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PubMed2005

Inhaled mannitol for the treatment of mucociliary dysfunction in patients with bronchiectasis: effect on lung function, health status and sputum.

OBJECTIVE: Inhaled mannitol increases mucus clearance in patients with bronchiectasis by an unclear mechanism. The effect of mannitol on lung function, health status and sputum properties was investigated. METHODOLOGY: Nine patients with bronchiectasis inhaled 400 mg of mannitol once daily for 12 days. Health status was assessed using the St George's Respiratory Questionnaire (SGRQ). Sputum was analysed for viscosity, elasticity, spinnability, surface tension, contact angle, solids, mucociliary transportability (MCTR) on a frog palate, and cough transportability (CTR) on a simulated cough machine. RESULTS: Lung function was unchanged with treatment (baseline FEV1 82.0 +/- 16.2%) apart from an improvement in FEF from 85.4 +/- 13% (baseline) to 90.7 +/- 14.4% (P < 0.05; 12th treatment; visit 7). The total SGRQ score (mean +/- SD) of 49.3 +/- 13.8 at baseline, decreased by 12.4 +/- 10.2 (P < 0.01; visit 7) and 10.1 +/- 9.4 units (P < 0.02) 6-10 days after treatment cessation. The baseline subscores for symptoms (72.9 +/- 11.8), activity (44.7 +/- 20.9) and impact (44.4 +/- 14.3) were reduced by 0.8 +/- 9.1 (P > 0.7), 8.4 +/- 16.0 (P > 0.1) and 19.2 +/- 13.7 (P < 0.005) units, respectively (visit 7). Mannitol reduced the baseline (mean +/- SE) surface tension from 94.5 +/- 1.4 to 84.7 +/- 2.1 mN/m (P < 0.0001), contact angle from 51.1 +/- 2.8 to 33.2 +/- 2.4 degrees (P < 0.0001), spinnability from 11.6 +/- 0.4 to 10.0 +/- 0.2 mm (P < 0.005), and solids from 5.7 +/- 0.4 to 4.3 +/- 0.7% (P < 0.02), acutely (visit 7). Viscosity, elasticity and MCTR did not change significantly, while CTR was increased from 25.8 +/- 1.0 to 34.1 +/- 2.7 mm (P < 0.003). CONCLUSION: Mannitol significantly improved the health status over 12 days and this improvement was maintained for 6-10 days after cessation of treatment. In addition, mannitol reduced the tenacity, increased the hydration of mucus acutely and improved cough clearability in patients with bronchiectasis.

Administration, Inhalation↗

PubMed1998

Estimation of regional lung function in interstitial pulmonary disease using 99mTc-technegas and 99mTc-macroaggregated albumin single-photon emission tomography.

For quantitative evaluation of the regional lung function in patients with interstitial pulmonary disease (IP) in the sitting position, 99mTc-Technegas and 99mTc-macroaggregated albumin (MAA) single-photon emission tomography (SPET) studies were performed in 12 healthy controls (HC) and 42 IP patients. Four transverse images were prepared from the data obtained and designated as slices no. 1-4 from the top downward. Regions of interest (ROIs) were determined in the anterior and posterior parts of the lung in each slice, and the ratio of the count per voxel in the ROIs to the count in the entire lung was calculated as the regional Technegas index (T). The regional perfusion index (Q) was calculated by a similar procedure using the data of 99mTc-MAA SPET. The ratios between T and Q (T/Q) in the anterior and posterior regions of the lung, and the ratios of T and Q between the anterior and posterior regions of the lung (Tp/Ta and Qp/Qa) were examined. In the HC group, T/Q decreased but Tp/Ta and Qp/Qa increased from the upper to the lower lung fields. When IP patients were classified into (I) those in whom T/Q decreased from the upper to the lower lung fields, (II) those in whom it was similar in all slices, (III) those in whom it increased from slice 3 to slice 4, and (IV) those in whom it increased from slice 2 to slices 3 and 4, this classification was more closely correlated with %VC than with %DLCO or PaO2. When the patients were classified according to Tp/Ta and Qp/Qa into (A) those in whom the values were greater in the lower than the upper lung field, (B) those in whom the values were similar in all slices, and (C) those in whom the values were smaller in lower than in upper lung fields, categories B and C were observed frequently even in patients whose %VC was in the normal range. This method is considered to be an effective means to evaluate the progression and pathology of IP and to detect early impairment of lung function.

