bluuebunny/crossref_metadata_2025 huggingface dataset:
The alveolitis of hypersensitivity pneumonitis
Authors: Costabel U
Published: November 2022

In the pathogenesis of hypersensitivity pneumonitis (HP) several immune mechanisms are involved. The initial phase, 4-48 h after antigen inhalation, appears to be immune complex mediated and is characterized by an early increase in bronchoalveolar lavage (BAL) neutrophils and the histopathologic features of oedema, neutrophil infiltration of the alveolar wall, and vasculitis. After 12 h to several days, the immune response possibly shifts to a cell-mediated reaction, and the alveolitis consists of cytotoxic effector cells as well as suppressor cells which may be required to modulate the B cell response of antibody production by plasma cells. In this phase, lymphocytes of the OKT8 positive phenotype, natural killer cells, and occasionally a few plasma cells are increased in BAL fluid. The characteristic histopathologic finding is a mononuclear infiltrate consisting of lymphocytes, plasma cells, and foamy histiocytes. After weeks to months, a delayed type hypersensitivity reaction may lead to a slight predominance of OKT4 positive cells in BAL fluid and to granuloma formation. Finally, after months to years, repeated immune-mediated injury to the alveolar wall with release of proteolytic enzymes and fibroblast growth factors may result in pulmonary fibrosis and end stage lung with concomitant increase in BAL neutrophils as in other fibrotic diseases.
Moderately severe chronic airflow obstruction. Can corticosteroids slow down obstruction?
Authors: Postma DS , Peters I , Steenhuis EJ , Sluiter HJ
Published: November 2022

In a former study in patients with severe chronic airflow obstruction (CAO), (forced expiratory volume in one second (FEV1) ranging from 350-910 ml), we concluded that daily oral corticosteroids might slow down the progression of disease. The results of the present long-term (14-20 yr) study on 139 non-allergic patients with less severe CAO (FEV1 greater than or equal to 1200 ml, FEV1 as a percentage of vital capacity (FEV1%VC) 40-55%) confirm and extend our former observations. Four patterns of the course of FEV1 and inspiratory vital capacity (VC) in time were recognized: 1) linear decrease; 2) no change; 3) initial increase, followed by decrease; 4) initial decrease, followed by increase. Groups 1 and 3 had a higher functional residual capacity as a percentage of total lung capacity (FRC%TLC) as compared to group 2 and 4; the work of breathing was lower in group 2 than in the other three groups. Otherwise the initial 82 parameters, including the degree of reversibility of airflow obstruction and smoking habits were comparable in the four groups. The four patterns of FEV1 showed a strong association with the long-term use of prednisolone. When oral prednisolone was instituted or increased to a dose of at least 10 mg/day continuously, FEV1 either remained constant, decreased more slowly or even increased over many years of follow-up. When the oral dose was diminished to below 10 mg/day, FEV1 decreased.(ABSTRACT TRUNCATED AT 250 WORDS)
Growth of lung and thorax dimensions during the pubertal growth spurt
Authors: DeGroodt EG , van Pelt W , Borsboom GJ , Quanjer PH , van Zomeren BC
Published: November 2022

In the follow-up study of adolescents residual volume (RV), vital capacity (VC), closing volume (CV), thorax height and thorax width were measured at six month intervals over a six year period; 149 girls and 477 boys, whose ages ranged between 11.5 and 18.5 yr during the follow-up, were investigated. In healthy subjects and in those with respiratory symptoms the rates of change of thoracic dimensions, as calculated by a robust linear regression technique, were moderately well correlated; the growth rates of RV and VC were only slightly correlated, and both were moderately well correlated with changes in thorax dimensions. Thorax height increased relative to thorax width in boys and girls during the follow-up. In boys, thorax height continued to grow, when standing height and thorax width had attained adult values in girls. Thus the thorax attains a more elongated shape. During the adolescent growth spurt the residual volume as a percentage of total lung capacity (RV%TLC) within subjects increased on average 0.6% per yr, and closing volume as a percentage of vital capacity (CV%VC) decreased on average 0.5% per yr. Both of these changes can be accounted for by decreased thorax compliance and increased outward chest recoil at low lung volumes.
Altered immunological reactivity in alveolar macrophages from patients with sarcoidosis
Authors: Gallagher RB , Guckian M , van Breda A , Odlum C , Fitzgerald MX , Feighery C
Published: November 2022

Lung macrophages may play an important role in the pathogenesis of pulmonary sarcoidosis. In this study, the ability of pulmonary macrophages and blood monocytes from sarcoidosis patients, normal controls and disease controls to provide the accessory signal necessary for the concanavalin A-induced activation of normal blood T cells was examined. Blood monocytes from all groups supplied a significantly greater accessory signal than lung macrophages. The accessory capacity of lavage macrophages from sarcoidosis patients varied over a wide range and correlations were sought between these values and other parameters of disease activity. Whilst there was no correlation with clinical parameters, accessory function of alveolar macrophages correlated significantly with the percentage of T helper cells in bronchoalveolar lavage (BAL) fluid (p less than 0.05) and, more closely, with the T helper:T suppressor ratio in BAL fluid (p less than 0.01). This interrelationship between macrophage activity and the T cell infiltrate favours the probability that both cell types participate in the sarcoid disease process and raises the possibility that T cells of both helper and suppressor phenotypes contribute to the pathogenesis.
Tonic sensory pathways of the respiratory system
Authors: Jammes Y
Published: November 2022

