Objectives: To assess respiratory elastance and resistive properties in patients with autoimmune liver disorders using the passive relaxation expiration technique and compare findings to a group of patients with non-a...Objectives: To assess respiratory elastance and resistive properties in patients with autoimmune liver disorders using the passive relaxation expiration technique and compare findings to a group of patients with non-autoimmune liver disease and control subjects. These findings were then related to control of ventilation and gas exchange. A secondary objective was to assess respiratory muscle strength and gas exchange and their relation to respiratory mechanics. Methods: Measurements included respiratory elastance and resistance using the passive relaxation method. Pulmonary function, gas exchange and control of ventilation were assessed using standard methods. Results: a) Compared to control subjects, Ers in patients with liver disease was on average 50% greater than in controls;b) mean respiratory resistance, expressed as the respiratory constants, K<sub>1</sub> and K<sub>2</sub> in the Rohrer relationship, Pao/V’ = K<sub>1</sub> + K<sub>2</sub>V’, was not different from control resistance;c) mean maximal inspiratory and maximal expiratory pressures averaged 36% and 55% of their respective control values;d) inspiratory occlusion pressure in 0.1 sec (P<sub>0.1</sub>) was increased and negatively associated with FVC;and e) increases in P<sub>0.1</sub>, mean inspiratory flow (Vt/Ti) and presence of respiratory alkalosis confirmed the increase in ventilatory drive. Despite inspiratory muscle weakness in patients, P<sub>0.1</sub>/Pimax averaged 5-fold higher than in control subjects. Conclusions: Despite inspiratory muscle weakness and a V’<sub>E</sub> similar to that in normal subjects, central drive is increased in patients with chronic liver disease. The increase in ventilatory drive is related to smaller lung volumes and weakly associated with increase in respiratory elastance. Findings confirm that P<sub>0.1</sub> is a reliable measure of central drive and is an approach that can be used in the evaluation of control of ventilation in patients with chronic liver disease.展开更多
Background: The severity of COPD is commonly assessed by the reduction in forced expiratory volume at one second (FEV1), although more recently prognostic factors influencing survival have also incorporated functional...Background: The severity of COPD is commonly assessed by the reduction in forced expiratory volume at one second (FEV1), although more recently prognostic factors influencing survival have also incorporated functional capacity, degree of breathlessness on exertion, and body mass index. Increasingly, the reliability of physiological parameters such as FEV1 to predict patient-centered outcomes has been brought into question. Objectives: To evaluate the relationship between dyspnea as assessed by the Modified Medical Council Dyspnea (MMRC) scale, the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2014) staging and indices of lung hyperinflation and spirometry. Methods: Data were retrospectively analyzed at a 600-bed tertiary care center including spirometry, plethysmographic lung volumes, single breath carbon monoxide diffusion capacity and dyspnea graded according to MMRC, and GOLD staging. Results: Data for 331 patients were analyzed. Differences amongst FEV1, IC, IC/TLC, FRC and RV/TLC were significant between GOLD I/II and GOLD III/IV groups. The closest relationship to GOLD staging was seen with FEV1, FVC and slow vital capacity (SVC). FEV1/FVC, IC, and IC/TLC were inversely associated with MMRC score, while RV/TLC exhibited a positive relation with MMRC score. Conclusions: Indices of lung hyperinflation are closely associated, with dyspnea as assessed by MMRC grading with TLC, RV/TLC and IC exhibiting the closest relations, more so than FEV1. GOLD staging also shows strong correlations with lung volume subdivisions (weakly with TLC), more so than with FEV1. That TLC changed little between GOLD stages can be explained by the presence of collateral interalveolar channels and population characteristics different from those of other studies. These findings further support the concept that more than a reduction in FEV1, lung hyperinflation contributes to the sensation of dyspnea in airflow limitation.展开更多