Adult↗

PubMed2001

A factor analysis of dyspnea indexes and lung function parameters in patients with chronic obstructive pulmonary disease.

The purpose of the present study was to investigate the correlation between dyspnea ratings and a large group of lung function parameters, and extract those factors that best reflect the functional profile of patients with COPD using factor analysis. Ninety nine patients with COPD in stable clinical condition (age 60 +/- 8 years, ATS score = 2.5 +/- 0.9, FEV1% pred. = 33 +/- 13%) were included in the study. The factor analysis of the results yielded 5 factors which accounted for 80.1% of the total variance of the changes. The highest coefficients found between the factors and the original group of variables after Varimax rotation are given in the following table: Factor 1: Oxygen-cost diagram: 0.92; ATS dyspnea score: -0.80; TL,CO/VA: 0.78; Factor 2: FEV1% pred.: 0.87; FEV1/VC%: 0.86; FEV1L: 0.79; Factor 3: MIF50% pred.: 0.85; FIV1% pred.: 0.76; PImax: 0.67; Factor 4: PaCO2: -0.81; SaO2: 0.77; Mean pulmonary arterial pressure: -0.67 Factor 5: Age: 0.88; Six minutes walk distance: -0.72 The factor analysis showed that the functional profile of COPD patients has several dimensions. Therefore, in order to have COPD comprehensively evaluated, assessment of dyspnea and the respective set of lung function parameters (exercise capacity, forced inspiration and pulmonary hemodynamics), should be included in the battery of tests, besides the conventional tests.

Dyspnea↗

PubMed1996

Mechanism of short-term improvement in lung function after emphysema resection.

We prospectively investigated the mechanism of airflow limitation before and after targeted emphysematous resection in 12 consecutively studied adult patients 68 +/- 4 yr of age (mean +/- SD) with very severe COPD undergoing bilateral thoracoscopic stapling techniques. Lung function, static lung elastic recoil, and airway conductance was measured 2 wk before and 5 to 6 mo after surgery. After surgery, there was a significant (p < 0.01) reduction in TLC (9.3 +/- 0.3 [mean +/- SEM] to 7.7 +/- 0.4 L), functional residual capacity, and residual volume. Airway conductance, FVC, and FEV1 (0.7 +/- 0.1 to 1.2 +/- 0.2 L) all improved significantly (p < 0.01). Lung elastic recoil increased markedly at TLC (from 10.3 +/- 0.5 to 14.6 +/- 1.0 cm H20; p < 0.001) as did maximal expiratory airflow in every patient. Analysis of maximal expiratory flow-static elastic recoil pressure curve indicated that conductance of the S segment (Gs) increased from 0.20 +/- 0.03 (mean +/- SEM) to 0.27 +/- 0.03 L/s/cm H20 (p < 0.01), and the critical transmural pressure (Ptm') decreased from 3.1 +/- 0.2 to 2.4 +/- 0.2 cm H20 (p < 0.02). Mean airway conductance increased from 0.14 to 0.22 L/s/cm H20 (p < 0.01). The improvement in maximal expiratory airflow can be primarily attributed to increased lung elastic recoil and its secondary effect on enlarging airway diameter causing increased airway conductance, increased Gs, and decreased Ptm'.

Aged↗

PubMed1988

Diminished lung function as a predisposing factor for wheezing respiratory illness in infants.

In a prospective study of 124 infants enrolled as newborns, we assessed the relation between initial lung function and the subsequent incidence of lower respiratory tract illness during the first year of life. The risk of having a wheezing illness was 3.7 times higher (95 percent confidence interval, 0.9 to 15.5; P = 0.06) among infants whose values for total respiratory conductance (the reciprocal of the resistance to air flow of the entire respiratory system) were in the lowest third, as compared with infants with values in the upper two thirds of the range of values for the group. Boys with initial values in the lowest third for an indirect index of airway conductance had a 10-fold increase (95 percent confidence interval, 2.2 to 44.2; P = 0.001) in the risk of having a wheezing illness. A 16-fold increase (95 percent confidence interval, 1.7 to 147.1; P = 0.002) in the risk of having a wheezing illness was found among girls whose initial values for lung volume at the end of tidal expiration were in the lowest third. We conclude that diminished lung function is a predisposing factor for the development of a first wheezing illness in infants.

