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Spirometry, measurement, and race in the nineteenth century.

Race correction is a common practice in contemporary pulmonary medicine that involves mathematical adjustment of lung capacity measurements in populations designated as "black" using standards derived largely from populations designated as "white." This article traces the history of the racialization and gendering of spirometry through an examination of the ideas and practices related to lung capacity measurements that circulated between Britain and the United States in the nineteenth century. Lung capacity was first conceptualized as a discrete entity of potential use in the diagnosis of pulmonary disease and monitoring of the vitality of the armed forces and other public servants in spirometric studies conducted in mid-nineteenth-century Britain. The spirometer was then imported to the United States and used to measure the capacity of the lungs in a large study of black and white soldiers in the Union Army sponsored by the U.S. Sanitary Commission at the end of the Civil War. Despite contrary findings and contestation by leading black intellectuals, the notion of mean differences between racial groups in the capacity of the lungs became deeply entrenched in the popular and scientific imagination in the nineteenth century, leaving unexamined both the racial categories deployed to organize data and the conditions of life that shape lung function.

Black People↗

Expiratory function in complete tetraplegics: study of spirometry, maximal expiratory pressure, and muscle activity of pectoralis major and latissimus dorsi muscles.

Respiratory complications, such as pneumonia and atelectasis, are major causes of mortality and inhibit rehabilitation programs in spinal cord injury. Tetraplegic patients cannot cough enough to clear their sputum because of expiratory muscle weakness, mainly of the abdominal muscles. However, tetraplegics are still able to activate some muscles during coughing. Some tetraplegics, even though they cannot contract the abdominal muscles, can cough effectively. It was supposed that some accessory expiratory muscles were activated during coughing in tetraplegics. We, therefore, studied the peak expiratory flow rate, expiratory muscle strength, and the activities of the pectoralis major and latissimus dorsi muscles in 11 complete tetraplegics. Peak expiratory flow rate was measured by spirometry. Expiratory muscles strength was assessed by maximal expiratory mouth pressure; muscle activity was assessed by means of the root mean square voltage obtained by surface electromyography. The results showed that peak expiratory flow rate, maximal expiratory mouth pressure, and root mean square of these two muscles were correlated with neurological level. Peak expiratory flow rate was correlated with peak expiratory flow rate. Peak expiratory flow rate was correlated with the root mean square voltage of the pectoralis major and latissimus dorsi muscles. It was supposed that these two muscles were activated as accessory expiratory muscles and play an important role in expiratory function in tetraplegic patients.

Adult↗

Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations.

Of 38 patients undergoing median sternotomy for cardiac operations all developed profound restrictive defects in pulmonary function during the first 72 h after tracheal extubation. Although decreased lung volumes were refractory to correction by vigorous, aggressive pulmonary therapy during this period, frequent and supervised treatment may prevent further deterioration in pulmonary function. The overall incidence of pneumonia was only 3% (1/38). Continuous positive airway pressure delivered by mask proved to be a nearly effortless form of postoperative respiratory therapy that was less painful than incentive spirometry or coughing and deep breathing, and therefore may be preferable.

Cardiopulmonary Bypass↗

Pocket computer for interpretation of office spirometry.

Office spirometry is an integral part of the evaluation of any patient with known or suspected lung disease. Though accurate and affordable bellows-type spirometers are available to clinicians, the available microprocessors that calculate test results markedly increase the cost of the equipment. I have successfully used an inexpensive pocket computer programmed to provide predicted values and interpretation of test results, printing this information in a format suitable for mounting in the office chart. The reliability of the results and interpretations permits convenient and low-cost pulmonary function testing in office patients when clinically warranted.

Adult↗

Rapid lung volumetry using ultrafast dynamic magnetic resonance imaging during forced vital capacity maneuver: correlation with spirometry.

