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PubMed2004

Outcome of pediatric patients with severe restrictive lung disease following reconstructive spine surgery.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To assess outcome and complications in pediatric patients with a vital capacity < or =45% of predicted who underwent reconstructive spine surgery for severe thoracic scoliosis. SUMMARY OF BACKGROUND DATA: Despite the known sequelae of untreated spine deformity, pediatric patients with severe restrictive lung disease are frequently not considered good operative candidates for surgical treatment on the basis of their underlying lung disease. Only a few reports have examined surgical treatment in this population. METHODS: A retrospective chart review was conducted on 21 pediatric patients with restrictive lung disease (average age 11.5 years, range 2-21 years). Eighteen patients completed pulmonary function testing, all with vital capacity < or =45%. The remaining three patients had clinical features of restrictive lung disease but could not perform pulmonary function testing. Eighteen patients underwent combined anterior and posterior spinal fusions. Before surgery, all patients were seen by the pulmonary, cardiology, pediatric, and anesthesia services, as well as neurology and gastroenterology services if indicated. Outcome variables examined were as follows: 1) days on oxygen, 2) need for tracheostomy, 3) days on ventilatory support, 4) mortality rate, 5) pulmonary complications, 6) blood loss, 7) other complications relative to the surgical procedure, and 8) length of stay. RESULTS: For the 21 patients, the preoperative average vital capacity was 32% predicted (range 18-43%). After surgery, the median time on supplemental oxygen was 3 days (range 0-90 days). Only one patient with a vital capacity of 29%, who was successfully extubated on postoperative day 4, developed a deep wound infection, which required incision and drainage, as well as recurrent right lung collapse, and subsequently required a tracheostomy to facilitate ventilator weaning. Four patients were on assisted ventilation before the surgery and continued to require it after surgery. Two additional patients required noninvasive positive pressure ventilation for a short period of time following the surgery. Pneumonia occurred in two patients, and pleural effusion occurred in two patients. Four patients developed postoperative atelectasis. There was one reoperation for implant failure. There were no mortalities or adverse neurologic outcomes. Major thoracic scoliosis measured an average of 82 degrees (range 40-140 degrees) before surgery, with correction to an average of 35 degrees (range 6-75 degrees). CONCLUSIONS: Reconstructive spine surgery in pediatric patients with severe restrictive lung disease and significant spinal deformity is well tolerated. Familiarity with different surgical techniques of salvage reconstruction and perioperative multidisciplinary management should be emphasized. Routine preoperative tracheostomy is not indicated.

Adolescent↗

PubMed1982

Serial pulmonary function in systemic sclerosis.

The natural history of the pulmonary involvement in systemic sclerosis is not well studied. Reported here are the serial measurements of pulmonary function in a well defined population of patients with systemic sclerosis followed over a mean of 63 months. The mean rate of loss of vital capacity (0.10 liters per year) for the 38 patients serially studied was more than three times the expected rate of loss for a normal population. The mean rate of loss of diffusing capacity (0.33 ml/min/mm Hg per year) for the 27 patients serially studied was similar to that for a normal population. The percent forced vital capacity expired in the first second increased 0.53 percent per year consistent with a progressive restrictive ventilatory defect. Smokers tended to lose vital capacity at a slightly greater rate than nonsmokers (p = 0.069). Individual variability in the course of pulmonary function was observed. Although the overall trend in our population was towards a slowly progressive restrictive ventilatory defect, pulmonary function in the nonsmokers did not change at rates different from those in a nonsmoking reference population.

Adolescent↗

PubMedDate not supplied

Comparison of outcomes after single and bilateral lung transplantation for obstructive lung disease.

