Significant Decrease In Pulmonary Function Research Articles

Exhaled Nitric Oxide and Pulmonary Oxygen Toxicity Susceptibility.

Individual susceptibility to pulmonary oxygen toxicity (PO2tox) is highly variable and currently lacks a reliable biomarker for predicting pulmonary hyperoxic stress. As nitric oxide (NO) is involved in many respiratory system processes and functions, we aimed to determine if expired nitric oxide (FENO) levels can provide an indication of PO2tox susceptibility in humans. Eight U.S. Navy-trained divers volunteered as subjects. The hyperoxic exposures consisted of six- and eight-hour hyperbaric chamber dives conducted on consecutive days in which subjects breathed 100% oxygen at 202.65 kPa. Subjects' individual variability in pulmonary function and FENO was measured twice daily over five days and compared with their post-dive values to assess susceptibility to PO2tox. Only subjects who showed no decrements in pulmonary function following the six-hour exposure conducted the eight-hour dive. FENO decreased by 55% immediately following the six-hour oxygen exposure (n = 8, p < 0.0001) and by 63% following the eight-hour exposure (n = 4, p < 0.0001). Four subjects showed significant decreases in pulmonary function immediately following the six-hour exposure. These subjects had the lowest baseline FENO, had the lowest post-dive FENO, and had clinical symptoms of PO2tox. Individuals with low FENO were the first to develop PO2tox symptoms and deficits in pulmonary function from the hyperoxic exposures. These data suggest that endogenous levels of NO in the lungs may protect against the development of PO2tox.

Minimally Invasive Diaphragm Plication for Acquired Unilateral Diaphragm Paralysis: A Systematic Review.

Objective: Diaphragm paralysis is a relatively uncommon entity that can be both congenital and acquired in nature. While commonly asymptomatic, it can also cause a significant decrease in pulmonary function and reserve, particularly in patients with underlying pulmonary diseases. Our aim was to summarize the current literature regarding the minimally invasive techniques used in the surgical correction of acquired diaphragm paralysis via traditional and robotic minimally invasive approaches. Methods: We conducted a systematic review of available literature using the Cochrane methodology and reported findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results: A total of 6,561 citations were identified through initial database and reference searches, of which 90 articles met the inclusion criteria for review. After further assessment, 33 appropriate full-text studies were selected for the review. Of the selected publications, the majority represented case reports and single-center retrospective studies with level of evidence 4. Only 1 level 2b study (individual cohort study) was identified, comparing minimally invasive and open approaches. Conclusions: Each of the minimally invasive approaches has its unique benefits and disadvantages, which are summarized and delineated in this article. Ultimately, no preferred method of diaphragm plication for diaphragm paralysis can be recommended at this time based on clinical data. The choice of procedure and surgical approach continues to be selected based on the surgeon's experience and preference.

Chest deformity as a cause of tracheobronchial compression. A pediatric case

the vertebral bodies, causing respiratory symptoms and altered pulmonary function. Straight back syndrome is a decreased in the anteroposterior diameter of the thorax. We present a 13-year-old patient with idiopathic scoliosis who Deformidad toracica como causa de compresion traqueobronquial. A proposito de un caso clinico pediatrico Chest deformity as a cause of tracheobronchial compression. A pediatric case developed progressive dyspnea, inspiratory stridor and a significant decrease in pulmonary function, because of extrinsic compression of the right main bronchus and the middle third of trachea by the thoracic vertebral bodies. She had also a decreased anteroposterior diameter of the thorax, being a determining factor in the appearance of symptoms. Surgery was performed by thoracic vertebra fixation T3 to T11, with subsequent clinical and functional respiratory improvement. Scoliosis associated with altered pulmonary function and stridor should make us suspect the existence of airway compression, especially in patients with reduction of the anteroposterior diameter of the thorax.

