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Biomedical subjects

R E Kanner

Publications and source records attributed to R E Kanner.

At least 37 records · Page 2Linked to original sources
PubMed1992

The lung health study: airway responsiveness to inhaled methacholine in smokers with mild to moderate airflow limitation. The Lung Health Study Research Group.

As part of a multicenter clinical trial (Lung Health Study), methacholine inhalation challenge testing was performed in 5,877 current cigarette smokers, ages 35 to 59 yr (mean 48.5 +/- 6.8 yr), with borderline to moderate airflow limitation (FEV1/FVC ratio 63.0 +/- 5.5). The test was successfully completed in 96.4% of subjects, of whom 63% were male and 95.9% were white. Symptomatic reactions to methacholine were rarely severe enough to require evaluation by a trial physician. Nonspecific airways hyperresponsiveness (AHR) was defined as a greater than or equal to 20% decline in FEV1 from the post-diluent control value after inhalation of less than or equal to 25 mg/ml methacholine. AHR was noted in a significantly higher percentage of women (85.1%) than men (58.9%). Moreover, nearly twice as many women as men (46.6 and 23.9%, respectively) responded to less than or equal to 5 mg/ml of methacholine. In both men and women, baseline degree of airways obstruction and clinical center were strongly associated with AHR (p less than 0.001), whereas age was not. Additional associations with AHR were analyzed in men and women separately using logistic regression after adjustment for baseline lung function, age, and center-to-center differences. In men, AHR was significantly related to symptoms of wheeze, chronic cough and/or sputum, and a history of asthma or hay fever (p less than 0.004), but not to current or lifetime tobacco use. By contrast, among women, AHR was not significantly associated with chronic cough and/or phlegm (p greater than 0.05) or a past history of asthma or hay fever (p greater than 0.1) and was only weakly related to wheeze and current asthma (p = 0.04), as well as to cigarette pack-years (p = 0.044). These results indicate that most continuing smokers with functional evidence of early chronic obstructive pulmonary disease have nonspecific AHR that is strongly related to gender and baseline lung function and, to a lesser extent, to respiratory symptoms. The reason for the striking effect of gender on AHR in early chronic obstructive pulmonary disease is unclear but cannot be attributed to male-female differences in age, cigarette use, presence of asthma, or baseline degree of airflow obstruction.

Adult↗
PubMed1990

Adjustment of DLCO for varying COHb, and alveolar PO2 using a theoretical adjustment equation.

The diffusing capacity of the lung for carbon monoxide (DL) is affected by changes in alveolar partial pressure of oxygen (PAO2), hemoglobin concentration (Hb), and carboxyhemoglobin concentration (COHb). A number of investigators have derived empiric adjustment equations to account for changes in these variables. We evaluated an adjustment of DL for changes in COHb and PAO2 using a single equation derived from Roughton and Forster's original definitions (J. Appl. Physiol., 1957). Unadjusted DL values declined significantly with rising COHb (-0.938%/percent COHb increase, P less than 0.0001) and rising PAO2 (-0.343%/mm Hg PAO2 increase, P less than 0.0001). Adjusted measured DL using the derived equation showed no significant change with changing COHb and PAO2 levels and provides an acceptable method for adjustment of DL for the effects of varying COHb and PAO2 levels from the standard conditions of COHb% = 0, and PAO2 = 110 mm Hg. Since a similar equation has previously been used to adjust for changes in DL due to anemia, we propose to use a single equation which is theoretically derived and empirically verified to adjust DL measurements for changes in COHb, PAO2 and hemoglobin.

Carbon Monoxide↗
PubMed1989

Long-term effect of almitrine bismesylate in patients with hypoxemic chronic obstructive pulmonary disease.

