scholarly journals Difficult Asthma: Consider All of the Possibilities

2000 ◽  
Vol 7 (5) ◽  
pp. 415-418 ◽  
Author(s):  
Lisa C Cicutto ◽  
Kenneth R Chapman ◽  
Dean Chamberlain ◽  
Gregory P Downey
Keyword(s):  
Vital Capacity ◽  
Total Lung Capacity ◽  
Main Bronchus ◽  
Emergency Department Visits ◽  
Lung Capacity ◽  
Control Asthma ◽  
History Of ◽  
Difficult Asthma ◽  
Tomography Scan

Asthma is a common respiratory disease that can often be managed successfully. However, there are patients that do not respond to the maximum doses of standard therapy and subsequently have a reduced quality of life. Many factors can contribute to a failure to respond to treatment, and a comprehensive approach is important when assessing and evaluating these patients. This report describes a patient referred for 'difficult to control asthma' who had multiple emergency department visits and hospitalizations. In addition to a history of wheezing, spirometry showed impaired flow and vital capacity was reduced. Further investigation showed a normal total lung capacity, and a computed tomography scan revealed main bronchus blockage by a tumour, which was confirmed by bronchoscopy. This led to a surgical resection of a mucoepidermoid carcinoma. This case highlights the need to consider all possibilities during the evaluation of patients with difficult asthma.

Previous volume history of the lung and regional distribution of residual volume

1981 ◽  
Vol 51 (2) ◽  
pp. 313-316 ◽  
Author(s):  
F. Ruff ◽  
R. R. Martin ◽  
J. Milic-Emili
Keyword(s):  
Vital Capacity ◽  
Total Lung Capacity ◽  
Regional Distribution ◽  
Breath Hold ◽  
Small Airways ◽  
Residual Volume ◽  
Lung Capacity ◽  
Lower Lung ◽  
History Of ◽  
Collateral Ventilation

By use of 133Xe, the regional distribution of residual volume (RV) was measured in six seated healthy men, following a fast vital capacity (VC) expiration a) without and b) with a breath hold at residual volume of approximately 30 s and c) following a slow (greater than 30 s) VC expiration from total lung capacity (TLC) without a breath hold at RV. After the breath hold at RV, regional RV/TLC in the lower lung zones decreased significantly compared wih results obtained with fast expiratory VC and no breath hold at RV. At lung top the opposite was true. The distribution of regional RV/TLC was the same following the slow VC expiration with no breath hold at RV as with the fast expiration with the breath hold at RV. The different regional distribution of RV in b and c relative to a was probably due mainly to collateral ventilation, i.e., during the breath hold at RV and the slow expiration some of the gas that was trapped in the dependent lung zones behind closed airways escaped into the upper regions of the lung where the small airways had remained patent, leading to increased expansion of upper alveoli.

STUDIES OF RESPIRATORY PHYSIOLOGY IN CHILDREN

PEDIATRICS ◽  
1959 ◽  
Vol 24 (2) ◽  
pp. 181-193
Author(s):  
C. D. Cook ◽  
P. J. Helliesen ◽  
L. Kulczycki ◽  
H. Barrie ◽  
L. Friedlander ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Respiratory Rate ◽  
Vital Capacity ◽  
Total Lung Capacity ◽  
Lung Compliance ◽  
Respiratory Physiology ◽  
Residual Volume ◽  
Lung Volumes ◽  
Lung Capacity ◽  
Residual Capacity

Tidal volume, respiratory rate and lung volumes have been measured in 64 patients with cystic fibrosis of the pancreas while lung compliance and resistance were measured in 42 of these. Serial studies of lung volumes were done in 43. Tidal volume was reduced and the respiratory rate increased only in the most severely ill patients. Excluding the three patients with lobectomies, residual volume and functional residual capacity were found to be significantly increased in 46 and 21%, respectively. These changes correlated well with the roentgenographic evaluation of emphysema. Vital capacity was significantly reduced in 34% while total lung capacity was, on the average, relatively unchanged. Seventy per cent of the 61 patients had a signficantly elevated RV/TLC ratio. Lung compliance was significantly reduced in only the most severely ill patients but resistance was significantly increased in 35% of the patients studied. The serial studies of lung volumes showed no consistent trends among the groups of patients in the period between studies. However, 10% of the surviving patients showed evidence of significant improvement while 15% deteriorated. [See Fig. 8. in Source Pdf.] Although there were individual discrepancies, there was a definite correlation between the clinical evaluation and tests of respiratory function, especially the changes in residual volume, the vital capacity, RV/ TLC ratio and the lung compliance and resistance.

