Comparison of albuterol to isoproterenol as a bronchodilator for use in pulmonary function testing

We compared the effectiveness of albuterol with isoproterenol as a bronchodilator for use in pulmonary function testing. A total of 180 patients presenting for routine pulmonary function testing were randomly assigned to receive 5 mg of either albuterol or isoproterenol by compressed air nebulizer. Forced expiratory maneuvers were performed before, 5 min after, and 10 min after bronchodilator administration. The average increase in FEV1 and FVC did not differ between drugs. Also, the fraction of patients achieving a clinically significant bronchodilator response did not differ between drugs. Importantly, there was no significant difference between average 5 and 10 min postbronchodilator values for FEV1 or FVC for either bronchodilator, suggesting that a peak response was reached by 5 min. These results show no advantage of isoproterenol over albuterol in terms of potency or speed of action. Given the well-known cardiovascular side effects of isoproterenol, albuterol is the preferable agent for use in pulmonary function testing.     

The combination of ipratropium and albuterol optimizes pulmonary function reversibility testing in patients with COPD

STUDY OBJECTIVES: To determine whether the combination of ipratropium bromide and albuterol results in greater and more consistent pulmonary function test (PFT) response rates than ipratropium bromide or albuterol alone in patients with COPD. DESIGN: Retrospective review of two recently completed 3-month, randomized, double-blind, parallel, multicenter, phase III trials. SETTING: Outpatient. PATIENTS: A total of 1,067 stable patients with COPD. INTERVENTIONS: Ipratropium bromide (36 microg qid), albuterol base (180 microg qid), or an equivalent combination of ipratropium bromide and albuterol sulfate (42 microg and 240 microg qid, respectively). MEASUREMENTS AND RESULTS: PFT response rates were analyzed using 12% and 15% increases in FEV1 compared with baseline values and were measured in the various treatment groups on days 1, 29, 57, and 85 in these trials. Regardless of whether a 12% or a 15% increase in FEV1 was used to define a positive response, an equivalent combination of ipratropium bromide and albuterol sulfate was superior to the individual agents (p < 0.05; all comparisons within 30 min). In addition, a 15% or more increase in FEV1 was seen in > 80% of patients who received the combination of ipratropium and albuterol sulfate during the initial PFT and continued to be observed 3 months after initial testing. CONCLUSIONS: Use of a combination of ipratropium bromide and albuterol sulfate is superior to the individual agents in identifying PFT reversibility in patients with COPD.     

Indications for pulmonary function testing

Pulmonary function testing is needed to determine the pathophysiology present in the patient with cardiopulmonary disease. Blood gases and pH should be obtained during emergency situations and during cranial, thoracic, and extensive cervical or abdominal surgery. Lung function tests can be divided in global such as spirometry and diffusing capacity which study the ventilation and transfer of gases and regional determinations of ventilation and perfusion. Both types of tests complement each other and should be used together. The spirometry should consist at least of determination of the vital capacity and is determined in the first second to ascertain if there is obstructive lung disease. Some tests such as flow-volume curves, alveolar-arterial gradients and closing volume are very useful to detect early pulmonary disease before any symptoms or findings are present. This is probably one of the most important medical indications for pulmonary function testing. Before certain types of surgery pulmonary function testing is indicated; if the spirometry and diffusing capacity tests are normal, there is no pulmonary contraindication for the planned surgery. In chest surgery if there is significant compromise of the spirometry and diffusing capacity regional lung function tests are indicated to study the pathophysiology at regional level, thus trying to circumscribe the lung resection to the diseased areas.     

Indications for pulmonary function testing

STUDY OBJECTIVE: To critically assess original studies evaluating the role of preoperative pulmonary function testing in predicting postoperative outcomes. DESIGN: MEDLINE search of English-language articles from 1966 to 1987 using the following medical subjects headings respiratory function tests, lung, lung diseases, and preoperative care. MEASUREMENTS AND MAIN RESULTS: Relevant studies were subdivided by operative site. We included only studies for which we could determine pre- and post-test probabilities of morbidity, mortality, sensitivity, and specificity. Preoperative pulmonary function testing was found to have measureable benefit in predicting outcome in lung resection candidates. In selected patients, split perfusion lung scanning and pulmonary exercise testing appeared to be useful. Confirmation of these reports is necessary before these preoperative tests can be routinely recommended. In studies of upper abdominal surgery, spirometry and arterial blood gas analysis did not consistently have measureable benefit in identifying patients at increased risk for postoperative pneumonia, prolonged hospitalization, and death. Studies of preoperative testing for other patients, including those having coronary artery bypass grafting, lacked adequate data for meaningful analysis. CONCLUSIONS: Preoperative pulmonary function testing helps clinicians to make decisions on management of lung resection candidates. Although many studies of patients before abdominal surgery have focused on the utility of preoperative pulmonary function testing, methodologic difficulties undermine the validity of their conclusions. The impact of testing on care of other preoperative patients is even less clear because of poor study design and insufficient data. Therefore, further investigation is necessary before a consensus can be reached on the role of preoperative pulmonary function testing in evaluating patients before all surgical procedures except lung resection.     

