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The bronchodilator efficacy and safety of metaproterenol sulfate were evaluated by double-blind crossover tests against placebo at three intervals during a 90-day treatment period in 50 asthmatic children. One group of 25 patients was continuously treated with metaproterenol syrup, and the other 25 with placebo syrup. Pulmonary function tests showed statistically significant improvements in forced expiratory volume, forced expiratory volume in one second, and peak expiratory flow rate after metaproterenol administration as compared with those measurements after treatment with placebo. Biweekly global evaluations of responses to metaproterenol administration were consistently more favorable than responses to placebo. Tachycardia and blood pressure changes after metaproterenol administration were consistent with the pharmacologic properties of beta-sympathomimetic stimulants. Side effects during metaproterenol treatment were minimal and laboratory data remained normal.
A 5-year prospective survey of 34 subjects with mild chronic bronchitis revealed marked individual variation in the annual rate of decrease in the forced expiratory volume in 1 sec. The mean annual decrease in the 1-sec forced expiratory volume was 0.046 +/- 0.057 liter. Although the annual decrease in the 1-sec forced expiratory volume was greater among smokers (0.056 +/- 0.061 liter per year) than non- and ex-smokers (0.016 +/- 0.021 liter per year; P less than 0.005), differences in tobacco consumption did not account for the individual variation. This variation was related, instead, to 3 phenomena believed to indicate the presence of host susceptibility to chronic bronchitis. These phenomena were bronchial reactivity to methacholine, ventilatory responsiveness to isoproterenol, and sputum eosinophilia. The correlation between the rate of decrease in 1-sec forced expiratory volume and the degree of methacholine reactivity was 0.76 (P less than 0.001); the correlation between the decrease in 1-sec forced expiratory volume and ventilatory responsoveness to isoproterenol was 0.45 (P less than 0.01). Deterioration of 1-sec forced expiratory volume was appreciably greater among those with sputum eosinophilia (0.062 +/- 0.06 liter per year) than among thse without eosinophilia (0.017 +/- 0.033 liter per year P less than 0.01). The progression of abnormality appeared to depend on an interaction between cigarette smoking and individual susceptibility. Even minimal tobacco consumption led to serious ventilatory deterioration when methacholine reactivity was high, whereas heavy smoking produced little effect on the decrease in 1-sec forced expiratory volume when methacholine reactivity was slight.
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BACKGROUND: Staging of bronchiolitis obliterans syndrome is based on the decline of forced expiratory volume in 1 second, a measure of overall ventilatory capacity. A single staging system is applied to all lung recipients, regardless of the bias which can be caused by the native lung after single lung transplantation. METHODS: We determined the decline of graft function in single lung recipients by a combination of two methods: 133-Xe radiospirometry and dynamic spirometry. The forced expiratory volume in 1 second fraction of the transplant (FEV1tx) was calculated from the proportion of ventilation of the transplant (Vtx) and forced expiratory volume in 1 second. Eight single lung recipients were followed up for a median observation period of 17 months; bronchiolitis obliterans syndrome developed in four of them. RESULTS: The fractional decline of forced expiratory volume in 1 second of the transplant was significantly greater than the decline of forced expiratory volume in 1 second (p = 0.016) in all patients during the follow-up. In the patients with bronchiolitis obliterans syndrome, the mean decline in forced expiratory volume in 1 second was 1.1 L (39.5%), and in forced expiratory volume in 1 second of the transplant it was 0.9 L (55.8%). The measurement of forced expiratory volume in 1 second of the transplant suggested stage 2a and 3a dysfunction in two grafts in which the assessment of forced expiratory volume in 1 second indicated stage 1a bronchiolitis obliterans syndrome. In one patient, decrease of forced expiratory volume in 1 second of the transplant was suggestive of chronic dysfunction 4 months before it was diagnosed by biopsy and declined lung function. CONCLUSIONS: The assessment of forced expiratory volume in 1 second seems to underestimate the severity of chronic dysfunction in single lung grafts. Instead, the determination of forced expiratory volume in 1 second of the transplant with radioactive tracers provides selective information of the graft function, which could be used for clinical evaluation of bronchiolitis obliterans syndrome in single lung recipients.
