Der Einfluß ein- und doppelseitiger Rekurrensparesen auf die körperliche Leistungsfähigkeit

Summary Patients suffering from uni- or bilateral recurrent laryngeal paresis were tested by means of spirometric and complex functional capacity tests. The results obtained from patients with unilateral paresis (spirometry, spiroergometry, acid-base equilibrium, oxygen tension) did not differ from those of the control group. A restriction of the functional capacity due to disorders of breathing was not found. In patients with bilateral paresis, physiologic parameters were always influenced by the respiratory tract stenosis. Functional tests resulted in alveolar hypoventilation up to total respiratory failure connected with decreased ergometric values.The results also gave an insight into the pathophysiologic mechanisms of the respiratory obstruction as a result of the stenosis under conditions of physical strain. Suggestions for evaluating the physical functional capacity of patients are given.

     

Electrocardiographic signs of cor pulmonale in asbestosis

Summary A cross-sectional study examining the prevalence of electrocardiographic (ECG) signs of cor pulmonale and their correlation with ventilatory capacity was carried out with 130 asbestosis patients and 121 referents. The ventilatory function of 120 of the 130 patients was measured, 41 having a normal FEV_1.0, 50 slight FEV_1.0 impairment and 29 moderate or severe FEV_1.0 impairment. The cor pulmonale signs were more prevalent in the asbestosis than in the reference group, the greatest differences being found in P_II,III,aVF amplitude, PV₁ amplitude, ÂQRS deviation to the right and shift of QRS transition to the left. These differences were not, however, statistically significant. The frequencies of electrocardiographic cor pulmonale findings in the three FEV_1.0 categories of asbestosis patients were established. The atrial parameters P_II,III,aVF, ÂP, and PV₁ correlated the best with FEV_1.0, but only the relationship PV₁/FEV_1.0 was significant (P<0.05). Most of the ventricular ECG parameters failed to show any association with FEV_1.0, especially SV_5,6 amplitude, which has displayed a strong positive correlation with FEV_1.0 in many studies dealing with obstructive lung diseases, and terminal notching of QRS. The present study suggests that the atrial ECG variables are the most valuable items for assessing right heart disease in patients with asbestosis.     

Effect of inhaled corticosteroids on small airways in asthma: Investigation using impulse oscillometry

BackgroundSmall airways appear to have an important role in asthma. Hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP) has ultrafine particles and accordingly greater deposition in the small airways than chlorofluorocarbon (CFC)-BDP. Impulse oscillometry systems (IOS), a new and non-invasive measure of pulmonary function, can examine the resistance of total (R5), large (R20), and small airways (R5–R20) separately, and low-frequency reactance area (AX), also considered a measure of small airways dysfunction.MethodsMild-to-moderate asthmatics who were inhaled corticosteroid naïve were randomized to receive 200 mcg HFA-BDP bid (n = 26) or 400 mcg CFC-BDP bid (n = 12) for 12 weeks in an open-label manner. Following baseline measurements, IOS and spirometry were repeated every 4 weeks, and methacholine challenge to separately assess airway sensitivity and airway reactivity and lung volumes at 12 weeks.ResultsModerate correlations were found between R5–R20 or AX and spirometry and lung volume indices of small airways, and between R20 and peak expiratory flow at baseline. The two groups did not significantly differ in baseline clinical or functional parameters. At 12 weeks, all IOS indices improved in the HFA-BDP group, whereas all but R5–R20 improved with CFC-BDP. R5–R20 and AX progressively improved with HFA-BDP; these changes achieved statistical significance at 12 weeks versus the CFC-BDP group. Other IOS and spirometry indices failed to show such trends. HFA-BDP significantly attenuated methacholine airway sensitivity; the degree of this attenuation strongly correlated with R5–R20 and AX baseline values, and with improvement of AX with treatment.ConclusionHFA-BDP is an effective treatment of small airways in asthma. Prolonged treatment provides a progressive effect over time, which is associated with an attenuation of airway responsiveness.     

