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PubMed1986

Skin, joint, and pulmonary changes in type I diabetes mellitus.

Three hundred seventy-five patients with diabetes mellitus were examined for the presence of sclerodermalike skin changes, limited joint mobility, and vital capacity changes. Nineteen percent of patients had vital capacities 2 SDs below the mean of predicted values. There was no significant relationship between decreased vital capacities and duration of diabetes, sclerodermalike skin changes, limited joint mobility, smoking history, proteinuria, or retinopathy. Cutaneous involvement consisting of thickening, tightening, and/or a waxy quality of the skin was noted in 190 patients (51%). The severity of skin involvement correlated positively with the patients' duration of diabetes, age, severity of joint contractures, and diabetic retinopathy. Thus, sclerodermalike skin changes appear to reflect generalized connective tissue alterations in diabetes and may indicate increased risk for diabetic microvascular complications.

Adolescent↗

PubMed2003

Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement.

This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation (TENS) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities. TENS, with a modulated frequency, intensity as high as the subject could tolerate, and electrodes placed on either side and parallel to the incision, was compared to placebo TENS and pharmacologic analgesia alone (control) by using a crossover design. Self-report of pain intensity, walking function, and vital capacity were assessed on 33 subjects. TENS resulted in significantly less pain than the control during both walking (P <.5) and vital capacity activities (P <.1) and significantly less pain than placebo TENS during vital capacity (P <.01). TENS also produced significantly better gait speeds than the control (P <.05) and greater gait distances (P <.01) than the control and placebo TENS. Vital capacity and pain intensity at rest were not significantly different among the 3 treatments. These results suggest TENS reduces pain intensity during walking and deep breathing and increases walking function postoperatively when used as a supplement to pharmacologic analgesia. The lack of effect on pain at rest supports the hypothesis that TENS works through reducing hyperalgesia.

Abdomen↗

PubMed1992

Kinetics of action of salbutamol inhaled from a metered dose inhaler (MDI) and a "Diskhaler".

In a double-blind cross-over study, 12 patients with reversible airways obstruction were treated with 200 micrograms salbutamol base in aerosol or 400 micrograms of powder following methacholine-induced bronchoconstriction. Salbutamol was inhaled either from a conventional metered dose inhaler (MDI) or from an inhaler (Diskhaler) utilizing the powdered form of the drug. The efficacy of both forms was identical whether assessed in terms of FEV1 or vital capacity. The ratio of the increase in FEV1 or vital capacity after bronchodilatation to the decrease during the prior bronchoconstriction was 1.4, indicating that both FEV1 and vital capacity improved over baseline following bronchodilatation. In six subjects, the onset of action of the powder form was more rapid, and in four the MDI acted more rapidly. In the group as a whole, the mean time constant for the action of salbutamol was identical (3.8 min) for the two forms. It is concluded that salbutamol powder has a similar efficacy and time course of action as the aerosol, probably because both formulations produce similar sized particles of the drug.

Administration, Inhalation↗

PubMed2005

Lung volumes in healthy Afro-Caribbean children aged 4-17 years.

Lung volumes in healthy children differ according to their ethnic origin. We wished to determine if any differences in the lung volumes of Afro-Caribbean (AC) children from those predicted by Caucasian reference values disappeared if the results were related to sitting height or to 90% or 77% of lung volumes predicted for height from Caucasian reference values based on standing height. We took, as our working hypothesis, that it is inappropriate to use Caucasian reference values to interpret data from Afro-Caribbean children, and that ethnic-specific reference values are required. This was a prospective, observational study. Subjects included 80 AC children with a median age of 9 (range, 4.3-17.8) years. Standing and sitting height were measured. Lung volumes were measured by body plethysmography (total lung capacity, TLC(pleth); functional residual capacity, FRC(pleth); and vital capacity, VC(pleth)), helium gas dilution (functional residual capacity, (FRC(He)), spirometry (forced expiratory volume in 1 sec, FEV(1)), and forced vital capacity (FVC). The lung volumes of AC children correlated significantly with standing height, but differed significantly from values predicted from Caucasian reference values based on standing height (P < 0.05). Significant differences remained for TLC(pleth), FRC(pleth), FRC(He), RV(pleth), VC(pleth), FEV(1), and FVC when the results were related to sitting height or 90% or 77% of values predicted from Caucasian reference values based on height (P < 0.05). Lung volumes in Afro-Caribbean children should be compared to ethnic-specific reference values.