Both respiratory centres and the preganglionic vagal motoneurones, which control respiratory (striated) and airway (smooth) muscles respectively, receive information on the lungs, the circulation and the skeletal and respiratory muscles. Each of these nervous pathways has two components: one is phasic, i.e. in phase with biological rhythms, and comes from mechanoreceptors connected to large myelinated fibres; the second has a tonic low frequency firing rate and corresponds to the spontaneous activity of polymodal receptors connected to thin sensory fibres, which act mostly as sensors of changes in extracellular fluid composition (O2 and/or CO2 partial pressure, pH, release of algesic agents etc...). Some of them also detect large mechanical disturbances or local temperature changes. The influence of tonic background sensory activity is well known in animals concerning the role played by arterial chemoreceptors in the control of ventilation and of thin vagal afferents from the lungs (bronchopulmonary C-fibres and irritant receptors) in reflex facilitation of the bronchoconstrictor vagal tone. Moreover, the stimulation of thin sensory fibres in particular circumstances is responsible for hyperventilation (arterial chemoreceptors and muscle afferents), increased airway tone (arterial chemoreceptors and mostly thin vagal afferent fibres) or bronchodilation (muscle afferents). These peripheral inputs project centrally on different structures and also on brain stem neurones, which integrate simultaneously chemosensory, vagal and muscle information. This results in complex interactions between the different sensory pathways.
Mecholyl aerosolized in the surrounding lung increases the resistance of the collateral pathways
Authors: Delaunois L , Delaunois M
Published: November 2022

Collateral ventilation allows gas exchange in pulmonary units distal to an airway obstruction. Regional control of this airflow may be possible because smooth muscle exists in the wall of collateral pathways. Evidence of an intrasegmental cholinergic control of these pathways has been previously shown. We performed this study to investigate the possible control of collateral ventilation by cholinergic receptors situated in the surrounding lung. By using the wedged catheter technique, we measured collateral resistance before and after aerosolization of methacholine in the lung surrounding the wedged segment: both collateral resistance and the time constant for collateral ventilation increased, providing that a cholinergic stimulation in the surrounding lung can influence collateral pathways. Fast and complete reversibility was obtained after isoproterenol or atropine injection. Collateral obstruction would seem to be due, therefore, to a muscular spasm. The effective compliance of the wedged segment decreased during the spasm induced by mecholyl in the surrounding lung, and could be attributed to an increased interdependence of this segment with surrounding segments. This effect was immediately reversed by intravenous bronchodilators. We conclude that cholinergic receptors on the smooth muscles of the external collateral channels can control collateral ventilation.
The rib cage and abdominal components of respiratory system compliance in tetraplegic patients
Authors: Goldman JM , Williams SJ , Denison DM
Published: November 2022

The specific compliance of the chest wall and lungs combined was measured in eight patients with stable tetraplegia. Expiration was impeded with a series of spring-loaded resistances, and end-expiratory pressures plotted against changes in chest wall volume at end-expiration. An optical contour mapping system was used to partition changes in chest wall volume into rib cage and abdominal components. These measurements suggest that the compliance of the whole system is reduced by one third in patients with stable tetraplegia, compared with normal subjects. This may be because of abnormal stiffening of the rib cage.
Upper respiratory tract involvement in sarcoidosis and its management
Authors: Wilson R , Lund V , Sweatman M , Mackay IS , Mitchell DN
Published: November 2022

Of some 750 sarcoidosis patients, 27 were found to have involvement of their nasal mucosa. Most had multisystem disease, which was usually chronic. Nasal stuffiness or blockage and crusting were the major symptoms, and were usually present at the first presentation with sarcoidosis. The larynx was involved in five cases. The Kveim test was positive in twelve of the fourteen patients in whom it was performed, serum angiotensin converting enzyme was frequently elevated and sinus radiographs were often abnormal. Topical medication improved symptoms in some patients, but the majority required systemic corticosteroids. It was possible to withdraw medication completely after seven years in only one patient. Relapse was encountered during reduction of dosage in other patients. Random biopsy of macroscopically normal nasal mucosa did not yield histological support for a diagnosis of sarcoidosis in twelve out of thirteen patients, but upper respiratory tract lymphoid tissue may contain granulomas in patients with sarcoidosis.
Occupational asthma due to isocyanates
Authors: Mapp CE , Boschetto P , Dal Vecchio L , Maestrelli P , Fabbri LM
Published: November 2022

162 subjects who had been exposed to isocyanates, who had developed symptoms during the exposure period, or in the evening or night and, therefore, had a history compatible with isocyanate-induced asthma, were studied with inhalation challenge testing to isocyanates (toluene diisocyanate and methylene diphenyl diisocyanate) and methacholine, because they were suspected of having occupational asthma. None of these subjects had symptomatic asthma before employment. The diagnosis of occupational asthma was delayed (duration of symptoms before diagnosis: 3.9 +/- 0.4 yrs). Isocyanate-asthma documented by a positive inhalation challenge to isocyanates was present in 57.4% of the subjects. A higher degree of airway responsiveness to methacholine was present in subjects with a positive isocyanate inhalation challenge compared to subjects with a negative challenge (Gmean and GESM: 0.407 (1.14) vs 0.942 (1.14) mg). The majority of the subjects complained of shortness of breath and cough. The low proportion of atopic subjects (21.5%) and of smokers (7.5%), and the high proportion of subjects with the late component in the asthmatic reaction (71%) appear to be common features in this disease.
Prevalence of respiratory symptoms in an unpolluted area of northern Italy
Authors: Viegi G , Paoletti P , Prediletto R , Carrozzi L , Fazzi P , Di Pede F , Pistelli G , Giuntini C , Lebowitz MD
Published: November 2022

