Maximal degree of airway narrowing induced by methacholine and adenosine monophosphate: relationship with the decrease in forced vital capacity.

Background Changes in forced vital capacity (FVC) may represent an indirect method for the detection of plateau in response to inhaled bronchoconstrictor agents. Objective To determine the relationship between the level of plateau obtained with either methacholine or adenosine monophosphate (AMP) and the decrease in FVC induced by each bronchoconstrictor agent. Methods Airway responsiveness to high concentrations of methacholine and AMP was determined in patients with intermittent asthma (n = 41) or allergic rhinitis (n = 26). Furthermore, allergen-induced changes in the response to each bronchoconstrictor agent were investigated in 18 pollen-sensitive patients. Concentration-response curve…

Repercusión funcional de la pleurodesis con tetraciclinas en el neumotórax espontáneo

Efectuamos un estudio comparativo de funcion pulmonar en individuos afectos de neumotorax espontaneo primario y sometidos a distinta opcion terapeutica. El grupo 1 fue tratado con reposo y oxigenoterapia. El grupo 2 fue sometido a drenaje toracico. En el grupo 3 se realizo toracoscopia y pleurodesis con clorhidrato de tetraciclina. Los grupos 1 y 2 no presentaron diferencias significativas con sus valores teoricos expresados en cifras absolutas en ninguna de las determinaciones. En el grupo 3 no hubieron diferencias significativas en FVC, FEV 1 , FEV 1 ,/FVC, FEF 25-75, MEF 25, MEF 50, TLC y DCO con respecto a sus valores teoricos, a excepcion de RV (p Concluimos que la pleurodesis con tetr…

Importance of noninvasively measured respiratory muscle overload among the causes of hospital readmission of COPD patients.

To evaluate the influence of respiratory muscle overload and right cardiac overload among the possible risk factors of hospital readmission in a 1-year follow-up of a cohort of patients with moderate-to-severe COPD.A total of 112 COPD patients who were admitted consecutively to the hospital for acute exacerbation. At hospital discharge, we evaluated the conventional clinical and functional determinations in addition to the pressure-time index (PTI), which is obtained using the equation PTI = (Pawo/Pimax) x (Ti/Ttot) x 100, where Pawo represents the mean airway pressure measured at the mouth during spontaneous breathing, Pimax is the maximal inspiratory pressure, Ti is the inspiratory time, …

Kyphoscoliosis ventilatory insufficiency: noninvasive management outcomes.

Objective: To determine the effects on symptoms, pulmonary function, sleep, and other clinical variables of treating kyphoscoliosis-associated chronic alveolar hypoventilation with nocturnal nasal ventilation. Design: Sixteen patients with kyphoscoliosis were treated with nocturnal nasal ventilation delivered by volume-cycled (seven patients) and pressure-cycled (nine patients) ventilators. Dyspnea, morning headaches, fatigue, hypersomnolence, and perceived sleep quality were assessed. Results: All pretreatment symptoms improved significantly with nasal ventilation. Likewise, Pao 2 (mm Hg), Pao 2 /Fio 2 , Paco 2 (mm Hg), pH, and forced vital capacity (in milliliters and as a percentage of p…

Comparison of Peak Cough Flows Measured by Pneumotachograph and a Portable Peak Flow Meter

To compare peak cough flows (PCF) obtained with a pneumotachograph (PCFp) with those measured using a portable peak flow meter (PCFm) in a population of healthy subjects and patients with neuromuscular disease.A total of 30 healthy subjects and 32 medically stable patients with neuromuscular diseases were studied. Using an oronasal mask connected, in a randomized order, to a pneumotachograph and to a portable peak flow meter, PCFp and PCFm were measured as every subject performed maximal cough efforts from total lung capacity.PCFp measurements were 377.70 +/-179.28 liters/min and PCFm measurements were 377.50 +/- 172.98 liters/min (not significant). The two measurements were correlated (r =…

Punciones arteriales: ¿siempre la radial y siempre con anestesia?

Influence of low temperature on bronchodilatation induced by terbutaline administered by metered dose or dry powder inhalers in asthmatics.

Low temperatures may affect dose delivery efficacy and clinical effectiveness of medication aerosols. In this study we examine the effect of cold ambient temperature on the bronchodilatation produced by terbutaline delivered from a chlorofluorocarbon pressurized metered dose inhaler (pMDI) compared to a multi-dose dry powder inhaler (DPI). Fourteen stable asthmatics were studied on two consecutive days. On day 1, after measuring FEV1 at room temperature (22 degrees C), each patient was randomized to receive 500 microg of terbutaline delivered from pMDI or DPI stored for 24 h at 22 degrees C with FEV1 recorded 20 min post-dose; then, patients were placed in a chamber at -10 degrees C, and af…

Effect of Salmeterol on Seasonal Changes in Airway Responsiveness and Exhaled Nitric Oxide in Pollen-Sensitive Asthmatic Subjects

Objective Using a model of natural allergen exposure, we examined the effect of regular treatment with salmeterol on allergen-induced changes in airway responsiveness and exhaled nitric oxide (ENO). Design Double-blind, randomized, parallel-group study. Setting Specialist allergy unit in a university hospital. Patients Asthmatic patients sensitized to pollen allergens were randomly allocated to monotherapy with salmeterol (n = 14) or placebo (n = 13). Interventions Salmeterol, 25 μg, and placebo inhalers, two puffs bid, for 6 weeks. Measurements Spirometry, the level of a provocative concentration of a substance (methacholine) causing a 20% fall in FEV 1 (PC 20 ), the PC 20 level for adenos…