Adolescent↗

PubMed1984

Nighttime ventilation improves respiratory failure in secondary kyphoscoliosis.

Four patients with cardiorespiratory failure caused by secondary kyphoscoliosis were studied. Polycythemia, cor pulmonale, restrictive lung pattern (functional residual capacity (FRC), 17 to 27% predicted; vital capacity (VC), 11 to 23% predicted), and abnormal arterial blood gases, primarily hypoventilation (PaO2, 31 to 44 mm Hg; PaCO2, 52 to 73 mm Hg), were seen in all. Supplementary oxygen, digoxin, diuretics, 15 min of intermittent positive-pressure breathing with inspired pressure (PI) 25 cm H2O 4 times daily, and tracheostomy failed to produce improvement. However, 12 h of nighttime ventilation (NTV) with PI 28 to 35 cm H2O through a permanent tracheostomy proved effective. Within 72 h, dyspnea at rest, restless sleep, and frequent waking resolved. Within 8 to 22 days, the PaO2 was approximately 58 mmHg and the PaCO2 was approximately 41 mm Hg while breathing 21% oxygen spontaneously during the day. The right heart failure resolved within 2 to 7 wk, and the hemoglobin count decreased to approximately 165 g/L within 2 to 6 months. There was a mean increase of 700 ml (72%) in functional residual capacity and 430 ml (49%) in vital capacity. The patients were discharged 2 days to 5 wk after NTV commenced. Daytime activity increased, approaching a normal life style. The improvement was sustained over a mean follow-up period of 3.4 yr. Problems included recurrent episodes of tracheobronchitis, mild self-limiting hemoptysis, and speech modification. Nighttime ventilation may be an effective alternative for long-term treatment of cardiorespiratory failure caused by secondary kyphoscoliosis.

Adult↗

PubMedDate not supplied

Respiratory consequences of exposure to wood dust and formaldehyde of workers manufacturing oriented strand board.

A cross-sectional study was performed at a plant in which 99 workers were employed in the manufacture of oriented strand board. This group was compared with 165 unexposed workers from the petroleum industry. Both groups were assessed, using a questionnaire, spirometry, and skin prick tests to common environmental antigens. Environmental studies showed a low dust level of 0.27 mg/m3, consisting of particles of a mass median aerodynamic equivalent diameter of 2.5 microns. There were variable concentrations of formaldehyde, up to 0.27 ppm. A significant difference between the oriented strand board workers and oil field workers was noted for the forced expiratory volume in 1 s/forced vital capacity ratio, without significant differences in either the forced expiratory volume in 1 s or the forced vital capacity. Oriented strand board workers who were current smokers were three times as likely to have a forced expiratory volume in 1 s/forced vital capacity ratio of less than 75% of that found in the currently smoking oil field workers. Significant reductions in forced expiratory volume in 1 s (p = .044) and forced vital capacity (p = .022) in oriented strand board workers were noted across the work shift. The oriented strand board workers complained of self-reported asthma and of lower respiratory tract symptoms significantly more frequently than did oil workers for all of the symptoms examined. The prevalence of atopy was not different in the two groups. Lung function was significantly better in oriented strand board workers who had no symptoms, compared with oriented strand board workers who were symptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

[A comparison of two delivery devices on the bronchodilatory effects of procaterol from a metered dose inhaler].

The bronchodilatory response to procaterol delivery by a metered dose inhaler with a spacer device (Volumatic) and a corniced extension tube was studied in a double blind manner in 18 asthmatic children, who were brought to our emergency room with acute attacks. The mean percent increase in forced expiratory volume in 1 second (FEV1) with the Volumatic was 55.6 +/- 39.3%, and 46.2 +/- 37.4% with the extension tube. There were no significant differences in the mean percent increase in FEV1, forced vital capacity (FVC), maximal flow rate at 50% of vital capacity (V50), maximal flow rate at 25% of vital capacity (V25) and peak expiratory flow rate (PEFR) between the two devices. It is concluded that there is no difference in the bronchodilatory effects of the two devices. The corniced extension tube has the advantage of being less expensive and more convenient to carry around.

