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PubMed1999

Lung function in school-aged asthmatic children with inhaled cromoglycate, nedocromil and corticosteroid therapy.

Two-thirds of the children with asthma in our area use cromones and only one-third steroids as the maintenance therapy. This study aimed to evaluate our treatment policy based on the international consensus. Peak expiratory flow (PEF), dynamic spirometry and bronchodilation test results were therefore collected in 195 school-aged patients who visited our outpatient clinic in 1995. Sixty-four children (33%) used cromoglycate, 86 (44%) nedocromil and 45 (23%) inhaled steroids. Twenty-five (12%) needed combination therapy, mainly with salmeterol. Lung function results were good, and there were no significant differences between the therapeutic groups irrespective of whether pre- or postbronchodilator values were considered. PEF was decreased in eight (4%), forced expiratory volume in one second (FEVI) in four (2%) and maximum mid-expiratory flow (MMEF) in 33 (17%) patients. At least one result was decreased in 39 (20%) cases, in most cases (77%) MMEF alone. Significant rises after salbutamol inhalations were observed in 17 (9%) in PEF, in two (1%) in FEV1 and 20 (10%) in MMEF values. Thus, the bronchodilation test was positive in 33 (17%) cases, and in 22 (11%) cases it was the only sign of bronchial obstruction. Over 70% of the children with asthma can be treated with cromones by a stepwise treatment modality. Inhaled steroids can be restricted to those not controllable by cromones. Lung function tests, including postbronchodilator values, should be part of the follow-up of continuous maintenance medication for asthma.

Administration, Inhalation↗

PubMed1998

[Measurement of exhaled nitric oxide. A new lung function test?].

Nitric oxide (NO) is a gas molecule produced endogenously in the lungs. It can be detected in the exhaled air of animals and humans. Nitric oxide can be generated in the air passages by a synthase which is induced in several cell types by exposure to proinflammatory cytokines. Its induction is blocked by glucocorticoids. An increased concentration of nitric oxide can be found in the exhaled air of patients with asthma and other inflammatory lung disorders. Gas analysers for measuring nitric oxide in exhaled air have recently been made commercially available. The test is non-invasive, simple to perform, and can also be used in patients with reduced lung function. The method seems to provide a unique non-invasive means of diagnosing and monitoring inflammation of the air passages, and in the future the test may become a useful tool in a clinical setting. Preliminary recommendations for measurements and technical standardization have recently been proposed by the European Respiratory Society.

Humans↗

PubMed2002

Abnormal lung function in healthy preterm infants.

The aim of this study was to assess the consequences of preterm birth for the functional development of the lungs. We studied 32 healthy preterm infants (gestational age 25 to 33 wk at birth) and 53 healthy full-term infants (37 to 42 wk) at the same mean postmenstrual age of 40 wk with a multibreath nitrogen washout technique to assess functional residual capacity (FRC), gas mixing efficiency, and dead space and with the single-breath occlusion technique to calculate compliance and resistance of the respiratory system. Twenty of the preterm infants were also assessed with the same methods at 34.2 (32 to 37) wk. At the same postmenstrual age the preterm infants had lower FRC/kg body weight, lower specific compliance, impaired gas mixing efficiency, and higher total and dead space ventilation/kg than the full-term infants. Specific compliance and specific conductance decreased but gas mixing efficiency increased from 34 to 40 wk. We conclude that premature exposure to extrauterine conditions changes lung function. Preterm infants showed signs of dysfunction of the terminal respiratory units and higher elastic recoil than infants who spent the corresponding time for development in utero. It is suggested that preterm birth per se affects alveolarization and formation of elastic tissue in the lungs.

Airway Resistance↗

PubMed1999

The effect of high-dose fluticasone propionate and budesonide on lung function and asthma exacerbations in patients with severe asthma.

