The effect of nasal decongestant on nasal mucous velocity.

Nasal mucous velocity was measured in 13 healthy nonsmokers before and 10 min after topical application of 2 alpha adrenergic nasal decongestant sprays, phenylephrine and tetrahydrozoline. Phenylephrine increased nasal mucous velocity from 8.4 +/- 2.7 mm per min (mean +/- SD) to 13.7 +/- 4.8 mm per min and tetrahydrozoline from 8.1 +/- 3.8 mm per min (mean +/- SD) to 13.8 +/- 5.1 mm per min. These increases were significant (P less than 0.01) when compared to topical application of phenylephrine and tetrahydrozoline vehicles, normal saline, and sham (empty aerosol container).     

Effects of nasal prongs on nasal airflow resistance

STUDY OBJECTIVES: The aim of this study was to investigate whether nasal prongs, which have been proposed to assess nasal flow during sleep, affect nasal airflow resistance (NR). DESIGN: NR was estimated by posterior rhinomanometry at a 0.5 L/s flow, under eight conditions: in the basal state, and with seven different nasal prongs. PARTICIPANTS: The study was performed in 17 healthy supine subjects, 8 of whom had basal NR values within the normal range (< or = 2 cm H(2)O.L(-1).s, group 1), and 9 had increased basal NR values (> 2.5 cm H(2)O.L(-1).s, group 2), because of nare narrowness and/or deviated nasal septum. Measurements and results: NR increased significantly while breathing with nasal prongs (p < 0.0001 in both groups). The changes in NR (DeltaNR) induced by the different nasal prongs were characterized by large intersubject and intrasubject variability, with a maximum DeltaNR of 24.2 cm H(2)O.L(-1).s. Significant differences were found between the DeltaNR induced by the different nasal prongs (p < 0.001 in group 1, and p < 0.0003 in group 2), and for six of them, DeltaNR was significantly higher in group 1 than in group 2 (p < 0.02). CONCLUSIONS: This study demonstrates that nasal prongs can markedly increase NR in subjects presenting with nare narrowness and/or deviated nasal septum. Further investigations that would include nocturnal polysomnography are still required to evaluate the possible influence of nasal prongs on the diagnosis of obstructive sleep apnea syndrome and its severity.     

Combined effects of a nasal dilator and nasal prongs on nasal airflow resistance

STUDY OBJECTIVES: Nasal prongs (NPs), when used to assess nasal flow, can result in dramatic increases in nasal airflow resistance (NR). The aim of this study was to investigate whether the NP-induced increases in NR could be corrected by the simultaneous use of an internal nasal dilator (ND). DESIGN: NR was estimated by posterior rhinomanometry, in the basal state (NRb), and while breathing with NP (NRp), with ND (NRd), and with both ND and NP (NRd + p). PARTICIPANTS: The study was performed in 15 healthy subjects. Measurements and results: NR (mean NRb [+/- SEM], 2.5 +/- 0.4 cm H(2)O/L/s) significantly decreased with ND (NRd = 1.4 +/- 0.2 cm H(2)O/L/s; p < 0.001) and significantly increased with NP (NRp = 3.8 +/- 0.8 cm H(2)O/L/s; p < 0.001). A significant logarithmic relationship was found between NRd and NRb (r(2) = 0.95; p < 0.0001), and a significant exponential relationship was found between NRp and NRb (r(2) = 0.99; p < 0.0001). While breathing with both ND and NP, NRd + p was significantly lower than NRb (1.9 +/- 1.4 cm H(2)O/L/s; p < 0.02). CONCLUSIONS: Our results demonstrate that the ND tends to slightly overcorrect the NP-induced increase in NR and suggest that, in view of the possible effects of NPs on upper airway resistance, the combination of both devices might be used for nasal airflow monitoring during nocturnal polysomnography in patients presenting with highly resistive nares.     

Combined effects of a mechanical nasal dilator and a topical decongestant on nasal airflow resistance.