Changes in pulmonary function after definitive radiotherapy for NSCLC

IntroductionThe objective of this study was to identify factors associated with early and long-term pulmonary function (PF) changes after definitive radiotherapy for NSCLC patients. PF was measured by spirometry i.e. forced expiratory volume in 1s (FEV1), and forced vital capacity (FVC). MaterialsEarly (within the first year) PF change was analyzed in 211 patients with 986 pairs of PF-tests (PFTs). Long-term PF change was analyzed relative to the PF at 12months after radiotherapy in 106 patients (1286 PFTs). To investigate the impact of patient and treatment related factors on PF, they were tested as covariates in multivariable analysis. ResultsEarly PF change was quantified at six months after the start of radiotherapy. Smoking status and increasing V60 was associated with a significant decrease in PF, whereas smoking was protective. In addition, neoadjuvant chemotherapy had a negative impact on FVC. Long-term FEV1 and FVC were analyzed using linear regression. Treatment year and V60 had a significant impact on loss of FEV1. V60 had a significant impact on FVC changes. ConclusionIn this study, early PF change reached a plateau at 6months after the start of radiotherapy for NSCLC. Large volume of lung receiving high dose was associated with long-term FEV1 change.

Systemic corticosteroids in acute exacerbation of chronic obstructive pulmonary disease

Abstract Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) lead to a significant decrease in pulmonary function and quality of life and an increase in mortality. However, systemic use of corticosteroids is able to improve the conditions of patients in AECOPD. By a short review of several clinical trials, we suggest that 40 mg prednisone per day for 5 days should be recommended for the treatment of AECOPD with a preference for oral prednisolone.

Airway responses and inflammation in subjects with asthma after four days of repeated high-single-dose allergen challenge.

BackgroundBoth standard and low-dose allergen provocations are an established tool in asthma research to improve our understanding of the pathophysiological mechanism of allergic asthma. However, clinical symptoms are less likely to be induced. Therefore, we designed a protocol for repetitive high-dose bronchial allergen challenges to generate clinical symptoms and airway inflammation.MethodsA total of 27 patients aged 18 to 40 years with positive skin-prick tests and mild asthma underwent repetitive high-dose allergen challenges with household dust mites for four consecutive days. Pulmonary function and exhaled NO were measured at every visit. Induced sputum was analysed before and after the allergen challenges for cell counts, ECP, IL-5, INF-γ, IL-8, and the transcription factor Foxp3.ResultsWe found a significant decrease in pulmonary function, an increased use of salbutamol and the development of a late asthmatic response and bronchial hyperresponsiveness, as well as a significant induction of eNO, eosinophils, and Th-2 cytokines. Repeated provocation was feasible in the majority of patients. Two subjects had severe adverse events requiring prednisolone to cope with nocturnal asthma symptoms.ConclusionsRepeated high-dose bronchial allergen challenges resulted in severe asthma symptoms and marked Th-2-mediated allergic airway inflammation. The high-dose challenge model is suitable only in an attenuated form in diseased volunteers for proof-of-concept studies and in clinical settings to reduce the risk of severe asthma exacerbations.Trial registrationClinicalTrials.govNCT00677209

Longitudinal evaluation the pulmonary function of the pre and postoperative periods in the coronary artery bypass graft surgery of patients treated with a physiotherapy protocol

BackgroundThe treatment of coronary artery disease (CAD) seeks to reduce or prevent its complications and decrease morbidity and mortality. For certain subgroups of patients, coronary artery bypass graft surgery (CABG) may accomplish these goals. The objective of this study was to assess the pulmonary function in the CABG postoperative period of patients treated with a physiotherapy protocol.MethodsForty-two volunteers with an average age of 63 ± 2 years were included and separated into three groups: healthy volunteers (n = 09), patients with CAD (n = 9) and patients who underwent CABG (n = 20). Patients from the CABG group received preoperative and postoperative evaluations on days 3, 6, 15 and 30. Patients from the CAD group had evaluations on days 1 and 30 of the study, and the healthy volunteers were evaluated on day 1. Pulmonary function was evaluated by measuring forced vital capacity (FVC), maximum expiratory pressure (MEP) and Maximum inspiratory pressure (MIP).ResultsAfter CABG, there was a significant decrease in pulmonary function (p < 0.05), which was the worst on postoperative day 3 and returned to the preoperative baseline on postoperative day 30.ConclusionPulmonary function decreased after CABG. Pulmonary function was the worst on postoperative day 3 and began to improve on postoperative day 15. Pulmonary function returned to the preoperative baseline on postoperative day 30.