We studied 67 healthy males aged 20-30 years, 29 of them non-smokers and 38 smokers. In smokers, forced expiratory volume (FEV), 1 s forced expiratory volume (FEV1) and peak flow (PF) were significantly lower than in non-smokers, while the FEV1/FEV ratio, flows and mean transit time (MTT) compared well. MTT appeared directly related to age and negatively to FEV1/FEV, with no difference between the two groups, but MTT was directly related to FEV in non-smokers and negatively in smokers. Multiple regression analysis, MTT = a + b(FEV)+c(age), showed that parameters b and c were significantly different between smokers and non-smokers and, in the former, parameter b was negative. In non-smokers the effects of age and FEV on MTT were roughly the same, but in smokers MTT was influenced above all by age, probably because MTT measured the effects of continued smoking.
For men participating in the Multiple Risk Factor Intervention Trial, the authors evaluated the relation between the baseline forced expiratory volume in one second and lung cancer mortality among smokers between the third and tenth years of follow-up (1973-1974 to 1984). This measure of ventilatory function was a powerful predictor of lung cancer deaths, with rates that increased from 3.02 per 1,000 person-years in the lowest quintile of forced expiratory volume to 0.43 in the highest quintile. This relation was not weakened by adjustments for smoking dose, including number of cigarettes smoked per day, tar and nicotine content, duration of smoking, or age at onset of smoking. Nor was forced expiratory volume related to time between its determination and lung cancer death. If these observations can be verified in other studies, the forced expiratory volume in one second may identify smokers at very high risk of lung cancer and, hence, in need of more aggressive preventive approaches.
BACKGROUND AND METHODS: A comparison of the forced expiratory flow between 25% and 75% of the forced vital capacity (FEF25-75) and forced expiratory volume in 1 second (FEV1) was conducted for the detection of obstructive airway disease as an early manifestation of obliterative bronchiolitis. Pulmonary function tests performed on heart-lung and double lung transplant recipients between March 1981 and March 1983 were reviewed. Thirty patients were identified who showed progressive deterioration in pulmonary function after transplantation. Ratios determining proportionate decreases were calculated from measurements of absolute values for the FEF25-75 and FEV1 at the point when the FEF25-75 reached < 70% and < or = 30% of predicted, divided by baseline values obtained before the decline in function. Similar ratios were obtained for FEV1 and FEF25-75 at the point the FEV1 declined > or = 20% from its baseline value. RESULTS: Comparison of the ratios for the FEF25-75 and FEV1 at FEF25-75 values < 70% and < or = 30% of predicted and a similar comparison when the FEV1 declined > or = 20% from baseline showed a greater proportional decrease in FEF25-75 than FEV1 (p < 0.01). With the use of the FEF25-75, declines in airway function were detected earlier. After transplantation a decline in FEF25-75 to < 70% of predicted occurred approximately 112 days before a 20% decline a FEV1. CONCLUSION: The FEF25-75 is more sensitive than the FEV1 for the early detection of obliterative bronchiolitis. A presumptive diagnosis of obliterative bronchiolitis can be made with physiologic criteria, providing infection or acute rejection has been ruled out. When conducting epidemiologic studies or for vital statistics we propose that a decline in FEF25-75 to < 70% be used to define the onset of obliterative bronchiolitis.
