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 3,296 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To investigate the response pattern of patients with chronic airway obstruction (CAO) to bronchodilators, 128 subjects consisting of 80 men and 48 women with a mean age of 52.6 years were randomly tested with three inhalant bronchodilators: a non-selective beta-agonist (isoproterenol), a beta 2-selective agonist (terbutaline) and an anticholinergics (ipratropium) plus placebo. All patients had a baseline FEV/FVC of less than 65% and their clinical diagnosis were classified as either COPD or bronchial asthma according to the criteria of the ACCP-ATS Joint Committee on Pulmonary Nomenclature. The drugs were delivered to the patient via a metered dose inhaler (MDI) using the conventional inhalation technique. Spirometry was measured at regular intervals with a computerized pulmonary function analyzer CHESTAC-65(Japan). A more than 15% increase in FEV1 and/or FVC after treatment was regarded as responsive. While 108 patients were tested with a single drug, the remaining 20 patients were tested sequentially with terbutaline, ipratropium and placebo in a randomized cross-over manner for studying additivity. Our results showed that the response rates of asthmatic patients to isoproterenol, terbutaline and ipratropium were 50%, 87% and 67%, respectively. Only 27% of COPD patients responded to isoproterenol and 60% to terbutaline. On the other hand, ipratropium possessed a 61% response rate in the treatment of COPD and showed a bronchodilator effect independent to that of terbutaline. Combined use of both drugs resulted in additional improvement. Once patients responded to the drugs, apparent changes in FEV1 and/or FVC occurred within 30 minutes and reached the maximum usually at 60 minutes post-inhalation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The response pattern of patients with chronic airway obstruction to bronchodilators. 280 62

We evaluated the outcome of the spirometry quality control program of the SA.R.A. multicenter project, the aim of which is the multidimensional assessment of asthma and COPD in the elderly (>/= 65 yr). The factors determining this quality were also evaluated. The program was based on standardized procedures (ATS recommendations), performed by specifically trained and certified personnel; a fully-computerized spirometer with customized software was used for spirometry. A reference center made monthly controls. Overall, 638 cases and 984 controls were examined. Spirometric measurements were obtained in 607 cases and 912 controls; 508 and 747 tests with at least three acceptable curves were obtained in cases and in controls, respectively (NS). The percentage of reproducible tests ranged between 95.8% for FEV(1) in controls and 87.6% for FVC in cases. The average reproducibility for FEV(1) was 61.6 ml in cases and 58.3 ml in controls (NS). Cognitive impairment, shorter 6-min walk distance, and lower educational level were found to be independent risk factors for a poorer acceptability rate (logistic regression analysis). Male sex and age were risk factors for a poorer reproducibility of FEV(1). Reproducibility tended to improve with time (p < 0.001). Although spirometry becomes increasingly difficult in aging patients, a rigorous quality control program can ensure that reliable data are obtained in the majority of patients.
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PMID:Quality control of spirometry in the elderly. The SA.R.A. study. SAlute Respiration nell'Anziano = Respiratory Health in the Elderly. 1076 96

We investigated ethnic differences in spirometry and gas transfer (DL(CO)) in a young, healthy population of nonsmoking physicians and medical students aged 22-33 yr, of European or Asian descent. Each answered questions detailing ethnic background, medical history, level of physical activity, and length of residence in the United States. Spirometry and single-breath DL(CO) maneuvers were performed in accordance with ATS standards. Venous blood was measured for hemoglobin (Hb). The same equipment was used to test all subjects. Data were analyzed by multiple linear regression. Eighty subjects were studied, with 20 in each of the following groups: European male, European female, Asian male, and Asian female. Asian values for forced vital capacity, forced expiratory volume in 1 s (FEV(1)), and alveolar volume (VA') were significantly lower than for Europeans, but DL(CO), DL(CO)/VA', and DL(CO)/VA'/Hb did not differ significantly. These differences could not be attributed to age, length of residence in the United States, activity level, or variance in baseline characteristics and anthropometric measurements, and therefore represent a true physiologic difference. Ethnic differences between individuals of Asian and European backgrounds should be considered when interpreting pulmonary function tests, especially when predicted values are based on populations of European descent.
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PMID:Ethnic differences in pulmonary function in healthy nonsmoking Asian-Americans and European-Americans. 1076 97