Using a multistage stratified geographic cluster sample of households living in an unpolluted area of Northern Italy (near Venice), we enrolled 3289 inhabitants (aged 8-64 yr) for a longitudinal respiratory study. During the first cross-sectional survey, before the start of operation of a large oil-burning thermoelectric power plant, they completed a standardized administered questionnaire and performed several lung function tests. In the whole sample, dyspnoea grade 1 (11%), chronic cough and chronic phlegm (9%) were the most frequent respiratory symptoms; all the symptoms except dyspnoea were more prevalent in males than in females. Smokers (S) showed higher prevalence rates than ex-smokers (ES) and nonsmokers (NS), especially in males. In both sexes, the frequency of respiratory symptoms increased with increasing smoking as assessed by pack-years. An inverse relationship between prevalence of symptoms and socio-economic status was also observed. All tests of lung function were significantly impaired in S compared with NS in males; single-breath CO diffusing capacity and slope of alveolar plateau but not spirometric indices were significantly impaired in female S compared to female ES and NS. Finally, our prevalence rates were lower than in other epidemiological surveys: this result may be ascribed to the low levels of air pollution measured in the area.
Lymphocyte subsets in peripheral blood and pleural fluid
Authors: Lucivero G , Pierucci G , Bonomo L
Published: November 2022

We have examined the distribution of B and T lymphocytes, T-cells with helper/inducer (T4+) or suppressor/cytotoxic (T8+) phenotypes and a subset of cells with natural killer (NK) activity and positive for the Leu 7 (HNK-1) surface antigen in peripheral blood and in lymphocyte-rich pleural effusions of patients with tuberculosis or malignancies (mesothelioma and lung cancer with pleural metastasis). In individual patients, the percentages of T lymphocytes were uniformly higher in pleural effusions than in peripheral blood; however, lower percentages of B lymphocytes and cells positive for the Leu 7 antigen were present in pleural fluids. The analysis of T-cell subpopulations demonstrated a selective enrichment of T lymphocytes with helper/inducer phenotype in pleural effusions, while the percentages of T-cells with suppressor/cytotoxic phenotype were similar in pleural fluid and peripheral blood. These results indicate that in lymphocytic pleural effusions the main lymphoid cell population is represented by T lymphocytes with helper/inducer phenotype, regardless of whether the effusion is due to tuberculosis or malignancies such as mesothelioma or lung cancer.
Diagnostic value of cancer antigen 15-3 (CA15-3) detected by monoclonal antibodies (115D8 and DF3) in exudative pleural effusions
Authors: Shimokata K , Totani Y , Nakanishi K , Yamamoto M , Hasegawa Y , Kawatsu H , Sasou H , Murate T , Ichiyama S , Kurasawa T , et al.
Published: November 2022

Pleural fluid levels of the cancer antigen 15-3 (CA15-3) detected by monoclonal antibodies (115D8 and DF3) were determined in 40 patients with carcinomatous pleural effusions and in 41 patients with tuberculous pleural effusions. Using a cut off level of 16 U/ml, 15 of the 40 carcinomatous fluids but none of the 41 tuberculous fluids were positive. Pleural fluid levels of CA15-3 were not correlated with those of carcinoembryonic antigen (CEA) or carbohydrate antigen 19-9 (CA19-9). Combined assay of CEA and CA15-3, or CA19-9 and CA15-3, increased the positive rate from 79 to 82% and from 67 to 73%, respectively. Measurement of pleural fluid CA15-3 levels are less useful in separating carcinomatous from tuberculous effusions than is measurement of CEA or CA19-9.
A scoring system on respiratory symptoms
Authors: Gulsvik A , Refvem OK
Published: November 2022

A method for quantitative recording of psychiatric symptoms has been modified for application to respiratory symptoms such as cough, attacks of breathlessness, wheezing and dyspnoea. The method was evaluated in a survey of 193 subjects without pulmonary disorders and 186 patients with pulmonary disorders. The average time taken to obtain scores for four symptoms was six minutes. Inconsistencies were few when the subjects selected statements about symptoms. Cough score discriminated between groups of healthy persons with various smoking habits. Wheezing score distinguished healthy persons from patients with obstructive lung disease more accurately than cough, attacks of breathlessness and dyspnoea score. Regression analyses showed that per score point of dyspnoea and cough the peak expiratory flow rate decreased by almost 12 and 7% of predicted, respectively.
Objective measurement of compliance with nasal CPAP treatment for obstructive sleep apnoea syndrome
Authors: Krieger J , Kurtz D
Published: November 2022

Compliance with nasal continuous positive airway pressure (CPAP) has become a major concern, since this treatment is efficacious, but constraining. In 46 consecutive obstructive sleep apnoea (OSA) patients, we measured compliance with nasal CPAP by establishing a mean rate of use, with a built-in time counter read at three-month intervals, over a mean follow-up period of 232 +/- 27 days. The mean rate of use in the whole group was 5.14 +/- 0.31 hours per day. The acceptance rate was 90.9-93.2%, showing that patient acceptance is not a limitation in the use of nasal CPAP.
Density dependence of respiratory input impedance re-evaluated with a head generator minimizing upper airway shunt
Authors: Rotger M , Peslin R , Navajas D , Gallina C , Duvivier C
Published: November 2022

