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PubMed1975

Positive airway pressure and vertical transpulmonary pressure gradient in man.

Static transpulmonary pressure (Pao-Pes) and the vertical gradient of transpulmonary pressure were determined in five sitting conscious normal subjects at mean airway pressures of 0 (ambient), 11, and 21 cmH2O. All subjects exhibited a nonuniform transpulmonary pressure gradient down the esophagus. The vertical pressure gradient was consistently larger in the lower (8-20cm below esophageal artifact) than in the middle region (0-8cm) of the esophagus. The gradient was not significantly altered by continuous positive airway pressure (11 and 21 cmH2O) or by changes in lung volume (60, 70, and 80% of total lung capacity (TLC)). Continuous positive airway pressure also did not result in a consistent change of the overall static pressure-volume curve of the lung. There was a small but statistically significant increase in TLC with each increase in airway pressure.

Biomechanical Phenomena↗
PubMed2004

On defining total lung capacity in the mouse.

Maximal lung volume or total lung capacity in experimental animals is dependent on the pressure to which the lungs are inflated. Although 25-30 cm H2O are nominally used for such inflations, mouse pressure-volume (P-V) curves show little flattening on inflation to those pressures. In the present study, we examined P-V relations and mean alveolar chord length in three strains (C3H/HeJ, A/J, and C57BL/6J) at multiple inflation pressures. Mice were anesthetized, and their lungs were degassed in vivo by absorption of 100% O2. P-V curves were then recorded in situ with increasing peak inflation pressure in 10-cm H2O increments up to 90 cm H2O. Lungs were quickly frozen at specific pressures for morphometric analysis. The inflation limbs never showed the appearance of a plateau, with lung volume increasing 40-60% as inflation pressure was increased from 30 to 60 cm H2O. In contrast, parallel flat deflation limbs were always observed, regardless of the inflation pressure, indicating that the presence of a flat deflation curve cannot be used to justify measurement of total lung capacity in mice. Alveolar size increased monotonically with increasing pressure in all strains, and there was no evidence of irreversible lung damage from these inflations to high pressures. These results suggest that the mouse lung never reaches a maximal volume, even up to nonphysiological pressures >80 cm H2O.

Animals↗
PubMed1991

Preoperative lumbar epidural morphine improves postoperative analgesia and ventilatory function after transsternal thymectomy in patients with myasthenia gravis.

OBJECTIVE: To test the hypothesis that preoperative lumbar epidural morphine improves postoperative pain control and ventilatory function after transsternal thymectomy in patients with myasthenia gravis. DESIGN: The study design was randomized, placebo-controlled, and double-blind. SETTING: After surgery, all patients were admitted to the Neuroscience Critical Care Unit for evaluation and treatment. PATIENTS: All patients with myasthenia gravis who presented to the hospital for thymectomy were asked to participate in the study. Twenty patients were randomized to either the placebo or epidural morphine groups. INTERVENTIONS: Patients received either epidural morphine (7 mg in 14 mL of sterile saline) or saline (14 mL) before induction of anesthesia. Supplemental iv opioids were administered intraoperatively, with need determined by the anesthesiologist. MAIN OUTCOME MEASURES: The main outcome measures were indicators of postoperative pain (e.g., Visual Analog Pain Score, requirement for supplemental opioid administration, respiratory rate) and ventilatory function (e.g., forced vital capacity, negative inspiratory pressure). RESULTS: Immediately after surgery, the Visual Analog Pain Score in the placebo group was twice as high as the score in the epidural morphine group (placebo 7.0 +/- 1.3; epidural morphine 3.5 +/- 1.2, p less than or equal to .05). During the first eight postoperative hours, the placebo group required more opioids (0.22 +/- 0.03 vs. 0.12 +/- 0.04 mg/kg morphine equivalents, p less than or equal to .06) than the epidural morphine group. Later, both groups received similar amounts of opioids. Patients receiving epidural morphine had better initial recovery of forced vital capacity (at 8 hrs: 55 +/- 6% [epidural morphine] vs. 34 +/- 5% [placebo] of preoperative value, p less than or equal to .05). Respiratory rate was lower for the first 12 postoperative hours in the epidural morphine group, without a difference in PaCO2. There was no difference between groups for the duration of postoperative intubation or ventilation. CONCLUSIONS: Preoperative lumbar epidural morphine facilitates postoperative analgesia and improves initial postoperative ventilatory performance.

Adult↗
PubMed2005

Respiratory failure in Pompe disease: treatment with noninvasive ventilation.

