Changes In Lung Function Tests Research Articles

Utility of exhaled nitric oxide to guide mild asthma treatment in atopic patients and its correlation with asthma control test score: a randomized controlled trial

BackgroundFractional exhaled nitric oxide (FeNO) is used for the diagnosis and monitoring of asthma, although its utility to guide treatment and its correlation with other tools is still under discussion. We study the possibility to withdraw inhaled corticosteroid treatment in atopic patients with mild asthma based on the FeNO level, as well as to study its correlation with other clinical control tools.MethodsProspective and randomized study including atopic patients aged 18 to 65 with mild asthma, stable, on low-dose inhaled corticosteroid (ICS) treatment, who had their treatment withdrawn based on a FeNO level of 40 ppb. Patients were randomized into two groups: control group (treatment with ICS was withdrawn regardless of FeNO level) and experimental group (according to the FeNO levels, patients were assigned to one of two groups: FeNO > 40 ppb on treatment with budesonide 200 mcg every 12 h and SABA on demand; FeNO ≤ 40 ppb only with SABA on demand). Follow-up was conducted for one year, during which medical assessment was performed with FeNO measurements, asthma control test (ACT), lung function tests (FEV1, FEV1/FVC, PEF, and RV/TLC), and recording of the number of exacerbations.ResultsNinety-two patients were included, with a mean age of 39.92 years (SD 13.99); 46 patients were assigned to the control group, and 46 patients to the experimental group. The number of exacerbations was similar between the groups (p = 0.301), while the time to the first exacerbation was significantly shorter in the control group (30.86 vs. 99.00 days), p < 0.001, 95% CI (43.332—92.954). Lung function tests (FEV1, FEV1/FVC, PEF, and RV/TLC) showed no differences between the groups (p > 0.05). Both FeNO and ACT showed significant changes in the groups in which ICS was withdrawn (p < 0.05 for both parameters). A significant negative correlation was observed between FeNO and ACT (r = -0.139, p = 0.008).ConclusionsIn atopic patients with mild asthma, withdrawal of ICS based on an FeNO of 40 ppb led to worsened symptoms but without changes in lung function tests or an increase in exacerbations. There was a negative correlation between FeNO values and symptomatic control measured by the ACT.Trial registrationClinical Trial Number: 2012–000372-42. Start Date: 2012–07-23. Trial registered prospectively (https://www.clinicaltrialsregister.eu/ctr-search/search?query=2012-000372-42). This study adheres to CONSORT guidelines of randomised control trials.

Single-dose pharmacokinetics and lung function of nebulized niclosamide ethanolamine in sheep

PurposeNiclosamide is approved as an oral anthelminthic, but its low oral bioavailability hinders its medical use requiring high drug exposure outside the gastrointestinal tract. An optimized solution of niclosamide for nebulization and intranasal administration using the ethanolamine salt has been developed and tested in a Phase 1 trial. In this study we investigate the pulmonary exposure of niclosamide following administration via intravenous injection, oral administration or nebulization.MethodsWe characterized the plasma and pulmonary pharmacokinetics of three ascending doses of nebulized niclosamide in sheep, compare it to intravenous niclosamide for compartmental PK modelling, and to the human equivalent approved 2 g oral dose to investigate in the pulmonary exposure of different niclosamide delivery routes. Following a single-dose administration to five sheep, niclosamide concentrations were determined in plasma and epithelial lining fluid (ELF). Non-compartmental and compartmental modeling was used to characterize pharmacokinetic profiles. Lung function tests were performed in all dose groups.ResultsAdministration of all niclosamide doses were well tolerated with no adverse changes in lung function tests. Plasma pharmacokinetics of nebulized niclosamide behaved dose-linear and was described by a 3-compartmental model estimating an absolute bioavailability of 86%. ELF peak concentration and area under the curve was 578 times and 71 times higher with nebulization of niclosamide relative to administration of oral niclosamide.ConclusionsSingle local pulmonary administration of niclosamide via nebulization was well tolerated in sheep and resulted in substantially higher peak ELF concentration compared to the human equivalent oral 2 g dose.