INTRODUCTION: Dynamic magnetic resonance imaging (MRI) has the potential for rapid noninvasive evaluation of changes in lung volume. The aim of this study was to perform rapid lung volumetry using ultrafast dynamic MRI to capture a forced vital capacity (FVC) maneuver. MATERIALS AND METHODS: Nine healthy volunteers underwent 2-dimensional spoiled gradient echo imaging in coronal and sagittal planes during FVC maneuvers. An elliptical model of the axial cross section of the lungs was used to generate rapid volume-time curves. Spirometric indices were correlated with MR volumetry findings. RESULTS: Total lung volume calculated from static MRI correlated well with the dynamic MR scans (r = 0.83; P < 0.01). Spirometric indices (first second of forced expiration and FVC) calculated from our MR volumetry technique correlated well with conventional spirometry (P < 0.01). CONCLUSION: The technique provides a means of sampling lung volume change during the rapid subsecond movements that take place during a FVC maneuver.

Adult↗

Long-term outcome after percutaneous dilational tracheostomy. Endoscopic and spirometry findings.

We studied 41 patients who had previously undergone percutaneous dilational tracheostomy at least 6 months following tracheal decannulation. The patients were examined using laryngotracheoscopy and spirometry to assess the long-term anatomical and functional consequences of percutaneous dilational tracheostomy. Apart from one patient who had requested a scar revision, no patient was symptomatic. A significant (> 10%) tracheal stenosis was identified in four asymptomatic patients, two of whom also had spirometric evidence of this obstruction. These results suggest that the long-term outcome after percutaneous tracheostomy is at least as good as that following conventional surgical tracheostomy. Refinements of the percutaneous technique, such as endoscopic guidance, may further improve the results.

Adolescent↗

Effects of immunotherapy on symptoms, PEFR, spirometry, and airway responsiveness in patients with allergic asthma to house-dust mites (D. pteronyssinus) on inhaled steroid therapy.

The present study was designed to investigate the effects of immunotherapy (IT) with an extract of Dermatophagoides pteronyssinus (Alergo-Merck Depot) during a 27-month period in patients with allergic asthma to house-dust mites. We included 11 patients (mean age 18 years) treated with a combination of IT and inhaled beclomethasone dipropionate (BDP) in comparison to another 11 (mean age 22 years) treated with BDP alone. We evaluated symptom scores, salbutamol use, peak expiratory flow rates (PEFR), spirometry, and bronchial hyperresponsiveness (BHR) during 18 months of therapy with BDP and in the 9 months after BDP interruption. The two kinds of treatment were efficient and comparable in relation to symptom score, salbutamol use, morning PEFR, FVC, and FEV1, but patients treated with IT and BDP had a faster improvement of BHR and PEFR variability. The interruption of BDP after 18 months of therapy was linked to an impairment of all end points, which were more pronounced in patients previously treated only with BDP. These findings suggest that in selected asthmatic patients allergic to house-dust mites, the association of IT and BDP is more effective than therapy with this inhaled steroid alone due to a faster and more striking improvement during the first months of treatment and to a lower rate of relapse after the interruption of therapy with BDP.

Administration, Inhalation↗

Respiratory complications following surgery. Improved prediction with preoperative spirometry.

Patients who are old, overweight, who smoke and/or have symptoms of respiratory disease have an increased risk of atelectases and/or arterial hypoxemia in conjunction with surgery. The present study in 53 middle-aged men, operated on for gallbladder or peptic ulcer disease, illustrates how spirometry can be used to improve the prediction of respiratory complications. The relative risk of atelectases was greater in patients with functional residual capacity-closing capacity (FRC-CC) below -0.11 and the risk prediction based on age, body weight, smoking habits and respiratory symptoms was improved by adding information on FRC-CC. Arterial hypoxemia was more common in patients with wash-out volumes (WOV) above than below 35 l. The preoperative identification in high-risk patients of arterial hypoxemia based on the above-mentioned risk factors, was improved by adding information on WOV.

Adult↗

The predictive value of preoperative perfusion/ventilation scintigraphy, spirometry and x-ray of the lungs on postoperative pulmonary complications. A prospective study.