In this study, noninvasive ventilation (NIV) was prospectively applied to eight patients (35.8 +/- 11.4 years) with late-onset Pompe disease and respiratory failure apparent from severe restrictive lung disease, nocturnal hypoxemia (83 +/- 8%), and daytime hypercapnia (66.7 +/- 17.9 mm Hg). The impact of NIV on respiratory function was followed for 34 +/- 17 months. Despite further decrease of vital capacity and inspiratory muscle strength, NIV normalized oxygen saturation during sleep (96 +/- 1%), daytime carbon dioxide tensions (44.1 +/- 3.6 mm Hg), and symptoms.

Adolescent↗
PubMed2005

Spirometry: an essential clinical measurement.

BACKGROUND: Respiratory disease is common and amenable to early detection and management in the primary care setting. Spirometric evaluation of ventilatory function plays a critical role in the diagnosis, differentiation and management of respiratory illness such as asthma, chronic obstructive pulmonary disease and restrictive lung disorders, and is important in the assessment of lung health in smokers and those exposed to occupational and environmental hazards. OBJECTIVE: This article covers the basic theory, fundamentals of test indications, performance and equipment, the interpretation of results and the nuances behind the spirogram and the flow-volume curve. DISCUSSION: The use of spirometry by primary care physicians, practice nurses and physiotherapists is now practicable and supported by a comprehensive range of devices, training courses and reference materials. Systematic use of ventilatory assessment both in the clinic and with patient self monitoring of peak flow and FEV1 has the capacity to improve patient understanding, confidence in self management, and quality of life for those with lung disease. Spirometry may also provide a useful modality for following the progress of those with neuromuscular disease and incipient respiratory muscle weakness and for the promotion of respiratory health in the community setting, although further research in all these areas is required.

Forced Expiratory Volume↗
PubMed1988

Lung function impairment as a guide to exercise limitation in work-related lung disorders.

The hypothesis that exercise limitation of respiratory origin can be predicted accurately from the lung function impairment has been tested using maximal oxygen uptake (VO2max) as the dependent variable in a multiple regression analysis. The subjects were 157 men who met objective criteria for exercise being limited by respiratory impairment. VO2max (mean value, 1.38 L min-1) was described by FEV1 and single-breath lung transfer factor (diffusing capacity) for carbon monoxide (TL') singly or in combination, but the accuracy was poor (at best, standard error of the estimate, 0.36 L min-1; r2, 29.1%). FEV1 could be replaced by FVC and FEV1/FVC. Description of VO2max was improved by also including in the equation the variables age, fat-free mass, and submaximal exercise ventilation (VE). Transfer factor did not then contribute significantly. VO2max as percent of predicted (mean value of 60%) was described by %FVC or %FEV1, but the accuracy was poor (SEE, 16.0%; r2, 14%). Prediction was improved somewhat by the alternative use of inspiratory vital capacity and FEV1/FVC. Transfer factor did not contribute additional information; however, inclusion of VE materially improved the accuracy (SEE, 12.9%; r2, 44%). Among a subgroup of 35 men whose lung disease was due to asbestos, %TL' or transfer factor measured using a multibreath estimate of residual volume (%TLCO) made a small contribution to the explained variance, e.g.: %VO2max = 0.44% FEV1 -0.78 VE + 0.16% TLCO + 52.3 SEE 7.27%. This equation also described the %VO2max of all subjects (SEE, 13%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Pulmonary O2 uptake on-kinetics in endurance- and sprint-trained master athletes.

The purpose of this study was to characterise the VO2 kinetic response to moderate intensity cycle exercise in endurance-trained (END) and sprint or power-trained (SPR) track and field master athletes ranging in age from 45 to 85 years. We hypothesised that the time constant (tau) describing the Phase II VO2 on-response would be smaller in the END compared to the SPR athletes, and that the tau would become greater with increasing age in both groups. Eighty-four master athletes who were competing at either the British or European Veteran Athletics Championships acted as subjects, and were classified as either END (800 m - marathon; n = 41), or SPR (100 - 400 m and field events; n = 43) specialists. Subjects completed two 6 minute "step" transitions to a work rate of moderate intensity on a cycle ergometer and pulmonary gas exchange was measured breath-by-breath. Analysis of variance revealed that SPR athletes had slower VO2 on-kinetics (i.e., greater tau) compared to END athletes at each of the age groups studied: 46 - 55 yrs (END: 25 +/- 6 vs. SPR: 36 +/- 9 s; p < 0.10), 56 - 65 yrs (END: 25 +/- 5 vs. SPR: 35 +/- 10 s; p < 0.05), 66 - 75 yrs (END: 29 +/- 10 vs. SPR: 40 +/- 13 s; p < 0.05), and 76 - 85 yrs (END: 31 +/- 10 vs. SPR: 51 +/- 18 s; p < 0.05). The VO2 on-kinetics became slower with advancing age in the SPR athletes (p < 0.05 between 56 - 65 and 76 - 85 yrs) but were not significantly changed in the END athletes. The slower VO2 on-kinetics in SPR compared to END master athletes is consistent both with differences in physiology (e.g., muscle fibre type, oxidative/glycolytic capacity) and training between these specialist athletes. Master END athletes have similar tau values to their younger counterparts (approximately 25 s) suggesting that participation in endurance exercise training limits the slowing of VO2 on-kinetics with age in this population.

