Maximum Breathing Capacity Research Articles

A. DANGER OF A NASAL CATHETER USED AS A MEANS OF OXYGENATION POSTOPERATIVELY

On examination. No cyanosis—regular pulse. Heart. Not enlarged clinically. Mitral presystolic murmur and opening snap audible. Lungs. Dry. B.P. 140/80. Haemoglobin (Haldane) 90. Vital capacity 2,120. Maximum breathing capacity. 60 litres/min. X-ray showed some enlargement of left auricle. E.C.G. showed no marked abnormality except for a flat P wave in lead I and notched and somewhat spread QRS complex. Cardiac catheter showed a mean P.A. pressure 38 ratn/Hg. On account of the moderate pulmonary hypertension, operation was decided upon.

The effect of repeated testing on the maximum breathing capacity in normal subjects.

The effect of repeated testing on the maximum breathing capacity in normal subjects.

The Treatment of Pulmonary Emphysema and of Diffuse Pulmonary Fibrosis with Nebulized Bronchodilators and Intermittent Positive Pressure Breathing

Twenty-two patients with chronic pulmonary emphysema were treated for two weeks with oxygen administered by intermittent positive pressure breathing (IPPB) four times daily for 20-minute periods. A bronchodilator was not used. The IPPB treatment without bronchodilators was considered unsatisfactory. Forty-three patients received the combined treatment of isuprel aerosol and oxygen by IPPB at some time during the period they were studied. Twenty patients received the combined treatment without previous regular use of nebulized bronchodilator and 70 per cent reported definite improvement in symptoms, including decreased dyspnea, cough and volume of sputum (when present). Twenty-three patients were treated during an initial period with oxygen and isuprel aerosol without IPPB. Eighteen of these reported symptomatic improvement, an incidence similar to that obtained with the combined bronchodilator and IPPB treatment. The incidence of improvement was similar to that of other reports, in which the combined treatment was used without control studies to determine the separate effects of the features of the combined treatment. Twenty-two of the 23 patients treated with bronchodilators alone then received IPPB in combination with the bronchodilator. Three patients became worse during treatment and two were hospitalized; 15 reported continued improvement. Four of these patients preferred aerosol without IPPB, six preferred the IPPB and bronchodilator combination, feeling that it “opened them up more” and five had no preference. Persistent objective improvement in vital capacity, maximal breathing capacity, nitrogen washout index or arterial oxygen saturation was unusual. Only four of the 42 patients, who at some time during the study received the combined treatment, had persistent improvement in vital capacity and maximal breathing capacity. Three of these patients were 25, 30 and 36 years old respectively and the fourth was 60 years of age. Many patients who had previously used aerosol bronchodilators were found to be using them inefficiently. When they were instructed in the correct use of a nebulizer and when they followed a systematic program similar to that used with IPPB in combination with aerosol bronchodilators, the incidence of symptomatic improvement was similar to that of patients using the combined treatment during short-term treatment. The lack of persistent change in the results obtained by various tests for pulmonary function suggests that none of these therapeutic methods alter the basic pulmonary lesion. The occasional improvement in arterial oxygen saturation, the decrease in cough and volume of sputum and the improved sense of well being suggest an improvement in the bronchial hygiene brought about by the use of aerosol bronchodilators. The only inherent feature of IPPB that we have observed is the assurance of a relatively large tidal volume during aerosol therapy. In alert, ambulatory patients a satisfactory tidal volume can be maintained without mechanical assistance. Five patients with pulmonary fibrosis of uncertain etiology, but with minimal evidence of bronchospasm or other obstructive features, did not improve with use of the combined treatment. Further controlled studies are needed to demonstrate (1) the relative therapeutic effects of long-term bronchodilator treatment with and with-out IPPB, and (2) whether or not the intrapulmonary distribution of gases and aerosols with IPPB differs from that of similar breathing patterns achieved solely by the respiratory muscles.

