Near normalization of spirometry in a subject with severe emphysema complicated by amiodarone lung.
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Aged↗
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Respiratory symptoms, asthma, exercise test spirometry, and atopy in schoolchildren from a Lima shanty town.
BACKGROUND: Little is known about the associations between symptoms of asthma, pulmonary function tests, and atopy in developing countries. While asthma in children is often associated with atopy, some studies of wheezing illness have found little or no association, leading to suggestions that there are subgroups of wheezing illness. The ISAAC study recently reported that the prevalence of reported asthma symptoms in Lima, Peru was among the highest in the world, but did not report on the atopic status of the subjects. METHODS: A cross sectional survey was conducted of children aged 8-10 years who had previously participated in a cohort study of respiratory and diarrhoeal illnesses in infancy. Questionnaires were administered asking about respiratory symptoms and asthma diagnoses, pulmonary function tests were performed before and after exercise on a treadmill, and atopy was determined from skin prick tests and specific serum IgE levels. RESULTS: A total of 793 children participated in the survey. The prevalence of asthma related symptoms in the last 12 months was 23.2%, but only 3.8% of children reported a recent asthma attack. The mean differences in pretest percentage predicted forced expiratory volume in one second (FEV(1)) were 8.1% (95% CI 2.4 to 13.8) between children who did and did not report an asthma attack in the last 12 months, and 5.3% (95% CI 2.8 to 7.9) in children who did and did not report respiratory symptoms. The corresponding differences in mean percentage fall in FEV(1) after exercise were 3.1% (95% CI -1 to 7.1) and 5.1% (95% CI 3.4 to 6.8). Recent asthma or respiratory symptoms were not associated with atopy in this population (odds ratios 1.29 (95% CI 0.56 to 2.97) and 0.91 (95% CI 0.61 to 1.37), respectively). CONCLUSIONS: Most asthma in these children was unrecognised and mild. Asthma and asthma symptoms in this population do not seem to be related to atopy.
Asthma↗
Altered thoracic gas compression contributes to improvement in spirometry with lung volume reduction surgery.
BACKGROUND: Thoracic gas compression (TGC) exerts a negative effect on forced expiratory flow. Lung resistance, effort during a forced expiratory manoeuvre, and absolute lung volume influence TGC. Lung volume reduction surgery (LVRS) reduces lung resistance and absolute lung volume. LVRS may therefore reduce TGC, and such a reduction might explain in part the improvement in forced expiratory flow with the surgery. A study was conducted to determine the effect of LVRS on TGC and the extent to which reduced TGC contributed to an improvement in forced expiratory volume in 1 second (FEV1) following LVRS. METHODS: The effect of LVRS on TGC was studied using prospectively collected lung mechanics data from 27 subjects with severe emphysema. Several parameters including FEV1, expiratory and inspiratory lung resistance (Rle and Rli), and lung volumes were measured at baseline and 6 months after surgery. Effort during the forced manoeuvre was measured using transpulmonary pressure. A novel method was used to estimate FEV1 corrected for the effect of TGC. RESULTS: At baseline the FEV1 corrected for gas compression (NFEV1) was significantly higher than FEV1 (p<0.0001). FEV1 increased significantly from baseline (p<0.005) while NFEV1 did not change following surgery (p>0.15). TGC decreased significantly with LVRS (p<0.05). Rle and maximum transpulmonary pressure (TP(peak)) during the forced manoeuvre significantly predicted the reduction in TGC following the surgery (Rle: p<0.01; TP(peak): p<0.0001; adjusted R2 = 0.68). The improvement in FEV1 was associated with the reduction in TGC after surgery (p<0.0001, adjusted R2 = 0.58). CONCLUSIONS: LVRS decreased TGC by improving expiratory flow limitation. In turn, the reduction in TGC decreased its negative effect on expiratory flow and therefore explained, in part, the improvement in FEV1 with LVRS in this cohort.
Forced Expiratory Volume↗
Lung function in white children aged 4 to 19 years: I--Spirometry.