A study design for statistical learning technique to predict radiological progression with an application of idiopathic pulmonary fibrosis using chest CT images

BackgroundIdiopathic pulmonary fibrosis (IPF) is a fatal interstitial lung disease characterized by an unpredictable decline in lung function. Predicting IPF progression from the early changes in lung function tests have known to be a challenge due to acute exacerbation. Although it is unpredictable, the neighboring regions of fibrotic reticulation increase during IPF's progression. With this clinical information, quantitative characteristics of high-resolution computed tomography (HRCT) and a statistical learning paradigm, the aim is to build a model to predict IPF progression. DesignA paired set of anonymized 193 HRCT images from IPF subjects with 6–12 month intervals were collected retrospectively. The study was conducted in two parts: (1) Part A collects the ground truth in small regions of interest (ROIs) with labels of “expected to progress” or “expected to be stable” at baseline HRCT and develop a statistical learning model to classify voxels in the ROIs. (2) Part B uses the voxel-level classifier from Part A to produce whole-lung level scores of a single-scan total probability's (STP) baseline. MethodsUsing annotated ROIs from 71 subjects' HRCT scans in Part A, we applied Quantum Particle Swarm Optimization–Random Forest (QPSO-RF) to build the classifier. Then, 122 subjects' HRCT scans were used to test the prediction. Using Spearman rank correlations and survival analyses, we ascertained STP associations with 6–12 month changes in quantitative lung fibrosis and forced vital capacity. ConclusionThis study can serve as a reference for collecting ground truth, and developing statistical learning techniques to predict progression in medical imaging.

Assessment of 18F-FDG uptake in idiopathic pulmonary fibrosis: influence of lung density changes

BackgroundIdiopathic Pulmonary Fibrosis (IPF) is a progressive and irreversible disease leading to terminal respiratory insufficiency. Fluorodeoxyglucose ([18F]-FDG) PET/CT has been proposed to track the activity of the disease. However, IPF is characterized by regional changes in lung density that affects the FDG uptake, a factor generally not taken into account in previous studies. In this work, we studied the relationship between severity of IPF and lung uptake of [18F]-FDG, evaluated by mean and maximum standardized uptake value (SUV), corrected (SUVmean-corr; SUVmax-corr) and uncorrected for lung density (SUVmean-uncorr; SUVmax-uncorr).Methods[18F]-FDG PET/CT was performed in 31 IPF patients between 2013 and 2017. Lung density was determined on CT. SUV values were correlated with lung function tests, carbon monoxide diffusion (DLCO) and 6-min walking test (6MWT) at baseline and at 1 year. Correlation with the GAP index, a well-validated prognostic score in IPF, was also determined.ResultsAt baseline, SUVmean-uncorr was highly correlated with lung density (r = 0.755; p < 0.001). SUVmean-uncorr and lung density were correlated with lung function tests (vital capacity (VC): p = 0.013 and p = 0.003; forced vital capacity (FVC): p = 0.004 and p = 0.001; total lung capacity (TLC): p = 0.001 and p = 0.001, respectively), while SUVmean-corr was not (VC: p = 0.733; FVC: p = 0.667; TLC: p = 0.382). Interestingly, SUVmean-corr was significantly higher in patients with a GAP index of 3 (p = 0.005), and negatively correlated with DLCO (r = − 0.398; p = 0.026) and desaturation during the 6MWT (r = − 0.401; p = 0.024). But no correlation was found with changes in lung function tests, walk distance and DLCO at 1 year.ConclusionTo evaluate the role of ([18F]-FDG) PET/CT in IPF, correction for lung density appears necessary. As suggested by the correlation with DLCO, density-corrected SUV seems related to the intrinsic disease activity and particularly to the integrity of the alveolar-capillary barrier. However, ([18F]-FDG) PET/CT has probably a limited prognostic value as no correlation was found between SUVmean-corr and the clinical evolution at 1 year. Further studies with a longer follow-up are warranted.

