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At least 199 records · Page 11Linked to original sources

Effects of a standard hyperbaric oxygen treatment protocol on pulmonary function.

The prescription of hyperbaric oxygen (HBO) therapy for disorders not related to diving is increasing. Pulmonary oxygen toxicity is well known, but the effect of the cumulative oxygen exposure corresponding to a standard HBO treatment protocol has not been quantified before. Twenty patients (10 male) had 21 HBO treatments at a partial pressure of oxygen of 240 kPa for 90 min daily. None had any previous lung disease and all had normal chest radiography and lung function at the start of the study. Dynamic lung volumes, forced expiratory flows and the transfer factor of the lung for carbon monoxide (TL,CO) were measured before the HBO treatment, on days 7, 14 and 21 during treatment and then 3-4 weeks after treatment. Four patients (one male) reported nonproductive coughing during the last week of treatment. There was a progressive reduction in forced expiratory volume in one second (FEV1) (p<0.001), mean forced mid-expiratory flow rate (FEF25-75%) (p<0.001) and forced expiratory flows at 50 and 75% of forced vital capacity (FVC) expired during HBO treatment. The reduction in FEV1 on day 21 was 4.4+/-1.7% and in FEF25-75% 10.3+/-6.1%. Four weeks after treatment there was a partial normalization. There were no changes in FVC or peak expiratory flow (PEF). TL,CO was slightly reduced on day 21 of treatment only (p<0.01) and fully normalized 1 month later. A reduction in small airways conductance is consistent with other studies where total oxygen exposures have been below the limit causing toxic pulmonary effects traditionally measured as a reduction in vital capacity. This effect is not considered to be of any clinical significance for patients treated with hyperbaric oxygen unless repeated treatment series are to be given.

Female↗

Residual lung volume and ventilatory muscle strength changes following maximal and submaximal exercise.

In order to evaluate a mechanism which may be responsible for the often observed acute increase in residual lung volume (RV) following exercise, 12 non-smoking males (20-30 yrs) performed two bouts of exercise on separate days; one to maximal heart rate (HRmax) and one to 85% of HRmax for 20 min. Prior to exercise and at 5, 15, 30, 60 and 120 min post-exercise, the following parameters were measured: RV, forced vital capacity (FVC), forced expiratory volume (FEV1.0), forced expiratory flow (FEF75-85), maximal expiratory pressure (PEmax), and maximal inspiratory pressure (PImax). Significant (p < 0.05) increases occurred in RV at 5, 15 and 30 min following maximal exercise and at 5 and 30 min after submaximal exercise. Changes in RV between the two exercise bouts were generally greater (p < 0.05) for maximal exercise. Accompanying the increases in RV were significant (p < 0.05) decreases in PEmax and decreases in FVC, while FEV1.0 and FEF75-85 remained generally unchanged or were slightly elevated. The data suggest that decreases in expiratory muscle strength due to fatigue may in part be responsible for increases in RV.

Adult↗

Effects of divided doses of a bronchodilator aerosol and the intervening time interval on the forced expiration.

Twelve patients with bronchial asthma participated in a blind, randomized, crossover study comparing the effects of 500 micrograms terbutaline in one inhalation, 125 micrograms in four inhalations taken in rapid succession, and 125 micrograms in four inhalations taken with an intervening time interval of 30 min. There were no significant differences between the three modes of inhalation of 500 micrograms terbutaline in any of the spirometric variables, i.e., 1-second forced expiratory volume, forced vital capacity, and maximal airflows when 50 and 75% of the forced vital capacity was exhaled from the total lung capacity. However, there were neither any significant differences between the levels of bronchodilation reached after administration of 500 micrograms and 2 or 3 X 125 micrograms terbutaline with an intervening time interval of 30 min. The time interval between the divided doses was possibly too long to achieve maximum accumulated effect of the four divided doses.

Aerosols↗

Medical screening of former asbestos cement workers in Israel: a pilot program.

A pilot screening program for the evaluation of former asbestos-cement workers was carried out in the Chest Disease Clinic of the Acco Public Health Office (Ministry of Health), Israel. A total of 184 subjects were evaluated using medical and occupational questionnaires, clinical examinations, and pulmonary function tests (forced expiratory volume, forced vital capacity). Thirty percent of individuals with more than 1 year of work experience had symptoms of breathlessness or cough. Individuals with 10 years or more of work experience showed a high prevalence of râles and reduced pulmonary function, as compared to those with shorter work histories. These findings indicate the urgent need for active follow-up of Israeli ex-asbestos workers. A proposed screening and surveillance program for this high-risk group is discussed with emphasis on follow-up, health education, and smoking cessation.