BACKGROUND: Patients with severely impaired pulmonary function are considered at high risk for emphysema operations. We prospectively evaluated 44 patients with a forced expiratory volume in 1 second of 0.5 L or less undergoing reduction pneumonoplasty for dyspnea uncontrolled by medical management (confirmed by Borg and modified Medical Research Council dyspnea scales). METHODS: There were 28 men and 16 women (mean age, 66 years) with a mean preoperative forced expiratory volume in 1 second of 0.41 L (range, 0.23 L to 0.50 L). Preoperative therapy consisted of bronchodilators (100% of patients), oxygen (80%), and steroids (72%). Hypercarbia was seen in 80% of patients, and 66% had pulmonary hypertension. Unilateral reduction pneumonoplasty by a video-assisted thoracic surgical approach was performed in 34 patients, 6 patients underwent bilateral reduction pneumonoplasty by a video-assisted thoracic surgical approach, and 4 patients underwent bilateral reduction pneumonoplasty by a video-assisted thoracic surgical approach, and 4 patients underwent bilateral reduction pneumonoplasty by median sternotomy. Discrete emphysematous regions were resected using staplers with buttressing, and regions of homogeneous emphysema were plicated with KTP or neodymium:yttrium-aluminum garnet laser radiation. RESULTS: There was one death within 30 days, two additional deaths within 60 days, and five additional deaths within 1 year. Hospital stay averaged 12 days. Intensive care unit stay averaged 4 days. Subjective improvement was noted by 89%. Borg and modified dyspnea scores improved from 7.6 to 4.5 (p < 0.01) and from 3.9 to 2.35 (p < 0.01), respectively. Forced expiratory volume in 1 second was 0.62 L at 1 year, a 51% improvement (p < 0.001). Forced vital capacity was 1.32 L preoperatively and 2.05 L at 1 year (a 56% improvement) (p < 0.001). CONCLUSIONS: This experience documents that patients with severely impaired lung function can successfully undergo operation for emphysema. To obtain these results one must tailor the operative approach to the patient's disease.
The effects of an upper respiratory infection on some commonly measured spirometric indices have been determined in this study. The forcod vital capacity, forced expiratory volume in one second, forced expiratory flow in the middle half of the vital capacity and the peak expiratory flow were significantly lower during the infection. This stresses the need in cross sectional and longitudinal pulmonary function evaluation, to avoid testing a subject while he has an upper respiratory infection.
Previous research has shown that forced expiratory volume (FEV) is a useful predictor of remaining life in older adults. The present analyses are an attempt to replicate results from a study of Swedish twins which demonstrated substantial heritability of FEV with a sample of middle-aged Russian adult twins. Data were collected from 116 pairs of Russian twins (monozygote = 71, dizygotic = 45, mean age = 40.9 years). Phenotypic correlations between FEV, age, gender, height, and cigarette consumption (in pack years) were all significant, ranging from -.72 to .31. After the effects of age, gender, height, and smoking were partialled out of FEV, quantitative genetic analyses were conducted. Shared environmental effects were significant, accounting for 47% of the variance in FEV. Genetic effects, which accounted for about 28% of the variance, could be dropped from the model without a significant decrease in the fit. These results are discussed in relation to previous research conducted in other countries.
To date, only one study has empirically examined the effects of sitting versus standing posture on the spirometric forced expiratory volumes. Because of design limitations, the small excess of sitting over standing values found in that study may have been due to a positive testing order effect. Using a crossover design, the present study of 90 middle-aged male subjects alternated the sitting-standing and standing-sitting testing sequence between subjects to avoid confounding by testing order effects. The major findings were that forced expiratory volumes in one and in six seconds and forced vital capacity were significantly larger (p less than 0.001) in the standing than in the sitting posture, with mean standing minus sitting differences ranging from +0.06 to +0.08 L for the 3 indexes. The larger expired volumes measured in the standing position in this study were probably due to the subjects taking slightly larger inspirations in this posture than in the sitting position.
We evaluated the relation between forced expiratory volume in 1 second (FEV1) and lung cancer incidence and mortality among members of the Kaiser Permanente Medical Care Program who took a multiphasic health checkup. FEV1 was inversely related to risk of lung cancer among former and current smokers, but not related among never-smokers. We observed a decreased risk of lung cancer mortality only in the higher quintiles of FEV1 in current smokers among men, but not in women. FEV1 appears to be associated with lung cancer as a physiologic marker for smoking-induced pulmonary damage.
The vital capacity (VC) and one-second forced expiratory volume (FEV1) of 482 men were measured and corrected for temperature but not pressure. The relationship between both VC and FEV1 and height and age was examined and found to be linear. In using these relationships for significance testing the 95% confidence limit is 1.65 standard deviations below the predicted value. Our results are expressed in graphical form to facilitate interpolation and will thus be of use to the clinical practitioner in Australia. Neither weight nor smoking habit was found to influence the relationship of VC or FEV1 with age or height.