Background: The breathing intolerance index, BIT, a noninvasive derivation of the tension-time index of respiratory muscles, has been recently used to evaluate patients with respect to their need for noninvasive venti...Background: The breathing intolerance index, BIT, a noninvasive derivation of the tension-time index of respiratory muscles, has been recently used to evaluate patients with respect to their need for noninvasive ventilation. Comparing the BIT index in different disorders with mild to moderate respiratory impairment, such as COPD and obesity, would be useful in determining differences in threshold for respiratory muscle fatigue amongst cohorts. Objectives: The purpose of this study was to compare control of ventilation and BIT in individuals with obesity, chronic obstructive pulmonary disease (COPD), and control subjects free of cardiorespiratory disorders. Because change in posture can alter respiratory load and control of ventilation, variables were assessed in two postures. Methods: We assessed 142 subjects consisting of 81 with obesity, 42 with COPD, and 19 non-smoking healthy adults. All subjects underwent evaluation of pulmonary function, control of ventilation and BIT index [(Ti/Ttot) × (Vt/FVC)] in seated and supine postures. Findings: BIT index was significantly greater in seated posture in all 3 cohorts due primarily to an increase in Vt in this position. BIT index was similar in value amongst cohorts in both postures, but tended to be higher in patients with obesity and COPD. Conclusion: While BIT index is higher in seated posture, and tends to be higher in patients with obesity and COPD as compared to control subjects, discrimination between cohorts is not found in our study because of small inter-group variations of respiratory function amongst cohorts. Thus, in clinically stable patients whose vital capacities are mild to moderately reduced, the BIT index alone cannot be recommended as a predictive guide for initiating assisted ventilation for respiratory failure. Nevertheless, because it is easy to perform, and is comfortably tolerated by patients, its potential usefulness may be in periodic measurements to monitor its increase as respiratory reserve declines.展开更多
<b>Rationale:</b><span style="font-family:""><span style="font-family:Verdana;"> Survival and longevity in patients with cystic fibrosis (CF) have improved with new tre...<b>Rationale:</b><span style="font-family:""><span style="font-family:Verdana;"> Survival and longevity in patients with cystic fibrosis (CF) have improved with new treatments, so that pregnancy can be safely undertaken despite physiologic limitations. Dyspnea still develops in the latter stages of pregnancy. To explain this symptom, we evaluated the effect of pregnancy on lung function before and after delivery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Records of 23 pregnant patients with CF were retrospectively reviewed for data analysis. Spirometry was recorded prior to pregnancy, at first and third trimesters, and every three months following delivery up to one year. Comparisons between time points were adjusted for age and pre-gestational BMI by analysis of variance (ANOVA). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Complete clinical and spirometric data were available for eleven of these patients (13 pregnancies total), obtained between 2009 and 2017. FEV1 and FVC declined significantly from baseline to third trimester (by 8.1%, p < 0.043 and 9.3%, p < 0.013, respectively). No statistically significant differences amongst spirometric values were observed, however, when adjusted for BMI and age over the entire time course. FEV1 and FVC recovered to baseline six months and one year following delivery, respectively. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">The changes in FEV1 and FVC occur as a result of increases in intravascular blood volume and lung water during the third trimester. At the same time</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> FEV1/FVC increases as there is reversal of bronchiolar constriction with elimination of extracellular fluid and lung water. Furthermore, restoration of end-expiratory lung volume post-partum counteracts reversal of air trapping with resolution of peribronchiolar edema, with FVC remaining unchanged. These changes would explain decrease in dyspnea following delivery in CF patients.展开更多
Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives:...Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives: In this retrospective pilot study, we evaluated patients with hematologic and solid malignancies by CPET to determine the primary source of their dyspnea. Methods: Subjects were exercised on a cycle ergometer with increasing workloads. Minute ventilation, heart rate, breathing reserve, oxygen uptake (V’O<sub>2</sub>), O<sub>2</sub>-pulse, ventilatory equivalents for carbon dioxide and oxygen (V’<sub>E</sub>/V’CO<sub>2</sub> and V’<sub>E</sub>/V’O<sub>2</sub>, respectively) were measured at baseline and peak exercise. The slope and intercept for V’<sub>E</sub>/V’CO<sub>2</sub> was computed for all subjects. Peak V’O<sub>2</sub> 4% predicted indicated a circulatory or ventilatory limitation. Results: Complete clinical and physiological