Acute Disease↗

PubMed1994

Pulmonary function and gastroesophageal reflux in systemic sclerosis.

OBJECTIVE: To determine the relations among esophageal dysfunction, gastroesophageal reflux, and lung involvement in patients with systemic sclerosis. DESIGN: Retrospective review of esophageal motility, esophageal pH, and pulmonary function data. SETTING: University hospital outpatient clinic and community. PATIENTS: 39 consecutively referred patients who were grouped according to the presence or absence of abnormal distal (pH < 4.0 for > 5% of the 24-hour monitoring period) or proximal (pH < 4.0 for > 1% of the 24-hour period) gastroesophageal acid reflux. Patients were also grouped according to the presence or absence of distal esophageal peristalsis. MEASUREMENTS: Esophageal manometry, dual-probe (distal and proximal) esophageal 24-hour pH measurements, and pulmonary function studies (forced vital capacity, forced expiratory volume at 1 second, total lung capacity, and single-breath carbon monoxide diffusing capacity [DLco]). RESULTS: The mean total lung capacity (values as percentage predicted) was 87.1% +/- 11.2% (SD) for patients with abnormal proximal reflux and 77.8% +/- 21.6% for patients with normal proximal reflux (difference, 9.3%; 95% CI, -1.4% to 20.0%). The mean forced vital capacity for these patients was 91.1% +/- 12.4% and 85.4% +/- 25.6%, respectively (difference, 5.7%; CI, -6.9% to 18.1%). The mean total lung capacity was 83.8% +/- 15.4% for patients with abnormal distal reflux and 77.9% +/- 22.7% for patients with normal distal reflux (difference, 5.9%; CI, -7.6% to 19.4%). Among potential confounders of pulmonary measures, only smoking was related to decreased pulmonary function (smoking related to decreased DLco P < 0.01). Smoking was more common in patients with abnormal distal reflux than in those with normal distal reflux (65% compared with 25%, P = 0.03). After adjusting for smoking, the difference in mean DLco between patients with abnormal compared with normal distal reflux was 7.19% (Cl, -8.5% to 22.9%). CONCLUSION: Important measures of lung volume indicative of interstitial lung disease (total lung capacity, forced vital capacity) do not appear to be related to abnormal gastroesophageal acid reflux in patients with systemic sclerosis.

Esophagus↗

PubMed1985

Diaphragmatic function following cervical cord injury: neurally mediated improvement.

Vital capacity measurements from 36 people rendered quadriplegic by traumatic cervical cord injuries generally increased during the first ten months after injury, indicating spontaneous improvement in respiratory muscle function. Reasoning that a renewal of neural supply to the diaphragm would probably be accompanied by a parallel renewal of neural supply to other muscles having adjacent motor pathways, the present study compared vital capacity measurements with concomitant muscle function evaluations from 20 of these people. Qualitatively, increases in vital capacity were invariably accompanied by increases in the function of a group of muscles (primarily of the shoulder and upper arm) having some segmental innervation in common with the diaphragm (C3-C5) but were only sometimes accompanied by increases in the function of a group of muscles (primarily of the forearm and wrist) having segmental innervation below that of the diaphragm (C6-C8). These findings suggest that the spontaneous improvement in vital capacity observed in quadriplegic people is mediated in part by corresponding improvement in the neural supply to the diaphragm. Quantitatively, however, linear regression analysis indicated that neither the rate nor the absolute amount of improvement in vital capacity could be predicted with any reliability from pulmonary function tests, neurologic examinations, or muscle function evaluations performed in the early stage of recovery.

Adolescent↗

PubMed1979

Experiences with high tetraplegics.