A long-term evaluation of the therapeutic efficacy and safety of oral almitrine bismesylate (AB) (50 mg twice daily) was made on 25 patients with COPD and moderate hypoxemia residing at an altitude of 1,500 m in a double-blind placebo-controlled study. Thirteen patients receiving AB (baseline PaO2, 54.3 +/- 4.9 mm Hg; mean +/- SD) and 12 patients receiving placebo (baseline PaO2, 53.0 +/- 4.1 mmHg) were periodically followed by arterial blood gas and other pulmonary function studies and plasma levels of AB. Eight patients receiving AB and nine patients receiving placebo were followed for 1 yr; all patients were followed for at least 90 days. AB administration resulted in an increase in PaO2 to 62.2 +/- 9.3 mm Hg (p less than 0.01) on Day 28. The increase was maintained until Day 360 (63.8 +/- 4.6 mm Hg; p less than 0.01). The mean plasma concentration of AB on Day 28 was approximately one-half that on Day 90 when the plasma level reached a near maximum. AB was associated with weight loss (five of 13 patients receiving AB lost more than 10% of their baseline body weight) and peripheral paresthesias of the lower extremities (three patients), both occurring at the peak plasma levels of the drug. We conclude that AB causes a long-term improvement in arterial oxygenation in hypoxemic patients with COPD residing at an altitude of 1,500 m. Our data suggest that lower doses of AB might produce the same effect on PaO2 with less adverse associated effects, and this should be tested in future studies.

Adult↗
PubMed1989

Bullous emphysema in monozygotic twins.

Monozygotic twins who developed bullous emphysema are described. This occurrence suggests that there is a genetic component that predisposes to the development of this disorder.

Adult↗
PubMed1988

Variability of the single-breath carbon monoxide transfer factor as a function of inspired oxygen pressure.

We measured single-breath CO transfer factor (TLCO) and alveolar oxygen partial pressure (PAO2) six times at each of three fractions of inspired oxygen (FIO2) (0.17, 0.21, 0.26) in twelve healthy subjects, to determine whether one FIO2 would have the advantage of producing less variable TLCO results than the others. Measured TLCO was adjusted for the increase in carboxyhaemoglobin during the tests. We found no significant differences in intra- or interindividual variance as a function of test FIO2.

Carbon Monoxide↗
PubMed1987

Physician's guide to spirometers.

Three pulmonary specialists compare the manual volume spirometer with the latest high-tech models and answer key questions on choosing the one that's right for your office. Also included: a buyer's guide to available models.

Catalogs, Commercial as Topic↗
PubMed1986

The relationship between alveolar oxygen tension and the single-breath carbon monoxide diffusing capacity.

The effects of alveolar oxygen tension (PAO2) on the single-breath carbon monoxide diffusing capacity (DLCO) were quantified and a factor was derived to accommodate for differences in PAO2 over commonly encountered altitudes and/or varying concentrations of oxygen in the test gas mixture (FIO2) We performed duplicate measurements of DLCO in 7 normal subjects with 6 different oxygen fractions (0.176, 0.196, 0.211, 0.22, 0.25, and 0.27). The PAO2 for each test was measured as the PO2 in the alveolar gas sample bag. DLCO varied inversely with PAO2 and changed by 0.35% for each mmHg change in PAO2 (r = -0.62, p less than 0.001). At an FIO2 of 0.25, PAO2 varied between subjects and was highly correlated with each subject's residual volume to total lung capacity ratio (r = -0.84, p less than 0.001). We suggest that laboratories can adjust the measured DLCO when PAO2 is not congruent to 120 mmHg by the following formula: DLCO (corrected = DLCO (measured) x [1.0 + 0.0035 (PAO2 - 120)].

Adult↗
PubMed1986

Large airway size, lung size, and maximal expiratory flow in healthy nonsmokers.

It has been postulated that airway size and lung size may be dissociated because of developmental differences between the tracheobronchial tree and the pulmonary parenchyma (dysanapsis). To test this hypothesis, we compared measurements of airway size (diameters, cross-sectional area, length and volume of the trachea, diameter and cross-sectional area of the mainstem bronchi) and lung size (total lung capacity, thoracic diameters, lung length), as determined from plain chest radiographs in 79 male and 86 female healthy nonsmokers. In both groups of subjects, the correlation between indexes of airway size and lung size was low. Airway size was not significantly different between men and women, when standardized for lung size. Tracheal diameter and length tended to increase with age. To assess the value of airway size measurements in the prediction of maximal expiratory flow, we compared tracheal and bronchial size with FVC, FEV 0.5, FEV1, and mean forced expiratory flow during the middle half of VC. The correlation between airway size and spirometric indexes was very low. Multiple regression analysis showed that the use of airway size variables in addition to the age and height variables did not substantially improve the prediction of maximal expiratory flow. Our results are consistent with the dysanapsis hypothesis, but they suggest that the introduction of radiologic estimates of large airway size in the prediction equations relating maximal expiratory flow to age and height is not justified, at least in the general population.