Total respiratory impedance was assessed from 4 to 30 Hz in ten normal subjects breathing air and a helium-oxygen gas mixture using two methods of applying pressure oscillations at the airway opening: 1) the conventional method where pressure is varied at the mouth: 2) the method recently developed by Peslin et al. (J Appl Physiol, 1985, 59, 1790-1795) in which pressure is varied both at the mouth and around the head to minimize transmural pressure across upper airway walls, and the corresponding artefact. When breathing air slightly lower resistances (p less than 0.05) and considerably higher inertances (p less than 0.001) were found using the head generator. Breathing helium-oxygen reduced respiratory resistance and its frequency dependence, as well as respiratory inertance very significantly (p less than 0.001), with minor differences between the changes seen with the two methods. In contrast, the changes in respiratory compliance were small, and not in the same direction, when pressure was varied at the mouth and around the head. It is concluded that the accuracy of the conventional method may be sufficient for diagnostic purposes in subjects without gross mechanical abnormalities, i.e. for early detection of mechanical abnormalities.
Posture-induced airflow limitation in asthma: relationship to plasma catecholamines and an inhaled anticholinergic agent
Authors: Larsson K , Bevegard S , Mossberg B
Published: November 2022

Postural influence on ventilatory function was investigated in thirteen asthmatic subjects on three consecutive days starting at 10.00 am. Lung function was measured in the seated position before and after four hours lying supine. Peak expiratory flow (PEF) was measured every 0.5 h in the supine position. Blood samples for determination of plasma catecholamines were collected before, during and after lying supine. After the initial lung function testing, placebo or ipratropium bromide (0.125 mg) was inhaled. On the third day the whole trial was performed seated, without any drug, as a control experiment. On the placebo day lying supine induced an initial, rapid fall of PEF followed by a progressive decrease during the four hours. The progressive decrease in PEF was apparently caused by bronchoconstriction. Ipratropium bromide prevented this posture-induced bronchoconstriction. On the day seated there was also a tendency towards a decline of PEF though less pronounced than in the supine position on the placebo day. No significant alterations in plasma levels of catecholamines were observed. We conclude that the supine posture is a stimulus to bronchoconstriction in asthma, likely to be involved in nocturnal wheezing. Postural bronchoconstriction is not explained by lowered plasma levels of adrenaline, as has been suggested for nocturnal asthma. The results raise the question of whether cholinergic mechanisms are involved.
Antiproteases are increased in bronchoalveolar lavage in interstitial lung disease
Authors: Sibille Y , Martinot JB , Staquet P , Delaunois L , Chatelain B , Delacroix DL
Published: November 2022

The present study evaluates different cellular and soluble components in the bronchoalveolar lavage (BAL) from patients with interstitial lung disease. We observed an increased T4/T8 lymphocyte ratio in BAL but not in blood from 24 patients with active pulmonary sarcoidosis compared to sixteen normal individuals and to eleven patients with inactive pulmonary sarcoidosis. Seven patients with hypersensitivity pneumonitis had a normal T4/T8 ratio. In the active sarcoidosis and hypersensitivity pneumonitis groups, alpha 1-Protease Inhibitor (alpha 1 PI) in BAL is significantly higher than in the normal group and a significant correlation between the two antiproteases (alpha 2-macroglobulin and alpha 1 PI) is observed. These data demonstrate that antiprotease levels (alpha 1 PI and alpha 2 M) are increased in the lower respiratory tract of patients with interstitial lung disease and that among cellular and soluble components of BAL, alpha 2 M represents a sensitive marker of the alveolitis.
Gallium-67 scanning in the staging of cryptogenetic fibrosing alveolitis and hypersensitivity pneumonitis
Authors: Vanderstappen M , Mornex JF , Lahneche B , Chauvot P , Bouvier JF , Wiesendanger T , Pages J , Webert P , Cordier JF , Brune J
Published: November 2022

Gallium-67 citrate is known to localize within inflammatory sites. Gallium-67 scanning is used for the evaluation of lung inflammation (i.e. alveolitis) during interstitial lung diseases. We investigated 27 patients with cryptogenetic fibrosing alveolitis (n = 17) and hypersensitivity pneumonitis (n = 10) using gallium-67 lung scanning and lung function tests (forced vital capacity, diffusing capacity, resting and exercise blood gases). Investigations were performed before and after one year of methylprednisolone treatment. None of eight healthy volunteers had any abnormal gallium-67 uptake. In all patients with cryptogenetic fibrosing alveolitis an initial abnormal gallium-67 uptake was observed (mean fixation index: 163 +/- 18). In addition, analysis of lung function tests a year after initial evaluation showed that unchanged or improving patients presented initially with a lower gallium-67 index than patients with evidence of deterioration (153.9 +/- 23.7 vs 251.0 +/- 23.3.; p less than 0.01). Similarly, among patients with hypersensitivity pneumonitis the index was lower in unchanged or improving patients than in those with deterioration (74.9 +/- 22 vs 226.7 +/- 4.9; p less than 0.05). Thus gallium-67 scanning is useful in the management of cryptogenetic fibrosing alveolitis and hypersensitivity pneumonitis.
Cumulative dose-response curves for assessing combined effects of salbutamol and ipratropium bromide in chronic asthma
Authors: Grandordy BM , Thomas V , de Lauture D , Marsac J
Published: November 2022