Airway Resistance↗

PubMed2005

Lung function and blood levels of copper, selenium, vitamin C and vitamin E in the general population.

BACKGROUND: Increased dietary intake of antioxidants has been associated with higher lung function, but few studies have used biological markers of antioxidant intake. OBJECTIVE: This study aimed to determine if antioxidant status, as measured by blood levels, influences lung function. DESIGN: Using a random subsample of 479 participants, aged 18-65 y old, from a larger cross-sectional observational study, the association of forced expiratory volume in 1 s (FEV1) with plasma copper, vitamin C, vitamin E and serum selenium was assessed. RESULTS: An s.d. increase in blood copper level was associated with a difference in FEV1 of -48 ml (95% confidence intervals: -95, -2 ml, P = 0.04), vitamin C +49 ml (+4, +94, P = 0.03), vitamin E -15 ml (-62, +32, P = 0.53) and selenium +52 ml (+7, +96, P = 0.02). The sizes of association were not appreciably altered in a mutually adjusted model. CONCLUSIONS: Higher levels of serum vitamin C and selenium appear to be associated with higher FEV1. The association between higher serum copper and lower FEV1 requires further study in view of the ubiquitous exposure to this mineral.

Adult↗

PubMed2005

Smoking habit, respiratory symptoms and lung function in young adults.

BACKGROUND: Smoking is the primary cause of deterioration in forced expiratory volume (FEV(1)) and the development of chronic obstructive lung disease. This study assessed the independent association of smoking with respiratory symptoms and lung function in young adults who took part in the European Community Respiratory Health Survey (ECRHS-I). METHODS: Cross-sectional multi-centre survey of a general population of young adults aged 20(44 years in the ECRHS(I conducted in five Spanish centres. Several groups were created in an exclusive and descendent manner from the subjects who completed the questionnaire in accordance with how they had answered the questions: asthma-related symptoms; chronic bronchitis symptoms; minor respiratory symptoms; chronic cough; and no respiratory symptoms. Among a subset of the population, forced spirometry tests were performed. Linear and logistical regression models were used to assess the relationship of smoking in the presence of symptoms and its impact on lung function, adjusted by other important variables. RESULTS: The prevalence of respiratory symptoms was higher among smokers. After adjusting for geographical area, total IgE, age, sex, and FEV(1), smoking was associated with an increased risk of chronic bronchitis and other respiratory symptoms. These risks increased with increasing number of cigarettes smoked per day. A deterioration of FEV(1) and the FEV(1)/FVC ratio was also directly associated with the number of cigarettes smoked per day. CONCLUSION: Even among young adults, smoking confers a high risk of developing a number of respiratory symptoms and the deterioration of the ventilatory function.

Adult↗

PubMed2001

Ischemic pre-conditioning of 5 minutes but not of 10 minutes improves lung function after warm ischemia in a canine model.

BACKGROUND: Protection from reperfusion injury by ischemic pre-conditioning (IPC) before prolonged ischemia has been proven for the heart and the liver. We now assess the efficacy of IPC to protect lungs from reperfusion injury. METHODS: Eighteen foxhounds (25 to 30 kg) were anesthetized, intubated, and ventilated with a fraction of inspired oxygen of 0.3 at a volume-controlled mode to maintain arterial pCO2 of 30 to 40 mm Hg. After left thoracotomy, we performed warm ischemia for 3 hours by clamping the left hilus, and followed with 8 hours of reperfusion (control, n = 6). In the treated groups, IPC was performed either for 5 minutes followed by 15-minute reperfusion (n = 6, IPC-5), or by 2 successive cycles of 10-minute ischemia, followed by 10-minute reperfusion (n = 6, IPC-10) before prior to the 3-hours warm-ischemia period. Pulmonary compliance and gas exchange were determined separately for each lung, and we recorded pulmonary and systemic hemodynamics. We performed bronchoalveolar lavage (BAL) at the end of the experiment and determined total protein concentration as well as tumor necrosis factor alpha (TNF-alpha) mRNA expression in cell-free supernatant and in BAL cells, respectively. We also assessed the wet/dry ratio of the lung. RESULTS: In the controls, on reperfusion, we encountered a progressive deterioration of gas exchange, especially of the reperfused left lung, which we could largely avoid using the IPC-5 protocol. Similarly, pulmonary compliance steadily declined but was much better in the ICP-5 group. Parallel to the improvement of gas exchange and lung mechanics, we found less total alveolar protein content and TNF-alpha mRNA expression in BAL cells in the IPC-5 than in the controls. However, we did not find IPC-10 to be paralleled by a significant improvement of lung function. Neither IPC-5 nor IPC-10 influenced the pulmonary vascular resistance index or the fluid accumulation in the lung. CONCLUSION: The major finding of the present study was that 5 minutes of IPC improved lung function after 3 hours of warm ischemia of the lung.

