Evolution of nocturnal pulse-oximetry results in patients with chronic obstructive pulmonary disease

The aim of this study was to evaluate if results of overnight pulse-oximetry (PO) change with time and progression of the disease. We studied 39 COPD patients. Majority of them (33 pts) were treated with long-term oxygen therapy (LTOT). Fifty pairs of PO were performed in the whole group separated from 1 to more than 3 years. Pulmonary function tests were performed at the same time as PO. Results of these tests showed progressive deterioration in the lung function-decrease of FEV1 and PaO2. Despite of that there were no statistically significant changes in any variable of PO in any studied group. This phenomenon is difficult to explain. It may resulted from the improvement in the cardiac output observed in COPD patient undergoing LTOT. May be that studied groups were not large enough or time of observation was too short to reveal differences. Stabilization of PO results in spite of deterioration in the lung function in COPD patients needs more studies.     

Predictors of functioning of patients with chronic obstructive pulmonary disease

The subcellular distribution of soluble and membrane-bound Arg-beta-naphthylamide-hydrolyzing activities was studied in the left and right rat brain during development and aging. During development, the soluble activity was heterogeneous, whereas adult animals showed the highest activity in the synaptosomal fraction. However, except in fetuses, membrane-bound activity was greatest in the microsomal fraction. Except in microsomal and myelin fractions, soluble and membrane-bound activities showed a decrease in 1-wk-old rats compared with fetuses and a subsequent increase to adult levels in 1-mo-old rats. This profile differed in the microsomal fraction, which increased steadily throughout development. In the synaptosomal fraction, both activities were lower in 24-mo-old rats than in 5-mo-old animals. No differences between the hemispheres were observed in soluble or membrane-bound fractions at any age tested.     

Prognostic value of hypercapnia in patients with chronic respiratory failure during long-term oxygen therapy

Hypercapnia observed in patients with chronic respiratory failure may not be an ominous sign for prognosis when they are receiving long-term oxygen therapy (LTOT). In this study, we selected 4,552 patients with chronic obstructive pulmonary disease (COPD) and 3,028 with sequelae of pulmonary tuberculosis (TBsq) receiving LTOT from 1985 to 1993 throughout Japan and prospectively analyzed their prognoses. The hypercapnic patients (PaCO2 >= 45 mm Hg) had a better prognosis than the normocapnic patients (35 <= PaCO2 < 45 mm Hg) for TBsq, but no difference was found between the two groups with COPD. Furthermore, Cox's proportional hazards model revealed that in TBsq hypercapnia was an independent factor for favorable prognosis, and that the relative risk for mortality was 0.76 in patients with 45 <= PaCO2 < 55 mm Hg, 0.64 for those with 55 <= PaCO2 < 65 mm Hg, and 0. 49 for patients with PaCO2 >= 65 mm Hg against normocapnic patients. This favorable effect of hypercapnia in TBsq was particularly apparent in the patients without severe airway obstruction. Even a rise of 5 mm Hg or more in PaCO2 over the initial 6- to 18-mo follow-up period was not associated with poor prognosis in TBsq, although it was in COPD. From these findings, we conclude that hypercapnia should not be generally considered an ominous sign for prognosis in those patients who receive LTOT.     

Relationships between blood oxygen parameters in patients with chronic obstructive lung disease

The hemoglobin-oxygen dissociation curve and the relationships between the parameters of tension, saturation, capacity, affinity and concentration of oxygen in the course of respiratory failure in chronic obstructive lung diseases (COLD) were studied. The study included 141 patients divided into four basic groups according to the value of pO2 (a): patients with normoxia, mild, moderate and severe arterial hypoxia. The blood-gas status was determined using the ABL-330 and OSM-3 analyzers (Radiometer A/S, Denmark). It is concluded that: 1. Presence of normoxia (pO2 and sO2 in norm) in COLD patients does not exclude abnormalities in their arterial blood oxygen transport and increased risk of tissue hypoxia. 2. Total oxygen concentration in respiratory failure is relatively stable and "independent" from the stepwise decrease of the arterial pO2, which results from the compensatory increase of the total and effective hemoglobin. 3. There are phase fluctuations of the ctO2/pO2 dissociation curve in the reference interval, expressed in the "lowering" of P50 and p90 in mild hypoxia and the "centering" or "raising" of their values in severe hypoxia. Such fluctuations are more pronounced in the p90 than in the p50. 4. The oxygen extraction tension lowers progressively (without reaching the anaerobic threshold) and the oxygen compensation factor elevates with the pO2 (a) reduction and the arising of hypercapnia and acidemia. 5. The calculated 2,3-diphosphoglycerate (2,3-DPG) concentration values are significantly higher in hypercapnics with COHb > 1% than in those with COHb < 1%. The relationships between hypoxia, oxygen affinity, hemoglobinemia and oxygen affinity as well as the dissociation curve properties in chronic respiratory failure are discussed.     

