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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This review addresses the use of the metered dose inhaler (MDI) to administer aerosol therapy in the treatment of asthma, bronchitis, and emphysema. Studies have shown that physicians' prescribing patterns for use of the inhaler have been inconsistent with optimal therapy. Furthermore, the medical literature suggests that the metered dose inhaler should replace the jet nebulizer in hospital and outpatient settings as a more efficient and cost-effective treatment method. All classes of aerosol drugs are now available for administration by the MDI. Reports suggest that patients whose conditions do not respond to treatment administered by the MDI may improve following instruction in the proper method of using the inhaler or by increasing the recommended dosage of medication for those receiving beta-adrenergic, anticholinergic, and glucocorticoid drugs. A consensus now recommends that aerosol glucocorticoids be considered the primary method of therapy for asthma; however, the effectiveness of glucocorticoids in the treatment of bronchitis and emphysema has not been determined. Although available data do not prove that drugs used in the treatment of asthma increase mortality, further study is recommended in view of the potential toxicity of these drugs.
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PMID:Metered dose inhaler therapy for asthma, bronchitis, and emphysema. 155 41

From a conceptual standpoint, the tests of pulmonary function can be divided into those that assess the ventilatory function of the lungs and those concerned with gas exchange. Tests of ventilatory function reflect alterations of the elastic resistance and flow resistance of the respiratory apparatus. The elastic properties of the lungs are assessed by determining the position and shape of the curve representing the relationship between the pressure across the lungs and absolute lung volume. When there is reduced distensibility of either the lungs or the chest wall, the volume-pressure curve is shifted down and to the right. The slope of the curve is reduced in the patient with pulmonary fibrosis, while it is normal in the patient with obesity. In asthma (or chronic bronchitis) and emphysema, the volume-pressure curve is shifted up and to the left. In emphysema, the slope of the curve is increased, while it is normal in patients with asthma or bronchitis. In practice, lung volume is used as an index of alterations of the volume-pressure characteristics of the lungs and/or chest wall. The vital capacity is often used as a surrogate for the TLC but it is lower than expected in both restrictive and obstructive disorders. The FEV1.0 reflects the degree of expiratory flow limitation. In a restrictive disorder, lung volume and the FEV1.0 are reduced, but the FEV1.0/FVC ratio is normal. In airflow limitation, lung volume, the FEV1.0, and the FEV1.0/FVC ratio are lower than expected. In airflow limitation, the reversibility with inhaled bronchodilator should be determined. Tests of airway responsiveness are indicated when evaluating patients with unexplained chronic cough, chest tightness, or wheezing, particularly if other lung function tests are normal. The adequacy of gas exchange is assessed by determining the arterial blood gas tensions--PaO2 and PaCO2--and the alveoloarterial pO2 gradient--P(A-a)O2. A lower-than-expected PaO2 can result from several different physiologic disturbances. When alveolar hypoventilation is the sole disturbance, the oxygen in the alveoli and in the blood perfusing them virtually comes into equilibrium, so that the P(A-a)O2 is normal. An elevated P(A-a)O2 is caused by either mismatching of ventilation and perfusion, true venous admixture, a diffusion abnormality, or a combination of these disturbances. Because dyspnea on exertion is a cardinal symptom of respiratory disease, exercise tolerance should be assessed. A reduced exercise tolerance may result from ventilatory limitation, impaired gas exchange, cardiac impairment, impaired delivery of the oxygen to the working muscles, or an inability to use the energy.
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PMID:Evaluation of respiratory function in health and disease. 160 91

The importance of smoking and other factors for lung cancer in women was investigated in a case-control study of women who had previously received a multiphasic health checkup at Northern California Kaiser Hospitals. Smoking and medical histories for 217 cases and matched controls were obtained from the multiphasic questionnaire. Odds ratios (ORs) and confidence intervals (CIs) associated with cigarette smoking were 35.1 (95% CI 4.8-256) for squamous and small cell and large cell carcinomas combined and 2.5 (95% CI 1.3-5.1) for adenocarcinoma. After adjusting for smoking, risk was increased in women with a family history of lung cancer (OR 1.9, 95% CI 0.7-5.6) and family history of any cancer (OR 1.8, 95% CI 1.0-3.2). A significant interaction existed between smoking and family history. Women with a history of bronchitis, pneumonia, or emphysema were at increased risk, whereas women with a history of asthma or hay fever experienced a significantly lower risk for lung cancer.
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PMID:Lung cancer in women: the importance of smoking, family history of cancer, and medical history of respiratory disease. 165 3