The goal of this study was to compare the isolated and combined effects of two treatments being used to reduce nasal airflow resistance (NR): an internal nasal mechanical dilator (Nozovent; Prevancure; Sté Pouret, Paris, France) and a topical decongestant, fenoxazoline hydrochloride (Aturgyl; Synthelabo; Le Plessis-Robinson, France). The study was performed in 17 healthy subjects. NR was estimated by active posterior rhinometry at a 0.5 L/s flow under four conditions: in the basal state, with the internal nasal mechanical dilator, after treatment with fenoxazoline hydrochloride, and with both fenoxazoline hydrochloride and the mechanical dilator. The mean NR (+/- SD) decreased from 1.65+/-0.54 cm H2O/L/s in the basal state to 1.02+/-0.27 cm H2O/L/s with the mechanical dilator (p < 0.001), 1.03+/-0.47 cm H2O/L/s with fenoxazoline hydrochloride (p < 0.001), and 0.48+/-0.15 cm H2O/L/s with both the mechanical dilator and fenoxazoline hydrochloride (p < 0.001). The decreases in NR observed after using either the mechanical dilator (deltaNR(N)) or fenoxazoline hydrochloride (deltaNR(A)) were not significantly different. The decrease in NR observed with both (deltaNR(N + A)) was not significantly different from the sum deltaNR(N) + deltaNR(A): 1.16+/-0.53 cm H2O/L/s vs 1.25+/-0.63 cm H2O/L/s, respectively (p > 0.05). deltaNR(N + A) strongly correlated with deltaNR(N) + deltaNR(A): deltaNR(N + A) = 0.80 (deltaNR(N) + deltaNR(A)) + 0.15 (r = 0.96; p < 0.0001). However, the slope of the regression line of deltaNR(N + A) vs deltaNR(N) + deltaNR(A) was significantly lower than unity (p < 0.003). These results demonstrate that, although not totally additive, the effects of using the mechanical dilator and fenoxazoline hydrochloride are cumulative. Further studies that include patients with nasal obstruction would allow us to better evaluate the benefit of a therapy combining both treatments.     

The effect of pre-irradiation dose intense CHOP on anthracyline resistance in localized nasal NK/T-cell lymphoma

We treated 17 patients with localized, nasal NK/T-cell lymphoma with two cycles of dose-intense CHOP (DI-CHOP) and early involved field radiation (IFRT). Sixteen out of 17 patients were evaluable for response. After two cycles of DICHOP, nine patients achieved complete remission (CR) (53%) and six had partial remissions (35%). After IFRT, 13 patients achieved CR (CR rate 76%; 95% CI, 56%-96%). The 3-year progression-free and overall survival rates were 56%, and 67%, respectively. This study shows that anthracycline-based chemotherapy seems to be ineffective in decreasing systemic failure even when administered at maximal dose intensity.     

The effect of topical benzamil and amiloride on nasal potential difference in cystic fibrosis.

