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PubMed1980

Single-breath diffusing capacity and lung volumes in small laboratory mammals.

We measured the single-breath diffusing capacity for carbon monoxide (DLCO), total lung capacity (TLC), functional residual capacity (FRC), and residual volume (RV) in anesthetized male hamsters, rats, guinea pigs, and rabbits whose weights varied from 40 to 3,500 g. TLC (defined as an airway pressure of 25 cmH2O) was calculated by neon dilution. The DLCO was estimated by a modification of the single-breath method. There was a high correlation between body weight and our measurement of both the diffusing capacity and the lung volumes. No significant difference in DLCO was observed in rats when measured in different body positions, at airway pressures of 10 or 20 cmH2O, from FRC or RV, in male or female rats, or following hyperventilation.

Animals↗
PubMed2002

Diabetes worsens pulmonary diffusion in heart failure, and insulin counteracts this effect.

Chronic heart failure (CHF) (hydrostatic stress) and diabetes (basal laminae thickening) share the potentiality of damaging the alveolar-capillary membrane. We investigated 15 control subjects and 3 groups of 15 patients each having type 2 diabetes (Group 1), CHF (Group 2), and diabetes and CHF (Group 3), to probe whether addition of diabetes worsens lung diffusion in CHF and whether insulin counteracts this effect. Compared with control subjects, carbon monoxide diffusing capacity (DL(CO)) and diffusing capacity of the alveolar-capillary membrane at rest were increasingly depressed from Group 1 through Group 3. DL(CO) was lower than predicted in 11 patients each in Groups 1 and 2 and in all patients in Group 3. Regular insulin (10 IU) was ineffective in CHF alone, whereas it improved DL(CO) and diffusing capacity of the alveolar-capillary membrane in diabetes; changes, however, were significantly greater in the patients with both diabetes and CHF (+17.6%, +27.3%) than in those with diabetes alone (+9.2%, +13.1%). Insulin did not affect lung spirometry, volumes, and hemodynamics. Thus, gas transfer is depressed in a number of patients with diabetes or CHF; comorbidity increases the frequency and extent of this disorder. Insulin facilitates diffusion in diabetes, through an influence on alveolar-capillary conductance, and its efficacy is greater in comorbidity; diabetes is more disturbing in patients with CHF and produces a synergistic rather than a simple additive effect.

Aged↗
PubMed2006

Medical and psychologic outcome of living lobar lung transplant donors.

BACKGROUND: Living donor lobar lung transplantation is a viable therapy for carefully selected patients with end-stage pulmonary disease. Its success is largely dependent upon donor outcome, including both physical and emotional factors. To date, there has been little focus on psychosocial outcomes of lobar lung donors. METHODS: Retrospective evaluation of 15 of 20 living lobar lung transplant donors was performed. Donors underwent evaluation of pulmonary function after recovery from donor lobectomy. Participants completed two self-report questionnaires, the SF-36 Health Survey (SF-36) and the Beck Depression Inventory (BDI), as well as an open-ended psychiatric interview. RESULTS: After lobar donation, mean forced expiratory volume in 1 second (FEV(1)) decreased by 21 +/- 2%, forced vital capacity (FVC) decreased by 16 +/- 3%, total lung capacity (TLC) decreased by 15 +/- 3%, and single-breath diffusing capacity (DLCO) decreased by 14 +/- 4%. All subjects scored higher than the national average on both the physical and mental health components of the SF-36. The BDI scores showed no evidence of clinical depression. However, the subjective interviews elicited two common complaints: (1) a decline in exercise performance, not accounted for by resting lung function measurements; and (2) a dissatisfaction with the degree of acknowledgment of their donation. CONCLUSIONS: Living lobar lung transplant donors enjoy generally satisfactory physical and emotional health. Donors report positive feelings about donation, but wish to be recognized and valued by the transplant team and by the recipient. Despite preservation of lung function within the normal range, some donors also experience a subjective decline in exercise tolerance. Long-term medical and psychologic follow-up appears warranted to monitor symptoms of exercise impairment and to enhance the donor experience.

Forced Expiratory Volume↗
PubMed2000

Modelling the production of nitric oxide within the human airways.

