Home About us Contact
|
Home About us Contact | ||
|
|
||
Total Lung Capacity (total + lung_capacity)
Selected AbstractsDoes lung growth occur when mature lobes are transplanted into children?PEDIATRIC TRANSPLANTATION, Issue 6 2002Suchada Sritippayawan Abstract: Lung volume increases after living donor lobar lung transplantation (LD) in children. The mechanism responsible for this increase may be alveolarization (lung growth) or alveolar dilation. The diffusing capacity of the lung for carbon monoxide adjusted for lung volume (DLco/VA) should decrease if alveolar dilation occurs, but not if lung growth occurs. Pulmonary function tests were measured 1,12 months after transplant in 20 children receiving LD transplants and in 11 children receiving cadaveric whole lung transplantation (CL). One month after transplant there were no differences between LD and CL recipients in age, gender, or height. Compared to the first month after transplant, height increased at 6,12 months after LD (p <,0.05), and only at 12 months after CL (p =,0.02). Total lung capacity (TLC) showed an 11,22% increase at 3,12 months after LD , and an 11,14% increase at 6,12 months after CL. DLco/VA showed an 11,17% decrease at 3,12 months after LD. However, in recipients of CL, DLco/VA showed a transient decrease of 10% at 3,6 months post-transplant, but was not significantly lower at 9,12 months. LD recipients had lower DLco/VA values than CL recipients at 6,12 months after transplant (p <,0.05). We conclude that following LD, lung volume increases, but DLco/VA decreases. We speculate that alveolar dilation, rather than alveolarization, is the primary mechanism of increased lung volume in children following LD. [source] Accuracy of Spirometry in Diagnosing Pulmonary Restriction in Elderly PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009Simone Scarlata MD OBJECTIVES: To compare the accuracy of a diagnosis of pulmonary restriction made using forced vital capacity (FVC) less than the lower limit of normal (LLN) with the criterion standard diagnosis made using total lung capacity (TLC) less than the LLN in an elderly population. DESIGN: Retrospective analysis. SETTING: A teaching hospital. PARTICIPANTS: Five hundred sixty-four ambulatory and acute care hospital patients aged 65 to 96 underwent complete pulmonary function evaluation. MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values (PPV, NPV) of diagnosis of pulmonary restriction defined as FVC less than the LLN were calculated in the overall sample and after stratification according to bronchial obstruction. Expected PPV and NPV at different background prevalence of true pulmonary restriction (5% and 15%) were calculated using the Bayes theorem. RESULTS: Low sensitivity (0.32) and high specificity (0.95) were found, with an area under the receiver operating characteristic curve (AUC) of 0.89. In participants without bronchial obstruction, specificity was even higher, although sensitivity decreased to 0.28 (AUC=0.92). The PPV was good (0.81), whereas with a low to moderate a priori probability (prevalence from 5% to 15%) the NPV was fair (,0.89). CONCLUSION: A reduction in FVC below LLN cannot reliably identify true pulmonary restriction in elderly people, confirming previous findings in the adult population. Normal FVC, instead, can effectively exclude pulmonary restriction regardless of the presence of bronchial obstruction when the a priori probability is low or moderately high. [source] Hyperpolarized 3He apparent diffusion coefficient MRI of the lung: Reproducibility and volume dependency in healthy volunteers and patients with emphysemaJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2008Sandra Diaz MD Abstract Purpose To measure the apparent diffusion coefficient (ADC) of hyperpolarized (HP) 3He gas using diffusion weighted MRI in healthy volunteers and patients with emphysema and examine the reproducibility and volume dependency. Materials and Methods A total of eight healthy volunteers and 16 patients with emphysema were examined after inhalation of HP 3He gas mixed with nitrogen (N2) during breathhold starting from functional residual capacity (FRC) in supine position. Coronal diffusion-sensitized MR images were acquired. Each subject was imaged on three separate days over a seven-day period and received two different volumes (6% and 15% of total lung capacity [TLC]) of HP 3He each day. ADC maps and histograms were calculated. The mean and standard deviation (SD) of the ADC at different days and volumes were compared. Results The reproducibility of the mean ADC and SD over several days was good in both healthy volunteers and patients (SD range of 0.003,0.013 cm2/second and 0.001,0.009 cm2/second at 6% and 15% of TLC for healthy volunteers, and a SD range of 0.001,0.041 cm2/second and 0.001,0.011 cm2/second, respectively, for patients). A minor but significant increase in mean ADC with increased inhaled gas volume was observed in both groups. Conclusion Mean ADC and SD of HP 3He MRI is reproducible and discriminates