The purpose of this study was to investigate the comparative efficacy and safety of equal doses of inhaled fluticasone propionate (FP) and inhaled budesonide (BUD) using their respective dry powder inhalers in a population of severe asthmatics requiring high doses of inhaled corticosteroid. This double-blind double-dummy parallel-group study compared the effects of 24 weeks of treatment with FP (2000 micrograms daily via a Diskhaler inhaler; Glaxo Wellcome, Evreux, France) and BUD (2000 micrograms daily via a Turbuhaler inhaler; Astra Pharmaceuticals, Rijswijka, Netherlands) on lung function and asthma exacerbations in 395 patients with asthma. FP was statistically significantly superior to BUD with respect to the percentage of symptom-free days (P = 0.02), the incidence of days free from rescue bronchodilator usage (P = 0.02) and the distribution of change in peak expiratory flow (PEF) expressed as a percentage of the predicted PEF (P = 0.04). During the treatment period FP was statistically significantly superior to BUD for change in forced expiratory volume in 1 sec (FEV1) at 8, 16 and 24 weeks, change in the median daytime symptom score during weeks 5-16, for incidence of symptom-free days and incidence of days free from rescue bronchodilator usage during weeks 17-24. There was no significant difference between FP and BUD with respect to the number of patients experiencing one or more asthma exacerbation (33.8 and 28.4% of patients, respectively). There was, however, evidence that the exacerbations were clinically less severe in patients treated with FP, in that the time to resolution was quicker (11.0 vs. 14.7 days; P = 0.035), mean duration of all exacerbations (for an individual patient) tended to be shorter (18.5 vs. 23.6 days; P = 0.12), the time off work was reduced (4.2 vs. 7.6 days; P = 0.012) and the lowest PEF recorded during the exacerbation was higher (301 vs. 263 l min-1; P = 0.07). There were no clinically relevant differences in the safety (serum cortisol levels, markers of bone turnover, adverse events) of FP and BUD at these microgram equivalent doses. The patients recruited into this study, in retrospect, probably had no need for such high doses of inhaled corticosteroid but, irrespective of this, FP at microgram equivalent doses showed evidence of superior efficacy to BUD with respect to lung function and severity of asthma exacerbations without producing any greater adverse systemic effect.

Administration, Topical↗

PubMed1997

[Reduced lung function parameters after physical exertion in Austrian Alps in ozone concentrations below the legal warning limit].

The ambient ozone concentration has increased greatly over the past decades, which may lead to environmental health problems, especially during the summer. WHO guidelines recommend an 8 hour mean value of < or = 60 ppb ozone without health risk. The aim of the present study was to investigate if elevated zone concentrations at moderate altitudes in the Austrian Alps, characteristic of the situation in the summer months, influence pulmonary function after physical exercise. 24 male non-smokers (mean age 26.7 +/- 4 years) were investigated in the Tyrol (Pitztal) at a mean sea level of 2434 m. During a mountain-guide course lasting for 6 days the subjects were physically active all day long. Spirometry was performed in the morning and in the evening after 8 h of exercise. Ozone and PM10 concentrations were measured on site. The ozone 24 hour mean values ranged between 53 and 71 ppb. A mean decrease of 5.3% (p < 0.00001) was measured in forced vital capacity (FVC) and forced expiratory volume (FEV1) at t3,m in immediately after the highest ozone 24 hour mean value had been registered (71 ppb). A clinically relevant decrease of FVC and FEV1 > 10% was observed at t3,m in 35% of the subjects. However, a linear dependence of lung function changes on the ozone 8 hour mean values was demonstrable for all measuring points only in 10% of these subjects. In 90% of the subjects with a decrease of lung function parameters > 10%, this reduction was at least not monocausally linked to ozone.

Adult↗

PubMed1995

Respiratory symptoms and lung function in wool textile workers.