Prospectively, 125 patients were examined with 99mTc-perfusion scintigraphy, 89mKr- or 127Xe-ventilation scintigraphy and chest radiogram prior to major surgery. Postoperative therapy-demanding pulmonary complications occurred in 18% of the patients. A statistical association could be demonstrated between all the preoperative tests except ventilation scintigraphy and the frequency of complications. However, the predictive values of each of the tests, or even the combined results, were not significantly different from the frequency of complications among all the patients. It is concluded that the predictive values of perfusion- and ventilation scintigraphy, spirometry and radiogram of the chest are too low to be of any practical use.

Adult↗

The efficacy of incentive spirometry in patients with COPD.

OBJECTIVE: Although incentive spirometry (IS) is frequently used to prevent postoperative pulmonary complications, its efficacy in patients with COPD has not been documented. The aim of this study was to evaluate the effects of IS on pulmonary function tests, arterial blood gases, dyspnoea and health-related quality of life in patients hospitalized for COPD. METHODOLOGY: A total of 27 consecutive patients (mean age, 68.4 +/- 7.9 years; 26 males) admitted for COPD exacerbations were recruited for the study. In total, 15 (IS treatment group) used IS for 2 months, together with medical treatment. The remaining 12 (medical treatment group) were given only medical treatment. Pulmonary function and blood gases were measured. Assessment of dyspnoea by visual analogue scale (VAS) and quality of life using the St. George's Respiratory Questionnaire (SGRQ) were performed at admission and after 2 months of treatment. RESULTS: The activity, impact and total scores for the SGRQ improved (all P < or = 0.0001), PaCO2 values decreased (P = 0.02), PaO2 and PAO2 values increased (P = 0.02 and P = 0.01, respectively) in the IS treatment group. However, there were no significant differences between the measurements made pretreatment and after 2 months of medical therapy in the medical treatment group, with regards to pulmonary function, blood gases, SGRQ scores and VAS. CONCLUSION: The use of IS appears to improve arterial blood gases and health-related quality of life in patients with COPD exacerbations, although it does not alter pulmonary function parameters.

Aged↗

Spirometry in healthy adult never-smokers.

Spirometry was performed in 277 female and 240 male subjects constituting a random, unbiased population sample representative for the population of Denmark. Equipment, calibration and measurement procedures conformed strictly with established standards. Statistical analysis showed that certain power transformations (cubic, quadratic or square root) of the data produced models that fitted the data statistically significantly better than linear models, where no transformations are applied, or logarithmic models where a logarithmic transformation is applied to the response variable. Differences between predictions obtained with the three models were, however, small and without practical significance. Neither rigid adherence to established, well documented standards nor elaborate statistical analysis reduced the inter-individual variance significantly in comparison to previous investigations. The results emphasize that it is important that reference values are appropriate for the methods and populations in question.

Adult↗

Comparison of effect of salbutamol and isoprenaline on spirometry and blood-gas tensions in bronchial asthma.

The effect of the aerosol inhalation of 200 mug. of salbutamol and 1,000 mug. of isoprenaline on spirometry and blood-gas tensions was compared in the same 11 asthmatic subjects. Both drugs significantly reduced airway obstruction, and the extent of the reduction did not differ for periods of up to 30 minutes. After isoprenaline tachycardia and a small significant fall in arterial oxygen tension occurred, whereas after salbutamol there was no change in pulse rate and the arterial oxygen tension did not fall.

Adult↗

The quality of home spirometry in school children with asthma.

