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21.
Sixty-five patients with severe alpha1-antitrypsin (AAT) deficiency (phenotype PiZ) were followed with spirometry at regular intervals of one year and a median
observation period of four years.
The annual decline in pulmonary function was adjusted for sex, age and height by division with the predicted normal pulmonary
function. The median decline in FEV1 was 1.9% predicted/year. The rate of decline was independent of age and pulmonary function, except for patients with FEV1 below 25% of predicted normal.
There was a tendency towards a slower median decline in FEV1 in exsmokers (1.7% predicted/year) compared to smokers (3.8% predicted/year) and never-smokers (3.7% predicted/year), however,
this difference was not significant (p > 0.1). At the time of diagnosis smokers and ex-smokers had a lower FEV1 (44 and 38% predicted) than never-smokers (85% predicted) (p < 0.02), and smokers and ex-smokers were generally younger (median age 44 and 42 years, respectively) than never smokers
(median age 55 years) (p > 0.1).
Our data indicate that smokers as well as nonsmokers with severe AAT deficiency are at risk of developing pulmonary emphysema.
The disease seems to appear later in nonsmokers, though once initiated it progresses at the same rate.
Presented at the Satellite Expert Meeting: α1-Antitrypsin Deficiency, Bürgenstock/Luzern, Switzerland, June 9–11, 1989. 相似文献
22.
Vanesa Hidalgo Sierra Miguel Ángel Hernández Mezquita Luis Palomo Cobos Myriam García Sánchez Ramón Diego Castellanos Soraya Jodra Sánchez Rosa Cordovilla Pérez Miguel Barrueco Ferrero 《Archivos de bronconeumologia》2018,54(9):460-466
Introduction
COPD is a highly prevalent but underdiagnosed disease, due to the limited availability of forced spirometry (FS) in primary care (PC). Microspirometers are inexpensive, easy-to-use devices that can measure FEV6 and FEV1/FEV6, and may help reduce underdiagnosis. The aim of this study was to validate the Piko-6 COPD screening device by demonstrating a good correlation with standard FS.Methods
FS and Piko-6 determinations were made in 155 patients suspected of having COPD. The correlations, ROC curves, and Youden's index of both methods were compared, taking FS as the gold standard.Results
FEV1, FVC and FEV6 correlation coefficients and FEV1/FVC and FEV1/FEV6 ratios were 0.87 (CI 0.836–0.909), 0.729 (CI 064–0.795) and 0.947 (95% CI 0.928–0.961), respectively. The ROC curve for FEV1 determined by Piko-6 achieved an area under the curve of 0.86 (95% CI: 0.78–0.92). Youden's index with a cut-off point of 0.70 for FEV1/FEV6 was 0.97.Conclusions
Piko-6 may be useful for COPD screening in PC. Measurements obtained with this device correlate well with those determined by FS, particularly the FEV1/FEV6 ratio. This, combined with its low cost and ease of use, may contribute to reducing COPD underdiagnosis, although its exact role in the diagnostic process remains to be determined. 相似文献23.
Hideo Iwasaka MD Kouji Itoh MD Hiroshi Miyakawa MD Takaaki Kitano MD Kazuo Taniguchi MD Natsuo Honda MD 《Journal of clinical monitoring and computing》1996,12(2):161-164
Objective. The Ultima SV respiratory monitor can be used to monitor the intraoperative effects of the lateral decubitus position and one-lung ventilation on ventilatory mechanics.Methods. Eight patients with esophageal cancer who required one-lung ventilation for esophagectomy and reconstruction were enrolled in the study. We monitored pressure-volume or flow-rate-volume loops continuously throughout the operation. Respiratory parameters were evaluated closely during five conditions of ventilation: two-lung ventilation in the supine position, two-lung ventilation in the lateral decubitus position, dependent one-lung ventilation in the lateral decubitus position, nondependent one-lung ventilation in the lateral decubitus position, and dependent one-lung ventilation in the lateral decubitus position with the chest opened. Respiratory rate was controlled at 10 breaths/min, and tidal volume was kept constant (10 ml/kg) during surgery.Results. Peak inspiratory pressure increased to 29.0 ± 9.0 (mean ± SD) cm H2O in the dependent one-lung in the lateral decubitus position with the chest opened (p < 0.01). Dynamic compliance decreased to 29.4 ± 4.9 ml/cm H2O in the dependent one-lung in the lateral decubitus position with the chest opened (p < 0.01). The changing configuration of the loops also offered additional and instantaneous information during one-lung ventilation.Conclusions. One-lung ventilation caused several changes in the whole respiratory system (lung, thorax, and endotracheal tube). Continuous monitoring of flow-rate-volume or pressure-volume loops with in-line spirometry provided comprehensive information regarding parameters in one-lung ventilation. 相似文献
24.
