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Lung function in children with recurrent bronchitis.

Lung function was studied in 29 children suffering from recurrent bronchitis (average number of bronchitis attacks per year: 4.2 +/- 0.5). Most of them (73%) were 1--7 years old. The date of exploration in relation to the last acute bronchitis was on average 6 weeks. Lung mechanics, residual functional capacity, blood gases and regional lung function were measured. Most of the children were suffering from some kind of functional disorder; alteration of lung mechanics -- increase of lung resistance (22/29) decrease of dynamic compliance (15/23); increase of functional residual capacity (6/10), non specific bronchial hypersensitivity (12/17); regional ventilatory and perfusion malfunction. These functional disorders could be the first evidence of the bronchial lesions which cause chronic obstructive bronchitis in adults.

Bronchitis

Study of lung function data by principal components analysis.

As a rational approach to the many lung function tests available, we have subjected the results of a battery of six lung function measurements made in 458 coalminers to the statistical technique of principal components analysis. By this means the six test results were reduced to three principal components without important loss of information. The first component appeared to represent lung size and the second the degree of airflow obstruction, and the third detected impairment of gas transfer factor in excess of that explained by the first two components. The values of the first principal component, used to select men with abnormal lung function, identified more younger men with functional abnormalities than a method based on comparison of observed and predicted values of forced expiration volume in one second. The values of the second and third principal components were used to classify types of functional abnormality. It is concluded that this statistical technique provides a sensitive method of identifying men with unusual lung function, particularly younger men, in a population and can be used to define and quantify different aspects of lung function.

Adult

The UCLA population studies of chronic obstructive respiratory disease. VII. Relationship between parental smoking and children's lung function.

Results of previous studies of the impact of parents' smoking on children's lung function have been conflicting. To evaluate further the effect of passive smoking on the lung function of children, we analyzed respiratory questionnaire and lung function results obtained during field testing of residents (aggregated according to household) of 4 census tracts in the Los Angeles area. We report here on 971 white, non-Hispanic, nonsmoking, nonasthmatic children residing in households in which the smoking status of both parents was known; households with ex-smoking parents were excluded from analysis. We divided these children into 3 categories related to parental smoking status: (1) at least mother smokes , (2) only father smokes , and (3) neither parent smokes . Prediction equations for several indexes of forced expired volume and flow were derived separately for boys and girls 7 to 17 yr of age. Analysis of variance was used to compare lung function residuals of children in the 3 different passive smoking categories. Analysis was performed separately on younger (7 to 11 yr of age) and older (12 to 17 yr of age) children of each sex. Among younger male children, residual values were significantly lower in the maternal smoking category than in the other 2 household categories for maximal flow and maximal flow after exhalation of 25% of forced vital capacity (FVC) (p less than or equal to 0.05); no differences were noted between the paternal-smoking only and nonsmoking household categories. A trend toward similar results was found in older male children, which approached significance (p less than 0.1). Among females, forced expiratory flow during the middle half of the FVC and maximal flow after exhalation of 75% of FVC were significantly lower in relation to maternal smoking in the older children only (p less than or equal to 0.05). ANOVA revealed no decrement in lung function in relation to passive smoking among children with asthma or bronchitis (n=138).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

[Changes of lung function in sarcoidosis].

This paper reports the changes of lung function in 26 cases of sarcoidosis and the correlation of lung function tests with chest X-ray films. The results showed that in the first stage of sarcoidosis, the chest films were normal: however, there were changes in lung volumes, ventilation and diffusion function. Therefore, the lung function tests and chest films should be done at the same time in order to supplement each other.

Adult

Effect of fenoterol on small airways and regional lung function in asymptomatic asthma.

Lung function tests for small airways were performed before and after inhalation of fenoterol by 11 young asymptomatic asthmatics and in 8 control subjects. In the asthmatics, minimal impairment in the tests was found except for increased expansion of the lower part of the lung (133Xe regional lung volumes) and an "abnormal" distribution pattern of a bolus of Xe inhaled from the residual volume. This suggests enhanced airway closure, especially in the lower area of the lung. Usual therapeutic doses of fenoterol (0.4 to 0.6 mg in puffs) could not correct these abnormalities, but 1.2 mg given to 2 patients resulted in changes similar to those observed in normals. The results suggest that small airway impairment in asymptomatic asthmatics is not only related to enhanced bronchomotor tone, but also to anatomical changes located especially at the base of the lung.