We investigated whether salbutamol (S) and ipratropium bromide (IB) exerted a true additive bronchodilator effect in asthma. In fifteen selected chronic asthmatics, individual cumulative dose-response curves to S and IB were performed on two separate days (linear regression of bronchodilator response (delta FEV1) between 20 and 80% of maximal response, versus log dose), and the dose of S equipotent to the IB dose giving the maximal bronchodilator effect (IBopt) was calculated by interpolation of each S curve. On two other days, each patient received IBopt or the equipotent S dose followed by an additional 400 micrograms S. On day 1 or 2, FEV1 reached 220 +/- 410 ml and 2410 +/- 380 ml (p less than 0.05) after the maximal dose of IB and S respectively. On day 3 or 4 after pretreatment by IB or S an additional 400 micrograms S gave a further increase, which was similar in both series (315 and 320 ml, respectively). FEV1 after combination treatment reached 238 +/- 350 ml and was not significantly different from the maximal effect of S (2440 +/- 290 ml). We conclude that S and IB exert a true pharmacological additive effect, since the combination effect is as great as the maximal effect of the most potent drug (S) and greater than the maximal effect of IB, and that the same additional dose of S gives the same increase after equipotent doses of S and IB.
Comparison of the dose-response curves obtained by forced oscillation and plethysmography during carbachol inhalation
Authors: Chinet T , Pelle G , Macquin-Mavier I , Lorino H , Harf A
Published: November 2022

We compared the cumulative dose-response curves obtained during carbachol inhalation by simultaneous measurements of airway specific conductance (sGaw) and respiratory conductance, in 23 subjects with or without bronchial hyperresponsiveness. The sGaw was measured by a body plethysmograph, whilst the random noise forced oscillation technique (FOT) was used to determine respiratory conductance. The sGaw was compared to respiratory conductance extrapolated to zero frequency (Grs0). Bronchial sensitivity was assessed by the threshold dose of carbachol (TD) that induced a decrease in sGaw and Grs0 of twice the baseline coefficient of variation. Bronchial responsiveness was assessed by the slopes (S) of the individual dose-response curves. The TD and S values obtained by FOT and by plethysmography were closely correlated (p less than 0.001). The carbachol doses inducing a 50% reduction in sGaw were equivalent to those causing a 42% reduction in Grs0 (r = 0.90; p less than 0.001). During bronchial challenge testing, FOT provides comparable information in terms of bronchial sensitivity and responsiveness to that supplied by plethysmography.
An incremental method to assess the linearity of gas flowmeters: application to Fleisch pneumotachographs
Authors: Duvivier C , Peslin R , Gallina C
Published: November 2022

A new method of studying the linearity of gas flowmeters was tested on different models of Fleisch pneumotachographs. The method applies a steady flow to the test flowmeter, which is increased in a stepwise manner by adding a constant flow-increment. This is achieved using two flow sources in parallel. The method does not require any reference flow channel and may be implemented with standard laboratory equipment. Using this method, the gain of Fleisch pneumotachographs, whatever their size, decreased by about 2-3% from low flows to about 40% of their nominal full scale (FS), and then increased almost linearly with increasing flow. The error was 8-13% at 200% FS. The following equation was devised to correct the data at high flow: Vc = Vt (1-K (Vt-S] where Vc and Vt are the corrected and measured flow respectively, K a gain correction factor and S a flow threshold below which no correction is needed. Applying this correction with suitable coefficients, the maximal error was below 3% from 0-200% FS.
A new multiple dose powder inhaler, (Turbuhaler), compared with a pressurized inhaler in a study of terbutaline in asthmatics
Authors: Persson G , Gruvstad E , Stahl E
Published: November 2022

Twelve adult asthmatic patients participated in an open, randomized, cross-over comparison between cumulatively increasing doses of terbutaline sulphate administered via the multiple dose powder inhaler (Turbuhaler) or via a pressurized inhaler. Turbuhaler and the pressurized inhaler showed equipotency both with respect to bronchodilatation and side effects. Both treatments produced a significant increase in pulmonary function measurements, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). No increase in pulse rate was seen with either treatment but there was an increase in tremor at higher doses with both treatments. Inhalation of beta-agonists via Turbuhaler seems to be an effective way of treating asthma.
Lung mechanics and activity of slowly adapting airway stretch receptors
Authors: Sant'Ambrogio FB , Sant'Ambrogio G , Fisher JT
Published: November 2022

Transpulmonary pressure is thought to be closely associated with slowly adapting mechanoreceptor activity. The transpulmonary pressure required to inflate the lung to a given volume depends on pulmonary compliance: for equal tidal volumes less pressure will be required if compliance is higher. Therefore, an inverse relationship is expected between receptor activity and lung compliance for equal changes in lung volume. We have studied 33 slowly adapting airway stretch receptors (SARs) in anaesthetized, vagotomized, paralysed and artificially ventilated dogs, with the chest open, at constant tidal volume and frequency. After lung compliance had been increased by hyperinflation, all of the ten tracheal receptors studied and fourteen of the 23 intrapulmonary receptors reduced their activity. Of the remaining intrapulmonary receptors five increased their activity and four were unaffected. Our results indicate that, although airway stretch receptor discharge is usually related to transpulmonary pressure, this relationship is not always present in the case of peripherally located endings; this is possibly due to a discrepancy between local transmural pressure and overall transpulmonary pressure. Thus, in addition to the well described independence of SAR discharge frequency from lung volume, the activity of SARs having peripheral locations is not always predictable on the basis of changes in transpulmonary pressure.
The effects of a mixture of surface-active agents (Sonarex) on upper airways resistance and snoring in anaesthetized dogs
Authors: Widdicombe JG , Davies A
Published: November 2022