The effect of corticotropin and cortisone on respiratory function in bronchial asthma

The effect of long-term therapy with corticotropin and cortisone on the pulmonary function of eight patients with bronchial asthma has been studied. Four patients showed normal pulmonary function at the end of the study, three were normal with the exception of an elevated residual volume, and one showed no change. In three cases in which the residual volume remained elevated, symptoms of asthma were only incompletely relieved. It was found that there was a rapid improvement in the vital capacity, maximum breathing capacity, and index of intrapulmonary mixing with treatment but the residual volume required somewhat longer periods of therapy to return to normal. It is believed that the changes in pulmonary function found in bronchial asthma are due to hyperinflation of the lungs occasioned by the bronchospasm cncountered in this disease and that, with treatment sufficient to completely remove the bronchospasm, these changes are reversible.

A method of measuring maximum breathing capacities in individual lungs by bronchospirometry

A brief review has been made of methods of assessing ventilatory function with special application to the tuberculous patient, who presents the particular problem of varying types and extent of disease in both lungs and for whom surgical treatment may be necessary on one or both sides. Often it is desirable to assess each lung separately, and various dynamic methods of measuring ventilation are surveyed. Kennedy's introduction of the Estimated Flow Rate at 40 breaths per minute (E.F.R. 40 ) is accepted as being a good practicable method to apply to the tuberculous patient. This paper outlines the application of the method to broncho-spirometry, whereby ratios of function as between individual lungs are obtained. It is emphasized that the ratios so obtained must be applied to flow rates obtained by orthodox spirometry before a true estimate of the flow rate from each lung can be obtained. The method is rapid, adding only five minutes to the period of intubation normally needed for other bronchospirometric measures. It is important that these dynamic measurements of ventilatory power should not replace, but should supplement the other well-tried methods of assessing respiratory capacity.

The progress of pulmonary deficiency in emphysema

Summary Some clinical and physiological features of emphysema have been reviewed in sixty-seven patients and compared with the severity of dyspnœa. It has been shown that dyspnœa is often an early symptom and bronchospasm a late symptom of this disease. All lung function tests showed increasing disorder, but Residual and Functional Residual Volumes showed early changes, whereas Vital Capacity and Maximum Breathing Capacity showed later but more consistent changes. The possible pathological basis of disordered function has been discussed.

Analysis of the respiratory response to carbon dioxide inhalation in varying clinical states of hypercapnia, anoxia, and acid-base derangement.

Individuals with cor pulmonale secondary to chronic pulmonary emphysema tend to have pulmonary ventilation which is less than normal both at rest and during exercise, despite the presence of factors ordinarily making for increased ventilation such as anoxemia and acidosis (1), and despite the fact that these ventilatory levels may be appreciably less than the observed maximum breathing capacity. Moreover, the ventilatory response to increased CO2 in the inspired air may be less than normal in certain patients with pulmonary emphysema (2-5). These observations

VITAL CAPACITY, MAXIMUM BREATHING CAPACITY, AND MAXIMUM BREATHING RATE OF JAPANESE CHILDREN AND ADOLESCENTS

The development of vital capacity, maximum breathing capacity, and maximum breathing rate were studied in Japanese children and adolescents. They were males and females, ages 8 to 16, living in an urban area. In all ages examined, the vital capacity and maximum breathing capacity per square meter of body surface were remarkably larger in males than in females. The maximum breathing rate was similar in both sexes until the age of 10. After that period, however, it increased rapidly within a couple of years in boys, whereas it remained or even decreased in girls. The results were compared to those reported in the United States.

Maximum breathing capacity and vital capacity determined by means of the Krogh spirometer.

Maximum breathing capacity and vital capacity determined by means of the Krogh spirometer.

