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Increased vital and total lung capacities in Tibetan compared to Han residents of Lhasa (3,658 m).

Larger chest dimensions and lung volumes have been reported for Andean high-altitude natives compared with sea-level residents and implicated in raising lung diffusing capacity. Studies conducted in Nepal suggested that lifelong Himalayan residents did not have enlarged chest dimensions. To determine if high-altitude Himalayans (Tibetans) had larger lung volumes than acclimatized newcomers (Han "Chinese"), we studied 38 Tibetan and 43 Han residents of Lhasa, Tibet Autonomous Region, China (elevation 3,658 m) matched for age, height, weight, and smoking history. The Tibetan compared with the Han subjects had a larger total lung capacity [6.80 +/- 0.19 (mean +/- SEM) vs 6.24 +/- 0.18 l BTPS, P less than 0.05], vital capacity (5.00 +/- 0.08 vs 4.51 +/- 0.10 1 BTPS, P less than 0.05), and tended to have a greater residual volume (1.86 +/- 0.12 vs 1.56 +/- 0.09 1 BTPS, P less than 0.06). Chest circumference was greater in the Tibetan than the Han subjects (85 +/- 1 vs 82 +/- 1 cm, P less than 0.05) and correlated with vital capacity in each group as well as in the two groups combined (r = 0.69, P less than 0.05). Han who had migrated to high altitude as children (less than or equal to 5 years old, n = 6) compared to Han adult migrants (greater than or equal to 18 years old, n = 26) were shorter but had similar lung volumes and capacities when normalized for body size. The Tibetans' vital capacity and total lung capacity in relation to body size were similar to values reported previously for lifelong residents of high altitude in South and North America. Thus, Tibetans, like North and South American high-altitude residents, have larger lung volumes. This may be important for raising lung diffusing capacity and preserving arterial oxygen saturation during exercise.

Adult

Total lung capacity of baboons and humans determined by planimetry of radiographs.

Total lung capacity and radiographic lung area of 25 young and 7 aged baboons (Papio cynocephalus) and seven nonsmoking young adult men were measured. For all subjects, total lung capacity and radiographic lung area raised to the 3/2 power were shown to be highly correlated (r = 0.995). The regression equation for this relationship was total lung capacity (ml) = 78 + 0.234 x radiographic lung area (1.5) (cm2). A more useful regression equation for predicting values of total lung capacity was found to be log total lung capacity = -0.3819 + 1.4153 x log radiographic lung area (r = 0.993), because the standard error of estimate remains a constant percentage of Y values (+/- 12%). Total lung capacity and radiographic lung area were also highly correlated with height, weight and arm span of young baboons and men (r greater than 0.92), but the lungs of aged baboons were disproportionately larger.

Adult

Computerized roentgenographic determination of total lung capacity.

A computerized technique for measuring total lung capacity from radiographic chest films based on methods originally suggested by Barnhard and associates has been developed. Total lung capacity is automatically determined by tracing the margins of the lungs in both posteroanterior and lateral radiographs with a commercially available hypersonic coordinate digitizer. The results compare favorably with those obtained using a body plethysmograph. This simple, automatic procedure requires minimal training, is rapid, and can be easily implemented.

Computers

[Determination of total lung capacity from the thoracic roentgen image].

Formulas for calculation of total lung capacity from chest X-rays were compiled from literature. Using the total lung capacity measured by bodyplethysmography as reference, these formulas and several modifications were tested for usefulness. The product of lung area in the posterior-anterior X-rays and the largest diameter from sternum to the dorsal rib bow in the frontal X-rays was the most simple and exact roentgenological indicator of total lung capacity. 95%-confidence intervals for predictive values gained by this method revealed to be of similar range as for total lung capacity estimated by the gas dilution methods in comparison to bodyplethysmography.

Adult

Rapid computer-aided radiographic calculation of total lung capacity (TLC).

Methods currently used for determining total lung capacity are either simple but inaccurate in the presence of airways disease (gas dilution) or accurate but not generally available (body plethysmography). The manual radiographic method is accurate both in normals and in patients with airways disease but is very tedious to use. The authors have developed a semi-automatic radiographic method utilizing a position transducer and a small computer which reduces the time for each determination from approximately 20 min. to 1 min. Agreement with manual calculations in 80 controls and 80 patients with airways disease is excellent (average correlation coefficient, 0.9872; average residual error, 2.65% or 156 ml).

Computers

Predictive equations for total lung capacity and residual volume calculated from radiographs in a random sample of the Michigan population.