Forced expiratory volume in 1 second (FEV1) declines normally with aging by approximately 30 mL/yr, but in susceptible smokers, the decline is greater (about 60 mL/yr), resulting in the development of chronic obstructive pulmonary disease (COPD). Smoking cessation usually restores the normal or near-normal rate of FEV1 decline, whereas intermittent quitting provides less benefit. Thus, smoking cessation is a critical component for the prevention of COPD progression. FEV1 is central to the definition of COPD and classification of its severity. FEV1 is a good predictor of exercise tolerance and correlates with survival and quality of life. More rapid FEV1 decline is also predictive of morbidity, mortality, and hospitalization rates. Risk factors for accelerated decline in FEV1, in addition to smoking, include frequent exacerbations, airways reactivity, and possibly chronic systemic inflammation. Genetic components of the decline in FEV1 are being actively explored, but none has been extensively validated other than alpha1-antitrypsin deficiency. To date, only smoking cessation has been definitively shown to be effective in reducing the rate of FEV1 decline, but other therapeutic strategies are under active research. Consequently, FEV1 and its change over time are important outcomes in COPD and valuable measures for the assessment of disease progression.
Forced expiratory volume in 1 second (FEV(1)) is a strong risk factor for cardiovascular disease, stroke, lung cancer, and all-cause mortality. One possible explanation for this association is that FEV(1) is a marker of other determinants of mortality risk, such as obesity and physical inactivity. In a population-based cohort study of 12,283 men and women aged 45-74 years from the European Prospective Investigation into Cancer-Norfolk Study recruited in 1993-1997, the cross-sectional association between physical activity and FEV(1) and that between physical activity and change in FEV(1) were analyzed. Indices of physical activity, including participation in vigorous recreational activity, stair climbing, and television viewing, were assessed with a validated questionnaire designed to assess activity in the previous year. Television viewing was negatively associated with FEV(1) in men and women (p < 0.001), whereas stair climbing and participation in vigorous leisure time activities were positively associated with FEV(1) in men and women (p < 0.001). The associations remained after adjustment for known confounders, including age, height, vitamin C, and smoking. Climbing more stairs and participating in vigorous leisure-time activity predicted a slower rate in annual percent decline in FEV(1) (p < 0.004 and p < 0.002, respectively). In conclusion, physical activity is associated with higher levels of FEV(1), whereas television viewing is associated with lower levels.
PURPOSE: To assess the relationship between adolescent and parent reports of adolescent health-related quality of life (HRQL) and between adolescent pulmonary function (forced expiratory volume in 1 second as percent of predicted) and reporter perceptions of adolescent health. METHODS: Twenty-four adolescents with cystic fibrosis (CF), their mothers, and their fathers completed the Child Health Questionnaire during routine CF clinic visits at 2 urban hospitals. Patients were between the ages of 11 and 18 years (mean age: 14.2 years) and were predominantly male (75%). The best measure of forced expiratory volume in 1 second as percent of predicted for the year of the study was also collected for each adolescent. RESULTS: Adolescent pulmonary function was related to the perceived adolescent physical health scales. It was not, however, associated to perceptions of adolescent emotional, social, or behavioral HRQL by any of the 3 family reporters. Associations were found between adolescent pulmonary function and self-reports of general health (0.73), role/social limitations-physical (0.47), and bodily pain (0.42). Adolescent pulmonary function was related to mother reports of adolescent general health (0.73), role/social limitations-physical (0.73), bodily pain (0.55), and physical functioning (0.70). Father perceptions of adolescent health were associated to adolescent pulmonary function on general health (0.54), role/social limitations-physical (0.60), and physical functioning (0.64). Associations between adolescent and parent perceptions of adolescent HRQL were also health scale-specific. Mother and child reports of adolescent HRQL were related on adolescent behavior problems (0.71) and role/social limitations attributable to behavior (0.48), role/social limitations attributable to physical (0.62), bodily pain (0.69), physical functioning (0.69), family activities (0.45), and general health (0.66). Associations were found between father and adolescent reports on perceived adolescent behavior problems (0.66); self-esteem (0.65); and role/social limitations attributable to physical (0.49), general health (0.61), and perceived mental health (0.48). CONCLUSIONS: Results demonstrate the need to include multiple informants and comprehensive, multidimensional measures of HRQL, in addition to pulmonary function, when assessing health in adolescents with CF.
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