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Nasal response to inhaled histamine measured by acoustic rhinometry in infants.

Aerosolized histamine, delivered via a face mask, is commonly used to evaluate bronchial responsiveness in infants. To investigate nasal response to inhaled histamine we have measured nasal passage geometry in 32 infants by the use of acoustic reflections. Satisfactory data were obtained from only 17 infants (12 males, 5 females, 6.6 +/- 4.4 months), because of awakening prior to completing the study in the remaining 15 infants. Acoustic rhinometry provided nasal cavity volume at 4 cm from the entrance of the nostril (V04), the minimum cross-sectional area (Amin), and the distance from the nostril to Amin (Dmin). Nasal geometry and lung function (maximum expiratory functional residual capacity [VmaxFRC] were measured before and immediately after a histamine challenge test using rapid thoratic compression. The histamine aerosols decreased both VO4 and Amin significantly by a mean of 17% and 13%, respectively (P < 0.001). There was a small, but significant increase (mean = 0.19 cm) of Dmin in the right side only, indicating a posterior dislocation of the narrowest site with swelling of the mucous membrane. In general, we found a dose-response relationship in grouped data, with a greater fall in VO4 with increasing dose of histamine, but there was no correlation between percent fall in VO4 and VmaxFRC. This pilot study suggests that histamine aerosol affects nasal cavity geometry and that of acoustic rhinometry in infants and children warrants further investigation.

Acoustics↗

[Plethysmographic measurement of lung volume in chronic obstructive pulmonary disease. Influence of the panting pattern].

In 9 healthy subjects and 22 patients with chronic obstructive disease, we computed total lung capacity (TLC) using an integrated flow pressure-corrected body plethysmograph. During panting manoeuvre, TLC derived from oesophageal pressure (TLCes) was compared to TLC derived from mouth pressure (TLCm). In healthy subjects, TLCm was identical to TLCes. Patients with obstructive disease exhibited different behaviours according to experimental conditions: a) in free frequency panting with mouth occlusion close to functional residual capacity (FRC) (9 patients), TLCm appeared to be significantly higher than TLCes (mean difference: 0.25 1; p less than 0.05); b) in panting with both low (less than 1 Hz) and high (2 Hz) frequencies and mouth occlusion close to FRC (7 patients), TLCm appeared to be significantly higher than TLCes only at a high frequency (p less than 0.05); c) in panting with both low and high frequencies and mouth occlusion close to TLC (6 patients), no significant difference was observed between TLCm and TLCes. These results suggest that in patients with chronic obstructive disease plethysmographic lung volume measurements are subject to error, due to the influence of extrathoracic airways. During occlusion at FRC, panting frequency was found to influence the results obtained, the error being minimized with low frequencies. In contrast, by occluding at TLC, we found that panting frequency was less likely to influence the results. However, potential sources of error still exist: for instance, the influence of abdominal gas or the panting pattern.

Adult↗

Effect of raised lung volume technique on subsequent measures of V'maxFRC in infants.

Partial and "full" forced expiratory maneuvers are both used to assess airway function in infants. Despite the increasing use of the raised volume technique, there is little information regarding the influence of lung inflations as are necessary for the raised volume technique on other measurements of lung function in infants. The aim of this study was to assess whether application of the raised volume technique influences subsequent tidal measurements of maximal expired flow at functional residual capacity (V'maxFRC). Paired measurements of V'maxFRC were obtained in 29 healthy infants (aged 6-65 weeks) before and after raised volume maneuvers, wherein a lung inflation pressure of 3 kPa was used. When compared with measurements prior to raising lung volume, there was a highly significant (P < 0.001) decrease in V'maxFRC by 40 ml.sec(-1) when measurements were repeated (95% CI, -59, -20 ml.sec(-1)), equivalent to a reduction of 20% or -0.6 SD scores in flows. There was no significant change in selected tidal breathing parameters, 95% CI of differences between the two sets of measurements being -1.5, 1.2 bpm for respiratory rate; -0.5, 0.2 ml.kg(-1) for weight corrected tidal volume, and -0.04, 0.01 for tidal breathing ratio (tPTEF:tE). In conclusion, although the mechanism remains unclear, raised volume maneuvers may influence subsequent measures of lung function in infants. Further research is needed to clarify the potential mechanisms. In the meantime, the potential impact of the order of lung function tests within any given study protocol should be considered carefully.

