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PubMed1975

Pulmonary involvement in patients with rheumatoid arthritis.

Vital capacity (VC) and single-breath diffusing capacity for carbon monoxide of the lungs (Dco) were measured and chest X-ray evaluated in 129 patients with rheumatoid arthritis (RA). 123 of them represented average RA patients, either hospitalized (84 patients, Group I) or outpatient material (39 patients, Group II). The remaining six patients (Group III) represented cases with marked changes in chest X-ray detected in an earlier study. Deviating findings in the 123 cases of Groups I and II were observed as follows: in one the lung function tests or X-ray examinations, 35%; abnormal X-rays, 18%; reduced VC or Dco, 28%; simultaneously low VC and Dco, 7%; and pathological findings in all three tests, 2%. Group III showed extremely low VC and Dco values. Changes in respiratory function involved restrictive impairment and diffusion defects, and the results further implied that restrictive changes develop early, whereas decreased diffusing capacity is associated with more advanced "rheumatoid lung". The disparity abnormal findings in chest X-ray changes and in lung function tests suggests that in examining pulmonary manifestations in patients witu RA, both radiographic methods and pulmonary function tests should be used for relevant evaluation.

Adult↗

PubMed2002

Effect of exercise-induced changes in residual lung volume on the determination of body composition.

The transient increase in residual lung volume (RV) as a result of exercise has been well documented. An accurate assessment of exercise-induced RV would be important when hydrostatic weighing (HW) is performed after exercise. The purpose of this study was to determine whether accurate HW measures could be performed after exercise when changes in RV are measured. Subjects (n = 32) performed pulmonary function (vital capacity [VC]-estimated RV), oxygen dilution-determined RV, and HW measures before and after either a maximal treadmill test (n = 16) or seated rest (n = 16). Two-way analysis of variance (p </= 0.05) was performed on RV and HW body composition to identify significance between pre- and posttreatment. A post hoc paired t-test was performed to identify the source of any significant interactions. Results showed that for exercising subjects, oxygen dilution-determined RV was significantly increased between pre- and posttreatment. Estimated RV did not differ significantly for either group. Hydrostatic weighing body composition data were not significantly different for either group when oxygen dilution-determined RV was used. Conversely, when estimated RV was used in the calculation of body composition, a significant difference was noted between pre- and posttreatment in the exercise group (percentage of fat increased, whereas percentage of lean body mass decreased). The results of this study suggest that accurate body composition estimation can be performed after exercise. Body composition accuracy, however, is reliant on the concomitant employment of HW and RV estimation techniques that are sensitive to transient changes in RV. For this study, the oxygen dilution method of RV determination was used. Estimated RV (VC method) was not sensitive to changes in RV, subsequently resulting in erroneous HW body composition after maximal exercise.

Adult↗

PubMed2002

[Hypodynamic respiratory insufficiency. Diagnostic investigation].

Patients with restrictive lung disease, owing to respiratory muscle dysfunction, have no parenchymal involvement. Their vital capacity (VC) and total lung capacity (TLC) are reduced to less than 50% and can lead to pneumonia and nocturnal hypercapnia and hypoxia. Their diffusion capacity is normal. With maximal static mouth pressure (Pimax) < 80 cm H2O and/or Pemax < 100 cm H2O, patients are referred to the national centres. Here, inspiratory muscular insufficiency is confirmed by sniff nasal inspiratory pressure and oesophageal pressure < 70 cm H2O. Expiratory muscular insufficiency is confirmed by a cough peak flow < 3-4 L/sec. and cough gastric pressure < 100 cm H2O. Sleep studies reveal nocturnal hypoventilation. Phrenic nerve stimulation is to be introduced in the diagnostic approach. Twitch mouth or oesophageal pressure < 10 cm H2O and twitch gastric pressure < 7 cm H2O are pathognomonic for neuromuscular respiratory insufficiency.

Female↗

PubMed2005

Applicability of commonly used Caucasian prediction equations for spirometry interpretation in India.