An interaction between filaggrin mutations and early food sensitization improves the prediction of childhood asthma

Asthma prediction in early infancy is essential for the development of new preventive strategies. Loss-of-function mutations in the filaggrin gene (FLG) were identified as risk factors for eczema and associated asthma. We evaluated the utility of the FLG mutations for the prediction of asthma. Eight hundred seventy-one individuals of the prospective German Multicenter Allergy Study cohort were genotyped for 3 FLG mutations. Information on asthma, eczema, and food sensitization was available from birth to 13 years of age. Pulmonary function was measured from 7 to 13 years of age. The predictive value of the FLG mutations and of atopic phenotypes in infancy was assessed for asthma. In infants with eczema and sensitization to food allergens, the FLG mutations predicted childhood asthma with a positive predictive value of 100% (95% CI, 65.5% to 100%). This subgroup was characterized by a significant decrease in pulmonary function until puberty and represented 8.1% of all asthmatic children and 19.1% of patients with asthma after infantile eczema. We found a strong synergistic interaction between the FLG-null alleles and early food sensitization in the disease transition from eczema to asthma (relative excess risk due to interaction, 2.64; 95% CI, 1.70-3.98; P = .00040). FLG mutations and food sensitization represent 2 distinct mechanisms interacting in the pathogenesis of asthma. In infants with eczema and food sensitization, genotyping of the FLG mutations allows the prediction of asthma before the onset of symptoms. Our findings might facilitate the development of early subgroup-specific interventions to prevent the progression from eczema to asthma.

ROLE OF MELATONIN AGAINST LUNG INFLAMMATION AGGRAVATED BY SLEEP DEPRIVATION

PURPOSE: Sleep loss is associated with a small but significant decrease in pulmonary function in patients with COPD. In the patients with pulmonary diseases, sleep deprivation aggravates lung inflammation and vice versa. Recent researches have shown the relationship between sleep deprivation and inflammation. However, the underlying mechanisms of that phenomenon remain unclear. In the present study, we designed to investigate whether melatonin protects acute lung inflammation with sleep deprivation.

Carbon in Airway Macrophages and Lung Function in Children

Kulkarni N, Pierse N, Rushton L, Grigg J. N Engl J Med. 2006;355:21–30 PURPOSE OF THE STUDY. To define the extent of pulmonary-function abnormalities that may be attributed to exposures to particulate matter with a median aerodynamic diameter of &amp;lt;10 μm (PM10) as a result of fossil fuel combustion. STUDY POPULATION. The study included 114 children (aged 8 to 15 years) without any chronic respiratory condition who were living in the same residence for 1 year. All children had a forced expiratory volume in 1 second (FEV1) of &amp;gt;80% predicted. METHODS. Pulmonary-function testing and induced sputum were obtained on the same day. PM10 values from all sources were collected for 1 year. The results were controlled for passive tobacco-smoke exposure. RESULTS. A total of 62 (56%) of the 114 subjects were able to produce sputum. An increase of 1 μg/m3 in PM10 was associated with an increase of 0.10 μm2 in the carbon content of airway macrophages. Each 1.0 μm2 increase in carbon content was associated with a significant decrease in pulmonary function (decrease of 17% in FEV1, 12.9% in forced vital capacity, and 34.7% in forced expiratory flow, midexpiratory phase). CONCLUSIONS. A significant reduction in pulmonary function resulted from increased exposure to products of fossil fuel combustion. REVIEWER COMMENTS. The reduction in pulmonary function in this cohort of children who did not have current lower airway symptoms is in the same order of magnitude as patients with moderate persistent asthma, which underscores the need for less toxic energy sources.

