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PubMed2001

Analysis of forced expired volume signals using multi-exponential functions.

Patients with pulmonary disease are often unable to complete forced expiration manoeuvres. The aim of the study is to evaluate whether forced vital capacity (FVC), the volume exhaled at the end of completed forced expiration, can be estimated by extrapolating volume-time curves obtained from uncompleted manoeuvres. The suitability of mono-, bi-, and tri-exponential functions to characterise complete volume-time curves from 50 subjects is investigated. Mono-exponential modelling is insufficient, whereas bi-exponential fitting yields an adequate description for 47 data sets. Tri-exponential models lead to overfitting in all but three cases (normalised sum of least squares: 50.2 +/- 34.5 for mono-, 2.76 +/- 4.11 for bi-, 2.74 +/- 4.19 for tri-exponential modelling; condition number of the correlation matrix: 1.0025 +/- 0.0004 for mono-, 1.08 +/- 0.08 for bi-, 34.7 +/- 100.1 for tri-exponential fitting (mean +/- SD)). Thus, FVC is estimated by the extrapolation of 27 uncompleted spirograms using bi- or tri-exponential models, depending on their accordance with measured data and on the identifiability of their parameters. This algorithm yields unbiased estimates (difference from measured inspiratory vital capacity: 0.01 +/- 0.21 L). This method can be used for investigation of the lung function of subjects who cannot complete the forced expiration manoeuvre.

Adolescent↗
PubMed2005

Assisted cough and pulmonary compliance in patients with Duchenne muscular dystrophy.

The aim of this study was to investigate the factors affecting cough ability, and to compare the assisted cough methods in patients with Duchenne muscular dystrophy (DMD). A total seventy-one male patients with DMD were included in the study. The vital capacity (VC) and maximum insufflation capacity (MIC) were measured. The unassisted peak cough flow (UPCF) and three different techniques of assisted peak cough flow were evaluated. UPCF measurements were possible for all 71 subjects. But when performing the three different assisted cough techniques, peak cough flows (PCFs) could be obtained from only 51 subjects. The mean value of MICs (1801 +/- 780 cc) was higher than that of VCs (1502 +/- 765 cc) (p< 0.01). All three assisted cough methods showed a significantly higher value than the unassisted method (F=80.92, p< 0.01). The manual assisted PCF under MIC (MPCFmic) significantly exceeded those produced by manual assisted PCF (MPCF) or PCF under MIC (PCFmic). The positive correlation between the MIC, VC difference (MIC-VC), and the difference between PCFmic and UPCF (PCFmic-UPCF) was seen (r=0.572, p< 0.01). The preservation of pulmonary compliance is important for the development of an effective cough as well as assisting the compression and expulsive phases. Thus, the clinical importance of the inspiratory phase and pulmonary compliance in assisting a cough should be emphasized.

Adolescent↗
PubMed1985

Diving pattern of Tsushima male breath-hold divers (Katsugi).

The present study was undertaken to investigate the diving pattern, buoyancy-mass relationship, and some respiratory functions in professional male breath-hold divers in Tsushima Island, Japan. These divers always wear neoprene wet suits and use fins and 4-kg counterweights. They usually dive to 3-10 m depths. The rate of descent was 1.12 m/s for deeper dives (greater than 10 m), which is nearly twofold greater than that of Korean female divers also wearing wet suits and fins. However, the rate of ascent (0.8 m/s) was comparable to that of Korean women divers. On a typical summer day, they spend nearly 4 h in the water and perform 175 dives. The average dive and surface time were 39 and 42 s, respectively. The total bottom time was estimated to be 67 min/d, nearly twice that of Korean women divers. These divers do not adjust the counterweight and all are using a 4-kg weight. Nevertheless, the buoyancy-mass relationship revealed that they maintain the same degree of positive buoyancy (approximately 10% above the neutral level) at surface as do Korean women divers who adjust counterweights. The vital capacity was significantly greater in the diver than in the control (P less than 0.05), which was largely due to the greater expiratory reserve volume in the diver. The end-tidal O2 and CO2 pressures of the diver resting in air were not different from those of the control. These results indicate that, while the basic diving pattern is similar in both male and female breath-hold divers, the overall efficiency of diving (in terms of the rate of descent and the bottom time) appears to be superior in male divers.

Adult↗
PubMed1995

Cardiopulmonary adaptation to exercise after acute weight loss in severely obese subjects.