data were available for 36 patients (M/F 20/16);32 (89%) exhibited ventilatory or circulatory limitation as shown by a reduced peak V’O<sub>2</sub> and 10 subjects with normal physiologic data. The largest cohort comprised the pulmonary vascular group (n = 18) whose mean ± SD peak V’O<sub>2</sub> was 61% ± 17% predicted. There were close associations between V’O<sub>2</sub> and spirometric values. Peak V’<sub>E</sub>/V’O<sub>2</sub> and V’<sub>E</sub>/V’CO<sub>2</sub> were highest in the circulatory and ventilatory cohorts, consistent with increase in dead space breathing. The intercept of the V’<sub>E</sub>-V’CO<sub>2</sub> relationship was lowest in patients with cardiovascular impairment. Conclusion: Dyspneic patients with malignancies exhibit dead space breathing, many exhibiting a circulatory source for exercise limitation with a prominent pulmonary vascular component. Potential factors include effects of chemo- and radiation therapy on cardiac function and pulmonary vascular endothelium.展开更多
<b>Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Tidal expiratory flow limitation (tEFL) is defined as absence of increase...<b>Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Tidal expiratory flow limitation (tEFL) is defined as absence of increase in air flow during forced expiration compared to tidal breathing and is related to dyspnea at rest and minimal exertion in patients with chronic airflow limitation (CAL). Tidal EFL has not been expressed as a continuous variable (0% - 100%) in previous analyses. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To relate the magnitude of tEFL to spirometric values and Modified Medical Research Council (MMRC) score and Asthma Control Test (ACT). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Tidal EFL was computed as percent of the tidal volume (0% - 100%) spanned (intersected) by the forced expiratory-volume curve. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Of 353 patients screened, 192 (114 M, 78 F) patients (136 with COPD, 56 with asthma) had CAL. Overall characteristics: (mean ± SD) age 59 ± 11 years, BMI 28 ± 7, FVC (% pred) 85 ± 20, FEV1 (% pred) 66 ± 21, FEV1/FVC 55% ± 10%, RV (% pred) 147 ± 42. Tidal EFL in patients with tEFL was 53% ± 39%. Using univariate analysis, strongest correlations were between tEFL and FVC and between tEFL and RV in patients with BMI < 30 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;">. In patients with nonreversible CAL, tEFL was positively associated with increasing MMRC, negatively with spirometric measurements, and positively with RV/TLC. In asthmatics, ACT scores were higher in patients with mean BMI ≥ 28 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> (p < 0.00014) and RV/TLC values > 40% (p < 0.03). </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Dyspnea is strongly associated with tEFL and lung function, particularly in patients with nonreversible CAL. Air trapping and </span><span style="font-family:Verdana;">BMI contribute to tEFL.展开更多
Pneumoscrotum is a rare condition described as the accumulation of air within the scrotum. We report the case of a patient with acquired immune deficiency syndrome (AIDS) with Pneumocystis jirovecii pneumonia who deve...Pneumoscrotum is a rare condition described as the accumulation of air within the scrotum. We report the case of a patient with acquired immune deficiency syndrome (AIDS) with Pneumocystis jirovecii pneumonia who developed a secondary pneumoscrotum as a complication of volutrauma from mechanical ventilation.展开更多
Background: Forced expiratory volume 1 second (FEV1) has traditionally been used as a readily available marker of health in adult cystic fibrosis (CF). However, due to the obstructive nature of this disease, it is pos...Background: Forced expiratory volume 1 second (FEV1) has traditionally been used as a readily available marker of health in adult cystic fibrosis (CF). However, due to the obstructive nature of this disease, it is possible that lung hyperinflation could be more closely related to disease severity than is FEV1. The purpose of this study was to determine if hyperinflation is more closely associated with quality of life, functional status, and pulmonary exacerbations than FEV1 in patients with CF. Methods: Sixty-eight adult patients with CF were evaluated in this retrospective study. We used IC and functional residual capacity (FRC) and their ratios to total lung capacity (TLC) as measures of lung hyperinflation. We used bivariate correlations and backwards regression analysis to assess possible associations between FEV1, lung hyperinflation, and measures of disease severity including questionnaire based quality of life, pulmonary exacerbation frequency, and mortality. The respiratory component of the Cystic Fibrosis Questionnaire–Revised (CRQ-R-Respiratory) was used as a measure of quality of life. Results: Both FEV1 and IC were negatively correlated with pulmonary exacerbations over a 3 year period (p = 0.004, r2 = 0.127;p < 0.001, r2 = 0.307, respectively), while FRC/TLC correlated positively with exacerbations (p = 0.007). Backwards regression analysis showed that among pulmonary function variables, IC had the strongest relationship with exacerbations over 3 years. A lower CFQ-R-Respiratory score was associated with greater mortality (p = 0.005). However, no statistically significant relationships were found between lung function and mortality. Conclusions: FEV1 and lung hyperinflation-as measured by IC and FRC/TLC-are both associated with pulmonary exacerbation frequency. This suggests that chronic dynamic hyperinflation contributes significantly to disease severity in adult cystic fibrosis.展开更多
文摘Objectives: To assess respiratory elastance and resistive properties in patients with autoimmune liver disorders using the passive relaxation expiration technique and compare findings to a group of patients with non-autoimmune liver disease and control subjects. These findings were then related to control of ventilation and gas exchange. A secondary objective was to assess respiratory muscle strength and gas exchange and their relation to respiratory mechanics. Methods: Measurements included respiratory elastance and resistance using the passive relaxation method. Pulmonary function, gas exchange and control of ventilation were assessed using standard methods. Results: a) Compared to control subjects, Ers in patients with liver disease was on average 50% greater than in controls;b) mean respiratory resistance, expressed as the respiratory constants, K<sub>1</sub> and K<sub>2</sub> in the Rohrer relationship, Pao/V’ = K<sub>1</sub> + K<sub>2</sub>V’, was not different from control resistance;c) mean maximal inspiratory and maximal expiratory pressures averaged 36% and 55% of their respective control values;d) inspiratory occlusion pressure in 0.1 sec (P<sub>0.1</sub>) was increased and negatively associated with FVC;and e) increases in P<sub>0.1</sub>, mean inspiratory flow (Vt/Ti) and presence of respiratory alkalosis confirmed the increase in ventilatory drive. Despite inspiratory muscle weakness in patients, P<sub>0.1</sub>/Pimax averaged 5-fold higher than in control subjects. Conclusions: Despite inspiratory muscle weakness and a V’<sub>E</sub> similar to that in normal subjects, central drive is increased in patients with chronic liver disease. The increase in ventilatory drive is related to smaller lung volumes and weakly associated with increase in respiratory elastance. Findings confirm that P<sub>0.1</sub> is a reliable measure of central drive and is an approach that can be used in the evaluation of control of ventilation in patients with chronic liver disease.
文摘Background: The severity of COPD is commonly assessed by the reduction in forced expiratory volume at one second (FEV1), although more recently prognostic factors influencing survival have also incorporated functional capacity, degree of breathlessness on exertion, and body mass index. Increasingly, the reliability of physiological parameters such as FEV1 to predict patient-centered outcomes has been brought into question. Objectives: To evaluate the relationship between dyspnea as assessed by the Modified Medical Council Dyspnea (MMRC) scale, the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2014) staging and indices of lung hyperinflation and spirometry. Methods: Data were retrospectively analyzed at a 600-bed tertiary care center including spirometry, plethysmographic lung volumes, single breath carbon monoxide diffusion capacity and dyspnea graded according to MMRC, and GOLD staging. Results: Data for 331 patients were analyzed. Differences amongst FEV1, IC, IC/TLC, FRC and RV/TLC were significant between GOLD I/II and GOLD III/IV groups. The closest relationship to GOLD staging was seen with FEV1, FVC and slow vital capacity (SVC). FEV1/FVC, IC, and IC/TLC were inversely associated with MMRC score, while RV/TLC exhibited a positive relation with MMRC score. Conclusions: Indices of lung hyperinflation are closely associated, with dyspnea as assessed by MMRC grading with TLC, RV/TLC and IC exhibiting the closest relations, more so than FEV1. GOLD staging also shows strong correlations with lung volume subdivisions (weakly with TLC), more so than with FEV1. That TLC changed little between GOLD stages can be explained by the presence of collateral interalveolar channels and population characteristics different from those of other studies. These findings further support the concept that more than a reduction in FEV1, lung hyperinflation contributes to the sensation of dyspnea in airflow limitation.