The aim of this study was to evaluate the feasibility and reproducibility of forced expiratory maneuvers during standard spirometric evaluation in preschool children. Among 570 young children attending our laboratory, we retrospectively selected 355 patients (14% 3-4-year-olds, 48% 4-5-year-olds, and 38% 5-6-year-olds) who carried out spirometric tests for the first time. The indications for such tests were history of asthma (70%), followed by chronic cough (20%) and other miscellaneous conditions (10%). Eighty-eight, 175, and 92 children performed one, two, and three acceptable tests respectively. Forced expired volume in 1 sec (FEV(1)) and forced vital capacity (FVC) did not differ significantly between attempts in children performing either two or three attempts. Forced expiratory time (FET), i.e., the total time required for the forced expiratory maneuver, was 1.7 +/- 0.1 sec (mean +/- SEM), and was no greater than 1 sec in 21.3% of all tested children. Consequently, FEV(1) does not appear to be well-suited to this age group. Forced expiratory volume in 0.50 and 0.75 sec (FEV(0.5), FEV(0.75)) were thus measured in the group of children performing three attempts (n = 92), and there was no statistical difference between attempts. In 267 children performing two or three tests, the ATS criteria of reproducing FEV(1) and FVC within <or= 0.1 L seemed to be preferable in this young population. Indeed, more than 70% of the tested children presented their two best efforts (FVC and FEV(1)) not varying by more than 0.1 L. Individual coefficients of variation (CV = SD/mean x 100%) over three tests for FEV(1) and FVC were 6.71 +/- 0.53% and 6.35 +/- 0.41% (mean +/- SEM), respectively. These results show that forced expiratory tests are not always feasible in young children, but that 55% (196/355) of our selected population performed reliable maneuvers (at least two FVC and FEV(1) reproducible within 0.1 L), provided that they were supervised by a carefully trained pediatric medical staff.
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PMID:Spirometry in children aged 3 to 5 years: reliability of forced expiratory maneuvers. 1141 77

Inhalation challenges with direct-acting stimuli histamine and methacholine are widely used to measure airway responsiveness. Three widely used methods (2-min tidal breathing method, breath-activated dosimeter method, hand-held manual nebulizer) are described. Careful standardization is important so as to best differentiate normal from increased airway responsiveness and to permit comparison between methods. With current methods standardized as suggested by the ATS, a methacholine (or histamine) PC(20) > 16 mg/mL is considered normal. A PC(20) < 16 mg/mL is highly sensitive for current symptoms of asthma. Interpretation of methacholine or histamine inhalation test requires that symptoms be current (within a few days) and that FEV(1) be normal.
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PMID:Bronchoprovocation methods: direct challenges. 1264 16

Maximal voluntary ventilation (MVV) may be determined directly by the sprint method or calculated from pulmonary function data, using the functions MVV = forced expired volume in 1 sec (FEV(1)) x 35 or MVV = FEV(1) x 40. The purpose of this paper was to test the validity of the equation over a wide range of lung function in children. Cystic fibrosis (CF), a chronic lung disease where children typically have a wide range of pulmonary function, was chosen as the study requirement. Spirometric data from 332 children with CF who underwent pulmonary function testing between 1987-2000 were stratified according to disease severity, and box-plots comparing the ratio of MVV to FEV(1) for each category were generated. As results indicated that the equation underestimates true MVV proportionally to the degree of airflow limitation, a new function to predict MVV for this population was derived and tested. The new equation was derived using data from patients who were tested on odd-numbered days (group A). The validity of the new equation was then tested on the patients tested on even-numbered days (group B). To test its validity, the results were compared to the "gold standard" sprint values using a Bland and Altman plot. MVV was expressed as a function of FEV(1) and predicted FEV(1): MVV = 27.7(FEV(1)) + 8.8(PredFEV(1)) (R(2) = 0.98, P < 0.05). In this way, the accuracy of the new equation was confirmed. Whenever possible, we recommend MVV be determined by the sprint method in accordance with ATS guidelines. If this is not feasible, we recommend considering the new prediction equation.
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PMID:Determination of maximal voluntary ventilation in children with cystic fibrosis. 1274 45

The aim of this study was to describe the impact of using bronchodilators on the prevalence of Chronic Obstructive Pulmonary Disease in a population-based survey (Platino study). A cluster sampling of subjects 40 years of age or older, representative of the metropolitan areas of 5 Latin American cities (Sao Paulo, Mexico, Montevideo, Santiago and Caracas) was chosen. Spirometry according to ATS standards was done before and after inhalation of 200 micrograms of salbutamol in 5183 subjects. Prevalences of airflow obstruction were estimated using different criteria, in tests done before and after bronchodilator use, and with reference values for pre- or post-bronchodilator use. Bronchodilator testing reduced the overall prevalence of FEV(1)/FVC% < 0.70 from 21.7% to 14% (35%). In the group with FEV(1)/FVC < 0.70 after bronchodilator use, 21% were asymptomatic from the respiratory point of view, and lacked significant adverse exposures. Subjects below the 5th percentile for FEV(1)/FVC and FEV(1)/FEV(6) were fewer than those with FEV(1)/FVC < 0.70, especially among the elderly. More subjects are below the 5th percentile of FEV(1)/FVC and FEV(1)/FEV(6) using reference values for tests after bronchodilator use than using the reference values determined without bronchodilator testing. Testing after bronchodilator use reduces the prevalence of airflow obstruction from 32 to 39% depending on the definition used. In addition, the subjects who were still obstructed after bronchodilator use were the ones who showed more respiratory symptoms and exposure to tobacco and other smokes and dusts, than subjects with reversible obstruction, suggesting an increased specificity for COPD.
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PMID:Impact of bronchodilator use on the prevalence of COPD in population-based samples. 1753 May 4