We measured upper airways resistance from the trachea and from the pharynx to the atmosphere, EMG of the genioglossus muscle and the sound of snoring, in anaesthetized greyhounds, breathing spontaneously through the upper airways. Using extra-corporeally produced continuous flow we determined flow/pressure curves for the upper airways and resistances from the trachea and from the pharynx. We tested the effects of 0.9% saline and of Sonarex (a proprietary mixture containing sodium chloride, glycerol, polysorbate 80 and benzalkonium chloride). Both saline and Sonarex decreased upper airways resistance, but the latter did so more consistently. With Sonarex, genioglossus activity increased and the sound of snoring decreased. Flow/pressure curves 5-20 min after Sonarex showed a decrease in upper airways resistance and a smoother curve, whereas those with saline showed an increase in resistance. The sound produced by continuous flow through the upper airways was decreased by Sonarex but increased by saline. Thus, both Sonarex and saline decrease upper airways resistance, but Sonarex also reduces the sound of snoring and the resistance and sound of continuous airflow through the upper airways.
Plant constituents of cotton dust and lung effects after inhalation
Authors: Rylander R
Published: November 2022

Experiments were performed to assess pulmonary reactions after inhalation of cotton dusts with different levels of tannins, terpenoid aldehydes and bacterial endotoxins. Guinea-pigs were exposed to cotton dust. Free lung cells were obtained by lavage 24 h later. A dose-response relationship was found between the number of neutrophils and the amount of endotoxin in the dust. No influence of terpenoid aldehyde or tannin levels could be detected. Cotton mill workers were exposed to dust from glanded and glandless cottons in an experimental cardroom. The average decreases in forced expiratory volume in one second (FEV1) over the workday after carding the two cottons were the same, although levels of dust, tannin or terpenoid aldehydes were different. The level of airborne endotoxin was, however, equal. The results support observations from other studies on the importance of endotoxin for the development of the acute reactions observed after cotton dust exposure.
CO2 response and pattern of breathing in patients with symptomatic hyperventilation, compared to asthmatic and normal subjects
Authors: Hormbrey J , Jacobi MS , Patil CP , Saunders KB
Published: November 2022

We studied six patients with symptomatic hyperventilation, using new techniques to quantify baseline variability of respiratory variables, and to assess CO2 sensitivity around the control point using a stimulus not detectable by the subject. We compared them with six normal subjects and six patients with mild asthma. Symptomatic hyperventilators had normal mean ventilation and end-tidal carbon dioxide tension (PETCO2) at rest. Asthmatic subjects had higher ventilation and lower PETCO2. Symptomatic hyperventilators had a larger number of sighs and abnormally wide fluctuations in baseline for inspiratory time, expiratory time, and PETCO2. These could not be explained by an abnormal ventilatory response to a transient CO2 input; the transient response near the control point was undoubtedly normal.
Nasal mucociliary transport in healthy subjects is slower when breathing dry air
Authors: Salah B , Dinh Xuan AT , Fouilladieu JL , Lockhart A , Regnard J
Published: November 2022

We assessed the effect of dry air (DA) nasal breathing on nasal clearance rate in healthy nonsmoking subjects. We measured saccharin nasal transit time (SNTT), an index of mucociliary clearance rate, in eleven normal subjects (six males, five females) breathing either room air (RA) or DA through the nose in random order on six different study days. On each study day, the trial was conducted at the same time, in the same nostril, using a patent airway. DA was breathed through a light-weight, tight-fitting, nasal mask (SEFAM, France) for 30 min and SNTT was then measured immediately. Saccharin (250 micrograms) was deposited on the anterior part of the inferior turbinate under visual control and saliva was swallowed every 30 s thereafter. SNTT was the time elapsed between deposition and first perception of saccharin taste. The group-average SNTT on DA was 18.5 +/- 8.6 min which was significantly longer than on RA (11.9 +/- 5.3 min). Our findings suggest that dry air breathing results in excessive water loss by the nasal mucosa, which may in turn reduce nasal mucociliary clearance rate through changes in the rheological properties or adhesiveness of nasal mucus and/or slowing of ciliary beating.
Pseudomonas thoracic empyema secondary to nosocomial rhinosinusitis
Authors: Meyer P , Guerin JM , Habib Y , Levy C
Published: November 2022

Three cases of Pseudomonas thoracic empyema occurring in nasotracheally intubated patients are reported. Paranasal rhinosinusitis, a well documented complication of prolonged nasotracheal intubation, could be the primary infectious location. Massive respiratory tract colonization leads to extensive necrotizing pulmonary lesions. Failure of diagnosis and treatment of sinus involvement could be responsible for persistent or recurrent pleural empyema. Treatment includes continuous pleural drainage, sinusitis treatment and antibiotics. This complication should be considered in the choice between early tracheostomy and prolonged nasotracheal intubation in Intensive Care Unit (ICU) patients.
Spontaneous bilateral chylothorax: uniform features of a rare condition
Authors: Garcia Restoy E , Bella Cueto F , Espejo Arenas E , Aloy Duch A
Published: November 2022