BACKGROUND: Published predicted values for total lung capacity and residual volume are often based on a small number of subjects and derive from different populations from predicted spirometric values. Equations from the only two large studies gave smaller predicted values for total lung capacity than the smaller studies. A large number of subjects have been studied from a population which has already provided predicted values for spirometry and transfer factor for carbon monoxide. METHODS: Total lung capacity was measured from standard posteroanterior and lateral chest radiographs and forced vital capacity by spirometry in a population sample of 771 subjects. Prediction equations were developed for total lung capacity (TLC), residual volume (RV) and RV/TLC in two groups--normal and total. Subjects with signs or symptoms of cardiopulmonary disease were combined with the normal subjects and equations for all subjects were also modelled. RESULTS: Prediction equations for TLC and RV in non-smoking normal men and women were square root transformations which included height and weight but not age. They included a coefficient for duration of smoking in current smokers. The predictive equation for RV/TLC included weight, age, age and duration of smoking for current smokers and ex-smokers of both sexes. For the total population the equations took the same form but the height coefficients and constants were slightly different. CONCLUSION: These population based prediction equations for TLC, RV and RV/TLC provide reference standards in a population that has provided reference standards for spirometry and single breath transfer factor for carbon monoxide.

Adult

Roentgenographic determination of total lung capacity in normal Chinese children.

Roentgenographic determination of total lung capacity (TLC) in children, rarely mentioned in the past, differs from the determination of TLC using helium dilution method in that it does not need the measurement of functional residual capacity. Therefore, it is useful for hospitals where pulmonary function testing (PFT) is not available. In this study, 87 out of 125 normal children completed both chest radiographs and PFT. Ellipsoid method which divides the lung field into several sections was used to calculate TLC from chest radiographs. The correlation coefficient of TLC measured by both chest radiographs and PFT was 0.7680, and paired Student's t-test of the mean values of the two groups showed P value greater than 0.05. Among the variables of height, weight, age and body surface area, height alone was able to predict the normal reference value of TLC. Line of regression between TLC and height was expressed as "TLC = 52.776 x Height- 4404.998", and correlation coefficient was 0.8013. Intersubject reproducibility was also verified. It is concluded that chest radiographs can be used to determine TLC in children.

Adolescent

A simple method for correcting single breath total lung capacity for underestimation.

The single breath method underestimates total lung capacity by comparison with the multiple breath method (TLCmb) because of inhomogeneity of ventilation distribution. This study proposes a simple correction for the single breath TLC (TLCsb), using inert gas phase III slope to account for the effects of uneven ventilation distribution. A model of a non-uniform lung ventilation was designed, composed of a serial dead space and two alveolar compartments arranged in parallel, whose relative ventilations were determined from the phase III plateau. Before correction TLCsb was 104-44% of TLCmb in 64 subjects (17 with diffuse interstitial disease, 42 with chronic obstructive pulmonary disease, and five healthy subjects). The limit of acceptability for the correction (TLCcorr) was determined from the 95% confidence interval of TLCsb/TLCmb in the healthy subjects. The correction resulted in a significant increase in TLCsb (p less than 0.004). TLCcorr remained under the limit of acceptability for only 12 patients with emphysema, and all 12 showed a large improvement in the TLC estimate. The presence of poorly ventilated zones during a single breath in these patients may explain this partial correction.

Adult

The mechanism of increase in total lung capacity during acute asthma.

In order to investigate the mechanism underlying the increased total lung capacity (TLC) observed during an acute asthmatic attack, we measured respiratory mechanics in a specially trained, exercise-induced, asthmatic. During the acute attack his TLC (determined plethysmographically) increased from 7.8 to 9.2 liters. The static pressure-volume curve of the lung shifted to the left and expiratory compliance increased from 0.24 to 0.55 liter/cm H2O. There was a parallel shift of the static pressure-volume curve of the chest wall resulting in an increase in the outward recoil of this structure. The maximum inspiratory pressure-volume curve of the total respiratory system was shifted so that the inspiratory muscles were able to generate greater pressures at any given lung volume during the attack. The findings indicate that the increase in TLC during acute bronchospasm results from the combination of loss of lung recoil, increased outward recoil of the chest wall and increased strength of contraction of the inspiratory muscles.

Acute Disease

Problems in the plethysmographic assessment of changes in total lung capacity in asthma.

We studied the effect of abdominal gas compression on plethysmographically determined total lung capacity (TLC) in asthmatic patients before, during, and after treatment of induced bronchospasm. TLC was derived from panting maneuvers near residual volume, at functional residual capacity, and near TLC. Significant differences among these "derived TLC" values increased significantly during bronchospasm. Whether or not TLC appeared to increase, and by how much, depended on the level of the vital capacity from which it was derived. Individual increases in TLC during bronchospasm could not be explained by increases in abdominal gas volume or in the extent to which it was compressed and decompressed during panting. We postulate that during the Boyle's Law panting maneuver, pleural, and therefore alveolar, pressure swings may be nonhomogeneous and greater over lung regions subtended by closed airways than over regions in communication with the mouth. This would result in an underestimation of alveolar pressure swings as measured at the mouth and an overestimation of thoracic gas volume, and would account in large part for the observed increase in discrepancies between the "derived TLC" values in asthma as well as the dependence of apparent TLC changes on the level of the VC at which the panting maneuver is performed.

Asthma

[Plethysmographic and radiologic measurement of the total lung capacity during acute attack of bronchial asthma].