Measurement of respiratory muscle performance in patients with chronic obstructive pulmonary disease

Respiratory muscle performance is measured in terms of strength and endurance. A RMSE-1 type measuring system for evaluation of respiratory muscle strength (RMS) and endurance (RME) has been developed and tested in normal subjects and patients with stable chronic obstructive pulmonary disease (COPD). The results showed that there was no significant difference between normal subjects and stable COPD patients in RMS measured as maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). The maximum load (Load(m)), mean mouth pressure at maximum load (Pmean), and the maximum sustainable inspiratory pressure (SIP(m)) as % MIP (SIP(m)/MIP) were taken as measure of RME. All measures of RME in COPD group were much lower than those in the normal. The measurement of RME can be used to evaluate the effect of respiratory muscle training and direct the respiratory rehabilitation in COPD patients.     

Exercise and oxygen inhalation in relation to prognosis of chronic obstructive pulmonary disease

We examined the relationship between prognosis and arterial blood gases during exercise and 100 percent oxygen inhalation in 54 patients randomly selected from 119 background patients with chronic obstructive pulmonary disease (COPD). Light exercise was performed and 100 percent oxygen was inhaled during clinically stable stages. By four years after these tests, 19/54 patients had died from respiratory failure. All subjects had similar physical and clinical features. Survivors had significantly higher PaO2 during air breathing than nonsurvivors; in nonsurvivors, FEV1 and MVV were significantly lower, and heart rate and RV/TLC were significantly higher. Exercise PaO2 of nonsurvivors decreased by 6.7 mm Hg, whereas that of survivors did not change. The P(A--a)O2 did not change in survivors and nonsurvivors during exercise, but in survivors it was significantly smaller. Mean PaO2 after 100 percent oxygen was significantly lower, and PaCO2 was significantly higher in nonsurvivors than in survivors, and in nonsurvivors the increase in PaO2 during 100 percent oxygen correlated positively with the time between first admission and death. These results indicate that patients with combination of resting arterial hypoxemia, worsened hypoxemia during stepped-up exercise, and lesser degree of arterial oxygenation and increased PaCO2 during 100 percent oxygen inhalation may have a poor prognosis.     

Quality of life in patients with chronic obstructive pulmonary disease and bronchial asthma

Review of data in the literature on the quality of life and its assessment in chronic obstructive lung disease and in bronchial asthma. The authors mention the most frequently used types of questionnaires and results achieved when using them. General questionnaires include the Sickness Impact Profile or the short version of a very detailed questionnaire which has 36 questions with sub-questions (SF-36 = Short Form-36). Specific questionnaires are focused on certain questions concerning different diseases. These questionnaires include SGRQ (St. George's Respiratory Questionnaire) which is used mainly in chronic obstructive lung disease. For this disease also the CRQ was developed (Chronic Respiratory Questionnaire) but its section on dyspnoea is not standardized. For evaluation of the quality of life of asthmatic patients several questionnaires exist, in particular for children. Several questions call for further standardization. The value of questionnaires is, however, beyond dount. They elucidate the situation which does not ensue even from detailed functional examination of the lungs or immunological examination. It appraises bodily and mental functions of man, restriction of his activity, the sensation of comfort and general evaluation of his health. Thus "classical" evaluation methods are extended by now non-traditional ways of appraisal of diseases which have a high prevalence and thus also great impact in the population.     