BACKGROUND AND METHODS: To determine the long-term functional outcome for single versus bilateral lung transplant for nonseptic obstructive lung disease, we compared the results from 39 single and nine bilateral lung transplant procedures. The nine bilateral lung transplants included three en bloc double lung and six bilateral sequential lung transplants. RESULTS: Early deaths within 30 days of transplantation occurred in two of nine (22%) bilateral and 4 of 39 (10%) single lung transplants (p = Not significant). Compared with pretransplant values, pulmonary function as assessed by the spirometric indexes of the percent predicted forced vital capacity, forced expiratory volume in one second, forced expiratory volume in one second/forced vital capacity, and forced expiratory flow at 25% and 75% of forced vital capacity improved significantly up to at least 12 months after transplantation for both single and bilateral lung transplant recipients. The degree of pulmonary function improvement was better in single as compared with bilateral lung recipients. By 6 months after transplantation, all but one single and all bilateral lung recipients were in New York Heart Association class I or II (p = Not significant). One-year survival was significantly better after single (77%) compared with after bilateral lung transplantation (35%) (p < 0.05). CONCLUSIONS: These results suggest that single lung transplantation is the procedure of choice for patients with nonseptic obstructive lung disease.

Adolescent↗

PubMed2003

Daytime predictors of sleep disordered breathing in children and adolescents with neuromuscular disorders.

Sleep disordered breathing with or without nocturnal hypercapnic hypoventilation is a common complication of respiratory muscle weakness in childhood neuromuscular disorders. Nocturnal hypercapnic hypoventilation as a sign of respiratory muscle fatigue, portends a particularly poor prognosis. We aimed at identifying daytime predictors of sleep disordered breathing at its onset and sleep disordered breathing with nocturnal hypercapnic hypoventilation. Forty-nine children and adolescents (11.3+/-4.4 years) with progressive neuromuscular disorders were studied with inspiratory vital capacity, peak inspiratory pressure, arterial blood gases, polysomnography, and a ten-item symptoms questionnaire. Daytime respiratory function was prospectively compared with polysomnographic variables. Sleep disordered breathing was found in 35/49 patients (71%). Twenty-four (49%) had sleep disordered breathing with nocturnal hypercapnic hypoventilation. Inspiratory vital capacity and peak inspiratory pressure, but not symptom score, correlated with sleep disordered breathing and severity of nocturnal hypercapnic hypoventilation. Sleep disordered breathing-onset was predicted by inspiratory vital capacity<60% (sens. 97%, spec. 87%). Sleep disordered breathing with nocturnal hypercapnic hypoventilation was predicted by inspiratory vital capacity<40% (sens. 96%, spec. 88%) and PaCO(2)>40 mmHg (sens. 92%, spec. 72%,). Sleep disordered breathing can reliably be predicted from simple daytime respiratory function tests, which, if applied systematically, will improve recognition of nocturnal respiratory failure.

Adolescent↗

PubMed1991

Postoperative pain treated by intravenous L-tryptophan: a double-blind study versus placebo in cholecystectomized patients.

The effectiveness of intravenous administration (i.v.) of L-tryptophan, which is the precursor of cerebral serotonin, was verified in the treatment of postoperative pain. The study was carried out on 45 female patients, aged between 34 and 61 years, undergoing cholecystectomy who were randomly divided into three groups. Group 1 (age: 50.33 +/- 8.64 years) received 100 ml of 5% mannitol solution i.v.; group 2 (age: 49.80 +/- 11.11 years) 100 ml of a mannitol solution containing 7.5 mg/kg L-tryptophan; and group 3 (age: 53.46 +/- 9.60 years) 100 ml of a mannitol solution containing 15 mg/kg L-tryptophan. Vital capacity (preoperative VC) was measured before surgery. Anesthesia used was isoflurane. Narcotics or neuroleptics were not used. Pain was assessed before treatment (T-0 min), at the end of administration (T-30) and at T-60, 120, 180, 240, 300 and 360 min by the following variables: respiratory rate (RR), heart rate (HR), mean arterial pressure (MAP), Scott-Huskisson test (VAS), pain vital capacity (PVC), analgesic vital capacity (AVC), and respiratory restoration factor (RRF) calculated from Bromage's formula (RRF = (AVC - PVC/preoperative VC - PVC) X 100). As regards variables RR, HR, MAP and VAS, differences between the values from T-30 to T-360 and the value at T-0 were calculated. Means and S.E.M. were calculated on the obtained values and on RRF values for each group. The significance of the differences between groups was calculated using Student's t test and Bonferroni's test. Results show a significant decrease of pain in groups 2 and 3 treated with L-tryptophan, in comparison with group 1 (controls). No significant difference was observed between the treated groups, although more lasting pain relief was observed in group 3 in comparison with group 2. Intravenous L-tryptophan showed its effectiveness in the treatment of postoperative pain even when used alone. Its use may be considered for patients with renal failure, in order to strengthen pharmacological analgesia or to prevent postoperative pain by its intraoperative administration.

