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PubMed1995

The effects of antireflux therapy on pulmonary function in patients with severe gastroesophageal reflux disease. Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group.

OBJECTIVES: Gastroesophageal reflux can induce bronchospasm, and antireflux therapy has been shown to improve pulmonary function in patients who have gastroesophageal reflux disease (GERD) associated with asthma. Our objective was to study the pulmonary effects of antireflux therapy in patients who had severe GERD without clinically apparent lung disease. METHODS: In a Department of Veterans Affairs Cooperative Study, patients who had complicated GERD without important lung disease were randomly assigned to receive one of three types of antireflux treatment, including two kinds of medical therapy and a surgical therapy. Patients had pulmonary function tests (PFTs), including total lung capacity, residual volume, forced vital capacity, forced expiratory volume in 1 s, maximal midexpiratory flow, and diffusing capacity for carbon monoxide. RESULTS: Two hundred forty-seven patients (243 men, four women; mean age 58 yr) entered the randomized trial, and 151 returned for PFTs at 1 yr. For the entire study group and for all three treatment groups, mean values for PFTs at 1 yr did not differ significantly from those at baseline. Even in subgroups of patients whose baseline PFTs were abnormal and whose esophagitis had healed completely, there were no significant changes in results of PFTs. CONCLUSIONS: For veteran patients with severe GERD and no obvious lung disease, 1 yr of antireflux therapy had no important effect on pulmonary function. These findings suggest that GERD is not commonly associated with inapparent, reversible pulmonary dysfunction.

Female↗

PubMed1994

[Lung resection for lung carcinoma with idiopathic interstitial pneumonia].

Of 12 patients who underwent lung resections for lung cancer with idiopathic interstitial pneumonia (IIP), eight patients survived and four patients died due to acute exacerbation of IIP after the operation. The preoperative values for percent forced vital capacity, predicted postoperative percent vital capacity, percent one-second forced expiratory volume index and serum level of C-reactive protein were significantly different between the group of patients who survived and that of having died. Three days after the operation, the percentage of lymphocytes among leukocytes and serum level of lactate dehydrogenase in the two groups were both significantly different. These findings showed that the operative strategy for patients with lung cancer and IIP needs specifically careful consideration for operative procedure, and preoperative serum levels of C-reactive protein and postoperative lactate dehydrogenase and the percentage of lymphocytes in leukocytes would be useful in evaluation of the severity of IIP.

Adenocarcinoma↗

PubMedDate not supplied

[Changes of lung volumes and respiratory muscle strength in patients with growth hormone deficiency].

The relationship between growth hormone deficiency (GHd) and ventilatory function is not well understood. We studied 7 patients with GHd since childhood who had been adequately treated with replacement therapy until cartilage fusion. Together with 7 well-matched (age and body-type) healthy control subjects, they underwent spirometry including determination of residual volume, and lung diffusing capacity. Also recorded were maximal respiratory muscle pressure during inspiration (PImax) and expiration (PEmax). Patients with GHd showed a significant reduction in total lung capacity and vital capacity while residual volume and lung diffusing capacity remained unchanged. All patients had a significant reduction of both PImax and PEmax. Previously treated adult subjects with GHd present a persistent decrease in lung mobilizing volumes associated with reduced respiratory muscle strength. These alterations may have implications in the management of GHd in adult patients.

Adult↗

PubMed1990

Postoperative pulmonary complications in children with neuromuscular scoliosis who underwent posterior spinal fusion.

Children with neuromuscular scoliosis may develop restrictive pulmonary disease, with substantially lower than normal predicted lung function. Posterior spinal fusion (PSF) is often used to slow down this rapid deterioration of pulmonary function. Postoperatively, these patients frequently develop pulmonary complications. In this retrospective study of 38 patients with neuromuscular scoliosis who underwent PSF, the preoperative vital capacity was related to postoperative pulmonary complications and need for postoperative ventilatory assistance. In two patients who developed postoperative atelectasis and pulmonary edema, the preoperative vital capacity was 44% of that predicted. In six patients who developed atelectasis only, it was 49.2%. In the remaining 30 patients who developed no postoperative pulmonary complications, the average was 64.6%. Low preoperative vital capacity was also shown to correlate with the need for longer postoperative ventilatory assistance. The preoperative vital capacity is an important prognostic parameter in evaluating postoperative pulmonary recovery.