A mechanism of action classification method unifying toxicology and ecotoxicology

Although the effectiveness of pulmonary rehabilitation in patients with chronic obstructive lung disease, cystic fibrosis, and interstitial lung disease is well documented, little is known about pulmonary rehabilitation in patients who are referred for lung transplantation. Nordic walking is a low-cost and accessible form of physical exercise with proven benefits. The purpose of this prospective study was to examine the effects of Nordic walking on lung function, perception of dyspnea, and health-related quality of life in patients referred for lung transplantation.Twenty-two of 40 patients who was qualified for lung transplantation at the Department of Lung Diseases in Zabrze, Poland, completed a rehabilitation program consisting of 12 weeks of Nordic walking. Lung function tests, exercise tolerance, and perception of dyspnea and quality of life were assessed before and after completion of the program.No adverse events were observed during the rehabilitation program. After 12 weeks, there was a significant increase in mean 6-minute walk distance (374 meters vs 288 meters, P < .034) and a significant reduction in perception of dyspnea after completion of the rehabilitation program. Assessment of general health and quality of life showed significant improvement (P < .05). No significant changes in lung function tests were noted.Nordic walking is a safe and feasible physical activity for pulmonary rehabilitation in patients with end-stage lung disease who are referred for lung transplantation. This rehabilitation technique results in significant improvements in patient mobility and quality of life.

Comparative Study of Nasal Symptoms and Pulmonary Function Tests Post FESS in Ethmoidal Polyposis.

Theobjective of this study wereto assess the pulmonary function in patients with ethmoidal polyposis who did not respond to medical treatment; to evaluate the effect of Functional Endoscopic Sinus Surgery on the lung function of these patients and to compare the total nasal symptom score in these patients. A prospective observational study was conducted in Department of ENT, KMC Manipal on 50 subjects with ethmoidal polyposis who were unresponsive to medical treatment and hence underwent FESS. Pulmonary function tests were assessed using spirometry and nasal symptoms were scored as per TNSS system prior to surgery and 3months post-surgery and compared with the pre-operative values and analysed. Pre operatively majority (35 patients) had TNSS value of 6-9 whereas post operatively the score was reduced to 2-3 in many patients (38 patients). The mean TNSS was 7.24 before surgery which declined to 2.82 after surgery with a p value < 0.0001 indicating a statistically significant improvement in the nasal symptoms post FESS. The mean pre-operative FVC, FEV1, MEFR were 2.94, 2.41 and 2.51L respectively whereas the mean post-operative values were 2.95, 2.39 and 2.49L respectively. There was no statistically significant change in lung function tests following FESS. Our study shows that FESS benefits patients with nasal polyposis by improving the symptoms and there by the quality of life without any adverse effects on the lower airways.

Nordic Walking in Pulmonary Rehabilitation of Patients Referred for Lung Transplantation

BackgroundAlthough the effectiveness of pulmonary rehabilitation in patients with chronic obstructive lung disease, cystic fibrosis, and interstitial lung disease is well documented, little is known about pulmonary rehabilitation in patients who are referred for lung transplantation. Nordic walking is a low-cost and accessible form of physical exercise with proven benefits. The purpose of this prospective study was to examine the effects of Nordic walking on lung function, perception of dyspnea, and health-related quality of life in patients referred for lung transplantation. MethodsTwenty-two of 40 patients who was qualified for lung transplantation at the Department of Lung Diseases in Zabrze, Poland, completed a rehabilitation program consisting of 12 weeks of Nordic walking. Lung function tests, exercise tolerance, and perception of dyspnea and quality of life were assessed before and after completion of the program. ResultsNo adverse events were observed during the rehabilitation program. After 12 weeks, there was a significant increase in mean 6-minute walk distance (374 meters vs 288 meters, P < .034) and a significant reduction in perception of dyspnea after completion of the rehabilitation program. Assessment of general health and quality of life showed significant improvement (P < .05). No significant changes in lung function tests were noted. ConclusionNordic walking is a safe and feasible physical activity for pulmonary rehabilitation in patients with end-stage lung disease who are referred for lung transplantation. This rehabilitation technique results in significant improvements in patient mobility and quality of life.

Immediate pulmonary dysfunction in ischemic heart disease patients undergoing off-pump versus on-pump CABG