The electrochemical defect in the bronchial epithelium in cystic fibrosis (CF) consists of defective chloride secretion and excessive sodium reabsorption. The sodium channel blocker, amiloride, has been shown to reversibly correct the sodium reabsorption in CF subjects, but long term studies of amiloride have been disappointing due to its short duration of action. Benzamil, a benzyl substituted amiloride analogue, has a longer duration of action than amiloride in cultured human nasal epithelium. The results of the first randomized, placebo controlled, double blind, crossover study are reported here comparing the effects of benzamil and amiloride on nasal potential difference (nasal PD) in CF. Ten adults with CF attended on three occasions. At each visit baseline nasal PD was recorded, the drug (amiloride 1 x 10(-3) M, benzamil 1.7 x 10(-3) M, or 0.9% sodium chloride) was administered topically via a nasal spray, and nasal PD was measured at 15, 30 min, 1, 2, 4 and 8 h. Results were expressed as maximum change in nasal PD from baseline (PDmax), time for PDmax to return to 50% of baseline (t0.5), and the area under the curve (AUC). PDmax values for benzamil (20.6+/-0.9 mV) and amiloride (20.3+/-1.6 mV), were similar. The duration of effect was much longer for benzamil as measured as either AUC or t0.5 AUC values were 11.8+/-1.6 mV for benzamil, 2.8+/-0.4 mV for amiloride and 0.6+/-0.4 mV for placebo. The AUC value for benzamil was significantly greater than amiloride (95% confidence interval (CI) for the difference 5.3-12.7 mV, p<0.0001). t0.5 values were 4.3+/-0.7 h for benzamil and 0.6+/-0.1 h for amiloride (95% CI for the difference 2.0-5.3 h, p<0.001). It is concluded that benzamil has a similar maximal effect to amiloride but a more prolonged duration of action on nasal potential difference in cystic fibrosis. Benzamil may be a useful sodium channel blocker for the long-term treatment of the biochemical defect in the lungs of patients with cystic fibrosis.     

The effect of short-term nasal CPAP on Cheyne-Stokes respiration in congestive heart failure.

We studied male patients (BMI = 27.6 +/- 3.4, mean +/- SD), mean age 54.1 +/- 8.9 years, with stable NYHA class 3-4 congestive heart failure (CHF) (LVEF = 24.3 +/- 11.5 percent) and normal daytime arterial blood gas values. These patients underwent three consecutive nights of full polysomnography; adaptation, control, and treatment with nasal CPAP. Each night's study was followed during the day by cognitive testing and multiple sleep latency tests (MSLT). The purpose of the study was to document the effect of nasal CPAP on these variables. The main findings of the study showed no significant differences between control and treatment nights with respect to the amount of Cheyne-Stokes respiration (CSR) observed, the nocturnal oxygenation, or sleep quality. Both subjective and objective measures of sleep quality showed no change from night to night. In addition, the degree of cognitive functioning and daytime sleepiness (as measured by MSLT) showed no significant differences between control and treatment nights. We conclude that short-term treatment with nasal CPAP in patients with CHF does not improve either CSR, nocturnal oxygenation, or sleep quality. Furthermore, most of our patients did not tolerate nasal CPAP therapy.     

Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance.

Nasal mucus velocity and nasal airflow resistance were measured in 15 healthy subjects before and at 5 and 30 minutes after drinking hot water by sip or straw, hot chicken soup by sip or straw, and cold water by sip. A sham drinking procedure with straw was also employed. Hot water by sip increased nasal mucus velocity from 6.2 to 8.4 mm per min, hot chicken soup by sip from 6.9 to 9.2 mm per min, and chicken soup by straw from 6.4 to 7.8 mm per min five minutes after administration. These increases were statistically significant compared to cold water, hot water by straw and sham. All values returned to their baseline at 30 minutes except cold water which significantly decreased the nasal mucus velocity from 7.3 to 4.5 mm per min. There were no significant changes from baseline in nasal airflow resistance 5 and 30 minutes following the above treatments. We conclude that drinking hot fluids transiently increases nasal mucus velocity in part or totally through the nasal inhalation of water vapor. Hot chicken soup, either through the aroma sensed at the posterior nares or through a mechanism related to taste, appears to possess an additional substance for increasing nasal mucus velocity. Finally, hot liquid might be superior to cold liquids in the management of fluids in upper respiratory tract infections.     

