Measurements of forced expiratory flows and fractional lung volume were made on 35 occasions in 22 children (ages 3-120 weeks) without respiratory disease. Maximal expiratory flow-volume curves were measured by the raised lung volume, thoracoabdominal compression technique. Functional residual capacity (FRC) was measured plethysmographically. Measurements of total lung capacity (TLC), residual volume (RV), FRC, forced vital capacity (FVC), and forced expiratory flows at 25, 50, 75, 85, and between 25% and 75% of expired FVC (FEF(25), FEF(50), FEF(75), FEF(85), and FEF(25-75), respectively) all increased in relation to infant length (P<0.001). RV/TLC, FRC/TLC, and FEF(25-75)/FVC declined in relation to increasing length (P<0.001). The forced expiratory flow and fractional lung volume measurements using this method were similar to previously reported estimates using other methods. These estimates represent a reasonable reference standard for infants and young children with respiratory problems.

Anesthesia, General↗

Influence of jacket tightness and pressure on raised lung volume forced expiratory maneuvers in infants.

While the use of the raised volume rapid thoraco-abdominal compression (RVRTC) technique has been shown to provide new insights into airway and pulmonary pathophysiology in infants, and appears to resemble the spirometric techniques used in older subjects, there is as yet no consensus regarding measurement procedures, which are known to vary considerably between laboratories (Gappa [1999] Pediatr Pulmonol 28:391-393). The aims of this study were to assess the effects of tightness of jacket fit, the efficiency with which pressure is transmitted from the jacket to the intrathoracic airways, and the effect of jacket pressure on parameters derived from the RVRTC technique. Paired forced expiratory maneuvers were performed in 20 infants with the jacket snugly or loosely wrapped around the infant's torso, and in a further 21 infants using "optimal" or a higher jacket pressure (P(j)) (1-2 kPa above "optimal" P(j)). When either a loosened jacket or a higher than "optimal" P(j) was used, forced expired flow at low lung volumes (FEF(75)) was significantly reduced by, on average, 8% and 7%, respectively. There were, however, minimal changes in forced vital capacity (FVC) or forced expired volume in 0.4 sec (FEV(0.4)). The observed changes may have been due to the increased pressure transmitted to the intrathoracic structures under these experimental conditions, and emphasize the need to assess optimal jacket pressure within each infant when using the RVRTC technique. In addition, when using a loosened jacket or a higher than "optimal" P(j), chest wall and upper airway reflexes such as glottic closure, peripheral airway closure, and negative flow dependence were more evident.

Confidence Intervals↗

Forced expiratory parameters in healthy preschool children (3-6 years of age).

In a group of 173 healthy preschool children 3-6 years of age (body height, 90-130 cm; 102 boys and 71 girls) out of total 279 children examined, maximum expiratory flow-volume (MEFV) curves were recorded in cross-sectional measurements. The majority (62%) of preschool children were able to generate an MEFV curve as correctly as older children. From the curves, maximum expiratory flows at 25%, 50%, and 75 % of vital capacity (MEF(25), MEF(50), and MEF(75)), peak expiratory flow (PEF), forced expiratory volume in 1 sec (FEV(1)), forced vital capacity (FVC), and area delineated by MEFV curve (A(ex)) were obtained. The purpose of the study was to establish reference values of forced expiratory parameters in preschool children suitable for assessment of lung function abnormalities in respiratory preschool children. The values of the studied parameters increased nonlinearly and correlated significantly with body height (P < 0.0001); the correlation was much lower with age. A simple power regression equation was calculated for the relationship between each parameter and body height. A best-fit regression equation relating functional parameters and body height was a power function. Based on the obtained regression equations with upper and lower limits, we prepared tables listing reference values of forced expiratory parameters in healthy Caucasian preschool children, against which patients can be compared. No statistically significant gender differences were observed for MEF(25), MEF(50), MEF(75), PEF, FEV(1), FVC, and A(ex) by extrapolation. The reference values were close to those obtained in our older children. A decline of the ratios PEF/FVC, FEV(1)/FVC and MEF/FVC with increasing body height suggested more patent airways in younger and smaller preschool children.