The aim of our study was to investigate the effects on baseline and exercise cardiopulmonary function and metabolic parameters of an acute (3-4 weeks) loss of at least 10% of initial weight in severely obese patients. Eight obese patients, 3 males and 5 females, mean age +/- SEM 42 +/- 6 yrs, body mass index (BMI) > 35 kg.m-2, underwent two cardiopulmonary function tests separated by 3 weeks of very low calorie protein-sparing diet (589 kcal.day-1) and a weight loss of 10% of initial weight (mean 8.43 +/- 0.72 kg). Eight normal subjects, matched for sex and age with the obese patients, served as controls. In the obese subjects, maximal workload (+15 +/- 3.6 W) and maximal oxygen consumption (V' O2) (+188 +/- 40.5 mL.min-1) were significantly increased after weight loss. Interestingly, exercise capacity at anaerobic threshold was not significantly different in obese subjects after weight loss with respect to normal subjects. Our results show that an acute but significant weight loss obtained with a very low calorie diet in obese patients is able to significantly improve maximal V' O2 and V' CO2 at anaerobic threshold. Moreover, this acute weight loss is able to partially reverse all of the cardiopulmonary alterations seen in obese patients both at baseline and during exercise.

Adaptation, Physiological↗
PubMed1990

Clinical, electrical and mechanical correlations during recovery from neuromuscular blockade with vecuronium.

In order to determine correlations between electromyographic (EMG), mecanomyographic (MMG) and clinical criteria of adequate recovery from neuromuscular blockade with vecuronium, seven young healthy conscious volunteers were given subparalysing doses of vecuronium. During recovery from neuromuscular blockade, vital capacity, negative inspiratory pressure, peak expiratory flow rate and five-second head lift were assessed. Neuromuscular monitoring included the evoked EMG response of the adductor digiti minimi and the simultaneous evoked MMG response of the adductor pollicis on the same side. We found that all subjects maintained head lift for five seconds at EMG T4T1 of 0.70, and they achieved normal respiratory tests at EMG T4/T1 of 0.90. The MMG T4/T1 needed for the subjects to perform normal respiratory tests was found to be 0.50, at which time six of the seven subjects were able to perform adequately the head lift test.

Adult↗
PubMed1998

The forced expiratory volume-time curve estimation using the electrocardiogram.

The feasibility of estimating the forced expiratory volume-time curve from the amplitude modulation of the electrocardiogram was studied using a numerical torso model and ECG signal processing. A two dimensional numerical model of the torso was solved for the maximum expiration and inspiration to study the changes in the surface potential as a result of changes in the lung volume. The numerical model showed that significant changes in the surface potential amplitude occur between maximum inspiration and maximum expiration and that this amplitude change in the left-right axis of the torso might be three times as large as in the front-back axis. In the experimental setup, ECG waveforms from the surface of the chest and the mouth air flow were simultaneously recorded from four male subjects during several forced vital capacity (FVC) maneuvers. The amplitude of the QRS complex was measured for different expired lung volumes and an estimation of the forced expiratory volume-time curve was obtained. The FVC and the FEV1 (forced expiratory volume after 1 s) spirometry indices were calculated for the two volume-time curves obtained from the electrocardiogram and from the spirometry measurements. The results differ between 0.1 and 0.8 1. These preliminary results are encouraging and might indicate that a relationship between the volume-time curve during FVC test and the electrocardiogram signals does exist. Further validation in a larger number of subjects and patients is needed before the technique can be applicable for clinical use.

Adult↗
PubMed2004

Impact of retrograde graft preservation in Perfadex-based experimental lung transplantation.