Our study investigated a group of 216 wool textile workers (158 women and 58 men). Respiratory symptoms were assessed by questionnaire in wool textile workers and in 130 not exposed (control) workers. Ventilatory capacity was measured in wool workers by recording maximum expiratory flow-volume (MEFV) curves on Monday before and after the work shift. Forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), and flow rates at 50% and the last 25% of the vital capacity (FEF50, FEF25) were measured on the MEFV curves. Analysis of the data demonstrated a significantly higher prevalence of all chronic respiratory symptoms in wool workers than in controls, being the highest in wool workers for nasal catarrh (M: 63.8%; F: 44.9%) and for sinusitis (M: 62.1%; F: 43.0%). A high prevalence of acute symptoms, associated with the work shift, was also noted in wool workers. Exposure to wool dust caused significant across-shift reductions of ventilatory capacity varying from 1.4% for FEV1 to 9.1% for FEF50. Textile workers exposed to wool for > 10 years in the workplace had similar across-shift reductions of ventilatory capacity tests as those with shorter exposures. In a large number of these wool workers, FEF50 and FEF25 were below 70% of predicted normal values. Smokers had acute and chronic lung function changes similar to those of nonsmokers, indicating that smoking did not account for all the respiratory effects seen in wool processing workers. Our data suggest that dust exposures in wool textile mills may be associated with the development of chronic respiratory symptoms and impaired lung function.

Adult↗

PubMed1996

Effect of ambient ozone exposure on lung function in farm workers.

Effects of ozone exposure on outdoor farm workers in the Fraser Valley of British Columbia, Canada, were investigated. Fifty-eight workers underwent spirometry daily before and after each 8- to 14-h workday from June 23 to August 26, 1993. The mean daily maximum (1 h) ambient ozone concentration was 40 ppb (range: 13 to 84 ppb). Concentrations of acid aerosols and fine particulates, potential confounders of ozone effects, were very low. In individual regressions of evening FEV1 and FVC on maximum daily ozone concentration, 47 of 53 workers with valid data (46 of 53 for FVC) had negative slopes. The average slopes (weighted by the inverse SE of the regression coefficients) were -3.3 and -4.7 ml for FEV1 and FVC, respectively, for each ppb increase in ozone (p < 0.001). Following correction for an individual's mean lung function level, date, and temperature, regression of either the afternoon or the daily change (afternoon-morning) corrected for the morning measurement of FEV1 and FVC on ozone showed similar magnitudes of effect. These associations were still apparent on the following morning, suggesting a persistent ozone effect. These results indicate that exposure of a population of outdoor workers to ambient ozone concentrations below 85 ppb is associated with decreased lung function over the day, which persists to the following day.

Adult↗

PubMed1976

Lung function and morphology after bilateral hilar stripping in dogs.

Acute changes of lung function and morphology were studied in 3 groups of dogs: after bilateral hilar stripping by ipsilateral approach (group 1), after right-side hilar stripping and left pneumonectomy by left-sided approach only (group 2) and in a control group. All dogs of group 1 showed a syndrome corresponding to functional hilar stripping with absent Hering-Breuer and cough reflex, slow respiration with increased tidal volume and discharge of fluid from the airways. Alveolar ventilation and oxygen tension, dead space/tidal volume ratio and pulmonary shunting did not change. Cardiac output and arterial oxygen tension were decreased. The lungs were heavy and histological examination showed lymphostasis and interstitial edema. The dogs of group 2 did not show significant changes in comparison to the control group.

Animals↗

PubMed1994

Asthma, lung function, and bronchial responsiveness in welders.