well between healthy controls and patients with emphysema at the higher gas volume. This method is robust and may be useful to gain new insights into the pathophysiology and course of emphysema. J. Magn. Reson. Imaging 2008. © 2008 Wiley-Liss, Inc. [source] Nasal administration of albuterol: an alternative route of deliveryJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 10 2004Anwar A. Hussain The use of metered-dose inhalers for the delivery of albuterol, a ,2 -selective adrenergic agonist, is associated with drawbacks, especially in children and the elderly. This investigation was designed to assess the effectiveness of albuterol delivered intranasally and to compare this delivery route with intratracheal and intravenous delivery. Three parameters of pulmonary function (peak maximal expiratory flow, maximal expiratory flow at 50% vital capacity, and total lung capacity) in anaesthetized, artificially ventilated guinea pigs were used to determine the degree of protection produced by albuterol against bronchoconstrictor responses provoked by acetylcholine. The heart rate was also measured. Although intranasal albuterol induced a slower protective action during the very initial phase of absorption, the drug was shown to be equally effective when administered either intranasally or intratracheally. In contrast, despite a significant effect initially in the case of intravenous albuterol, its ability to influence pulmonary function faded rather rapidly. No statistically significant differences in heart rate could be detected among the different treatment groups. In conclusion, intranasal albuterol may offer an alternative to metered-dose inhalers for the treatment of acute bronchospasm and for prevention of exercise-induced asthma, especially for children and the elderly. [source] Lower airway obstruction is associated with increased morbidity in children with sickle cell disease,PEDIATRIC PULMONOLOGY, Issue 3 2009Jessica H. Boyd MD Abstract Rationale The association between pulmonary function and morbidity in children with sickle cell disease (SCD) has not been previously evaluated. Our objective was to study the relationship between abnormalities in pulmonary function and morbidity as represented by the rate of hospitalizations for pain or acute chest syndrome (ACS) in children with SCD. Methods Results of pulmonary function tests obtained for clinical indications in children ages 6,18 years were classified as lower airway obstruction (forced expiratory volume in 1 sec/forced volume capacity <95% confidence interval adjusted for age, gender, race, and height), restriction (total lung capacity <80% predicted adjusted for gender, age, race, and height), and normal lung function. Incidence rates of pain or ACS were compared between children with lower airway obstruction or restriction and children with normal lung function. Results A total of 102 children, mean age at evaluation 12.0 years with follow-up of 3.8 years, were included. Children with lower airway obstruction had twice the rate of morbidity compared to children with normal lung function (2.5 vs. 1.2 hospitalizations for pain or ACS per patient-year, P,=,0.003) (Risk ratio: 2.0; 95% CI: 1.3,3.3). Children with restriction did not have different rates of future morbidity compared to children with normal lung function (1.4 vs. 1.2 hospitalizations for pain or ACS per patient-year, P,=,0.68) (Rate ratio: 1.1; 95% CI: 0.6,2.1). Conclusions We conclude that children with SCD who have lower airway obstruction should have increased surveillance for future morbidity. Pediatr Pulmonol. 2009; 44:290,296. © 2009 Wiley-Liss, Inc. [source] Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough,PEDIATRIC PULMONOLOGY, Issue 8 2006John Saito MD Abstract Assessing airway disease in young children with wheeze and/or cough is challenging. We conducted a prospective, descriptive study of lung function in children <3 years old with recurrent wheeze and/or cough, who had failed empiric antiasthma and/or antireflux therapy and subsequently underwent flexible bronchoscopy. Our goals were to describe radiographic, anatomical, microbiological, and physiological findings in these children, and generate hypotheses about their respiratory physiology. Plethysmography and raised-volume rapid thoracoabdominal compression (RVRTC) techniques were performed prior to bronchoscopy. Mean Z-scores (n,=,19) were ,1.34 for forced expiratory volume at 0.5 sec (FEV0.5), ,2.28 for forced expiratory flows at 75% of forced vital capacity (FVC) (FEF75), ,2.25 for forced expiratory flows between 25,75% of FVC (FEF25,75), 2.53 for functional residual capacity (FRC), and 2.23 for residual volume divided by total lung capacity (RV/TLC). Younger, shorter children had markedly depressed FEF75 and FEF25,75 Z-scores (P,=,0.002 and P,=,<0.001, respectively). As expected, lower airway anatomical abnormalities, infection, and inflammation were common. Elevated FRC was associated with anatomical lower airway abnormalities (P,=,0.03). FVC was higher in subjects with neutrophilic inflammation (P,=,0.03). There was no association between other physiologic variables and bronchoscopic/bronchoalveolar lavage fluid findings. Half of those with elevated RV/TLC ratios (Z-score >2) had no evidence of chest radiograph hyperinflation. We conclude that in this population, plethysmography and RVRTC techniques are useful in identifying severity of hyperinflation and airflow obstruction, and we hypothesize that younger children may have relatively small airways caliber, significantly limiting airflow, and thus impairing secretion clearance and predisposing to lower airway infection. Pediatr Pulmonol. 