Adult

[Lung function tests in emphysema].

Several lung function tests are capable of detecting typical functional abnormalities in pulmonary emphysema, such as reduced elastic recoil of lung tissue, elevation of intrathoracic gas volumes, expiratory bronchial collapse or uneven patterns of ventilation. The measurement of elastic recoil by means of an esophageal catheter also seems to be a reliable technique for detecting early stages of emphysema, but its use for routine clinical investigations remains impracticable. The elevation of intrathoracic gas volumes determined by body plethysmography or helium dilution technique may sometimes be influenced by reversible bronchial obstructions or additional restrictive ventilatory defects. Expiratory collapse of the intrathoracic airways, however, proves to be a regular finding in advanced pulmonary emphysema. It results from decreased stability of the peripheral and central bronchial wall as well as from a shifting of bronchial and transmural pressure gradients to the peripheral airways. The occurrence of a pressure dependent expiratory stenosis can easily be demonstrated by the spirometric flow-volume curve during forced expiration, thus differentiating patients with asthma from those with chronic bronchitis and emphysema. The minimal program for detection and evaluation of emphysematous alterations of the lung by functional tests should consist in the measurement of intrathoracic gas volumes, recording of the forced expiratory volume and the analysis of the flow-volume curve.

Emphysema

Effects of mitral valve surgery on static lung function and exercise performance.

Lung function at rest was assessed in 50 patients before and six months after mitral valve surgery. There were small increases in spirometric volumes (FEV1 and vital capacity) with decreases in total lung capacity and residual volume, but no change in carbon monoxide transfer factor or transfer coefficient (KCO). Progressive exercise tests performed before and after operation in 19 of the patients confirmed an improved exercise capacity after surgery. The patients with the greatest symptomatic improvement in breathlessness were also those who achieved the greatest increase in maximum work load and the greatest decrease in ventilation for a given oxygen consumption. Depression of the ST segment of the electrocardiogram and frequent ventricular ectopic beats on exercise remained common after surgery and may have been due to digoxin treatment.

Adult

A guide to lung function tests.

In patients with respiratory disease, measurement of lung function should be part of the assessment if possible. In the ward, clinic and lung function laboratory there are tests available to examine airflow, lung volume, gas transfer and exercise capacity. These provide information on lung function which may be vital for adequate diagnosis and assessment of the patient.

Blood Gas Analysis

[Correlation of roentgen picture and lung function testing within the scope of silicosis evaluation].

The chest roentgenograms codified according to the 1980 ILO classification and the lung function tests of 100 persons with silicosis have been compared with each other. The results show that, with a higher degree of dissemination and a growing size of nodes, there is a statistically significant tendency to increasing gravity of pathological results of resistance and the arterial blood gas analysis. A correlation between the degree of dissemination and the size of nodes to other lung function parameters (vital capacity, intrathoracic gas volume) cannot be finally established. Furthermore, neither coding as category B nor the employment of the symbols em (emphysema) and tb (tuberculosis) allow conclusions to be drawn about the results of lung function tests. The poor correlation is caused on one hand by the insufficient description of the morphological parameters important for function, due to the restricted classification. On the other hand there is little correlation between chest roentgenogram and lung function, as lung function in anthracosis is essentially influenced by obstructive bronchitis, which has only a loose connection with silicosis.--Lung function must be the central point in the process of forming an opinion. Chest roentgenograms are important for clarifying the causes of pathological changes and allow a simple observation of progress.

Airway Resistance

Impaired lung function in patients with IgA deficiency and low levels of IgG2 or IgG3.

We examined the relation between serum levels of IgG subclasses and lung function, as determined by spirometry, lung volumes, the single-breath nitrogen test, and static recoil pressures, in 29 patients with IgA deficiency and repeated upper or lower respiratory tract infections. Four of the patients had decreased levels of IgG2, and two had decreased levels of IgG3. Two or more lung-function values were abnormal in each of these six patients and also in three others with normal levels of IgG subclasses. Low levels of IgG2 and IgG3 were significantly related to abnormal lung function (P less than 0.01). The 20 patients with normal lung function all had IgG-subclass levels above the lower range. There may be a causal relation between low levels of IgG subclasses and deterioration in lung function, suggesting that patients with combined IgA and IgG-subclass deficiencies may benefit from immunoglobulin prophylaxis.

Adolescent

Alterations in bronchoalveolar lavage fluid but not in lung function and bronchial responsiveness in swine confinement workers.

