Forced inspiratory measurements and the vital and inspiratory capacities.
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Adult↗
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[Respiratory function tests in normal subjects. Predictive equations in the calculation of inspiratory capacity, expiratory reserve and dynamic pulmonary volumes].
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Adolescent↗
[The significance of forced inspiratory capacity for the diagnosis of stenosing processes in the area of larynx and trachea].
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Goiter↗
Vital capacity following traumatic brain injury.
This study was designed to describe lung volume subdivisions in individuals with traumatic brain injury. Records were reviewed for 114 consecutive referrals for motor speech evaluations in a community re-entry residential rehabilitation programme. Obtained measures were vital capacity, inspiratory capacity, and expiratory reserve volume at the time of evaluation. Seventy-nine per cent of subjects evidenced at least moderate deficits in expiratory reserve volume, with 60% evidencing severe deficits. Inspiratory capacity was the least affected, with 61% of subjects evidencing values within normal limits. Possible contributors to reduced expiratory reserve volumes include expiratory muscle weakness due to physical inactivity, inability to voluntarily perform the task, or perceived effort.
Adolescent↗
Respiratory muscle fatigue after marathon running.
Respiratory muscle fatigue has been demonstrated in the laboratory as well as in pathological states, but whether it occurs in healthy individuals under physiological conditions is unknown. To determine whether fatigue of the respiratory muscles may develop with endurance exercise, we measured spirometry and respiratory muscle strength and endurance in four runners before and after completion of a marathon race (42.2 km). Strength was assessed by measuring maximal inspiratory (PImax) and expiratory (PEmax) pressures and transdiaphragmatic pressure during inspiratory capacity (PdiIC); endurance was determined by measuring maximal voluntary ventilation (MVV). After marathon running (mean time, 3 h 24 min) there was no change in forced vital capacity, inspiratory capacity, or flow rates from prerace values. Decreases were observed between pre- and postrace PImax (165.8 +/- 11.0 vs. 138.5 +/- 7.6 cmH2O; P less than 0.01) PEmax (240.0 +/- 20.4 vs. 173.0 +/- 22.6 cmH2O; P less than 0.05), PdiIC (78.8 +/- 11.6 vs. 63.3 +/- 7.0 cmH2O; P less than 0.10), and MVV (178 +/- 24.2 vs. 161.2 +/- 23.2 l/min; P less than 0.005). The decrements in respiratory muscle strength and endurance suggest the development of respiratory muscle fatigue after marathon running.
Adult↗
The effects of nebulized salbutamol on lung function and exercise tolerance in patients with severe airflow obstruction.
The effects of 10 mg of nebulized salbutamol on lung mechanics and exercise tolerance in 10 patients with severe airflow obstruction are described. All patients were previously considered to have irreversible airflow obstruction as demonstrated by little or no improvement in expiratory flow rates either during a corticosteroid trial or after inhalation of 100 micrograms of isoprenaline. There was a small improvement in expiratory flow rate after nebulized salbutamol but the greatest increases were seen in slow vital capacity, inspiratory capacity, inspiratory flow rates, dynamic compliance during tidal breathing, mid-inspiratory and expiratory pulmonary resistance and exercise tolerance. The mechanism of these effects and their therapeutic significance is discussed.
Aged↗
Preoperative pulmonary function evaluation for laparoscopic cholecystectomy.