Function tests in pulmonary surgery

In the preoperative evaluation of pulmonary function the results of clinical investigations are decisive for the question of operability and for the choice of intervention. Great importance is attached to the anamnesis. All available roentgenograms must be carefully studied, the anatomic extent of the disease noted and diaphragmatic and costal mobility assessed. Inspection of the bronchial tree is also important. In some cases bronchography is advisable. A simple and practical test of pulmonary function is registration of the maximal breathing capacity. In more doubtful cases spirometry with determination of the residual capacity is advised. For estimation of the individual pulmonary function, which is of great practical importance when planning surgery, bronchospirometry is the most valuable aid and may be used on very wide indications. There are few contraindications to its use and in the great majority of patients it is easily performed. When bronchospirometry is not possible or is contraindicated, heart catheterization with occlusion of the pulmonary artery may be carried out. This applies chiefly to patients in whom tests of total function and bronchospirometric findings leave doubt of operability. Heart catheterization, with or without occlusion of the pulmonary artery, and possibly during exercise, may also be contemplated when greatly impaired total function or clinical evidence of cardiac disease indicate pulmonary hypertension. Severe hypertension carries an unfavorable prognosis. Blood gas analysis of samples taken at rest and during exercise, and also with the pulmonary artery occluded, may provide valuable complementary information in patients with severe pulmonary emphysema or other changes which impair the gaseous exchange in the lungs. In the immediate postoperative period continuous study of the blood gases is extremely important for the early detection of CO 2 retention. Postoperative studies of pulmonary function are useful particularly for estimating working capacity or disability for such purposes as insurance. By appraisal of the respiratory efficiency some time after the operation valuable knowledge may be gained of the effects of various surgical procedures on respiratory function.

Prediction of maximum breathing capacity from timed vital capacity

Summary 1. The 2-second T.V.C. and the M.B.C. have been measured in 623 male and female subjects aged 8–70 years, of whom 318 showed no evidence of cardiac or respiratory disease and 305 suffered from various disorders of these systems. 2. Equations have been calculated and graphs have been drawn to show the relationship between the M.B.C. and the 2-second T.V.C. 3. It is concluded that a useful prediction of the actual M.B.C. (as distinct from the predicted normal M.B.C.) can be obtained from the 2-second V.C.

Normal standards for lung volumes, intrapulmonary gas-mixing, and maximum breathing capacity.

Subunits of the voltage-gated potassium channel Kv1.1 containing mutations responsible for episodic ataxia (EA), a human inherited neurological disease, were expressed in <i>Xenopus</i> oocytes. Five EA subunits formed functional homomeric channels with lower current amplitudes and altered gating properties compared with wild type. Two EA mutations located in the first cytoplasmic loop, R239S and F249I, yielded minimal or no detectable current, and Western blot analysis showed reduced protein levels. Coinjection of equal amounts of EA and wild-type mRNAs, mimicking the heterozygous condition, resulted in current amplitudes and gating properties that were intermediate between wild-type and EA homomeric channels, suggesting that heteromeric channels are formed with a mixed stoichiometry of EA and wild-type subunits. To examine the relative contribution of EA subunits in forming heteromeric EA and wild-type channels, each EA subunit was made insensitive to TEA, TEA-tagged, and coexpressed with wild-type subunits. TEA-tagged R239S and F249I induced the smallest shift in TEA sensitivity compared with homomeric wild-type channels, whereas the other TEA-tagged EA subunits yielded TEA sensitivities similar to coexpression of wild-type and TEA-tagged wild-type subunits. Taken together, these results show that the different mutations in Kv1.1 affect channel function and indicate that both dominant negative effects and haplotype insufficiency may result in the symptoms of EA.

The relation between the fast vital capacity curves and the maximum breathing capacity.

<b>1. Please consider the following:</b> A 45-year-old man needs treatment for an inflammatory neurological condition refractory to steroids. Treatment options include: intravenous immunoglobulin (IVIg) methotrexate azathioprine cyclosporine cyclophosphamide Which of the above drugs would you most wish to avoid, or only administer with extreme caution, if he also had: interstitial lung disease gout IgA deficiency renal failure haemorrhagic cystitis <b>2. Please study Fig. 1 (reproduced with kind permission from Dr P. Bain):</b> This patient is most likely to have which of the following type of tremor: Dystonic tremor of right arm? Dystonic tremor of left arm? Holmes tremor? Cerebellar tremor? <b>3. Please read the following passage.</b> A 46-year-old hairdresser was referred to the psychiatric service because she believed she was a witch. She had been sacked from her job six months previously because of her increasingly erratic

Effects of inhalation of CO2, muscular exercise and epinephrine on maximal breathing capacity.