OBJECTIVE: Optimal preservation of postischemic organ function is a continuing challenge in clinical lung transplantation. Retrograde instillation of preservation solutions has theoretical advantages to achieve a homogeneous distribution in the lung due to perfusion of both the pulmonary and the bronchial circulation. Thus far, no systematic screening studies followed by in vivo large animal reevaluation including stereological analysis of intrapulmonary edema exist concerning the influence of retrograde preservation on postischemic lung function after preservation with low potassium dextran (LPD) solution (Perfadex). MATERIALS AND METHODS: For initial screening in an extracorporeal rat model eight lungs, each, were preserved for 4 h using antegrade or retrograde preservation with LPD solution (Perfadex; PER(ant)/PER(ret)). Respiratory and hemodynamic results after reperfusion were compared to low-potassium Euro-Collins (LPEC). For systematic reevaluation, five pig lungs, each, were preserved correspondingly for 27 h, and results were compared to sham-operated control lungs. In both models, edema formation was quantified stereologically. Statistics comprised different ANOVA models. RESULTS: In both models, use of PER(ret) resulted in significantly higher oxygenation capacity, lower inspiratory pressures, and lower amounts of intraalveolar edema as compared to PER(ant). Results of PER(ret) were not different from sham controls in the in vivo model; furthermore, a continuous retrograde elimination of blood clots from pulmonary microcirculation was noticed. CONCLUSIONS: Retrograde application of LPD solution (Perfadex) results in significant functional and histological improvement as compared to antegrade perfusion. This innovative technique can be applied very easily in clinical practice and might be an ideal adjunct to further optimize the results after lung transplantation with LPD-based graft protection.

Animals↗
PubMed2001

Selected contribution: airway caliber in healthy and asthmatic subjects: effects of bronchial challenge and deep inspirations.

In 9 healthy and 14 asthmatic subjects before and after a standard bronchial challenge and a modified [deep inspiration (DI), inhibited] bronchial challenge and after albuterol, we tracked airway caliber by synthesizing a method to measure airway resistance (Raw; i.e., lung resistance at 8 Hz) in real time. We determined the minimum Raw achievable during a DI to total lung capacity and the subsequent dynamics of Raw after exhalation and resumption of tidal breathing. Results showed that even after a bronchial challenge healthy subjects can dilate airways maximally, and the dilation caused by a single DI takes several breaths to return to baseline. In contrast, at baseline, asthmatic subjects cannot maximally dilate their airways, and this worsens considerably postconstriction. Moreover, after a DI, the dilation that does occur in airway caliber in asthmatic subjects constricts back to baseline much faster (often after a single breath). After albuterol, asthmatic subjects could dilate airways much closer to levels of those of healthy subjects. These data suggest that the asthmatic smooth muscle resides in a stiffer biological state compared with the stimulated healthy smooth muscle, and inhibiting a DI in healthy subjects cannot mimic this.

Adult↗
PubMed1999

Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration.

BACKGROUND: General anaesthesia impairs the gas exchange in the lungs, and moderate desaturation (SaO2 86-90%) occurred in 50% of anaesthetised patients in a blinded pulse oximetry study. A high FiO2 might reduce the risk of hypoxaemia, but can also promote atelectasis. We hypothesised that a moderate positive end-expiratory pressure (PEEP) level of 10 cmH2O can prevent atelectasis during ventilation with an FiO2 = 1.0. METHODS: Atelectasis was evaluated by computed tomography (CT) in 13 ASA I-II patients undergoing elective surgery. CT scans were obtained before and 15 min after induction of anaesthesia. Then, recruitment of collapsed lung tissue was performed as a "vital capacity manoeuvre" (VCM, inspiration with Paw = 40 cmH2O for 15 s), and a CT scan was obtained at the end of the VCM. Thereafter, PEEP = 0 cmH2O was applied in group 1, and PEEP = 10 cmH2O in group 2. Additional CT scans were obtained after the VCM. Oxygenation was measured before and after the VCM. RESULTS: Atelectasis (> 1 cm2) was present in 12 of the 13 patients after induction of anaesthesia. At 5 and 10 min after the VCM, atelectasis was significantly smaller in group 2 than group 1 (P < 0.005). A significant inverse correlation was found between PaO2 and atelectasis. CONCLUSIONS: PEEP = 10 cmH2O reduced atelectasis formation after a VCM, when FiO2 = 1.0 was used. Thus, a VCM followed by PEEP = 10 cmH2O should be considered when patients are ventilated with a high FiO2 and gas exchange is impaired.

Adult↗
PubMed2004

Acute carbon dioxide exposure in healthy adults: evaluation of a novel means of investigating the stress response.