Of the 1468 patients with traumatic spinal cord injury who were admitted to the Texas Institute for Rehabilitation and Research (TIRR) between 1959 and 1977, 67 patients were complete tetraplegics with motor levels of C4 and above. The age, sex, motor level, aetiology of injury, and initial and final vital capacity of these patients are analysed. A substantial gain in vital capacity was attained in all C4 motor tetraplegics regardless of their initial vital capacity. Twenty patients with motor levels of C3 and above have been admitted to TIRR since 1963. Five of these 20 C3 and above tetraplegics have had bilateral phrenic stimulators implanted. The mortality rates and causes of death in these groups of patients are presented. Survival curves are presented on 615 traumatic spinal cord injuried patients as compared to a standard matched group. Survival curves are also presented for the two groups of high tetraplegics who were admitted to TIRR from 1963 through 1969 and from 1970 through 1977.

Adolescent↗

PubMed1975

Postoperative management after thymectomy.

This paper reports a retrospective study of the preoperative and postoperative management of 28 patients who underwent thymectomy between 1956 and 1973. Patients who received postoperative artificial ventilation were compared with the group who did not with respect to sex, age, severity of disease, preoperative vital capacity, and thymic histology. Evidence is presented that postoperative artificial ventilation is required when the preoperative vital capacity with the patient on optimum anticholinesterase treatment is less than 2 litres. Additional features associated with a probable need for artificial ventilation were the presence of a thymoma, bulbar symptoms, especially dysphagia, and age over 50 years. These should be taken into account in any patient whose vital capacity is close to the critical level of 2 litres. When postoperative ventilation was required it was usually necessary for 12 days or more, and tracheostomy should therefore be done at or before thymectomy. Most patients in this series received the same dose of anticholinesterases after operation as before it and no evidence was found of a sudden decrease in requirements for anticholinesterase therapy. Two patients did not, and in them a myasthenic crisis was precipitated. We propose that the preoperative drug regimen can be continued in the immediate postthymectomy period, allowing selection of patients for tracheostomy and artificial ventilation primarily on the basis of the preoperative vital capacity.

Adolescent↗

PubMed1979

Farmer's lung disease: long-term clinical and physiologic outcome.

To determine the long-term effects of farmer's lung disease and the factors influening the outcome, 141 patients with farmer's lung disease were evaluated. At the time of the last follow-up, 29 patients had died and 92 (mean age, 54 years) were studied clinically, physiologically, and radiologically. The mean length of disease was 14.8 years (range, 2.25 to 40 years). Symptoms at the time of the last follow-up included complaints of cough (33 per cent of the patients), breathlessness while walking on the level (20 per cent), breathlessness on minor exertion (14 per cent), and breathlessness while at rest (3 per cent). Twenty-eight per cent had chronic bronchitis. Thirty-nine per cent (36 of 92 patients) had some evidence of interstitial changes on roentgenogram. Abnormal vital capacity was present in 11 patients (12 per cent), abnormal total lung capacity in 11 (12 per cent), and abnormal CO difussing capacity in 27 (30 per cent). The ratio of one-sec forced expiratory volume to forced vital capacity was abnormal in 23 patients (25 per cent), and arterial PO2 was abnormal in 39 (40 per cent). Patients with a history of 5 or more symptomatic recurrences had significantly smaller values (P less than 0.05) for vital capacity, total lung capacity, and CO diffusing capacity than did those patients with less than 5 recurrences. There was no significant relation between continued farming or length of disease and lung function. On the basis of several measurements of airway function, 34 of the patients (58 per cent) were found to have some abnormality, It is concluded that symptomatic recurrences may be the most important factor in determining the danger of progressive disease. Persistently positive precipitins were correlated with decreased CO diffusing capacity. Moreover, airway disease is relatively uncommon but does occur, and in some cases it is a possible consequence of farmer's lung disease.

Adult↗

PubMed1990

Pulmonary function testing reference values and interpretations in pediatric training programs.