OBJECTIVE: A study was performed to produce reference standards for spirometric lung function in white children and to calculate standard deviation scores adjusted for gender and pubertal stage. METHODS: A cross sectional study was made of 772 white children aged 4.6 to 18.8 years (455 male) tested on an OHIO 840 spirometer and assessed anthropometrically and pubertally. RESULTS: Before puberty there was a linear increase in all lung function measurements with height. During puberty a sudden increase occurred, but subsequently the relationship was again linear. No simple single equation described this pattern. Advanced puberty in younger children conferred a respiratory advantage, whilst delayed puberty resulted in the converse. Girls had poorer volumes per unit height, but young girls had superior airflow/unit lung volume. In both sexes lung volumes and flows bore a constant relationship to external thoracic dimensions. CONCLUSIONS: Puberty has a dramatic effect on lung function. Regression equations for predicted values of lung function measurements and for calculation of standard deviation scores are given (with pubertal correction factors) for each gender.
Adolescent↗
Regional pulmonary function by lobar spirometry in unanesthetized sheep.
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Animals↗
Spirometry in children. Methodology for obtaining optimal results for clinical and epidemiologic studies.
Spirometric methodology for clinical and epidemiologic use in children was evaluated in 123 third and fourth grade school children 8 and 9 yr of age. They performed spirometric testing in the middle of October and again in the middle of November 1979. The results demonstrated that spirometric standards developed from adult studies can be applied to children. In addition, a minimum of 5 and a maximum of 8 maneuvers should be attempted to provide at least 3 acceptable tracings. In children, the allowable difference between the 2 best acceptable tracings of 5% or 100 ml, whichever is greater, was demonstrated to be a reasonable guideline. The results are equally reproducible when the maximal values, the mean of the 2 or 3 best values, or the values from the "best sum" tracing (the tracing with the highest value for the sum of the FVC and FEV1) are used.
Child↗
Longitudinal changes of body mass index, spirometry and diffusion in a general population.
The aim of this study was to evaluate the effects of body mass index (BMI) changes over an 8-yr follow-up, on longitudinal changes of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and carbon monoxide diffusing capacity of the lung (DL,CO) indices in a general population sample of North Italy. To avoid including weight changes possibly related to physical growth, only the 1,426 adults (>24 yrs, 46% males) with complete follow-up were selected. Median linear regression models were applied to estimate the medians of change (computed as follow-up minus baseline values) of VC, FVC, FEV1 and DL,CO indices, as functions of changes of BMI over the follow-up period, separately by sex, after considering several potential confounders and effect modifiers. The extent of lung function loss tended to be higher among those who, at baseline, reported greater BMI values. Males experienced larger losses than females (20 and 16 mL FEV1 median reduction for a BMI unit increase in males and females, respectively). Conversely, longitudinal changes of BMI caused a slight and nonsignificant increase in DL,CO values in both sexes. Over an 8-yr follow-up, the detrimental effect of gaining weight might be reversible for many adults as most of those who reduced their body mass index values also increased their lung function. Overweight patients with ventilatory impairment should be routinely encouraged to lose weight for improving their lung function.
Adult↗
Evaluation of the asthmogenicity of propafenone, a new antiarrhythmic drug. Comparison of spirometry with methacholine challenge.