The measurement of exhaled nitric oxide (NO) is well established for monitoring of airway inflammation in bronchial asthma. It is known that the concentration of NO determined as steady state (plateau) value at a constant expiratory flow rate depends on the flow rate chosen. This suggests that the exhaled NO is released within the conducting airways, whereas alveolar NO levels are negligible. The processes involved can be described through a lung model comprising an alveolar compartment and an airway compartment thought of as a pipe. This concept has been formulated mathematically and the models proposed in the literature are essentially equivalent. NO plateau levels obtained at different flow rates allow the estimation of 1) an effective airway wall NO concentration that represents the driving force for NO release, 2) an airway diffusing capacity for NO which depends on factors impeding or facilitating NO transport, including an increase in NO-producing surface area. Clinical studies will have to assess whether the knowledge of these or related parameters offers a significant advantage over the determination of exhaled NO at a single flow rate.

Biological Transport↗
PubMed1991

Computer analysis of hypoxemia during hemodialysis.

Arterial oxygen partial pressure decreases during hemodialysis if acetate as buffer is used or if certain types of bioincompatible dialyzer membranes are used. Several hypotheses considering the main cause of this hypoxemia have been proposed. To gain more insight into the mechanisms leading to this hypoxemia, a mathematical model for the computerized simulation of exchange processes during hemodialysis has been used. To simulate the ventilation-perfusion ratio (VA/Q), a simplified two-compartment model of the lung has been applied. The simulation results reveal that hypoxemia during hemodialysis has two reasons. In acetate hemodialysis, the main cause is a shift of the CO2-bicarbonate equilibrium caused by "consumption" of hydrogen ions during acetate metabolization resulting in hypoventilation due to a decrease in CO2 partial pressure. During hemodialysis with bioincompatible dialyzer membranes, the hypoxemia may be explained by an increase in inhomogeneity of the VA/Q ratio in the lung. The loss of CO2 and bicarbonate into the dialysate during acetate hemodialysis has only a minor effect on arterial PO2 and cannot explain the observed hypoxemia. The decrease of O2 diffusing capacity during hemodialysis with bioincompatible membranes has only a negligible effect on the arterial PO2. The simulation results show also that the venous PO2 in the brain may fall below a critical level of less than 25 mm Hg, thereby possibly causing oxygen deficiency in the cortex.

Acetates↗
PubMed2005

Preliminary report of the 6-minute walk test as a predictor of radiation-induced pulmonary toxicity.

PURPOSE: To assess the 6-minute walk test (6MWT) as a predictor of radiation therapy-induced lung injury (RTLI). METHODS AND MATERIALS: The 6MWT is a simple, economical, and reproducible test that measures both how far a person can walk in 6 min and any associated changes in vital signs. As part of a prospective trial to study RTLI, a pre-RT 6MWT was performed in 41 patients. The predictive capacities of pre-RT 6MWT, forced expiratory volume in 1 s (FEV1), and single-breath diffusing capacity for carbon monoxide (DLCO) for the development of RTLI were assessed with receiver operating curve (ROC) techniques. To evaluate the 6MWT, alone or with mean lung dose (MLD) of radiation, as a predictor of RTLI, the rates of RTLI in patient subgroups defined by 6MWT results were compared by using Fisher's exact test. RESULTS: Thirty-one patients with > or =3 months' follow-up were evaluable. The median baseline 6MWT result was 1400 ft. Of 31 patients, 7 developed Grade > or =2 RTLI. Of 15 patients with an MLD >18 Gy (the median), 5 developed RTLI, compared with 2 of 16 with MLD < or =18 Gy (p = 0.22). Among those with an MLD < or =18 Gy, the RTLI rates were 0 of 8 and 2 of 8 for 6MWT results > or =1400 ft or <1400 ft, respectively, p = 0.46. The ROC area under the curve for individual metrics was as follows: FEV1 0.66, MLD 0.70, DLCO 0.61, and 6MWT 0.47. Combining FEV1 with 6MWT increased the ROC to 0.71, suggesting that the ratio might be a better predictor than the individual values. Patients with a high 6MWT/FEV1 ratio had a lower rate of RTLI than those with a relatively low ratio. CONCLUSIONS: The 6MWT might provide prognostic information beyond pulmonary function tests and dosimetric parameters in predicting RTLI. Additional work is needed to better assess the utility of these functional metrics.