Female↗
PubMed1985

Gallium-67 citrate imaging in underground coal miners.

Twenty-two underground coal workers with 27 or more years of coal dust exposure were studied with gallium-67 citrate (Ga-67) imaging. Radiographic evidence of coal workers pneumoconiosis (CWP) was present in 12 subjects. The Ga-67 scan was abnormal in 11 of 12 with, and 9 of 10 without, CWP. The Ga-67 uptake index was significantly correlated with total dust exposure (p less than 0.01) and approached significant correlation with the radiographic profusion of the nodules (0.10 greater than p greater than 0.05). There was no correlation between Ga-67 uptake and spirometric function, which was normal in this group of patients; furthermore, increased lung uptake of gallium did not indicate a poor prognosis in subjects no longer exposed to coal dust. While coal dust exposure may be associated with positive Ga-67 lung scan in coal miners with many years of coal dust exposure, the scan provided no information not already available from a careful exposure history and a chest radiograph. Since Ga-67 scanning is a relatively expensive procedure we would recommend that its use in subjects with asymptomatic CWP be limited to an investigative role and not be made part of a routine evaluation.

Aged↗
PubMed1984

The relationship between airways responsiveness and chronic airflow limitation.

In 84 subjects with varying degrees of chronic airflow limitation (CAL), airways responsiveness (AR) measured by the response to an inhaled bronchodilator was negatively correlated with pulmonary function. Correlation coefficients were AR and FEV1, r = -0.39, p less than .001; AR and FEV1 percent predicted, r = -0.41, p less than .001; and between AR and FVC percent predicted, r = -0.28, p less than .006. This confirms the findings of others who used bronchoprovocation techniques to measure AR. Previously reported associations between AR and annual rate of change (ARC) of the FVC and FEV1 were reevaluated to determine if they are independent of any relationship between AR and baseline pulmonary function. Baseline FVC and FEV1 were not significantly correlated with ARC, while AR retained its significant association when evaluated by Pearson correlation coefficients and partial correlation coefficients adjusting for baseline FVC and FEV1, and when baseline values were included in liner regression models. Thus, AR in these subjects is a predictor of ARC of the FVC and FEV1 independent of baseline pulmonary function values.

Adult↗
PubMed1983

Predictors of survival in subjects with chronic airflow limitation.

In a study of chronic airflow limitation, we followed 140 subjects living in Utah at altitudes of 1,300 to 1,500 meters for seven to 13 years. Twelve-year survival probabilities were determined and compared with an age- and sex-matched Utah population. The lowest 12-year survival probability was 0.40 for those patients with a forced expiratory volume in one second/forced vital capacity (FEV1/FVC) of less than or equal to 0.40, indicating that there is much variability in survival. Other indicators of a lower survival probability (and increased death risk ratio) were an FEV1 percent predicted less than or equal to 50, an FEV1 less than or equal to 1.5 liters, male gender, partial pressure of oxygen (PO2) [exercise] less than or equal to 50 mm Hg, partial pressure of carbon dioxide (PCO2) [rest] greater than 39 mm Hg, PCO2 (exercise) greater than 39 mm Hg, FVC percent predicted less than or equal to 80, PO2 (rest) less than or equal to 55 mm Hg, and a carbon monoxide diffusing capacity (DLCO) percent predicted less than or equal to 80. Current smokers had a poorer survival probability than the reference population and an increased death risk when compared with the nonsmokers in the study. Pack/years of smoking also affected survival. Other variables associated with reduced survival were a diagnosis of chronic bronchitis combined with emphysema, more rapid annual declines in the FEV1 and/or FVC, low alpha 1-antitrypsin levels, a 20 percent improvement in FEV1 following the use of a bronchodilator aerosol, and a lower socioeconomic class. Differences between these findings and those noted in other studies are in the main due to differences in the characteristics (such as age, diagnosis, and extent of disease) of the patients in the study populations. The findings have relevance in estimating a patient's prognosis and for developing guidelines for disability determination purposes.

Adult↗
PubMed1983

Spirometry in children. Methodology for obtaining optimal results for clinical and epidemiologic studies.

