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PubMed1997

Effect of surgical lung volume reduction on breathing patterns in severe pulmonary emphysema.

Surgical lung volume reduction may improve pulmonary function and dyspnea in advanced pulmonary emphysema. To investigate mechanisms of these beneficial effects we studied breathing patterns before and after surgery. Nineteen patients with diffuse pulmonary emphysema (FEV1 < 35% of predicted, total lung capacity > 130% predicted) were studied within 1 mo before, and 1.5 to 7 mo after thoracoscopic volume reduction. Changes of rib cage and abdominal volumes were monitored with calibrated respiratory inductive plethysmography for 20 to 60 min during natural breathing at rest. Pulmonary function and dyspnea were also assessed. Postoperative tidal volumes, respiratory cycle times, and minute ventilation were not significantly different from preoperative values. The contribution of abdominal volume changes to tidal volumes increased from a mean +/- SD of 43 +/- 17% preoperatively to 58 +/- 14% postoperatively (p = 0.03). The fraction of inspiratory time with abdominal paradoxical motion decreased from 12.3 +/- 8.3% preoperatively to 5.1 +/- 5.1% postoperatively (p = 0.02). The phase shift between rib cage and abdominal motion was reduced postoperatively. Hyperinflation, airway obstruction, and subjective ratings of dyspnea were significantly improved. The better synchronization of rib cage-abdominal motion and the greater contribution of abdominal volume changes to tidal volumes are consistent with a reduction of inspiratory loading and a greater force-generating capacity of the diaphragm after surgery.

Adult↗
PubMed1991

[Lung function after lobectomy in chronic pulmonary emphysema].

We compared the prediction of postoperative pulmonary function in two groups: chronic pulmonary emphysema (CPE) group (n = 30) and normal control group (n = 41). These patients had a lobectomy because of lung cancer. We measured pulmonary function test (FVC, EFV1, TLC, FRC, RV, DLco), and pulmonary perfusion scan before and after surgery. We found correlation between the predicted and measured postoperative values very close in control group. Whereas, in CPE group, these correlations were very low especially in FVC and FEV1. We also calculated the pulmonary function on the operated and the non-operated sides. The correlation were very high without FEV1 in control group and all the measured values did not correlate to the predicted values. On the non-operated side, the correlations were high in both control and CPE groups. From these results we can conclude that it is difficult to predict the postoperative pulmonary function in the case of chronic pulmonary emphysema.

Chronic Disease↗
PubMed1999

[Pathophysiology and management of pulmonary emphysema].

The predominant physiological abnormalities of pulmonary emphysema are chronic airway obstruction, hyperinflation of the lung, decrease of lung elastic recoil, and impaired gas exchange. Patient who still smokes must be advised and supported in an effort to stop smoking before medical treatment. The treatment goals are to induced bronchodilation, decreased the inflammatory change and promote expectoration to prevent the progressive deterioration in lung function and improves quality of life. Inhaled beta 2-agonists, anticholinergics, and oral theophylines, as bronchodilators improved exertional dyspnea and exercise tolerance. Inhaled and oral corticosteroids have an anti inflammatory effect for chronic airway inflammation. Comprehensive respiratory treatments including home oxygen therapy and rehabilitation are also successfully applied for these patients.

Adrenergic beta-Agonists↗
PubMed1998

Quantitative analysis of pulmonary emphysema: three-dimensional fractal analysis of single-photon emission computed tomography images obtained with a carbon particle radioaerosol.