Female↗

Effect of airway closure on ventilation distribution.

We examined the effect of airway closure on ventilation distribution during tidal breathing in six normal subjects. Each subject performed multiple-breath N2 washouts (MBNW) at tidal volumes of 1 liter over a range of preinspiratory lung volumes (PILV) from functional residual capacity (FRC) to just above residual volume. All subjects performed washouts at PILV below their measured closing capacity. In addition five of the subjects performed MBNW at PILV below closing capacity with end-inspiratory breath holds of 2 or 5 s. We measured the following two independent indexes of ventilation maldistribution: 1) the normalized phase III slope of the final breaths of the washout (Snf) and 2) the alveolar mixing efficiency of those breaths of the washout where 80-90% of the initial N2 had been cleared. Between a mean PILV of 0.28 liter above closing capacity and that 0.31 liter below closing capacity, mean Snf increased by 132% (P less than 0.005). Over the same volume range, mean alveolar mixing efficiency decreased by 3.3% (P less than 0.05). Breath holding at PILV below closing capacity resulted in marked and consistent decreases in Snf and increases in alveolar mixing efficiency. Whereas inhomogeneity of ventilation decreases with lung volume when all airways are patent (J. Appl. Physiol. 66: 2502-2510, 1989), airway closure increases ventilation inequality, and this is substantially reduced by short end-inspiratory breath holds. These findings suggest that the predominant determinant of ventilation distribution below closing capacity is the inhomogeneous closure of airways subtending regions in the lung periphery that are close together.

Adult↗

Keratinocyte growth factor transiently alters pulmonary function in rats.

Keratinocyte growth factor (KGF) is a mitogen for pulmonary epithelial cells. Intratracheal administration of KGF to adult rats results in alveolar epithelial type II and bronchiolar epithelial cell proliferation. While cellular responses to KGF have been intensively studied, functional consequences regarding lung function are unknown. Therefore, in this study, we sought to investigate whether KGF alters pulmonary function variables. Rats received either recombinant human KGF (rHuKGF) (5 mg/kg) or vehicle intratracheally. Before and on days 3 and 7 after treatment, pulmonary function was determined by body plethysmography. Subsequently, lung histological changes were quantified. rHuKGF induced a transient proliferation of alveolar and bronchiolar epithelial cells. The extent of type II cell hyperplasia was significantly correlated with a transient reduction in tidal volume and an increase in breathing frequency. In addition, quasi-static compliance, total lung capacity, and vital capacity were reduced after rHuKGF instillation, suggesting the development of a transitory restrictive lung disorder. Moreover, reduced expiratory flow rates and forced expiratory volumes, as well as increased functional residual capacity after rHuKGF but not vehicle, suggest obstructive lung function changes. In conclusion, the induction of alveolar and bronchiolar epithelial cell proliferation by KGF is paralleled by moderate functional consequences that should be taken into account when the therapeutic potential of KGF is tested.

Animals↗

Roentgenographic determination of total lung capacity in normal Chinese children.

Roentgenographic determination of total lung capacity (TLC) in children, rarely mentioned in the past, differs from the determination of TLC using helium dilution method in that it does not need the measurement of functional residual capacity. Therefore, it is useful for hospitals where pulmonary function testing (PFT) is not available. In this study, 87 out of 125 normal children completed both chest radiographs and PFT. Ellipsoid method which divides the lung field into several sections was used to calculate TLC from chest radiographs. The correlation coefficient of TLC measured by both chest radiographs and PFT was 0.7680, and paired Student's t-test of the mean values of the two groups showed P value greater than 0.05. Among the variables of height, weight, age and body surface area, height alone was able to predict the normal reference value of TLC. Line of regression between TLC and height was expressed as "TLC = 52.776 x Height- 4404.998", and correlation coefficient was 0.8013. Intersubject reproducibility was also verified. It is concluded that chest radiographs can be used to determine TLC in children.

Adolescent↗

Chest wall configurational changes before and during acute obstructive episodes in asthma.

