Single-breath gas distribution in chronic obstructive lung disease. Isoproterenol effect on neon dilution volume and diffusing capacity.
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Adult↗
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Results for “Pulmonary Diffusing Capacity”
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Progressive interstitial lung disease from prolonged methotrexate therapy.
Progressive interstitial fibrosis with roentgenographic honeycombing developed in the case of a psoriatic patient who had been on a regimen of methotrexate for 18 years. Examination revealed a combined restrictive and obstructive defect in pulmonary mechanics and severe compromise of gas transfer across the pulmonary alveolar-capillary membrane. Improvement in the level of arterial blood gases and pulmonary diffusing capacity occurred after discontinuation of methotrexate therapy. Interstitial fibrosis of the lung is a potential complication of methotrexate therapy for psoriasis.
Aged↗
Indications of reduced pulmonary function in type 1 (insulin-dependent) diabetes mellitus.
Abnormalities of pulmonary function tests have been described in type 1 (insulin-dependent) diabetes mellitus (IDDM). To better characterise such abnormalities and to verify whether these latter are associated with the presence of diabetic microvascular disease we compared 23 non-smoking patients who had IDDM with 24 non-smoking healthy control subjects strictly matched for sex, age, and body mass index. Compared with controls, diabetic patients had a reduced forced vital capacity (FVC) (87.5 +/- 13.1% vs. 96.4 +/- 13.6% of the predicted; P = 0.03) and forced expiratory volume in 1 s (FEV1) (90.5 +/- 17.7% vs. 101.2 +/- 13.2% of the predicted; P = 0.02). While within the group of patients the presence of retinopathy and autonomic neuropathy were not associated with modifications of pulmonary function tests, those with altered urinary albumin excretion rate (AER > or = 20 micrograms/min; range 21-589) (n = 7) had a significantly lower pulmonary diffusion capacity (DLCO) than the 16 normoalbuminuric subjects (62.6 +/- 7.2% vs. 88.7 +/- 20.1% of the predicted; P = 0.01). Moreover, in the group of patients, DLCO was inversely related with AER (r = -0.43; P = 0.04). In conclusion, IDDM is characterised by reduced FVC and FEV1, while a significant decrease in DLCO may be considered as selectively associated with renal disease.
Adult↗
[The oxygen pathway: how well-built is the respiratory system?].
The question is explored of how the structural systems that constitute the pathway for oxygen from the air through the lung and the circulation of blood to the mitochondria in muscle cells affect the O2 flow rate, and whether their quantitative structural characteristics conform to the hypothesis of symmorphosis which postulates a match of structural design to overall functional demand. By combining physiological and morphometric studies, it is first demonstrated that the diffusing capacity of the human lung is slightly larger than that needed for maximal O2 uptake. Comparative studies of small and large species (from the mouse to the cow) and of athletic and sedentary species pairs (such as horses and cows) show that the design parameters of muscle cells and their mitochondria, of the capillaries, and of blood and circulation are coadjusted to O2 demand by the muscles during exercise. In contrast, the lung is only partially adjusted to this level of demand, a fact which may be related to the slight excess capacity of its gas exchanger. In the organ that forms the interface to the environment this may be a desirable safety factor.
Animals↗
Lung function in essential mixed cryoglobulinemia: a short-term follow-up.
Lung involvement in essential mixed cryoglobulinemia (EMC) has been recently described. In order to assess whether patients with EMC experience an accelerated deterioration of lung function, nineteen patients (17 females, 2 males; 49.6 +/- 6.6 years) underwent a short-term follow-up of lung function, chest X-ray and serologic investigations. Reduction of forced expiratory flows and presence of roentgenologic signs of interstitial involvement were confirmed in the baseline evaluation. In addition, a decrease of diffusing capacity was shown. After a mean interval of 15 months, no significant change in lung function was found, with the exception of decrease in maximal expiratory flow at 50% of forced vital capacity, total lung capacity, functional residual capacity, coefficient of transfer of CO. A slight decrease of hemolitic complement (CH50) and of complement fraction (C3) was also observed. This study suggests that patients with EMC tend to have an involvement of pulmonary interstitial space, possibly related to immune complex deposition, but they do not show a severe decline of lung function. Periodical assessment of lung function and chest X-ray is, however, worthwhile.
