[Clinical gasometric and functional tests of respiratory system in patients with bronchial asthma following the therapy using negatively ionized air].
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28 young adults suffering from allergic perennial asthma have been treated by Lomudal spray or a matching placebo for 4 weeks. Judgment criteria were symptoms evolution, number of crisis, functional respiratory tests before and after treatment, patients and clinician judgments of efficacy and tolerance. Results of functional respiratory tests remind unchanged while symptomatology improved significantly. The total number of crisis was dramatically reduced by sodium cromoglycate treatment compared to placebo. Judgments significantly favoured sodium cromoglycate. Tolerance was excellent in both group.
REASONS FOR PERFORMING STUDY: The long-established conventional reference technique (CRT) for measuring respiratory mechanics in horses lacks sensitivity and there is a need for further refinement in new technology, such as the impulse oscillometry system (IOS). OBJECTIVES: To evaluate the potential use of the IOS as a clinical respiratory function test and compare it to the current CRT in horses suffering from common upper and lower airway dysfunctions. METHODS: Six healthy horses were tested before and after induction of a unilateral nasal obstruction (UNO) or transient left laryngeal hemiplegia (LLH). Six heaves-affected horses were tested in clinical remission and during a heaves crisis, before and after nebulisation of cumulative doses of a bronchodilator therapy (ipratropium bromide; IPB). RESULTS: As opposed to the CRT, the IOS was able to detect partial upper airway obstruction (UAO) caused by UNO or LLH in resting horses, without differentiating both conditions. Upper airway obstruction caused an upward shift of resistance (R(rs)) from 5 to 35 Hz without altering reactance (X(rs)). As for the CRT, IOS respiratory parameters measured in heaves-affected horses in crisis differed significantly from values measured during remission. The difference in frequency-dependent behaviour of R(rs) and X(rs) allowed discrimination between upper and lower airway obstructions. Bronchodilator treatment induced significant dose-dependent changes in X(rs) at 5 and 10 Hz, from the first dose. Total pulmonary resistance (RL) and R(rs) at 5 Hz were affected from the second dose and displayed similar sensitivity. Although post treatment RL values were comparable to remission, R(rs) and X(rs) remained significantly different, characterising persistent peripheral obstruction. CONCLUSIONS: The IOS was more sensitive than the CRT in detecting partial UAO in resting horses and persistent post treatment peripheral dysfunction in heaves-affected horses. The IOS is a sensitive test that provides graded quantitative and qualitative information on disease-induced respiratory dysfunctions as well as on treatment efficiency in horses. POTENTIAL RELEVANCE: The IOS could represent a practical and sensitive alternative respiratory function test for routine clinical investigations of common airway obstructive diseases and therapy in horses.
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The purpose of this investigation was to compare the respiratory function of patients with different clinical types of muscular dystrophy (MD). A total of 190 patients representing facioscapulohumeral MD (n = 20), limb-girdle MD (n = 50), Becker MD (n = 20), Duchenne MD (n = 90), and the "intermediate" type of MD (n = 10) were studied using simple spirometric respiratory function tests. The respiratory modifications observed in the 3 adult forms indicate that pulmonary function was almost normal. Respiratory function in Duchenne muscular dystrophy (DMD) was always characterized by a restrictive syndrome which severely impaired pulmonary function. The vital capacity (VC) underwent ascending, plateau, and descending phases during the course of the disease. The VC at the plateau stage may be used as an estimate of life span. The most interesting finding was the high degree of variability in the restrictive syndrome associated with DMD. In the DMD group 30% presented a severe restrictive respiratory syndrome associated with a life span of less than 20 years (Type 1), 40% had a serious restrictive syndrome and variable mortality (Type 2), and the remaining 30% had a moderate restrictive respiratory syndrome (Type 3).
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UNLABELLED: Myasthenia Gravis (MG) is a neuromuscular disease often associated with thymic pathology due to neuromuscular transmission impairment by circulating antibodies directed against the cholinergic postsynaptic receptor on the neuromuscular junction (Anti-AchR-Ab). The treatment of MG includes cholinesterase inhibitors, steroids and thymectomy. Plasmapheresis can remove Anti-AchR-Ab but more recently plasma-perfusion (PP), a more specific apheresis for selective removal of noxious plasma components, has been developed. AIM OF THE STUDY: To study the effect of PP treatment, performed by using specific immunocolumns for Anti-AchR-Ab, on the clinical outcome of MG patients non-responder to steroid therapy or thymectomy. MATERIALS AND METHODS: We treated 8 patients suffering from severe MG by a cycle of 6 sessions of PP. We used columns containing triptophan as a specific ligand for Anti-AchR-Ab. In order to evaluate the effectiveness of treatment we used functional tests (muscular tests, respiratory function, electromyography) and laboratory tests (Anti-AchR-Ab; immunoglobulins, complement fractions, immunocomplexes). RESULTS: After one to three PP sessions, early clinical improvement in bulbar and respiratory symptoms were found in all patients and EMG showed improvement of neuromuscular transmission. Serum concentration of immunological markers decreased progressively and significantly during the treatment. Clinical improvements were progressive despite the tendency for Anti-AchR-Ab to reach initial values between one session and another. We observed no side effects due to the type of immunocolumns used. CONCLUSIONS: Triptophan columns appear to be able to remove large quantities of Anti-AchR-Ab and immunological markers from plasma. Our experience shows that PP performed using triptophan columns in patients suffering from severe MG provides good clinical results, improving patients' outcome, without any risk linked to the procedure.