Airway responses to inhaled histamine in asymptomatic smokers and nonsmokers

1977 ◽  
Vol 42 (4) ◽  
pp. 508-513 ◽  
Author(s):  
N. E. Brown ◽  
E. R. McFadden ◽  
R. H. Ingram
Keyword(s):  
Vital Capacity ◽  
Total Lung Capacity ◽  
Aerosol Deposition ◽  
Flow Volume ◽  
Maximal Flow ◽  
Airway Reactivity ◽  
Lung Capacity ◽  
Large Airway ◽  
Airway Response ◽  
Airway Responses

Bronchia reactivity to inhaled histamine was assessed in asymptomatic cigarette smokers and in nonsmoking atopic and nonatopic subjects. The only prechallenge between-group difference was the ratio of maximal flow on 80% helium-20% oxygen (Vmax HeO2) to maximal flow on air (Vmax air) from partial expiratory flow volume curves at 25% vital capacity (25% VC PEFV): Mean +/- SEM for smokers 1.18 /+- 0.06, atopics 1.45 +/- 0.08, nonatopics 1.51 +/- 0.03. This suggests that prior to inhalation to total lung capacity, the predominant site of resistance at flow limitation was in smaller airways of the smokers and in larger airways of both groups of nonsmokers. Following inhalation of histamine, smokers and nonatopics had similar changes in lung volumes and Vmax air which were less than in atopics. The Vmax HeO2/Vmax air ratios at 25% VC PEFV increased in smokers and decreased in nonsmokers: smokers 1.48 +/- 0.08, atopics 1.22 +/- 0.10, nontopics 1.16 +/- 0.06. This suggests a predominant large airway response in smokers and a prominent small airway response in nonsmokers. These responses may reflect differences in the predominant site of aerosol deposition rather than in airway reactivity.

Interaction of inhaled LTC4 with histamine and PGD2 on airway caliber in asthma

1989 ◽  
Vol 66 (1) ◽  
pp. 304-312 ◽  
Author(s):  
G. D. Phillips ◽  
S. T. Holgate
Keyword(s):  
Time Course ◽  
Vital Capacity ◽  
Total Lung Capacity ◽  
Forced Expiratory Volume ◽  
Maximal Flow ◽  
Lung Capacity ◽  
Airway Caliber ◽  
Relevant Interaction

To investigate possible mediator interaction in asthma, the effect of inhaled leukotriene (LT) C4 on bronchoconstriction provoked by histamine and prostaglandin (PG) D2 was studied in nine asthmatic subjects. The provocation doses of histamine, PGD2, and LTC4 required to produce a 12.5% decrease in baseline forced expiratory volume in 1 s (FEV1, PD12.5) and to further this fall to 25% (PD25–12.5) were determined. On three subsequent occasions, subjects inhaled either the PD12.5 LTC4 plus vehicle or vehicle plus the PD25–12.5 of either histamine or PGD2, and FEV1 and maximal flow at 70% of vital capacity below total lung capacity after a forced partial expiratory maneuver (Vp30) followed for 45 min. From these results, predicted time-course curves for LTC4 with histamine and LTC4 with PGD2 were calculated. On two final occasions, airway caliber was followed for 45 min after inhalation of the PD12.5 LTC4 followed by the PD25–12.5 of either histamine or PGD2. During the first 9 min after LTC4-histamine and LTC4-PGD2, the decreases in airway caliber were greater than the calculated predicted response. This interaction, although small, was significant with LTC4-PGD2 for both FEV1 (P = 0.01) and Vp30 (P less than 0.05) and with LTC4-histamine for Vp30 (P less than 0.05) but not for FEV1 (P less than 0.05). We conclude that inhaled LTC4 interacts synergistically with histamine and PGD2 and that this effect, although small, may be a relevant interaction in asthma.