ARTICLESEffects of Inhalation of CO2, Muscular Exercise and Epinephrine on Maximal Breathing CapacityBenjamin M. Lewis, and James W. MortonBenjamin M. Lewis, and James W. MortonPublished Online:01 Nov 1954https://doi.org/10.1152/jappl.1954.7.3.309MoreSectionsPDF (790 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInEmailWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation More from this issue > Volume 7Issue 3November 1954Pages 309-312 https://doi.org/10.1152/jappl.1954.7.3.309PubMed13211515History Published online 1 November 1954 Published in print 1 November 1954 Metrics

Bronchodilator Activity of Three New Drugs in Patients with Pulmonary Emphysema

Many therapeutic agents have been employed effectively for the relief of bronchospasm. Preparations in current clinical use have been shown to be more efficacious than older ones, but no single agent has proved entirely satisfactory. Therefore, the present study was undertaken in order to evaluate the bronchodilator properties of three new drugs. As will be demonstrated, extensive preliminary observations showed that only one of these appeared to offer definite indications of therapeutic value. The bronchodilator activityof this drug was then studied in greater detail. PART I. Method Seventeen male patients of average age 59, with intrinsic asthma or hypertrophic emphysema with clinical evidence of associated bronchospasm were studied. Ventilometric measurements of vital capacity, maximum breathing capacity, volume of deep respiration, and breathing reserve were made with the Collins ventilometer. Although a number of additional tests were employed in this and other studies, these four appeared, in the experience of this laboratory, to provide a simple but reliable clinical measure of lung function. Observations on each subject were made on each of four separate days. The drugs studied, and their dosages, were as follows: 1) Paveril phosphateR** a papaverine analogue - 50 mg. 2) Antrenylzt anticholinergic - 1.0 mg. 3) Drug 1313,tt adrenergic - 10 mg. Amlnophylline, 0.5 Gm., was separately administered as a basis for comparison.

N-allylnormorphine (nalline) action on narcotized and non-narcotized subjects

1. 1. Nalline has been found to be a safe and reliable specific antidote for narcotic-induced respiratory depression. 2. 2. The action of nalline upon opiate-induced circulatory depression is more gradual but just as marked. 3. 3. Nalline did not appear to be effective against barbiturate intoxication. 4. 4. In non-narcotized individuals nalline produced a slightly diminished respiratory rate, minute ventilation and maximal breathing capacity. A sedative effect was experienced by all subjects. 5. 5. We found 5 to 10 mg. of intravenous nalline effective as the initial dose. However, in order to maintain the stimulating effect a slow intravenous drip of an additional 5 to 10 mg. in 5 per cent glucose in water is advisable. 6. 6. The dramatic effect of nalline in opiate intoxication indicates that it should be available for emergency use in all emergency wards, operating rooms and in the bag of the practicing physician.

Pulmonary function measurements

1. 1. An accurate evaluation of the degree of pulmonary function impairment may be made from the following physiologic tests: (1) ventilation measurements from spirogram tracings (total vital capacity, three-second vital capacity, maximal breathing capacity and the shape of the exhalation curve following a deep breath); (2) the degree of bronchospasm present; (3) the residual volume and alveolar nitrogen percentage after seven minutes of oxygen breathing; (4) the arterial blood-oxygen saturation at rest and immediately after step-up exercise; (5) the oxygen uptake during step-up exercise; (6) the percentage of oxygen extracted from the inspired air breathed; and (7) the character and duration of dyspnea after step-up exercise. 2. 2. A numerical ventilation factor derived from the three-second vital capacity (a timed measurement), the maximal breathing capacity and the residual percentage of total lung volume, the three most important aspects related to breathing resistance and pulmonary ventilation, has been found to be a useful measurement in pulmonary function evaluation. 3. 3. The great importance of comparing resting and exercise measurements in pulmonary function studies, and especially arterial blood-oxygen saturation, is stressed. 4. 4. Intermittent positive pressure breathing has been found a helpful treatment procedure for oxygen administration in hypercapnia and for giving some relief from the dyspnea of chronic pulmonary insufficiency. The more effective treatment of the bronchospasm, the improved bronchial drainage and the deep-breathing exercise constitute the more important aspects in decreasing breathing resistance and, in turn, the dyspnea.