Adult↗
Lung development in relation to gas exchange capacity.
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Adolescent↗
What factors explain racial differences in lung volumes?
In order to examine the physical characteristics that may determine racial differences in lung volumes, we studied healthy, nonsmoking Caucasian, Chinese and Indian males of similar ages (range 18-51 yrs). We measured spirometric function, flow volume curves, lung volumes, inspiratory and expiratory muscle pressures, alveolar distensibility and diffusing capacity, together with height, weight and fat free mass. Chest shape was measured using radiographs. The mean total lung capacity and vital capacity in the Caucasian group, expressed as percentage predicted, were 5 and 10% higher than in the Chinese group and 17 and 20% higher than in the Indian group. Chinese values for these measurements were 12 and 10% greater than Indian. We found that Caucasians had higher fat free masses, higher inspiratory and expiratory muscle pressures and wider chests than the other races. The Caucasians and Chinese had longer chests than the Indians. There was no difference in alveolar distensibility or in the diffusion coefficient between the groups. These findings suggest that Caucasians have larger lung volumes than Chinese and Indians because they have increased numbers of alveoli and physically larger chest cavities, and not because of greater alveolar distensibility. Chest dimensions, together with height and race explained 90% of the variation in forced vital capacity and 86% of the variation in total lung capacity. Height multiplied by fat free mass, a "physique factor", previously suggested as the best predictive factor for forced vital capacity in Caucasians, did not account for much of the variation in forced vital capacity between Caucasians and Indians, presumably because it takes no account of differences in chest dimensions.
Adolescent↗
Helium-3 MRI diffusion coefficient: correlation to morphometry in a model of mild emphysema.
Hyperpolarised gases have been most recently used in magnetic resonance imaging to demonstrate new image-derived pulmonary function parameters. One of these parameters is the apparent diffusion coefficient, which reflects the sizes of the structures that compartmentalise gas within the lung (i.e. alveolar space). In the present study, noninvasive parameters were compared to microscopic measurements (mean linear intercept and mean alveolar internal area). Nonselective helium-3 gas density coronal ex vivo images and apparent diffusion maps were acquired in control and elastase-induced panacinar emphysema rats. Total lung capacity was considered the reference for both imaging experiments and lung fixation. A mild degree of emphysema was found based on mean linear intercept (134 +/- 25 microm) versus control (85 +/- 14 microm). The apparent diffusion coefficients were significantly different between the two groups (0.18 +/- 0.02 and 0.15 +/- 0.01 cm2 x s(-1) for elastase and control, respectively). A significant correlation between the apparent diffusion coefficient and corresponding morphometric parameters in mild emphysema was demonstrated for the first time. This study opens the possibility of estimating absolute airspace size using noninvasive techniques.
Animals↗
Asbestos-induced visceral pleural fibrosis reduces pulmonary compliance.
To determine the nature of respiratory functional impairment caused by asbestos-induced visceral pleural fibrosis (VPF) and to discover which pulmonary physiological variable best reveals it, we examined 59 asbestos-exposed construction workers having asbestos-related changes on chest radiographs. Computed tomography scans of the thorax were also performed. Visceral pleural fibrosis was diagnosed in 29 subjects: seven had only VPF, 17 had VPF and pleural plaques, and five had VPF, plaques, and asbestosis. In subjects without VPF, 23 had plaques, six had plaques and asbestosis, and one had only minor fibrotic parenchymal changes insufficient for a diagnosis of asbestosis. Flow-volume spirometry, body plethysmography, static and dynamic compliance, and pulmonary diffusing capacity for carbon monoxide were measured. The subjects with VPF had significantly lower static (p = 0.005) and dynamic (p = 0.007) compliance values than those without. Other respiratory function variables failed to show any significant differences. We conclude that the measurement of static and dynamic compliance is a useful method in assessing pulmonary function impairment caused by visceral pleural fibrosis.
Adult↗
Higher arterial oxygen saturation during submaximal exercise in Bolivian Aymara compared to European sojourners and Europeans born and raised at high altitude.