In order to study the allergic, immunological, functional and bronchial hyperreactivity (BHR) differences between wheezy bronchitis and perennial asthma, the author studied 285 children aged 4 to 13, divided in three groups: asthma group (A.g.) 102; wheezy bronchitis (W.b.g.) 103; control group 20. The following tests were done: skin prick test (SPT) with D. pteronyssinus (DP), Total IgE, specific IgE anti-DP (RAST), functional respiratory tests (FRT) with a Jaeger whole body plethysmography, and acetylcholine challenge to test the nonspecific BHR. The results show us that there are a greater number of positive SPT and positive RAST, functional abnormalities and a higher sensitivity to acetylcholine in asthmatic children (A.g.) than in those with wheezy bronchitis (differences between the two groups are statistically significant). (table; see text) The findings indicate that it exists in w.b. children an allergo-immunological mechanism and a bronchial hyperreactivity as we observe in asthma, but in a milder degree. W.b. must be carefully watched over because an important number go on to overt asthma. In conclusion, there is a close link between wheezy bronchitis and asthma in children. Atopic w.b. should be treated as an atopic asthma.
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We reviewed the records of 52 amyotrophic lateral sclerosis (ALS) patients examined between 1995 and 2000 who had needle electromyography (EMG) of their respiratory muscles, including the diaphragm, at or near the time of their diagnosis. With respiratory function testing, patients with abnormal diaphragmatic EMG at diagnosis (Group 1, n=23) had significantly lower forced vital capacity (FVC), lower daytime arterial PO(2) and higher PCO(2) measurements (p<0.05) than patients with normal diaphragmatic EMG (Group 2, n=29). Twenty-eight percent of the patients without symptoms or signs of respiratory insufficiency at the time they were examined had an abnormal diaphragm EMG. Mean survival of Groups 1 and 2 were similar. However, sub-analysis of patients within each group, comparing those treated with non-invasive positive pressure ventilation (NIPPV) with those not treated, showed that treated patients in Group 1 (abnormal diaphragm EMG) survived significantly longer (p<0.05) than untreated patients. They also started NIPPV earlier than treated patients in Group 2. We conclude that respiratory muscle EMG was simply and safely performed on ALS patients at or around the time of diagnosis. The procedure can detect sub-clinical respiratory muscle dysfunction. The technique used for EMG of the respiratory muscles, its pitfalls and contraindications are also reviewed.
BACKGROUND: Diaphragmatic weakness (DW) is a potential manifestation of primary myopathies. Prevalence and impact on respiratory function have not been defined. METHODS: Respiratory function (inspiratory vital capacity, IVC; maximal inspiratory muscle pressure, PImax; respiratory muscle effort, P (0.1)/PImax) and polysomnography/nocturnal capnometry (PtcCO(2)) was analysed in 49 patients with primary myopathies. DW was defined as > 25 % drop of IVC upon shift from upright to supine position. RESULTS: 19/54 (35 %) of patients, mostly AMD (68 %) and DMD (42 %) had DW. Restrictive ventilatory defect was moderate (IVC 37.2 +/- 26.2 %) in patients with and without DW (IVC 46 +/- 26 %, p = n. s.). DW caused a -33 %, respective - 25 %, supine drop of IVC and PImax, resulting in severe restriction in supine position (IVC (supine) 24.9 +/- 19.1 %, PImax (supine) 2.0 +/- 1.0 kPa, P (0.1)/PImax (supine) 19.9 +/- 12,8 %). All patients with DW and 75 % without had sleep-disordered breathing. This was significantly more severe in DW: 90 % (vs 17 % without DW) had continuous nocturnal hypoventilation (PtcCO(2) 62 +/- 2 mm Hg), 70 % (vs 18 % without DW) had combined nocturnal and diurnal hypercapnic respiratory failure (PaCO(2) 54,7 +/- 11.8 mm Hg). DW was an independent risk factor for sleep disordered breathing, for nocturnal and diurnal respiratory failure (r = 0.95, p < 0,05). Predictive thresholds thereof were accurate and identical to previously determined only for supine function data. CONCLUSION: DW is common in primary myopathies and predictive of nocturnal and diurnal respiratory failure. Supine respiratory function tests are necessary for clinical diagnosis and respiratory risk stratification.
Respiratory function tests (forced vital capacity and forced expiratory volume in one second) were performed serially in pregnancy, the puerperium, and at least six weeks post partum in 27 patients with a history of asthma and in 12 control subjects. Eleven asthmatic patients with spirometric evidence of respiratory obstruction in pregnancy on at least one occasion were considered to have active disease. This group had significantly impaired respiratory function tests when compared to controls. The remaining 16 asthmatic patients were considered to be in remission. No changes in respiratory function tests attributable to pregnancy could be demonstrated in the asthma or control groups. Patients with active asthma tended to have smaller babies than patients with asthma in remission or the control patients.
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