Adult↗

PubMed1980

Alcohol consumption and airway obstruction.

To clarify the basis of the reported association between alcohol and pulmonary disease, the relationship between intake of alcohol and pulmonary function was examined in 2,539 community-dwelling adult participants in an ongoing longitudinal study of risk factors for airway obstruction. Forced expiratory volume in 1 s, expressed as a percentage of forced vital capacity, was used as the indicator of airway obstruction, and forced vital capacity expressed as a percentage of the predicted value was used as an index of restriction. Although crude (unadjusted) mean values of the ratio of forced expiratory volume in 1 s to forced vital capacity were significantly lower for heavy than for light drinkers, the difference disappeared when adjustment was made for numerous confounding factors (including such recognized risk factors for pulmonary disease as cigarette smoking, low socioeconomic status, male sex, and age). There was also no evidence of an association between consumption of alcohol and airway restriction. Although these findings do not rule out a possible effect of alcohol on pulmonary disease, its impact, if any, is probably the result of interaction with other factors associated with alcoholism, if not derived primarily from those other factors.

Adult↗

PubMed1979

Role of single-breath carbon monoxide-diffusing capacity in monitoring the pulmonary effects of bleomycin in germ cell tumor patients.

Serial pulmonary function tests including single-breath carbon monoxide-diffusing capacity (DLCO), forced vital capacity (FVC), and forced expiratory volume in 1 sec were performed in a relatively homogeneous group of male patients with germ cell tumors treated with vinblastine, bleomycin, and cis-diamminedichloroplatinum. Of the pulmonary function tests used, the DLCO was shown to be the most sensitive indicator of subclinical bleomycin pulmonary effects. Decreases in DLCO were both total dose and schedule dependent. Patients receiving their total dose of bleomycin at a rate of 25 +/- 2 (S.D.) units/week developed a linear decrease in DLCO with increasing total doses of bleomycin. Changes in FVC did not correlate with bleomycin total dose. Although both the mean DLCO and FVC decreased after completion of bleomycin therapy, the mean FVC returned to base-line levels rapidly, whereas the decrease in mean DLCO was persistent for several months. When routine volumetric tests (FVC and forced expiratory volume in 1 sec) and DLCO are used in a systematic manner, DLCO is the most sensitive indicator of the subclinical pulmonary effects of bleomycin in germ cell tumor patients treated with vinblastine, bleomycin, and cis-diamminedichloroplatinum.

Adult↗

PubMed2006

Clinical and electrophysiological predictors of respiratory failure in Guillain-Barré syndrome: a prospective study.

