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PubMed1999

Subjective symptoms and prognosis after lung volume reduction surgery in patients with severe pulmonary emphysema.

Lung volume reduction surgery improves symptoms in patients with severe pulmonary emphysema, but patients are not always satisfied surgical results. Our purpose was to determine the profiles and prognosis of unsatisfactory cases of lung volume reduction surgery. A total of 58 patients with advanced symptomatic emphysema underwent thoracoscopic volume reduction of emphysematous lung tissue. Patients subjectively evaluated their condition 3 months after surgery as "better," "same," or "worse" than before surgery. Of these, 30 evaluated themselves as "better" (58%), 17 as the "same" (33%), and 4 (8%) as "Worse." Most patients with vital capacity (VC) exceeding 2,000 mL (percentage of vital capacity for the predicted value (%VC) of > 60%) with upper-lobe-predominant and centrilobular emphysema were satisfied with surgical results. All patients with lower-lobe-predominant or whole-lung panacinar emphysema evaluated their results as "worse." Six late deaths occurred due to pulmonary infection (3), respiratory failure (2), and an unknown sudden cause (1), with most of these patients having preoperative low VC and high postoperative partial carbon dioxide pressure in the arterial blood (PaCO2).

Aged↗

PubMed2003

Effect of forced deflation maneuvers upon measurements of respiratory mechanics in ventilated infants.

OBJECTIVE: To determine the effect of forced deflation maneuvers on respiratory mechanics and to assess the reproducibility of such measurements in intubated infants with lung disease. DESIGN AND SETTING: Prospective study in the pediatric intensive care unit of a university children's hospital. PATIENTS: Ten clinically stable infants requiring mechanically assisted ventilation for acute pulmonary disease, mean age 5.9 months (1-18), mean weight 5.8 kg (3.2-13). INTERVENTIONS: Two sets of measurements of compliance (Crs) and resistance (Rrs) were obtained at 20-min intervals both before and after +40/-40 cmH(2)O forced deflation maneuvers. Forced deflation measurements were repeated at the end of the study. RESULTS: . Forced deflation caused a significant increase in Crs from 0.53+/-0.09 and 0.58+/-0.11 ml/cmH(2)O/kg to 0.71+/-0.11 and 0.68+/-0.11 ml/cmH(2)O/kg. Rrs measurements did not differ. The low coefficients of variation for repeated measures of the baseline measurements (Crs 4.2+/-0.5%, Rrs 7.1+/-0.8%, for forced vital capacity 8.6+/-2.5%, maximum expiratory flows at 25% vital capacity 16.0%+/-3.3%) confirmed the good reproducibility during stable conditions. CONCLUSIONS: Inflation and deflation maneuvers affect subsequent measurements of respiratory system compliance but not measurements of maximum expiratory flow-volume relationships in intubated infants, probably through recruitment of lung volume. Careful interpretation and planning of the sequence of infant pulmonary function testing is necessary to reassure that changes are not related to short-term alterations in volume history.

Airway Resistance↗

PubMed1980

Evaluating commercially available spirometers.

This study was designed to: (1) determine the performance characteristics of available spirometers; (2) assess the practically and applicability of the American Thoracic Society's (ATS) Snowbird Workshop recommendations on Standardization of Spirometry; and (3) determine whether spirometer testing could be done with room air. Nineteen spirometers were tested with 16 different forced vital capacity waveforms. Fourteen spirometers met the ATS forced vital capacity requirements. Three of these 14 spirometers had difficulties in determining the end of expiration. Fourteen of the devices tested met the requirements for forced expiratory volume in one second. Ten of 13 devices tested for maximal voluntary ventilation were satisfactory. The standards recommended by ATS were believed to be applicable and practical. The testing methods recommended by ATS need to be expanded to include more patient waveforms. Testing with room air is easier and simpler and, for most devices, just as effective as heated and humidified air. We conclude that most available spirometers can faithfully record forced spirograms and that if a spirometer meets the ATS requirements, it makes no difference on which device the spirogram is recorded.