Adult↗
PubMed1995

Cold acclimation and endurance training in guinea pigs: changes in lung, muscle and brown fat tissue.

The effects of an intermittent high intensity stimulus (running) or a chronic low intensity stimulus (cold acclimation) of oxidative metabolism on maximal oxygen uptake (VO2,max), lung O2 diffusing capacity (DLO2) and skeletal muscle as well as fat tissue mitochondrial content in growing guinea pigs are described. Young male guinea pigs were assigned to three experimental groups (n = 5): control (C), endurance trained (T; at 70% VO2max) or cold acclimated (CA; 5-7 degrees C) for six weeks. Animals were sacrificed at the end of the experimental period and tissue for morphometric analysis of the lung, muscle and interscapular fat was sampled. T and CA animals significantly increased weight specific VO2max by 23% and 29%, respectively. Despite a significant increase in absolute lung volume in T (+10%) and in weight specific lung volume in CA (+20%) neither absolute nor weight specific DLO2 was significantly affected by the experimental treatments. In trained animals the total volume of mitochondria remained unchanged in samples representative for the entire musculature but was significantly increased in M. vastus intermedius (+72%). Intramyocellular lipids increased significantly both in M. vastus intermedius (+244%) as well as in the whole body musculature (+164%). Cold acclimation increased the mitochondrial content of the interscapular fat pad by approximately 20-fold but had no effect on total mitochondrial volume in muscle. We conclude that the increase in oxygen demand resulting from exercise training or from cold acclimation could be accomodated by the existing lung diffusing capacity and did not induce a global change of oxidative capacity in skeletal muscle tissue in growing guinea pigs. Exercise training caused oxidative capacity to increase only in a locomotor muscle activated during running whereas cold acclimation greatly increased interscapular fat tissue oxidative capacity.

Acclimatization↗
PubMed1988

The alveolar carbon monoxide uptake fraction: a simple, alternative measure of carbon monoxide transfer.

The measurement and interpretation of "diffusing capacity" by either single-breath or steady-state methods are complicated by both technical and conceptual difficulties. The CO uptake fraction is less complex but, as originally described, it is unacceptably sensitive to dead-space ventilation. A modification (the "alveolar CO uptake fraction", UA) largely removes this factor. We have measured UA in thirteen healthy subjects and 100 patients with a variety of pulmonary disorders. It is reproducible and appears sensitive to clinical abnormality. Its technical and interpretative simplicity suggest its use as an alternative to other measures of CO transfer.

Carbon Monoxide↗
PubMed1994

Interrelationships between pulmonary and extrapulmonary involvement in systemic sclerosis. A longitudinal analysis.

PURPOSE: (1) To evaluate the relationship between the degree of pulmonary involvement by systemic sclerosis (SSc) and the degree of involvement of other organ systems by SSc at baseline. (2) To assess the degree of impairment in lung function at presentation and the annual rate of change in lung function to predict the rate of progression of involvement of extrapulmonary organ systems by SSc over time. (3) To determine whether survival in patients with SSc can be predicted from the degree of lung function impairment at baseline or from the annual rate of change in lung function. METHODS: Semiquantitative indices of pulmonary and extrapulmonary involvement and pulmonary function tests (PFTs) were analyzed and compared in 62 nonsmoking scleroderma patients enrolled in a 3-year prospective drug trial, vs 47 in a "study group" who underwent serial evaluation. The other 16 "early withdrawals" withdrew prior to the second evaluation. The indices of organ system involvement were based on clinical, physiologic, and biochemical findings as previously published. The PFTs included total lung capacity (TLC), forced vital capacity (FVC), FEV1, and single-breath diffusing capacity for carbon monoxide (Dsb). Annualized rates of change in PFTs and indices of extrapulmonary involvement were calculated for each subject from data collected on at least 2 separate occasions at least 6 months apart. Spearman rank correlations were performed between individual baseline PFTs (expressed as percent predicted) and (a) indices of extrapulmonary involvement at baseline, (b) annualized rates of change in PFTs, and (c) annualized rates of change in indices of extrapulmonary involvement. Correlations also were performed between the rate of change in each lung function measure and rates of change in indices of extrapulmonary involvement. The ability of PFTs at baseline and their rates of change to predict cumulative survival was assessed by Cox stepwise regression. RESULTS: The degree of impairment in baseline PFTs was related to involvement of the right side of the heart but not to other extrapulmonary system involvement. Baseline PFTs were not related to the rate of subsequent decline of lung function or worsening of extrapulmonary organ system involvement. Subsequent annual rates of decline in lung function were related to worsening skin and upper gastrointestinal involvement. Cumulative survival may be related to the rate of decline in DCO, TLC, and FVC, but was not predicted by impairment in any measure of lung function. CONCLUSION: With the exception of involvement of the right side of the heart consistent with cor pulmonale, the degree of pulmonary involvement by SSc was not correlated with the extent of extrapulmonary involvement. The degree of pulmonary involvement by SSc did not predict subsequent worsening of either pulmonary or extrapulmonary involvement. Worsening pulmonary involvement by SSc, in general, does not correlate with worsening involvement of extrapulmonary organ systems, except for the skin and upper gastrointestinal tract. A rapid decline in DCO or lung volumes may predict poor survival.