目的 了解我国肺量计检查报告质最控制现状.方法 收集2008年1-10月我国36家大型综合性医院肺功能室的肺量计检查报告单,参照ATS和ERS的肺活量测试标准进行质量分析,肺量计检查各质量控制标准的符合情况以百分率来描述.结果 共收集345例报告单,82.5%(282/342)的报告单符合测试起始质量的标准;65.8%(219/333)的报告单达到分析呼气流畅质量的标准,其余114例不符合标准的报告单中,咳嗽占8.7%(29/333),声门早闭占2.4%(8/333),口嘴漏气占8.7%(29/333),提前中止占7.8%(26/333),阻塞口器占1.8%(6/333),未尽最大努力占14.7%(49/333);50.6%(119/235)的报告单达到分析测试结束质量的标准;测试次数≥3次的占22.6%(78/345),其中65例有各次测试数据报告,可分析其重复性,符合标准的占95.4%(62/65),占总数的18.0%(62/345),AFVC<150 ml的占95.4%(62/65),△FVC<100 ml的占92.3%(60/65),△FEV_1<150 ml的占100.0%(65/65),△FEV_1<100 ml的占87.7%(57/65);在345例报告单中,同时符合上述4项标准的仅占总数的7.2%(25/345).结论 我国医院的用力肺功能检查质量有待提高. 相似文献
25.
Unilateral diaphragm paralysis is an important and often unrecognized cause of dyspnea. In patients with appropriate risk
factors, such as prior head and neck surgery and presentation of positional dyspnea or dyspnea on submersion, unilateral diaphragmatic
paralysis should be considered. We present our approach to the diagnosis of diaphragm paralysis and demonstrate the utility
of upright/supine spirometry and M-mode ultrasonography in these patients’ evaluation. 相似文献
26.
Serum Uric Acid to Creatinine Ratio in Patients with Chronic Obstructive Pulmonary Disease 总被引:1,自引:0,他引:1
Serum uric acid (UA), the final product of purine degradation, has been shown to be increased in the hypoxic state. We assessed
whether the presence of higher values of serum UA and serum UA to creatinine ratio is associated with clinical or functional
characteristics in patients with chronic obstructive pulmonary disease (COPD). Fifty-nine consecutive stable patients with
COPD, without comorbid conditions, were included. Clinical and functional characteristics were compared between patients with
levels below and above the median values of serum UA and serum UA to creatinine ratio. Patients with serum UA levels above
the median value differed significantly from the group with levels below this value only in FVC (p = 0.04), and serum UA did not correlate significantly with the parameters analyzed. Patients with the serum UA to creatinine
ratio above the median value had lower FVC (63 ± 18 vs. 73 ± 15 percentage of predicted, p = 0.028), lower FEV1 (43 ± 19 vs. 55 ± 18 percentage of predicted, p = 0.019), and a higher level of dyspnea (MRC scale, 1.5 ± 1.1 vs. 0.8 ± 1.0, p = 0.011). The serum UA to creatinine ratio correlated with FVC (r = −0.27), with FEV1 (r = −0.31), and with dyspnea (r = 0.29). In view of these results, we consider that the serum UA to creatinine ratio warrants evaluation as an additional
parameter for predicting outcome in COPD. 相似文献
27.
28.
《COPD》2013,10(2):175-183
AbstractThe aim of this study was to determine if components of the COPD Assessment Test (CAT), a validated health status impairment instrument, had additional utility in identifying patients at risk for COPD in whom spirometry testing is appropriate. This study was part of the Canadian Obstructive Lung Disease prevalence study. Consenting participants ≥ 40 years of age were identified by random digit dialing. Smoking history, 8-item CAT scores, and post-bronchodilator spirometry were recorded for each. Stepwise logistic regression analysis was used to identify variables related to the presence of airway obstruction and a final logistic model was developed which best predicted COPD in this sample. Of the 801 individuals approached, 532 were included: 51 (9.6%) had COPD, the majority (92%) of whom fit GOLD I or II severity criteria. Items that correlated significantly with a COPD diagnosis included the CAT total score (p = 0.01) and its breathlessness (p < 0.0001) and phlegm (p = 0.001) components. The final logistic model included: age (<55 or ≥55 years), smoking status (current, former, never) and the CAT breathlessness score (ordinal scale 0–5). The area under the receiver-operating characteristic curve for this model was 0.77, sensitivity was 77.6%, specificity was 64.9% and the positive likelihood ratio was 2.21. In summary, the triad of smoking history, age at least 55 years and the presence of exertional breathlessness were key elements of a simple model which had reliable measurement properties when tested in a random population. This may help identify patients at risk for COPD for whom spirometry testing is recommended. 相似文献
29.
30.