Evaluation Studies as Topic↗

PubMed1991

The effects of varying inflation and deflation pressures on the maximal expiratory deflation flow-volume relationship in anesthetized rhesus monkeys.

Deflation flow-volume curve analysis is a pulmonary function test sensitive to small airways dysfunction that is suitable for use in infants and children who are intubated. This test relies upon deflation flow-volume (DFV) curve analysis, which is a technique to obtain maximal expiratory flow-volume curves (MEFV) by forced deflation of the lungs in infants who are intubated. The method mimics the voluntary forced flow-volume curves that adults and older children undertake. We studied 10 anesthetized male Rhesus monkeys of the same weight as human infants but developmentally equivalent to older children. We reviewed the effects on forced deflation vital capacity (DVC) and flows at various subdivisions of vital capacity (PEF, MEF50, MEF25, MEF10) of systematically varying the required inspiratory and deflation pressure during the course of 56 consecutive deflation maneuvers. Inflation pressures of +40 and +50 cm H2O caused a marked but transient bradycardia along with a (probably spurious) short-lasting fall to 89% mean arterial oxygen saturation (SaO2). Increasing positive and negative pressures increased DVC and expiratory flows. The highest mean DVC was 75.6 +/- 1.3 ml/kg, PEF was 128.0 +/- 3.5, MEF50 was 85.9 +/- 2.2, MEF25 was 74.3 +/- 1.9, and MEF10 was 38.5 +/- 2.9 ml/kg/s, all obtained at the pressure gradient of 90 cm H2O (+50/-40 cm H2O) at the start of the deflation maneuver. At this gradient, the intraindividual coefficients of variation were: DVC = 0.8%, PEF = 3.1%, MEF50 = 2.2%, MEF25 = 2.1%, MEF10 = 5.4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1991

Longitudinal analysis of lung function growth in healthy children and adolescents.

Lung function and height in 242 8-yr-old and 299 12-yr-old children without known or suspected predisposition to lung disease were measured annually over 6 and 8 yr, respectively. Growth of forced expiratory volume in 1 s (FEV1), vital capacity, and expiratory flow after expiring 50% of vital capacity were statistically modeled by age and height by use of a multivariate normal model for longitudinal data. This method has the flexibility to fit an appropriate (not necessarily linear) mathematical description of average lung function while concurrently modeling the covariance between measures on the same individual. Differences in lung function growth between girls and boys, pre- and post-puberty, showed that girls had a steadier though less pronounced increase in lung function with height. In boys, before puberty there was deficit in lung volume relative to height (not evident in girls), which was compensated for by rapid growth after puberty. The standard error of FEV1 predictions based on current height and age were more than halved when measurements of FEV1, age, and height taken 1 yr before were incorporated. We found evidence for dysanaptic growth in childhood. Fitted models have application to early detection of departures from healthy lung function.

Adolescent↗

PubMed1986

Body weight and coronary disease risk: patterns of risk factor change associated with long-term weight change. The Normative Aging Study.

Previous studies have suggested that excess body weight increases coronary disease risk by modification of the levels of other risk factors and in addition may contribute to overall risk independently. Few studies, however, have systematically characterized long-term change in risk factors with specific changes in overall weight while they have controlled for the effects of multiple potential confounders. Also, very little information is available on the differential impact of weight change on risk factor changes with advancing age. The present investigation used 15 years of longitudinal data collected on 1,396 men participating in the Veterans Administration Normative Aging Study in Boston, Massachusetts. Multiple regression analysis was used to predict change in each of eight putative coronary disease risk factors from change in weight and the interaction between weight change and age. These included blood pressure, serum cholesterol, triglycerides, fasting and two-hour postprandial blood glucose, uric acid, and forced vital capacity of the lungs. After controlling for initial levels of the risk factor, weight, age, and smoking status, change in weight remained a significant predictor of long-term change in each of the risk factors studied. In addition, the interaction between weight change and age was significant for fasting glucose, uric acid, and forced vital capacity, indicating that the effect of weight gain on uric acid and forced vital capacity was greater in younger men whereas the effect of weight gain on fasting glucose was greater in older men.