Testing of lung function and bronchial reactivity, bronchoalveolar lavage (BAL), and a skin prick test with a standard panel and six "swine" extracts obtained from swine and swine environment were performed in 20 randomly selected nonsmoking swine confinement workers. In addition, blood samples for detection of antibodies by the diffusion in gel-enzyme-linked immunosorbent assay (DIG-ELISA) technique and precipitating antibodies were drawn. Air samples for measurement of dust and endotoxin levels were collected. All the farmers regarded themselves as healthy. The results were compared with reference groups consisting of urban nonsmoking subjects who had not been exposed to pig farming environment. The pig farmers had normal lung function and the bronchial reactivity was not different from the reference group. In the BAL fluid of the farmers, the concentration of total cells and granulocytes was increased while the concentrations of lymphocytes and macrophages were normal. The BAL fluid concentrations of albumin, fibronectin, and hyaluronan were elevated in the farmers. Skin prick tests with swine extracts were negative in all farmers. Antibodies (assessed by DIG-ELISA) against swine dander, swine dust, and pig feed were increased and precipitating antibodies against swine dander were found in 14, against pig food in five, and against swine confinement dust in three of the 20 pig farmers. The concentration of airborne total dust was 7.4 mg/cu mm and the endotoxin concentration was 37 (22 to 60) ng/cu mm during tending the pigs and increased, during feeding, to 13.8 mg/cu mm and 315 (194 to 716) ng/cu mm, respectively. There was no correlation between exposure and lung function or lavage findings. In conclusion, randomly selected pig farmers had signs of airway inflammatory reaction and activation of the immune system without alteration in lung function and bronchial reactivity.

Adult

Regional and total lung function studies in patients with hemidiaphragmatic paralysis.

Global and regional lung function were studied in 17 subjects with hemidiaphragmatic paralysis. Global lung function (VC, MVV, and FEV1) in the sitting postion was reduced by an average of about 25%. Regional lung function data in the same position showed a considerable decrease in perfusion (19%), ventilation (20%), and lung volume (7%) of the diseased side as compared to reference values obtained in healthy volunteers. Compared to the partition of function in the supine, the perfusion of the affected lung increased when it was lowermost in the lateral decubitus postion, while regional FRC decreased and ventilation changed little. When uppermost, perfusion and ventilation of the affected lung decreased while FRCr increased somewhat. The arterial oxygen tension was significantly below normal in the supine position but in the normal range in the sitting position. It increased further during exercise. Bronchography showed compression of the basal lung segments on the affected side in the erect, and kinking and obliteration of lower lobe bronchi in the supine position and still more when the lung was lowermost in the lateral decubitus position.

Activities of Daily Living

Lung function in workers using cadmium containing solders.

The lung function of 57 male workers previously exposed to cadmium in connection with the use of cadmium containing solders was examined by spirometry (FVC, FEV1, FEV%, and MMF) and single breath nitrogen washout (CV, CV%, and phase III). A reference group (n = 31) from a nearby industry was examined at the same time. Despite the fact that the exposure in previous years had been relatively high, in the order of 0.05-0.5 mg Cd/m3, and that 24 (42%) of the workers had cadmium induced renal damage in the form of beta 2-microglobulinuria there was no evidence of pulmonary damage. There were no significant differences in lung function data from the exposed and reference group and there was no dose-response relation within the exposed group. It thus appears that signs of kidney toxicity in the form of low molecular weight proteinuria precede those that may be identified in the lung with commonly used lung function tests.

Cadmium

Lung function and bronchial reactivity in aluminum potroom workers.

Lung function and bronchial reactivity were measured in 38 aluminum potroom workers with no airway symptoms and in 20 healthy referents (office workers). All of the participants were non-smokers. The magnitude of exposure to airborne dust (alumina) and fluorides was determined. The aluminum potroom workers had obstructive lung function impairment with a significant decrease in expiratory flow and an increase in residual volume. Diffusing capacity was found to be lower than in the referents. No bronchial hyperreactivity was found in the aluminum potroom workers. The exposure to inhaled alumina and particulate and gaseous fluorides in the plant was low, 15-20% of the Swedish exposure limits. The finding of only modest lung function alterations with no bronchial hyperreactivity in the aluminum potroom workers is not consistent with the results of other authors. This discrepancy can probably be explained by the fact that the exposure to inhaled contaminants in the investigated aluminum plant was low.

Adult