Inhaled formoterol dry powder versus ipratropium bromide in chronic obstructive pulmonary disease.

We compared the effectiveness of inhaled formoterol with that of ipratropium in the treatment of chronic obstructive pulmonary disease (COPD). After a 2-wk run-in period, 780 patients with COPD were randomized to receive for 12 wk formoterol dry powder 12 or 24 microg twice daily, ipratropium bromide 40 microg four times daily, or placebo in a multicenter, double-blind, parallel-group study. The primary efficacy variable was the area under the curve for forced expiratory volume in 1 s (FEV(1)) measured over 12 h after 12 wk of treatment. Secondary variables included diary symptoms and quality of life. Both doses of formoterol and ipratropium significantly increased the area under the curve for FEV(1) in comparison with placebo (all p < 0.001). Both doses of formoterol were also significantly superior to ipratropium (all p < 0.025). Compared with placebo, both doses of formoterol significantly improved symptoms (all p < or = 0.007) and quality of life (p < 0.01 for total scores) whereas ipratropium did not show significant effects (all p > or = 0.3). All study treatments exhibited a similar safety profile. We conclude that formoterol is more effective than ipratropium bromide in the treatment of COPD, as the efficacy of ipratropium on airflow obstruction does not translate into a clinical benefit that patients can perceive.     

Inhaled nitric oxide (NO) for vasoreactivity testing in pulmonary hypertension

Thirty patients (24F, 6M, aged 40.5 +/- 15.4 years) with chronic precapillary pulmonary hypertension (primary pulmonary hypertension--PPH)--20 pts, associated with connective tissue disease--6 pts, due to thromboembolism--2 pts and Eisenmenger syndrome--2 pts) were submitted to 5 min inhalation of 10 and 20 ppm of nitric oxide (NO) during right heart catheterization. For the whole group this test resulted in minimal changes in directly assessed hemodynamics. However, individual reactions differed markedly between patients. Assuming three levels of criteria of preserved reactivity (liberal, standard, demanding) 11/30 (37%) patients had fall in PAP and PVR > or = 20% from baseline, 4/30 (13%) decreased PAP and PVR by > or = 20% and 30% respectively and 2 (7%) patients normalized PAP and decreased PVR > or = 50% from baseline, respectively. Interestingly, even liberal criteria were fulfilled positive test was observed exclusively in patients with primary PH. In one patient with connective tissue disease and systemic hypertension acute pulmonary congestion appeared during NO testing, with concomitant increase in systemic arterial pressure and pulmonary wedge pressure. No other complications were noted and no rebound PH after discontinuation of NO was observed in any of the patients. Conclusion: 1. Acute inhaled nitric oxide test appears to be safe in patients with PH and no coexisting left heart dysfunction. 2. It allows for stratification of patients according to the degree of preserved pulmonary vascular reactivity. However, criteria which would permit to select optimal treatment based on the results of NO test require further studies.     

Pediatric pulmonary function testing

Pulmonary function testing is an essential component in the diagnosis and monitoring of the pediatric asthmatic. Very young children are capable of performing spirometry, lung Volumes, airway mechanics, and other testing. Obtaining valid test results in children is dependent on multiple factors including equipment selection, environment, technologist training and competence level, and the child's developmental age. Multiple test methods are discussed to assess the degree of airway obstruction and reversibility.     

Diagnosis of upper airway obstruction by pulmonary function testing.