Adult↗

PubMed1988

Effect of normobaric hyperoxia on airways of normal subjects.

Airway responsiveness to inhaled cholinergic agonist during the early stage of pulmonary O2 toxicity was examined to determine whether normobaric hyperoxia alters airway function. Eight healthy nonsmoking males with moderate base-line methacholine responsiveness breathed normobaric O2 (greater than or equal to 95%) over 12 h and on another occasion breathed air in an identical protocol. Vital capacity, expiratory flow, airway responsiveness to methacholine, and respiratory symptoms were measured at 0, 4, 8, and 12 h while subjects breathed O2 and 12 h afterwards. After 12 h, forced vital capacity was significantly decreased with O2 breathing but not with air breathing. At 4, 8, or 12 h of exposure and 12 h after exposure, there was no difference in methacholine sensitivity or reactivity between O2 and air-exposure trials. The earliest manifestations of pulmonary normobaric O2 toxicity in normal adults include diminished vital capacity and the onset of respiratory symptoms, but early O2 toxicity does not produce altered responsiveness to inhaled methacholine.

Adult↗

PubMed1985

Contribution of the rib cage to breathing in tetraplegia.

In tetraplegia there is often paradoxical inward motion of the rib cage during inspiration. The volume of this negative contribution is difficult to estimate but can be obtained by optical mapping. The partitioning of ventilation between the rib cage and abdomen in six normal subjects, 10 stable tetraplegic patients, and one tetraplegic patient at intervals during rehabilitation has been studied by this technique. In normal subjects the tidal volume and the vital capacity were the sum of positive contributions from the rib cage and abdomen. In stable tetraplegic subjects with similar neurological levels, the rib cage contribution varied widely but the total chest wall displacement could not be predicted from the vital capacity. In the patient studied sequentially rib cage paradox reversed with time after injury, and this was associated with an absolute increase in vital capacity and an improvement in the action of the diaphragm.

Adolescent↗

PubMed1997

Predicting respiratory failure in sarcoidosis patients.

BACKGROUND AND AIM OF WORK: Although sarcoidosis is a multisystem disease, mortality from sarcoidosis is usually due to respiratory failure. In order to identify those patients at risk of death from respiratory failure from sarcoidosis, we analyzed a seven-year experience of patients seen at the University of Cincinnati Interstitial Lung Disease clinic. RESULTS: A total of 479 patients were seen during that time. Of these, 22 (4.6%) died. Thirteen patients died from respiratory failure, three died from cardiac disease, and two each from neurologic or hepatic disease. Two patients died from unrelated disease. Analysis of the patients who died from respiratory failure was compared to the other patients. All patients who died from respiratory failure had fibrotic changes demonstrated by chest roentgenogram. All patients who died had at least one vital capacity less than 2.5 liters, with the majority of patients who died of respiratory failure having a vital capacity of less than 1.5 liters. CONCLUSIONS: Patients who die from respiratory failure from their sarcoidosis have fibrosis demonstrated on chest roentgenogram and a reduced vital capacity, usually less than 1.5 liters.

Adult↗

PubMed1998

Postoperative respiratory function in children after abdominal surgery. A comparison of epidural and intramuscular morphine analgesia.