Animals↗

PubMed1983

Clinical efficiency of neobiphyllineR-studies on lung function and serum levels after rectal application of a combination of methyl-xanthines.

In a group of 12 patients suffering from reversible airways obstruction, lung function data and serum levels were studied before and after rectal application of a combination of methyl-xanthines (400 mh theophylline, 600 mg diprophylline, 600 mg proxyphylline). The follow-up over a period of 10 hours showed an immediate bronchodilator effect of the mixture within 30 minutes to 1 hour; bronchodilation was still detectable after an interval of 10 hours. The improvement in lung function correlated with the serum levels. No side effects were noted after rectal administration of the drugs.

Adult↗

PubMed2006

Lung function measurements in a preterm animal model of respiratory failure: comparison of two different neonatal ventilators.

A variety of ventilators are used in the NICU. Ventilator and lung function measures are often applied in weaning protocols or as outcome variables. The effect of different ventilators on these measures has not been well studied. Our objective was to compare ventilator and lung function measurements in a chronic preterm animal model managed with two different neonatal ventilators. Timed baboon pregnancies exposed to antenatal steroids were delivered by C/S at 125 days (term = 185 days). Infants were immediately intubated, given surfactant, and ventilated with low tidal volumes (4-6 ml/kg) for 6-14 days using well-defined protocols. One group was ventilated via InfantStar (IS) and the other by VIP-Bird (VIP). Physiologic and pulmonary function data were serially recorded with the VitalTrends plethysmography system. Between ventilator comparisons were made. InfantStar (IS) was used on 22 infants in 2002-03, VIP was used on 29 infants in 2004-05. No differences were found for gestation, birth weight, gender, paO(2), paCO(2), FiO(2), arterial/alveolar ratio, dynamic compliance, inspiratory resistance, or tidal volumes. From 24 to 336 h, peak and mean airway pressure, ventilator rate, and ventilatory efficiency index (VEI: PIP x R x CO(2)/1,000) were significantly greater in the VIP group at multiple time points. VIP use was associated with a significant increase in expiratory airway resistance (Rexp - cmH(2)O/L/s) at all but one-time points studied. Compared to the IS, use of the VIP-Bird ventilator in surfactant treated immature baboons with RDS was associated with increased expiratory airway resistance and indices of impaired ventilation, but not oxygenation. Ventilator management in the NICU, especially weaning, may be affected by the specific ventilator in use.

Animals↗

PubMed1991

Ventilatory lung function in young cigarette smokers: a study of susceptibility.

The objective of this study was to estimate the effect of cigarette smoking on ventilatory lung function among young adults with special emphasis on the recognition of susceptible subgroups. In a cross-sectional study of 1,044 adults aged 15-40 yrs, a statistically significant linear relationship between quantity of smoking in cigarette-years and level of forced expiratory volume in one second (FEV1) was found. Among current cigarette smokers, FEV1 level was on average 35 ml lower for each 100 cigarette-years of exposure (corresponding to smoking of ten cigarettes per day for 10 yrs) compared to lifelong nonsmokers in a linear regression adjusted for confounding. Potentially susceptible subgroups were studied by introducing interaction terms between quantitative smoking and gender, wheezing, atopy, asthma, childhood respiratory illness and exposure to environmental tobacco smoke during the growth period, to the additive linear regression model explaining the FEV1 level. Wheezing was found to modify the effect of smoking significantly: the FEV1 level was on average 68 ml lower for each 100 cigarette-years due to interaction between smoking and wheezing. An introduction of the interaction term eliminated the independent effect of smoking. The results suggest that the detrimental effect of smoking on FEV1 in young adults may be limited to individuals with wheezing. Thus, the presence of wheezing among smokers indicates a higher risk for low level of ventilatory lung function compared to smokers who do not wheeze.