There is controversy on the behavior of total lung capacity (TLC) during an acute asthma attack because the severe airflow obstruction causes an overestimation of the intrathoracic gas measured by plethysmography. We measured plethysmographic and radiologic TLC (TLCpl, TLCrx) in 17 patients with acute asthma, at admission and 3-5 days later when clinical and spirometric improvement was seen. TLCrx was measured planimetrically from routine chest X-rays in postero-anterior and lateral projection. Patients had a mean age of 32 +/- 15 years (ranging from 8-53) and six were males. FEV1 and FVC increased significantly in the second evaluation (1.36 +/- 0.7 vs 1.99 +/- 0.7 L, and 1.97 +/- 0.9 vs 2.6 +/- 1 L respectively, p less than 0.05), whereas airway resistance decreased (13.4 +/- 5.3 vs 9.8 +/- 3.4 cm H2O/L/s, p less than 0.05). On the other hand, we did not find a significant change in TLCpl (4.4 +/- 1.1 vs 4.6 +/- 1.2 L) nor in TLCrx (4.2 +/- 0.9 vs 4.1 +/- 0.8 L). We found no significant difference between TLCpl and TLCrx.

Acute Disease

Mechanisms for reduced total lung capacity at birth and during hyaline membrane disease in premature newborn monkeys.

To determine whether the cause of reduced total lung capacity (TLC) in hyaline membrane disease (HMD) is due to alveolar collapse, alveolar edema, or both, TLC was measured by N2-washout in premature Macaca nemestrina monkeys during the first 3 h of life. The TLC of animals with HMD was only one-third that of healthy premature monkeys over the first 3 h of life (p less than 0.01). At 3.5 h, lung tissue was rapidly frozen in situ during lung inflation to TLC. Samples of frozen lung tissue were freeze dried, embedded, sectioned, and examined by point counting. Animals with HMD had alveolar saccules filled with the residue of proteinaceous fluid, but little alveolar collapse was noted. The proportion of points falling on empty alveolar spaces was 74% in the healthy animals but only 18% in animals with HMD (p less than 0.01); there was a 70-fold increase in the residue present in alveoli of animals with HMD (p less than 0.05). In a separate experiment, rapid serial measurements of TLC by N2-washout showed that healthy premature monkeys, but not those with HMD, have a steady increase in TLC during the first few minutes of life, presumably due to clearance of lung liquid. Although the initial cause of reduced TLC in HMD appears to be inadequate clearance of fetal lung liquid, by 3 h of age proteinaceous alveolar edema is primarily responsible.

Animals

Regional lung expansion at total lung capacity in intact vs. excised canine lungs.

A computer-based biplane videoroentgenographic recording technique that determines the spatial coordinates of radiopaque lung parenchymal markers was used to compare regional lung expansion at total lung capacity (TLC) in the intact dog (prone and supine) and after removal from the chest. The reproducibility of the technique was examined by repeated determinations of intermarker distances at various static lung volumes during stepwise inflation and deflation of the lungs. Most of the variability in repeated determinations of intermarker distances at any lung volume was due to cardiogenic motion. When marker positions were determined repeatedly at the same phase of the cardiac cycle, the maximum coefficient of variation was less than 3% for a marker pair separated by 16.5 mm. At TLC, distances between all intralobar marker pairs in the intact thorax (prone and supine) and excised were highly linearly related (r = 0.96-0.99), whereas distances between interlobar marker pairs did not correlate as well (r = 0.77-0.86). We conclude that at TLC 1) the intact thorax does not distort the shape of the individual lobes from the state of isotropic expansion, and 2) in different body positions, overall lung shape may be different due to displacementof lobes relative to each other, but individual lobes remain uniformly expanded.

Animals

Discrimination of normal and overinflated lungs and prediction of total lung capacity based on chest film measurements.

Plethysmography and roentgenography were performed on normal subjects and patients with emphysema. 23 measurements from postero-anterior and lateral roentgenograms were subjected to discriminant and regression analyses to discover (a) which variable(s) best distinguished normal from overinflated lungs and (b) whether these or other variables could be used to predict total lung capacity. A combination of measurements was found to work best in each case.

Adult

Lung volumes in scoliosis before and after correction by the Harrington instrumentation method.

Studies of static lung volumes were performed before and after surgery in 92 scoliotic patients, aged 10 to 25 years. The majority of the patients had idiopathic dorsal curves. Vital capacity, total lung capacity, functional residual capacity and residual volume were measured at least 18 months after surgery. A significant increase was observed in all static volumes, averaging 10 per cent; the pre- and postoperative values were expressed in per cent of predicted normal values according to age and height. Correction of body height was taken into consideration in the prediction of normal values. Patients with the more advanced scoliosis had the greatest improvement in lung volumes. The patients were treated postoperatively with a Milwaukee brace for an average of 15 months. The use of this brace, which allows for chest expansions, might account for the improved lung function compared to previous series where plaster body jackets were used. Thus the correction of idiopathic scoliosis by the standard posterior fusion with Harrinton instrumentation together with our postoperative routine provides a lasting reduction of the spinal deformity, prevents progression of respiratory impairment and, in fact, increases the lung volumes, vital capacity, total lung capacity and functional residual capacity by an average of 10 per cent.

Adolescent