Adolescent↗

PubMed2001

Respiratory symptoms and pulmonary functional changes in patients with irritable bowel syndrome.

OBJECTIVE: Scientific evidence of functional interface between the immune and sensory motor systems of the gut and respiratory systems has been reported. In recent studies excess prevalence of bronchial hyper-responsiveness has been shown among patients with irritable bowel syndrome (IBS). The purpose of our study was to investigate the possible relationship between IBS and asthma. METHODS: One hundred thirty-three patients with IBS (108 women, 25 men) and 137 control subjects (105 women, 32 men) were included in this study. Both for IBS and the control group, the mean ages were 41.64+/-9.45 yr and 39.94+/-10.62 yr, respectively. Patients more than 50 yr old, with any organic GI disease, acute respiratory system infection, current or ex-smokers, and patients using drugs affecting smooth muscle and autonomic nervous system were not included in the study. Respiratory symptoms were questioned and pulmonary function tests were performed for every subject. RESULTS: There were 45 (33.8%) and eight (5.8%) subjects with respiratory symptoms in IBS and control groups, respectively (p < 0.0001). Twenty-one (15.8%) patients from the IBS group and two (1.45%) patients from the control group had the diagnosis of asthma according to history, clinical, and PFT findings. There was no statistical difference between two groups with respect to percentage of forced vital capacity and forced expiratory volume in 1 s-to-forced vital capacity. The difference between the two groups in forced expiratory volume in 1 s, flow after 50% of the vital capacity has been exhaled, peak expiratory flow rate, and maximal mid-expiratory flow rate was statistically significant (p < 0.01). CONCLUSION: We found that the prevalence of asthma was more common in the IBS group than in controls. Our finding supports the speculation that asthma and IBS may share common pathophysiological processes.

Adult↗

PubMedDate not supplied

Comparison of breathing patterns during exercise in patients with obstructive and restrictive ventilatory abnormalities.

Patients with obstructive and restrictive ventilatory abnormalities suffer from exercise intolerance and dyspnea. Breathing pattern components (volume, flow, and timing) during incremental exercise may provide further insight in the role played by dynamic hyperinflation in the genesis of dyspnea. This study analyzed the breathing patterns of patients with obstructive and restrictive ventilatory abnormalities during incremental exercise. It also explored breathing pattern components with dyspnea at maximum oxygen uptake (VO2 max). Twenty patients, thirteen obstructive patients (forced expiratory volume 38% +/- 13% predicted, forced expiratory volume in 1 s/forced vital capacity ratio 39 +/- 8%), and seven restrictive patients (forced vital capacity 55 +/- 16% predicted, forced expiratory volume in 1 s/forced vital capacity ratio 84% +/- 11%) performed symptom-limited incremental exercise tests on a cycle ergometer with breath-by-breath determination of ventilation and gas exchange parameters. Breathing patterns were analyzed at baseline, 20, 40, 60, 80, and 100 percent of VO2 max. Dyspnea was measured at end-exercise with a 100 mm visual analogue scale. The timing ratio of inspiratory to expiratory time (T(I)/T(E)) and the flow ratio of inspiratory flow to expiratory flow ratio (V(I)/V(E)) were different (p < 0.008) between obstructive and restrictive patients at all exercise intensity levels. The timing components of expiratory time (T(E)) and inspiratory time to total time (T(I)T(TOT)) were significantly different (p < 0.008) at baseline and maximum exercise. Dyspnea scores were not significantly different. For obstructive patients, correlations were noted between T(I)/T(E), V(I)/V(E), T(I)T(TOT) and dyspnea (p < 0.05). Breathing pattern-timing components, specifically T(I)/T(E), in patients with obstructive and restrictive ventilatory abnormalities during exercise provided further insight into the pathophysiology of the two conditions and the contribution of dynamic hyperinflation to dyspnea.