文摘Background: The breathing intolerance index, BIT, a noninvasive derivation of the tension-time index of respiratory muscles, has been recently used to evaluate patients with respect to their need for noninvasive ventilation. Comparing the BIT index in different disorders with mild to moderate respiratory impairment, such as COPD and obesity, would be useful in determining differences in threshold for respiratory muscle fatigue amongst cohorts. Objectives: The purpose of this study was to compare control of ventilation and BIT in individuals with obesity, chronic obstructive pulmonary disease (COPD), and control subjects free of cardiorespiratory disorders. Because change in posture can alter respiratory load and control of ventilation, variables were assessed in two postures. Methods: We assessed 142 subjects consisting of 81 with obesity, 42 with COPD, and 19 non-smoking healthy adults. All subjects underwent evaluation of pulmonary function, control of ventilation and BIT index [(Ti/Ttot) × (Vt/FVC)] in seated and supine postures. Findings: BIT index was significantly greater in seated posture in all 3 cohorts due primarily to an increase in Vt in this position. BIT index was similar in value amongst cohorts in both postures, but tended to be higher in patients with obesity and COPD. Conclusion: While BIT index is higher in seated posture, and tends to be higher in patients with obesity and COPD as compared to control subjects, discrimination between cohorts is not found in our study because of small inter-group variations of respiratory function amongst cohorts. Thus, in clinically stable patients whose vital capacities are mild to moderately reduced, the BIT index alone cannot be recommended as a predictive guide for initiating assisted ventilation for respiratory failure. Nevertheless, because it is easy to perform, and is comfortably tolerated by patients, its potential usefulness may be in periodic measurements to monitor its increase as respiratory reserve declines.
文摘<b>Rationale:</b><span style="font-family:""><span style="font-family:Verdana;"> Survival and longevity in patients with cystic fibrosis (CF) have improved with new treatments, so that pregnancy can be safely undertaken despite physiologic limitations. Dyspnea still develops in the latter stages of pregnancy. To explain this symptom, we evaluated the effect of pregnancy on lung function before and after delivery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Records of 23 pregnant patients with CF were retrospectively reviewed for data analysis. Spirometry was recorded prior to pregnancy, at first and third trimesters, and every three months following delivery up to one year. Comparisons between time points were adjusted for age and pre-gestational BMI by analysis of variance (ANOVA). </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Complete clinical and spirometric data were available for eleven of these patients (13 pregnancies total), obtained between 2009 and 2017. FEV1 and FVC declined significantly from baseline to third trimester (by 8.1%, p < 0.043 and 9.3%, p < 0.013, respectively). No statistically significant differences amongst spirometric values were observed, however, when adjusted for BMI and age over the entire time course. FEV1 and FVC recovered to baseline six months and one year following delivery, respectively. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">The changes in FEV1 and FVC occur as a result of increases in intravascular blood volume and lung water during the third trimester. At the same time</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> FEV1/FVC increases as there is reversal of bronchiolar constriction with elimination of extracellular fluid and lung water. Furthermore, restoration of end-expiratory lung volume post-partum counteracts reversal of air trapping with resolution of peribronchiolar edema, with FVC remaining unchanged. These changes would explain decrease in dyspnea following delivery in CF patients.
文摘Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives: In this retrospective pilot study, we evaluated patients with hematologic and solid malignancies by CPET to determine the primary source of their dyspnea. Methods: Subjects were exercised on a cycle ergometer with increasing workloads. Minute ventilation, heart rate, breathing reserve, oxygen uptake (V’O<sub>2</sub>), O<sub>2</sub>-pulse, ventilatory equivalents for carbon dioxide and oxygen (V’<sub>E</sub>/V’CO<sub>2</sub> and V’<sub>E</sub>/V’O<sub>2</sub>, respectively) were measured at baseline and peak exercise. The slope and intercept for V’<sub>E</sub>/V’CO<sub>2</sub> was computed for all subjects. Peak V’O<sub>2</sub> 4% predicted indicated a circulatory or ventilatory limitation. Results: Complete clinical and physiological data were available for 36 patients (M/F 20/16);32 (89%) exhibited ventilatory or circulatory limitation as shown by a reduced peak V’O<sub>2</sub> and 10 subjects with normal physiologic data. The largest cohort comprised the pulmonary vascular group (n = 18) whose mean ± SD peak V’O<sub>2</sub> was 61% ± 17% predicted. There were close associations between V’O<sub>2</sub> and spirometric values. Peak V’<sub>E</sub>/V’O<sub>2</sub> and V’<sub>E</sub>/V’CO<sub>2</sub> were highest in the circulatory and ventilatory cohorts, consistent with increase in dead space breathing. The intercept of the V’<sub>E</sub>-V’CO<sub>2</sub> relationship was lowest in patients with cardiovascular impairment. Conclusion: Dyspneic patients with malignancies exhibit dead space breathing, many exhibiting a circulatory source for exercise limitation with a prominent pulmonary vascular component. Potential factors include effects of chemo- and radiation therapy on cardiac function and pulmonary vascular endothelium.