BACKGROUND: Handheld electronic spirometers provide the opportunity for more comprehensive monitoring of lung function at home than has hitherto been available. The aim of this study was to assess the quality of spirometric data collected at home by 90 asthmatic schoolchildren aged 7-14 years. METHODS: After training, children carried out twice daily recordings at home for four consecutive periods of 4 weeks using a data storage spirometer (Vitalograph), encouraged by 4-weekly visits from a research nurse. Compliance (proportion of blows recorded at correct time of day), technical quality (by machine criteria), and valid data recorded (the multiple of compliance and technical ability) were assessed. RESULTS: Mean compliance declined from 81.4% to 70.4% (p<0.001) between the first and last month, although the technical quality of the manoeuvres (81.9% and 80.1%, respectively) did not change significantly (p=0.48). CONCLUSIONS: There was a steady reduction of valid data over the four periods (from 73.6% to 64.3%, 59.7%, and 57.6%) with wide individual differences. Even under ideal conditions, home spirometry provides an incomplete (and therefore potentially biased) picture of long term changes in pulmonary function.

Adolescent↗

Forced oscillation technique and spirometry in cold air provocation tests.

BACKGROUND: Impedance measurements by the forced pseudo random noise oscillation technique can be used to study the mechanical characteristics of the respiratory system. The objective of this study was to analyse the changes in impedance to a cold air provocation test in patients with asthma, and to correlate these changes with those in the forced expiratory volume in one second (FEV1). METHODS: The response to isocapnic hyperventilation with cold air was assessed by respiratory impedance measurements and spirometry in 60 patients with bronchial asthma in whom the provocative dose of histamine resulting in a 20% fall in FEV1 (PD20) was < or = 8 mumol. RESULTS: Cold air provocation resulted in a mean(SD) fall in FEV1 from 3.75(0.85) litres to 3.10(0.90) litres. The mean(SD) decrease in FEV1 as a percentage of predicted was 15.4(3.8)%. The oscillatory resistance at 8 Hz increased from a mean(SD) of 0.367(0.108) kPa/l/s to 0.613(0.213) kPa/l/s and at 28 Hz the resistance increased from 0.348(0.089) to 0.403(0.099) kPa/l/s. Frequency dependence of resistance became significantly more negative. The reactance at 8 Hz decreased from a mean(SD) of -0.035 (0.041) kPa/l/s to -0.234(0.199) kPa/l/s, and the resonant frequency increased from 12.5(4.9) Hz to 25.7(9.1) Hz. Significant correlations were calculated between the decrease in FEV1 and changes in the various impedance parameters, especially between the decrease in FEV1 and the increase in resistance at 8 Hz (r = -0.66), and the decrease in FEV1 and the increase in the resonant frequency (r = -0.63). CONCLUSION: Cold air provocation in asthmatic subjects results in changes in the impedance of the respiratory system that correlate well with the changes in FEV1. These changes in impedance reflect ventilatory inhomogeneities in the peripheral compartment of the bronchial tree. These observations show the value of this technique in the evaluation of induced bronchoconstriction, as both a quantitative and a qualitative analysis of the response is possible.

Adult↗

Evaluation of the VMM turbine for spirometry in the applied physiology laboratory.

The volume measurement module turbine (VMM) was evaluated in 51 subjects for spirometry in applied physiology against the Stead-Wells spirometer (SW) and Wright peak flow meter (WM). The volume and flow ranges (VMM) were, FEV1 1.32 to 3.94 L (mean 2.62, confidence interval [CI] 2.46 to 2.78); forced vital capacity (FVC) 1.97 to 5.06 L (mean 3.50, CI 3.29 to 3.71); and peak expiratory flow rate (PEFR) 290 to 624 L.min-1 (mean 434, CI 407 to 461). The mean difference for FEV1 was 0.09 L (CI 0.05 to 0.14), FVC 0.04 L (CI -0.02 to 0.10), and PEFR 18.0 L min-1 (CI 8.7 to 27.3) less than SW or WM. Bias with FEV1 and FVC was not significant, though PEFR demonstrated a significant proportional error. The repeatability coefficients for FEV1 and FVC were 0.18 and 0.20, comparable to the SW; but for PEFR they were greater, 58.4 versus 33.8 L.min-1 by WM. The VMM turbine is accurate and reliable for the measurement of FEV1 and FVC over the ranges studied; however, care should be taken when interpreting PEFR.