Adolescent↗

PubMed1997

Lung function in infants with sickle cell disease.

We performed pulmonary function testing in 20 infants (11 male and 9 female; ages 3-30 months) with sickle cell disease to assess whether abnormal lung function develops early in life. Respiratory system compliance (Crs) and resistance (Rrs) were measured by the passive occlusion technique, functional residual capacity (FRC) was measured by the nitrogen washout technique, and tidal flow-volume loops and partial expiratory flow-volume curves were obtained by the thoracoabdominal compression technique to detect airway obstruction. Patients with Hb SS (Group I, n = 12) had significantly lower hemoglobin levels and a higher (but not significant) incidence of acute chest syndrome (ACS), vasoocclusive crisis (VOC), splenic sequestration, transfusions, and history of intermittent bronchospasm compared to with patients with hemoglobinopathies Hb SC, Hb Sbt and Hb SF (Group II; n = 8). Both groups had elevated FRC, decreased maximum expiratory flows at FRC (V'max,FRC), and decreased time needed to reach peak expiratory flow (tme/tE), suggesting lower airway obstruction (LAO) and hyperinflation. Restrictive disease was found in only three patients of Group I. Our findings suggest that in sickle cell disease (especially among patients with Hb SS), abnormal lung function (predominantly LAO) may be present in early infancy. Airway reactivity may play a role in the pathogenesis, but the relation to VOC or ACS remains unclear.

Airway Resistance↗

PubMed1996

Assessing lung function.

Poor perception of significant symptoms by many sufferers of chronic lung diseases and less than optimal assessment by clinicians can lead to inadequate management of many respiratory problems. This article examines some of the strategies and pitfalls in the evaluation of the history, the physical examination and lung function tests.

Humans↗

PubMedDate not supplied

The effect of prolonged occupational exposure to the low concentrations of nitrogen oxides in combination with ammonia on chronic bronchitis and the lung function.

The purpose of this study was the assessment of the effect of low concentrations of nitrogen oxides and ammonia on the appearance of the chronic bronchitis symptoms and lung function. The material in total consisted of 183 workers employed in the Chemical Factory in Tarnów (Poland). The study methods encompassed the environmental factors in all places of work and the questionnaire based interviews with the lung function testing of the workers. The results obtained prove that prolonged effect of the exposure to nitrogen oxides, even below the accepted safety level, causes a more frequent appearance of chronic bronchitis symptoms and lower FMF values. This may signal the narrowing of bronchiole as a result of the exposure to nitrogen oxides, independent of the effects on the mucous membranes of the bronchi, demonstrated by the excessive prevalence of chest symptoms. There is no reason to believe, as based on the results of this study, that the effects of nitrogen oxides could be in any way dependent on the tobacco smoking or on the accompanying concentrations of NH3.

Adult↗

PubMed2001

Lung function tests and risk factors for pneumonia in adults with chickenpox.

BACKGROUND: Varicella is 25 times more likely to be complicated by pneumonia in adults than in children. Data on changes in lung function following pneumonia are limited. This study was undertaken to describe the epidemiological factors associated with pneumonia and to investigate lung function up to 1 year following chickenpox. METHODS: Thirty eight consecutive suitable patients admitted to a university hospital were enrolled in the study; 19 had pneumonia and 19 did not. Epidemiological data and density of rash were recorded, spirometric tests were performed, and carbon monoxide transfer factor was measured. RESULTS: Varicella pneumonia was associated with the presence of respiratory symptoms (p=0.006), current smoking (p=0.003), and history of close contact (p=0.009). There was a trend towards patients with pneumonia having a more severe rash. No association was observed between pneumonia and age or sex. Current smokers had a higher mean number of spots than non-smokers (p=0.005). Carbon monoxide transfer factor at hospital discharge was reduced in 27 patients (71%), more markedly in the group with pneumonia (p=0.009). Nine patients (seven with pneumonia) still had a reduced carbon monoxide transfer factor (mean reduction 36%) at 12 months. CONCLUSION: Chickenpox may result in a defect in carbon monoxide transfer factor for at least a year after acute illness.