Adult↗

Exposures to polyvinyl chloride, methyl ketone and other chemicals. The pulmonary and non-pulmonary effect.

As part of the continuing assessment of the health impact of exposures in the emerging industries of Nigeria, a study was conducted to determine the relative impact of exposures encountered in four operations of a shoe factory. The health impact assessment consisted of spirometric lung function evaluations and environmental measurement for polyvinyl chloride (1.6 +/- 5 ppm). The study showed that there were differences among exposure subgroups with respect to pulmonary, neurological and dermal toxicities and that these differences were dictated by the types of exposure encountered. Pulmonary toxicity was most severe in the vinyl chloride-exposed subgroup. Neurological impact was most severe in the leather and methylethyl ketone-exposed subgroup and dermal toxicity most severe in the subgroup exposed to plasticizers and stabilizers. There existed substantial deficits in lung function (forced expiratory volume, forced vital capacity FEV1, FVC) among the subgroups relative to normal, non-industrially exposed Nigerians of similar age and height. The deficits in lung function, particularly in FVC, paralleled the variations in the prevalence of restrictive lung disease, which for the whole study group was 56.5 cases per 1000 person-years. The vinyl chloride-exposed subgroup had the highest prevalence of restrictive lung disease, 92.6 cases per 100 person-years. Step-wise multiple regression suggested that 27% of the deficit in FEV1 was explainable by the number of exposures. The use of person-years as a denominator gives a better estimate of risk than the total number of subjects as it incorporates both the number exposed and the total exposure experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollutants, Occupational↗

Flow limitation in normal infants: a new method for forced expiratory maneuvers from raised lung volumes.

Forced expiratory maneuvers generated by rapid thoracic compression have been used to assess airway function in infants. It remains unclear whether flow limitation can be achieved in healthy infants because low pressure transmission across the chest wall and inspiratory effort may limit the maximum transpulmonary pressure developed during the maneuver. We have found that several rapid inflations to a lung volume set at an airway pressure of 30 cmH2O (V80) briefly inhibit respiratory effort and allow forced expiration to proceed from V80 to residual volume. We used a water-filled esophageal catheter to measure isovolume pressure-flow curves in seven healthy infants (3-88 mo). Forced vital capacity (FVC) was defined as the volume between V80 and residual volume. Pressure transmission between the compression jacket and the esophagus decreased with decreasing lung volume and averaged 60 and 37% at 50 and 75% of expired FVC, respectively. Subjects demonstrated plateaus in their isovolume pressure-flow curves at 50% of expired FVC and lower lung volumes. We conclude that this new methodology enables forced expiratory maneuvers to achieve flow limitation in healthy infants over at least the lower portion of their lung volume.

Child Development↗

Racial and gender differences in susceptibility to tobacco smoke among patients with chronic obstructive pulmonary disease.

BACKGROUND: Although chronic obstructive pulmonary disease (COPD) has been considered a disease of Caucasian men, recent data show mortality rising faster among women and African-Americans. Some have suggested these groups are more susceptible to tobacco smoke. We examined this issue in our own population of COPD patients. METHODS: Beginning in March 2003 we prospectively developed a COPD research database to facilitate recruitment for clinical trials. Enrollees are recruited from clinics and paid advertising and their demographics, medical/smoking histories, and spirometric data are recorded. We examined the smoking histories and pulmonary function of enrollees over 45, with 20 pack-years of smoking, FEV(1)/FVC (forced expiratory volume forced vital capacity) <0.70, and a race-adjusted post-bronchodilator FEV(1)<80%. The primary outcome was the loss of lung function per pack-year smoked, or Susceptibility Index (SI), calculated using the formula: (% predicted FEV(1)-100)/pack-years. RESULTS: A total of 585 patients enrolled during the study period and 330 met our inclusion criteria. Caucasians were older than African-Americans (63 vs. 58, P=0.0003) and had more pack-years of smoking (57 vs. 43, P=0.0003). There were no differences in lung function or bronchodilator reversibility among the racial or gender subgroups. Caucasians had less loss of lung function per pack-year smoked than African-Americans (SI=-1.02% vs. -1.34%, P=0.007) and men less than women (SI=-0.98% vs. -1.21%, P=0.001). Caucasian males appeared relatively protected from tobacco smoke (SI=-0.93%), while African-American women appeared most susceptible (SI=-1.42%). CONCLUSIONS: There are important differences in racial and gender susceptibility to tobacco smoke among patients with COPD. African-American females appear to be at highest risk and may benefit most from smoking cessation.