Thirty children undergoing urological and abdominal surgery were entered into a randomised trial comparing the effects of epidural and intramuscular morphine on postoperative respiratory function. The forced vital capacity and the forced expired volume in 1 s were measured before and 6 h after surgery and on each of the following seven days. Significant decreases (p < 0.01) in forced vital capacity and forced expired volume in 1 s were seen after surgery. After the first postoperative day, a gradual recovery in pulmonary function was observed but the measured parameters had not returned to their pre-operative control values by the end of the study. There were no statistically significant differences between the two groups during the study with respect to forced vital capacity and forced expired volume in 1 s. The quality of analgesia was better in the epidural morphine group than in the intramuscular morphine group. The incomplete recovery of pulmonary function suggests that pain is not the only cause of postoperative respiratory changes in these patients.

Abdomen↗

PubMed1988

Lung volume changes in children and adults during speech production.

This study examined whether the behavior of the respiratory system during speech production differed between adults and children as a function of articulatory and intensity factors. Changes in the mean cross-sectional area of the rib cage and abdomen were measured and percent vital capacity calculated using respiratory inductive plethysmography. Statistical analysis revealed a number of significant differences between the results for children and adults: (a) At the loud intensity level, the adults used a larger percent of their vital capacity than did the children; (b) Adults went further into their functional residual capacity (FRC) at the loud intensity level than at the comfortable level, whereas the children did not; and (c) At the loud intensity level, children used a greater percent of their vital capacity (VC) while reading a passage containing consonants requiring high lung volume increments than while reading a passage requiring low lung volume increments; the adults did not show this effect. These findings suggest that respiration in children is influenced primarily by articulatory demands and secondarily by intensity demands. Whereas, adult respiration responds primarily to the maintenance of vocal intensity level. Finally, the so-called "lung volume range for speech" used by the children was placed significantly lower in their overall VC range than was that of the adults. This result is coupled with the observation that children consistently encroached further into their FRC than did the adults across all conditions, although the effect reached significance only at the loud intensity level while the children read the high-volume passage.

Adult↗

PubMed2006

A phase II/III clinical study of enzyme replacement therapy with idursulfase in mucopolysaccharidosis II (Hunter syndrome).

PURPOSE: To evaluate the safety and efficacy of recombinant human iduronate-2-sulfatase (idursulfase) in the treatment of mucopolysaccharidosis II. METHODS: Ninety-six mucopolysaccharidosis II patients between 5 and 31 years of age were enrolled in a double-blind, placebo-controlled trial. Patients were randomized to placebo infusions, weekly idursulfase (0.5 mg/kg) infusions or every-other-week infusions of idursulfase (0.5 mg/kg). Efficacy was evaluated using a composite endpoint consisting of distance walked in 6 minutes and the percentage of predicted forced vital capacity based on the sum of the ranks of change from baseline. RESULTS: Patients in the weekly and every-other-week idursulfase groups exhibited significant improvement in the composite endpoint compared to placebo (P = 0.0049 for weekly and P = 0.0416 for every-other-week) after one year. The weekly dosing group experienced a 37-m increase in the 6-minute-walk distance (P = 0.013), a 2.7% increase in percentage of predicted forced vital capacity (P = 0.065), and a 160 mL increase in absolute forced vital capacity (P = 0.001) compared to placebo group at 53 weeks. Idursulfase was generally well tolerated, but infusion reactions did occur. Idursulfase antibodies were detected in 46.9% of patients during the study. CONCLUSION: This study supports the use of weekly infusions of idursulfase in the treatment of mucopolysaccharidosis II.

Adolescent↗

PubMed1976

The effect of acute, intensive cigarette smoking on maximal expiratory flows and the single-breath nitrogen washout trace.

The effect of acute, intensive cigarette smoking on forced vital capacity and the single-breath expired N2 trace was studied in 82 smokers. There were significant decreases in the "effort-dependent" tests, such as peak flow and 1-sec forced expiratory volume, but no change in the more "effort-independent" tests, such as maximal mid-expiratory flow and maximal expiratory flow at 25 per cent of the vital capacity. Closing volume was unchanged in absolute terms and as a percentage of vital capacity. Closing capacity was unchanged in absolute terms and as a percentage of total lung capacity, but there was a significant increase in the slope of Phase III of the N2 washout curve after the acute smoking session. The tests of function that changed significantly after acute, intensive smoking were the ones that improved in 52 subjects who modified their smoking habits. The data suggest that acute, intensive cigarette smoking may be associated with an increase in resistance to air flow in the larger airways or a reduction in effort, and with increased nonuniformity of intraregional distribution of ventilation.