Little is known on the long-term validity of reference equations used in the calculation of FEV(1) and FEV(1)/FVC predicted values. This survey assessed the prevalence of chronic airflow obstruction in a population-based sample and how it is influenced by: (i) the definition of airflow obstruction; and (ii) equations used to calculate predicted values. Subjects aged 45 or more were recruited in health prevention centers, performed spirometry and fulfilled a standardized ECRHS-derived questionnaire. Previously diagnosed cases and risk factors were identified. Prevalence of airflow obstruction was calculated using: (i) ATS-GOLD definition (FEV(1)/FVC<0.70); and (ii) ERS definition (FEV(1)/FVC<lower limit of normal) with European Community for Coal and Steel (ECCS) reference equations and with predicted values derived from the presumably normal fraction of the studied population. A total of 5008 subjects (4764 adequate datasets) were studied. Prevalence of airflow obstruction was 8.71% with ATS-GOLD definition and 6.40% with ERS definition and ECCS predicted values. The ERS definition with predicted values derived from the studied population provided a 7.96% prevalence. Severity distribution of airflow obstruction was also influenced by the equation used to calculate predicted values of FEV(1). Prevalence and severity of chronic airflow obstruction are influenced not only by the definition used but also by equations used to calculate predicted FEV(1)/FVC and FEV(1) values. These equations likely need to be periodically revised.
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PMID:FEV1/FVC and FEV1 for the assessment of chronic airflow obstruction in prevalence studies: do prediction equations need revision? 1865 59

This study identifies equations for predicting lung function values in a population of 'healthy', nonsmoking older adults, explores the applicability of prediction equations derived from younger adult populations to the elderly, and examines the justification of developing population-specific reference equations for older age. FVC, FEV(1), and PEF were measured according to the ATS criteria in 651 ambulatory volunteers aged 65-86 years, representative for the Croatian Mediterranean population. After exclusion of eversmokers and subjects with respiratory symptoms and/or diseases, 261 asymptomatic subjects were included in the analyses. Sex-specific reference equations and lower limits of normal were derived by using a linear model with height and age as predictors. The equations for lung volumes were more reliable than those for PEF. The new FVC and FEV(1) reference equations were found to be in agreement with those generated previously from primarily young and middle-aged adults. The latter perform reasonably well when extrapolated for ages beyond 65 years. Cross-validation of reference equations existing for the elderly showed that almost all European and U.S. equations systematically overpredicted lung function parameters in the Croatian sample. The overpredictions in means ranged between 14% and 34% for FVC and between 10% and 20% for FEV(1). Differences increased towards the extremes of distribution, which rendered these equations inappropriate for our elderly subjects. They identified FVC in 25-55% of the subjects as being below the lower limit of normal. The observed discrepancies strongly support the establishment of age- and population-specific reference equations for lung function assessment in older age.
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PMID:New reference equations for forced spirometry in elderly persons. 1902 84

Repercussions of obesity on the lung function have been widely studied. The effect of serious malnutrition is less well known. The aim of study was to determine spirometric parameters in 102 malnourished girls with anorexia nervosa. Among these patients, only 71 aged 12-18 years (mean 15.6), mean BMI 15.8 kg/m(2), met the ATS/ERS forced expiratory maneuver criteria for spirometry. The most frequently observed abnormalities were: decreased IC seen in 33 (46%) girls and decreased PEF in 45 (63%) patients. Maximum voluntary ventilation was within the normal range in all but 2 subjects. Diminished values of FEV(1), FVC, FEV(1)/FVC, MEF(50) were observed in 10 (14%), 13 (18%), 3 (4%), and 3 (4%) patients, respectively. We found strong positive correlations between weight and absolute values of the examined parameters. We assume that spirometric abnormalities in anorexia are probably a result of respiratory muscle weakness and body mass loss.
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PMID:Spirometric parameters in malnourished girls with anorexia nervosa. 1921 7


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