Black or African American↗

A 10-year follow-up study of pulmonary function in symptomatic elite cross-country skiers--athletes and bronchial dysfunctions.

A high prevalence of asthma-like symptoms and abnormal bronchial reactivity to various stimuli has been reported among endurance athletes. This report presents the cases of three cross-country skiers who have shown a progressive development of airway obstruction during their sport careers. The observed decline in FEV1, FEV1/FVC and/or FVC (FEV, forced expiratory volume; FVC, forced expiratory vital capacity) was greater than expected from longitudinal regression equations describing the ageing effect on pulmonary function. The three subjects encountered abnormal respiratory discomfort during their sport activity which was not systematically associated with abnormal bronchial reactivity (either to methacholine or exercise hyperventilation). At the end of the follow-up periods (9-12 years), all three skiers presented objective signs of airflow limitations during intense exercise. This report suggests that repeated chronic hyperventilation of cold dry air in cross-country skiers for several years can induce permanent bronchial disorders which may include remodeling processes and induce ventilatory limitations during intense exercise.

Adult↗

Respiratory effects of live influenza virus vaccine: healthy older subjects and patients with chronic respiratory disease.

Twenty-one healthy, middle-aged volunteers and 8 patients with chronic lung disease were given live, attenuated influenza virus vaccine by nasal spray. Forced vital capacity, 1-sec forced expiratory volume, ratio of 1-sec forced expiratory volume to forced vital capacity, residual volume, ratio of airway conductance to lung volume, maximal expiratory flows after exhalation of 50 and of 75 per cent of the forced vital capacity, closing volume, slope of Phase III, volume of isoflow, single-breath diffusing capacity for CO, and arterial blood gases were measured before and 3, 7, 10, and 21 days after exposure. Vaccination was well tolerated by the healthy volunteers without change in pulmonary function. In contrast, the patients tended to develop increased respiratory symptoms and had a slight decrease in mean forced expiratory volume in 1 sec 3 weeks after vaccination.

Administration, Intranasal↗

Follow-up evaluation of a prevalence study for chronic bronchitis and chronic airway obstruction.

Follow-up of the prevalence study of respiratory symptoms and chronic airway obstruction was performed after a 6- to 7-year interval. One hundred fifteen of 117 subjects (98%) originally labeled "abnormal" (chronic bronchitis or asthma by history, or ratio of 1-sec forced expiratory volume to forced vital capacity less than 60 per cent), and 111 of a random sample of 116 subjects (96%) originally labeled "normal" were traced. Nineteen patients were dead, 14 "abnormal" subjects, and 5 "normal" subjects (P less than 0.01). Eighty-eight of the originally labeled "abnormal" subjects and 91 of the random "normal" sample could be retested by spirometry. Subjects with lower initial ratios of 1-sec forced expiratory volume to forced vital capacity tended to lose more 1-sec forced expiratory volume and forced vital capacity. Early identification of respiratory symptoms and spirometric abnormalities may identify persons at increased risk of death who could benefit from appropriate therapy.

Adult↗

[Obstruction of the peripheral airways : clinical aspects, radiological picture, therapeutic impact].

Peripheral airways obstruction (PAO) is a pathophysiologic syndrome combining normal values of the usual tests (one-second forced expiratory volume, airway resistance) and abnormalities of "sensitive" tests (dynamic compliance, closing volume, forced expiratory flows, response to helium-oxygen mixtures). Clinical data are scarce, and the radiological aspects nonspecific. The natural history of the PAO is not fully understood. Therapeutic measures could be useful, but their efficacy was not yet systematically evaluated. From the theoretic point of view, the notion of bronchiolar obstruction is important in as much as it represents the initial phase of any obstructive process. In practice, the detection of a PAO identifies the "at risk" subject allowing the application of efficient preventive measures.

Humans↗

Evaluation of the lung function test in reversible glottis-dilating operations.