2006; 41: 709,719. © 2006 Wiley-Liss, Inc. [source] Lung volumes in healthy Afro-Caribbean children aged 4,17 yearsPEDIATRIC PULMONOLOGY, Issue 2 2005Karl P. Sylvester BSc Abstract Lung volumes in healthy children differ according to their ethnic origin. We wished to determine if any differences in the lung volumes of Afro-Caribbean (AC) children from those predicted by Caucasian reference values disappeared if the results were related to sitting height or to 90% or 77% of lung volumes predicted for height from Caucasian reference values based on standing height. We took, as our working hypothesis, that it is inappropriate to use Caucasian reference values to interpret data from Afro-Caribbean children, and that ethnic-specific reference values are required. This was a prospective, observational study. Subjects included 80 AC children with a median age of 9 (range, 4.3,17.8) years. Standing and sitting height were measured. Lung volumes were measured by body plethysmography (total lung capacity, TLCpleth; functional residual capacity, FRCpleth; and vital capacity, VCpleth), helium gas dilution (functional residual capacity, (FRCHe), spirometry (forced expiratory volume in 1 sec, FEV1), and forced vital capacity (FVC). The lung volumes of AC children correlated significantly with standing height, but differed significantly from values predicted from Caucasian reference values based on standing height (P,<,0.05). Significant differences remained for TLCpleth, FRCpleth, FRCHe, RVpleth, VCpleth, FEV1, and FVC when the results were related to sitting height or 90% or 77% of values predicted from Caucasian reference values based on height (P,<,0.05). Lung volumes in Afro-Caribbean children should be compared to ethnic-specific reference values. Pediatr Pulmonol. 2005; 40:109,112. © 2005 Wiley-Liss, Inc. [source] Longitudinal pulmonary status of cystic fibrosis children with meconium ileusPEDIATRIC PULMONOLOGY, Issue 4 2004Zhanhai Li PhD Abstract Although meconium ileus (MI) is the earliest manifestation of cystic fibrosis (CF), and is associated with poorer growth, the longitudinal pulmonary progression of CF children with MI is not clear. To test the hypothesis that MI is associated with worse pulmonary outcomes, we prospectively compared from diagnosis to 12 years of age 32 CF children with MI to 50 CF children without MI who were diagnosed during early infancy through neonatal screening. Pulmonary outcome measures included respiratory symptoms, respiratory infections, pathogens, antibiotic usage, hospitalizations, quantitative chest radiology, spirometry, and lung volume determinations. Obstructive lung disease was defined as percent predicted spirometry values below the lower limits of normal. Longitudinal analyses revealed no significant differences in cough, wheezing, respiratory infections, prevalence of and median times to acquisition of Pseudomonas aeruginosa or Staphylococcus aureus, antibiotic usage, and chest radiograph scores between the two groups. However, MI children showed significantly worse forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), forced expiratory flow between 25,75% of FVC (FEF25,75), % predicted FEV1, % predicted FEF25,75, and total lung capacity (TLC). These differences were particularly apparent beginning at age 8,10 years. MI children also had higher rates of and shorter median times to obstructive lung disease. Subgroup analyses showed MI children treated surgically and those treated medically had similar pulmonary outcomes. In conclusion, MI children have worse lung function and more obstructive lung disease than those without MI. Such abnormalities are accompanied by reduced lung volume. MI is a distinct CF phenotype with more severe pulmonary dysfunction. Pediatr Pulmonol. 