The incidence of asthma was compared in welders welding in stainless steel (SS) or mild steel (MS). The study was comprised of welders who had been welding for at least 6 months during the preceding 10 year period in four companies, but who had not been welding occupationally prior to this time. The inclusion criteria were met by 42 SS welders with a total welding time of 196 years. Sixteen of these had left work, six because of airway symptoms. Eighty-five MS welders with a total welding time of 403 years were included. Forty-eight of these had left work, 10 citing airway symptoms as a main reason for leaving work, according to responses in a mailed questionnaire. Ex-welders with airway symptoms were in some cases further investigated with spirometry and bronchial provocation tests. In other cases, medical records gave a clear diagnosis. In addition, bronchial responsiveness and lung function were measured and airway symptoms were recorded in presently active welders. Twenty-three of the 26 active SS steel welders and 23 of the 37 active MS steel welders were examined, together with a reference group of 26 (out of 30 invited) vehicle assemblers. There was no difference in the incidence of welding-associated asthma (5% for SS, 7% for MS welders per 1,000 welding-years). Bronchial responsiveness and lung function in active welders was normal and did not differ between MS and SS welders or between welders and a reference group of vehicle fitters. Welders had a significantly higher prevalence of airway symptoms as compared to vehicle fitters.

Adult↗

PubMed2006

Budesonide/formoterol improves lung function compared with budesonide alone in children with asthma.

UNLABELLED: We aimed to compare the efficacy and safety of budesonide/formoterol (Symbicort) with budesonide alone (Pulmicort) or budesonide (Pulmicort) and formoterol (Oxis) administered via separate inhalers in children with asthma. In a 12 wk, double-blind study, a total of 630 children with asthma (mean age 8 yr [4-11 yr]; mean forced expiratory volume in 1 s (FEV(1)) 92% predicted; mean inhaled corticosteroid dose 454 microg/day) were randomized to: budesonide/formoterol (80/4.5 microg, two inhalations twice daily); a corresponding dose of budesonide alone (100 microg, two inhalations twice daily); or a corresponding dose of budesonide (100 microg, two inhalations twice daily) and formoterol (4.5 microg, two inhalations twice daily) (budesonide + formoterol in separate inhalers). The primary efficacy variable was the change from baseline to treatment (average of the 12-wk treatment period) in morning peak expiratory flow (PEF). Other changes in lung function and asthma symptoms were assessed, as was safety. Budesonide/formoterol significantly improved morning PEF, evening PEF and FEV(1) compared with budesonide (all p < 0.001); there was no significant difference between budesonide/formoterol and budesonide + formoterol in separate inhalers for these variables. All other diary card variables improved from baseline in all treatment groups; there were no significant between-group differences. Adverse-event profiles were similar in all groups; there were no serious asthma-related adverse events in any treatment group. CONCLUSION: budesonide/formoterol significantly improved lung function in children (aged 4-11 yr) with asthma compared with budesonide alone. Budesonide/formoterol is a safe and effective treatment option for children with asthma.

Adrenergic beta-Agonists↗

PubMed1992

Lung function impairment following mycoplasmal and other acute pneumonias.

We prospectively studied the lung function of 106 consecutive young patients with pneumonia. At the time of hospital admission we observed impaired spirometric function in 48% of the patients. During and following treatment, the frequency of abnormalities in pulmonary function tests decreased rapidly. However, at the 15th day of hospitalization, abnormal ventilatory function was still demonstrated in 21% of the patients. Such prolonged impairment of ventilatory function was significantly more likely to result from pneumonia caused by Mycoplasma pneumoniae than from forms caused by adenovirus or Streptococcus pneumoniae.

Adenovirus Infections, Human↗

PubMed1978

Ventilatory lung function studies in Pacific Island Micronesians.

In the first study of ventilatory lung function in people of the Micronesian race, observations in 182 normal subjects (117 males and 65 females) between the ages of 15 and 80 years were used to calculate regression equations for FVC, FEV1, and FEV1%. Mean values of FVC and FEV1 were found to be lower than those reported for Caucasians and Polynesians, but similar to Melanesians, Negroes and Chinese. Values of FEV1% were comparable among all races. The three Oceanic races showed a smaller reduction of FVC and a larger reduction of FEV1% with increasing age than did Caucasians. Although the biological significance of this variability of ventilatory function in different races is uncertain, the definition of racial norms is already proving useful in studies of pulmonary airway disease among Oceanic peoples.