Spirometric methodology for clinical and epidemiologic use in children was evaluated in 123 third and fourth grade school children 8 and 9 yr of age. They performed spirometric testing in the middle of October and again in the middle of November 1979. The results demonstrated that spirometric standards developed from adult studies can be applied to children. In addition, a minimum of 5 and a maximum of 8 maneuvers should be attempted to provide at least 3 acceptable tracings. In children, the allowable difference between the 2 best acceptable tracings of 5% or 100 ml, whichever is greater, was demonstrated to be a reasonable guideline. The results are equally reproducible when the maximal values, the mean of the 2 or 3 best values, or the values from the "best sum" tracing (the tracing with the highest value for the sum of the FVC and FEV1) are used.

Child↗
PubMed1983

Antinuclear antibodies in Utah coal miners.

Antinuclear antibodies (ANA) were detected using a mouse kidney substrate in 69 of 238 (29 percent) underground Utah coal miners at a titer of 1:16. At titers of 1:4 and higher, 52 percent were positive. The majority had a speckled pattern and were not directed against any previously characterized antigens. Fifteen of 28 with high titer ANA had reduced complement. The ANA was more apt to be present in those with coal workers' pneumoconiosis (CWP), and as ANA titer increased, the percentage with CWP increased. The ANA increased with both age and coal mine dust exposure. It is hypothesized that ANA and CWP both result from long-term dust exposure, but that there is insufficient evidence to implicate ANA in the pathogenesis of CWP.

Age Factors↗
PubMed1983

Bronchocentric granulomatosis associated with rheumatoid arthritis.

A 49-year-old woman with biopsy-proved bronchocentric granulomatosis (BCG) had repeated exacerbations of seronegative rheumatoid arthritis and vasculitis of the skin concurrent with BCG. To our knowledge, there have been no prior reports of this form of systemic involvement in BCG. While its pathogenesis remains obscure, this case, along with another recent report of eye involvement, suggests that BCG is part of a widespread immunologic response and is not a distinct entity.

Arthritis, Rheumatoid↗
PubMed1983

Bilateral vocal cord paralysis for 26 years with respiratory failure. Timing of restoration of tidal volume and serum electrolytes after tracheostomy.

A 31-year-old man had respiratory failure caused by bilateral vocal cord paralysis. He had had limited exercise tolerance since the age of five years, when he had had poliomyelitis. Respiratory failure was present for at least three months. Following relief of the upper airway obstruction by tracheostomy, the patient's tidal volume increased from 200 ml to 500 ml in two days, his carbon dioxide tension fell from 75 to 38 mm Hg, and his arterial bicarbonate level decreased from 39.8 to 25.6 mEq/L in five days. The patient is currently doing well with a permanent tracheostomy.

Adult↗
PubMed1981

Respiratory disease in Utah coal miners.

Two hundred forty-two Utah underground coal miners volunteered to participate in a respiratory disease study. They were an older group (mean, 56 years of age) and had spent a mean of 29 years in the coal-mining industry. The prevalence of chronic bronchitis was 57%, and that of coal worker's pneumoconiosis, 25%; only one worker had progressive massive fibrosis. Significant impairment of pulmonary function was found among those with a history of cigarette smoking. Chronic bronchitis or coal worker's penumoconiosis among nonsmokers did not impair pulmonary function. There was a significant association among the nonsmokers between increasing exposure to coal dust and coal worker's pneumoconiosis, but not for changes in pulmonary function. Coal mine dust had a significant influence in causing the symptom complex of chronic cough and sputum production, and coal worker's pneumoconiosis.

Bronchitis↗
PubMed1980

Effect of viral infections on pulmonary function in patients with chronic obstructive pulmonary diseases.

The effect of 100 separate viral infections of the respiratory tract on pulmonary function was evaluated prospectively over an eight-year period in 84 patients with chronic obstructive pulmonary diseases and in eight normal subjects. Some viral infections were associated with small acute declines in forced vital capacity and/or 1-sec forced expiratory volume of 25-300 ml. These declines were detectable only during the 90-day period after infection. The greatest abnormalities of pulmonary function followed infections with influenza virus, and the mean acute changes in 1-sec forced expiratory volume (-118.5 ml) were significantly greater than expected (-15.2 ml; P = 0.03). Smaller, statistically insignificant declines followed infections with parainfluenza virus, rhinovirus, adenovirus, and respiratory syncytial virus, and no changes were detectable after infections with coronavirus, herpes simplex virus, Mycoplasma pneumoniae, and Haemophilus influenzae. Long-term effects of influenza or other viral infections on the course of chronic obstructive pulmonary disease were not detected in this study population.

Acute Disease↗