OBJECTIVE: The purpose of this study was to quantify the heterogeneous distribution of a carbon particle radioaerosol in the lungs of patients with pulmonary emphysema using single-photon emission computed tomography (SPECT) and fractal analysis. SUBJECTS AND METHODS: Ventilation SPECT was performed on 19 patients with pulmonary emphysema, seven patients with suspected pulmonary emphysema, and 14 healthy volunteers. We delineated the lungs using five cutoff levels (15%, 20%, 25%, 30%, and 35% of the maximal pixel radioactivity) and measured the total number of pixels in the areas surrounded by the contours obtained with each cutoff level. We calculated fractal dimensions from the relationship between the total number of pixels and cutoff levels transformed into logarithms. RESULTS: The fractal dimensions increased with the severity of pulmonary emphysema. The fractal dimensions for patients with pulmonary emphysema, patients with suspected pulmonary emphysema, and healthy volunteers were 2.03+/-0.61 (mean +/- SD), 0.77+/-0.09, and 0.59+/-0.06, respectively. A significant difference (p < .0005) in the fractal dimension was found when any of these three groups was compared with any other group of subjects. CONCLUSION: Three-dimensional quantitative evaluation of the emphysematous lung was possible using SPECT and fractal analysis. Our results suggest that fractal analysis can quantify the heterogeneity of the distribution of a carbon particle radioaerosol in the lung. Fractal analysis appears to be applicable for routine clinical use because it is simple and the fractal dimensions can be obtained easily without using special software.

Aged↗
PubMed1996

[Pulmonary emphysema: surgical indications].

Surgery for pulmonary emphysema, with the exception of lung transplantation, is limited at present to resection of the emphysematous areas. The resection of a unique bulla within an otherwise healthy parenchyma can be indicated in case of complications but rarely in asymptomatic patients. When the bullae are large (i.e. volume greater than one-third of the hemithorax) in a patient suffering from diffuse emphysema, bullectomy is the ideal indication. Mortality varies from 0 to 10%, essentially due to infection or acute respiratory failure. In most patients, the subjective improvement in terms of dyspnea and the objective improvement as measured by spirometry remains significative up to 5 years after surgery. Inversely, surgical resection is classically considered to be contraindicated in patients with small poorly-limited bullae. Recent data would however question this idea since subjective and objective improvement after reduction of the lung volume is still present 1 year after surgery in most patients, even those with severe obstruction. The mechanism is probably related to increased elastic recoil. Even if only temporary improvement can be achieved for a few years, the persisting course of emphysema would suggest that volume reduction should always be entertained as an alternative before lung transplantation.

Humans↗
PubMedDate not supplied

Demonstration of communication between alveolus and interstitium in persistent interstitial pulmonary emphysema: case report.

Persistent interstitial pulmonary emphysema (PIPE) is an uncommon complication of premature infants suffering from hyaline membrane disease who have been treated with mechanical ventilation. The presumed mechanism for the development of the disease is via a break in the bronchioalveolar system that allows air to escape into the interstitium. We report a case of a 9-week-old child who developed the localized form of the disease and underwent a lobectomy. Immunohistochemical stains helped to demonstrate the communication between the airway system and interstitium. This report strengthens the theory that the disease develops from airway rupture at the alveolar level.

Cysts↗
PubMed1976

[Synoptical X-ray diagnostics of pulmonary emphysema (author's transl)].

In marked chronic obstructive pulmonary emphysema, especially in the classical emphysematous type of abnormal thorax, a good correlation can be found between the anteroposterior expansion of the thorax, the reduced inspiratory capacity, the clinical state, disturbed mechanics of breathing and the x-ray-state. On the contrary, in clinical emphysema of a lower degree, especially in subclinical, i. e. in predominantly asymptomatic pulmonary emphysema of the elderly, the effectiveness of the roentgenological examination is very small.

Aged↗
PubMed1987

Pulmonary emphysema: current concepts of pathogenesis.

Pulmonary emphysema is a major public health problem and is primarily a disease of smokers. The pathogenesis of emphysema in smokers is likely to be multifactorial and may involve protease-antiprotease imbalance, abnormal host response to injury, the inactivation of antiproteases by oxidants, and direct damage of lung tissue by pulmonary phagocytes. The data regarding current concepts of pathogenesis of emphysema in smokers are reviewed in this article.

Blood Proteins↗
PubMed2001

Genetic polymorphism in matrix metalloproteinase-9 and pulmonary emphysema.