Comparison of per cent predicted and percentile values for pulmonary function test interpretation

BACKGROUND:

Pulmonary function tests (PFTs) are commonly interpreted as a fraction of predicted normal values, with an abnormal test often defined as less than 80% or greater than 120% of the predicted value. However, recommendations of the American Thoracic Society/European Respiratory Society suggest using a percentile-based approach to define an abnormal test (less than the fifth or greater than the 95th percentiles).

OBJECTIVE:

To compare PFT values obtained by the per cent predicted method with the percentile-based method for lung function parameters.

METHODS:

Full PFTs performed between January 2000 and July 2004, at the Health Sciences Centre (Winnipeg, Manitoba) were analyzed. Using the Crapo and Gutierrez equations, per cent predicted and percentile values were calculated. An abnormal test was defined as less than 80% or greater than 120% of predicted (per cent predicted method) or as less than the fifth or greater than the 95th percentiles (percentile method). Using the percentile method as reference standard, the diagnostic test characteristics of the per cent predicted method were calculated.

RESULTS:

The full PFTs of 2176 men and 1658 women were analyzed using the Crapo and Gutierrez equations. The mean (± SD) age of all subjects was 52±15 years. Per cent agreement between the two tests was more than 94% for all parameters except for reduced residual volume (88%). Per cent predicted methods had suboptimal sensitivity for abnormal total lung capacity (88% to 89%), increased residual volume (83% to 89%) and reduced diffusion capacity (89% with Crapo equations). Suboptimal specificity (83% to 86%) was observed for decreased residual volume.

CONCLUSION:

The results of the per cent predicted and percentile-based approaches for PFT interpretation were similar for the majority of lung function parameters. These two methods can be used interchangeably for spirometry. However, caution may be warranted in relying solely on per cent predicted methods for assessing lung volume or diffusion capacity.     

International Correspondents

Twenty years ago the island of Cuba was about the only Caribbean tourist attraction. A few tourists strayed to Jamaica, and not more than a mere handful visited Puerto Rico. The American tourist then discovered Puerto Rico, aided in no small way by Fidel Castro. At the same time “Operation Bootstrap” was creating an economic boom in the Island, re-orienting its economy towards industry, offering tourist facilities like modern luxury hotels, legalized gambling, inexpensive jet fares, and “guaranteed sunshine” in its beaches. The Madison Avenue type of advertising took over, with the net result that the handful of tourists of twenty years ago have multiplied to the one million mark in 1967.     

The influence of air pollution on cardiovascular and pulmonary function and exercise capacity: Canadian Health Measures Survey (CHMS)

Background

Air pollution has been associated with adverse cardiovascular effects.

Objective

To measure the association between air pollution, spirometry, blood pressure, and exercise capacity.

Methods

We used data from 5604 subjects collected during the Canada Health Measures Survey to test the association between air pollution measured on the day of the survey and spirometry (n=5011 subjects), blood pressure, and exercise capacity (n=3789 subjects).

Results

An interquartile range (IQR) increase in ozone (17.0 ppb) was significantly associated with a 0.883% higher resting heart rate, a 0.718% higher systolic and 0.407% higher diastolic blood pressure, a 0.393% lower FEV₁/FVC expressed as a percentage of predicted, and a 1.52% reduction in the aerobic fitness score (p<0.05). Resting systolic and diastolic blood pressure were approximately 0.5 mmHg higher for an (IQR 4.5 μg/m³) increase in PM_2.5 (IQR 4.5 μg/m³) and 1 mmHg higher for a 12.6 ppb increase in NO₂ (IQR 12.6 ppb). An increase in PM_2.5 was also associated with an approximate 0.4% decrease in percent predicted FEV₁ and FVC (p<0.05).

Conclusion

Exposure to higher concentrations of air pollution was associated with higher resting blood pressure and lower ventilatory function. Ozone was associated with reduced exercise capacity.     