Aged↗

PubMed1979

Obstruction of the respiratory pathways, its evaluation by methods of functional examination of the lungs and development in patients with cystic fibrosis.

In 28 patients with cystic fibrosis aged 5--24 years the values of maximum expiratory flow rates (Vmax) at lower volume levels were assessed, as well as the "specific" conductance of the respiratory pathways (Gaw/TGV), the vital capacity (VC), total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), RV/TLC and FRC/TLC ratios and the one-second forced expiration of the vital capacity (FEV1) to evaluate obstruction of the respiratory pathways. Most markedly and most frequently abnormal were the values of Vmax, RV and of the RV/TLC ratio. These findings revealed that in almost all patients with CF there was already during the initial examination an obstruction of the peripheral respiratory pathways and hyperinflation of the lungs. During repeated measurement of the above values of lung function in 15 patients with cystic fibrosis during a period of 1--5 years when the patients increased in height by 10 cm on average, the above values did not deteriorate on average. There was, however, an individual variability of the investigated values during this period. The comprehensive treatment provided in our country prevented in patients with CF a deterioration of obstruction of the respiratory pathways during the period of investigation.

Adolescent↗

PubMed1993

Does Harrington instrumentation improve pulmonary function in adolescents with idiopathic scoliosis? A meta-analysis.

A meta-analysis of the effects of Harrington instrumentation on vital capacity in adolescent patients with idiopathic scoliosis was conducted in an attempt to clarify the conflicting conclusions of different studies. Thirty-eight studies were assessed. Those that did not prevent sufficient statistical information and those that did not allow for normal growth during the interval between tests were excluded. The five studies remaining for analysis, involving a total of 173 patients, showed an increase in mean vital capacity ranging from 2% to 11% of predicted vital capacity. The weighted mean effect size for the five studies analyzed was 0.22 with 95% confidence intervals of 0.01-0.43. The authors conclude that Harrington instrumentation leads to a small but statistically significant improvement in vital capacity.

Adolescent↗

PubMed1982

Effects of cardioselective and nonselective beta-adrenergic antagonists on pulmonary mechanics.

After a 7-day lead-in period, one of three beta-adrenergic antagomists was taken for 2 wk by 10 healthy male subjects. The drugs were metoprolol (cardioselective) and propranolol and nadolol (both nonselective). Dosage was according to currently recommended regimens and was increased after the first week (50 to100 mg b.i.d., 20 to 40 mg q.i.d., and 80 to 160 mg q.d.). Pulmonary mechanics and density dependence (DD) of maximal expiratory flow were measured before and at the end of the placebo lead-in period and the low- and high-dose treatment weeks. Total lung capacity (TLC), residual volume (RV), and RV/TLC all rose (P less than 0.05) after high-dose nadolol. Forced vital capacity (FVC) and expiratory reserve volume fell (P less than 0.05) after high-dose nadolol. Forced vital capacity (FVC) and expiratory reserve volume fell (P less than 0.05) after high-dose metoprolol. There was no change in forced expiratory volume in 1.0 sec (FEV1), FEV1/FVC, maximal midexpiratory flow rate, or airway resistance with any of the beta-antagonists. Decreases (P less than 0.05) in maximal expiratory flow determined at 50% of the vital capacity occurred after propranolol and metoprolol, but not after nadolol. A dose-related decrease in DD at 50% of the vital capacity accompanied nadolol dosing, but was significant only after the high-dose regimen. The decreases in DD with nadolol, as well as its effect on RV/TLC, are consistent with small airway narrowing. The findings with metoprolol and propranolol suggest that they affect central as well as peripheral airways.

Adrenergic beta-Antagonists↗

PubMed2003

Comparison of a new desktop spirometer (Spirospec) with a laboratory spirometer in a respiratory out-patient clinic.