BackgroundMany studies have shown important changes in lung function tests after coronary artery surgeries. It is controversial if off-pump surgery can give a better and shorter recovery than the on-pump. The aim of this work was to study immediate early pulmonary dysfunction in ischemic heart disease patients undergoing off-pump versus on-pump coronary artery bypass grafting (CABG) in order to evaluate pulmonary dysfunction caused by cardio-pulmonary bypass (CPB) in patients undergoing on-pump CABG. Patients and methodA prospective randomized study was carried out on 40 patients submitted to coronary artery surgery at Kasr El-Aini University Hospital, Cairo, Egypt. They were randomly divided into two groups; group A: 20 patients undergoing CABG using heart-lung machine (on-pump), and group B: 20 patients undergoing off-pump CABG. All patients had: spirometric evaluation, 6 min walk test pre-operatively and at the post-operative fifth day. Measurement of arterial blood gases (ABGs) and calculation of P/F ratio was recorded pre-operative, post-induction and post CABG. Post-operative intensive care unit (ICU) events were also assessed. ResultsPost-operative spirometric data and 6 min walk distance decreased in both groups, when compared to pre-operative values, with significant differences between the two groups. No significant reduction in arterial oxygen pressure (PaO2), carbon dioxide pressure (PaCO2) and P/F Ratio occurred post-operatively. ConclusionPulmonary functions deteriorate significantly after coronary artery revascularization with and without CPB, but to a significant greater reduction among those on-pump than among those off-pump surgeries.

Optimization of chronic obstructive pulmonary disease treatment in clean-up workers of the Chornobyl NPP accident in the remote period after irradiation

According to the results of the clinical and epidemiological studies in clean-up workers of Chernobyl NPP accident in the remote period were detected the growth of morbidity of chronic obstructive pulmonary disease with substantial features of pathomorphosis, that make difficulties for treatment. The aim of the study was to determine the effectiveness of long-term administration (6 months) combination Аmbroxol (30 mg x 3 times per day) and Essenciale (600 mg x 2 times per day) added to basic treatment in patients with moderate to severe COPD - clean-up workers of the Chornobyl NPP accident. Studied 60 COPD patients before treatment and after 1 year from the beginning, who were randomly assigned to two groups: the first group of patients ( 32 persons ) additionally was appointed long reception (6 months) combination ambroxol (30 mg three times a day ) and Essenciale (600 mg twice daily ), in the second group (28 people) patients received only basic therapy. The doses of radiation exposure were 25 - 500 mSv. Were studied clinical, functional characteristics, the number of exacerbations. Low response to the basic COPD therapy were shown by clean-up workers of the Chornobyl NPP accident, which is defined by the absence of significant changes in lung function tests. Additional appointments to the basic treatment of COPD ambroxol combination (30 mg 3 g / d) of Essenciale (600 mg 3 g / d) within 6 months of the liquidators of the Chernobyl possible to reduce the frequency of exacerbations in 46.9% patients without significant improvement in lung function tests.

Longitudinal decline in lung function in patients with primary immunoglobulin deficiencies

clinical symptoms in 90%. The variable disease penetrance within a given pedigree can only be explained by a ‘‘second signal.’’ In our patient the nature of this second signal was shown not to be one of the known genes involved in hemophagocytosis. Once intravenous immune globulin and prednisone were started, ferritin and sIL-2R levels did not completely normalize (ferritin, 600-750 mg/L [upper limit of normal, 350 mg/L]; sIL-2R, 4320 U/mL [upper limit of normal, 2400 U/mL]), even after almost 3 years of follow-up. Hemophagocytosis was detected in neither bone marrow smears nor in spleen and lymph node biopsy specimens. Clinically, the patient fulfilled the diagnosis of hemophagocytic lymphohistiocytosis but was not treated accordingly. The hemophagocytic lymphohistiocytosis parameters (ie, blood cell counts, ferritin, lactate dehydrogenase, sIL-2R, and triglycerides) were considered to be triggered by the pneumonia. The hypoimmunoglobulinemia and defective immunization responses were most compatible with CVID and highly unusual for ALPS. Increased susceptibility to malignancy, particularly hematological malignancy, is the most worrying consequence of ALPS. Lymphoma develops in about 10% of patients, and the relative risks of (non)Hodgkin lymphoma are 15to 50-fold, respectively. Also, patients who have CVID and granulomatous or lymphocytic interstitial lung disease are at high risk for early mortality and B-cell lymphomas. The absence of an increased risk among relatives suggests that the increased cancer morbidity in patients with CVID is related to the immunodeficiency per se rather than to specific genetic traits shared with their relatives. Whether the risk of lymphoproliferative malignancy in our family is increased remains uncertain. The grandfather has died from a mucosa-associated lymphoid tissue lymphoma but was healthy until he presented at old age. We do not know whether he carried the same FAS mutation. In conclusion, mutations in FAS (TNFRSF6) might not only result in clinical ALPS but also in hypogammaglobulinemia and reduced reactivity on immunization, which is defined as CVID. Similar phenotypic overlap was most recently suggested in a study including patients with ALPS and CVID, some of whom were carrying a FAS mutation. Our patient adds to this complex overlap syndrome, presenting with CVID and features of hemophagocytosis, whereas his FAS-mutated family members were without any clinical disease. Taco W. Kuijpers, MD, PhD Paul A. Baars, PhD Daan J. aan de Kerk, MD Machiel H. Jansen Natasja Dors, MD Rene A. W. van Lier, MD, PhD Steven T. Pals, MD, PhD