Acute hypercapnia was studied to assess its potential as a noninvasive and simple test for evoking neuroendocrine, cardiovascular and psychological responses to stress in man. A single breath of four concentrations of carbon dioxide (CO(2)), 5%, 25%, 35% and 50%, was administered to nine healthy volunteers in a randomized, single-blind fashion. Although no adverse effects occurred, most subjects were unable to take a full inspired vital capacity breath of 50% CO(2). In response to the remaining exposures, subjective and somatic symptoms of anxiety increased in a dose-dependent manner. Unlike 5% and 25% CO(2), 35% CO(2) stimulated significant adrenocorticotropic hormone and noradrenaline release at 2 min and cortisol and prolactin release at 15 min following inhalation. This same dose also provoked a significant bradycardia that was followed by an acute pressor response. No significant habituation of psychological, hypothalamic-pituitary-adrenal (HPA) or cardiovascular responses following 35% CO(2) was seen when this dose was repeated after 1 week. A single breath of 35% CO(2) safely and reliably produced sympathetic and HPA axis activation and should prove a useful addition to currently available laboratory tests of the human stress response.

Adaptation, Physiological↗
PubMed2003

Airway re-narrowing following deep inspiration in asthmatic and nonasthmatic subjects.

After bronchoconstriction, deep inspiration (DI) causes dilatation followed by airway re-narrowing. Re-narrowing may be faster in asthmatic than nonasthmatic subjects. This study investigated the relationship between re-narrowing and the magnitude of both DI-induced dilatation and the volume-dependence of respiratory system resistance (Rrs) during tidal breathing. In 25 asthmatic and 18 nonasthmatic subjects the forced oscillation technique was used to measure Rrs at baseline and after methacholine challenge, during 1 min of tidal breathing, followed by DI to total lung capacity (TLC) and passive return to functional residual capacity (FRC). Dilatation was measured as the decrease in Rrs between end tidal inspiration and TLC, re-narrowing as Rrs at FRC immediately after DI, as per cent Rrs at end-tidal expiration, and volume dependent tidal fluctuation as the difference between mean Rrs at end-expiration and end-inspiration. Asthmatic subjects had greater re-narrowing, less dilatation, and greater tidal fluctuations both at baseline and after challenge. Re-narrowing correlated with baseline tidal fluctuation and inversely with dilatation. Both baseline tidal fluctuation and dilatation were significant independent predictors of re-narrowing. Following deep inspiration-induced dilatation, faster airway re-narrowing in asthmatic than nonasthmatic subjects is associated not only with reduced deep inspiration-induced dilatation but also with some property of the airways that is detectable prior to challenge as an increased volume dependence of resistance.

Adult↗
PubMed1986

Breath holding in divers and non-divers--a reappraisal.

The two phases of breath holding, the voluntary inactive and involuntary active phases, were identified by non-invasive methods using the induction plethysmograph. Eight trained divers and 7 non-diving control subjects familiar with respiratory apparatus were studied. During breath holding from normocapnia and total lung capacity it was not possible to distinguish between the two groups in respect of the pattern or duration of breath holding or alveolar gas tensions at the breakpoint. Divers could, however, hold their breath much longer after hyperventilation (165 +/- 40.0 and 121 +/- 31.4 seconds; P less than 0.01). This was associated with a longer second phase than occurred in non-divers (78.0 +/- 29.7 and 17.6 +/- 13.1 seconds; P less than 0.01) and more severe alveolar hypoxia (percentage oxygen 7.6 +/- 1.8 and 10.9 +/- 1.7%; P less than 0.01). It is concluded that these divers had a hyperventilation-dependent attenuated hypoxic ventilatory response. Subjects could also be identified who have either a very short (less than 10 seconds) or very long (greater than 45 seconds) second phase. They were considered to be at risk of developing underwater hypoxia and unexpected loss of consciousness. It is further suggested that analysis of the phases of breath holding holds promise as a screening test of both novice and experienced divers.

Carbon Dioxide↗
PubMed1989

Exercise end-expiratory lung volumes in lean and moderately obese women.

End-expiratory lung volumes (EELV) and expiratory flow rates were determined in 10 moderately obese (mean, 35 percent fat) and 10 relatively lean women (22 percent fat) at rest and during exercise on a treadmill at 55 and 85 percent of VO2max. Expiratory reserve volume (ERV) as a percentage of forced vital capacity (FVC) was used as an index of EELV. Differences in body weight, body fatness, and VO2max were significant (P less than 0.05). The resting EELV in the obese women was less than (P less than 0.01) that in the leaner women (32 vs 37 percent). During exercise at the two intensities, the EELV remained near the resting value in the obese women (approximately 30 percent). In contrast, the leaner women experienced an initial decrease in EELV during exercise at 55 percent of VO2max (i.e., from 37 to 32 percent) (P less than 0.01); thereafter, the EELV changed no further during exercise at 85 percent of VO2max. There were no significant differences in relative expiratory flow rates at rest or during exercise between the obese and lean women. In conclusion, moderately obese women fail to decrease their EELV during exercise in contrast to leaner women who do. A non-linear respiratory system pressure-volume curve, plus increased resistance as maximal flow is approached may combine to determine a lower limit of EELV during exercise.