We compared 11 patients with upper airway obstruction (obstruction at or proximal to the carina) to 22 patients with chronic obstructive pulmonary disease and to 15 normal subjects utilizing spirometry, lung volumes, airway resistance, maximal voluntary ventilation, single-breath diffusion capacity, and maximal inspiratory and expiratory flow-volume loops. Four values usually distinguished patients with upper airway obstruction: (1) forced inspiratory flow at 50 percent of the vital capacity (FIF50%) less than or equal to 100 L/min; (2) ratio of forced expiratory flow at 50 percent of the vital capacity of the FIR50% (FEF50%/FIF50%) larger than or equal to 1; (3) ratio of the forced expiratory volume in one second measured in milliliters to the peak expiratory flow rate in liters per minute (FEV1/PEFR) larger than or equal to 10 ml/L/min; and (4) ratio of the forced expired volume in one second to the forced expired volume in 0.5 second (FEV1/FEV0.5) larger than or equal to 1.5. The last ratio can be determined with a simple spirometer.     

The role of pulmonary function testing in pulmonary fibrosis

Interstitial lung diseases are characterized by disruption of the distal pulmonary parenchyma. The clinical history manifestations, cough and dyspnea, and physical exam manifestations, inspiratory crackles, are nonspecific. Pulmonary function testing aids in the evaluation and management of patients with interstitial lung disease although the pattern of abnormality is nonspecific. Pulmonary function testing can provide an estimate of histologic severity but not a definitive quantification of histologic fibrosis or inflammation. Pulmonary function tests can provide a baseline estimation of prognosis and be used to monitor disease progression or response to therapy. The forced vital capacity and diffusion capacity are the most valuable serial measurements, but further data are required to examine composite scoring and exercise gas exchange.     

Transient global amnesia complicating pulmonary function testing

Transient global amnesia (TGA), a disorder characterized by the acute onset of anterograde and retrograde amnesia, is well known to neurologists and has been reported in association with a wide range of triggers. We report a patient who experienced the onset of TGA during pulmonary function testing. Potential mechanisms and other scenarios provoking TGA relevant to the pulmonologist, such as bronchoscopy, exercise testing, high altitude, and the use of phosphodiesterase inhibitors are discussed.     

Parental attitudes toward infant pulmonary function testing

Infant pulmonary function tests (PFTs) have proven increasingly popular and useful for clinical and research purposes. Informed consent requires accurate information on side effects. Our aim was to quantify minor side effects from a parental point of view by means of a questionnaire. The parents of 97 infants attending for PFTs were asked to complete a simple questionnaire. Eighty-one parents (84%) returned the questionnaire. Forty-one percent felt that their infants were not troubled by the process of administering the sedative chloral hydrate, whereas 55% suffered mild to moderate distress. In contrast, 94% of infants were not distressed by the actual PFTs. Similarly, 46% of parents were not distressed by the administration of sedative to their infant, with 49% expressing distress to a mild or moderate degree. Although 73% of parents were not distressed by watching their infants undergo the PFTs, 27% were to a mild to moderate degree. Seventy-three percent of infants were untroubled on waking. Seventy percent of infants had a good nights sleep after the PFTs. The vast majority of parents (94%) were happy to recommend that others allow their infants to undergo similar testing. We noted that most problems caused by infant PFTs relate to the administration of the sedative. Most infants awake from the tests not distressed and sleep normally the following night. Pediatr Pulmonol. 1998;25:309–313. © 1998 Wiley-Liss, Inc.     

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随着现代电子技术和生物工程学的飞速发展,肺功能仪不断推陈出新。选用肺功能仪,主要从3个方面进行考虑:一是仪器的适用性,是指适合医院自身情况、能真正用于开展业务的仪器。二是仪器的性价比,是指性能优越、计量准确,且价格合理的仪器。三是售后服务与技术支持,是指故障率低且维修服务及时的仪器。肺功能仪的日常维护是仪器可靠性的保障,其中流速/容量校准、检测气体浓度校准等日常仪器校准是重要内容,当仪器已使用多年或疑有测量误差过大时,建议采用标准呼吸模拟器进行质量检测。     

肺功能检查的感染预防与控制

肺功能检查是研究呼吸生理的一种工具，也是呼吸系统疾病诊断和疗效评估的重要部分。全球支气管哮喘(简称哮喘)防治创议(GINA)和慢性阻塞性肺疾病(COPD)防治创议(GOLD)指出，肺功能检查在哮喘和COPD的诊断中必不可少。目前，肺功能检查广泛应用于呼吸内科、胸腹部外科、儿科、妇产科、环境医学监测、航空医学、高原医学、职业病评定等各个领域。但是，由于肺功能检查潜在着可导致交叉感染的危险，因而建立与完善预防感染的控制措施显得十分重要，应引起人们的认真关注。