BACKGROUND & OBJECTIVE: The applicability of Caucasian prediction equations in interpreting spirometry data in Indian patients has not been studied. The present study was undertaken to see if Caucasian and north Indian prediction equations can be used interchangeably while interpreting routine spirometric data. METHODS: Forced vital capacity (FVC), forced expiratory volume in first second (FEV(1)), and FEV(1)/FVC ratio were recorded from 14733 consecutive spirometry procedures in adults. Predicted values and lower limits of normality were calculated using regression equations previously derived at this centre, and four commonly used Caucasian equations described by Knudson, Crapo, European Community for Coal and Steel (ECCS) and the Third National Health and Nutrition Examination Survey (NHANES III). For men, 90 per cent of predicted values were also derived. Kappa estimates were used to study agreement, and Bland Altman analysis was performed to quantify differences, between interpretations from Indian and Caucasian equations. Receiver operating characteristic (ROC) curves were constructed to assess utility of using a fixed percentage of Caucasian predicted values in categorizing FVC or FEV(1) as abnormal. RESULTS: The use of Caucasian prediction equations (and 90% of predicted values in men) resulted in poor agreement with Indian equation in most height and age categories among both men and women. Bland Altman analysis revealed a large bias and wide confidence limits between Caucasian and Indian equations, indicating that the two cannot be used interchangeably. ROC analysis failed to yield good results with use of any single fixed percentage of Caucasian predicted value while categorizing FVC or FEV(1). INTERPRETATION & CONCLUSION: Our results showed that the use of Caucasian prediction equations, or a fixed percentage of their predicted values, resulted in misinterpretation of spirometry data in a significant proportion of patients. There is a need to assess performance of more than one regression equation before choosing any single prediction equation.

Adolescent↗

PubMed1991

Lung mechanics and gas exchange in steroid treated pulmonary sarcoidosis. A seven year follow-up.

Fifteen patients with pulmonary sarcoidosis, representing the functionally most severely affected quartile of referred patients, were prescribed steroids during one year. During this period and after 7 years on average, measurements were made of lung volumes, the static elastic pressure/volume (PstL/V) curve and lung resistance (RL). Lung mechanics and arterial blood gases were studied at exercise. Within months static compliance (CstL) and the arterial partial pressure of oxygen improved along with radiography. A modest positive trend continued throughout the follow-up. The vital capacity followed CstL changes closer than did the total lung capacity, which remained low. Though CstL improved, transpulmonary pressure at maximal inspiration increased and the upper part of the PstL/V curve became flatter. RL remained moderately increased. The course of the physiologic findings may be explained by fairly stable parenchymal and peribronchial fibrosis after cessation of active inflammation, and by regress of reflex inhibition of inspiration. Thus most subjects showed modest improvement during and after treatment. The initial study of lung function provided important prognostic information. The study does not allow conclusive evidence with respect to long term benefit of treatment, but encourages continued use of steroids under the guidance of function tests.

Adult↗

PubMed1988

Changes in respiratory muscle function after neostigmine injection in patients with myasthenia gravis.

In sixteen patients with myasthenia gravis, the weakness of respiratory muscles, especially of expiratory, caused some disturbances in lung function. Thirty minutes after injection of neostigmine, general improvement of muscle function was accompanied by an increase of strength and endurance of respiratory muscles. The mean value of maximal inspiratory mouth pressure (PImax) increased by 33%, maximal expiratory mouth pressure (PEmax) by 23.5% and maximal voluntary ventilation (MVV) by 21%. As a consequence of these changes amelioration of lung function indices was found, vital capacity increasing on average by 13% and residual volume decreasing by 12.5%. We concluded that patients with generalized myasthenia gravis have disturbances in lung function which may be partially improved by neostigmine injection or other anticholinesterase agents.

Adult↗

PubMed1986

Lung function in patients with ankylosing spondylitis. A study of the influence of disease activity and treatment with nonsteroidal antiinflammatory drugs.

Progressive ankylosis of the thoracic skeleton in ankylosing spondylitis (AS) causes restrictive pulmonary function impairment characterized by a reduction in vital capacity (VC). After a wash-out period of 2 weeks, 33 men with active AS were treated with either diflunisal or phenylbutazone according to a double blind randomized design for 12 weeks, followed by an open extension period of 36 weeks. A spirometric study was performed at baseline, Week 12, and Week 48. In the active phase of the disease a correlation was found between VC and chest expansion, whereas neither of these variables was related to the thoracic pain and over-all disease activity. We also found that the VC correlated with the lumbar flexion index, but not with the erythrocyte sedimentation rate or IgA. Although all clinical efficacy variables showed an improvement during treatment with both drugs, no change in VC was found, even in patients with the most restricted ventilatory impairment. We conclude that the VC is not an appropriate variable for the evaluation of short term therapy in AS.