Protease-antiprotease imbalance due to genetic variation may be responsible for the development of pulmonary emphysema induced by smoking. Since matrix metalloproteinases (MMPs) have recently been suggested to play important roles in the pathogenesis of pulmonary emphysema, the association between the functional polymorphism of MMP-9 (-1562C/T) and the development of pulmonary emphysema was examined in 110 smokers and 94 nonsmokers in Japan. The T allele frequency was higher in subjects with distinct emphysema on chest CT-scans (n = 45) than in those without it (n = 65) (0.244 vs 0.123, P = 0.02). Logistic regression analysis demonstrated that the T allele is a risk factor for smoking-induced emphysema (odds ratio = 2.69, P = 0.02). DL(CO)/VA was lower (P = 0.02) and emphysematous changes were more conspicuous (P = 0.03) in subjects with C/T or T/T (n = 35) than in those with C/C (n = 75). These results suggest that the polymorphism of MMP-9 acts as a genetic factor for the development of smoking-induced pulmonary emphysema.

Adult↗
PubMed2002

Pathogenesis and management of virus infection-induced exacerbation of senile bronchial asthma and chronic pulmonary emphysema.

The number of senile patients with therapy resistant bronchial asthma, chronic pulmonary emphysema increases due to the habit of smoking and increased number of older people, and these inflammatory pulmonary diseases are the leading causes of death worldwide. Rhinoviruses cause the majority of common colds, and provoke exacerbations of bronchial asthma and chronic pulmonary emphysema. Here, I review the pathogenesis and management of rhinovirus infection-induced exacerbation of senile bronchial asthma and chronic pulmonary emphysema.

Aged↗
PubMed1998

[One year follow-up of pulmonary rehabilitation in patients with pulmonary emphysema--physiological outcome].

To evaluate the long-term effects of pulmonary rehabilitation on physiological outcome, 12 patients with pulmonary emphysema were enrolled in an inpatient pulmonary rehabilitation program for 6 weeks. After discharge from the hospital, they were followed up for 1 year. The pulmonary rehabilitation program consisted of breathing retraining, thoracic mobilization, exercise training, and patient education. Although the subjects did not participate in outpatient maintenance group sessions after their discharge, they continued breathing retraining and exercise training at home. Their vital capacity improved significantly, and was sustained over the course of the year; other pulmonary functions, however, did not change significantly. Maximum exercise load increased 31% after the rehabilitation program; although it was 18% higher than baseline at follow-up one year later, that was not a significant change. The follow-up data on exercise traming had generally deteriorated 1 year after the rehabilitation program. The change in maximum exercise load from baseline before and after the inpatient pulmonary rehabilitation program correlated closely with the change in maximum exercise load thereafter to follow-up one year later (R = 0.62). We conclude that it is pessible to estimate long-term change in exercise capacity on the basis of short-term changes achieved during inpatient pulmonary rehabilitation. It may be necessary to develop maintenance programs of some kind to help pulmonary emphysema patients retain the benefits of pulmonary rehabilitation over the longer term.

Aged↗
PubMed1993

Increased leukocyte elastase of the tracheal aspirate at birth and neonatal pulmonary emphysema.

OBJECTIVE: The authors have previously shown the association of elevated neonatal serum IgM and chorioamnionitis in infants in whom pulmonary emphysema characteristic of Wilson-Mikity syndrome subsequently developed. This paper extends the observation to the measurement of polymorphonuclear leukocyte elastase-alpha 1-proteinase inhibitor complex (PMN elastase-alpha 1-PI) in tracheal aspirates of infants with chronic lung disease. PATIENTS: Tracheal aspirates were obtained from 90 very low birth weight neonates within 24 hours of birth. Serum also was collected within 72 hours of birth, and placentas were examined for signs of inflammation. RESULTS: The mean PMN elastase-alpha 1-PI was significantly elevated (21.8 micrograms/mg albumin) in infants with a pulmonary emphysema syndrome like that designated by Wilson-Mikity compared either with those with bronchopulmonary dysplasia (1.5 micrograms/mg albumin, P < .01) or those with respiratory distress syndrome in whom bronchopulmonary dysplasia did not develop (2.3 micrograms/mg albumin, P < .01). Infants with pulmonary emphysema had a significantly elevated mean serum IgM and a high incidence of chorioamnionitis. CONCLUSIONS: The level of PMN elastase-alpha 1-PI was increased in the tracheal aspirates of newborns in whom pulmonary emphysema developed. Intrauterine inflammation may increase the level of PMN elastase in the fetal respiratory tract. This increase in PMN elastase-alpha 1-PI in fetal lung tissue may cause lung injury in utero, resulting in postnatal pulmonary emphysema consistent with the Wilson-Mikity syndrome following ventilation.