A 67-yr-old woman was admitted with dyspnoea, chest and neck pain and swelling of both supraclavicular fossae and the neck. Chest X-ray showed bilateral pleural effusions. Thoracocentesis yielded a milky fluid with a high triglyceride level. Four previously published cases had similar clinical manifestations. The pathophysiology is discussed.
Morphological studies of bronchial mucosal biopsies from asthmatics before and after ten years of treatment with inhaled steroids
Authors: Lundgren R , Soderberg M , Horstedt P , Stenling R
Published: November 2022

To examine the influence of inhaled steroids on the bronchial mucosa, biopsies from six patients with severe bronchial asthma were studied before and after ten years of daily treatment with inhaled steroids. Biopsies from six healthy subjects were also examined. In the biopsies taken from the asthmatic patients before treatment there was a significant increase in inflammatory cell numbers compared with the biopsies from the control subjects. In all patients scanning electron microscopy showed a reduced coverage by cilia. Squamous cell metaplasia was seen in two patients. After ten years of treatment the number of inflammatory cells was significantly reduced compared to that before treatment and was not different from the control biopsies. Most of the epithelial cells showed a ciliated surface. Small focal areas with non-ciliated cells could still be seen in four patients. In the two patients with squamous cell metaplasia before treatment, small areas of metaplasia could still be seen. Despite the absence of inflammation and reduced epithelial damage during treatment all patients still had bronchial hyperresponsiveness.
Mucosal inhibition of cholinergic contractions in ferret trachea can be transferred between organ baths
Authors: Ullman A , Lofdahl CG , Svedmyr N , Bernsten L , Skoogh BE
Published: November 2022

The influence of the mucosa on the contractile responses to cholinergic nerve stimulation in an in vitro nerve muscle preparation of ferret trachea was studied. Repeated contractions were induced by alternating direct vagal nerve stimulation (DNS) and electrical field stimulation (EFS). With intact mucosa there was a marked successive decrease of the contractile responses. During 60 minutes the responses decreased to 46 +/- 8% of baseline (Mean +/- SEM, n = 6), compared to 86 +/- 2% in preparations, in which the mucosa was initially removed. The mucosa dependent inhibition could be partly blocked by indomethacin (10 microM). The inhibitory effect could be transferred via the bath fluid from a donor preparation with intact mucosa to a recipient preparation with removed mucosa. Fluid transferred from a donor preparation with removed mucosa or from indomethacin treated preparations did not affect the contractile responses in the recipient preparation. We conclude that ferret tracheal mucosa can release a factor which inhibits the contractile responses to cholinergic nerve stimulation. The release of this factor can be blocked to a major part by indomethacin and the factor can be transferred from a donor to a recipient preparation.
The relative responsiveness to inhaled leukotriene E4, methacholine and histamine in normal and asthmatic subjects
Authors: O'Hickey SP , Arm JP , Rees PJ , Spur BW , Lee TH
Published: November 2022

The relative bronchoconstricting potencies of leukotriene E4 (LTE4) methacholine and histamine have been compared in asthmatic and normal subjects. LTE4 responsiveness in asthmatic subjects, as measured by the dose which produced a 35% fall in specific airways conductance (PD35), ranged from 0.06-24.4 nmol (geom mean 4.1 nmol, n = 20). This was significantly less than the PD35 in normal subjects (range 39.0-370 nmol, geom mean 105 nmol, n= 6; p less than 0.001). There was a correlation between LTE4 and methacholine responsiveness (r = 0.84, p less than 0.001) and between LTE4 and histamine responsiveness (r = 0.79, p less than 0.001). LTE4 was 73 times more potent than methacholine and 112 times more potent than histamine in asthmatic subjects. LTE4 was 20 times more potent than methacholine and 58 times more potent than histamine in normal subjects. LTE4 is a potent bronchoconstrictor agent, and LTE4 responsiveness correlates with both histamine and methacholine responsiveness.
Hypoxic ventilatory response and acute mountain sickness
Authors: Milledge JS , Thomas PS , Beeley JM , English JS
Published: November 2022

The acute ventilatory response to hypoxia (HVR) and to hypercapnia (CO2VR) was measured in 32 members of two mountaineering expeditions prior to their departure. Both teams made rapid ascents to their base camps at 5200 m and 4300 m and remained there for at least four days. Symptom scores for acute mountain sickness (AMS) were collected daily for these four days. There was a range of AMS from the unaffected to severe sickness requiring evacuation, but there was no correlation between AMS scores and HVR or CO2VR. When ascent to altitude takes a day or more, HVR (measured at sea level) is probably not the major determinant of ventilation and from our studies does not predict susceptibility to AMS. The rate of respiratory acclimatization is probably more important.
Subclinical alveolar inflammation in rheumatoid arthritis: superoxide anion, neutrophil chemotactic activity and fibronectin generation by alveolar macrophages
Authors: Perez T , Farre JM , Gosset P , Wallaert B , Duquesnoy B , Voisin C , Delcambre B , Tonnel AB
Published: November 2022