Urine leukotriene E 4 levels are associated with decreased pulmonary function in children with persistent airway obstruction

Use of leukotriene receptor antagonists improves disease control in children and adults with asthma. However, the relationship between cysteinyl leukotriene levels and indices of daily asthma control has not been studied directly. We sought to assess the relationship between daily variability in urinary leukotriene E(4) (LTE(4)) levels and daily lung function in children primarily taking inhaled corticosteroids (ICSs) and long-acting beta-agonists (LABAs). Fifty children primarily with moderate-to-severe asthma were followed with measurements of urinary LTE(4), monitoring of FEV(1), and albuterol use. Increasing urinary LTE(4) levels were associated with significant (P = .006) decreases in percent predicted FEV(1) (ppFEV(1)) averaging 4.7% per interquartile range increase in LTE(4) and accompanied by increased albuterol use (P = .03). Children with lower FEV(1)/forced vital capacity ratios demonstrated larger LTE(4)-related FEV(1) decreases (6.4%) compared to those with higher ratios (4.2%, P = .009). This association was blunted in children taking montelukast (1.4% ppFEV(1) decrease) compared with that in children not taking this medication (5.4% ppFEV(1) decrease, P = .05). Children with lower lung function ratios demonstrated greater blunting of the LTE(4) effect with montelukast (0.9% ppFEV(1) decrease) compared to those with higher ratios (3.6% ppFEV(1), P = .0002). Daily variability in LTE(4) levels is associated with clinically significant decreases in pulmonary function. In children who demonstrate a response associated with an increase in urinary LTE(4) levels, leukotriene receptor antagonists protect against daily FEV(1) decreases. This protection might be greatest in those with persistent airway obstruction despite use of ICS and LABA therapy. Therapies designed to block cysteinyl leukotriene production or function might benefit children receiving ICS and LABA therapy who continue to experience persistent disease.

Oxygen Radicals in Inflammation and Allergy Related to Viral Infections

Oxygen radicals including superoxide anion (O(2)(-)) and nitric oxide (NO) are involved in a variety of inflammatory diseases induced by viral infection. In this review, we focus on the role of oxygen radicals in allergic inflammation such as bronchial asthma induced by viral infection--specifically, with respiratory syncytial virus (RSV). This infection in early childhood is a risk factor for development of wheezing, significant decreases in pulmonary function, and increases in airway reactivity. RSV infection also exacerbates recurrent wheezing attacks in patients with established asthma. Recently, we have demonstrated that RSV enhanced superoxide production by human eosinophils stimulated with a lipid mediator such as platelet-activating factor. This response depends on a beta2 integrin, alphaMbeta2, which is critical for eosinophil effector functions. Our results suggest that eosinophils and their products promote RSV-induced airway inflammation in asthma. Close delineation of the mechanism by which RSV enhances eosinophilic inflammation in asthma should yield clues to more effective therapy.

Pulmonary function changes after radiotherapy in non–small-cell lung cancer patients with long-term disease-free survival

To evaluate the changes in pulmonary function after high-dose radiotherapy (RT) for non-small-cell lung cancer in patients with a long-term disease-free survival. Pulmonary function was measured in 34 patients with inoperable non-small-cell lung cancer before RT and at 3 and 18 months of follow-up. Thirteen of these patients had a pulmonary function test (PFT) 36 months after RT. The pulmonary function parameters (forced expiratory volume in 1 s [FEV(1)], diffusion capacity [T(lcoc)], forced vital capacity, and alveolar volume) were expressed as a percentage of normal values. Changes were expressed as relative to the pre-RT value. We evaluated the impact of chronic obstructive pulmonary disease, radiation pneumonitis, mean lung dose, and PFT results before RT on the changes in pulmonary function. At 3, 18, and 36 months, a significant decrease was observed for the T(lcoc) (9.5%, 14.6%, and 22.0%, respectively) and the alveolar volume (5.8%, 6.6%, and 15.8%, respectively). The decrease in FEV(1) was significant at 18 and 36 months (8.8% and 13.4%, respectively). No recovery of any of the parameters was observed. Chronic obstructive pulmonary disease was an important risk factor for larger PFT decreases. FEV(1) and T(lcoc) decreases were dependent on the mean lung dose. A significant decrease in pulmonary function was observed 3 months after RT. No recovery in pulmonary function was seen at 18 and 36 months after RT. The decrease in pulmonary function was dependent on the mean lung dose, and patients with chronic obstructive pulmonary disease had larger reductions in the PFTs.