Adolescent↗

PubMed2005

Molds in floor dust, building-related symptoms, and lung function among male and female schoolteachers.

UNLABELLED: Five hundred and twenty-two teachers from 15 public schools, eight 'water-damaged' schools, and seven 'non-damaged' schools with no visible water damage were included in a cross-sectional design. Mold growth was assessed by recording the amount of dust on the floor and in the air in classrooms and the content of a number of mold species in the dust (CFU/g dust). The evaluation of health symptoms included symptoms recorded by questionnaire and spirometry, bronchial challenge, and CO-diffusion capacity. Nasal lavage fluid was analyzed for IL-8 and ECP. Personal and psychosocial factors were included as confounders. In this study population mucus membrane irritation symptoms (MMI) and general symptoms were reported more frequently by women than by men with odds ratios ranging from 1.4 to 2.1. Women's reports of symptoms from mucous membranes and skin and general symptoms were positively associated with mold exposure. Odds ratio for 'difficult to concentrate' after adjustment for confounders was 11.2 (1.4-90.1, 95% CI) at high levels of mold exposure. None of the lung function tests performed in this study were associated with mold exposure, to the 'water damaged' vs. 'non-damaged' classification, or to the symptoms reported. IL-8 and ECP were not associated either. PRACTICAL IMPLICATIONS: Psychosocial and personal reasons dominate in MMI and general symptoms. Headache and difficulties to concentrate associated with indoor mold exposure, mainly for women. No lung function impairment associated with indoor mold exposure.

Adult↗

PubMed1988

Respiratory symptoms and lung function in furriers.

Forty women who had been occupationally exposed in the fur coat manufacturing industry were studied. The mean age was 30 years; mean duration of exposure was 14 years. A group of 31 females who did not work in the furrier industry also was included in the study as the control group. A higher prevalence of all chronic respiratory symptoms was found among furriers when compared with controls; these differences were statistically significant for nasal catarrh (p less than 0.05) and sinusitis (p less than 0.01). Among the furriers, the highest prevalence of respiratory symptoms was recorded for chronic cough in 20 workers (50.0%), followed by sinusitis in 12 (30.0%), dyspnea in 10 (25.0%), and nasal catarrh in 8 workers (20.0%). Among the furriers, two (5.0%) had symptoms characteristic of occupational asthma. Most of the symptomatic furriers complained of acute symptoms during their work shifts. Statistically significant mean reductions in lung function over the work shift were recorded in furriers for forced vital capacity (FVC), -4.1%; one-second forced expiratory volume (FEV1), -5.2%; and flow rate at 50% vital capacity (FEF50%), -6.3%. Furriers demonstrated significantly lower mean Monday preshift measurements for FVC and flow rate at 25% (FEF25%) (p less than 0.05) when compared with those predicted. Preshift administration (by spinhaler) of 40 mg disodium cromoglycate in three workers reduced the intensity of acute respiratory symptoms and diminished the reductions in ventilatory capacity over the work shift. Data from six additional male workers demonstrated similar findings for symptoms and lung function. Our data suggest that furriers are at risk of developing both acute and chronic respiratory symptoms as well as ventilatory capacity impairment as a result of occupational exposure.

Adult↗

PubMed1995

The effect of unilateral intercostal nerve transfer upon lung function.

Intercostal nerve transfer is a well-established technique in the treatment of some severe brachial plexus lesions in adults. There is, however, concern that in the presence of an ipsilateral phrenic nerve palsy it may lead to a significant compromise of respiratory function. 20 patients having intercostal nerve transfers had their lung function assessed pre-operatively and 6 weeks post-operatively. The patients were subsequently questioned about symptoms of respiratory dysfunction. There was no evidence that intercostal nerve transfer leads to a significant reduction in respiratory function in adults. It therefore appears safe to perform intercostal nerve transfers in adults following brachial plexus injuries even in the presence of an ipsilateral phrenic nerve palsy.