Arterial oxygen saturation (SaO(2)) was measured at 3,600-3,850 m by pulse oximetry at rest and during submaximal exercise in three study groups: 1) highland Aymara natives of the Bolivian altiplano (n = 25); 2) lowland European/North American sojourners to the highlands with at least 2 months of acclimatization time to 3,600 m (n = 27); and 3) subjects of European ancestry born and raised at 3,600 m (n = 22). Aymara subjects maintained approximately 1 percentage point higher SaO(2) during submaximal work up to 70% of their maximal work capacity, and showed a smaller rate of decline in SaO(2) with increasing work compared to both European study groups. The higher-exercise SaO(2) of Aymara compared to Europeans born and raised at 3,600 m suggests genetic adaptation. The two European study groups, who differed by exposure to high altitude during their growth and development period, did not show any significant difference in either resting or exercise SaO(2). This suggests that the developmental mode of adaptation is less important than the genetic mode of adaptation in determining exercise SaO(2). A weak correlation was detected (across study groups only) between the residual forced vital capacity (FVC) and the residual SaO(2) measured at the highest level of submaximal work output (P = 0.024, R = 0.26). While firm conclusions based on this correlation are problematic, it is suggested that a part of the higher SaO(2) observed in Aymara natives is due to a larger lung volume and pulmonary diffusion capacity for oxygen. Results from this study are compared to similar studies conducted with Tibetan natives, and are interpreted in light of recent quantitative genetic analyses conducted in both the Andes and Himalayas.
Adaptation, Physiological↗
Scanning electron microscope study of the morphology of the reptilian lung: the Savanna monitor lizard Varanus exanthematicus and the pancake tortoise Malacochersus tornieri.
The morphology of the lungs of two reptilian species, Varanus exanthematicus and Malacochersus tornieri, have been studied on gross preparations, latex casts, and critical-point-dried tissues. The shape of these lungs was observed to conform with that of the body, the lung of the monitor lizard (Varanus) being long and ovoid while that of the pancake tortoise (Malacochersus) was rounded and laterally indented. With respect to the size distribution of the gas exchange compartments, the lungs were observed to be notably heterogenous. In both species these units were generally smaller in diameter in the cranial region of the lung while those in the caudal region were larger. The gas exchange compartments in the tortoise were more profusely compartmented with the primary, secondary, and tertiary septa being well developed while in the lizard only the primary and secondary septa were observed. The tertiary septa in the tortoise lung and the secondary septa in that of the monitor lizard defined the terminal gas exchange units, the faveoli. The cast impressions closely resembled the actual lung tissue and convincingly revealed the hierarchical design of the gas exchange compartments as they radiate from the air chambers and ducts, terminally giving rise to the faveoli. This stratification clearly increases the surface area available for gas exchange in these lungs. Disparate refinements of the basic reptilian lung design, as noted here, may lead to differing anatomic pulmonary diffusing capacities for oxygen to which characteristics like energetics and mode of respiration in this taxon may be attributed.
Animals↗
[Evaluation of interstitial shadows by thin slice computed tomography].
We developed a method for evaluation of interstitial shadows by thin slice computed tomography (CT). We studied thirty-seven cases with interstitial shadows confirmed by thin slice CT, and 13 normal cases. Thin slice CT was scanned on 3 levels: 1) at the aortic arch, 2) about 2 cm below the carina, and 3) about 1 cm above the right diaphragm. Each level was scanned bilaterally to produce 6 regions of interest (ROI); CT numbers were recorded from each ROI. CT numbers ranging from -1000 to 100 Hounsfield units (H.U.) were classified into 4 different bands, -1000 - (-900) H.U. (low band), -900 - (-750) H.U. (medium low band), -750 - (-500) H.U. (medium high band), and -500 - 100 H.U. (high band), for cases with interstitial shadows and for normal cases. We calculated the prevalence of CT numbers in each band for both normals and subjects with interstitial shadows. Compared to the normals, subjects with interstitial shadows showed fewer pixels in the medium low band and more pixels in the medium high and high bands. Furthermore, the prevalence of CT numbers in each band correlated with %TLC, %VC, and pulmonary diffusing capacity. We conclude that thin slice CT is a useful method for evaluation of the extent and characteristics of interstitial shadows.
Alveolitis, Extrinsic Allergic↗
Compromised respiratory function in postnatal lambs after placental insufficiency and intrauterine growth restriction.