Bone Diseases↗
PubMed2004

Role of the chest radiograph in the preoperative assessment of the pulmonary function in patients with cirrhosis candidates to liver transplant.

PURPOSE: To appraise the role of chest radiography (CXR) in the clinical assessment of pulmonary complications occurring as a result of liver disease of any cause, a standardised reading of CXR was compared both with the results of lung function studies and with the severity of liver disease in 60 consecutive patients with cirrhosis candidates to liver transplant. MATERIALS AND METHODS: CXR were scored for signs of cardiomegaly, enlargement of central and or peripheral vessels, hyperkinetic circulatory and/or intravascular volume states, abnormally increased interstitial lung markings, and pleural effusion by three independent observers. RESULTS: The CXR score of this complete vascular-interstitial deficiency showed a high interobserver reproducibility and was significantly increased in those patients with a more decompensated liver cirrhosis. Moreover, a larger number of CXR signs of vascular and interstitial deficiency was present in those patients who had a more severe cirrhosis (Child-Pugh class 3). Functional indices of pulmonary gas exchange and diffusing capacity were worse in patients with end-stage liver cirrhosis, and for some indices the correlation was statistically significant. The comparison between lung function and CXR score showed that on average lung function impairment was significantly less severe in patients with lower CXR scores. CONCLUSIONS: In conclusion, the information derived from a standardised reading of CXR is valuable in the clinical assessment of the pulmonary damage induced by liver cirrhosis as it allows discrimination of classes of severity of liver disease and of lung function impairment. When integrated with physiologic measurements and, if necessary, with high resolution tomographic studies, chest radiography helps to discriminate patients with advanced liver cirrhosis and progressing towards a hepatopulmonary syndrome, who need a proper therapeutic management.

Adult↗
PubMed1999

Longitudinal decline in measured firefighter single-breath diffusing capacity of carbon monoxide values. A respiratory surveillance dilemma.

Seattle firefighters participate in a voluntary annual medical surveillance program including measurements of ventilatory capacity (FVC and FEV1) and single-breath diffusing capacity of carbon monoxide (DLCO). From 1989 to 1996, average % predicted DLCO (Crapo) for all participating firefighters declined from 94.4% (95% confidence interval [CI]: 93.4% to 95.5%) to 87.3% (95% CI: 86.2% to 88.3%), with no significant change in average FVC or FEV1. A random-effects regression model based on data from 812 firefighters with at least two annual sets of DLCO measurements showed the expected associations between DLCO and age, height, gender, race, ventilatory capacity, and smoking. In addition, two important temporal changes were observed, including, for an average firefighter, a large mean decline in DLCO of -1.02 ml/min/mm Hg associated with year of measurement, and a relatively smaller decline of -0.006 ml/min/mm Hg associated with number of fires fought. Although the stability of ventilatory capacity over time is reassuring, the marked temporal decline in diffusing capacity among this population of firefighters raises issues of concern. Interpretation of the observed decline poses a dilemma in terms of the reliability and efficacy of diffusing capacity as a screening tool, in whether DLCO is subject to unacceptable technical variability or whether it might provide more sensitive detection of early adverse respiratory effects of smoke inhalation.