Passive cigarette smoke exposure acutely decreases pulmonary function in normal, nonasthmatic controls

Rationale Relatively little is known about the short-term pulmonary effect of passive cigarette smoke exposure in the normal, nonasthmatic individual. Methods Ten healthy subjects went to naturally smoky environments (bars, nightclubs, or restaurants) and serially recorded pulmonary and nonpulmonary symptoms (Sxs), performed pulmonary function tests, and recorded carbon monoxide (CO) levels every 30 minutes for up to 3 hrs. Results Subjects had no Sxs upon entering the smoky environment. After 60 minutes of smoke exposure, subjects developed substantial nonpulmonary Sxs (eyes, nose and throat), but complained of virtually no pulmonary Sxs (wheezing, chest tightness, coughing, shortness of breath). Despite the paucity of pulmonary Sxs, the forced expiratory volume in 1 second (FEV1) dropped 14.7% from baseline after 60 mins, and decreased further to 20.4% below baseline after 2 hrs. The CO level rose steadily from unmeasureable levels at the beginning of exposure to a peak level of 20 parts per million at the end of the smoke exposure. There was a strong linear correlation between increasing CO levels and decreasing FEV1 values (r=0.9159; p<0.0001). Conclusions Short-term passive exposure to cigarette smoke produces significant decreases in pulmonary function in normal, nonasthmatic subjects, despite the relative absence of pulmonary Sxs. In these subjects, these nonpulmonary Sxs appear to be better markers of decreasing pulmonary function than traditional pulmonary Sxs. Finally, increasing levels of CO in the smoky environment are strongly associated with decreasing pulmonary function, suggesting that this component of cigarette smoke may play a role in the pathogenesis of cigarette smoke-induced asthma.

Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function.

Thirty unpremedicated ASA physical status 1-3 patients aged between 18 and 69 years, scheduled for upper limb surgery, received a conventional supraclavicular brachial plexus block using a nerve stimulator and bupivacaine 0.375% 0.5 ml.kg-1. Spirometric measurements of pulmonary function and ultrasonographic assessments of diaphragmatic function were made before the block and at 10-min intervals after injection until full motor block of the brachial plexus had developed. Complete paralysis of the ipsilateral hemidiaphragm occurred in 50% of patients. Seventeen per cent of patients had reduced diaphragmatic movement and the rest (33%) had no change in diaphragmatic movement. Those with complete paralysis all showed significant decreases in pulmonary function, whereas those with reduced or normal movement had minimal change. All patients remained asymptomatic throughout, with normal oxygen saturation on room air.

Laparotomy potentiates cytokine release and impairs pulmonary function after hemorrhage and resuscitation in mice.