Adult↗

PubMed1976

Follow-up evaluation of a prevalence study for chronic bronchitis and chronic airway obstruction.

Follow-up of the prevalence study of respiratory symptoms and chronic airway obstruction was performed after a 6- to 7-year interval. One hundred fifteen of 117 subjects (98%) originally labeled "abnormal" (chronic bronchitis or asthma by history, or ratio of 1-sec forced expiratory volume to forced vital capacity less than 60 per cent), and 111 of a random sample of 116 subjects (96%) originally labeled "normal" were traced. Nineteen patients were dead, 14 "abnormal" subjects, and 5 "normal" subjects (P less than 0.01). Eighty-eight of the originally labeled "abnormal" subjects and 91 of the random "normal" sample could be retested by spirometry. Subjects with lower initial ratios of 1-sec forced expiratory volume to forced vital capacity tended to lose more 1-sec forced expiratory volume and forced vital capacity. Early identification of respiratory symptoms and spirometric abnormalities may identify persons at increased risk of death who could benefit from appropriate therapy.

Adult↗

PubMed1996

Decreased ventilatory function in hard metal workers.

OBJECTIVES: To study individual effects on pulmonary function of exposure to hard metal including cobalt. METHODS: All of the workers in a hard metal company (583 men and 120 women) were examined for smoking, respiratory symptoms, ventilatory function, occupational history of exposure to hard metal, and present exposure to airborne cobalt. The ventilatory function indices (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume in one second per cent (FEV1%), peak expiratory flow (PEF), mid-maximal flow (MMF), forced expiratory flow at 50% vital capacity (V50), forced expiratory flow at 25% vital capacity (V25)) were standardised for height and age and expressed as a percentage of predicted values. RESULTS: Two way analysis of variance of indices of ventilatory function showed that an interaction of hard metal exposure and smoking decreased %V50 for both men and women. Among the currently exposed men, those with asthmatic symptoms (defined as reversible dispnoea with wheeze) had significantly lower %FVC, %FEV1%, %PEF, %MMF, %V50, and %V25 than did workers without asthma. The ventilatory disfunction did not differ between exposed and non-exposed workers with asthmatic symptoms. Even among the men without asthmatic symptoms, %V50 was significantly lowered by the interaction of hard metal exposure and smoking. The multilinear regression analysis of indices of ventilatory function for all of the subjects on sex, smoking (Brinkman index), exposure to hard metal, and asthmatic symptoms showed that asthmatic symptoms and smoking had significant effects on all variables and that the decrease in %V25 was associated with hard metal exposure. In the currently exposed and non-exposed workers, multilinear regression analysis applying indices for cobalt exposure (mean cobalt concentration, duration of exposure, and cumulative dose) showed that not only asthmatic symptoms or smoking but also duration of exposure had significant decreasing effects on %FVC, %MMF, and %V25. CONCLUSIONS: Occupational exposure to hard metal probably causes impairment of ventilatory function in a dose dependent manner.

Adolescent↗

PubMed2006

Obstructive and restrictive spirometric patterns: fixed cut-offs for FEV1/FEV6 and FEV6.