Body Composition↗
PubMed1993

Expiratory airflow limitation and hyperinflation during methacholine-induced bronchoconstriction.

To investigate the role of airflow limitation on the increase of end-expiratory lung volume (EELV) during bronchoconstriction, nine stable asthmatic subjects and seven healthy subjects were challenged with inhaled methacholine (MCh). Changes in airway caliber were assessed by using forced expiratory volume in 1 s, partial forced expiratory flow at 50% of control forced vital capacity, and specific airway conductance. To detect airflow limitation, tidal flow-volume curves were superimposed on partial forced flow-volume curves at absolute lung volume. The electromyogram of the diaphragm was recorded by surface electrodes in four asthmatic and four healthy subjects, and the electrical diaphragmatic activity (DIA) during expiration was expressed as a percentage of the duration of expiratory time. In 10 subjects (9 asthmatic and 1 healthy) the partial forced expiratory flow recorded after some MCh dose impinged on tidal expiratory flow recorded before MCh. When this occurred it was associated with an increase in EELV by 0.54 +/- 0.07 (SE) liter (P < 0.001), which was larger than that occurring when lower MCh doses (0.11 +/- 0.04 liter, P < 0.05) were used, and with a moderate increase in DIA of 15 +/- 2.5% (P < 0.01). Six healthy subjects did not increase EELV after MCh despite a significant degree of bronchoconstriction; in these subjects tidal expiratory flow never impinged on forced expiratory flow, and DIA never increased. These results suggest that hyperinflation during MCh-induced bronchoconstriction is triggered by dynamic compression of the airways and is associated with moderate increase of DIA during expiration.

Adolescent↗
PubMedDate not supplied

Maximum insufflation capacity: vital capacity and cough flows in neuromuscular disease.

OBJECTIVE: To investigate the relationships between vital capacity (VC), maximum insufflation capacity (MIC), and both unassisted and assisted peak cough flows (PCFs). DESIGN: The 108 patients were divided into two groups, those whose MICs were greater than their VCs (group 1) and those whose MICs could not exceed their VCs (MIC = VC, or group 2). RESULTS: The MIC correlated positively with the VC for group 1 patients, but the percent increase in MIC correlated negatively with VC. Both VC and MIC correlated significantly with both unassisted and assisted PCF, respectively. Assisting the cough increased the PCF of 37 patients over a previously defined critical level of 2.7 L/sec. The MIC VC difference and percent increase in MIC also correlated significantly with the difference between unassisted and assisted PCF. Although the group 2 patients did not have true cough flows because of inability to close the glottis, their peak expiratory flows were significantly less than the unassisted and assisted PCF of the group 1 patients. CONCLUSIONS: The greater the MIC VC difference, the greater the PCF, and, thereby, the ability to expel airway mucus and avert respiratory complications. The lower the VC, the greater the percent increase in MIC and the greater the percent increase in assisted PCF. Maximal insufflations are extremely important to increase PCF for patients with neuromuscular conditions who have VCs of < 1500 ml.

Adult↗
PubMed2003

Maximal dynamic expiratory pressures with fast and slow inspirations.