Adult↗

PubMed1987

Pulmonary function in patients with sarcoidosis. A three year follow-up.

During a 3 year period, 101 patients were consecutively diagnosed as having sarcoidosis. During the 3 year follow-up 9 patients died, 6 of them directly or indirectly due to their sarcoidosis. In 78 patients bronchoscopy and spirometry were performed at the primary investigation, and after 3 years a new spirometry was performed. A positive bronchial mucosal biopsy, bronchial sarcoidosis, was found in 31 (40%) of the 78 patients. Mean values of vital capacity, total lung capacity and forced expiratory volume in one second were normal in both patients with bronchial sarcoidosis and those without. Abnormal spirometry was found in 16 (21%) patients at the initial examination and in 11 (14%) at the follow-up. There were 10 (32%) patients with and 6 (13%) without bronchial sarcoidosis who had an abnormal spirometry. At follow-up a normalized lung function was found in 8 (50%) of the 16 patients with abnormal spirometry. Only 3 (4.8%) patients with initially normal lung function had abnormal lung function at follow-up. Our findings indicate a very little risk of developing abnormal lung function if there are normal findings at the primary investigation. Corticosteroids seem to have some effect, especially in patients with endobronchial sarcoidosis.

Adult↗

PubMed1979

[Comparative evaluation of the functional state of the respiratory system in workers exposed to asbestos and cotton dust].

63 spinners exposed to cotton dust and 75 spinners exposed to asbestos dust were examined. In the women working in asbestos spinning room chronic nonspecific respiratory tract diseases prevalence was found to amount to 30% and in the cotton exposed group it was 15%. Mean values of lungs' vital capacity remained within the due values, although they were statistically significantly lower in asbestos exposed spinners (p less than 0,001). On the other hand, the percentage ratio of the forced expiratory capacity of 1 second was statistically significantly lower (0,001 less than p less than 0,01) in those exposed to cotton dust. The authors point to the occurrence of functional disturbances of the respiratory tract prior to radiological symptoms of lung asbestosis and their correlation with clinical symptoms.

Adult↗

PubMed1983

[New elements in the interpretation of flow-volume curves].

We have measured flow-volume curves (FV) in 167 normal individuals of both sexes aged 20 to 89. All were non-smokers and none had cardio-respiratory disease. The flows at 25, 50 and 75 per cent of vital capacity (VC) as well as flows normalized by VC or total lung capacity (TLC) gave, in general, good correlation coefficients with age. The parameters V25/TLC and especially V50/TLC gave for the best correlations with age and we suggest these parameters in future when flow volume curves are used to assess respiratory pathophysiology. Normal values as well as regression equations of these parameters with age are proposed for various age groups in the 20-89 years age range.

Adult↗

PubMedDate not supplied

Influence of matching volume on reproducibility of maximal expiratory flow-volume curves.

We examined the influence of "matching volume" on intrasubject variability of the descending limb of maximal expiratory flow-volume (MEFV) curves on air and helium-oxygen (He) in 18 healthy subjects and 28 patients with airflow limitation. Duplicate forced expirations were analysed according to four methods of alignment. With the first method, flows corresponding to identical percentiles of separate FVC (SEPVC) were compared. With the remaining three, we aligned curves at TLC, mid-vital capacity (VC50) and RV, respectively, for comparison of: a) flow at identical percentiles of the averaged FVC and b) expired volume at identical percentiles of the averaged peak flow. In healthy subjects, variability of flow at 50% and 75% of expired FVC (FEF50 and FEF75) did not change significantly with method, except that FEF75 on air varied more with method SEPVC than with VC50. In airflow limitation, FEF75 was significantly less reproducible when curves were matched at RV than at TLC, both on air and He. Over the latter part of expiration, an arbitrary index of variability of flow-defined volume also indicated that method RV gave the poorest precision in patients. We conclude that selection of matching volume does not influence the variability of MEFV-curves in health. In airflow limitation, however, TLC appears to be the most reliable volume for alignment.

Adolescent↗

PubMed1982

The influence of lung volume on gas transfer in scoliosis.

Single-breath carbon monoxide transfer factor (DLCO) and diffusion coefficient (KCO) have been compared with vital capacity and total lung capacity in 119 subjects with scoliosis, 74 with idiopathic scoliosis, 32 with congenital osteogenic scoliosis and 13 with paralytic scoliosis. In each group mean values of DLCO were below, and for KCO above, predicted values. Furthermore, in each group, DLCO was correlated with lung volume and KCO inversely correlated with lung volume. The reduction in DLCO is probably due to the reduction in the total alveolar surface area and the increased values for KCO probably result from an increase in pulmonary capillary blood volume per unit alveolar volume at low lung volumes.