The purpose of this study was to determine fixed cut-off points for forced expiratory volume in one second (FEV(1))/FEV(6) and FEV(6) as an alternative for FEV(1)/forced vital capacity (FVC) and FVC in the detection of obstructive and restrictive spirometric patterns, respectively. For the study, a total of 11,676 spirometric examinations, which took place on Caucasian subjects aged between 20-80 yrs, were analysed. Receiver-operator characteristic curves were used to determine the FEV(1)/FEV(6) ratio and FEV(6) value that corresponded to the optimal combination of sensitivity and specificity, compared with the commonly used fixed cut-off term for FEV(1)/FVC and FVC. The data from the current study indicate that FEV(1)/ FEV(6) <73% and FEV(6) <82% predicted can be used as a valid alternative for the FEV(1)/FVC <70% and FVC <80% pred cut-off points for the detection of obstruction and restriction, respectively. The statistical analysis demonstrated very good, overall, agreement between the two categorisation schemes. For the spirometric diagnosis of airway obstruction (prevalence of 45.9%), FEV(1)/FEV(6) sensitivity and specificity were 94.4 and 93.3%, respectively; the positive and negative predictive values were 92.2 and 95.2%, respectively. For the spirometric detection of a restrictive pattern (prevalence of 14.9%), FEV(6) sensitivity and specificity were 95.9 and 98.6%, respectively; the positive and negative predictive values were 92.2 and 99.3%, respectively. This study demonstrates that forced expiratory volume in one second/forced expiratory volume in six seconds <73% and forced expiratory volume in six seconds <82% predicted, can be used as valid alternatives to forced expiratory volume in one second/forced vital capacity <70% and forced vital capacity <80% predicted, as fixed cut-off terms for the detection of an obstructive or restrictive spirometric pattern in adults.

Adult↗

PubMed2001

Changes in spirometry over time as a prognostic marker in patients with Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) causes a progressive impairment of muscle function leading to hypercapnic respiratory failure. Most studies of respiratory function in DMD have been cross-sectional rather than longitudinal, and these data have not been related to survival. We retrospectively studied 58 patients with DMD with at least 2 yr of follow-up spirometry and known vital status. Spirometry was abnormal at entry: median FEV(1) 1.60 L (range 0.4 to 2.6 L), FVC 1.65 L (range 0.45 to 2.75 L), FVC 64% predicted (range 29 to 97%). Individual rates of change of vital capacity varied, with a median annual change of -0.18 L (range 0.04 to -0.74 L), -8.0% predicted FVC (range 2 to -39%). During the study 37 patients died; the median age of death, calculated by Kaplan-Meier analysis, was 21.5 yr (range 15 to 28.5 yr). The age when vital capacity fell below 1 L was a strong marker of subsequent mortality (5-yr survival 8%). The maximal vital capacity recorded and its rate of decline (however expressed) predicted survival time. Repeated spirometric measurement provides a simple and relatively powerful means of assessing disease progression in these patients and should be considered when planning treatment trials.

Adolescent↗

PubMed2007

Waist circumference is associated with pulmonary function in normal-weight, overweight, and obese subjects.

BACKGROUND: Obesity is becoming a serious public health issue and is related to lung dysfunction. Because both weight and height are indicators of body size, body mass index (BMI) may not be an ideal index of obesity in prediction of pulmonary dysfunction. OBJECTIVE: The objective of the study was to determine the predictability of waist circumference (WC) and BMI for pulmonary function in adults with and without excess body weight. DESIGN: A cross-sectional study of 1674 adults aged > or = 18 y was conducted in a rural community. Height, weight, WC, and pulmonary function were measured. Multivariate analysis was conducted. RESULTS: WC was negatively associated with forced vital capacity and forced expiratory volume in 1 s, and the associations were consistent across sex, age, and BMI categories. On average, a 1-cm increase in WC was associated with a 13-mL reduction in forced vital capacity and an 11-mL reduction in forced expiratory volume in 1 s. The association between WC and pulmonary function was consistent in subjects with normal weight, overweight, and obesity. In subjects with normal weight, BMI was positively associated with forced vital capacity and forced expiratory volume in 1 s. CONCLUSION: WC, but not BMI, is negatively and consistently associated with pulmonary function in normal-weight, overweight, and obese subjects.

Abdominal Fat↗