OBJECTIVE: Hypercarbia with respiratory acidosis is a recognized complication of laparoscopic cholecystectomy. This study was performed to identify preoperatively those patients who may develop hypercarbia and acidosis during the procedure. DESIGN: Retrospective analysis of preoperative variables. PATIENTS: Thirty-one consecutive patients underwent laparoscopic cholecystectomy at one institution who were receiving both preoperative pulmonary function tests and arterial blood gas analysis. RESULTS: More than 80 demographic, laboratory, and perioperative variables were entered into a univariate analysis to identify predictors of intraoperative acidosis (pH, < 7.35). Patient age, duration of the procedure, and preoperative blood gas values were not predictors of intraoperative acidosis. Several univariant predictors for patients experiencing carbon dioxide pneumoperitoneum-induced hypercarbia were identified; these included an elevated American Society of Anesthesiologists classification and significant decreases in forced expiratory flow at 25% of maximum, maximal forced expiratory flow, maximal voluntary ventilation, vital capacity, inspiratory capacity, and diffusing capacity of the lung for carbon monoxide. CONCLUSIONS: This study suggests that neither age nor preoperative arterial blood gas values are predictive of intraoperative hypercarbia and acidosis during periods of carbon dioxide pneumoperitoneum. However, preoperative pulmonary function measures of decreased flow, limited capacity, and compromised diffusion do correspond to the development of intraoperative acidosis. Preoperative evaluation with pulmonary function tests demonstrating forced expiratory volumes less than 70% of predicted values and diffusion defects less than 80% of predicted values can identify those patients who are at risk of developing hypercarbia and acidosis.
Acidosis, Respiratory↗
Effect of large-volume paracentesis on pulmonary function in patients with cirrhosis and tense ascites.
The effect of large-volume paracentesis on lung function was evaluated in 12 male patients with cirrhosis. All underwent pulmonary function tests including spirometry, plethysmography and single-breath carbon-monoxide diffusing capacity 1 day before and after paracentesis. The amount of ascitic fluid removed ranged from 3.6 to 131 (mean +/- SD, 7.4 +/- 3.01). After paracentesis, forced vital capacity, forced expiratory volume at 1 s, total lung capacity, functional residual capacity, inspiratory capacity, expiratory reserve volume, diffusing capacity and alveolar volume increased significantly. In contrast, Kco (diffusing capacity corrected by alveolar volume) decreased significantly. After paracentesis, the increase in diffusing capacity was highly correlated with lung volumes and the amount of removed ascitic fluid. Nevertheless, a significantly negative correlation was found between the change of Kco before and after paracentesis and that of lung volumes. The increase in lung volumes and ventilation to the lower lungs with unfavorable ventilation-perfusion matching might explain the discrepancy between changes in diffusing capacity and Kco after large-volume paracentesis. In conclusion, these results suggest that pulmonary function in patients with cirrhosis and tense ascites is partly improved by large-volume paracentesis. Large-volume paracentesis might be useful for symptomatic relief in selected patients with tense ascites.
Ascites↗
Combined effects of ozone and nitrogen dioxide on respiratory function in man.
Ten young adult males were exposed to either filtered air or 0.50 ppm ozone plus 0.50 ppm NO2 in filtered air under four environmental conditions: 25 degree C, 45 % rh; 30 degrees C, 85% rh; 35 degrees C, 40% rh; and 40 degrees C, 50% rh. There were eight 2-hour exposures per subject. After 1 hour of sitting exposure the subjects exercised for 30 minutes (35-40% predicted maximum capacity) which increased ventilatory exchange to approximately 40 L/min (BTPS). Pulmonary function tests were performed before, during, and after exposure. Metabolism and ventilation were determined during the last 15 minutes of exercise. A symptom questionnaire was completed at the termination of each exposure following reexamination by a physician. There was a decrease in vital capacity, inspiratory capacity, and several flow-related measures of lung function during exposure. The response to exposure to the combined pollutants (O3 and NO2) was similar to that observed in ozone exposures alone. No synergism was observed.
Adult↗
Changes in respiratory function tests during pregnancy.
Anatomical, physiological and biochemical adaptations that occur during pregnancy are profound. Changes in respiratory physiology are a part of the same process. In the present study of 70 selected women, 50 pregnant and nonpregnant control, it was found that out of seven parameters studied five showed changes. There were changes in respiratory frequency, tidal volume, vital capacity, inspiratory capacity and expiratory reserve volume. Maximum voluntary ventilation and timed vital capacity did not change. RF, VT, VC and IC rose significantly while ERV had a significant fall. These changes may be affecting ante-intranatal behaviour of pregnant women and their pregnancy outcome.