Adolescent↗

PubMed1995

Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis.

STUDY DESIGN: A prospective study of 19 adolescents and seven adults with idiopathic scoliosis undergoing posterior spinal fusion with segmental spinal instrumentation and a concomitant thoracoplasty had pulmonary function evaluation before surgery and at selected time points up to a minimum 2 years after surgery. OBJECTIVES: The objectives were to determine the effects thoracoplasty had on pulmonary function and chest cage dimension changes at a minimum 2-year follow-up in idiopathic scoliosis patients. SUMMARY OF BACKGROUND DATA: The cosmetic benefits of thoracoplasty on the rib hump deformity are well accepted. The rib resection procedure allowed for procurement of autogenous bone used for the arthrodesis. Short- and long-term pulmonary function evaluation was necessary to determine proper patient selection and any potential sequelae from the rib resection procedure. METHODS: All patients had pulmonary function tests consisting of forced vital capacity, forced expiratory volume in 1 second, and total lung capacity performed before surgery and 3 months, 1 year, and 2 years after surgery. Ten adolescents also had computed tomographic scans before and after surgery to evaluate chest cage dimension changes after the procedure. RESULTS: The 3-month postoperative pulmonary function test values of the 19 adolescents experienced a statistically significant decline, averaging 16% (P < 0.05), however, the mean values for each parameter returned to just slightly below the preoperative value at 2-years follow-up. The pulmonary function test values of the seven adults experienced a 27% initial decline 3 months after surgery and a residual 23% decline 2 years after surgery; both values were statistically significant (P < 0.05). CONCLUSIONS: We reserve the thoracoplasty procedure for adolescents and adults with preoperative pulmonary function values that will tolerate the morbidity associated with the rib resection. Adolescent patients appear to normalize their pulmonary function tests by 2 years follow-up, whereas long-term pulmonary function in the adult patient remains a concern.

Adolescent↗

PubMed1994

Inhaled platelet-activating factor increases airway sensitivity but not maximal airway narrowing to methacholine in normal subjects.

To examine the effect of inhaled platelet-activating factor (PAF) on airway sensitivity and on maximal airway narrowing, we measured airway response to doubling concentrations of methacholine (MCh) 48 h before and 48 h after inhalation of 10, 50 and 100 micrograms of PAF in six nonatopic, nonasthmatic subjects. The forced expiratory volume in one second (FEV1) and airflow at 30 percent of vital capacity (V30) from partial forced expiration were used to assess changes in airway calibre. Inhalation of PAF caused only minor changes in FEV1. In contrast, inhalation of 100 micrograms of PAF caused a significant fall in V30 from 2.64 +/- 0.35 to 1.35 +/- 0.43 l.min-1 (p < 0.05). Two days after PAF inhalation a leftward shift of the concentration-response curve to MCh was observed. The MCh concentration causing a 20% fall in FEV1 (PC20FEV1) was 11.25 +/- 1.78 and 2.38 +/- 1.29 mg.ml-1 (geometric mean +/- GSEM; p < 0.05) before and after PAF inhalation, respectively. PAF did not affect the maximal airway response to MCh. The maximum percentage fall in FEV1 was 36.2 +/- 1.9% at baseline and 37.6 +/- 1.8% after PAF inhalation. Likewise, maximum percentage change in V30 was 72.8 +/- 3.7% at baseline and 73.6 +/- 3.4% after PAF inhalation. The results of this study show that PAF inhalation increases airway sensitivity without altering the maximal bronchoconstrictive response to MCh in normal subjects.

Administration, Inhalation↗

PubMed1995

Activation of bronchoalveolar lavage T lymphocytes and clinical, functional and radiological features in sarcoidosis.

