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Transpulmonary pressure at full inspiration and and dynamics of the airways in patients with obstructive lung disease.
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Spirometric standards for healthy nonsmoking adults.
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Bronchodilator and corticosteroid effects on regional and total airway resistance in patients with asthma, chronic bronchitis, and chronic pulmonary emphysema.
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Perfusion-ventilation scintiphotography in bullous disease of the lung.
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Respiratory function and effective collateral flow 8 years after ligation of the left pulmonary artery.
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The maximal expiratory flow-volume curve: its use in the detection of ventilatory abnormalities in a population study.
Flow-volume and spirometric parameters obtained in a randomly selected population were examined with regard to their sensitivity in detecting abnormalities among persons who smoked and/or had respiratory symptoms. Data obtained from subjects who were totally free of cardiorespiratory symptoms and who had never smoked cigarettes were used to develop "normal" prediction equations. Using as normal limits the per cent of predicted value above which 95% of these "normal" subjects fell, maximal expiratory flow at 75% of the expired vital capacity (Vmax75) detected the greatest proportion of abnormalities in the remainder of the population. When examined according to age, however, Vmax75 was most sensitive in older subjects, whereas 1-sec forced expiratory volume was superior in younger subjects. There was a slight tendency for Vmax75 to be affected in subjects with reactive airway syndromes and for the 1-sec forced expiratory volume to be affected in heavy smokers or subjects with chronic productive cough. If one parameter was markedly abnormal, the entire flow-volume curve was likely to be affected, but concordance of the parameters examined was not complete. For the latter reason, considerable caution must be exercised in attempting to use multiple parameters in defining abnormality, unless one applies more stringent criteria for abnormality.
Follow-up evaluation of a prevalence study for chronic bronchitis and chronic airway obstruction.
Follow-up of the prevalence study of respiratory symptoms and chronic airway obstruction was performed after a 6- to 7-year interval. One hundred fifteen of 117 subjects (98%) originally labeled "abnormal" (chronic bronchitis or asthma by history, or ratio of 1-sec forced expiratory volume to forced vital capacity less than 60 per cent), and 111 of a random sample of 116 subjects (96%) originally labeled "normal" were traced. Nineteen patients were dead, 14 "abnormal" subjects, and 5 "normal" subjects (P less than 0.01). Eighty-eight of the originally labeled "abnormal" subjects and 91 of the random "normal" sample could be retested by spirometry. Subjects with lower initial ratios of 1-sec forced expiratory volume to forced vital capacity tended to lose more 1-sec forced expiratory volume and forced vital capacity. Early identification of respiratory symptoms and spirometric abnormalities may identify persons at increased risk of death who could benefit from appropriate therapy.
Chronic obstructive airway disease in patients with Sjögren's syndrome.
To determine the incidence of airway disease in Sjögren's syndrome, respiratory function was evaluated in 13 patients with this disorder. Six patients had clear evidence of airway disease without overt evidence of loss of elastic recoil, and 7 patients had normal pulmonary function studies. Five of the 6 patients with abnormal pulmonary function studies had never smoked cigarettes. Of the patients with severe airway disease, all had exertional dyspnea but none had chronic cough with sputum production or recurrent bronchospasm. The 3 patients with the most severely impaired pulmonary function studies showed abnormal single-breath nitrogen curves, increased residual volumes, and hypoxemia, whereas static pressure-volume curves and maximal static elastic recoil at total lung capacity were within predicted norms. Lung biopsy of 2 patients showed mononuclear cell infiltration aroung narrowed small airways. We concluded that certain patients with Sjögren's syndrome develop an unusual type of chronic obstructive airway disease, which is probably a result of a chronic mononuclear cell inflammatory process similar to that seen in their salivary and lacrimal glands. The data suggest that human airways should be considered another target organ of Sjögren's syndrome. Earlier reports have stressed the association of a restrictive pulmonary defect with Sjögren's syndrome. Our data suggest that the restrictive pulmonary defect seen in patients with the complete variation of Sjögren's syndrome is probably the result of the associated connective tissue disorder, rather than the result in the sicca complex.
How many spirograms for a histamine challenge?
Several reports have shown that a prior deep inspiration exerts a blunting effect on pharmacologically induced bronchoconstriction. Inspiration to total lung capacity is a mandatory requirement for valid determination of the FEV1, and thus, the FEV1 may underestimate the magnitude of induced airway obstruction. The present study was designed to assess the effect that the performance and separate analysis of 2 consecutive FEV1 maneuvers (FEV(1)1, FEV(1)2), obtained at different levels of histamine-induced bronchoconstriction, may have on the final interpretation of a histamine challenge. Eight asymptomatic nonsmoking asthmatics (mean age, 24 yr; range, 19 to 27 yr) underwent a total of 16 histamine challenges. Paired FEV1 measurements (FEV(1)1, FEV(1)2) were obtained after inhalation of buffer solution (control) and 3 min after inhalation of aerosolized, serially diluted, histamine diphosphate solutions. A significant airways response (FEV1 decreasing by 20% or more from the control value) was observed in all subjects after inhalation of 5 mg/ml of histamine or less, indicating histamine airway hypersensitivity. At lower doses of histamine the mean values for FEV(1)1 and FEV(1)2 were similar to the control value. At higher histamine doses FEV(1)2 was consistently higher than FEV(1)1 (p = 0.007) and exceeded FEV1 1 by a mean of 9% after inhalation of the provocational histamine concentration; delta FEV1(FEV(1)2-FEV(1)1) was correlated with the log10 of cumulative inhaled histamine dose units (p = 0.040). Assuming that the difference between corresponding FEV1 determinations at a given level of induced bronchoconstriction is a direct consequence of changes in lung mechanics induced by deep inspiration, we are led to conclude that during histamine inhalation challenges, only 1 spirogram should be performed at each level of induced bronchoconstriction.