We induced bronchial obstruction in 7 otherwise healthy asthmatic subjects and then measured the degree of airway obstruction and the dimensions of the chest wall including the anteroposterior (AP) diameters of the upper and lower rib cage and the abdomen and the transverse diameter of the lower rib cage. Airway obstruction was accompanied by a pronounced increase in the end-expiratory AP diameter of the upper rib cage in all 7 subjects and of the low lateral rib cage in 3 of the 4 subjects in whom this was measured. Other end-expiratory dimensions showed variable changes. In 6 of 7 subjects, obstruction caused the lower rib cage to become more elliptical in cross section during inspiration; transient inward motion of the lower anterior rib cage during early inspiration was noted. This latter motion coupled with the continuous outward motion of the upper anterior rib cage produced a pronounced rocking motion of the sternum during inspiration. These distortions of the chest cage were maximal when obstruction was most severe and gradually diminished as obstruction resolved. These inspiratory changes in chest cage cross-sectional configuration are similar to those seen in normal subjects who attempt to overcome external resistive loading by the increased use of inspiratory muscles; the end-expiratory configuration in asthma indicates an increase in functional residual capacity, which is actively maintained. Multiple degrees of freedom of motion of the chest cage exist during obstructive episodes. Estimates of volume change from measurements of rib cage cross-sectional area and abdominal diameter should be made with caution.

Abdomen↗

Accuracy of tidal volume, lung volume, and flow measurements by inductance vest in COPD patients.

We analyzed the accuracy of the inductance vest in measuring several ventilatory parameters in five patients with chronic obstructive pulmonary disease (COPD). We assessed tidal volume (VT) accuracy at different respiratory frequencies in different lying body positions with different thoracic and abdominal contributions to breathing and the accuracy over a 4-h time span. Mean percent error was calculated without regard to direction of error. The mean error of vest VT estimation was 7.6% for all body positions studied and 5.6% for right and left lateral positions combined. Vest VT accuracy was unchanged after 4 h and with changes in thoracic and abdominal contributions to VT. The mean errors for inspiratory and expiratory times were 3.3 and 2.0%, respectively. Volume was differentiated to flow. For respiratory rates ranging from 12 to 30 breaths/min, the mean error of the vest and our differentiation circuit in duplicating peak flows measured at the mouth was 3.5%. The ability of the vest to estimate changes in end-expiratory position or functional residual capacity was not as good as with VT; the mean error was 30.7%. For estimation of VT, ventilatory timing, and airflow in COPD patients, the inductance vest performs well. For measurement of changes in lung volume, improvements in vest design need to be made.

Abdomen↗

Bullous degeneration of the left lower lobe in a heroin addict.

A 34 yr old heroin addict was referred because of chest pain caused by air-trapping in a bulla in the left lower lobe. There was a marked difference between the functional residual capacity measured by body-plethysmography and helium dilution. A slow wash-in and wash-out were demonstrated by ventilation scintigraphy with Xenon133. Bullous degeneration is a known complication of intravenous drug abuse. Usually these bullae are found in the upper lobes. Possible causative mechanisms are discussed.

Adult↗

Effect of nitrogen dioxide, ozone, and peroxyacetyl nitrate on metabolic and pulmonary function.

The metabolic and pulmonary function responses were investigated in 32 non-smoking men and women (8 men and 8 women 18-26 years of age, and 8 men and 8 women 51-76 years of age) who were exposed for 2 hours to each of 8 conditions: 1) filtered air (FA), 2) 0.13 ppm peroxyacetyl nitrate (PAN), 3) 0.45 ppm ozone (O3), 4) 0.60 ppm nitrogen dioxide (NO2), 5) 0.13 ppm PAN + 0.45 ppm O3 (PAN/O3), 6) 0.13 ppm PAN + 0.60 ppm NO2 (PAN/NO2), 7) 0.60 ppm NO2 + 0.45 ppm O3 (NO2/O3), and 8) 0.13 ppm PAN + 0.60 ppm NO2 + 0.45 ppm O3 (PAN/NO2/O3). The subjects alternated 20-min periods of rest (n = 3) and cycle ergometer exercise (n = 3) at a work load predetermined to elicit a ventilatory minute volume (VE) of approximately 25 L/min (BTPS). Functional residual capacity (FRC) was determined pre- and post-exposure. Forced vital capacity (FVC) was determined before and after exposure, and 5 min after each exercise period. Heart rate was monitored throughout each exposure, and VE was measured during the last 2 min of each exercise period. Exposure to FA, PAN, NO2, and PAN/NO2 had no effect on any measure of pulmonary or metabolic function. Ozone was primarily responsible for the pulmonary function effects observed. There was no significant difference between the responses to O3 exposure and the responses to the three O3 mixtures, indicating no interactions between the pollutants. The results suggest that women may be somewhat more responsive to O3 exposure than men, and that older people (51-76 years of age) may be less responsive to O3 than younger people (18-26 years of age).