Effects of theophylline on respiratory drive in patients with chronic obstructive pulmonary disease

Effects of theophylline administration on the respiratory drive were studied in seven patients with chronic obstructive pulmonary disease (COPD). End tidal CO2 (PetCO2), minute ventilation (Ve), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), oxygen consumption (VO2), carbon dioxide output (VCO2), serum theophylline level (STL), ventilatory response (VeR), and mouth occlusion pressure response (OPR) to rise in PetCO2 on rebreathing were measured before and at 2-hour intervals after oral administration of 5 mg/kg anydrous theophylline or placebo. Mouth occlusion pressure response and VeR showed c significant increase after theophylline but not after placebo. Significant positive correlation between changes (delta) in STL and OPR (delta OPR = 0.025 + 0.8 delta STL; SEE = 1; r = 0.4; P < 0.005) and between STL and VeR (VeR = 0.82 + 0.055 STL +/- SEE = 0.7; r = 0.46; P < 0.01) and an inverse correlation between delta STL and delta PetCO2 (delta PetCO2 = 13.8 - 0.59 delta STL; SEE = 9.1; r = 0.61; P < 0.001) were noted. There was no correlation between the indices of respiratory drive and FEV1, Ve, VO2, or VCO2. It is concluded that theophylline increases respiratory drive in clinically employed doses independently of its bronchodilator or metabolic effects.     

Respiratory effects of pharingeal gas insufflation in patients with chronic obstructive pulmonary disease

In the cranio-facial region the giant-cell reparative granuloma (GCRG) is a typical lesion of the maxillary bones. Because giant-cell reparative granuloma is not strictly a granuloma, clinically and histologically, many authors prefer call it giant-cell lesion (GCL). A review of the literature have along with our experiences is reported. Authors present 17 patients with giant-cell lesion and their results, treated at the Maxillo-Facial Department of Parma. Clinical, radiographic and pathologic features were evaluated and differential diagnosis was considered, showing the real great difficulty in differential diagnosis also and especially for surgical treatment.     

Patterns of hospitalization in elderly patients with asthma and chronic obstructive pulmonary disease

The purpose of this study was to describe the impact of asthma and chronic obstructive pulmonary disease (COPD) in the elderly on health care utilization. The Health Care Financing Administration (HCFA) file for the year 1984 through 1991 involving beneficiaries < or = 65 yr were searched for the diagnoses of asthma and COPD by ICD-9 codes. The study groups were created by determining the first admission for an exacerbation of either disease during each year from 1984 through 1991. Patients were identified by their social security number. The 1984 cohort consisted of 56,692 patients with asthma exacerbation and 162,899 with COPD exacerbation. The 1991 cohort consisted of 67,758 patients with asthma exacerbation and 131,974 patients with COPD exacerbation. In addition, the 1984 cohort was tracked by social security number for evidence of rehospitalization for either asthma or COPD through 1991. Length of hospitalization increased as patients grew older. The discharge rate to an independent living facility diminished as age increased. The use of convalescent and nursing homes or home health care after discharge more than doubled from 1984 through 1991. The utilization of health care resources by elderly patients with asthma and COPD is immense, both during hospitalization and after discharge.     

Effect of flurenizide on adaptive reactions in patients with chronic obstructive pulmonary disease

Studies on the wake-sleep cycle with participation of eight female volunteers were performed before, during, and after a 120-day bed rest with the head-end of bed tilted down at 6 degrees (HDT). Methods of polysomnography and actography were applied. The test-subjects were assigned into 2 groups. Group A was prescribed to use countermeasures throughout the experiment; no countermeasures was administered by group B. Evidence of significant alteration in sleep structure at different time points in HDT is given in comparison with data about females of the control group under the conditions of everyday activity. Sleep deviations in the subjects were reordered at each of the three points of investigation and differed from those in control. HDT was shown to modify the sleep structure in experimental groups A and B. A supposition is made that under these conditions the dynamics of physical activity during night sleep had an adaptive character.     

Functional outcome of patients with chronic obstructive pulmonary disease and exercise hypercapnia

Chronic hypercapnia is associated with a poor prognosis in chronic obstructive pulmonary disease (COPD). Some patients are normocapnic at rest but retain CO2 during exercise. The significance of this abnormality on the course of the disease is unknown. Sixteen stable COPD patients (13 males and 3 females, aged 60 +/- 5 yrs, mean +/- SD) who had previously undergone pulmonary function tests and progressive exercise testing with arterial blood sampling at rest and maximal capacity, entered the study. At first evaluation (E1), subjects were normocapnic at rest (arterial carbon dioxide tension (Pa,CO2): 4.9-5.7 kPa, (37-43 mmHg)) and all presented exercise-induced hypercapnia (end-exercise Pa,CO2 > 5.7 kPa (43 mmHg) with a minimal 0.5 kPa (4 mmHg) increase from resting value). The subjects were re-evaluated 24-54 months later (34 +/- 8 months) (second evaluation (E2)). At E2, forced expiratory volume in one second (FEV1) had decreased from 42 +/- 13 to 38 +/- 15% of predicted values, and mean resting Pa,CO2 had increased from 5.2 +/- 0.3 to 5.7 + 0.4 kPa. Maximal exercise capacity (Wmax) decreased between E1 and E2 from 76 +/- 30 to 56 +/- 22 W. Even if Wmax was lower at E2, end-exercise, Pa,CO2 was higher than at E1 (6.6 +/- 0.8 vs 6.4 +/- 0.5 kPa). At E2, eight subjects presented resting hypercapnia (group H), whilst the others remained normocapnic (Group N). Group H subjects had higher Pa,CO2, at Wmax than Group N and lower Wmax than Group N at E2.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pharmacotherapy of chronic obstructive pulmonary disease