A bronchospirometric study of pulmonary function after decortication in pulmonary tuberculosis.
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Significance of bronchospirometric values.
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Bronchospirometric investigations before and after a small thoracoplasty.
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The definitive functional results after partial pulmonary resection; bronchospirometric investigation.
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Early prediction of the need for hospitalization in children with acute asthma.
We studied 133 asthmatic children in the emergency room who were aged 4 to 17 years and who were not receiving ongoing training in pulmonary function testing, to determine whether spirometry correlated with the outcome of the emergency treatment of the acute attack and with relapse during the next four days. A clinical score derived from the physical exam was obtained at the time of spirometry. Patients were hospitalized or discharged home based solely on their clinical response to therapy. The pediatrician making that decision was blinded to the results of the spirometry. The initial pretreatment clinical score or spirometry alone identified the majority of patients hospitalized, but each falsely identified many discharged patients who did not relapse, 20 percent and 15 percent, respectively. Predictive criteria for hospitalization, combining spirometry with a careful clinical evaluation prior to the start of emergency treatment, substantially reduced the number of falsely identified patients. With use of the predictive criteria, the majority of children admitted to the hospital would have been identified hours before that decision was made on clinical grounds alone (5.5 +/- 0.7 hrs). This study suggests a role for spirometry as an adjunct to clinical evaluation in the early identification of the need for hospitalization of acutely ill asthmatic children.
[Studies on pulmonary gas exchang during intermittent positive pressure breathing and voluntary hyperventilation in patients with bronchial asthma and chronic pulmonary emphysema, with special reference to changes in distribution of ventilation and perfusion].
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Changing patterns of aerosol deposition during methacholine bronchoprovocation.
During bronchoprovocation testing with methacholine, induced changes in airway geometry are known to affect sites of drug deposition. However, it is not known if changes in these sites determine measured responsiveness. We assessed the importance of sites of deposition as determinants of reactivity by comparing particle behavior in two subject groups with and without hyperresponsiveness. By administering radiolabeled aerosols of similar aerodynamic characteristics to methacholine aerosol, we measured the deposition pattern in terms of the specific central to peripheral ratio (sC/P) before and after methacholine inhalation (sC/P1 and sC/P2, respectively) and thereby quantified the changes in deposition sites that occur during the course of a typical bronchoprovocation test. Subjects whose FEV1 decreased by 20 percent or greater were classified as methacholine responsive (MR; nine subjects), and the remainder were classified as non-methacholine responsive (NMR; seven subjects). The two groups had similar baseline FEV1 percent predicted (FEV1 percent) and initial deposition patterns (sC/P1) with particles depositing primarily in peripheral airways (mean +/- SE; sC/P1 1.43 +/- 0.070 and 1.39 +/- 0.65, MR and NMR, respectively, p = NS). Following methacholine inhalation, the deposition pattern changes markedly for all subjects with particles depositing primarily in central airways (sC/P2 2.58 +/- 0.24, p = 0.001, and 2.15 +/- 0.22, p = 0.001 from baseline, p = NS between groups) By definition, the MR subjects had a significantly greater change in FEV1 than the NMR subjects. Preferential deposition in central airways occurs in all subjects during bronchoprovocation testing and does not significantly determine methacholine responsiveness.
Technical and functional assessment of 10 office spirometers: A multicenter comparative study.
STUDY OBJECTIVES: To investigate the technical properties and user friendliness of 10 office spirometers devoted for use in general practice, and to compare the results with standard diagnostic spirometers. DESIGN: Multicenter study. SETTING: Ten spirometer models were tested independently in three pulmonary function laboratories and by three general practitioners (GPs). MEASUREMENTS: The laboratories studied the technical quality of the office spirometers in terms of precision and agreement with standard spirometers, whereas the three GPs assessed their user friendliness. The spirometers tested were as follows: Spirobank (Medical International Research; Rome, Italy); Simplicity (Puritan Bennett; Pleasanton, CA); OneFlow (Clement Clarke International; Harlow, Essex, UK); Datospir 70 (Sibelmed; Barcelona, Spain); Datospir 120 (Sibelmed); SpiroPro (SensorMedics; Yorba Linda, CA); EasyOne (NDD; Zurich, Switzerland); MicroLoop (Micro Medical; Chatham, Kent, UK); SpiroStar (Medikro; Kuopio, Finland); and Pneumotrac (Vitalograph; Maids Moreton, Buckingham, UK). FVC and FEV1 were measured in 399 subjects. User friendliness was assessed by the three GPs using a questionnaire. RESULTS: The precision of FEV1 of the office and standard spirometers was comparable, but three office spirometers had > 200 mL limits of precision for FVC. Some devices presented a proportional difference on the FEV1 with standard spirometers, underestimating the small values. The limits of agreements between standard and some office spirometers for FEV1/FVC ratio was > 10%. The overall user friendliness was estimated as good. CONCLUSIONS: The global quality and user friendliness of several office spirometers make them acceptable for the detection of COPD, although differences between the laboratory and some of the office spirometers values suggest that the misclassification rates may be increased when using some models of office spirometers.