Vital capacity, maximum breathing capacity and maximum breathing rate in healthy male adults.

The vital cabacity and the maximum breathing capacity have been studied in 1, 169 healthy individuals of different ages from 20 to 80 years in connection with an interest in the air velocity index.The results show that the values of vital capacity, maximum breathing capacity and maximum breathing rate per square meter of body surface are, to some extent, decreased in accordance with the advent of age, although the maximum breathing rate appears most suitable to evaluate a failure in the ventilatory function associated with emphysema or silicosis.

SPIROMETRIC ANALYSIS OF LUNG FUNCTION FOLLOWING PULMONARY RESECTION IN CHILDHOOD

A group of 40 individuals who underwent pulmonary resection in childhood were studied by means of spirometric tracings. The time interval between operation and testing varied from 3 months to 19 years. The ages at operation ranged from 3 years to 15 years. No significant disturbance of resting ventilation, oxygen consumption or average tidal air was found. Reduction in vital capacity corresponded to the extent of resection performed and was more marked in those instances in which bilateral resection was necessary. It was noted that reduction in vital capacity was more evident in the inspiratory phase in all instances except those suspected of having continuing pulmonary disease. In these individuals the reduction in vital capacity was more marked in the expiratory reserve phase. Maximum voluntary ventilatory capacity reduction was likewise compared to extent of surgical resection and showed a correlation similar to that of vital capacity. Evidences of pulmonary emphysema were more apparent in those cases whose maximum breathing capacity was markedly reduced. In all but one instance breathing reserve figures were within the normal range. Although children tolerate pulmonary surgery extremely well, the age at operation is not the significant factor in the degree of resultant pulmonary function. The important factors are those of extent of pulmonary resection and consequent pulmonary emphysema.

The Use of Pulmonary Function Tests for Disability Appraisal: Including Evaluation Standards in Chronic Pulmonary Disease

An accurate evaluation of the degree of pulmonary function impairment can be made from the following physiological tests: (1) Ventilation measurements from spirogram tracings (total vital capacity, three second vital capacity, maximal breathing capacity and the shape of the exhalation curve following a deep breath), (2) the degree of bronchospasm present, (3) the residual volume and alveolar nitrogen per cent after seven minutes oxygen breathing, (4) the arterial blood oxygen saturation at rest and immediately after step-up exercise, (5) the oxygen uptake during step-up exercise and (6) the character and duration of dyspnea after step-up exercise. A numerical ventilation factor has been derived from the three second vital capacity (a timed measurement), the maximal breathing capacity and the residual per cent of total lung volume. In about 75 per cent of the group of 500 coal miners studied the ventilation factor was correct in predicting the degree of pulmonary function impairment as compared to an evaluation based on comprehensive studies including arterial blood and respiratory gas analysis. Improved techniques and apparatus for measuring maximal breathing capacity and residual air volumes by the oxygen open circuit method are presented. The step-up exercise test is quite satisfactory for obtaining the exercise measurements in pulmonary function evaluation, equal to or superior to the treadmill. Vital capacity as a volume measurement should not be used as a single test of lung function in chronic pulmonary disease, as it can be misleading and responsible for false interpretations. Evaluation standards for the normal and four grades of pulmonary function impairment are given for the physiological tests which appear to be most useful in pulmonary function appraisal.