Adolescent↗

PubMed2002

Lung function and asthma symptoms in children: relationships and response to treatment.

UNLABELLED: The aim of this study was to determine the relationships between the forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF) and asthma symptom scores, as well as their response to treatment, in children with no recent exacerbations of asthma. Asthma symptom scores, FEV1 and PEF were characterised, and their relationships and changes at follow-up studied in 64 children (mean age 9.5 y) referred to asthma outpatients. The mean FEV1 and PEF at the initial clinic visit were 94% of predicted values. At follow-up, mean FEV1 and PEF were similar. However, symptom scores (maximum obtainable score for each variable = 3) for exercise, nocturnal cough and morning cough were abnormal at the initial visit (mean +/- SD, exercise 1.0 +/- 0.7, nocturnal cough 1.7 +/- 1.2, morning cough 1.6 +/- 1.2) and improved significantly at follow-up (exercise 0.8 +/- 0.7, nocturnal cough 0.9 +/- 1.1, morning cough 1.0 +/- 1.2) (p < 0.05). A significant relationship was not observed between lung function and total symptom score, at either the initial or follow-up clinic visit. Neither FEV1 nor PEF significantly correlated with individual symptom scores. While symptom control improved, no significant relationships between change in asthma symptom scores and change in FEV1 and PEF between the initial and follow-up visits were observed. CONCLUSION: Clinic ("office") spirometry, currently performed world-wide, cannot be uniformly regarded as an indicator of asthma status. In addition to the measurement of lung function, quantitative symptom scoring may be a helpful tool for physicians in the assessment of childhood asthma status.

Adolescent↗

PubMed2004

Optimization of lung function before pulmonary resection: pulmonologists' perspectives.

Many risk factors for morbidity and mortality with lung resection have been identified. Factors such as age, gender, and cancer stage cannot be altered, but lung function can be optimized by treating COPD or asthma with bronchodilators, corticosteroids, or antibiotics (when indicated) and by inspiratory muscle training. Although smoking cessation 2 months in advance of surgery may not be feasible, cessation nevertheless should be encouraged because it may decrease postoperative inflammation and in the long-term may decrease the risk of recurrence. In addition, morbidity and mortality can be minimized by careful patient selection using lung scanning or CT to determine predicted postoperative functions (FEV1% and DLco%) and some form of exercise testing, such as cardiopulmonary exercise testing or simple stair climbing. When the risk of surgery is high, any benefit from possible cure must be weighed against the risk of long-term disability or death. Although much data are available to guide clinicians in these decisions, there still is no one test that provides the answer in individual cases. The art and science of medicine must merge at this point.

Humans↗

PubMed1999

The effect of thoracentesis on lung function and transthoracic electrical bioimpedance.

This study aimed to determine the relationship between improvement in lung function and changes in transthoracic electrical bioimpedance (TEB) after thoracentesis in patients with pleural effusions. Fifteen patients with pleural effusions due to either malignant (n = 8) or cardiac (n = 7) diseases were included. Pulmonary function was assessed before and after thoracentesis. During thoracentesis the patients were monitored with TEB. Using linear correlation analysis, the increases for each litre of aspirated thoracic fluid were: forced expiratory volume in 1 s (FEV1) 0.261; forced vital capacity (FVC) 0.331; total lung capacity (TLC) 0.58; and the lung diffusing capacity (DLCO); 2.4 ml min-1 mmHg-1. Baseline impedance increased by 2.3 Ohm l-1 aspirated thoracic fluid. The relative increase in baseline impedance was twice as high for patients with cancer as for patients with heart failure (P < 0.05). We found only minor changes in systolic blood pressure and mean arterial pressure. The improvements in diffusing capacity, airflow, and lung volumes after thoracentesis are correlated to an increase in baseline impedance, but changes are dependent on the primary disease.

Aged↗