Adult↗
PubMed1980

Density dependence of maximal expiratory flow in chronic obstructive pulmonary disease.

Pulmonary mechanics were studied in 22 patients with chronic obstructive pulmonary disease (COPD) who had no evidence of asthma. Eleven of the 22 patients had a density dependence of maximal expiratory flow within the reported normal range. Patients with normal density dependence (responders) were not different from those with decreased density dependence (nonresponders) in mean age, smoking history, symptoms of cough or dyspnea, maximal expiratory flow at 75, 50, and 25% of the vital capacity during air breathing, total lung capacity, or static elastic lung recoil at 50% of the vital capacity. The nonresponders had smaller vital capacity values, larger ratios of residual volume to total lung capacity, higher resistance, and lower static recoil at total lung capacity. There was a correlation between diffusing capacity for CO and density dependence. There was an inverse relationship between the change in density dependence after inhalation of isoproterenol and initial density dependence. Dysanaptic lung growth and increased compliance of the central airways are potential mechanisms for normal density dependence in these patients. The prevalence of normal density dependence in these patients with established COPD raises serious questions concerning the usefulness of density dependence in the early detection of COPD. The differences in density dependence may indicate differences in pathogenesis of the airflow obstruction and hence may be of prognostic significance.

Airway Resistance↗
PubMed1984

Exercise testing in occupational lung diseases.

The authors discuss the value of exercise testing in two areas of importance in occupational pulmonary disease: (1) the surveillance of worker populations in order to gain epidemiologic and physiologic understanding of disease and (2) the assessment of work capacity in individual patients.

Asbestosis↗
PubMed1996

Pulmonary function in Sardinian fire fighters.

Our study examined the respiratory function of 92 firemen whose main activity is fire fighting in forests and open country. Such fire fighting activities are to be considered a risk to the respiratory tract, taking into account studies already in the literature that have evaluated the nature and quantity of inhalable toxins present in activities of this kind. The control group was composed of 51 Carabinieri (policemen), who were asked to fill in a questionnaire about their work activities. Forced expiratory volume and flow, total lung capacity, respiratory volume, and the permeability of the alveolar-capillary barrier were measured. Firemen and Carabinieri (policemen) showed FVC rates higher than the European Community for Coal and Steel standards. The firemen showed a significant reduction in forced expiratory volume in 1 second (FEV1)[3.90 (0.50) vs. 4.04 (0.44); p < 0.05] and forced expiratory flow at 75% of forced vital capacity (FVC) (FEF75) [8.37 (4.11) vs. 8.38 (1.67) p < 0.05] and more markedly in the FEV 1/FVC relationship [80.07 (5.89) vs. 83.89 (1.67) p < 0.001] and in FEF50 [4.73 (1.34) vs. 5.54 (1.44) p < 0.01] and FEF25[1.58 (.47) vs. 1.99 (.69) p < 0.001]. There were no marked differences in air-blood exchanges. No correlation was found between respiratory function data and years of service or the number of fires extinguished during work experience.

Adult↗
PubMedDate not supplied

Retrospectroscope: the single breath test of diffusing capacity for carbon monoxide.

In this paper I briefly review the significance of the single breath test of diffusing capacity for carbon monoxide (DLCO). I then attempt to answer the question of why this simple test has not become widely used in the past twenty years. The reasons are primarily due to failure in communication between research workers and practicing physicians. The practicing clinicians have difficulty with mathematical analyses and do not appreciate the limits for which the test is valid. Under steady-state conditions DLCO measures the transfer factor for the whole lungs, i.e. the volume of CO taken up by pulmonary capillary blood from alveolar gas when the alveolar CO pressure is one. It is independent of regional inhomogeneities. DL is the product of Krogh's K and alveolar volume. Krogh's K tends to become constant near total lung capacity while DL does not. For this reason K will probably vary less than DL and should always be reported when doing this test. In terms of the simple lung model with a single homogeneous alveolar compartment K is equal to DL per unit alveolar volume. I expect the measurement of K and DLCO by the modified Krogh single breath test to become a screening test for lung disease in its early stages.

Carbon Monoxide↗
PubMed2003

A comparison of three scoring systems for predicting complications after major lung resection.