Our aim was to obtain an objective evaluation of the airway before and after reversible glottis-dilating operations using the lung function test. Bilateral abductor vocal cord paralysis remains mostly a complication of thyroid surgery. After thyroid surgery, the paralysis is potentially reversible, and the patient has a chance for recovery mostly in the first 6 months. According to these considerations, a reversible vocal cord laterofixation procedure was used instead of tracheostomy. The operations were performed endoscopically using high-frequency JET ventilation and the special endo-extralaryngeal suture technique by Lichtenberger. This technique was used in 92 cases. The pre- and postoperative data of reversible glottis-dilating techniques could be compared in 23 non-selected patients. Lung function tests that were performed were forced inspiratory volume (FIV1), forced expiratory volume (FEV1), peak inspiratory flow rate (PIF), peak expiratory flow rate (PEF) and resistance of the airways (Raw). For the evaluation of the functional results, we used the body-pletysmograph. Our aim was to obtain a quantitative evaluation of the results. These values allow us to compare the results achieved by using different glottis-dilating methods. The FEV1 (forced expiratory volume) improved 25%, and the FIV1 (forced inspiratory volume) improved 39% after the operations on average. PEF (peak expiratory flow rate) and PIF (peak inspiratory flow rate) improved 37 and 45% after glottis-dilating surgery on average. The Raw (resistence of airways) was 271.5% on average before the operations, and after reversible glottis-dilating operations decreased to a level of 200.6%.

Adolescent↗

Prediction of hypoxemia and mechanical ventilation after lung resection for cancer.

BACKGROUND: Hypoxemia usually occurs after thoracotomy, and respiratory failure represents a major complication. METHODS: To define predictive factors of postoperative hypoxemia and mechanical ventilation (MV), we prospectively studied 48 patients who had undergone lung resection. Preoperative data included, age, lung volume, force expiratory volume in one second (FEV1), predictive postoperative FEV1 (FEV1ppo), blood gases, diffusing capacity, and number of resected subsegments. RESULTS: On postoperative day 1 or 2, hypoxemia was assessed by measurement of PaO2 and alveolar-arterial oxygen tension difference (A-aDO2) in 35 nonventilated patients breathing room air. The other patients (5 lobectomies, 9 pneumonectomies) required MV for pulmonary or nonpulmonary complications. Using simple and multiple regression analysis, the best predictors of postoperative hypoxemia were FEV1ppo (r = 0.74, p < 0.001) in lobectomy and tidal volume (r = 0.67, p < 0.01) in pneumonectomy. Using discriminant analysis, FEV1ppo in lobectomy and tidal volume in pneumonectomy were also considered as the best predictive factors of MV for pulmonary complications. CONCLUSIONS: These results suggest that the degree of chronic obstructive pulmonary disease in lobectomy and impairment of preoperative breathing pattern in pneumonectomy are the main factors of respiratory failure after lung resection.

Adult↗

White blood cell counts in persons aged 65 years or more from the Cardiovascular Health Study. Correlations with baseline clinical and demographic characteristics.

A higher white blood cell (WBC) count has been shown to be a risk factor for myocardial infarction and stroke in middle-aged populations. This study evaluated the relation between baseline WBC count and other risk factors, as well as subclinical and prevalent disease, in the Cardiovascular Health Study, an epidemiologic study of coronary heart disease and stroke in 5,201 persons aged 65 years or older. Baseline data were collected over a 12-month period in 1989-1990. WBC counts were statistically significantly higher in people with prevalent and subclinical atherosclerotic cardiovascular disease than in those who were free of disease. WBC counts correlated (p < 0.01) positively with coagulation factors, measures of glucose metabolism, creatinine, smoking, and triglycerides. In contrast, WBC counts correlated negatively with high density lipoprotein cholesterol, forced expiratory volume, forced vital capacity, and height. The correlations between WBC counts and risk factors were similar in both the entire cohort and the subgroup of persons who had never smoked. The authors conclude that WBC counts in the elderly are associated with prevalent and subclinical atherosclerotic cardiovascular disease, as well as its risk factors.

Age Distribution↗

Investigation of the chronic pulmonary effects of low-dose oral methotrexate in patients with rheumatoid arthritis: a prospective study incorporating HRCT scanning and pulmonary function tests.