A questionnaire was sent to all pediatric training programs to evaluate the use of pulmonary function reference standards and the interpretation of pulmonary function test results. Responses were obtained from 107 of 130 institutions, and 94 of these had pulmonary function laboratories available. Of the 94, 60 used one of three reference standards. The primary reason the reference standards were chosen was either unknown or because they came with the spirometer (24), were recommended by another person or were those used in that person's training (34), or were thought to be the best standards available or most applicable to the population to be tested (31). To define abnormality, most used an 80% predicted cutoff for forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow at 25% to 75% vital capacity. For a change in an individual through time, most used a 10% change for forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow at 25% to 75% vital capacity. Thirteen used statistical methods to define abnormal individuals and none used statistical methods to define a significant change over time. Although there are a few guidelines for reference standards and interpretations of pulmonary function tests, it appears that most laboratories are not using those guidelines and that further guidelines and education are needed.

Adolescent↗

PubMed2002

John Hutchinson's mysterious machine revisited.

John Hutchinson, a surgeon, recognized that the volume of air that can be exhaled from fully inflated lungs is a powerful indicator of longevity. He invented the spirometer to measure what he called the vital capacity, ie, the capacity to live. Much later, the concept of the timed vital capacity, which became known as the FEV(1), was added. Together, these two numbers, vital capacity and FEV(1), are useful in identifying patients at risk of many diseases, including COPD, lung cancer, heart attack, stroke, and all-cause mortality. This article cites some of the rich history of the development of spirometry, and explores some of the barriers to the widespread application of simple spirometry in the offices of primary care physicians.

Diffusion of Innovation↗

PubMed1992

Flow-volume relationships during spontaneous breathing through endotracheal tubes.

OBJECTIVE: Breathing spontaneously through an endotracheal tube is often equated with "breathing through a straw." The objective of this study was to examine whether endotracheal tubes functionally act as tubular resistors in patients during tidal breathing, machine-initiated breaths, and vital capacity maneuvers. DESIGN: Descriptive study. SETTING: University hospital surgical ICU. PATIENTS: Eighteen mechanically ventilated, critically ill, postoperative patients (34 to 87 yrs). MEASUREMENTS: Flow-volume loops were recorded during tidal and machine breaths, as well as during vital capacity maneuvers. The loops were inspected visually for evidence of air flow limitation. Expiratory characteristics were examined using the ratio of expiratory volume in 1 sec to the expiratory volume in 0.5 sec and the ratio of expiratory volume in 1 sec to peak expiratory flow rate. The ratio of expiratory volume in 1 sec to that in 0.5 sec (greater than 1.5) and the ratio of expiratory volume in 1 sec to peak expiratory flow rate (greater than 10 mL/L/min) are seen with upper airway obstruction. MAIN RESULTS: Mean spontaneous tidal volume was 361 +/- 92 (SD) mL and vital capacity was 1104 +/- 16 mL, while the ratio of expiratory volume in 1 sec to that in 0.5 sec was 1.57 +/- 0.17 and 1.7 +/- 0.1 (p less than .05), respectively. The ratio of expiratory volume in 1 sec to peak expiratory flow rate was 9.9 +/- 1.7 during tidal breathing and 12.9 +/- 1.2 (p less than .05) during vital capacity maneuvers. CONCLUSIONS: Endotracheal tubes of the diameters used in these adult postoperative patients (7 and 8 mm) cause only minimal limitation to air flow during the small volumes and low-flow rates observed during tidal breathing. Evidence of greater air flow limitation was seen during vital capacity maneuvers.

Adult↗

PubMed2006

Respiratory muscle testing: a valuable tool for children with neuromuscular disorders.