BACKGROUND: The performance of spirometers is often evaluated under ideal conditions with computer-generated waveforms or in vivo testing with healthy subjects. Real-life conditions are less ideal because of comorbidities, age of the subjects, and a variety of air flow limitations. Evaluation of new spirometry equipment can also be performed under these less favorable conditions. The Spirospec is a new desktop spirometer that is commercially available, but its accuracy has not been evaluated in a clinical setting. OBJECTIVE: Test the Spirospec with subjects with normal and pathologic pulmonary function. METHODS: A group of 45 patients (mean age 38.4 years, 27 male) booked for evaluation in the pulmonary function laboratory of a tertiary care university hospital were tested with both a Spirospec and a standard Jaeger Masterlab 4.0 spirometer, according to the guidelines of the American Thoracic Society. Three subgroups (normal spirometry, obstructive air flow limitation, and restrictive air flow limitation) of 15 consecutive subjects each underwent spirometry. RESULTS: Pulmonary function measurements from the Spirospec correlated closely (r = 0.95-0.99) with those from the Masterlab 4.0, showing good limits of agreement and differences between the 2 devices: forced vital capacity 0.03 L, forced expiratory volume in the first second (FEV(1)) -0.01 L, peak expiratory flow -0.41 L/s, peak inspiratory flow 0.43 L/s, forced expiratory flow at 50% of total lung capacity 0.13 L/s, and forced expiratory flow at 75% of total lung capacity 0.12 L/s. With the exception of forced vital capacity and FEV(1), these differences were statistically significant (p < 0.05). CONCLUSION: The Spirospec is comparable to the Masterlab 4.0, with high accuracy for FEV(1) and forced vital capacity and clinically acceptable differences in the measured flow variables.

Adult↗

PubMed1982

Total effective time of the forced expirogram in disease: sources of error and a correction factor.

Effective time of the forced expirogram is a sensitive index for the detection of mild airways obstruction. However, there is evidence that this measurement is not superior to maximum flow rates in the lower half of the forced vital capacity or even FEV1 and FEV1% in some patients suffering from obstructive lung disease. Furthermore we noticed that in some patients with a decrease of the forced vital capacity caused by exacerbation of airways obstruction, the effective time was not appreciably changed. We concluded that this apparent disadvantage of the effective time is the result of the different forced vital capacities. To eliminate this error we transformed the forced expirogram to the equivalent curve that the patient would produce, if his forced vital capacity was equal to the predicted mean value for his age, sex, and height. The derived corrected total effective time seems to have increased sensitivity for detection of small changes in expirograms obtained from the same subject or from different subjects.

Asthma↗

PubMed1990

The effect of the halovest and body position on pulmonary function in quadriplegia.

Pulmonary function (vital capacity) was measured in ten quadriplegics and ten normal subjects in the following situations: supine, sitting, supine with a halovest, and sitting with a halovest. When changing from the supine to sitting positions, vital capacity decreased in the quadriplegics and increased in normal subjects. The halovest significantly reduced the vital capacity in normal subjects, but had much less of a detrimental effect in quadriplegics. As a result of this prospective, controlled study, we conclude the following: (a) the compromised state of pulmonary function in quadriplegics is not a contraindication for the use of a halovest, (b) the halovest causes a significant (p less than 0.01) restriction in vital capacity in able bodied subjects, and (c) when tenuous pulmonary function exists in a quadriplegic, pulmonary mechanics are better in the supine position.

Adult↗

PubMed1996

Alterations in pulmonary function after retroperitoneoscopic surgery.

OBJECTIVE: To evaluate and compare changes in pulmonary function after retroperitoneoscopic and open surgery. PATIENTS AND METHODS: From June 1994 to October 1995. 11 patients (five men and six women, mean age 44.7 years, range 29-69) underwent retroperitoneoscopic procedures (Group 1) and 11 patients (eight men and three women, mean age 57.5 years, range 22-73) underwent flank-incision procedures (Group 2). The surgery comprised eight adrenalectomies and one each of nephroureterectomy, nephrectomy and pyelolithotomy in Group 1, and five adrenalectomies, four nephroureterectomies, one ureterolithotomy and one excision of a retroperitoneal tumour in Group 2. Pulmonary function tests (PFTs) were performed before and 3 days after surgery; the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory volume at 25% (FEV25%), FEV1/FVC, vital capacity (VC), total lung capacity (TLC), residual lung volume (RV) and functional residual capacity (FRC) were compared between the groups. The post-operative changes in the PFTs were assessed using a paired t-test and the degree of change in both groups compared using the Mann-Whitney U-test. Other factors possibly influencing PFT were analysed using multiple regression. RESULTS: Pulmonary function was impaired in both groups on the third day after surgery. In Group 2, the FVC, FEV1, FEV25%, VC and TLC had declined significantly (all P < 0.05) from the pre-operative value. In Group 1, only the FVC and VC decreased significantly (P < 0.05). Post-operative pulmonary complications occurred in two patients in Group 2 but in none of those in Group 1, showing that pulmonary function was generally less affected in Group 1 than in Group 2. CONCLUSION: Although pulmonary function was impaired 3 days after surgery in both groups, retroperitoneoscopic surgery, by eliminating a large flank incision, caused less post-operative pulmonary dysfunction than open surgery.