In order to evaluate whether age and pulmonary function testing may predict postoperative morbidity and mortality in the patients having received thoracic surgery, 203 patients were included in this study. Spirometry, flow volume curve, lung volume determination and arterial blood gas analysis were performed in all of them. Postoperative complications were classified into respiratory complications including pneumonia, purulent bronchitis, atelectasis, respiratory failure and so on; and non-respiratory complications including subcutaneous emphysema, internal bleeding, stump leakage, dysarrythmia and so on. Of the 117 patients over 65 years of age, 27 (23.1%) had postoperative respiratory complications, 27 (23.1%) had non-respiratory complications, and 7 (5.93%) expired postoperatively. Of the 86 patients under 65 years of age, 21 (24.4%) had postoperative respiratory complications and 9 (7.6%) had postoperative non-respiratory complications, but one expired. The incidences of postoperative mortality and non-respiratory complications were both higher in the patients over 65 years of age (p less than 0.05). Our results indicated that age is a risk factor of thoracic surgery, even if the pulmonary function testing meet the surgical criteria.
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PMID:[Age and pulmonary function testing in predicting postoperative morbidity after thoracic surgery]. 165 25

The above epidemiological study was undertaken with the object of establishing the proportion of respiratory pathology represented by chronic bronchopulmonary obstructive bronchitis, emphysema, bronchial asthma in a highly industrialized city such as Taranto. The period covered was the years 1988, 1989 and first half of 1990. In addition, the distribution of chronic obstructive bronchopulmonary disease according to sex and age and the influence of smoking were analyzed.
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PMID:[Obstructive bronchopneumopathies in respiratory pathology in Taranto. Epidemiological data]. 166 78

A 76-year-old man was referred to our hospital with complaints of productive cough, dyspnea and peripheral cyanosis. The chest X-ray film indicated the pulmonary emphysema and acute bronchitis, but no abnormal intracardiac calcification. The electrocardiogram revealed a peaked P-wave, complete left bundle branch block, and ventricular premature contraction. Chest tomography demonstrated abnormal intracardiac calcium deposition in the right heart region. Two-dimensional echocardiography revealed the tricuspid annular calcification in the postero-lateral portion, showing a synchronous movement with tricuspid annular motion throughout the cardiac cycle. The size of calcification was 10 x 14 mm. The tricuspid valve showed no significant regurgitation. Left ventricular dilatation, associated with mild mitral regurgitation and impairment of systolic function (EF = 49%) was revealed by echocardiography. Serum examination revealed positive in Wassermann reaction. This case of tricuspid annular calcification might be caused by atherosclerotic degenerative change related to the aging process, or by an unknown mechanism related to pulmonary emphysema.
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PMID:[A case of tricuspid annular calcification]. 179 47

The authors analyze the role of the initial inpatient stage of long-term oxygen therapy (LOT) in combined treatment of chronic pulmonary failure in patients with chronic obstructive bronchitis, lung emphysema, and pneumosclerosis. The treatment lasted 30 days both in the main and in the control groups. In addition to basic therapy, the main group patients received 38% O2 for 15 h a day. To decrease the risk of PaCO2 elevation with a possible respiratory disorder, particularly in patients with initial hypercapnia, it is suggested that a special oxygen test with simultaneous control of acid-base balance and gas composition of the arterial blood may be carried out. In contrast to the control group, the main group patients demonstrated an improvement of gas composition of the arterial blood and of the parameters such as the alveolar-arterial gradient according to O2, the physiological pulmonary shunt. The combined use of oxygen therapy and resistance at expiration made it possible to ameliorate a number of external respiration function parameters, diffusion lung capacity, and enhanced the effect of oxygen therapy. It is shown that patients with PaO2 may be given LOT within the range of 60-69 mm Hg, provided the pulmonary physiological shunt exceeds 20%.
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PMID:[The hospital stage of the long-term oxygen therapy of chronic lung failure in patients with chronic obstructive bronchitis]. 180 14