2004; 38:277,284. © 2004 Wiley-Liss, Inc. [source] Beryllium lymphocyte proliferation test surveillance identifies clinically significant beryllium diseaseAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2009Margaret M. Mroz MSPH Abstract Background Workplace surveillance identifies chronic beryllium disease (CBD) but it remains unknown over what time frame mild CBD will progress to a more severe form. Methods We examined physiology and treatment in 229 beryllium sensitization (BeS) and 171 CBD surveillance-identified cases diagnosed from 1982 to 2002. Never smoking CBD cases (81) were compared to never smoking BeS patients (83) to assess disease progression. We compared CBD machinists to non-machinists to examine effects of exposure. Results At baseline, CBD and BeS cases did not differ significantly in exposure time or physiology. CBD patients were more likely to have machined beryllium. Of CBD cases, 19.3% went on to require oral immunosuppressive therapy. At 30 years from first exposure, measures of gas exchange were significantly worse and total lung capacity was lower for CBD subjects. Machinists had faster disease progression as measured by pulmonary function testing and gas exchange. Conclusions Medical surveillance for CBD identifies individuals at significant risk of disease progression and impairment with sufficient time since first exposure. Am. J. Ind. Med. 52:762,773, 2009. © 2009 Wiley-Liss, Inc. [source] Relationship between induced sputum cytology and inflammatory status with lung structural and functional abnormalities in asbestosisAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2008José Henrique Setta MD Abstract Background Asbestosis is associated with lung cellular and immunological abnormalities. Induced sputum cytology and local and systemic markers of inflammation may be helpful to characterize disease status and progression in these patients. Methods Thirty-nine ex-workers with asbestosis on high-resolution CT (HRCT) and 21 non-exposed controls were evaluated. Sputum cytology and IL-8 in serum and sputum were related to lung function impairment. Results Subjects with asbestosis had reduced sputum cellularity but higher macrophage/neutrophil ratio and % macrophage as compared with controls. Sputum and serum IL-8 were also higher in patients with asbestosis (P,<,0.05). In addition, evidence of lung architectural distorption on HRCT was associated with increased levels of serum IL-8. Interestingly, absolute macrophage number was negatively correlated with total lung capacity (r,=,,0.40; P,=,0.04) and serum IL-8 to lung diffusing capacity (r,=,,0.45; P,=,0.01). Conclusions Occupationally exposed subjects with asbestosis on HRCT have cytologic abnormalities in induced sputum and increased local and systemic pro-inflammatory status which are correlated to functional impairment. Am. J. Ind. Med. 51:186,194, 2008. © 2008 Wiley-Liss, Inc. [source] Mechanical ventilatory constraints during incremental cycle exercise in human pregnancy: implications for respiratory sensationTHE JOURNAL OF PHYSIOLOGY, Issue 19 2008Dennis Jensen The aim of this study was to identify the physiological mechanisms of exertional respiratory discomfort (breathlessness) in pregnancy by comparing ventilatory (breathing pattern, airway function, operating lung volumes, oesophageal pressure (Poes)-derived indices of respiratory mechanics) and perceptual (breathlessness intensity) responses to incremental cycle exercise in 15 young, healthy women in the third trimester (TM3; between 34 and 38 weeks gestation) and again 4,5 months postpartum (PP). During pregnancy, resting inspiratory capacity (IC) increased (P < 0.01) and end-expiratory lung volume decreased (P < 0.001), with no associated change in total lung capacity (TLC) or static respiratory muscle strength. This permitted greater tidal volume (VT) expansion throughout exercise in TM3, while preserving the relationship between contractile respiratory muscle effort (tidal Poes swing expressed as a percentage of maximum inspiratory pressure (PImax)) and thoracic volume displacement (VT expressed as a percentage of vital capacity) and between breathlessness and ventilation . At the highest equivalent work rate (HEWR = 128 ± 5 W) in TM3 compared with PP: , tidal Poes/PImax and breathlessness intensity ratings increased by 10.2 l min,1 (P < 0.001), 8.8%PImax (P < 0.05) and 0.9 Borg units (P < 0.05), respectively. Pulmonary resistance was not increased at rest or during exercise at the HEWR in TM3, despite marked increases in mean tidal inspiratory and expiratory flow rates, suggesting increased bronchodilatation. Dynamic mechanical constraints on VT expansion (P < 0.05) with associated increased breathlessness intensity ratings (P < 0.05) were observed near peak exercise in TM3 compared with PP. In conclusion: (1) pregnancy-induced increases in exertional breathlessness reflected the normal awareness of increased and contractile respiratory muscle effort; (2) mechanical adaptations of the respiratory system, including recruitment of resting IC and increased bronchodilatation, accommodated the increased VT while preserving effort,displacement and breathlessness, relationships; and (3) dynamic mechanical ventilatory constraints contributed to respiratory discomfort near the limits of tolerance in late gestation. [source] Plethysmography and impulse oscillometry assessment of tiotropium and ipratropium bromide; a randomized, double-blind, placebo-controlled, cross-over study in healthy subjectsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 4 2006D. Singh Aims Spirometry, plethysmography and impulse oscillometry (IOS) measure