Adult↗

PubMed2006

Optimum expression of adult lung function based on all-cause mortality: results from the Reykjavik study.

A variety of reference curves are used to derive predicted values for adult lung function, even within ethnically similar populations. Alternatives to percentage predicted value are sometimes used to allow for height in research. Strength of association with total mortality can be used to choose the optimal expression, between forced expiratory volume in 1s (FEV(1)) divided by height(2), FEV(1)/height(3), FEV(1)% predicted and difference from predicted. Data from the Reykjavik Study cohort, 1976-2002, included 5544 men and 8062 women randomly selected from the population. Total mortality was analysed by Cox proportional hazards regression in relation to each height-adjusted measure, allowing for age group, period of recruitment and body mass index, and smoking before or at baseline. FEV(1)/height(2) and FEV(1)/height(3) had stronger associations with mortality than FEV(1)% predicted and difference from predicted in men and in women. There were similar findings for forced vital capacity (FVC) in non-smokers and in women. FEV(1)/height(2) was slightly better predictive than FEV(1)/height(3) in men, but distributions of FEV(1)/height(3) in men and women were closer than those of FEV(1)/height(2). Clinical practise and epidemiological research would benefit from agreement on how to adjust lung function for height. Replication of these analyses in other cohort studies would inform the choice between FEV(1)/height(2) and FEV(1)/height(3).

Age Distribution↗

PubMed1999

Lung function, blood gases, pH and serum electrolytes of small-scale miners exposed to chrome ore dust on the Great Dyke in Zimbabwe.

We measured and compared lung function indices and some blood parameters (gases, electrolytes, glucose, pH, red cell indices) of 54 male small-scale miners (SSM) chronically exposed to chrome ore dust to those of 50 nonmining control subjects (NMC) and 46 large-scale chrome miners (LSM) who had taken internationally recommended precautionary measures (secondary control). The respirable dust level in the SSM environment (6.0 +/- 0.5 mg/m3) was significantly higher (P < 0.001) than in the NMC and LSM environments (0.3 +/- 0.1 mg/m3 and 0.5 +/- 0.3 mg/m3, respectively). There were no significant differences in neither dust levels nor lung function status between NMC and LSM environments. The values of FVC, FEV1, PEFR and FEV1% of the SSM were 3.5 +/- 0.09 l, 2.61 +/- 0. 09 l, 6.07 +/- 0.36 l/second and 76.19 +/- 2.36%, respectively. These values were significantly lower than those of NMC (P < 0.01, respectively). However, the blood parameters of the SSM and NMC were not significantly different. The results are indicative of both restrictive and obstructive ventilatory defects in the SSM which may be attributed exposure to chrome ore dust in the environment. Associated risk factors appear to be advancing age, prolonged exposure to chrome ore dust and acid base disturbance.

Adult↗

PubMed1986

Regional lung function impairment following post-operative radiotherapy for breast cancer using direct or tangential field techniques.

We have compared the effect of tangential and direct irradiation on regional lung function in 22 consecutive patients with breast cancer, who had been treated by post-operative irradiation 3 months prior to the examination. The tangential technique (total dose 32-36 Gy, less than 5 Gy of the lung) was employed in eight of the patients, while the direct technique (total dose 40 Gy, 5-20 Gy to the lung) was used in the other 14. In the group that had been treated by the tangential technique, there was no impairment of the ventilation or perfusion of the irradiated lung compared with the contralateral lung. The radiographs of the thorax were all normal. In the group that had been treated by the direct technique, there was a reduction in both the ventilation and the perfusion in 12 of the patients (p less than 0.01). The radiographs of the thorax were abnormal in only seven of these 12 patients. In both groups the regional leakiness of the lungs was evaluated as the pulmonary clearance of inhaled nebulised 99Tcm-DTPA. Due to differences in smoking habits between and within the groups, the results were not conclusive. It is concluded that the regional lung function was not significantly affected by the tangential technique, in contrast to a pronounced and harmful effect of the direct technique.

Aged↗