Airway Obstruction↗

Assessing bronchodilator responsiveness in infants using partial expiratory flow-volume curves.

Our objective was to compare the effectiveness of maximum forced expiratory flow measured at functional residual capacity (V'maxFRC) and the ratio of flow at 75% of the forced expiratory volume to peak forced expiratory flow (FEF(75)/FEF(peak)) for detecting bronchodilator-related changes in wheezy infants. In 55 infants (mean age, 7.8 +/- 3.1 months) with a history of recurrent wheezing, V'maxFRC and FEF(75)/FEF(peak) were measured at baseline and 15 min following nebulized albuterol. Mean results from 4 baseline and 4 postalbuterol partial expiratory flow-volume curves were compared at baseline and following bronchodilator challenge. The strength (relative effect size) of each measure for assessing change was quantified by dividing the mean of the pre- to postdifferences by the standard deviation of the differences. Mean percent predicted V'maxFRC was 41.3 +/- 34.3% at baseline and 44.4 +/- 34.0% following albuterol. Mean FEF(75)/FEF(peak) was 26.7 +/- 13.4% at baseline and 35.8 +/- 14.3% following albuterol. The mean percent change from baseline [(post-pre)/pre] in percent predicted V'maxFRC was 18.3 +/- 39.3, and for FEF(75)/FEF(peak), it was 44.1 +/- 36.8. The change in FEF(75)/FEF(peak) following albuterol was significantly greater than the change in V'maxFRC (P < 0.0001). The relative effect size for mean percent change from baseline in V'maxFRC was 0.47, and for FEF(75)/FEF(peak), 1.20. Changes in FEF(75)/FEF(peak) appear to differentiate changes in airway function following administration of a bronchodilator better than do changes in V'maxFRC.

Asthma↗

Exercise tolerance and effects of training in young patients with cystic fibrosis and mild airway obstruction.

We evaluated the effects of an 8-week aerobic training (1 hr, three times a week) on physical performance of ten patients with cystic fibrosis (CF) (median age, 12.5 yr; range 11.1-15.3 yr), with mild airway obstruction (FEV1 = 77 +/- 22% pred.), and ten healthy age-matched children (CONTR) (median age, 12.7 yr; range 12.2-15.2 yr). Physical performance was tested with maximal incremental (MAX) and submaximal (SMAX) (fixed workload of 1.7 W/kg during 6 min) exercise tests on a cycle ergometer. These and standard spirometric and anthropometric measurements were performed at the beginning and end of a period with usual daily activity and one with the training program. The kinetics of ventilatory parameters at the onset and end of SMAX were displayed by fitting data on oxygen uptake and minute ventilation by monoexponential curves (least-squares method). At the start and the end of the training period, all children were timed for endurance run to voluntary exhaustion and for sprinting through an obstacle course. A pattern of relative hyperventilation during SMAX and of poor performance in endurance and obstacle runs were evident at the start of the training period in patients with CF. The effects of training on MAX and SMAX were small and partial; the improvement in field test performances was significant only for CF and could be attributed to improvement of skill and motivation.

Adolescent↗

Longitudinal response of pulmonary function to bronchodilators in cystic fibrosis.

Previous studies have found that between 0 and 95% of patients with cystic fibrosis (CF) have a significant response to bronchodilators. These studies have been limited by small numbers and the measurement of response at one point in time. We analyzed the response to bronchodilators of patients with CF in a longitudinal and cross-sectional manner using pulmonary function data from 1980 to 1988. Overall, the proportion of patients with a positive response to bronchodilators was relatively large but not consistent over time. Of 573 tests in 127 persons, a positive response occurred in 68 tests of 51 patients. A negative response occurred in 19 tests of 17 patients. Only nine patients had a positive response in more than one third of their tests. The cross-sectional analysis showed variability similar to previous cross-sectional studies. Although a large proportion of patients with CF had a response to bronchodilators, the response was not consistent and may have been related to the number of tests performed. Continued longitudinal testing is necessary for valid decisions for bronchodilator use and for documenting the length, variability, and clinical significance of these responses.

