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PubMed1985

The effect of D-penicillamine on pulmonary findings in systemic sclerosis.

D-penicillamine has been used for the treatment of systemic sclerosis for 2 decades. Forty-four systemic sclerosis patients who received a mean dose of 636 mg of D-penicillamine for 2.3 years and 48 untreated patients, who had repeat pulmonary function tests performed after a mean of 3.5 and 4.8 years, respectively, were evaluated. There were no significant changes in the vital capacity or the forced expiratory volumes during this time in either group. However, the diffusing capacity for carbon monoxide improved from 76% of predicted to 87% of predicted in D-penicillamine-treated patients. Untreated patients changed slightly, from 73% of predicted to 76% of predicted. When multiple logistic regression analysis was used to account for factors which could have biased treatment comparisons, the improvement related to use of the D-penicillamine was significant (P less than 0.05). This improvement in the D-penicillamine-treated patients was associated with no further progression of dyspnea or fibrosis on chest radiograph, as well as reduced skin thickening. These data suggest that D-penicillamine may be useful in the treatment of systemic sclerosis that involves the lung; however, further studies are needed.

Colchicine↗
PubMed2002

Bronchial responsiveness and lung function related to cigarette smoking and smoking cessation.

BACKGROUND: The relationships between bronchial responsiveness and both cigarette smoking and smoking cessation are still controversial. METHODS: To investigate the effects of cigarette smoking and smoking cessation on bronchial reactivity and the level of pulmonary function, bronchial responsiveness to methacholine using the forced oscillation method, the transfer factor, and spirometry were measured in 180 nonsmokers, 109 current smokers, and 82 ex-smokers. The following indices of bronchial responsiveness were used: (1) baseline respiratory resistance (Rrs); (2) the cumulative dose of methacholine (DA) causing an increase in Rrs by twice the baseline values (bronchial sensitivity); and (3) the slope of linearly decreased respiratory conductance (SGrs) representing bronchial reactivity. RESULTS: Current smokers had significantly higher baseline Rrs (p<0.001) and bronchial responsiveness than did nonsmokers and ex-smokers. In 24.7% of smokers, Rrs increased by twice or more upon challenge with methacholine (responders), compared with 0% of nonsmokers (p<0.0001) and 19.5% of ex-smokers (p=0.28). SGrs for responders among ex-smokers was found not to differ from that for responders among smokers. However, smokers had a significantly lower DA of inhaled methacholine than did ex-smokers. Cigarette smoking was also associated with an appreciable reduction in FEV1/FVC (forced expiratory volume in 1s/forced vital capacity), DLCO (carbon monoxide diffusing capacity), and DLCO/VA (alveolar volume). CONCLUSION: There seems to be a partially reversible phenomenon that leads to improvement in airway responsiveness and DLCO upon smoking cessation.

Adult↗
PubMed2006

Improvement of lung function in patients with systemic sclerosis after 6 months cyclophosphamide pulse therapy.

This study aims to analyze the effects of cyclophosphamide pulse therapy on parameters of lung function in patients with systemic sclerosis. Nineteen patients with systemic sclerosis (15 women and four men, aged 25-67 years, mean disease duration 5 years and 9 months) were included in this study. The main reason for the beginning of cyclophosphamide therapy was the decrease of transfer-factor (DLCO) or diffusing coefficient for carbon monoxide (DLCO/VA) under 70% of predictive value. Intravenous cyclophosphamide was administered monthly in a dose of 500 mg/m(2 )body surface. The efficacy was evaluated by comparison of forced vital capacity (FVC), DLCO, and DLCO/VA at the baseline and 1 month after the sixth pulse. Statistical analyses were performed using Student's T test and Wilcoxon's test. The difference between FVC at the baseline (86.6%) and at the end of the follow-up period (89.2%) was not statistically significant (t=-1.25, p>0.05). However, a significant increase of DLCO (from 61.2% to 70.5%, z=-2.04, p=0.04) and DLCO/VA (from 57.8% to 72.5%, z=-2.67, p=0.008) was observed. Minor side effects were noticed in some patients. Two patients had nausea after cyclophosphamide infusion, two patients had insignificant decrease of creatinine clearance, and two patients had temporary and mild leukopenia. In patients with systemic sclerosis and lung involvement, an improvement of lung-diffusing capacity was noticed 6 months after the beginning of cyclophosphamide pulse therapy, with only minor side effects.