Cardiopulmonary response following surgical repair of pectus excavatum in adult patients

Severe pectus excavatum are common in adult patients, often causing psychological complaints and physiological impairments. Although lung function at rest may minimally deteriorate after surgical correction, it remains unclear if surgery improves exercise capacity. The objective of present study is to assess whether the surgical repair of pectus excavatum in adults would improve exercise tolerance. A prospective study was performed to compare pulmonary and cardiovascular function at rest and at maximal exercise, before, and at 1 year after pectus excavatum repair. From December 2005 to May 2009, 120 adult patients underwent pectus excavatum repair. Of these patients, 70 (nine women, 61 men) underwent thorough preoperative, 6-, and 12-month postoperative assessments, and were included in the present study. Age ranged from 18 to 62 years (mean 27 years). The pectus index (Haller index) was 4.5 ± 1.1. Lung function tests at rest were within the normal range, whereas maximal oxygen uptake (peak VO₂) was only 77 ± 2% of the predicted value. At 1-year follow-up, the pectus excavatum repair was associated with minor changes in lung function tests and significant increase (p=0.0005) in VO₂ (87 ± 2% of the predicted value). Postoperative O₂ pulse increase at maximal exercise suggested that aerobic capacity improvement was the result of better cardiovascular adaptation at maximal workload. These results demonstrate sustained improvement in exercise cardiopulmonary function at 1-year follow-up of pectus excavatum surgical repair in adult patients.

Off-pump versus on-pump coronary artery revascularization: effects on pulmonary function

Many studies have shown important changes in lung function tests after coronary artery surgeries. It is controversial if off-pump surgery can give a better and shorter recovery than the on-pump. A prospective study was conducted on 42 patients submitted to coronary artery surgery and divided into two groups: 21 off-pump using intraluminal shunt (G (I)) and 21 on-pump (G (II)), matched by the anatomical location of the coronary arteries lesions. All patients had spirometric evaluation, blood gas measurements and alveolo-arterial oxygen gradient (A-aDO(2)), at the fourth and 10th postoperative days (PO(4) and PO(10)). Preoperatively, G(I) and G(II) had similar results (P>0.372). Spirometry showed decreases at PO(4) and remained decreased until PO(10) for both groups, with significant differences between the groups. The blood gas measurements showed reduction in arterial oxygen pressure (PaO(2)) and carbon dioxide pressure (PaCO(2)), while there was an increase in A-aDO(2) at PO(4) and PO(10) in both groups. The results suggest that different changes occur in pulmonary function when the surgery is performed with or without cardiopulmonary bypass. The off-pump patients showed significantly greater improvement than the on-pump group.

Augmentation therapy in emphysema patient with ZZ α-1-antitrypsin deficiency

α-1-antitrypsin deficiency (AATD) (PiZZ) emphysema patient was treated with 60–120 mg/kg body weight of Prolastin® weekly or every second week over 8 years (from 1992 until 2000). The therapy was re-started in summer 2002 and terminated in autumn 2004. Results from lung function tests, liver enzymes and plasma inflammatory markers are presented from years 2002 and 2004, and 7 months after termination of treatment. No changes in lung function tests, liver enzymes or plasma inflammatory markers were observed during a period of study. Blood neutrophils were isolated in October 2004, before and after Prolastin® infusion, and in October 2005. Neutrophils were analyzed for baseline and zymosan-induced interleukine-8 (IL-8) release. In response to zymosan neutrophils isolated after Prolastin® infusion released significantly lower levels of IL-8 than neutrophils obtained before Prolastin® infusion or after termination of treatment. Thus, blood neutrophils exhibit diminished capacity to release IL-8 after direct use of the augmentation therapy.