Bronchopulmonary Dysplasia↗
PubMed1990

Biological effects of inhaled 239PuO2 in rats with pre-existing pulmonary emphysema.

The modifying effects of pre-existing pulmonary emphysema on the deposition, distribution, retention and effects of inhaled 239PuO2 in the rat were investigated. The presence of emphysema in the rats was documented by morphometric and respiratory function measurements. For rats exposed to similar airborne concentrations of 239PuO2, initial lung burdens of 239Pu per kg body mass were lower in rats with emphysema than in those without emphysema; however, the retention of 239Pu over time was similar in both groups. The distribution of 239Pu particles in the lungs of rats with emphysema tended to be more random than in the lungs of control rats. The life span, and incidences of non-neoplastic and neoplastic lesions in the lung, and risk of lung tumours per unit of alpha dose to the lungs in the rats with emphysema were similar to or less than in the control rats, when groups with similar initial lung burdens of 239Pu were compared. The results of this study suggest that humans with uncomplicated pulmonary emphysema are not necessarily more sensitive to the carcinogenic effects of inhaled 239PuO2 than individuals with normal lungs.

Administration, Inhalation↗
PubMed1997

[Spinal cord ischemia caused by dissecting aortic aneurysm in a patient with acute exacerbation of pulmonary emphysema].

A 61-year-old man with pulmonary emphysema was admitted due to acute exacerbation of chronic respiratory failure and a complaint of chest pain. A chest CT scan on admission showed aneurysmal dissection from the ascending aorta to the descending aorta. Analgesia was noted below the fourth thoracic vertebra, which supplies the accessory respiratory muscles including the intercostal muscles. Even after recovery from circulatory failure, his chest muscles were weak and he could not be removed from mechanical ventilation. An autopsy revealed ischemia of the spinal cord at the T4 level. In contrast, The C3 level of the spinal cord, which supplies the diaphragm, was intact. Paralysis of accessory respiratory muscles including intercostal muscles may have caused the continuation of the respiratory failure. This case shows the importance of accessory respiratory muscles in maintaining chest wall movement in patients with chronic pulmonary emphysema.

Acute Disease↗
PubMed1997

[Associations between breathing pattern during submaximal exercise and exercise capacity in patients with pulmonary emphysema].

We sought to clarify the factors associated with exercise capacity in patients with pulmonary emphysema. Exercise capacities of 20 men with pulmonary emphysema were evaluated by bicycle ergometery, and the results were used to divide the subjects into two groups: high exercise capacity (n = 10) and low exercise capacity (n = 10). Pulmonary-function tests were done, emphysema scores were computed from CT scans, breathing pattern was recorded during submaximal exercise (up to 20 watts), and index of rapid shallow breathing was computed. Neither FEV1 nor airway resistance differed between the two groups, and patients with lower exercise capacity tended to have lower tidal volumes and higher values of the index of rapid shallow breathing during submaximal exercise. Functional residual capacity measured by body plethysmography and emphysema scores were inversely associated with exercise capacity. We speculate that among patients with pulmonary emphysema and a given degree of airway obstruction, a high functional residual capacity causes breathing during submaxinal exercise to be rapid and shallow, and that this rapid and shallow breathing makes ventilation inefficient, increases the work of breathing, and limits exercise capacity.

Aged↗