The effect of ipratropium nasal spray on bronchial methacholine challenge

PURPOSES: To determine the effect ipratropium bromide nasal spray has on methacholine challenge testing for airway hyperresponsiveness. MATERIALS AND METHODS: Ten subjects with known airway hyperresponsiveness to methacholine who had been clinically stable in the preceding 2 months participated in a randomized, double-blind, placebo-controlled, crossover study. Methacholine challenge testing was conducted on successive days: day 1 after pretreatment with aqueous 0.03% nasal ipratropium, and day 2 with normal saline solution placebo. RESULTS: The provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) was higher after nasal ipratropium than after saline solution placebo (2.1 mg/mL vs 1.6 mg/mL, p = 0.02). This difference is equal to approximately one-half concentration difference, probably within the limits of reproducibility of the test. CONCLUSIONS: Pretreatment with nasal ipratropium results in a small increase in PC20. Although this difference achieves statistical significance, it is probably not clinically significant.     

The effect of continuous positive airway pressure therapy on nasal patency

Background

Nasal congestion and obstruction are reported in the majority of continuous positive airway pressure (CPAP) users and are frequently cited as reasons for noncompliance. To our knowledge, no study has demonstrated a change in objective or subjective nasal patency in patients with obstructive sleep apnea (OSA) after a therapeutic trial of CPAP therapy.

Methods

This prospective nonrandomized trial tested the hypothesis that CPAP therapy would result in both objective and subjective improvements in nasal patency in patients with OSA. Prior to initiation of CPAP, acoustic rhinometry (AR) was used to determine nasal volume and minimum cross‐sectional area in the upright and reclined positions. Subjective nasal patency was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Both assessments were repeated at follow‐up visits.

Results

AR data demonstrated a statistically significant increase in total nasal volume (TV) in the reclined position (p = 0.002) and minimum cross‐sectional area (MCA) in both the sitting and reclined positions (p = 0.006, p = 0.021) in OSA patients after >30 days of CPAP therapy and with >70% compliance. NOSE scores decreased significantly (p = 0.038) representing an improvement in nasal patency.

Conclusion

Objective and subjective measurements of TV and MCA increased after initiation of CPAP therapy in this prospective study.

     

外源性一氧化氮及氦—氧混合气对支气管哮喘患者通气功能的影响

目的 探讨同时吸入氦－氧混合气和不同浓度的一氧化氮（ＮＯ）对支气管哮喘患者通气功能的影响。方法 选取１８例哮喘患者随机分为两组,一组吸入氦－氧混合气的同时加入１００ｐｐｍ的ＮＯ,另一组则加入４０ｐｐｍ的ＮＯ。在不同时间检测患者的通气功能,并与吸入β２受体激动剂进行比较。结果 哮喘患者吸入氦－氧混合气后与呼吸空气比较其用力肺活量（ＦＶＣ）、１秒钟用于呼气容积（ＦＥＶ１）、呼气流速峰值（ＰＥＦＲ）和最     

The effect of antihypertensive therapy on insulin resistance

Insulin resistance is one of the main causes of diabetes mellitus type 2. This primary, genetically determined, by external environmental factors enhanced, reduced insulin effectiveness in target tissues (liver, muscle, adipose tissue) associated with compensatory hyperinsulinaemia is manifested by a prohypertensive effect. Secondary insulin resistance causes deterioration of diabetes compensation regardless of its type. It may have a number of causes and after their elimination it is fully reversible. Secondary insulin resistance can be influenced also by drugs. This fact must be born in mind when selecting antihypertensive treatment in diabetics.     

Postural changes in nasal and pulmonary resistance in subjects with asthma.