Acetates↗

Ability of new lung function tests to assess methacholine-induced airway obstruction in infants.

We assessed the ability of innovative lung function tests to detect bronchial obstruction induced by methacholine bronchial challenge. Fifty-five recurrently wheezy infants (mean age 16 +/- 5.2 months) free of respiratory symptoms underwent baseline lung function tests. Forty-two completed the methacholine challenge. Maximal flow at functional residual capacity (VmaxFRC) was obtained using the squeeze technique; compliance and resistance of the respiratory system (Crs, Rrs) was measured with the passive expiatory flow volume technique; tidal volume breathing patterns were analyzed from recordings of respiratory rate (RR), tidal volume (VT), and inspiratory time divided by total cycle of duration (Ti/Ttot). Expiratory tidal flow volume (V/VT) curves were described with multiple indices such as the ratio of expiratory time necessary to reach peak tidal expiratory flow (Fpet) to expiratory time (Tme/Te). Transcutaneous oxygen tension (PtCO2) was measured as an indicator of response to methacholine challenge. Of 42 infants 41 responded to methacholine by a change > or = 2 standard deviations from baseline values. The mean SD unit changes were 9.8 in PtCO2, 3.7 for VmaxFRC, 2.8 for Crs, 2.09 for Rrs, 3.1 for RR, 1.6 for Ti/Ttot, 2.2 for Tme/Te 3.9 for PFVt. We conclude that these noninvasive lung function tests, especially VmaxFRC and Fpet, can be used to detect minor or moderate airway obstruction. Further studies are needed to determine the value of the tests in assessing bronchial disease and effects of its treatment.

Airway Obstruction↗

Airway hyperresponsiveness in cigarette smoke-exposed rats.

To investigate the possibility that altered airway-parenchymal interaction may account for bronchial hyperresponsiveness induced by cigarette smoke exposure, we tested the effect of administration of cigarette smoke (SM), elastase (EL), and both SM and EL on airway responsiveness in 41 Long-Evans male rats. Twelve were exposed to 30 puffs of SM for 15 weeks; 8 received a single intratracheal injection of EL (250 IU/kg); 9 received both EL and SM exposure (SE); 12 control rats were exposed to room air (CO). After 15 weeks, animals were anesthetized and mechanically ventilated (Vt = 2.5 ml, f = 80/min). Methacholine (MCh) dose-response curves (DRCs) were constructed by calculating pulmonary resistance (RL) after ultrasonic nebulization of saline followed by doubling concentrations of MCh (0.0625-256 mg/ml). Exposure to cigarette smoking, with or without elastase, led to a significant reduction in body weight and increased total lung capacity (TLC) compared to exposure to CO. However, there was no significant change in static compliance in the experimental groups, despite increased lung volume. The concentration resulting in a doubling of RL (EC200RL) was significantly lower in rats treated with SM (n = 7) than CO (n = 8) (3.3 vs. 56.1 mg/ml, geometric mean, p < 0.01). The concentration at which a maximal RL was achieved was lower in SM than CO, EL, and SE (p < 0.05). To assess the possible influence of airway-parenchymal interaction on responsiveness, we measured RL both at functional residual capacity (FRC) and at a volume above FRC equivalent to 1 tidal volume. RL changed similarly in all groups. Despite similar effects on mechanics of both cigarette smoke exposure and elastase administration, only cigarette smoke-exposed animals exhibited evidence of hyperresponsiveness. In this model cigarette smoke-induced hyperresponsiveness is unrelated to changes in either lung elasticity or airway-parenchymal interaction.