Pulmonary and systemic effects of inhaled PACAP38 in healthy male subjects

Pituitary adenylate cyclase activating polypeptide 1-38 (PACAP38) displays biological activities (e.g. bronchodilatory, pulmonary vasodilatory and anti-inflammatory properties) that are relevant in several pulmonary diseases. The aim of this study was to assess the safety and tolerability and the pulmonary and systemic effects of inhaled PACAP38 in humans. Twelve healthy male subjects (mean age 28) were studied in a randomized, double-blind, placebo-controlled dose escalation trial with inhalation of PACAP38 to a cumulative dose of 480 microg. Lung function was measured by body plethysmography. Systemic absorption was evaluated by plasma levels, skin blood flux (estimated by laser Doppler imager fluxmetry) and systemic haemodynamics. Inhalation of PACAP38 did not cause relevant adverse reactions or an increase of PACAP38 plasma levels. No statistically significant changes in lung function tests and no systemic effects (blood pressure, pulse rate or skin blood flux) occurred. Inhaled PACAP38 was well tolerated without systemic side-effects in healthy male subjects.

Airway inflammation: exhaled NO measurement in clinical practice

<h3>Key points</h3> Measurement of FeNO has been approved for clinical use to monitor anti-inflammatory treatment in asthma. Increases in FeNO are suggestive of eosinophilic airway inflammation and are readily reduced by anti-inflammatory treatment. Increases in FeNO predict loss of asthma control before the appearance of symptoms and changes in lung function tests. Evaluation of EBC biomarkers for potential clinical applications are ongoing. <h3>Educational aims</h3> Long term: to improve management of asthma and other chronic inflammatory airway diseases. Short term: to introduce the measurement of exhaled NO; to summarise the main points of current guidelines for exhaled NO measurement; to give information on the usefulness of exhaled NO measurement in asthma management; and to give basic information on exhaled breath condensate. <h3>Summary</h3> Asthma is defined as an inflammatory disorder of the airways. Therefore, it is reasonable to add an “inflammometer” to the available methods of disease monitoring. In this respect, several biomarkers have been tested from different samples, including blood, urine and exhaled breath. Breath tests for the determination of exhaled biomarkers offer great opportunities for disease monitoring, as they are simple, completely non-invasive, can be performed in children and also in severe patients, and can be repeated even at short intervals. This article will focus on the use of exhaled biomarkers to monitor airway inflammation. The central aim is to introduce the measurement of exhaled NO as a prototype for the application of biomarkers in the management of asthma. The field of EBC is also mentioned to give some background information on the sampling of non-volatile biomarkers in exhaled breath.

Healthy worker effect and changes in respiratory symptoms and lung function in hairdressing apprentices

Aims: To compare the prevalence and incidence of respiratory symptoms and lung function values between hairdressing apprentices and office apprentices. Methods: A total of 322 hairdressing apprentices and 277 office...

Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves' disease and their reversibility with carbimazole therapy.

Dyspnoea is a common complaint among patients with thyrotoxicosis. However, its causative mechanisms have not been identified. We assessed the role of thoracic diaphragmatic muscle weakness in dyspnoea among patients with active Graves' disease. Twenty-seven patients (19 female, 8 male) with active Graves' disease were assessed for the clinical severity of dyspnoea, functional (pressure generating capacity) and anatomical aspects (thickness and excursion) of the diaphragm at presentation. The severity of dyspnoea was assessed using a visual analogue scale (VAS) and the 6 min walk test. Lung function tests, diaphragmatic strength (sniff oesophageal pressure, SniffP(oeso)), maximum inspiratory and expiratory pressures, diaphragmatic thickness and movements on real time ultrasonography were evaluated during normal and deep respiration. Twenty of the 27 patients were reassessed after achieving euthyroidism with carbimazole therapy at a mean interval of 5+/-2 months. Reevaluation after carbimazole therapy revealed a significant reduction in dyspnoea on the VAS (59+/-26 to 23+/-13%). Patients covered a similar distance during the 6 min walk before and after euthyroidism. Significant improvement was observed in the vital capacity (2.57+/-0.62 to 2.94+/-0.60 l), forced expiratory volume in the first second (2.21+/-0.49 to 2.45+/-0.47 l), total lung capacity (3.57+/-1.19 to 4.1+/-1.12 l), diaphragmatic movement during deep respiration (5.5+/-1.0 to 6.6+/-1.1 cm) and SniffP(oeso) (68.7+/-23 to 93.1+/-25.2 cmH(2)O). There was no significant change in the distance walked in 6 min, tidal volume, lung diffusion capacity and diaphragmatic thickness. There was no significant correlation between the net change in dyspnoea score and net change in lung function tests, diaphragmatic movement and SniffP(oeso). Significant functional weakness of diaphragm muscle is present in patients with active Graves' disease. This weakness is more marked during a maximal respiratory manoeuvre, indicating a diminished diaphragmatic reserve which could be the cause of dyspnoea observed on exertion among patients with thyrotoxicosis.