Maximal dynamic expiratory pressures are higher when forced expiration is preceded by a fast inspiration to total lung capacity (TLC) than when preceded by a slow inspiration and a few seconds pause at TLC. We hypothesized that these pressure differences are due to the stretch-shorten cycle (SSC), which refers to enhancement of muscle force when a concentric muscle contraction is immediately preceded by an eccentric contraction. Seven volunteers [36 (2) years; mean (SEM)] performed maximal forced expirations against minimal resistance with fast (F) or slow (S) maneuvers. F maneuvers consisted of a fast inspiration to TLC followed immediately by a fast expiration, whereas S consisted of a slow inspiration to TLC and a 4- to 5-s pause at TLC prior to forced expiration. We measured esophageal pressure ( P(es)), peak expiratory flow rate (PEFR), and the EMG activity of the transversus abdominis (Tr) by means of intramuscular fine-wire electrodes. The subjects performed several runs of each maneuver in a random order, and runs with the greatest expiratory P(es) were analyzed. In comparison with S, F yielded greater P(es) [182 (15) versus 167 (15) cm H(2)O; P=0.003)] but similar PEFR [9.8 (0.7) versus 9.6 (0.7) l/s, P>0.05] and EMG activity of the Tr during forced expiration [221 (31) versus 208 (34) a.u., P>0.05]. Further analysis revealed significant EMG activity of Tr during end-inspiration (eccentric contraction) with F maneuvers only [73 (22) versus 32 (17) a.u., P<0.05]. We conclude that the ability of expiratory muscles to generate greater P(es) with F maneuvers is related to the sequence of an eccentric contraction, which is followed immediately by concentric contraction in a manner analogous to SSC described in skeletal muscles.

Adult↗
PubMed1998

Inspiratory muscle activity during bird song.

The apparently continuous flow of bird song is in reality punctuated by brief periods of silence during which there are short inspirations called minibreaths. To determine whether these minibreaths are accompanied, and thus perhaps caused, by activity in inspiratory muscles, electromyographic (EMG) activity was recorded in M. scalenus in zebra finches and in M. scalenus and Mm. levatores costarum in cowbirds, together with EMGs from the abdominal expiratory muscles, air sac pressure and tracheal airflow. EMG activity in Mm. scalenus and levatores costarum consistently preceded the onset of negative air sac pressure by approximately 11 ms during both quiet respiration and singing in both species. The electrical activity of these two muscles was very similar. Compared with during quiet respiration, the amplitude of inspiratory muscle EMG during singing was increased between five- and 12-fold and its duration was decreased from >200 ms to on average 41 ms during minibreaths, again for both species, but inspiratory muscle activity did not overlap with that of the expiratory muscles. Thus, there was no indication that the inspiratory muscles acted either to shorten the duration of expiration or to reduce the expiratory effort as might occur if both expiratory and inspiratory muscles were simultaneously active. Inspiratory and expiratory muscle activities were highly stereotyped during song to the extent that together, they defined the temporal pattern of the songs and song types of individual birds.

Abdominal Muscles↗
PubMed1996

Dose response to inhaled terbutaline powder and peak inspiratory flow through Turbuhaler in children with mild to moderate asthma.

The purpose of this study was to investigate the relative effectiveness of 0.25 mg, 0.5 mg, and 1.0 mg of terbutaline, administered via Turbuhaler, in children with mild to moderate asthma, and to register peak inspiratory flow rates through Turbuhaler (PIFTBH). Thirty-seven children in Portugal (one center) and 45 children in Sweden (one center) aged 3-10 years participated in two separate, double-blind, placebo-controlled, crossover, and randomized studies of the same design. Because of differences in other therapies for asthma and climate, combination of the two studies into one metanalysis did not appear appropriate. The children inhaled 0.25 mg, 0.5 mg, and 1.0 mg terbutaline sulfate and placebo t.i.d. for consecutive 2-week periods without washout periods. Peak expiratory flow rates (PEF) were measured at home before and 15 minutes after each inhalation in the morning, afternoon, and evening. PIFTBH was measured twice at each of four clinic visits. At the Portuguese center the increases in mean morning PEF from before to after inhalation were 32 L/min after 0.25 mg, 35 L/min after 0.5 mg, and 40 L/min after 1.0 mg. The corresponding figures in Sweden were 26 L/min, 31 L/min, and 29 L/min after 0.25 mg, 0.5 mg, and 1.0 mg, respectively. For children 3-6 years, mean values for PIFTBH were 60 L/min in Portugal (n = 15), and 58 L/min in Sweden (n = 23). In the 7-10 year group the mean PIFTBH was 72 L/min (n = 22) in Portugal, and 68 L/min (n = 22) in Sweden. We conclude that inhalation of terbutaline sulfate via Turbuhaler at a small dose of 0.25 mg resulted in good bronchodilation and was comparable to inhalations of 0.5 mg and 1.0 mg in children aged 3-10 years with mild to moderate asthma. PIFTBH were comparable to values previously recorded in healthy 6-year-old and older children and in adult asthmatic patients.

Administration, Inhalation↗