Adult↗

PubMed2004

Respiratory function changes after chemotherapy: an additional risk for postoperative respiratory complications?

BACKGROUND: Patients receiving chemotherapy for lung cancer usually modify their lung function during treatment with increases in forced expiratory volume in 1 second (FEV(1)) and forced vital capacity (FVC) and decreases in lung diffusion for carbon monoxide (DLCO). This prospective study was designed to evaluate functional changes in forced expiratory volume in 1 second, forced vital capacity, and DLCO after three courses of induction chemotherapy with cisplatinum and gemcitabine in stage IIIa lung cancer patients and to assess their impact on respiratory complications after lung resection. METHODS: From March 1998 to January 2001, 30 consecutive patients with N2 nonsmall cell lung cancer had surgical resection after neoadjuvant treatment. Pre-chemotherapy and postchemotherapy results of standard respiratory function tests and DLCO were compared in patients with and without postoperative respiratory complications. RESULTS: All 30 patients completed the chemotherapy protocol without respiratory complications. Significant improvements (p < 0.05) were recorded after chemotherapy in transition dyspnea score, PaO(2) (mean value from 79.8 to 86.4 mm Hg), forced expiratory volume in 1 second % (from 78.1% to 87.5%) and forced vital capacity % (from 88.1% to 103.3%). Lung diffusion for carbon monoxide was significantly impaired after chemotherapy (from 74.1% to 65.7%; p = 0.0006), as well as DLCO adjusted for alveolar volume (from 92.8% to 77.4%; p < 0.0001). One patient died after surgery and 4 patients (13.3%) experienced postoperative respiratory complications. Compared with patients without complications, these 4 patients had higher mean increase in FEV(1) after chemotherapy (+26.8% vs + 6.7%; p = 0.025), but greater mean decrease in DLCO/Va (-27.8% vs -13.6%; p = 0.03). Impact of change in DLCO on postoperative respiratory complications was not confirmed by multiple logistic regression analysis (p = 0.16). CONCLUSIONS: In lung cancer patients, forced expiratory volume in 1 second and forced vital capacity assessed after neoadjuvant chemotherapy are not reliable indicators of the likelihood of respiratory complications after surgery. The risk of respiratory complication may be directly linked to loss of DLCO/Va. Lung diffusion for carbon monoxide assessed after neoadjuvant chemotherapy is probably the most sensitive risk indicator of respiratory complications after surgery. We recommend that DLCO studies be performed before and after chemotherapy in lung cancer patients undergoing induction therapy.

Carbon Monoxide↗

PubMed1987

Dilatation, compensatory growth, or both after pneumonectomy during childhood and adolescence. A thirty-year follow-up study.

