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

Arterial oxygenation, breathing pattern, and electroencephalogram were studied during sleep in patients with chronic bronchitis and emphysema and in healthy subjects. All of the 10 "blue and bloated" patients had episodes of transient hypoxaemia lasting 1--100 min, when their oxygen saturation fell by more than 10%, whereas such desaturation did not occur in 2 "pink and puffing" patients or in 4 healthy subjects. Hypoxaemic episodes usually occurred during the rapid-eye-movement stage of sleep. It is suggested that these hypoxaemic episodes result from a combination of hypoventilation and impaired ventilation/perfusion relationships and that these episodes may contribute to the development of the pulmonary hypertension and secondary polycythaemia which characterises "blue and bloated" patients.
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PMID:Transient hypoxaemia during sleep in chronic bronchitis and emphysema. 8 61

The effect of 0.8 mg nitroglycerine on haemodynamics and pulmonary functions was examined in 12 patients with chronic obstructive pulmonary disease. Resting heart rate was increased from 72 to 82/min by nitroglycerine, but at rest and on exercise there was only a slight reduction in systolic blood pressure, the diastolic level remaining essentially unchanged. There was a decrease in cardiac index of 16 and 15% at rest and on exercise, respectively. A highly insignificant reduction in mean pulmonary artery pressure occurred both at rest and on exercise. Respiratory variations of pulmonary artery pressure markedly decreased after nitroglycerine and correlated well with airway resistance, which fell by 28%. Pulmonary vascular resistance fell from 188 to 149 dyn.s.cm-5. Vital capacity increased after nitroglycerine as a sign of reduction of pulmonary emphysema. Partial pressure of arterial oxygen and carbon dioxide showed no definite changes at unchanged respiratory rates. Thus nitroglycerine produces a marked improvement in haemodynamics and pulmonary function without any increase in ventilatory distribution abnormalities. These results support the use of nitroglycerine as one of several means of treating chronic obstructive pulmonary disease.
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PMID:[Nitroglycerine in chronic obstructive pulmonary disease (author's transl)]. 10 70

There's no doubt that chronic obstructive lung disease can have a disastrous impact on the heart's right ventricle--often producing hypertrophy or even failure--but its effects on the left ventricle are less clear. Some researchers speculate that disease of the right ventricle leads to disease of the left, while others consider the lung disease itself to be the more likely mechanism. Ordinarily, the left ventricle holds up well, even in far-advanced emphysema and chronic bronchitis. Recognizing the cases that do occur is important, however, since only minimal left ventricular failure can seriously compromise respiratory function. Treatment is the same as for left ventricular failure of any cause, but special precautions should be observed, particularly in prescribing diuretics. If frank pulmonary edema supervenes, mechanical ventilation and supplemental oxygen are necessary.
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PMID:The left ventricle in emphysema and chronic bronchitis. 13 13

Twenty-one patients with severe chronic bronchitis and emphysema (FEV1 less than 1 1) inhaled 80 microgram of the atropine-like agent ipratropium or placebo in a double-blind study and three hours later inhaled 200 microgram salbutamol. After 80 microgram ipratropium, mean FEV1 was significantly greater than after 200 microgram salbutamol (P less than 0.025), but the difference was only 40 ml and the clinical significance of this difference is unproved. There was no correlation between the patient's response to ipratropium and the response to salbutamol. When salbutamol was administered three hours after ipratropium, the FEV1 rose to higher levels than after either agent alone (P less than 0.01). Studies breathing 80% helium/20% oxygen suggest that ipratropium dilates both large and small airways. There was no correlation between the response to helium/oxygen and the response to either bronchodilator. The results suggest that in severe chronic bronchitis and emphysema ipratropium is at least as effective as salbutamol, and that such patients should have reversibility studies with salbutamol alone, ipratropium alone, and after both agents together. The combination of ipratropium and salbutamol may be clinically useful.
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PMID:Bronchodilatation and the site of airway resistance in severe chronic bronchitis. 15 91

In 15 patients with chronic bronchitis with or without emphysema breathing of room air was compared with breathing of 20.9% O2 in helium and in argon. Minute ventilation and alveolar ventilation showed no differences, whereas the alveolar and arterial pO2 and PCO2 showed an improvement of the CO2 gas exchange and a deterioration of the O2 gas exchange. This contradictory behaviour cannot be explained by shunts or inhomogeneities or influence of gaseous or alveolo-capillary diffusion. Perhaps the physicochemical properties of the alveolo-capillary membrane change by the depletion of nitrogen. The recommendation of helium-oxygen breathing, proposed by other authors for patients with obstructive airway diseases, cannot be supported, when the gas exchange for O2 is deteriorated.
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PMID:[Respiratory gas exchange during breathing of O2 in different inert gases (author's transl)]. 20 10