Adult↗
Understanding pulmonary function tests.
Lung volume measurements include vital capacity, inspiratory capacity, expiratory reserve volume, functional residual capacity, residual volume, total lung capacity and tidal volume. Minute ventilation and forced vital capacity help to determine the patient's ability to move air. Other tests measure parameters such as diffusion across the alveolocapillary membrane and gas distribution. Combined with blood gas measurements, these tests are invaluable in the study of dyspneic patients and patients undergoing major surgery, in monitoring of pulmonary disease and in selection of therapy.
Humans↗
Alternative methods for assessing bronchodilator reversibility in chronic obstructive pulmonary disease.
BACKGROUND: Bronchodilator reversibility testing is recommended in all patients with chronic obstructive pulmonary disease (COPD) but does not predict improvements in breathlessness or exercise performance. Two alternative ways of assessing lung mechanics-measurement of end expiratory lung volume (EELV) using the inspiratory capacity manoeuvre and application of negative expiratory pressure (NEP) during tidal breathing to detect tidal airflow limitation-do relate to the degree of breathlessness in COPD. Their usefulness as end points in bronchodilator reversibility testing has not been examined. METHODS: We studied 20 patients with clinically stable COPD (mean age 69.9 (1.5) years, 15 men, forced expiratory volume in one second (FEV(1)) 29.5 (1.6)% predicted) with tidal flow limitation as assessed by their maximum flow-volume loop. Spirometric parameters, slow vital capacity (SVC), inspiratory capacity (IC), and NEP were measured seated, before and after nebulised saline, and at intervals after 5 mg nebulised salbutamol and 500 microg nebulised ipratropium bromide. The patients attended twice and the treatment order was randomised. RESULTS: Mean FEV(1), FVC, SVC, and IC were unchanged after saline but the degree of tidal flow limitation varied. FEV(1) improved significantly after salbutamol and ipratropium (0.11 (0.02) l and 0.09 (0.02) l, respectively) as did the other lung volumes with further significant increases after the combination. Tidal volume and mean expiratory flow increased significantly after all bronchodilators but breathlessness fell significantly only after the combination treatment. The initial NEP score was unrelated to subsequent changes in lung volume. CONCLUSIONS: NEP is not an appropriate measurement of acute bronchodilator responsiveness. Changes in IC were significantly larger than those in FEV(1) and may be more easily detected. However, our data showed no evidence for separation of "reversible" and "irreversible" groups whatever outcome measure was adopted.
Aged↗
Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD.
The aim of this study was to test the hypothesis that use of tiotropium, a new long-acting anticholinergic bronchodilator, would be associated with sustained reduction in lung hyperinflation and, thereby, would improve exertional dyspnoea and exercise performance in patients with chronic obstructive pulmonary disease. A randomised, double-blind, placebo-controlled, parallel-group study was conducted in 187 patients (forced expiratory volume in one second 44 +/- 13% pred): 96 patients received 18 microg tiotropium and 91 patients received placebo once daily for 42 days. Spirometry, plethysmographic lung volumes, cycle exercise endurance and exertional dyspnoea intensity at 75% of each patient's maximal work capacity were compared. On day 42, the use of tiotropium was associated with the following effects at pre-dose and post-dose measurements as compared to placebo: vital capacity and inspiratory capacity (IC) increased, with inverse decreases in residual volume and functional residual capacity. Tiotropium increased post-dose exercise endurance time by 105 +/- 40 s (21%) as compared to placebo on day 42. At a standardised time near end-exercise (isotime), IC, tidal volume and minute ventilation all increased, whilst dyspnoea decreased by 0.9 +/- 0.3 Borg scale units. In conclusion, the use of tiotropium was associated with sustained reductions of lung hyperinflation at rest and during exercise. Resultant increases in inspiratory capacity permitted greater expansion of tidal volume and contributed to improvements in both exertional dyspnoea and exercise endurance.