OBJECTIVES: Although complications occur frequently after major lung resection, current predictive models are not entirely satisfactory. We devised a new predictive scoring system and compared it to two existing systems. METHODS: We performed an initial retrospective review of 400 patients who underwent major resection for lung cancer from 1980 to 1995. Predictive covariates (age, spirometry, diffusing capacity) associated with three or more complication groups were used to develop a scoring system. This system (EVAD) was then evaluated against the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) and Cardiopulmonary Risk Index (CPRI) systems for patients operated between 1996 and 2001. RESULTS: Major resection for lung cancer included lobectomy (188) and pneumonectomy (30). Complication categories were: pulmonary (23; 10.5%); cardiovascular (24; 11.0%); infectious (8; 3.6%); other (29; 13.2%); nonfatal (45; 20.6%); and any (53; 24.2%). Death occurred in ten patients (4.6%). Mean EVAD scores were significantly different between groups with and without complications in all categories except infectious complications and death, whereas mean CPRI scores differed only for pulmonary complications, nonfatal complications, and death, and mean POSSUM scores did not appropriately differ for any complications. EVAD predicted incremental risk in all complication categories except cardiovascular, infectious, and death, whereas CPRI predicted incremental risk only for nonfatal and possibly any complications, and POSSUM did not predict incremental risk for any complication category. Receiver operating characteristic analysis demonstrated the EVAD system to be equivalent to or better than CPRI and POSSUM for all complication categories. CONCLUSIONS: A simple scoring system (EVAD) that utilizes pulmonary function test data and patient age predicts the likelihood of complications after major lung resection. It is easier to use and at least as accurate as other scoring systems currently in use.

Adult↗
PubMed1990

Clearance of 99mTc-DTPA in pigeon fancier's hypersensitivity pneumonitis.

The rate of clearance of inhaled 99mTc-DTPA was measured in 20 nonsmoking pigeon fanciers and 7 control subjects. The degree of their avian contact and pigeon-related symptoms were noted, humoral immune response in the form of IgG antibody to pigeon gamma globulin was quantified, and diffusing capacity and total lung capacity were measured. Thirteen fanciers who had a high level of antibody had increased rates of clearance of 99mTc-DTPA (mean half-time clearance of 16.8 [+/- SEM 2.02] min [p = 0.001]) even if they were asymptomatic and even if their diffusing capacity and total lung capacity were normal. Seven control subjects without exposure to pigeon-derived antigens had normal clearance (mean 72.6 [+/- 5.98] min), and seven fanciers with antigen exposure but without an antibody response had intermediate rates of clearance (mean 42.57 [+/- 5.11] min). Clearance was not directly related to the indices of intensity and duration of antigen exposure. The measurement of rate of clearance of 99mTc-DTPA in pigeon fanciers can identify an alteration in pulmonary integrity more subtle than found with conventional pulmonary function tests and may therefore be a useful test for studying the pulmonary response to inhaled antigen and for detecting the earliest stages in the evolution of hypersensitivity pneumonitis.

Animals↗
PubMed2005

[A follow-up study of the lung function and the chest CT changes in medical staff with severe acute respiratory syndrome in Beijing].

OBJECTIVE: To analyze the lung function and radiological changes in rehabilitating severe acute respiratory syndrome (SARS) patients of medical staff in Beijing. METHODS: Follow-up lung function tests and chest high-resolution computerized tomography (HRCT) were performed in medical staff with SARS from Dec. 2003 to Feb. 2004. RESULTS: Thirty-one (7.64%) of 406 patients showed abnormal ventilatory function, while 165 of 404 patients showed diffusing abnormality. Of the 434 patients who had received HRCT scans, 151 (34.79%) showed abnormalities including subpleural and basal ground-glass and reticular attenuation, nodular septal thickening and bronchiectasis. Of the 395 patients who had received both lung function test and HRCT scanning, 55 (13.92%) had abnormalities both in the lung function and HRCT. The decrease in diffusing capacity in patients with HRCT changes was more significant than those without HRCT changes. CONCLUSIONS: Lung function and lung imaging were abnormal in some patients with SARS after recovery. It is suggested that the lung damage is chronic, and follow-up is needed.

Adult↗