OBJECTIVE: Methotrexate has a well-recognized side-effect of acute hypersensitivity pneumonitis. There is concern about whether chronic pulmonary toxicity can occur with methotrexate treatment. Our objective was to compare chest high-resolution computed tomography (HRCT) findings and serial pulmonary function tests in rheumatoid arthritis (RA) patients on methotrexate with findings for a control group of patients with RA who were not being treated with methotrexate. METHODS: Study patients had an initial chest radiograph, full pulmonary function tests and chest HRCT. Pulmonary function tests were then performed regularly over a 2-yr period. RESULTS: Fifty-five RA patients on methotrexate and 73 control patients with RA were enrolled for the study. Mean dose of methotrexate was 10.7 mg/week (S.D. 2.5 mg/week) and mean duration of treatment at entry into the study was 30 (20) months. Twenty per cent of patients with RA treated with methotrexate had pulmonary fibrosis (PF) on initial HRCT compared with 23% in the control group. When the patients with and without PF were compared, there was no statistical difference in the duration (mean difference -4.18 months, P=0.237) or dose (mean difference -0.8 mg/week P=0.52) of methotrexate therapy. Mean changes after 2 yr in forced expiratory volume, forced vital capacity, diffusion capacity for carbon monoxide and residual volumes were not different in the methotrexate group compared with the control group. CONCLUSION: There is no evidence to suggest clinically, from HRCT assessment or serial pulmonary function tests, that low-dose methotrexate is associated with chronic interstitial lung disease.

Administration, Oral↗

Scoliosis and pulmonary function.

The effect on pulmonary function of all three dimensions of the scoliotic deformity was analyzed with computer tomography in 33 patients with thoracic idiopathic scoliosis. Both static (total lung capacity [TLC], vital capacity [VC] and functional residual capacity [FRC] ) and dynamic volumes (forced expiratory volumes in one second [FEV-1]) were negatively correlated to the lateral deformity and, to a lesser degree, to rotation. Of the computer tomography variables reflecting kyphosis, the sagittal diameter was correlated positively to all lung volumes though negatively to the quotient FRC/TLC while the KLi was correlated positively to VC and FEV1. The conclusion is drawn that the Cobb angle gives the most accurate estimation of lung volume compromise and that operative treatment should aim of reducing the lateral dislocation of the vertebrae and at maintaining normal sagittal thoracic curve.

Adolescent↗

A chronic pulmonary syndrome associated with graft-versus-host disease after allogeneic marrow transplantation.

Of 143 consecutive patients who survived at least 6 months after bone marrow transplantation (allogeneic [n = 131]; syngeneic [n = 5]; or autologous [n = 7]) and whose pulmonary function was evaluated before and on at least 2 occasions after BMT, 29 (20%) developed a chronic pulmonary syndrome without evidence for an infectious etiology. Twenty-eight (97%) presented with cough and 22 (76%) with dyspnea; abnormal chest signs were crackles in 23 (79%) and wheeze in 22 (76%). Chest roentgenogram showed pulmonary infiltrates in 15 (52%) cases but was normal in 14 (48%). All patients had major reductions in lung volumes (forced expiratory volume in 1 sec [FEV1]; relaxed vital capacity [VC]; and alveolar volume [VA]), and/or diffusing capacity (pulmonary diffusing capacity [TLCO] and single-breath carbon monoxide coefficient [KCO]). The obstructive component varied with only 18 (62%) patients developing overt airways obstruction (FEV1/VC < 75%), and in 6 of this group the fall in lung volumes preceded the onset of airways obstruction. Open lung biopsy (n = 4) showed both bronchiolitis obliterans and chronic patchy interstitial pneumonitis. The development of this syndrome was associated with acute (P < 0.001) and chronic (P < 0.0001) graft-versus-host disease of other organ systems. Twenty-four (83%) patients had a partial or complete response to immunosuppressive agents. Six (21%) have died, five (17%) of pulmonary complications. We suggest that this syndrome may be a manifestation of chronic GVHD involvement of the lung.

Adolescent↗

How mild is mild asthma?

Nineteen asthmatic volunteers underwent methacholine-induced asthma to the point when tightness in the chest was just sensed (threshold symptom). Changes in the following indices of lung function were measured--static lung volumes, forced expiratory volume in one second, and airways conductance. The increase in airways resistance necessary for threshold detection was at least double that previously reported in experiments using external resistive loads. Despite the mildness of the symptom, increases in lung volumes to the levels previously described during acute and severe asthma were occasionally found. It is emphasised that there may be little leeway in respiratory reserve between the development of minor and severe symptoms in some asthmatic patients.

Airway Resistance↗