Aged↗
Changes in lung volume and rib cage configuration with abdominal binding in quadriplegia.
Previous studies suggest that abdominal binding may affect the interaction of the rib cage and the diaphragm over the tidal range of breathing in quadriplegia. To determine whether abdominal binding influences rib cage motion over the entire range of inspiratory capacity, we used spirometry and the helium-dilution technique to measure functional residual capacity (FRC), inspiratory capacity, and total lung capacity (TLC) in eight quadriplegic and five normal subjects in supine, tilted (37 degrees), and seated positions. Combined data in all three positions indicated that, with abdominal binding, FRC and TLC decreased in normal subjects [delta FRC = -0.33 + 0.151 (SD) P less than 0.01); delta TLC = -0.16 + 0.121, P less than 0.05]. In quadriplegia there was also a reduction in FRC with binding (delta FRC = -0.32 + 0.101, P less than 0.001). However, TLC increased in quadriplegia (delta TLC = 0.07 + 0.061, P less than 0.025). In an additional six quadriplegic and five normal subjects, we used magnetometers to define the influences of abdominal binding on rib cage dimensions and TLC. In quadriplegia, rib cage dimensions were increased at TLC with abdominal binding, whereas there was no change in normals. Our data suggest that this inspiratory effect of abdominal binding on augmenting rib cage volume in quadriplegia is greater than the effect of impeding diaphragm descent, and thus abdominal binding produces a net increase in TLC in quadriplegia.
Abdomen↗
A pilot study of pain, analgesia use, and pulmonary function after colectomy with or without a preoperative bolus of epidural morphine.
OBJECTIVE: To determine whether patients who received a preoperative bolus of epidural morphine plus postoperative parenteral analgesia had less pain and better pulmonary function over the first 2 days after a colectomy than patients who received postoperative parenteral analgesia alone. DESIGN: Repeated measures, quasi-experimental, random assignment. SETTING: Northeastern general hospital. SUBJECTS: Thirteen patients were randomized to receive parenteral with (n = 6) or without (n = 7) epidural analgesia. OUTCOME MEASURES: Indicators of pain (intensity of pain and pain-related distress, intensity of words used to describe pain, intramuscular-equivalent amount of morphine administered, duration from start of surgery to first request for analgesia) and pulmonary function (forced expiratory volume in one second FEV1], forced vital capacity [FVC], inspiratory capacity [IC], peripheral oxygen saturation [SaO2] values). MEASUREMENT: Indicators of pain and pulmonary function were obtained the day before surgery, approximately 6 hours after surgery, and the first two mornings after surgery. RESULTS: Six hours after surgery, patients in the epidural group had less pain (p = 0.0177) and related distress (p = 0.0303) and greater FVC (p = 0.0303) and FEV1 (p = 0.0025) than patients in the no-epidural group. On the first postoperative morning, patients in the epidural group had less distress related to pain (p = 0.0350) but similar respiratory rates and spirometry values. Inspiratory capacity was not statistically different but was always larger in the epidural group. Of patients who breathed room air, SaO2 was higher in the epidural group over the first two postoperative days (p = 0.0286 each occasion). Patients in the epidural group received their first on-demand analgesic an average of 30 hours after the start of surgery compared with 6 hours for patients in the no-epidural group (p = 0.0022). There were no significant differences in the total number of words used to describe the type of pain, and both groups described the pain with fewer words than expected on the first and second mornings after surgery. CONCLUSIONS: Results should be confirmed through study of a larger sample with the hypothesis that pain relief, selected aspects of pulmonary function, and peripheral oxygenation may be superior for patients who receive a preoperative bolus of epidural analgesia for abdominal surgery.
Adult↗
Association of esophageal dysfunction and pulmonary function impairment in systemic sclerosis.