Epidemiologic studies have shown persistent effects of low birth weight on respiratory function and lung health, but underlying mechanisms are not understood. Our aim was to determine the effects of intrauterine growth restriction (IUGR), a major cause of low birth weight, on postnatal respiratory function. IUGR was induced by umbilico-placental embolization during late gestation in chronically catheterized sheep. Umbilico-placental embolization was performed between 120 d of gestation and term ( approximately 146 d) during which fetuses were hypoxemic and hypoglycemic relative to controls. Umbilico-placental embolization led to a 48% reduction in birth weight compared with controls, and throughout the postnatal study period IUGR lambs (n = 8) remained lighter than controls (n = 8). Respiratory function was repeatedly studied in lambs for 8 wk after birth; during this period, IUGR lambs were mildly hypoxemic and tended to be hypercapnic compared with controls. In IUGR lambs, relative to controls, O(2) consumption (mL/min/kg) and minute ventilation (mL/kg) were increased and pulmonary diffusing capacity (adjusted for functional residual capacity) was decreased. Functional residual capacity, measured by helium dilution, and total lung capacity (measured at 30 cm H(2)O) were smaller in IUGR lambs than in controls. When adjusted for functional residual capacity, static lung compliance was reduced and chest wall compliance was increased in IUGR lambs. At 8 wk, pulmonary DNA and protein concentrations were decreased in IUGR lambs relative to controls. We conclude that restriction of fetal growth by placental insufficiency induces alterations in the lungs and chest wall that result in persistent impairments in respiratory function during early postnatal life.
Animals↗
Oxygen transfer kinetics of red blood cells of the turtle Pseudemys scripta elegans.
The kinetics of O2 uptake into, and release from, the red blood cells (RBC) of the turtle Pseudemys scripta elegans were determined with a stopped-flow technique at varied temperature (10-30 degrees C) and pH (7.5-7.9). The results were compared to those obtained for RBC of other vertebrates and related to morphometric and physiological data on gas/blood diffusion in turtle lungs. The O2 transfer conductance of RBC, G, for O2 release into high concentrations of dithionite, considered to represent the best estimate of true RBC transfer conductance for O2 uptake and release, averaged 0.17 +/- 0.01 at 30 degrees C, 0.13 +/- 0.01 at 20 degrees C, 0.09 +/- 0.01 at 10 degrees C (mean +/- SD, in mmol.min-1.Torr-1.(mlRBC)-1). These values are about one half the corresponding value for human RBC, and this difference may be due to the larger size of turtle RBC (volume, 327 microns 3) compared to human RBC (90 microns 3). The temperature dependence of G, Q10 = 1.3 indicates that, as in human RBC, diffusion through aqueous media is the main limiting factor for O2 exchange. Morphometric data on the lungs of Pseudemys scripta suggest that the resistance to O2 transfer by RBC is lower than that offered by the gas-blood barrier. The total apparent transfer resistance to CO, obtained from previous measurements of pulmonary diffusing capacity for CO in the same species, is much higher than that predicted from the combination of RBC O2 kinetics and morphometric data on gas-blood barrier.
Animals↗
The diagnostic value of conventional X-ray examination of the lungs in comparison with high-resolution computed tomography (HRCT), isotope perfusion scintigraphy and the diffusion capacity in patients with pneumoconiosis.
A precise diagnosis of initial reticular forms of pneumoconioses is very difficult. The present study focuses on 30 patients with initial reticular forms of silicosis, asbestos induced interstitial lung fibrosis, mixed dust pneumoconioses and pneumoconioses of electrowelders. The anterior-posterior chest radiography (according to the ILO International Radiological Classification of Pneumoconioses, 1980), high-resolution computed tomography (HRCT), perfusion scintigraphy with 99mTc and the changes in the diffusion capacity were compared. The diagnostic value of these methods was assessed. The study continues by expanding the groups of patients examined and by including the membrane component of diffusion.
Adult↗
Effect of percutaneous transcatheter embolization on pulmonary function, right-to-left shunt, and arterial oxygenation in patients with pulmonary arteriovenous malformations.