Adult↗
PubMed2005

Persistence of lung function abnormalities despite sustained success of percutaneous mitral valvotomy: the need for an early indication.

AIMS: We assessed early and long-term pulmonary function changes after percutaneous balloon mitral valvotomy (PBMV). METHODS AND RESULTS: Mitral area, lung function, and exercise capacity were evaluated before, immediately after, and 3 months, 6 months, and 12 months after successful PBMV in 24 patients. PBMV resulted in a significant and sustained increase in mitral area, from 1.0 +/- 0.1 to 1.9 +/- 0.1 cm2 (p = 0.001) [mean +/- SD], with a progressive increase in exercise tolerance at 6-month follow-up (from 22.6 +/- 1.4 to 28.2 +/- 1.2 mL/kg, p = 0.0001). An immediate drop in the diffusing capacity of the lung for carbon monoxide (DLCO) was observed (from 26.7 +/- 1.5 to 22.3 +/- 1.1 mL/min/mm Hg, p = 0.0002) after PBMV, followed by a gradual regression to baseline values at 3 months; at 1 year, the DLCO remained elevated (27.3 +/- 6.3 mL/min/mm Hg). The flow in the small airways was reduced at baseline, and there was no significant change during follow-up. CONCLUSIONS: PBMV produces an initial decrease in DLCO, suggesting a reduction of pulmonary congestion. During follow-up, the regression to the initial lung diffusion values despite a sustained hemodynamic improvement suggests that some irreversible interstitial changes were present. In patients with mitral stenosis, an impairment of lung function parameters suggests that PBMV must be performed early, even if patients have few symptoms.

Adult↗
PubMed1982

Evaluation of lung ventilation and carbon monoxide-diffusing capacity in patients with nonseminomatous testicular tumors treated with bleomycin.

Spirometric tests and CO transfer tests were systematically employed before, during, after the therapy and in the follow-up of 33 patients affected by seminomatous testicular tumours treated with 4-5 Einhorn courses (PVB). The aim was to demonstrate possible bleomycin-induced pulmonary toxicity and its relationship with the cumulative dose of the drug. Our patients, who never had clinical or radiological signs of pulmonary toxicity, did not show significant change in the functional respiratory tests throughout therapy, except for 6 patients who had a reduction in CO transfer of about 30% after the 2nd or 3rd course which persisted up to the end and during the follow-up. We did not find any correlation of such a reduction with predisposing factors.

Adolescent↗
PubMed1976

Bronchoconstriction and pulmonary hypertension during abortion induced by 15-methyl-prostaglandin F2alpha.

Patients have experienced severe breathlessness during second trimester abortion initiated by the intramuscular injection of 15-methyl-prostaglandin F2alpha (15-me-PGF2alpha). In four healthy women given 400 mug of 15-me-PGF2alpha to induce abortion, pulmonary function tests showed reductions in arterial oxygen tension, maximum expired air flow and vital capacity. Residual lung volume and the slope of phase III of the closing volume curves increased.

Abortion, Induced↗
PubMed2002

Abnormal lung function in healthy preterm infants.

The aim of this study was to assess the consequences of preterm birth for the functional development of the lungs. We studied 32 healthy preterm infants (gestational age 25 to 33 wk at birth) and 53 healthy full-term infants (37 to 42 wk) at the same mean postmenstrual age of 40 wk with a multibreath nitrogen washout technique to assess functional residual capacity (FRC), gas mixing efficiency, and dead space and with the single-breath occlusion technique to calculate compliance and resistance of the respiratory system. Twenty of the preterm infants were also assessed with the same methods at 34.2 (32 to 37) wk. At the same postmenstrual age the preterm infants had lower FRC/kg body weight, lower specific compliance, impaired gas mixing efficiency, and higher total and dead space ventilation/kg than the full-term infants. Specific compliance and specific conductance decreased but gas mixing efficiency increased from 34 to 40 wk. We conclude that premature exposure to extrauterine conditions changes lung function. Preterm infants showed signs of dysfunction of the terminal respiratory units and higher elastic recoil than infants who spent the corresponding time for development in utero. It is suggested that preterm birth per se affects alveolarization and formation of elastic tissue in the lungs.

Airway Resistance↗
PubMed2001

Reduction of lung distensibility in acromegaly after suppression of growth hormone hypersecretion.