Adult↗

Exercise-induced bronchoconstriction alters airway nitric oxide exchange in a pattern distinct from spirometry.

Exhaled nitric oxide (NO) is altered in asthmatic subjects with exercise-induced bronchoconstriction (EIB). However, the physiological interpretation of exhaled NO is limited because of its dependence on exhalation flow and the inability to distinguish completely proximal (large airway) from peripheral (small airway and alveolar) contributions. We estimated flow-independent NO exchange parameters that partition exhaled NO into proximal and peripheral contributions at baseline, postexercise challenge, and postbronchodilator administration in steroid-naive mild-intermittent asthmatic subjects with EIB (24-43 yr old, n = 9) and healthy controls (20-31 yr old, n = 9). The mean +/- SD maximum airway wall flux and airway diffusing capacity were elevated and forced expiratory flow, midexpiratory phase (FEF(25-75)), forced expiratory volume in 1 s (FEV(1)), and FEV(1)/forced vital capacity (FVC) were reduced at baseline in subjects with EIB compared with healthy controls, whereas the steady-state alveolar concentration of NO and FVC were not different. Compared with the response of healthy controls, exercise challenge significantly reduced FEV(1) (-23 +/- 15%), FEF(25-75) (-37 +/- 18%), FVC (-12 +/- 12%), FEV(1)/FVC (-13 +/- 8%), and maximum airway wall flux (-35 +/- 11%) relative to baseline in subjects with EIB, whereas bronchodilator administration only increased FEV(1) (+20 +/- 21%), FEF(25-75) (+56 +/- 41%), and FEV(1)/FVC (+13 +/- 9%). We conclude that mild-intermittent steroid-naive asthmatic subjects with EIB have altered airway NO exchange dynamics at baseline and after exercise challenge but that these changes occur by distinct mechanisms and are not correlated with alterations in spirometry.

Adaptation, Physiological↗

Respiratory function in esophageal hiatus hernia. I. Spirometry, gas distribution, and arterial blood gases.

As a part of a preoperative investigation, spirometry and blood gas tensions were studied in 64 subjects with X-ray-verified hiatus hernia (34 sliding, 22 mixed, and 8 of paraesophageal variety). According to the transverse diameter of the hernia. They were divided into 3 groups, small (2-5.9 cm), medium (6-9.9 cm), and large (10-17 cm) hernias. No correlation between the size of the hernia, reflux incidence, and spirometric findings could be demonstrated. A significant reduction of the arterial oxygen tension was found in small hernias and in vital capacity and maximal voluntary ventilation (MVV) in medium-sized hernias. Significant reduction in MVV was noted in the large hernia group. A common spirometric finding in all groups was a significant increase in residual volume and wash-out volume. The incidence of restrictive or obstructive pulmonary impairment was high in large (39%) and small (32%) hernias and relatively low in medium-sized hernias (8%). Roentgenological fibrosis was not found in any of the patients, while 4 showed emphysematous changes.

Adult↗

Effect on spirometry of distilled water and cromoglycate solutions nebulised by a small portable ultrasonic nebuliser.

The airway response to inhaled ultrasonically nebulised distilled water and three disodium cromoglycate solutions (DSCG in distilled water, normal saline and buffered saline) produced by a small portable nebuliser was determined by spirometry in 12 stable adult asthmatics in a double-blind trial. The mean percentage falls in forced expiratory volume in 1s (FEV1) were 13.4% following distilled water, 5.6% following DSCG in distilled water, 4.8% following DSCG in normal saline, 6.9% after DSCG in buffered saline. The fall in FEV1 was significantly greater (p less than 0.01) after distilled water than after all DSCG solutions with no significant difference between the DSCG solutions. Coughing was also greater during inhalation of nebulised distilled water than during inhalation of nebulised DSCG solutions (p less than 0.01).

Adult↗