Bronchopulmonary dysplasia and very low birthweight: Lung function at 11 years of age

To determine the relationship between lung function at 11 years of age and bronchopulmonary dysplasia (BPD) in very low birthweight (VLBW) children. This study comprised 154 consecutive surviving VLBW children, divided into three groups with respect to their neonatal respiratory morbidity: group I developed BPD; group II required assisted ventilation but did not develop BPD; and group III required no assisted ventilation. Lung function tests were measured on 120/154 (77.9%) children at 11 years of age. The relationship between various lung function variables and neonatal lung disease was analysed by multiple linear regression. Several lung function variables reflecting airflow were significantly diminished in the BPD group (n = 15), and residual volume was significantly higher. Despite poorer lung function overall, few children in the BPD group had lung function abnormalities in the clinically significant range (n = 2[13.3%] with a forced expired volume in 1 $ < 75% predicted; n = 2[13.3%] with a forced vital capacity < 75% predicted; n = 1 [6.7%] with a residual volume/total lung capacity > 35%). There were no significant differences in lung function variables between group II (n = 41) and group III (n = 64). Changes in lung function tests between 8 and 11 years did not very significantly between the three groups. VLBW children with BPD in the newborn period have period have poorer lung function at 11 years of age than other surviving VLBW children without BPD, although few have lung function abnormalities in the clinically significant range.

Changes in lung function and perfusion after irradiation in patients with lung cancer

The changes in lung function were prospectively studied for patients with lung carcinoma who were treated with relatively high doses of irradiation. Their dyspnoea score, lung volume spirometry, diffusion capacity and ipsilateral hemithorax perfusion were measured at presentation, again between 5 and 6 months after irradiation (Group 1, 36 evaluable patients), and once more between 11 and 12 months (Group 2, 16 evaluable patients). There was a worsening of the dyspnoea score from 1 to 2, in a large percentage of patients, but only 6% developed a dyspnoea score of 3. The largest change in lung function tests was a decrease in the diffusion capacity (DLCO) to 14% at 6 months and 12% at 12 months (statistically significant, P < 0.0001 paired t-test). The forced vital capacity (FVC) and the total lung capacity (TLC) showed a lesser decrease at 6 and 12 months, and the smallest decrease, which was not statistically significant, was in the forced expiratory volume in 1 s (FEV1). There was also a statistically significant decrease in the ipsilateral hemithorax lung perfusion of 16% at 6 months and 20% at 12 months. There was a weak correlation between the decrease in the DLCO and the FEV1 at follow-up. There was no statistically significant correlation between initial perfusion or decreased perfusion and the decrease in lung function. Lung irradiation should be regarded as an ablative form of therapy, analogous to surgery, in patients with a projected survival of 6 months or more. The DLCO is the most sensitive indicator of clinical damage and its pretreatment assessment should be useful in predicting clinical tolerance to irradiation.

Two Methods of Administering Nebulized Salbutamol

Wood, D. O., Chandler, Dianne and Dugdale, A. E. (1978). Aust. Paediatr. J., 14, 150–153. Two methods of administering nebulized salbutamol. A controlled study. A cross‐over study has been designed to test the efficiencies of two methods of delivering a continuous aerosol of salbutamol to children with acute wheezing and respiratory distress. The methods used were the conventional face mask and a wide bore tube which the child held In his mouth. Statistical analysis of the change in lung function tests following the two methods of administration showed no significant differences in effectiveness. A child should be allowed to use either mask or tube for delivery of aerosols or bronchodilators depending on his preference.