RATIONALE: Data on respiratory muscle performance in children with neuromuscular disorders are limited. OBJECTIVES: The aim of this study was to assess respiratory muscle strength by volitional and nonvolitional tests and to compare these tests with forced vital capacity. METHODS: Inspiratory muscle strength was assessed by measuring transdiaphragmatic and esophageal pressures generated during volitional and nonvolitional maneuvers, whereas expiratory muscle strength was assessed by measuring the gastric pressure generated during a cough maneuver. Lung volumes were assessed by measuring forced vital capacity. MEASUREMENTS AND MAIN RESULTS: Forty-one patients with Duchenne muscular dystrophy (n = 20), spinal amyotrophy (n = 8), and congenital myopathy (n = 13) were included, aged 2 to 18 yr. All the patients were able to perform the sniff and the cough maneuver. Sniff transdiaphragmatic pressure decreased with age in Duchenne patients, whereas it increased with age in patients with spinal amyotrophy and congenital myopathy. Magnetic stimulation of the phrenic nerves was obtained in all patients. Twenty-five (61%) patients were able to perform forced vital capacity. In the three groups of patients, a positive correlation was observed between volitional, assessed by the sniff maneuver, and nonvolitional respiratory muscle tests, assessed by the magnetic stimulation of the phrenic nerves. Also, forced vital capacity correlated with sniff transdiaphragmatic pressure and cough gastric pressure. CONCLUSIONS: Volitional respiratory muscle tests correlated with nonvolitional tests and with forced vital capacity. Simple volitional respiratory muscle tests constitute a valuable tool for the assessment of respiratory muscle strength in young patients with neuromuscular disorders.

Adolescent↗

PubMed1989

[Changes in lung ventilation functions in 332 patients with deformity of the spinal column].

Examination of lung ventilation was performed on 332 patients with deformity of spinal column. The results suggest that there are significant differences in vital capacity, forced expired volume in one second/forced vital capacity, maximum ventilation volume, index of air flow velocity and residual capacity/total lung capacity between the patients and controls. Comparisons according to the degree of deformity (antiflexion above 70 degrees and below 69 degrees), type of deformity (lateralflexion and multipledeformity involving chest, hip joint) and duration of the disease (over 15 years and below 10 years) show significant differences in vital capacity and maximum ventilation volume. Preoperative examination of pulmonary function can provide an objective basis for operative indication, selection of anesthesia and postoperative care.

Adolescent↗

PubMedDate not supplied

The actions of dopamine on the airways.

BACKGROUND: Dopamine exerts inhibitory and excitatory effects on different systems. In the lungs, dopamine modulates respiratory functions through carotid bodies and modulates pulmonary blood vessel tone, alveolar liquids, and bronchial exchange, and possibly participates in the regulation of airways diameter. It has been reported that dopamine has no acute effect on human airways in normal subjects or those with asthma background. However, inhaled or infused dopamine decreased histamine-induced bronchoconstriction in both normal and asthmatic subjects. We have examined the possible modulating effect of dopamine on bronchial diameter by administering inhaled dopamine and the DA2 dopaminergic blocker metoclopramide to subjects with various degrees of bronchial tone. METHODS: We examined 56 volunteers. Arterial blood pressure and heart rate were determined in every subject. By means of spirometry, we measured forced vital capacity, forced expiratory volume in the first second, maximal forced expiratory flow, and forced expiratory flow at 50% of vital capacity, before and after each treatment. By inhalation with a nebulizer, we administered dopamine (0.5 microg/kg/min) to 10 healthy subjects, 10 subjects with asthma without acute bronchospasm, and 16 subjects with acute asthma attack; intravenous metoclopramide (7 microg/kg/min) was administered to 10 healthy subjects and 10 subjects with asthma without acute bronchospasm. For ethical reasons, metoclopramide was not used in subjects with acute asthma attack. STATISTICS: non-parametric Wilcoxon tests for paired samples, ANOVA tests, and Bonferroni multiple comparison tests were performed. RESULTS: Inhaled dopamine increased forced expiratory volume in the first second, forced vital capacity, maximal forced expiratory flow, and forced expiratory flow at 50% of vital capacity in the acute asthma attack group, but there were no modifications in the healthy group or in the asthma without acute bronchospasm group. Metoclopramide did not induce changes in respiratory parameters in healthy individuals or in those with asthma without acute bronchospasm. CONCLUSIONS: Inhaled dopamine was able to induce bronchodilatation when the bronchial tone was already increased by acute asthma attack, but it did not modify the resting bronchial tone in normals or in asthmatics without acute bronchospasm. DA2 blockade with metoclopramide did not modify resting bronchial tone either. We suggest that dopamine exerts a modulatory effect on bronchial tone of human airways depending on the degree of existing basal tone.

Administration, Inhalation↗