噻托溴铵干粉吸入在慢性阻塞性肺疾病序贯治疗中的应用

目的探讨噻托溴铵干粉吸入在慢性阻塞性肺疾病急性加重症状控制后应用的疗效和安全性。方法将60例肺功能为中度(GOLDⅡ级,FEV1/FVC<70%,50%≤FEV1<80%预计值)的COPD病人随机分为两组,治疗组应用噻托溴铵干粉吸入,对照组使用异丙托溴铵定量气雾剂,治疗12个月,在第1个月、第6个月、第12个月,分别行肺功能检查,测FEV1和FVC,同时记录12个月内急性加重次数。结果治疗组第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1占预计值的百分比上升值及急性加重次数较对照组有显著性差异(p<0.05);治疗组的常见不良反应为口干(6%),无其他不适。结论噻托溴铵对于肺功能为中度的COPD患者疗效显著且安全可靠。     

Effect of e-learning and repeated performance feedback on spirometry test quality in family practice: a cluster trial

PURPOSE Spirometry has become an indispensable tool in primary care to exclude, diagnose, and monitor chronic respiratory conditions, but the quality of spirometry tests in family practices is a reason for concern. Aim of this study was to investigate whether a combination of e-learning and bimonthly performance feedback would improve spirometry test quality in family practices in the course of 1 year.METHODS Our study was a cluster trial with 19 family practices allocated to intervention or control conditions through minimization. Intervention consisted of e-learning and bimonthly feedback reports to practice nurses. Control practices received only the joint baseline workshop. Spirometry quality was assessed by independent lung function technicians. Two outcomes were defined, with the difference between rates of tests with 2 acceptable and repeatable blows being the primary outcome and the difference between rates of tests with 2 acceptable blows being the secondary outcome. We used multilevel logistic regression analysis to calculate odds ratios (ORs) for an adequate test in intervention group practices.RESULTS We analyzed 1,135 tests. Rate of adequate tests was 33% in intervention and 30% in control group practices (OR = 1.3; P=.605). Adequacy of tests did not differ between groups but tended to increase with time: OR = 2.2 (P = .057) after 3 and OR = 2.0 (P = .086) in intervention group practices after 4 feedback reports. When ignoring test repeatability, these differences between the groups were slightly more pronounced: OR = 2.4 (P = .033) after 3 and OR=2.2 (P = .051) after 4 feedback reports.CONCLUSIONS In the course of 1 year, we observed a small and late effect of e-learning and repeated feedback on the quality of spirometry as performed by family practice nurses. This intervention does not seem to compensate the lack of rigorous training and experience in performing spirometry tests in most practices.     

Bronchodilator efficacy of the fixed combination of ipratropium and albuterol compared to albuterol alone in moderate-to-severe persistent asthma

BACKGROUND: The potential of anticholinergics to provide bronchodilatory benefits over short-acting beta(2)-agonists (SABA) alone in patients with moderate-to-severe persistent asthma has not been well defined. METHODS: An outpatient, randomized, double-blind, single-dose, crossover study in adult asthmatics with moderate-to-severe obstruction despite treatment with inhaled corticosteroids (ICS) was conducted comparing the fixed combination of ipratropium and albuterol (IB+ALB) to albuterol alone (ALB). Serial spirometry was performed over 6h. SABA were withheld for 8h, ICS and LABA for 24h. RESULTS: A total of 113 patients were randomized, 106 completed the study (males n=47; mean+/-SD age=51+/-13 years). Mean+/-SD baseline FEV(1)=1.4+/-0.5 L (49+/-12% predicted). IB+ALB resulted in significantly greater improvements over ALB in the average improvement over baseline in FEV(1) as approximated from the area under the curve from 0 to 6h after drug administration (72 ml, p<0.01) and mean peak FEV(1) response (55 ml, p<0.01) as well as higher FEV(1) responses at individual time points from 0.5 to 6h postdose (p<0.01 for all). Time to onset of response was similar between groups but time to peak and duration of response were longer with IB+ALB versus ALB (120 versus 60 min and 245 versus 106 min, respectively). CONCLUSION: IB+ALB resulted in significantly greater improvement in FEV(1) and longer duration of response compared to ALB alone in patients with moderate-to-severe persistent asthma (Trial number: 1012.50; ClinicalTrial.gov NCT00096616).