Effect of volume and volume history of the lungs on pulmonary shunt flow

1964 ◽  
Vol 207 (1) ◽  
pp. 235-238 ◽  
Author(s):  
Nicholas R. Anthonisen
Keyword(s):  
Lung Volume ◽  
Total Lung Capacity ◽  
Full Range ◽  
Transpulmonary Pressure ◽  
Pulmonary Shunt ◽  
Shunt Flow ◽  
Lung Capacity ◽  
Surface Active Properties ◽  
History Of ◽  
Surface Active

Relative pulmonary shunt flow (Qs/Qt), was measured in denitrogenated open-chested cats during apnea over the full range of lung volumes. The particular lung volume and transpulmonary pressure were also measured. When completely collapsed lungs were inflated, Qs/Qt decreased sharply to 3% at total lung capacity (TLC). During deflation from TLC Qs/Qt was insensitive to changes in lung volume. Qs/Qt remained low during reinflation after deflation from TLC. These changes in shunt flow can be interpreted as due to either recruitment or collapse of gas exchange units during lung volume change. It appears that completely collapsed lungs inflate very unevenly but that deflation from TLC proceeds remarkably evenly. Reinflation after deflation from TLC also seems to proceed evenly, and the manifest pressure-volume hysteresis is most likely due to hysteresis of the surface-active properties of the alveolar lining material.

Effect of volume history on distribution of inspired gas in asthmatics

1987 ◽  
Vol 62 (3) ◽  
pp. 1179-1185 ◽  
Author(s):  
R. B. Filuk ◽  
N. R. Anthonisen
Keyword(s):  
Vital Capacity ◽  
Total Lung Capacity ◽  
Lung Parenchyma ◽  
Phase Iii ◽  
Ventilation Distribution ◽  
Lung Capacity ◽  
Beta Agonists ◽  
Airway Tone ◽  
Washout Curves ◽  
Volume History

Twelve stable adult asthmatics slowly inhaled boluses of He at 20, 40, or 60% vital capacity (VC); these volumes were achieved either by expiring from total lung capacity (TLC) or by inspiring from residual volume (RV). Inspirations were continued to TLC and then were followed by slow expirations to RV while expired He was measured as a function of expired volume. At 20% VC slopes of alveolar plateaus (phase III) were positive, at 40% VC they were flat, and at 60% VC they were negative; at 20 and 60% VC the slopes were steeper than those in normals. When boluses were administered at 40 and 60% VC, He washout curves were independent of lung volume history. However at 20% VC the slope of phase III was significantly less positive when boluses were given after inspiration from RV than after expiration from TLC. In eight subjects, who were given inhaled beta-agonists, slopes of all He washouts decreased and became independent of volume history at 20% VC. We conclude that in asthmatics at low lung volumes the airways that determine ventilation distribution behave as though they have less hysteresis than the lung parenchyma probably due to increased airway tone.

scholarly journals Features of glossopharyngeal breathing in breath-hold divers

2006 ◽  
Vol 101 (3) ◽  
pp. 799-801 ◽  
Author(s):  
Leigh M. Seccombe ◽  
Peter G. Rogers ◽  
Nghi Mai ◽  
Chris K. Wong ◽  
Leonard Kritharides ◽  
...  
Keyword(s):  
Vital Capacity ◽  
Total Lung Capacity ◽  
Breath Hold ◽  
Lung Capacity ◽  
Diving Depth ◽  
Highly Correlated ◽  
Pressure Changes ◽  
Air Compression ◽  
The Relationship ◽  
Measured Volume