Propafenone is a new membrane-stabilizing antiarrhythmic agent that structurally resembles the beta-adrenergic receptor antagonist, propranolol. To determine the potential asthmogenicity of this new drug, pulmonary function, airway reactivity to methacholine, blood pressure, the electrocardiogram, and plasma concentrations were measured in 12 patients with mild intermittent asthma after 48 to 72 hours of treatment with placebo and with oral propafenone in low dosage (150 mg every eight hours) and high dosage (300 mg every eight hours) in a double-blind crossover manner. The forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory flow over the middle half of the FVC (FEF25-75%), heart rate, and blood pressure during the three regimens of treatment were not significantly different; however, the QRS interval on the ECG was significantly widened with both dosages of active drug, and the mean provocative dose of methacholine (+/- SE) required to reduce FEV1 by 20 percent (PD20) decreased from 3.0 +/- 0.6 mg/ml with placebo to 2.1 +/- 0.7 mg/ml with the high dosage of propafenone (p less than 0.01). The mean PD20 on the low-dose regimen was not significantly different from placebo or high-dose therapy. A potentially relevant increase in airway reactivity, as measured by a ratio of less than 0.5 for PD20 after treatment to PD20 after placebo, occurred in seven subjects with high-dose and in one subject during low-dose treatment (p less than 0.01). These data suggest that propafenone should be used with caution in patients with asthma and that bronchial provocation will provide a more sensitive measure of the asthmogenicity of a drug with beta-adrenergic receptor antagonist activity than pulmonary function tests. Moreover, use of bronchial provocation allows the selection of subjects with mild disease, thus reducing the risk of potentially severe bronchospasm.
Adult↗
[Computer analysis of respiratory sounds in bronchial obstruction evaluation in small children that do not collaborate with spirometry tests].
BACKGROUND: There are changes in inspiratory breath sound intensity in patients with airway obstruction. Airway narrowing may change sound spectral characteristics. AIM: To define the characteristics of lung sounds at standardized air flow during methacholine challenge and to compare acoustic changes with transcutaneous oxygen tension (PtcO2) during induced airway narrowing. PATIENTS AND METHODS: Forty asthmatic children (20 male) aged 5.2 +/- 1 years and 40 normal children (18 male), aged 5.6 +/- 1 years were studied. All patients were free of respiratory tract infections one month before the study. A methacholine challenge from 0.06 to 8 mg/ml was performed; the test was ended when a fall in PtcO2 of > 20% from baseline was observed or if the final concentration was reached. Subjects breathed through a pneumotachograph aiming at flows of 0.4 to 0.6 l/s. Respiratory sounds were recorded using contact sensors at the suprasternal notch and at the posterior right lower lobe. From average spectra, power at low (100-200 Hz = P1) and high frequencies (400-2000 = P2) was calculated. Frequencies below which 50% (F50) and 99% (SEF90) of the spectral power between 100 and 2000 Hz was contained, were also calculated. RESULTS: In asthmatics, the metacholine concentration at which a 20% fall in PtcO2 was observed, was lower than in normal children (p < 0.05). There was an increase in P1 (p < 0.01) and a reduction in P2 (p < 0.01) during inspiration, in subjects that experienced a 20% reduction in PtcO2. Also, there was an increase in F50 and SEF99 during inspiration in lung sounds, but not over the trachea. CONCLUSIONS: Lung sounds analysis can be useful for the assessment of airway reactivity in asthmatic children.
Asthma↗
[Thr prognostic value of chronic cough, sputum and spirometry assessed by 10-year mortality among 1487 working men (author's transl].
The aim of the present study is to find out whether or not the diagnosis of chronic bronchitis at an early stage of the disease makes it possible to forecast an excess of mortality within 10 years, among 1487 men examined in 1960/61 while they were at work and aged at the time between 30 and 59 years. After having shown the prognostic value of chronic phlegm and spirographic measurements (VC, FEV1.0, FEV1.0/VC), we tried to state precisely their prognostic value by controlling the tobacco consumption and the socio-occupational class, which are bound to them and are themselves prognostic. FEV 1.0 is the most discriminant variable; its reduction is prognostic as young as 35. Survival-rates decrease regularly with the reduction of FEV1.0; this prognostic role seems to remain in all sociooccupational classes and for smokers as well as for non-smokers; it is more evident for the men who had chronic phlegm than in those who did not have such a symptom. It has been impossible to draw clear conclusions about the prognostic value of phlegm on these points because of interaction existing between phlegm and age.
Adult↗
[Is good collaboration in spirometry a criterion for predicting the correct use of inhalation bronchodilators?].
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Administration, Inhalation↗
[Chronic obstructive lung disease: spirometry should be for respiratory diseases like ECG for heart diseases: an interview with Dr. Marcel Julian by Robert Henry].