Airway Resistance↗

Pulmonary structure and function in adult dairy cows with an expanded lung field.

Pulmonary function tests were performed on seven adult dairy cows with an expanded lung field (ExLF) and the results were compared to the values from seven cows with normal lung fields. The cows with ExLF had an increased functional residual capacity (FRC) and end-tidal N2 concentration of the final breath of the multiple-breath N2 washout (FETN2,fb), and an abnormal distribution of ventilation. The measurements of ventilation and gas exchange and pulmonary mechanics did not differ between the two groups. Postmortem examination of the lungs of five of the cows in each group indicated the cows with ExLF had a bronchiolitis with varying degrees of goblet cell hyperplasia, epithelial cell hyperplasia and metaplasia, smooth muscle hypertrophy, inflammatory cell infiltrate, vascular thickening, peribronchiolar fibrosis, and a mild overinflation of the lung. A histopathological score, based on the preceding indices and bronchus-associated lymphoid tissue, was correlated with FRC, FETN2,fb, the lung clearance index and pulmonary resistance. There were no correlations between the histopathological score and any of the measures of ventilation and gas exchange.

Animals↗

Comparison of four methods for calculating the total lung capacity measured by body plethysmography.

Static lung volumes were measured plethysmographically one hour apart in healthy subjects (n = 14) and in patients with chronic pulmonary disorders of various etiologies (n = 25). The total lung capacity (TLC) obtained from paired measurements of functional residual capacity (FRC) and inspiratory capacity (IC) was calculated according to the four following methods: 1) average FRC plus the largest IC, 2) average FRC plus the average IC, 3) largest sum of FRC and corresponding IC, and 4) average of individual FRC and IC sums. The data, analysed for average values and for reproducibility in the group as a whole and in the healthy subjects and patients separately indicate that: a) For the group as a whole the largest average TLC values were found with method 3 followed by methods 4 and 1. The differences were statistically significant for all comparisons but one (method 1 vs method 4). A similar pattern was found for the healthy subjects and patients separately. b) For the group as a whole, the one hour reproducibility tended to be worse from method 1 through method 4 but the intermethod differences were not statistically significant. For the healthy subjects, the reproducibility tended to be better for methods 3 and 4 and for the patients this was the case for methods 1 and 2. The average reproducibiltiy of methods 1 and 2 was similar for both the healthy and patient groups and these methods seemed more suitable for TLC calculations. Because it is more widely employed, method 1 is recommended.

Adolescent↗

[Comparative study by body plethysmography and spirometry with the helium dilution method in patients with tuberculosis].

The persisting defects after treatment of tuberculosis in 51 patients were evaluated by a simultaneous measurement of the functional residual capacity (FRC) using the body plethysmograph and the helium dilution method. In most patients large volumes of trapped air were detected by the difference of two methods of measurement. The amount of trapped air showed to be dependent of the other pulmonary parameters obtained: Tiffeneau index, FRC measured by body plethysmography, difference between predicted and measured FRC.

Airway Resistance↗

Nonuniformity of diffusing capacity from small alveolar gas samples is increased in smokers.