The two-hit theory has emerged as a mechanism to explain the development of organ failure after traumatic injury. We evaluated the effects of exploratory laparotomy (EL) as a second hit on mice after hemorrhage and resuscitation (H/R). Our hypothesis was that mice exposed to prior H/R would demonstrate more evidence of acute lung injury (ALI), as well as an augmented cytokine response, than mice exposed to H/R or EL alone. Three groups of mice were examined. Mice undergoing H/R alone were labeled as the H/R group. Mice undergoing sham H/R (cannulation but no hemorrhage), followed 5 days later by EL, were labeled as the EL group; and mice undergoing H/R, followed 5 days later by an EL, were labeled as the H/R + EL, or two-hit, group. Respiratory function was determined by using whole-body plethysmography and lung gas diffusion. Serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were assayed at 1 and 4 hours after the injury stimuli. Evaluation of the change in pulmonary function after 24 hours demonstrated that EL alone induces a significant decrease in pulmonary function, whereas two-hit mice did not exhibit a potentiated response. Alveolar function was significantly degraded in the EL group compared with all other groups (p < 0.0001). TNF-alpha did not change after any injury at any time. However, evaluation of IL-6 levels demonstrated a substantial increase after H/R, EL, and H/R + EL compared with baseline and at 1 hour. Comparison of the three groups at 4 hours did not demonstrate any differences in serum concentrations of IL-6. Histologic evaluation lungs demonstrated that the most severe lung injury was seen in the EL mice. It would appear that serum TNF-alpha has little impact on the pathogenesis of ALI after EL, whereas serum IL-6 may be more important. Exploratory laparotomy resulted in a significant change in pulmonary function. Contrary to our initial hypothesis, two-hit mice did not demonstrate more evidence of ALI and, in fact, demonstrated less lung injury than EL mice.

Adverse effects of brompheniramine on pulmonary function in a subset of asthmatic children

The role of antihistamines in the therapy of bronchial asthma has remained controversial. Early studies suggested a possible aggravation of symptoms but more recent studies implied their safety. Ten asthmatic children who reported a feeling of chest tightness and subsequent wheezing after taking a preparation containing brompheniramine maleate were studied in addition to 10 control asthmatic children who reported no such adverse effect. All children were only intermittently symptomatic and did not require constant bronchodilator therapy. They were well at the time of the study. Challenges were performed with the antihistamine alone (4 mg of brompheniramine maleate), a decongestant-antihistamine combination (4 mg of brompheniramine maleate, 5 mg of phenylephrine HCl, 5 mg of phenylpropanolamine HCl), and a placebo. Results indicated a statistically significant decrease in pulmonary function in the study children when challenged with the antihistamine and decongestant-antihistamine preparation but not when challenged with the placebo. The 10 control asthmatic children did not exhibit this phenomenon and premedication with theophylline prevented the decrease in pulmonary function in the study group. Therefore a subset of asthmatic children does appear to exist in whom the use of an antihistamine may be harmful.

Evaluation of bronchospasm during excretory urography.

Mean pulmonary function was significantly decreased in 57 patients during excretory urography. Patients with a history of allergy had significantly greater mean decreases in flow rates than those without. Twelve did not have significant decreases in pulmonary function after needle puncture and intravenous injection of 5% dextrose in water. Eight healthy subjects did not have significant mean decreases after intravenous injection of 5% saline. Most patients undergoing excretory urography have bronchospasm that is greater in magnitude in those with a history of allergy.

Effects of ozone on pulmonary function in normal subjects. An environmental-chamber study.

Twenty healthy adults, 10 smokers and 10 nonsmokers, were exposed to 0.5 ppm of ozone for 6 hours in an environmental chamber. They engaged in two 15-min, medium-exercise stints on a bicycle ergometer during this period. The symptoms most commonly noted with exposure to ozone, dry cough and chest discomfort, were experienced by more nonsmokers than smokers. Subjects who experienced symptoms, in general, were those who developed objective evidence of decreased pulmonary function. Significant changes from control values for the group as a whole with exposure to ozone were observed for the following pulmonary function tests: specific airway conductance, pulmonary resistance, forced vital capacity, and 3-sec forced expiratory volume. No significant change was observed with respect to diffusing capacity for CO, static compliance, or the various tests derived from the N2 elimination rate. In addition, nonsmokers exhibited a significant decrease in dynamic compliance after exposure to ozone. When the smokers were considered as a separate group, no significant decrease in pulmonary function was observed, although some individual smokers showed adverse functional changes.