The effects of percutaneous transcatheter embolization on pulmonary function and exercise capacity were assessed in 15 patients with pulmonary arteriovenous malformations (PAVM). Vital capacity (VC), FEV1, DLCO, SaO2, exercise performance, and right-to-left shunt (100% oxygen method) were measured before and 2 to 6 months after treatment. Surgical correction had been attempted in 9 patients prior to referral, and 11 had associated hereditary hemorrhagic telangiectasia (HHT). Lung function tests before intervention showed normal VC and FEV1/VC ratios, reduced DLCO (mean 71% predicted, range 36 to 123%), a resting supine SaO2 of 86% (range 67 to 95%) and mean shunt fraction of 33% (range 15 to 47%). Despite further marked falls in SaO2 on exertion, exercise capacity was well preserved. Following steel coil embolization of all PAVM with a feed vessel internal diameter greater than 3 mm (one to four sessions per patient), mean shunt fraction improved from 33 to 19% and resting SaO2 from 86 to 92% with no change in VC. A consistent improvement in diffusing capacity was seen only in patients with coexisting HHT. Exercise capacity increased in the majority (unchanged in 6), and SaO2 during maximal exercise improved in all except one patient. There were no long-term complications following embolization. These findings indicate that embolization of all macroscopic PAVM, undertaken primarily to reduce the risk of paradoxical embolization, is safe and results in substantial improvements in resting and exercise SaO2 without evidence of loss of normal lung. The right-to-left shunts remaining following embolization may reflect the presence of numerous microscopic PAVM in these patients.
Adolescent↗
Upper abdominal surgery: does a lung function test exist to predict early severe postoperative respiratory complications?
We evaluated the capacity to predict severe respiratory complications (SRCs) following upper abdominal surgery (UAS) by using the results of a respiratory questionnaire and preoperative pulmonary function tests. Lung volumes, flows and transfer factor of the lung for carbon monoxide (TL,CO,sb) were assessed in 361 consecutive adult patients (248 males and 113 females). SRCs were diagnosed 24 h after UAS by clinical examination and chest radiography. Univariate and stepwise multiple logistic regression analyses were performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of each single input variable, and to determine which indices best predicted outcome. These patients had a 1% mortality rate and 14% incidence of SRCs, with a male:female ratio of 0.86. The best predictors for SRCs by multiple analysis were: preoperative current hypersecretion of mucus (OR=133; p<0.0001); an increase in residual volume (RV) (OR=3.11; p=0.01); and, to a lesser extent, low percentage of predicted values both of forced expiratory volume in one second (FEV1 % pred) and TL,CO,sb. The algorithm thus obtained (logit theta) was extremely sensitive (84%), specific (99%), and accurate (95%) for preoperative prediction of SRCs. We have found that preoperative current hypersecretion of mucus and pulmonary hyperinflation, and to a lesser extent percentage predicted values both of forced expiratory volume in one second and transfer factor of the lung for carbon monoxide, have a significant predictive capacity for severe respiratory complications following upper abdominal surgery.
Abdomen↗
Application of linear integration in the morphometric study of mild and severe pulmonary alveolar injury.
In this study we applied linear integration morphometry to characterize the pulmonary alveolar reaction to toxic injury and to study possible relationships between the major tissue and cell compartments of alveolar tissue, normal and injured. Acute alveolar injury of mild and severe intensity was induced in Swiss-Webster mice by the ip administration of the chemicals diquat (4 mg/kg) and butylated hydroxytoluene (BHT; 400 mg/kg). Animals were sacrificed at Days 1 and 2 after diquat treatment and at Days 1, 3, and 5 after BHT treatment. Sampling and analysis of alveolar tissue were conducted at both levels of light and electron microscopy. Thickness distributions of arithmetic and reciprocal intercepts, as well as the arithmetic (tau) and harmonic (tau h) mean thicknesses, were established for the following alveolar compartments: septum, alveolo-capillary barrier (ACB), type I and total epithelia, capillary endothelium, and interstitium. A relative measure of the pulmonary diffusion capacity and the capillary load of alveolar septa were also determined. The parameters calculated from these thickness distributions, such as their slopes, percentages of thin intercepts, and tau/tau h ratios, proved very sensitive and useful in the detection and characterization of morphological alterations in the type I epithelial and capillary endothelial cells following either mild or severe alveolar injury. The epithelial, endothelial, and interstitial layers of pulmonary septa were all characterized by their own pattern of structural changes, so that it proved impossible to relate them in a simple way to the tissue reaction, which can be easily studied at the light microscopic level. Linear integration morphometry thus proved very useful as a morphometric approach to the study of pulmonary alveolar injury and repair.
Animals↗