BACKGROUND: Although centrilobular emphysema, and small airway, interstitial and alveoli inflammation can be detected pathologically in the lungs of smokers with relatively well preserved lung function, these changes are difficult to assess using available physiological tests. Because submaximal single breath washout (SBWSM) manoeuvres improve the detection of abnormalities in ventilation inhomogeneity in the lung periphery in smokers compared with traditional vital capacity manoeuvres, SBWSM manoeuvres were used in this study to measure temporal differences in diffusing capacity using a rapid response carbon monoxide analyzer. OBJECTIVE: To determine whether abnormalities in the lung periphery can be detected in smokers with normal forced expired volumes in 1 s using the three-equation diffusing capacity (DLcoSB-3EQ) among small alveolar gas samples and whether the abnormalities correlate with increases in peripheral ventilation inhomogeneity. PARTICIPANTS AND DESIGN: Cross-sectional study in 21 smokers and 21 nonsmokers all with normal forced exhaled flow rates. METHODS: Both smokers and nonsmokers performed SBWSM manoeuvres consisting of slow inhalation of test gas from functional residual capacity to one-half inspiratory capacity with either 0 or 10 s of breath holding and slow exhalation to residual volume (RV). They also performed conventional vital capacity single breath (SBWVC) manoeuvres consisting of slow inhalation of test gas from RV to total lung capacity and, without breath holding, slow exhalation to RV. DLcoSB-3EQ was calculated from the total alveolar gas sample. DLcoSB-3EQ was also calculated from four equal sequential, simulated aliquots of the total alveolar gas sample. DLcoSB-3EQ values from the four alveolar samples were normalized by expressing each as a percentge of DLcoSB-3EQ from the entire alveolar gas sample. An index of variation (DI) among the small-sample DLcoSB-3EQ values was correlated with the normalized phase III helium slope (Sn) and the mixing efficiency (Emix). RESULTS: For SBWSM, DI was increased in smokers at 0 s of breath holding compared with nonsmokers, and correlated with age, smoking pack-years and Sn. The decrease in DI with breath holding was greater in smokers and correlated with the change in Sn with breath holding. For SBWVC manoeuvres, there were no differences due to smoking in Sn or Emix, but DI was increased in smokers and correlated with age and smoking pack-years, but not with Sn. CONCLUSIONS: For SBWSM manoeuvres the increase in DI in smokers correlated with breath hold time-dependent increases in Sn, suggesting that the changes in DI reflected the same structural alterations that caused increases in peripheral ventilation inhomogeneity. For SBWVC manoeuvres, the increase in DI in smokers was not associated with changes in ventilation inhomogeneity, suggesting that the effect of smoking on DI during this manoeuvre was due to smoke-related changes in alveolar capillary diffusion, rather than due solely to alterations in the distribution of ventilation.

Adult↗

Closing capacity measurement during general anesthesia.

A modification of the single-breath nitrogen closing volume (CV) test allows measurement of closing capacity (CC) during general anesthesia. In the modification, inspiration and expiration are mechanically produced by a hydraulically powered cylinder. For 14 awake, normal subjects results of the CV test performed using this mechanical method differed that those obtained following spontaneous inspiration and expiration. Mean (+/-SE) CC's were 2.25 (+/-0.15) and 2.42 1 (+/-0.14) (P less than 0.01) using spontaneous and mechanical methods, respectively. The slopes of Phase III of the CV traces were 2.24 (+/-0.27) and 2.66 per cent N2/L (+/-0.32) (P less than 0.01), respectively. To eliminate differences due to measurement technique, the modified CV test was used both before and during anesthesia with halothane in 70 per cent N2 in 11 normal, supine, spontaneously breathing subjects. CC's were 1.89 l (+/-0.16) before and 1.84 l (+/-0.15) during anesthesia (P greater than .5). Mean functional residual capacities (FRC) by the closed-circuit helium method were 1.77 l (+/-0.15) before and 1.45 l (+/-0.17) during anesthesia (P less than .001). With CC unchanged and FRC decreased following induction, CC/FRC increased from 1.07 (+/-0.08) to 1.37 (+/-0.11) (P less than .005), suggesting increased small-airway closure during anesthesia.

Adult↗

Pulmonary functions during peritoneal dialysis.

Lung volumes, flows, flow volume loop, diffusing capacity and closing volume were studied in 7 patients (Group I) before, with 2 liter dialyzate in the peritoneal cavity and after 8 hours of peritoneal dialysis. The functional residual capacity, residual volume and the total lung capacity decreased (P less than 0.01, less than 0.05, and less than 0.05 respectively) with 2 liter dialyzate in the peritoneal cavity and returned to baseline after the dialyzate was removed. Arterial blood gas analysis was performed in another 8 patients (Group II) before, with 2 liter dialyzate in the peritoneal cavity, and after the dialyzate had been drained. No significant difference was observed in PaO2, PaCO2 or pHa during any phase of the study. It is concluded that except for a minor decrease in FRC, RV and TLC, there were no deleterious effects with the use of 2 liter dialyzate volume on gas exchange or pulmonary functions during peritoneal dialysis.

Adult↗