The ventilatory function of 230 patients with pneumonectomy, performed at ages ranging from 2 to 40 years, has been followed for more than 30 years (mean 33 years). We have tried to analyze whether the available data gave information about the nature and the mechanisms adapting the remaining lung to the larger than normal pleural space and about the persistence of this adaptation in the longer term. There were 32 patients with a persistent, disturbed forced expiration (mean 50% of vital capacity). This group of patients was excluded from the study to answer the above questions, because the subdivisions of the total lung capacity in this group differed significantly from those in the group of 98 patients with a normal forced expiratory volume of 72% (mean) of vital capacity. The data of the 98 patients, who were subdivided into seven age groups at the time of pneumonectomy, permitted the following conclusions: In the youngest age group (0 to 5 years), the ventilatory capacity is hardly smaller than the predicted capacity for two lungs; this suggests that compensatory growth by way of hyperplasia might have been the most important adaptive mechanism in this group. In the age group 6 to 20 years, a significant difference is still found as compared to the group of patients operated on at an older age; this difference indicates that in this period compensatory growth, possibly mainly simple hypertrophy, still played an important but gradually decreasing role. The fact that the effect of the adaptational mechanisms could be observed more than 30 years after ablation of one lung, without loss in quality of function (i.e., forced expiratory volume constituting a normal percentage of the vital capacity), indicates that the adaptive mechanisms also compensate for the loss in lung tissue in the longer term. A striking finding was the stability of the tidal volume/functional residual capacity ratio, which, especially in the younger age groups, was very close to the predicted value for two lungs. This finding is in agreement with the fact that most persons with a healthy remaining lung lead a normal family and social life after pneumonectomy.

Adaptation, Physiological↗

PubMed1993

Effects of maxillomandibular fixation on respiration.

The effects of maxillomandibular fixation (MMF) on respiration were studied by measuring pulmonary function in 27 healthy volunteer subjects and in six post-operative patients who underwent MMF after sagittal split ramus osteotomies. In addition, airflow resistance of the mouth was measured in seven healthy subjects under MMF. In the healthy subjects, the ratio of forced expiratory volume in one second to forced vital capacity and peak expiratory flow rate were reduced by 22.9% and 52.1%, respectively, after application of MMF, indicating the presence of respiratory obstruction, whereas the ratio of forced vital capacity to predicted forced vital capacity, an indicator of restrictive respiratory defects, was not significantly affected. The obstructive type of respiratory defect was found to be the result of increased airflow resistance with MMF. The decrease of forced expiratory volume was greater in all postoperative patients than in the healthy subjects. The results indicate that careful preoperative and postoperative airway management is essential for the safety of patients undergoing MMF for the treatment of oral and maxillofacial conditions.

Adult↗

PubMed1994

Boomerang pillows and respiratory capacity.

An experimental study was done to determine whether subjects placed on boomerang pillows would have lower vital capacities than subjects placed on straight pillows after 30 minutes. A sample of 42 subjects took part in the study in a nursing laboratory. A crossover design was used in which subjects were measured in both conditions. The findings indicated that there was no significant difference in the vital capacities of subjects in the two conditions. An associated finding was that the vital capacities were significantly lower in a semi-Fowler's position than in a straight chair. It was concluded that boomerang pillows are safe to use for persons without respiratory problems. Further research is needed into the effect of boomerang pillows on persons with respiratory deficits.

Bedding and Linens↗

PubMed1987

Pulmonary function in sickle cell trait.

Pulmonary function abnormalities, which have been reported to occur in persons with sickle cell trait (hemoglobin AS), could intensify the hypoxic stimulus for the systemic formation of sickle cells at high altitude. We sought to determine whether pulmonary function abnormalities occur as a result of exposure to high altitudes in persons with hemoglobin AS. In a prospective study, 13 men with hemoglobin AS ("cases") and 13 controls (hemoglobin AA) matched by age, sex, and race were exposed to five to seven altitude simulations (ranging from 1524 to 7620 m [5000 to 25,000 ft]) in a hypobaric chamber. Measurements of diffusing capacity for carbon monoxide (DLco), forced vital capacity, forced expiratory volume in one second, and forced midexpiratory flow were obtained before and after each exposure. Data before exposures did not differ statistically between cases and controls. Altitude had no systematic effect on DLco or spirometric values in cases compared with values in controls (p greater than 0.05). Individual declines in forced vital capacity or DLco of more than 10% occurred with similar frequency in both groups. Measurements made after the series of exposures showed no change from those made before. We conclude that short serial exposures to hypoxia at high altitudes does not acutely or cumulatively alter DLco or spirometric values in healthy, nonexercising persons with sickle cell trait.

Adult↗