One technique employed by competitive breath-hold divers to increase diving depth is to hyperinflate the lungs with glossopharyngeal breathing (GPB). Our aim was to assess the relationship between measured volume and pressure changes due to GPB. Seven healthy male breath-hold divers, age 33 ( 8 ) [mean (SD)] years were recruited. Subjects performed baseline body plethysmography (TLCPRE). Plethysmography and mouth relaxation pressure were recorded immediately following a maximal GPB maneuver at total lung capacity (TLC) (TLCGPB) and within 5 min after the final GPB maneuver (TLCPOST). Mean TLC increased from TLCPRE to TLCGPB by 1.95 (0.66) liters and vital capacity (VC) by 1.92 (0.56) liters ( P < 0.0001), with no change in residual volume. There was an increase in TLCPOST compared with TLCPRE of 0.16 liters (0.14) ( P < 0.02). Mean mouth relaxation pressure at TLCGPB was 65 (19) cmH2O and was highly correlated with the percent increase in TLC ( R = 0.96). Breath-hold divers achieve substantial increases in measured lung volumes using GPB primarily from increasing VC. Approximately one-third of the additional air was accommodated by air compression.

Response of lung volumes and ventilation to posture change and upright exercise

1962 ◽  
Vol 17 (5) ◽  
pp. 783-786 ◽  
Author(s):  
John S. Hanson ◽  
Burton S. Tabakin ◽  
Edgar J. Caldwell
Keyword(s):  
Vital Capacity ◽  
Total Lung Capacity ◽  
Treadmill Exercise ◽  
Body Position ◽  
Upright Posture ◽  
Residual Volume ◽  
Lung Volumes ◽  
Lung Capacity ◽  
Posture Change ◽  
Normal Males

Variations in size of the various lung volumes due to changes in body position and as a consequence of treadmill exercise were studied in five normal males. Assumption of the upright posture was associated with highly significant increases in total lung capacity, vital capacity, expiratory reserve volume, and residual volume as compared to resting supine values. Level walking was associated with a decrease of expiratory reserve volume, but a further expansion of residual volume. Vital capacity decreased slightly, but total lung capacity increased by virtue of the proportionately large residual volume increases. Elevation of the treadmill to 4° resulted in slight decreases in all lung volumes, total lung capacity evidencing a barely significant decline. Positional changes in ventilation are described, and on the basis of the “lung clearance index” an increased efficiency of ventilation is seen in the upright posture. Factors possibly operative in these alterations are discussed. Submitted on February 21, 1962

scholarly journals Poorer Prognosis of Idiopathic Pleuroparenchymal Fibroelastosis Compared with Idiopathic Pulmonary Fibrosis in Advanced Stage

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Makoto Shioya ◽  
Mitsuo Otsuka ◽  
Gen Yamada ◽  
Yasuaki Umeda ◽  
Kimiyuki Ikeda ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Vital Capacity ◽  
Total Lung Capacity ◽  
Unknown Etiology ◽  
Advanced Stage ◽  
High Resolution Computed Tomography ◽  
Pleuroparenchymal Fibroelastosis ◽  
Radiological Criteria ◽  
Lung Capacity

Objective. Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare disease characterized by predominant upper lobe pulmonary fibrosis of unknown etiology. However, the prognosis of IPPFE has not been discussed. We investigated the clinical characteristics and prognostic factors of IPPFE and idiopathic pulmonary fibrosis (IPF). Methods. We performed a retrospective cohort study on 375 consecutive idiopathic interstitial pneumonia patients between April 2004 and December 2014. Among them, we diagnosed IPPFE and IPF patients using high-resolution computed tomography radiological criteria. Results. Twenty-nine IPPFE patients (9 males, 20 females) and 67 IPF patients (54 males, 13 females) were enrolled. IPPFE patients were significantly more likely to be females and nonsmokers and had lower body mass index, lower values of predicted percentage of forced vital capacity (%FVC), and a higher residual volume-to-total lung capacity ratio than IPF patients. Survival analysis revealed that they had significantly poorer prognosis than IPF patients in GAP (gender, age, and physiology) stages II + III. %FVC and GAP index independently predict mortality in patients with IPPFE. Conclusions. Patients with IPPFE showed poorer prognosis in the advanced stage than patients with IPF. %FVC and GAP index are independent predictors of survival in patients with IPPFE.

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