Whether the growth of the lungs in acromegaly is due to alveolar hypertrophy or alveolar hyperplasia is a subject of debate. To discriminate these hypotheses, we compared pulmonary distensibility and diffusing capacity among 11 patients with active acromegaly and 11 matched control subjects, evaluating the response of pulmonary distensibility and diffusing capacity to suppression of growth hormone (GH) hypersecretion. We performed lineal and exponential analyses of quasistatic pressure-volume curves. Patients with active acromegaly had a greater TLC, lung compliance, and shape constant, K, than did normal subjects. We found no significant differences between the study groups in carbon monoxide diffusing capacity or diffusing capacity per unit of alveolar volume. After treatment, patients with inactive acromegaly showed a reduced TLC (6.95 +/- 1.40 [mean +/- SD] L versus 6.35 +/- 1.23 L), reduced lung compliance (3.61 +/- 0.90 L/kPa versus 2.36 +/- 0.79 L/ kPa), reduced K coefficient (2.62 +/- 0.65 kPa(-)(1) versus 1.35 +/- 0.40 kPa(-)(1)), and increased maximal recoil pressure (1.74 +/- 0.38 kPa versus 2.28 +/- 0.25 kPa). We conclude that the increased lung distensibility with normal diffusion capacity demonstrated in patients with active acromegaly, which was partly reversible after suppression of GH hypersecretion, suggests that lung growth in acromegaly may result from an increase in alveolar size.

Acromegaly↗
PubMed1976

Seropositive rheumatoid arthritis associated with decreased diffusion capacity of the lung.

Sixty-two patients with classical or definite rheumatoid arthritis were subjected to lung function analysis. The various parameters--spirography, plethysmography, blood gas analysis, measurement of lung compliance, and diffusion capacity--were correlated with duration and stage of disease, and with rheumatoid factor titres. A statistically significant correlation was found to exist between Rose-Waaler titre and specific diffusion capacity. Similar results between Rose-Waaler titre and lung compliance, however, were not statistically significant.

Adolescent↗
PubMed2001

Increased circulating levels of alpha1-antitrypsin and calprotectin are associated with reduced gas diffusion in the lungs.

The aim was to examine the relationship of serum inflammatory markers to the level of single-breath diffusing capacity of carbon monoxide (TL,CO). A stratified sample (n = 1,121) of a Norwegian general population aged 18-73 yrs was examined. The inflammatory markers measured were calprotectin, a prominent protein in the cytosol fraction of neutrophil granulocytes, and alpha1-antitrypsin (alpha1-AT), the major inhibitor of neutrophil elastase in the lower respiratory system. Both markers have increased circulating levels in the course of an acute inflammatory reaction. Subjects with a TL,CO < 80% of predicted value had a higher level of both alpha1-AT (p = 0.003) and calprotectin (p < 0.03) than those with a TL,CO > 100%. In multiple linear regression analyses, alpha1-AT was still significantly associated with TL,CO after adjusting for sex, age, smoking habits, haemoglobin, carboxyhaemoglobin, forced expiratory volume in one second and alveolar volume. In a similar analysis, no significant overall association was found between calprotectin and TL,CO, but in a stratified analysis, calprotectin was significantly related to TL,CO in females. However, no significant sex interaction in the relationship between the inflammatory markers and TL,COo was found. The findings suggest that increased levels of alpha1-antitrypsin and of calprotectin are risk factors for decreased diffusing capacity of carbon monoxide.

Adolescent↗
PubMed1990

Adaptations and limitations in the pulmonary system during exercise.

In most circumstances in health, efficient alveolar ventilation and alveolar-to-arterial exchange of O2 and CO2 are among the strongest of links in the gas-transport chain during maximal exercise. Indeed, in most instances, the metabolic cost of ventilation represents the only significant contribution of the pulmonary system to the limitation of O2 transport of locomotor muscles and thus to the limitation of maximum performance. Of the "weaknesses" inherent in the healthy pulmonary system response to exercise, the most serious one may well be its absence of structural adaptability to physical training or to the trained state. Thus, the lung's diffusion capacity and pulmonary capillary blood volume remain unaltered in the highly trained human or horse, while maximum pulmonary blood flow rises linearly with the enhanced max VO2. Similarly, ventilatory requirement rises markedly, with no alteration in the capability of the airways to produce higher flow rates or of the lung parenchyma to stretch to higher tidal volumes, and little or no change in the pressure-generating capability of inspiratory muscles. The case of the elderly athlete who remains capable of achieving high maximum pulmonary blood flows and ventilatory requirements and whose lung undergoes a normal aging process underscores the importance of deficits (from "normal") on the capacity end of this continuum of cost versus capacity in the pulmonary system. The asthmatic athlete may represent another such example of limited flow-generating capacity; and the healthy, young, highly fit athlete who shows marked reductions in SaO2 and in max VO2 at even moderately high altitudes demonstrates that, in many situations, precious little room can be added to the demand side or removed from the capacity side before signs of failure can be seen.