BACKGROUND: Respiratory failure is the most serious short-term complication of Guillain-Barré syndrome and can require invasive mechanical ventilation in 20-30% of patients. We sought to identify clinical and electrophysiological predictors of respiratory failure in the disease. METHODS: We prospectively assessed electrophysiological data and clinical factors, including identified predictors of delay between disease onset and admission, inability to lift head, and vital capacity, in patients admitted with Guillain-Barré syndrome. We related these factors to subsequent need for ventilatory support. Neurophysiological findings were classified as demyelinating, axonal, equivocal, unexcitable, or normal. Predictive values of clinical and electrophysiological data were tested using classification trees to build up a predictive model. This model was initially built up in a two-third (fitting set) then validated in a one-third (validation set) of the total sample. The fitting and validation sets were randomly selected. We also assessed the predictive value of this model for disability at 6 months. FINDINGS: From 1998, to 2006, 154 patients with Guillain-Barré syndrome were included in the study and 34 (22%) were subsequently ventilated. Demyelinating Guillain-Barré syndrome was more common in patients who went on to be ventilated than in those who were not (85%vs 51%, p=0.0003). Vital capacity and the proximal/distal compound muscular amplitude potential (p/dCMAP) ratio of the common peroneal nerve were retained in the tree model, with a probability of needing ventilation of less than 2.5% in patients with a ratio of greater than 55.6% and a vital capacity more than 81% of predicted. A p/dCMAP ratio of the peroneal nerve less than 55.6% and age older than 40 years were retained as independent predictors of disability at 6 months. INTERPRETATION: Neurophysiological testing is helpful for assessing risk of respiratory failure, which is highest in patients with evidence of demyelination and very low in those without both 55.6% conduction block of the common peroneal nerve and a 20% reduction in vital capacity.

Action Potentials↗

PubMed1992

Postoperative pulmonary function abnormalities after coronary artery bypass surgery.

In 18 patients, postoperative effects of coronary bypass surgery were evaluated. Pulmonary function studies were conducted preoperatively, and 1 and 6 weeks postoperatively, by means of spirometry, respiratory pressures, body plethysmography and impedance measurement of the respiratory system using the forced oscillation technique. One week postoperatively, total lung capacity (P less than 0.0001), inspiratory vital capacity (P less than 0.0001) forced expiratory volume (P less than 0.0001) and functional residual capacity (P less than 0.01) decreased significantly, while residual volume remained unchanged. This restrictive respiratory impairment was accompanied by significant decreases in inspiratory (P less than 0.0001) and expiratory (P less than 0.01) mouth pressures and significant decreases in respiratory resistance values (P less than 0.01). Six weeks postoperatively, significant differences in total lung capacity (P less than 0.0001), inspiratory vital capacity (P less than 0.0001) and forced expiratory volume (P less than 0.0001) persisted, while respiratory pressures returned to the preoperative values. It is concluded that respiratory muscle weakness contributes to the immediate postoperative restrictive lung function loss. Furthermore, structural alterations of chest wall mechanics have to be supposed for the persisting late restrictive pulmonary impairment.

Adult↗

PubMed1993

Long-term functional results after bilateral lung transplantation. Bordeaux Lung and Heart-Lung Transplant Group.

Between February 1988 and January 1992, 61 patients have undergone bilateral lung transplantations (42 heart-lung and 19 double-lung) in Bordeaux. The underlying diseases were primary or secondary hypertension (20), emphysema (22), or other diseases including cystic fibrosis, pulmonary fibrosis, silicosis, and sarcoidosis (19). Actuarial survival for double-lung and heart-lung transplant recipients was 66% and 72% at 1 year and 57% and 53% at 3 years, respectively. Forty-two patients were still alive 6 months after operation, and we studied their pulmonary function at the short and long term. All parameters except arterial carbon dioxide tension had improved dramatically at 6 months (p < 0.0001). Vital capacity, forced expiratory volume in 1 second, and forced expiratory flow rate between 25% and 75% of vital capacity were at 79% +/- 3%, 92% +/- 5%, and 105% +/- 8% of the predicted values, respectively. Arterial oxygen tension was 88 +/- 3 mm Hg. Nine months after operation, a slight decrease in forced expiratory volume in 1 second and forced expiratory flow rate between 25% and 75% of vital capacity appeared but values remained more than 75% predicted. This was related to the occurrence of obliterative bronchiolitis in 6 patients (14%). At 9 months, flow rates and oxygen tension of these 6 patients were highly different from those of patients free of obliterative bronchiolitis (p < 0.0002 for flow rates and p < 0.01 for oxygen tension). Only 1 patient required retransplantation. The others are living an almost normal life. Our results are discussed in view of the published reports on single-lung transplantation. Short-term results of bilateral lung transplantation are thus excellent and maintained on a long-term basis. Therefore, in our opinion, bilateral lung transplantation is the therapy of choice for pulmonary hypertension and emphysema.