Interstitial lung disease (ILD) can be detected by pulmonary function testing (PFT) in 30-40% of rheumatoid arthritis (RA) patients. We assessed by bronchoalveolar lavage (BAL) the patterns of alveolitis in 21 RA patients: group 1 comprised 12 patients without evidence of ILD, and group 29 patients with clinical ILD defined by abnormal pulmonary function tests and/or chest X-ray. Cellular characteristics of BAL were studied in both groups. In addition, alveolar macrophages (AM) from patients in group 1 were isolated, and three parameters of cellular activation were studied: superoxide anion, fibronectin and neutrophil chemotactic activity generation. Total cell counts were not increased in group 1 but significantly increased in group 2 compared to controls. In group 1, 5/12 patients had elevated lymphocyte percentage (greater than 18%) suggesting subclinical lymphocyte alveolitis. In contrast, neutrophil alveolitis (greater than 4%) was found in 7/9 patients in group 2, mean percentage 12.9 +/- 4.2, compared with 1.2 +/- 6.4% in controls and 1.9 +/- 0.5% in group 1. These changes were not correlated with disease duration nor rheumatoid factor titres. Marked elevation of lymphocyte percentage was observed in patients with abnormal serum beta-2-microglobulin. Alveolar macrophages from group 1 patients released increased amounts of superoxide anion (7260 +/- 2700 vs controls 850 +/- 120 URL/5.10(5) cells), neutrophil chemotactic activity (21 +/- 4.8 vs controls 8.1 +/- 0.7 cells/HPF), and fibronectin (6.1 +/- 1.6 vs controls 1.3 +/- 0.2 ng.10(6) cells/hour). Whether or not lymphocyte alveolitis and/or AM dysfunction are pathogenic mechanisms of subsequent interstitial lung disease in patients who are still free of symptoms remains to be determined.
Diabetes mellitus, plasma glucose and lung function in a cross-sectional population study
Authors: Lange P , Groth S , Kastrup J , Mortensen J , Appleyard M , Nyboe J , Jensen G , Schnohr P
Published: November 2022

To assess possible associations between diabetes mellitus (DM), plasma glucose, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), we analysed the results from a cross-sectional study of 11,763 subjects. The subjects were 20 yrs of age or older and were representative of the population of Copenhagen City. Two hundred and eighty four of the participants had DM as assessed by questionnaire. One hundred and seven subjects who did not report having DM had a plasma concentration of glucose higher than or equal to 11.1 mmol.l-1. In all age groups of diabetic subjects there was a slight impairment of lung function. It was more prominent in diabetic subjects treated with insulin than in subjects treated with oral hypoglycaemic agents and/or diet. Even in subjects without known DM, there was a significant association between reduction in lung function and raised plasma glucose concentration. On average, FVC (and FEV1) was reduced by 334 ml (and 239 ml) in diabetic subjects treated with insulin, and by 184 ml (and 117 ml) in diabetic subjects treated with hypoglycaemic agents and/or diet compared to control subjects.
The bronchodilator response from inhaled terbutaline is influenced by the mass of small particles: a study on a dry powder inhaler (Turbuhaler)
Authors: Persson G , Wiren JE
Published: November 2022

This study was carried out to investigate if particles approximately less than 5 microns are optimal when delivered from a dry powder inhaler. It was performed as a cumulative dose response study of twelve asthmatic adults. Three different versions of a dry powder inhaler, Bricanyl Turbuhaler, were studied. Each inhaler delivered 0.5 mg of pure terbutaline sulphate with each dose. Out of this 0.5 mg, they delivered 90 micrograms, 40 micrograms and 5 micrograms, respectively, of particles approximately less than 5 microns with each dose at an inspiratory flow rate of 28 l.min-1. Terbutaline 0.5 mg, 0.5 mg, 1.0 mg and 2.0 mg was inhaled with a 30 min interval between the doses. Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were measured 5 and 20 min after each dose. The bronchodilator response was greater with the inhaler delivering 90 micrograms of small particles with each dose than with the inhaler delivering 5 micrograms, thus confirming the importance of small (approximately less than 5 microns) particles.
Thoracoscopic closure of distal bronchopleural fistulas, using tissue glue
Authors: Aasebo U
Published: November 2022

Three patients with distal bronchopleural fistulas, in whom chest tube and drainage did not lead to closure of the fistulas, were successfully treated with tissue glue (Histoacryl), delivered through a thoracoscope. The fistulas were identified by injecting methylene blue through the suction canal of a fibreoptic bronchoscope. Patient 1 had multiple fistulas, needed several treatment sessions, and the effect lasted for 18 months, after which the fistulas recurred. The other two patients showed no sign of recurrence of the fistulas; in one patient until death from other causes after 4 months; and in the other for a follow-up period of 18 months.
Levomepromazine (Nozinan) reduces nonspecific bronchial hyperreactivity in asthmatics
Authors: Faurschou P , Madsen F , Pals H , Rosetzsky A
Published: November 2022

Ten patients with bronchial asthma were challenged with histamine before and after receiving saline and active drug (levomepromazine or antazoline) (a total of six challenges). The antihistaminic effect of levomepromazine (25 mg) was found to be comparable to that of antazoline (100 mg), evaluated from skin prick tests. Prechallenge forced expiratory volume in one second (FEV1) was found to be larger after levomepromazine than after antazoline (p less than 0.05), indicating a direct bronchodilating effect. This increased threshold airway calibre may have influenced the results of challenge, but change in provocative concentration producing 20% fall (PC20) was not statistically significantly correlated to change in FEV1. Levomepromazine increased PC20 2-doubling concentration compared to antazoline (p less than 0.05). Variation was observed in two minutes' ventilation during tidal volume breathing challenge. However, there was no statistically significant variation in two minutes' ventilation during challenge after receiving levomepromazine or antazoline. It was concluded that levomepromazine possesses a bronchodilating capacity and reduces bronchial hyperreactivity.