Adaptation, Physiological↗
PubMed1976

Extended experience in the long-term corticosteroid treatment of pulmonary sarcoidosis.

A 15-yr experience with symptomatic pulmonary parenchymal sarcoidosis treated with corticosteroids has included 250 patients. Within the past 5 yr 192 patients have been actively studied and these are reported in detail. Varied clinical observations are described. Serial measurements of vital capacity and steady-state carbon monoxide diffusing capacity were performed. All of these patients were sufficiently symptomatic and incapacitated to require treatment. Ninety-one percent were Black, 72% were female, and 72% were in the third and fourth decades. In response to treatment there was overall clinical improvement and an increase in vital capacity in 150 (83%) of 180 patients, although only a temporary increase in 12 of these patients. By contrast, only 82 (46%) showed an increase in carbon monoxide steady-state diffusing capacity and only temporarily in 19 patients. Changes in vital capacity correlate well with changes in symptoms and the radiographic appearance and are of great assistance in assessing the clinical course and need for continued treatment. The diffusing capacity is more difficult to interpret. Continued treatment was required in 74 patients (48%) because of recurrent clinical relapses as treatment was withdrawn. Such relapses were observed in 70% of the patients. Improvement and discontinuation of treatment was achieved in 66 patients (42%). In the 44 in whom there was no observed relapse, 34 were treated for less than 2.5 yr. In the total group, longer periods of treatment, 2.5-10 yr or more, were required in 104 patients (54%). In this series of 192 patients there were 7 deaths, with 22 deaths in the total 15-yr series of 250 patients. Of these, 18 were directly attributed to the sarcoidosis. Clinical improvement coincident with corticosteroid treatment and the frequency of relapse as treatment is withdrawn strongly support the benefits of corticosteroid treatment for symptomatic pulmonary sarcoidosis. When relapses occur and recur, retreatment is necessary and often long-term maintenance doses of prednisone (10-15 mg daily) are required for many years. The relatively infrequent problems related to this treatment are greatly exceeded by the clinical benefits.

Adrenal Cortex Hormones↗
PubMed1999

Diffusing capacity predicts operative mortality but not long-term survival after resection for lung cancer.

OBJECTIVES: We sought to determine whether diffusing capacity influences operative mortality and long-term survival after resection for lung cancer. METHODS: We retrospectively reviewed the case histories of patients who underwent major resection for lung cancer. The association between operative mortality and predicted postoperative diffusing capacity was examined. Long-term survival among operative survivors was compared between the groups with high and low predicted postoperative diffusing capacity. RESULTS: The group comprised 410 patients with a mean age of 62.3 years. We performed 273 lobectomies, 35 bilobectomies, and 102 pneumonectomies. A total of 32 operative deaths (7.8%) were associated with low predicted postoperative diffusing capacity (P <.001). If we examine only operative survivors, there is no significant difference in survival data between patients with a predicted postoperative diffusing capacity of less than 50 and those with a predicted figure of 50 or more (stage I, 111 vs 90 months; stage II, 26 vs 32 months; stage IIIa 32 vs 26 months; log rank P >.5 for each). On the basis of the Cox proportional hazards model, predicted postoperative diffusing capacity did not have a statistically significant effect on long-term survival (estimated hazard ratio corresponding to a 20-point decrease in predicted postoperative diffusing capacity = 1. 13; 95% confidence interval: 0.92 to 1.37). CONCLUSION: A poor diffusing capacity is associated with high operative mortality but does not adversely affect long-term survival after major lung resection among operative survivors. Improving the perioperative management of patients undergoing major lung resection may enable inclusion of more patients with reduced diffusing capacity in the candidate pool for surgery, thus maximizing survival for early-stage lung cancer.

Adult↗