Aged↗
PubMed2000

Effects of inhaled steroids on methacholine-induced bronchoconstriction and gas trapping in mild asthma.

According to a recent hypothesis, airway smooth muscle regulates airway calibre mostly at high lung volume, whereas the mucosa and adventitia dimensions dominate at low lung volumes. It was thought that if inhaled steroids decrease the thickness of airway wall in asthma, then forced vital capacity (FVC), which reflects the functional changes at low lung volume, should decrease less during induced bronchoconstriction than flow at high volume. The study was conducted in 31 mild asthmatics under control conditions and during a methacholine challenge before and after 4-weeks treatment with inhaled fluticasone dipropionate (1.5 mg daily, 16 patients) or placebo (15 patients). After fluticasone dipropionate treatment, control forced expiratory volume in one second (FEV1), and maximal flow at 50% of control FVC during forced expiration after a maximal (V'max,50) and a partial inspiration (V'p,50) significantly increased. During methacholine challenge, FVC decreased less than did FEV1 or V'max,50, and so did inspiratory vital capacity compared to V'p,50. Both the provocative dose of methacholine causing a 20% fall in FEV1 and the bronchodilator effect of deep inhalation significantly increased. The latter was assessed by means of the regression coefficient of all V'max,50 plotted against V'p,50. No significant changes in these parameters occurred after placebo. These data show that inhaled steroids remarkably blunt the occurrence of gas trapping during induced bronchoconstriction in mild bronchial asthma, possibly due to their effect on airway wall remodelling.

Administration, Inhalation↗
PubMed2002

Exercise hypercapnia in advanced chronic obstructive pulmonary disease: the role of lung hyperinflation.

In severe chronic obstructive pulmonary disease (COPD), carbon dioxide retention during exercise is highly variable and is poorly predicted by resting pulmonary function and arterial blood gases or by tests of ventilatory control. We reasoned that in patients with compromised gas exchange capabilities, exercise hypercapnia could be explained, in part, by the restrictive consequences of dynamic lung hyperinflation. We studied 20 stable patients with COPD (FEV(1) = 34 +/- 3 percent predicted; mean +/- SEM) with varying gas exchange abnormalities (Pa(O(2)) range, 35 to 84 mm Hg; Pa(CO(2)) range, 31 to 64 mm Hg). During symptom-limited maximum cycle exercise breathing room air, Pa(CO(2)) increased 7 +/- 1 mm Hg (p < 0.05) from rest to peak exercise (range, -6 to 25 mm Hg). We measured the change in Pa(CO(2)) after hyperoxic breathing at rest as an indirect test of ventilation-perfusion abnormalities. The change in Pa(CO(2)) from rest to peak exercise correlated best with the acute change in Pa(CO(2)) during hyperoxia at rest (r(2) = 0.62, p < 0.0005) and with resting arterial oxygen saturation (r(2) = 0.30, p = 0.011). During exercise, the strongest correlates of serial changes in Pa(CO(2)) from rest included concurrent changes in end-expiratory lung volume expressed as a percentage of total lung capacity (partial correlation coefficient [r] = 0.562, p < 0.0005) and oxygen saturation (partial r = 0.816, p < 0.0005). In severe COPD, the propensity to develop carbon dioxide retention during exercise reflects marked ventilatory constraints as a result of lung hyperinflation as well as reduced gas exchange capabilities.

Carbon Dioxide↗
PubMed1998

[Respiratory muscle function and serum enzymology in hyperthyroidism before and after treatment].