different aspects of lung function. These methods have not been compared for their ability to assess long- and short-acting anticholinergic agents. We therefore performed a double-blind, placebo-controlled, four-way cross-over study in 30 healthy subjects. Methods Single doses of tiotropium bromide (Tio) 54 and 18 mcg, ipratropium bromide (IB) 40 mcg and placebo were administered. Specific conductance (sGaw), total lung capacity (TLC), inspiratory capacity (IC) and residual volume (RV) were measured using plethysmography, while IOS measured resistance (R5,25) and reactance (RF and X5). Pulmonary function was measured for 26 h post dose. Results Tio caused significant improvements in sGaw, forced expiratory voume in 1 s (FEV1), maximum mid-expiratory flow (MMEF) and R5,R25 at time points up to 26 h, with no clear differences between doses. IB improved the same parameters, but only up to 8 h. The weighted mean change (0,24 h) caused by Tio 54 mcg compared with placebo for FEV1 was 240 ml (95% confidence interval 180, 300), while for sGaw the ratio of geometric means (Tio compared with placebo) was 1.35 (1.28, 1.41). Neither drug caused consistent statistically significant changes in RF, forced vital capacity, TLC or IC over 26 h. RV was significantly improved from 8 to 24 h by Tio 54 mcg only. Conclusions In addition to spirometry, IOS resistance measurements and sGaw can distinguish between the effects of long- and shortacting anticholinergic effects in healthy subjects. [source] Asystole and increased serum myoglobin levels associated with ,packing blackout' in a competitive breath-hold diverCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 6 2009Johan P. A. Andersson Summary Many competitive breath-hold divers use ,glossopharyngeal insufflation', also called ,lung packing', to overfill their lungs above normal total lung capacity. This increases intrathoracic pressure, decreases venous return, compromises cardiac pumping, and reduces arterial blood pressure, possibly resulting in a syncope breath-hold divers call ,packing blackout'. We report a case with a breath-hold diver who inadvertently experienced a packing blackout. During the incident, an electrocardiogram (ECG) and blood pressure were recorded, and blood samples for determinations of biomarkers of cardiac muscle perturbation (creatine kinase-MB isoenzyme (CK-MB), cardiac troponin-T (TnT), and myoglobin) were collected. The ECG revealed short periods of asystole during the period of ,packing blackout', simultaneous with pronounced reductions in systolic, diastolic, and pulse pressures. Serum myoglobin concentration was elevated 40 and 150 min after the incident, whereas there were no changes in CK-MB or TnT. The ultimate cause of syncope in this diver probably was a decrease in cerebral perfusion following glossopharyngeal insufflation. The asystolic periods recorded in this diver could possibly indicate that susceptible individuals may be put at risk of a serious cardiac incident if the lungs are excessively overinflated by glossopharyngeal insufflation. This concern is further substantiated by the observed increase in serum myoglobin concentration after the event. [source] Association of findings in flow-volume spirometry with high-resolution computed tomography signs in asbestos-exposed male workersCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 1 2009Päivi Piirilä Summary Introduction:, Disorders of pulmonary tissue and pleura are visualized by findings in high-resolution computed tomography (HRCT), and the impairment caused by these findings is assessed by pulmonary function tests. Our aim was to determine how some commonly used spirometric variables are related to certain HRCT signs, in order to find out which HRCT signs are associated with restrictive and which with obstructive ventilatory impairment. Methods:, Altogether 590 asbestos-exposed workers, 95% of whom were smokers or ex-smokers, were studied with HRCT; 19 pathological signs were scored. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, forced expiratory flow at 50% of FVC (MEF50) and total lung capacity (TLC) were measured, and their relationship with HRCT signs was examined with bivariate correlations and multiple regression analysis. Results:, FVC and TLC were negatively correlated with fibrosis score, parenchymal bands, extent of pleural thickenings and positively with widened retrosternal space. FEV1/FVC ratio was negatively correlated with emphysema types and widened retrosternal space and positively with parenchymal bands and subpleural nodules. Thickened bronchial walls did not separate between restrictive and obstructive ventilatory function. Conclusions:, HRCT signs showed distinctive patterns in restrictive and obstructive ventilatory impairment. These results can be used to help to analyse the lung function of patients simultaneously exposed to asbestos and smoking, when this relationship requires elucidation. In addition, the results may be helpful in explaining some radiological findings. [source] | ||||||||||