文摘<b>Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Tidal expiratory flow limitation (tEFL) is defined as absence of increase in air flow during forced expiration compared to tidal breathing and is related to dyspnea at rest and minimal exertion in patients with chronic airflow limitation (CAL). Tidal EFL has not been expressed as a continuous variable (0% - 100%) in previous analyses. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To relate the magnitude of tEFL to spirometric values and Modified Medical Research Council (MMRC) score and Asthma Control Test (ACT). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Tidal EFL was computed as percent of the tidal volume (0% - 100%) spanned (intersected) by the forced expiratory-volume curve. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Of 353 patients screened, 192 (114 M, 78 F) patients (136 with COPD, 56 with asthma) had CAL. Overall characteristics: (mean ± SD) age 59 ± 11 years, BMI 28 ± 7, FVC (% pred) 85 ± 20, FEV1 (% pred) 66 ± 21, FEV1/FVC 55% ± 10%, RV (% pred) 147 ± 42. Tidal EFL in patients with tEFL was 53% ± 39%. Using univariate analysis, strongest correlations were between tEFL and FVC and between tEFL and RV in patients with BMI < 30 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;">. In patients with nonreversible CAL, tEFL was positively associated with increasing MMRC, negatively with spirometric measurements, and positively with RV/TLC. In asthmatics, ACT scores were higher in patients with mean BMI ≥ 28 kg/m</span><sup><span style="font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> (p < 0.00014) and RV/TLC values > 40% (p < 0.03). </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Dyspnea is strongly associated with tEFL and lung function, particularly in patients with nonreversible CAL. Air trapping and </span><span style="font-family:Verdana;">BMI contribute to tEFL.
文摘Pneumoscrotum is a rare condition described as the accumulation of air within the scrotum. We report the case of a patient with acquired immune deficiency syndrome (AIDS) with Pneumocystis jirovecii pneumonia who developed a secondary pneumoscrotum as a complication of volutrauma from mechanical ventilation.
文摘Background: Forced expiratory volume 1 second (FEV1) has traditionally been used as a readily available marker of health in adult cystic fibrosis (CF). However, due to the obstructive nature of this disease, it is possible that lung hyperinflation could be more closely related to disease severity than is FEV1. The purpose of this study was to determine if hyperinflation is more closely associated with quality of life, functional status, and pulmonary exacerbations than FEV1 in patients with CF. Methods: Sixty-eight adult patients with CF were evaluated in this retrospective study. We used IC and functional residual capacity (FRC) and their ratios to total lung capacity (TLC) as measures of lung hyperinflation. We used bivariate correlations and backwards regression analysis to assess possible associations between FEV1, lung hyperinflation, and measures of disease severity including questionnaire based quality of life, pulmonary exacerbation frequency, and mortality. The respiratory component of the Cystic Fibrosis Questionnaire–Revised (CRQ-R-Respiratory) was used as a measure of quality of life. Results: Both FEV1 and IC were negatively correlated with pulmonary exacerbations over a 3 year period (p = 0.004, r2 = 0.127;p < 0.001, r2 = 0.307, respectively), while FRC/TLC correlated positively with exacerbations (p = 0.007). Backwards regression analysis showed that among pulmonary function variables, IC had the strongest relationship with exacerbations over 3 years. A lower CFQ-R-Respiratory score was associated with greater mortality (p = 0.005). However, no statistically significant relationships were found between lung function and mortality. Conclusions: FEV1 and lung hyperinflation-as measured by IC and FRC/TLC-are both associated with pulmonary exacerbation frequency. This suggests that chronic dynamic hyperinflation contributes significantly to disease severity in adult cystic fibrosis.