OBJECTIVE: The aim of this study was to investigate the relationship between esophageal dysfunction and pulmonary involvement in patients with systemic sclerosis (SSc). METHODS: Pulmonary function parameters were compared between groups of patients with and without manometric evidence for SSc-induced esophageal dysmotility. RESULTS: Twenty-six of 43 patients (60.5%) exhibited a marked hypo- or aperistalsis of the smooth muscle portion of the esophagus. Total lung capacity, inspiratory vital capacity, and forced vital capacity were significantly lower in patients with esophageal dysfunction compared with those with normal esophageal peristalsis (p < 0.001). Patients with the diffuse form of SSc (n = 20) had significantly lower values for total lung capacity and inspiratory vital capacity compared with patients with the limited type of SSc (n = 23; p < 0.05). CONCLUSION: There is a significant association of esophageal dysmotility with reduced lung volumes in SSc. Possible explanations for these findings are pulmonary damage due to increased gastroesophageal reflux and, more likely, simultaneous involvement of the lungs and the esophagus in the disease process.
Esophageal Motility Disorders↗
Lung volumes, chest wall configuration, and pattern of breathing in microgravity.
We studied the changes in functional residual capacity (FRC), thoracoabdominal volume (Vw), and chest wall configuration in five normal subjects seated in an aircraft flying parabolic trajectories resulting in 20-s periods of microgravity. We measured vital capacity (VC), inspiratory capacity, and tidal volume by integrating airflow at the mouth and changes in rib cage and abdominal volume (delta Vrc and delta Vab, respectively, where delta Vrc + delta Vab = delta Vw) using induction plethysmography. During microgravity (0 Gz) FRC decreased by 413 +/- 70 (SE) ml and VC by 0.37 liter. The decrease in Vw did not differ from that in FRC and was entirely the result of reduction of Vab, the Vrc showing no significant change. During tidal breathing the abdominal contribution (delta Vab/delta Vw) increased from 0.39 +/- 0.08 at 1 Gz to 0.57 +/- 0.08 at 0 Gz. During brief periods of hypergravity (approximately 1.8 Gz) all changes were opposite in sign and relatively smaller. Limited data during "roller coaster" flight patterns suggested that, in contrast to configurational changes, the temporal pattern of breathing was uninfluenced by changes in Gz. We conclude that at the onset of weightlessness there are substantial changes in lung volume and thoracoabdominal configuration. Abdominal contribution to tidal excursions increases but the temporal pattern of breathing is unchanged.
Abdomen↗
Evaluation of bronchodilator responses in patients with "irreversible" emphysema.
Given the emerging physiological and clinical rationale for pharmacological lung-volume reduction, assessment of volume responses to bronchodilators is likely to be highly relevant in chronic obstructive pulmonary disease (COPD). The authors examined the magnitude of lung-volume reduction after acute bronchodilator treatment in patients with advanced emphysema. Eighty-four stable patients with emphysema (mean+/-SEM forced expiratory volume in one second (FEV1): 32+/-1% predicted) performed spirometry and body plethysmography before and 15-30 min after 200 microg salbutamol. Only irreversible patients with a postbronchodilator change in FEV1 <10% pred were considered in this study. Postsalbutamol, the majority of subjects (83%) had significant improvements in one or more lung volumes: on average, residual volume (RV), functional residual capacity (FRC), inspiratory capacity (IC), forced vital capacity and slow vital capacity changed by -18+/-2, -10+/-1, 8+/-1, 9+/-1 and 7+/-1% pred (p<0.0005 each). Total lung capacity (TLC) decreased 0.12+/-0.04 L (p<0.01). Change in IC reflected change in FRC (r=-0.60, p<0.0005), but more strongly in the 57% of patients with no significant change in TLC (r=-0.93, p<0.0005). The magnitude and frequency of volume responses were greatest in patients with the most severe COPD; for example, RV decreased by 0.51+/-0.09 L (23+/-4% pred) and 0.27+/-0.04 L (14+/-2% pred) in severe and moderate subgroups, respectively. Significant reductions in lung hyperinflation occurred in the absence of a change in forced expiratory volume in one second after low-dose salbutamol in a majority of patients with advanced emphysema; the greatest changes occurred in those with the most severe disease.
Aged↗