Adult↗

PubMed1983

Respiratory functions in thermal burns.

In our present series, respiratory functions were observed in patients with a relatively small extent of burn compared to that commonly represented by the published works, and for a considerable duration of time (three weeks), commencing soon after the burn trauma. Respiratory rate increased in the post burn trauma and the peak expiratory rate was observed on the 8th post burn days and then it gradually fell but still remaining much higher than the control normal value. The minute volume and tidal volume also showed similar rise on the 8th post burn day and then gradually fell to below the mean level of 3rd post burn day before the 3rd post burn week. Forced vital capacity, forced expiratory volume in one second, forced expiratory volume in three seconds, forced expiratory volume in one second as a percentage of forced vital capacity, forced expiratory volume in three seconds, as a percentage of forced vital capacity and peak expiratory flow rates, did not vary much and indicated no significant respiratory abnormality.

Burns↗

PubMed1995

Evaluation of deformities and pulmonary function in adolescent idiopathic right thoracic scoliosis.

Seventy patients with adolescent idiopathic right thoracic scoliosis had full assessment of their pulmonary function using a computerised pulmonary function system. Their mean age at evaluation was 13.8 years. The following measurements were obtained from anteroposterior and lateral standing and antero-posterior supine bending radiographs: lateral curvature, vertebral rotation, kyphosis, maximum sterno-vertebral distance and apical rib-vertebral angles. Using the above measurements, the flexibility of curve, vertebral rotation and rib-vertebral angle asymmetry were calculated. Patients were classified into three groups on the basis of their predicted vital capacity, to determine whether radiological features of deformity can help identify patients with compromised pulmonary function. The mean Cobb angle and vertebral rotation for the 70 patients were 50 degrees (range 35-100 degrees) and 22 degrees (range 1-44 degrees) respectively. The mean flexibility of curve and vertebral rotation were 52% and 49% respectively. Mean thoracic kyphosis was 25 degrees, ranging from -7 to 55 degrees. Of the patients with Cobb angle less than 90 degrees, 71% had vital capacity less than 80% of predicted values, and of these, 18% had marked compromise of vital capacity (less than 60% of predicted values). Mean values of Cobb angle, vertebral rotational flexibility, kyphosis, rib-vertebral angle asymmetry (in standing as well as supine bending radiographs) differed significantly between patients with more than 80% of predicted vital capacity and those with 60% or less of predicted values. Radiological features indicative of better pulmonary function were: rotational flexibility exceeding 55%, rib-vertebral angle asymmetry (standing) less than 25 degrees and kyphosis greater than 15 degrees. Two deformity parameters--that give a better prediction of pulmonary function than the widely used Cobb angle, vertebral rotational flexibility and rib-vertebral angle asymmetry--were identified in this study.

Adolescent↗

PubMed1996

Bilateral cervical plexus block for thyroidectomy and parathyroidectomy in healthy and high risk patients.

We evaluated the benefits of bilateral deep cervical plexus block regional anesthesia in healthy and high risk patients undergoing thyroid and parathyroid surgery and assessed its effects on respiratory function. Twenty-one patients undergoing thyroid and parathyroid operations were studied. Bilateral superficial and deep plexus blocks were performed in all patients except one (who received only superficial plexus block because of a slightly prolonged prothrombin time) with 0.375-0.5% bupivacaine with 1:200,000 epinephrine. Intraoperatively, supplemental intravenous sedatives/narcotics were titrated to achieve patient comfort and cooperation. To allay anxiety, patients were allowed to listen to music via headphones intraoperatively. Forced vital capacity was measured before block, 10 minutes after the block and in the recovery room in half the patients. Eighteen patients tolerated the procedure well with supplemental sedation. Two patients required supplemental inhalation anesthesia via mask and one required tracheal intubation because of coughing prior to surgery. Three high risk patients tolerated the procedure well requiring only intraarterial line monitoring. Postoperatively, 11 patients had minimal incisional pain, 13 patients had mild pain on swallowing and 2 patients complained of nausea. There were no significant differences in the baseline forced vital capacity vs. forced vital capacity measured after the block and in the recovery room. This study indicates that regional anesthesia is an appropriate alternative to general anesthesia in selected patients undergoing thyroid and parathyroid surgery and did not compromise respiratory function.