INTRODUCTION: Subjects with asthma frequently have nasal symptoms and complain of orthopnoea but airflow resistance is usually only assessed during oral breathing and while seated. METHOD: We have used a forced oscillation technique to measure total respiratory resistance (Rrs) at 6Hz during mouth breathing (Rrs,mo) and during nose breathing (Rrs,na) in the sitting and supine postures; resistance of the nasal airway (Rnaw) was estimated as Rrs,na--Rrs,mo. Forced oscillations were applied during normal tidal breathing and the mid-tidal lung volume (MTLV) was determined for each breathing route and posture. SUBJECTS: Three groups of subjects were studied: 10 normal subjects without lung or nasal disease (N; five males, mean age 33.5 [range 23-58] years, mean FEV1 105%pred, FEV1/VC 86%); seven subjects with asthma alone (A; four males, 40.3 [23-57] years, mean FEV1 66%pred, FEV1/VC 74%); 10 asthmatic subjects with nasal obstructive symptoms (AN; six males, 62.8 [38-80] years, mean FEV1 56%pred, FEV1/VC 75%). RESULTS: In all three groups of subjects, mean Rrs,mo and Rrs,na were higher in the supine than sitting posture. In normal subjects the increase in supine Rrs,mo was associated with a 0.6 liter fall in MTLV. In asthma supine Rrs,mo increased despite a much smaller fall in MTLV; supine increases in Rrs,na were particularly large in presence of nasal disease. DISCUSSION: Values of airflow resistance are 2-3 times higher in both normal and asthmatic subjects when breathing via the nose and supine than under normal laboratory conditions of oral breathing and seated.     

Effect of nasal or oral breathing route on upper airway resistance during sleep.

Healthy subjects with normal nasal resistance breathe almost exclusively through the nose during sleep. This study tested the hypothesis that a mechanical advantage might explain this preponderance of nasal over oral breathing during sleep. A randomised, single-blind, crossover design was used to compare upper airway resistance during sleep in the nasal and oral breathing conditions in 12 (seven male) healthy subjects with normal nasal resistance, aged 30+/-4 (mean+/-SEM) yrs, and with a body mass index of 23+/-1 kg x m2. During wakefulness, upper airway resistance was similar between the oral and nasal breathing routes. However, during sleep (supine, stage two) upper airway resistance was much higher while breathing orally (median 12.4 cmH2O x L(-1) x s(-1), range 4.5-40.2) than nasally (5.2 cmH2O x L(-1) x s(-1), 1.7-10.8). In addition, obstructive (but not central) apnoeas and hypopnoeas were profoundly more frequent when breathing orally (apnoea-hypopnoea index 43+/-6) than nasally (1.5+/-0.5). Upper airway resistance during sleep and the propensity to obstructive sleep apnoea are significantly lower while breathing nasally rather than orally. This mechanical advantage may explain the preponderance of nasal breathing during sleep in normal subjects.     

The effect of cardiac contraction on collateral resistance in the canine heart.

We determined whether the coronary collateral vessels develop an increased resistance to blood flow during systole as does the cognate vascular bed. Collateral resistance was estimated by measuring retrograde flow rate from a distal branch of the left anterior descending coronary artery while the main left coronary artery was perfused at a constant pressure. Retrograde flow rate was measured before and during vagal arrest. We found that in 10 dogs the prolonged diastole experienced when the heart was stopped caused no significant change in the retrograde flow rate, which indicated that systole has little effect on the collateral resistance. However, when left ventricular end-diastolic pressure was altered by changing afterload or contractility, a direct relationship between end-diastolic pressure and collateral resistance was noted.     

The effect of acute, intensive cigarette smoking on maximal expiratory flows and the single-breath nitrogen washout trace.

The effect of acute, intensive cigarette smoking on forced vital capacity and the single-breath expired N2 trace was studied in 82 smokers. There were significant decreases in the "effort-dependent" tests, such as peak flow and 1-sec forced expiratory volume, but no change in the more "effort-independent" tests, such as maximal mid-expiratory flow and maximal expiratory flow at 25 per cent of the vital capacity. Closing volume was unchanged in absolute terms and as a percentage of vital capacity. Closing capacity was unchanged in absolute terms and as a percentage of total lung capacity, but there was a significant increase in the slope of Phase III of the N2 washout curve after the acute smoking session. The tests of function that changed significantly after acute, intensive smoking were the ones that improved in 52 subjects who modified their smoking habits. The data suggest that acute, intensive cigarette smoking may be associated with an increase in resistance to air flow in the larger airways or a reduction in effort, and with increased nonuniformity of intraregional distribution of ventilation.