To investigate the effect of hyperthyroidism on respiratory muscle function and its possible mechanism, the thyroid function, serum enzymology, serum potassium, pulmonary function and respiratory muscle function were examined in 60 patients with Grave's disease before treatment and 26 patients among them after treatment, and 20 normal subjects as control. T3, T4, and FT4 increased while FVC and PImax, which reflect the respiratory muscle strength, and Pi/PImax, which reflects the reserve capacity of inspiratory muscle, decreased significantly in the 60 patients with Grave's disease, compared with the ones of normal subjects. The comparison of above measurements in the 26 patients between before- and after-treatment showed that respiratory muscle strength increased obviously along with the improvement of throid function. The serum enzymology, potassium and TSH, however, were not abnormal and not changed after treatment. The thyroid functions in 10 patients with hyperthyroid heart disease were not different, compared with the ones of other 50 patients without hyperthyroid heart disease, but their respiratory muscle strength was significantly lower than the ones of latter. The above results suggested that hyperthyroidism could lead to significant decrease of respiratory muscle strength and its reserve capacity, whereas treatment for hyperthyroidism would improve respiratory muscle function, so the measurement of respiratory muscle function in hyperthyroidism cases might be useful in prediction of hyperthyroid heart disease.

Adult↗
PubMed1979

Prolonged respiratory paralysis in wound botulism.

Two patients had wound botulism with longer duration of respiratory paralysis than previously described. Each sustained extensive trauma to soft tissues and grossly contaminated wounds when thrown from a vehicle in a rural area. Progressive muscular weakness and respiratory distress occurred 8 and 13 days after injury, in the presence of infected wounds and clinical and laboratory findings characteristic of botulism. Spontaneous vital capacity and inspiratory effort served as bedside indicators of ventilatory function throughout 11 weeks of ventilatory support in each case and paralleled other clinical assessments of progress and recovery. Wound botulism may result in neuromuscular paralysis for a prolonged period. These cases illustrate the primary role of scrupulous nursing and respiratory care throughout such a period of ventilatory insufficiency.

Adult↗
PubMed2003

[Specifying work and rest schedule for those using heavy individual means of respiratory system protection].

The authors present data concerning influence of gas-masks with higher respiratory resistance on functional state of subjects performing physical and operator tasks. Finding are that only individuals with high general capacity for work (PWC170 over 3.0 W/kg of body weight) could perform tasks in heavy gas-masks, therefore only for them the specification of work and rest schedule is possible. Real flow rates for inspiration and expiration under physical load in gas-mask occurred exceeding the value (30 l/min) that is accepted in national standards and servers for calculating the individual respiratory protective means resistance to air flow.

Adaptation, Physiological↗
PubMed1991

[Forced expiration and inspiration under hyperbaric conditions].

In 37 healthy men aged 23-53 years the ratio of one-second and forced vital capacity of the lungs during forced inspiration and expiration FIV1/FIVC and FEV1/FEVC was recorded, (i.e. 0.901 as compared with MPa) a significantly higher value of FIV1/FIVC than of FEV1/FEVC was recorded, (i.e. 0.901 as compared with 0.857, p less than 0.05), at pressure of 0.4 MPA the reverse occurred: variable FIV1/FIVC was substantially smaller than FEV1/FEVC (0.635 vs. 0.731, p less than 0.01). The authors express the view that this phenomenon could be explained by the theory which assumes that the expiratory muscles in healthy subjects do not display during forced expiration their maximum strength and only under hyperbaric conditions when the stream resistance of the airways rises their strength is fully used. On the other hand, the maximal strength of the inspiratory muscles is involved already during normal pressure and thus a significant increase cannot occur under conditions of overpressure.

Adult↗
PubMed1979

Pulmonary function in identical twins: comparison of nonsmokers and smokers.

Forty-five apparently normal pairs of identical twins were given pulmonary function tests to determine the role of genetics in bronchial susceptibility to cigarette smoke. Maximal expiratory flow at 60 per cent of total lung capacity (Vmax60) was the best discriminator of smokers from nonsmokers among pairs in which one member smoked and the other did not. The intrapair difference of Vmax60 values in pairs in which both members smoked was the same as in pairs in which both members did not smoke. These data support the view that genetic factors are important in determining the vulnerability of the airways to cigarette smoke.

Adult↗
PubMed1979

Pulmonary function and maximum exercise responses following acute ozone exposure.