Aerosols↗

Bronchial hyperreactivity in children with Marfan syndrome.

Marfan syndrome is known to have pulmonary manifestations such as pneumothorax. There have been few previous studies of pulmonary function tests and none of bronchial hyperreactivity. Therefore, pulmonary function tests were performed in 11 children with Marfan syndrome and 11 normal children. Bronchial responsiveness was tested in ten of the Marfan patients by methacholine challenge test and response to bronchodilator. Because of disproportionate length of legs in Marfan patients, an "ideal" standing height was calculated from sitting height. Pulmonary function tests, as absolute values or as percent predicted based on "ideal" height, were not different in Marfan patients and normals, although a few individual patients had abnormal function (mostly airway obstruction and hyperinflation). Response to methacholine challenge was positive on forced expiratory volume in 1 second (FEV1), forced expiratory flow between 25 and 75% VC (FEF25-75%), and FEF50%, in 37.5%, 60%, and 70% of tests respectively. A significant response to bronchodilators was obtained in 40% of patients as measured by FEV1, in 90% by FEF25-75% and in 100% by FEF50%. Pulmonary function tests after bronchodilator were significantly higher when compared with values before the bronchodilator as well as with the baseline before methacholine. Therefore, most if not all patients with Marfan syndrome had hyperreactive airways in this relatively small group of patients. Even though only one patient had a diagnosis of asthma, six more had subtle symptoms. It is concluded that tests for bronchial hyperreactivity could be part of the routine investigation in Marfan syndrome. Further studies on larger numbers of patients are still needed.

Adolescent↗

Chronic graft-versus-host disease and pulmonary function.

Pulmonary complications are a major cause of morbidity and mortality in bone marrow transplant recipients. Earlier series, consisting mainly of adults, have shown evidence of obstructive changes of pulmonary functions in association with chronic graft-versus-host disease (CGVHD). We longitudinally evaluated spirometry in 46 patients who received bone marrow transplants as children or as young adults to determine whether they had similar abnormalities. Group mean FEV1/FVC, and percent predicted FVC, FEV1, and FEF25-75 values did not demonstrate obstructive changes in association with CGVHD in this patient population. Our findings suggest that younger patients with CGVHD, as a group, may fare better than older bone marrow transplant recipients with CGVHD. However, due to small sample sizes, it cannot be conclusively stated that the pulmonary function parameters analyzed do not differ in the two patient groups.

Adolescent↗

Forced expiratory flows and lung volumes in normal infants.

Forced expiratory flows at functional residual capacity (VmaxFRC) by the rapid compression technique and functional residual capacity (FRC) by the helium dilution technique were assessed in 112 normal infants with a mean age of 10.7 months (range, 1.0-31.0). In predicting FRC, log transformation was appropriate and body length was the best predicator. For VmaxFRC, age was a better predictor than length, and logarithmic transformation was not required. In(FRC) = -5.465 + 2.49 x In(length) SD = 0.178; r2 = 0.83 VmaxFRC = -397 + 9.36 x (age) SD = 88; r2 = 0.52 There were no gender differences for FRC or VmaxFRC; however, male infants exposed to passive cigarette smoke tended to have lower flows than male infants not exposed (P < 0.07). This study establishes normative values for VmaxFRC and FRC in infants between 1 and 31 months of age, and suggests that passive cigarette smoke exposure has an adverse effect upon forced expiratory flows in male infants.

Age Factors↗

Lung function tests in neonates and infants with chronic lung disease: forced expiratory maneuvers.