Previous studies on the relationship between activated BAL T lymphocytes and clinical features in sarcoidosis revealed controversial results. We determined lavage lymphocytes, T lymphocytes, activated T lymphocytes, helper, suppressor and natural killer cells in 50 patients with pulmonary sarcoidosis and compared the results with clinical findings, serum angiotensin converting enzyme (ACE), the radiological pattern and lung function data (vital capacity [VC], total lung capacity [TLC], FEV1, transfer coefficient KCO and arterial-alveolar oxygen difference [AaDO2] during exercise). Patients with erythema nodosum (n = 7) showed a lower proportion of activated T lymphocytes (p < 0.05) and lymphocytes (p < 0.01) than the other patients. There was a significant correlation between activated T lymphocytes and AaDO2 during exercise (r = 0.49, p < 0.001), and an inverse correlation was seen between activated T lymphocytes and VC or TLC (r = -0.35 and r = -0.36, p < 0.01). We conclude that the percentage of activated BAL T cells may be related to the degree of parenchymal involvement as expressed by functional disturbance.

Adult↗

PubMed1998

[The relationship of carcinoembryonic antigen and neutrophils to pulmonary function in healthy smokers].

We evaluated the relationship of carcinoembryonic antigen (CEA) and neutrophils to pulmonary function in healthy smokers. Smokers in whom levels of CEA were greater than 5.0 ng/ml (n = 70) and in whom CEA levels were 5.0 ng/ml or less (n = 693) had significantly higher mean concentrations of leukocytes and neutrophils than non-smokers (n = 651) (leukocytes: 6,883 +/- 1,889/mm3 or 5,581 +/- 1,457/mm3 vs. 4,507 +/- 1,111/mm3, p < 0.01; neutrophils: 4,389 +/- 1,542/mm3 or 3,343 +/- 1,164/mm3 vs. 2,700 +/- 884/mm3, p < 0.01). Differences in the ratio of vital capacity to the predicted vital capacity (%VC) were not significant. In addition, the ratio of forced expiratory volume in one second to forced vital capacity (FEV 1.0%) in smokers with CEA levels greater than 5.0 ng/ml was decreased compared with smokers with CEA levels of 5.0 ng/ml or less and in non-smokers (90.2 +/- 8.4% vs. 93.3 +/- 6.7% or 92.9 +/- 6.5%, p < 0.01). These results suggest that in healthy smokers high serum CEA levels are related to a decreased FEV 1.0%.

Adult↗

PubMed1976

[Standard values of lung function diagnostics in children (author's transl)].

A joint study of 7 laboratories was initiated for the determination of standard function values in childhood. The sample included 3500 children. The vital capacity, forced expiratory volume, residual capacity, total capacity and work of breathing were determined and normal values calculated. These parameters were correlated with body height, body surface area, body weight and age. For an easy estimation of the predicted values regression formulas of the measured function are elaborated.

Child↗

PubMed1979

Changes in the forced expiratory spirogram in young male smokers.

Forced expiratory spirograms and peak expiratory flow were measured in 102 resident male medical students (60 nonsmokers and 42 smokers). Forced vital capacity; forced expiratory volume in 1 sec; forced expiratory volume in 1 sec expressed as a percentage of forced vital capacity; forced expiratory flows between 80 and 70 per cent, between 55 and 45 per cent, between 30 and 20 per cent, and between 15 and 5 per cent of the forced vital capacity; forced expiratory time for the last 0.5 liter of the forced vital capacity; and maximal mid-expiratory flow were determined from the forced expiratory spirogram. Peak expiratory flow, all forced expiratory flows (except the forced expiratory volume in 1 sec), and the ratio of forced expiratory volume in 1 sec to forced vital capacity were significantly lower, and forced expiratory time for the last 0.5 liter of the forced vital capacity was significantly higher in the heavy smokers (those who had smoked a lifetime total of more than 10,000 cigarettes) than the nonsmokers. The light smokers (those who smoked a lifetime total of fewer than 10,000 cigarettes) had values between those of nonsmokers and the heavy smokers. Thus, a definite dose-related response to smoking was seen. Flows at lower lung volumes showed greater percentage changes than flows at higher lung volumes. The forced expiratory flow between 30 and 20 per cent of the forced vital capacity was the most sensitive test for detecting abnormality in smokers. Among heavy smokers, 58 per cent had abnormally low forced expiratory flow between 30 and 20 per cent of the forced vital capacity, whereas only 47 per cent had abnormally low ratio of forced expiratory volume in 1 sec to forced vital capacity, and 32 percent had abnormally low maximal mid-expiratory flow. The results show that even subjects with short smoking histories may have changes in pulmonary function that probably reflect narrowing of small airways. Moreover, these changes can easily be detected by simple tests, such as evaluation of a forced expiratory spirogram.

Adult↗