We examined the role of intermediate alpha 1-antitrypsin deficiency in predisposing to abnormalities of lung distensibility and airway function in 20 heterozygotes (Pi MZ) who were individually matched with a control Pi M subject of similar age, height, and smoking habits drawn from the same male, working population. There were no significant differences between the heterozygotes and their controls in the results of spirometry, maximum expiratory flow-volume curves (breathing air), single breath nitrogen test, arterialised capillary blood oxygen pressure, or single breath carbon monoxide transfer. Additional studies were made in 12 of the pairs of Pi MZ and Pi M subjects. Comparison of maximum expiratory flow-volume curves breathing air and 80% helium-20% oxygen showed no differences between the Pi MZ and Pi M subjects. Although airway function was similar in the two groups, four of 12 Pi MZ subjects showed abnormalities of the pressure-volume curve of the lung (reduction in lung recoil pressure, abnormal shape factor, increase in functional residual capacity). Abnormalities of washout of a helium-sulphur hexafluoride gas mixture, of a type previously described as characteristic of emphysema, were found in two of the men with abnormal pressure-volume curves. The results suggest that Pi MZ subjects have an increased susceptibility to alveolar abnormalities without increased abnormalities of airway function; this may explain the increased frequency of emphysema at necropsy despite many studies showing no predisposition to abnormal airway function in life. The functional changes we observed would be unlikely to cause symptoms. The risk of disablement from chronic lung disease appears to be only slightly enhanced by intermediate alpha 1-antitrypsin deficiency.
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PMID:Lung distensibility and airway function in intermediate alpha 1-antitrypsin deficiency (Pi MZ). 31 7

To determine pulmonary function abnormalities in patients with neonatal bronchopulmonary dysplasia (BPD), we measured distribution of ventilation by nitrogen washout, minute and tidal volume, and arterial and alveolar gases in three groups of ten preterm infants with similar birth weights (mean = 1,340 g) and gestational ages (mean = 30.3 weeks). Infants in group A were never artificially ventilated, those in group B were ventilated but had no subsequent BPD, and those in group C were ventilated and developed BPD. Infants with BPD had severe maldistribution of ventilation (pulmonary clearance delay 223% versus 47% and 60% for groups A and B). They had decreased tidal volumes (5.3 ml versus 7.0 and 6.2 ml) and higher respiratory rates (60/min versus 47 and 48) but similar minute volumes. They also had increased PaCO2 (53.6 torr versus 41.9 and 43.4 torr) and increased arterial-alveolar carbon dioxide gradients (6.8 torr versus 3.1 and 1.8 torr). There was no statistically significant difference between groups B and C for the time spent in fractional inspired oxygen greater than 0.40 and greater than 0.60, or the time ventilated for intubated, or the incidence of patent ductus arteriosus. Early pulmonary interstitial emphysema was much more common in the infants who subsequently developed BPD (eight of ten versus two of ten, P less than .01).
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PMID:Chronic pulmonary disease in neonates after artificial ventilation: distribution of ventilation and pulmonary interstitial emphysema. 33 Dec 23

The functions of each lung were measured 41 and 79 months following hypothermic twenty-four four lung preservation and autotransplantation in six and four dogs respectively. Functional results were compared with long-term autotransplanted canine lungs. Compliance, total lung capacity, functional reserve capacity and ventilation of preserved lungs were similar to autotransplanted lungs, and only slightly decreased as compared with normal animals. There was no statistically significant difference between the pulmonary diffusion capacity and oxygen uptake of the preserved and autotransplanted lungs group and autotransplants alone. However, in both groups, diffusion capacity and oxygen uptake were decreased as compared with intact animals. Pulmonary hypertension was found on occlusion of the contralateral lung's artery: it was due to increased pulmonary vascular resistance. No gross narrowing of the pulmonary artery or venous anastomosis was found that could explain the increased resistance. Diffuse emphysema of various degrees was observed in all animals. This study seems to indicate that hypothermic preservation of the lung does not affect significantly the long-term functional ability of the organ, and probably will have practical value in future clinical lung transplantation.
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PMID:Hypothermic lung preservation functions, six or more years later. 34 22

Pulmonary emphysema is regularly complicated by pulmonary hypertension which is, however, mostly of minor degree. As long as pulmonary capillary pressure and cardiac output remain within normal limits, the elevated pressure in the pulmonary artery is due to an increase of vascular resistance for which hypoxia is responsible in the first place, while rarefaction of vascular ramifications due to the emphysematic destructive process in the pulmonary parenchyma plays only a secondary role. Breathing of oxygen decreases pulmonary hypertension, an effect which is reinforced by combination of oxygen with IPPB. Phentolamine lowers both vascular resistance and pressure in the pulmonary artery in short-term administration. The effect of hemodilution on pulmonary hypertension in emphysematic patients with hypoxic polycythemia is, however, somewhat disappointing if the hematocrit value remains below 60%. Some rheological causes for this therapeutic failure are discussed.
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PMID:[Lung circulation in emphysema]. 34 45

The effect of pressure-limited (PL) and volume-limited (VL) ventilation on mortality and morbidity in infants with severe hyaline membrane disease (HMD) was examined in a prospective controlled study. Criteria for mechanical ventilation were PaO2 value of 50 mm Hg or less or a Paco2 value of 70 mm Hg or greater, while the infant was receiving nasal continuous positive airway pressure (CPAP) at oxygen concentrations (FIO2) of 0.8 or greater and CPAP of 8 cm H2O or greater; HMD associated with severe perinatal asphyxia requiring mechanical ventilation in the delivery room. Consecutive patients were alternately assigned to receive either PL or VL ventilation. Twenty infants were ventilated with PL machines using low peak inspiratory pressures (mean maximum inspiratory pressure of 28 cm H2O) and prolonged inspiratory times. Twenty other infants were ventilated with VL machines, using essentially unlimited peak inspiratory pressures (mean maximum inspiratory pressure of 62 mm H2O) and prolonged expiratory times. There were no significant differences in survival, incidence of pneumothorax or pulmonary interstitial emphysema, or noteworthy bronchopulmonary dysplasia.
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PMID:Mortality and morbidity associated with pressure- and volume-limited infant ventilators. 35 90


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