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Bronchospirometry↗
N-acetylcysteine in cystic fibrosis and Pseudomonas aeruginosa infection: clinical score, spirometry and ciliary motility.
The effect of peroral N-acetylcysteine (NAC) in patients with cystic fibrosis (CF) and chronic pulmonary Pseudomonas aeruginosa infection was studied in 52 patients in a double-blind, placebo-controlled, cross-over trial of two, 3 month durations. Active treatment consisted of NAC, 200 mg x 3 daily (patients weighing less than 30 kg) or 400 mg x 2 daily (greater than 30 kg). The effect was evaluated by a subjective clinical score, weight, sputum bacteriology, blood leucocyte count, sedimentation rate, titres of specific antimicrobial antibodies, lung function parameters and measurement of nasal ciliary function in vitro. 31 patients completed the study. No significant differences in lung function or subjective clinical scores were seen between NAC and placebo for the study group as a whole. Patients with peak expiratory flow rate (PEFR) below 70% of predicted normal values showed a satisfactory significant increase in PEFR, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) during NAC treatment. No effect of NAC on ciliary activity was observed.
Acetylcysteine↗
[Assessing the effectiveness of preventive influenza vaccination using the spirometry and electrocardiography in patients with cardiovascular diseases].
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Cardiovascular Diseases↗
[Pulmonary artery loop and dysplastic tracheal stenosis. Case report with pre- and postoperative spirometry and discussion of the value of diagnostic signs].
Since his second week of life a boy, with pulmonary artery sling now 8 3/4 years old suffered from mainly expiratory stridor during exercise and dyspnoe during bronchopulmonary infections, twice in a life-threatening manner. The indirect diagnostic signs were all negative, bronchoscopy revealed a narrow distal trachea and a pulsating stenosis of high degree at the bifurcation. Bronchographic findings were characteristic. Angiocardiographically the retrotracheal run of the left pulmonary artery could only be proved by marking the trachea with a catheter. After operation at the age of 8 1/4 years, the boy had no relevant subjective complaints during a follow-up of 6 months. Spirometric lung function tests before and after corrective operation revealed a considerable obstruction of central intrathoracic airways that persisted after operation, only peak flow improved significantly. According to the bronchological findings the reason therefore is a dysplastic tracheobronchial stenosis, which is seen often in combination with PAS.
Bronchography↗
[Differential spirometry and computerized pulmonary ventilation- perfusion scintiphotography as preoperative functional studies in thoracic surgery].
With purposes of a better knowledge of the respiratory function, and for a more and more exact postoperative functional prognosis, the authors considered the results obtained by the differential bronchospirometry and the pulmonary ventilation-perfusion imaging. Through the study of 10 patients, susceptible of operations for lung extirpation, they could so evaluate the reliability and usefulness of said two functional investigations, which can integrate and complete each other.
Aged↗
[Effect of obesity on the ventilatory capacity of the respiratory system. II. Reference spirometry values of VC and FEV1 for overweight males].
642 persons without respiratory and circulatory diseases were selected from 1087 steel mill workers. The examined persons were classified according to the intervals of relative body mass. The relations between spirometric parameters (VC and FEV1) and degree of obesity were studied. For each interval the equations of multiple regression were calculated, taking into account the dependence of VC and FEV1 on age, height and present body mass. The numeric factor from the equation of multiple regression of coefficient describing the dependence of VC on the present body mass was positive in 90-114% and 115-124% intervals but negative in 125-134% and 135% of body mass. In case of FEV1 the negative factor of the same coefficient was not negative until 135% of body mass. A positive correlation of VC and FEV1 with the present body mass in the whole population was shown. If the group of obese persons was formed on the basis of Wot anthropometric index (which included skinfolds thickness, present body mass and height), significantly lower values of VC and FEV1 were found in comparison to non-obese counterparts. For the persons with morbid obesity a new method of calculation of predicted VC and FEV1 values was presented. The equation of multiple regression used for this purpose takes into account the dependence of spirometric values on age and Wot index.
Adult↗