We examined changes in pulmonary function during resting exposure to concentrations of ozone at 0.75, 0.50, 0.25, and 0.00 parts/million (ppm), and determined the effect these exposures had on a subsequent maximum exercise test using filtered air. In order to determine if recovery of pulmonary function would be facilitated by increased ventilation due to maximum exercise, a control condition was conducted with subjects resting for a period equivalent to the maximum exercise condition. Eight males and five females participated in eight different conditions in order to answer these two questions. Resting 2-h exposure to 0.75 and 0.50 ppm ozone caused significant decrements in forced vital capacity of 10% and 5%, respectively. However, 0.00 and 0.25 ppm ozone induced no pulmonary decrement. None of the pollutant conditions reduced subsequent maximum exercise performance (ml O2.min-1.kg-1, heart rate, and total performance time). The pulmonary function responses after the maximum capacity test returned to pre-ozone values for the 0.50 ppm condition, but were still significantly decreased for the 0.75 ppm condition. The increased ventilatory exchanges from maximum exercise did not facilitate the return of pulmonary function. It appeared that increased ventilation during ozone exposure plays a significant role only in inducing pulmonary function decrement, but not in facilitating the return of pulmonary function to normal values.

Adult↗
PubMed2005

Comparison of the acute effect of tiotropium versus a combination therapy with single inhaler budesonide/formoterol on the degree of resting pulmonary hyperinflation.

In 20 COPD patients (FEV(1) < or =65% predicted, IC<80% predicted), we evaluated changes in the degree of pulmonary hyperinflation after acute administration of tiotropium 18 microg or budesonide/formoterol 320/9 microg. The study consisted of a screening visit and two study days separated by at least one week. Functional parameters were measured before and 30, and 120 min after inhalation of single study drug. Both tiotropium and budesonide/formoterol induced significant changes in functional parameters after 30 and 120 min. However, the impact of tiotropium on the degree of pulmonary hyperinflation was larger than that of budesonide/formoterol, although only differences in IC and TGV between the two treatments were significant (P<0.05), at least after 120 min, whereas those in RV were not significant. The documentation that tiotropium is able to modify IC even after an acute administration indicates its capacity of influencing expiratory flow limitation in a very fast manner and this is an important finding. In fact, changes in IC after bronchodilators in patients with COPD with expiratory flow limitation at rest may represent an objective tool for prescribing these drugs to attain symptomatic improvement and better quality of life, even in the absence of a significant increase in FEV(1).

Aged↗
PubMed1984

Vascular rings and slings: long-term follow-up of pulmonary function.

Between 1968 and 1983, 54 patients underwent surgery for symptomatic aortic arch and pulmonary artery anomalies at St Christopher's Hospital for Children. Presenting symptoms included stridor, wheeze, apnea, recurrent pulmonary infections, or dysphagia. Diagnosis was established with chest roentgenogram, bronchoscopy, barium esophagram, and arteriography. Four types of vascular anomalies were encountered; double aortic arch (24 patients), right aortic arch with left ligamentum arteriosum (17 patients), anomalous innominate artery (10 patients), and pulmonary artery sling (three patients). There were no intraoperative deaths and only one postoperative death. All surviving patients had immediate relief of their severe respiratory or swallowing symptoms. Mild respiratory symptoms persisted postoperatively from 3 months to 4 years and included frequent or severe upper respiratory infections, persistent cough, stridor and pneumonia. Five of the 53 surviving patients were lost to follow up. The remaining 48 patients were followed from 6 months to 14 years and all but one patient noted complete resolution of all respiratory symptoms. Twenty-nine patients at follow up were old enough to undergo pulmonary function testing including vital capacity, functional residual capacity, and inspiratory and expiratory flow volume loops. Seventeen of these 29 asymptomatic patients consented to these studies, and nine of these patients had abnormal flow volume loops indicative of significant central airway obstruction; the other eight studies were normal. We conclude that surgical repair for vascular rings and slings is safe and symptomatically efficacious. However, anatomic tracheal or bronchial distortion persists in a significant number of these patients as evaluated by pulmonary function studies.

Adolescent↗
PubMed1988

Volumes and breathing patterns during speech in healthy and asthmatic subjects.

The lung volumes and ventilatory patterns used by 10 healthy subjects and 14 patients with varying degrees of asthma were studied. The protocol included conversation, monologue, and counting at two loudness levels. Lung-volume changes were measured with a Respitrace and recorded with associated speech sounds. Volumes, durations, and flows were analyzed for sequences of respiratory cycles. Asthmatics used a greater percentage of their reduced vital capacity. Their inspiratory flow rates were slower, and expiratory rates faster. Asthmatics spent a greater proportion of the total respiratory cycle time on inspiration, and expired a greater volume of gas without sound. Patterns of ventilation suggested that asthmatics favored respiratory over communication needs to a greater extent than healthy subjects. Activities that forced priority to communication needs (counting to a metronome) were inadequate for gas exchange in asthmatics and could be sustained for only a limited period of time.

Asthma↗