The harmful effect of cement dust upon living organisms consists in irritating, sensitizing and pneumoconiotic properties of its components. In animal studies it has been observed that cement dust induces atrophic and hypertrophic changes in nasal and pharyngeal mucosa and chronic exfoliative bronchitis. In the lungs of experimental animals slight tissue fibrosis and some emphysema foci were found. The examination of workers exposed to cement dust has shown that disorders of the upper respiratory airways they suffer from include most often chronic rhinitis, laryngitis and pharynx catarrh. Also, it has been noticed that chronic bronchitis in the exposed workers was 1.7 times more frequent compared to those non-exposed, and that asthma was diagnosed in some of the exposed workers. Chronic bronchitis was usually characterized by the symptoms of impaired, obstructive lung ventilation. Defects in lung ventilation were strictly related to the duration of mild cases of cement pneumoconiosis diagnosed in a small percentage of workers who were exposed for at least 10 years to high dust concentrations. Long-term contact of skin with cement results in inflammatory changes or, in some cases, in chemical burns. Etiological factors of inflammatory skin changes are allergenic elements (Cr, Nr, Co) and irritating agents found in cement.
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PMID:[Biological effect of cement dust]. 181 89

In England and Wales there is a strong geographical relation between current mortality from chronic bronchitis and emphysema in adults and infant mortality from bronchitis and pneumonia 50 years ago. Follow-up studies of infants and children show that certain pulmonary infections cause persisting abnormalities of lung function. This suggests that infection of an organ system during a period of rapid growth may have permanent deleterious effects. Long-term consequences of infection may also depend on age-related differences in the host response. The relationship between age of infection with hepatitis B virus and the likelihood of becoming a chronic HBsAg carrier is an example of this. Evidence that the common communicable diseases of childhood tend to have occurred late in cases of multiple sclerosis hints at similar mechanisms in this disease. The current patterns of motor neuron disease mirror the epidemiology of poliovirus infection 40 years ago both in geographical distribution and in changes over time. The same neuronal populations are affected in both these conditions; is there a causal link?
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PMID:Childhood infection and adult disease. 185 18

Since 1940, 760 cases of silicosis have been diagnosed as part of the State of North Carolina's (NC) pneumoconiosis surveillance program for dusty trades workers. Vital status was ascertained through 1983 for 714 cases that had been diagnosed since 1940 and death certificates were obtained for 546 of the 550 deceased. Mortality from tuberculosis, cancer of the intestine and lung, pneumonia, bronchitis, emphysema, asthma, pneumoconiosis, and kidney disease was significantly increased in whites. Mortality from tuberculosis, ischemic heart disease, and pneumoconiosis was significantly increased in non-whites. The standardized mortality ratio (95% CI) for lung cancer based on U.S. rates was 2.6 (1.8-3.6) in whites, 2.3 (1.5-3.4) in those who had no exposure to other known occupational carcinogens, and 2.4 (1.5-3.6) in those who had no other exposure and who had been diagnosed for silicosis while employed in the NC dusty trades. Age-adjusted lung cancer rates in silicotics who had no exposure to other known occupational carcinogens were 1.5 (.8-2.9) times higher than that in a referent group of coal miners with coalworkers' pneumoconiosis (CWP) and 2.4 (1.5-3.9) times higher than that in a referent group of non-silicotic metal miners. Age- and smoking-adjusted rates in silicotics were 3.9 (2.4-6.4) times higher than that in metal miners. This analysis effectively controls for confounding by age, cigarette smoking, and exposure to other known occupational carcinogens, and it is unlikely that other correlates of silica exposure could explain the excess lung cancer mortality in the silicotics.
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PMID:Silicosis and lung cancer in North Carolina dusty trades workers. 186 18


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