This fourth paper in a review series on the role of lung function testing in infants and young children with acute neonatal disorders and chronic lung disease of infancy (CLDI) addresses measurements of forced expiration using rapid thoraco-abdominal compression (RTC) techniques and the forced deflation technique. Following orientation of the reader to the subject area, we focus our comments on the areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. All studies on infants and young children with CLDI using forced expiratory or deflation maneuvers demonstrated that forced flows at low lung volume remain persistently low through the first 3 years of life. Measurement of maximal flow at functional residual capacity (V'maxFRC) is the most commonly used method for assessing airway function in infants, but is highly dependent on lung volume and airway tone. Recent studies suggested that the raised volume RTC technique, which assesses lung function over an extended volume range as in older children, may be a more sensitive means of discriminating changes in airway function in infants with respiratory disease. The forced deflation technique allows investigation of pulmonary function during the early development of CLDI in intubated subjects, but its invasive nature precludes its use in the routine setting. For all techniques, there is an urgent need to establish suitable reference data and evaluate within- and between-occasion repeatability, prior to establishing the clinical usefulness of these techniques in assessing baseline airway function and/or response to interventions in subjects with CLDI.

Airway Resistance↗

Respiratory function at age 8-9 years in extremely low birthweight/very preterm children born in Victoria in 1991-1992.

Our aim was to determine respiratory function at 8 years of age in extremely low birth weight (ELBW; birth weight, < 1,000 g)/very preterm (< 28 weeks of gestation) children born in the 1990s compared with normal birth weight (NBW; birth weight, >2,499 g) controls. The ELBW/very preterm subjects comprised 298 consecutive survivors with either birth weight < 1,000 g or gestational age < 28 weeks born in the state of Victoria during 1991-1992. Controls comprised 262 randomly selected NBW survivors. Respiratory function was measured on 81% (240/298) of the ELBW/very preterm children and 79% (208/262) of the NBW controls. Respiratory function variables reflecting airflow were substantially diminished in ELBW/very preterm children compared with NBW controls. Moreover, the proportions with clinically important reductions in airflow were higher in the ELBW/very preterm group (e.g., forced expired volume in 1 sec, < 75%; ELBW/very preterm, 19.7%; NBW, 2.4%; P < 0.0001). Within the ELBW/very preterm group, children who had bronchopulmonary dysplasia (BPD) in the newborn period and those who had later asthma had significantly reduced respiratory function in variables reflecting airflow. In conclusion, the abnormalities in respiratory function in ELBW/very preterm children compared with NBW subjects described in the presurfactant era persisted in the 1990s, especially in those who had BPD in the newborn period.

Asthma↗

High resolution computerized tomography of the chest and pulmonary function testing in evaluating the effect of tobramycin solution for inhalation in cystic fibrosis patients.

To evaluate the sensitivity of high-resolution computerized tomography (HRCT) of the chest compared to spirometry measures in evaluating the effects of tobramycin solution for inhalation (TSI) in cystic fibrosis (CF) patients.Thirty-two subjects >/=6 years old with mild to moderate CF lung disease were enrolled in a randomized, double-blind, placebo-controlled pilot study. Duration was 28 days; 31 subjects completed the study.HRCT scores decreased 4.06 +/- 3.20 (mean +/- SD) for TSI and decreased 0.17 +/- 1.78 for placebo subjects (P = 0.13). Mean forced expiratory flow during middle half of forced vital capacity (FEF(25%-75%)) predicted increased 6.08 +/- 4.86 for TSI and decreased 0.60 +/- 2.34 for placebo (P = 0.23). Percentage forced expiratory volume in 1 s (FEV(1)) predicted increased slightly for both TSI and placebo (1.29 +/- 3.33 for TSI and 1.17 +/- 1.4 for placebo) (P = 0.97). Two of eight HRCT component scores (atelectasis and inhomogeneity) were observed to be highly discordant with observed HRCT global total score and other HRCT component scores. A modified total score was calculated by dropping them from the global total score. The modified HRCT total scores decreased 6.68 +/- 3.09 for TSI subjects and increased 0.02 +/- 2.0 for the placebo subjects (P = 0.07). Sample sizes were calculated to show statistical significance by differences in modified total HRCT scores, global total HRCT scores, FEF(25%-75%) predicted or FEV(1) % predicted. A total of 60, 100, 200, and over 800 patients would be necessary respectively.HRCT can be a useful measure of change in CF pulmonary disease, requiring a smaller sample size than that required to show treatment effect by pulmonary function testing (PFT) alone.

Administration, Inhalation↗