Adult↗

PubMed2001

A two-year randomized, placebo-controlled trial of dornase alfa in young patients with cystic fibrosis with mild lung function abnormalities.

OBJECTIVE: Our objective was to determine whether long-term treatment of young patients with cystic fibrosis (CF) with dornase alfa maintains lung function and reduces respiratory tract exacerbations. STUDY DESIGN: This was a 96-week, randomized, double-blind, placebo-controlled trial involving 49 CF centers. Inclusion criteria were age 6 to 10 years and forced vital capacity > or = 85% predicted. Patients were excluded for hospitalization for complications of CF within 2 months and use of dornase alfa within 6 months. Patients were treated with dornase alfa 2.5 mg or placebo once daily with a jet nebulizer and a compressor. RESULTS: Patients were randomized, 239 to dornase alfa and 235 to placebo. At baseline the mean age was 8.4 years, the mean forced expiratory volume in 1 second 95% predicted, the mean forced expiratory flow, midexpiratory phase 85% predicted, and the mean forced vital capacity 102% predicted. At 96 weeks the treatment benefit for dornase alfa compared with placebo in percent predicted (mean +/- SE) was 3.2 +/- 1.2 for forced expiratory volume in 1 second (P =.006), 7.9 +/- 2.3 for forced expiratory flow between 25% and 75% of vital capacity (P =.0008), and 0.7 +/- 1.0 for forced vital capacity (P =.51). The risk of respiratory tract exacerbation was reduced by 34% in patients who received dornase alfa (relative risk 0.66, P =.048). There was no statistically significant difference between the groups in changes in weight-for-age percentile. Adverse event profiles for the treatment groups were similar. CONCLUSIONS: Treatment of young patients with CF with dornase alfa maintains lung function and reduces the risk of exacerbations over a 96-week period.

Age Factors↗

PubMed1987

Flow-volume loop changes reflecting respiratory muscle weakness in chronic neuromuscular disorders.

In order to identify the changes in pulmonary function and in the flow-volume loop due to respiratory muscle weakness, two groups of 10 nonsmokers with stable, chronic neuromuscular disease but without respiratory symptoms were studied: one without (Group 1) and one with (Group 2) respiratory muscle weakness as assessed by measurement of maximal static inspiratory and expiratory pressures. In Group 1, pulmonary function was normal except for increased ratio of one-second forced expiratory volume to forced vital capacity and forced expiratory flow at 25 to 75 percent forced vital capacity, which may reflect increased elastic lung recoil. Group 2 had mild volume restriction, appropriate for the degree of respiratory muscle weakness, and reduced inspiratory and expiratory flow rates. Pulmonary function was significantly more disturbed in Group 2 than in Group 1, and correlated well with maximal static inspiratory and expiratory pressures. Analysis of the flow-volume loop configuration revealed that four parameters describing effort-dependent portions were significantly related to maximal static inspiratory pressure and maximal static expiratory pressure. These parameters were peak expiratory flow, the slope of the ascending limb of the maximal expiratory curve, a drop of forced expiratory flow near residual volume, and forced inspiratory flow at 50 percent of vital capacity. A flow-volume loop score obtained from these four parameters was significantly higher in Group 2 than in Group 1 (2.8 +/- 1.03 versus 1.1 +/- 1.37; p less than 0.01). A flow-volume loop score of 2 or more had 80 percent specificity and 90 percent sensitivity in predicting respiratory muscle weakness in these patients with chronic neuromuscular disease. These data suggest that sensitive assessment of the flow-volume loop configuration as part of routine pulmonary function testing may help to suspect and identify respiratory muscle weakness.