Despite a significant reduction in cigarette consumption, chronic obstructive pulmonary disease continues to be an important cause of mortality in the United States. COPD is characterized by progressive airflow obstruction which is punctuated by acute exacerbations. Nicotine substitution and use of bupropion have been shown to double long-term smoking cessation success. The combination of albuterol and ipratropium bromide produces a synergistic beneficial effect on pulmonary function and symptoms. Long-acting inhaled beta 2-agonists improve symptoms better than as needed albuterol. Oral corticosteroids appear to be helpful during acute exacerbations; however, the chronic use of steroids benefits only a minority of patients. Broad- spectrum antibiotics are indicated during acute exacerbations if there is increased sputum volume and purulence. System-oriented administration of pneumococcal and influenza vaccinations is more successful than provider or client-oriented approaches.     

Radiology of chronic obstructive pulmonary disease

This article reviews the radiologic manifestations and complications of chronic obstructive pulmonary disease, particularly those seen in association with emphysema. Current concepts on the pathogenesis of chronic obstructive pulmonary disease are discussed and related to findings on high-resolution CT scan and histologic examinations. Controversial issues concerning the detection and grading of emphysema using radiologic and physiologic tests are also addressed.     

Controlled expiration in mechanically-ventilated patients with chronic obstructive pulmonary disease (COPD)

In patients with severe chronic obstructive pulmonary disease (COPD), lung emptying may be affected by flow limitation. We tested the hypothesis that the airway compression leading to flow limitation can be counteracted by controlling the expiratory flow. The effects of an external resistor on lung emptying were studied in six patients with COPD, who were mechanically ventilated whilst sedated and paralysed. Respiratory mechanics were obtained during ventilatory support with and without the resistor. Airway compression was assessed using the interruptor method. For the study, a turbulent resistor was applied with the highest resistance level that did not increase the end-expiratory lung volume. At this resistance level, external positive end-expiratory pressure (PEEP) was generated in all patients. As total PEEP levels remained unchanged at both settings during the controlled expiration, the levels of intrinsic PEEP were significantly decreased from 0.96+/-0.30 to 0.53+/-0.19 kPa (mean+/-SD). Comparison of the expiratory flow-volume curves at both settings revealed that, during the controlled expiration, the flows were significantly decreased during the first 40% of the expired volume and significantly increased during the last 60%. As the end-expiratory lung volumes remained unchanged during both settings, these increments in flow indicated a decrease in effective resistance. Airway compression was observed during unimpeded expirations in all patients using the interruptor method. During the application of the resistor, airway compression was no longer detectable. In patients with chronic obstructive pulmonary disease receiving ventilatory support, the application of an external resistor could decrease effective expiratory resistance by counteracting airway compression, without increments in end-expiratory lung volume.     

Functional performance in people with chronic obstructive pulmonary disease

The extent to which individuals with a chronic physical illness perform their day-to-day activities and maintain the independence and autonomy they desire is both an indicator of adaptation and an important clinical outcome criterion. Yet the concept of functional performance is not well understood. Studies of people with chronic obstructive pulmonary disease (COPD) have attempted to identify physiologic and psychosocial factors that contribute to functioning in this population. These studies have used a melange of terms, including functional status, functional ability, quality of life, and health status interchangeably. They have also employed a variety of instruments to operationalize functional performance and an assortment of predictors to understand the phenomena. Perhaps as a result of this disarray, no attempt has been made to synthesize the literature for nursing research and practice. The purpose of this paper is to summarize the research on functional performance in people with COPD, indicate areas of understanding and quandary, suggest possible flaws, and propose several new directions for practice and research.