Chronic Disease↗

PubMed1986

Effects of posture and spinal bracing on respiratory function in neuromuscular disease.

Effects of posture and spinal bracing on lung function were studied in 40 children with neuromuscular disease, 20 of whom had scoliosis and were non-ambulant. Change from sitting to supine position had little effect on lung function in ambulant children, but caused a significant 12% reduction in forced vital capacity in a group of 16 non-ambulant children with scoliosis, suggesting diaphragmatic weakness in some. Spinal bracing, using a rigid supporting jacket, resulted in a significant reduction in mean vital capacity of 22%. The degree of impairment in forced vital capacity was proportional to the severity of the scoliosis (as measured by the Cobb's angle), to the amount of correction achieved by the brace, and to the degree of diaphragmatic weakness. Spinal bracing in a child with established severe scoliosis causes appreciable respiratory impairment, and this may explain why it is less likely to be tolerated than early prophylactic bracing.

Braces↗

PubMed1986

The effect of bucindolol on the airway function of asthmatics.

The airway and cardiovascular effects of separate single oral doses of 50, 100 and 200 mg of bucindolol were compared to those of placebo in a double-blind trial in 16 patients with mild to moderately severe asthma. Heart rate (HR), blood pressure (BP), forced vital capacity (FVC), forced expired volume in one second (FEV1), maximum expiratory flow at 50% of vital capacity (FEF50) and maximum expiratory flow at 75% of expired vital capacity (FEF75) were measured before and at intervals for 4h, when salbutamol (200 micrograms) was inhaled and the measurements repeated 15 min later. There was an interval of at least 4 days between each drug treatment day. Four of the 16 patients developed clinically significant bronchoconstriction with 50 mg (3) or 100 mg (1) of bucindolol and were withdrawn from the study. The remaining patients showed impaired bronchodilator response to salbutamol for each bucindolol dose as compared to placebo. No significant BP or HR effects were measured. Two patients withdrew because of circumstances unrelated to bucindolol induced bronchoconstriction. The development of bucindolol induced bronchoconstriction in this group of mild to moderate asthmatics was not predicted by the level of baseline pulmonary function, or the level of histamine responsiveness. However, there was a weak relationship between bucindolol induced bronchoconstriction and salbutamol induced bronchodilation. There are no definitive asthmatic characteristic to predict the likelihood of significant bucindolol induced bronchoconstriction in this asthmatic population.

Adult↗

PubMed1976

Pulmonary function evaluation during the Skylab and Apollo-Soyuz missions.

Previous experience during Apollo postflight exercise testing indicated no major changes in pulmonary function. Pulmonary function has been studied in detail following exposure to hypoxic and hyperoxic normal gravity environments, but no previous study has reported on men exposed to an environment that was both normoxic at 258 torr total pressure and at null gravity as encountered in Skylab. Forced vital capacity (FVC) was measured during the preflight and postflight periods of the Skylab 2 mission. Inflight measurements of vital capacity (VC) were obtained during the last 2 weeks of the second manned mission (Skylab 3). More detailed pulmonary function screening was accomplished during the Skylab 4 mission. The primary measurements made during Skylab 4 testing included residual volume determination (RV), closing volume (CV), VC, FVC and its derivatives. In addition, VC was measured in flight at regular intervals during the Skylab 4 mission. Vital capacity was decreased slightly (-10%) in flight in all Skylab 4 crewmen. No major preflight-to-postflight changes were observed. The Apollo-Soyuz Test Project (ASTP) crewmen were studied using equipment and procedures similar to those employed during Skylab 4. Postflight evaluation of the ASTP crewmen was complicated by their inadvertent exposure to nitrogen tetroxide gas fumes upon reentry.

Aerospace Medicine↗