Maximal Response Plateau to Adenosine 5′-Monophosphate in Asthma

Background No information is available on the plateau in response to adenosine 5′-monophosphate. The aims of the present study were to determine whether plateau can be detected with AMP and the relation with the plateau in response to methacholine, and to identify the relation between the plateau and indirect markers of airway inflammation, such as exhaled nitric oxide (ENO) and exhaled breath condensate (EBC) pH. Methods Airway responsiveness to high concentrations of methacholine and AMP, ENO levels, and EBC pH values were obtained in 31 subjects with well-controlled asthma. Concentration-response curves were characterized by their concentration of agonist that produces a decrease in FEV …

Patrones de frecuentación y factores asociados al ingreso en el hospital de las urgencias hospitalarias por asma y por enfermedad pulmonar obstructiva crónica

El objetivo de este trabajo fue describir las caracteristicas epidemiologicas de las urgencias por asma y por enfermedad pulmonar obstructiva cronica atendidas en el Hospital Clinico Universitario de Valencia, asi como analizar los factores que se asocian a los ingresos hospitalarios por dichos procesos. Para ello se revisaron todas las historias clinicas de urgencias medicas de mayores de 14 anos del mencionado hospital correspondientes al periodo 1993-1995 y se identificaron las urgencias por asma y enfermedad pulmonar obstructiva cronica segun un protocolo establecido. Tras un analisis descriptivo de las variables sociodemograficas se analizaron las series temporales del numero de urgenc…

Effects of a controlled program of moderate physical exercise on insulin sensitivity in nonobese, nondiabetic subjects.

OBJECTIVE: To study the effect of a moderate, aerobic physical exercise program on insulin resistance and its accompanying metabolic changes in a group of healthy, middle-age, nonobese subjects, without modifying oxygen consumption and body weight. DESIGN: The inclusion of subjects was carried out among volunteers from the health personnel of our center, who complied with the inclusion criteria. PARTICIPANTS: Twelve subjects (age 30-60 years, 5 females), nonsmokers, body mass index (BMI) <27 kg/m2 and fasting plasma glucose <6.1 mmol/L. INTERVENTIONS: Insulin resistance was assessed using the Bergmann minimal model modified with insulin, and basal and maximum metabolic rate were measured wi…

Mechanical insufflation-exsufflation vs. tracheal suctioning via tracheostomy tubes for patients with amyotrophic lateral sclerosis: a pilot study.

To compare the effects of mechanical insufflation-exsufflation vs. suctioning via tracheostomy tubes on respiratory variables for six amyotrophic lateral sclerosis patients.In this prospective crossover study, six consecutive patients with amyotrophic lateral sclerosis who required continuous mechanical ventilation via tracheostomy tubes and developed chest infections underwent measurement of pulse oxyhemoglobin saturation (SpO2), peak inspiratory pressure (PIP), mean airway pressure (Pawm), and work of breathing performed by the ventilator (WOBv) at baseline and 5 and 30 min after tracheal suctioning and 5 min after mechanical insufflation-exsufflation.The baseline values were 93.50 +/- 2.…

Differences in the Response to Methacholine Between the Tidal Breathing and Dosimeter Methods

Background It has been postulated that differences in provocative concentration of methacholine causing a 20% fall in FEV 1 (PC 20 ) values between the dosimeter method and tidal breathing method might be due to differences in the dose of agonist delivered to the mouth. The aim of the present study was to determine the influence of the dose of aerosol delivered to the mouth on differences in the response obtained with each challenge method. Methods This study measured airway responsiveness to methacholine by dosimeter method and tidal breathing method in 27 subjects with suspected asthma. The dosimeter was modified to deliver an identical volume to that obtained with the tidal breathing met…

Predictors of Ineffective Cough during a Chest Infection in Patients with Stable Amyotrophic Lateral Sclerosis

In patients with neuromuscular diseases, a chest infection is associated with a reduction in respiratory muscle function that may result in decreased cough effectiveness.To determine if a clinical or functional parameter in patients with amyotrophic lateral sclerosis (ALS) in a stable condition could predict spontaneous cough ineffectiveness during a respiratory tract infection.Forty consecutive patients with ALS referred to our Respiratory Care Unit were studied during a one-year follow-up.FEV(1), FVC, FEV(1)/FVC, peak cough flow (PCF), peak velocity time (PVT), maximum inspiratory and expiratory pressures, and bulbar dysfunction evaluation using the Norris scale bulbar subscore (NBS). A t…

The Effect Of Spirometry On Bronchial And Alveolar Nitric Oxide In Subjects With Asthma

Home Mechanical Ventilation in Amyotrophic Lateral Sclerosis Patients Is Not Always a Problem

A simple noninvasive pressure–time index at the mouth to measure respiratory load during acute exacerbation of COPD A comparison with normal volunteers

We assessed the validity of the pressure-time index (PTI) measured at the mouth as a noninvasive and simplified alternative to conventional tension-time index for assessing respiratory load and inspiratory muscle force reserve. PTI was measured within 48 h of hospital admission and at 24 h before discharge in 37 consecutive patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) using the equation PTI = (P(awo)/MIP)(T(I)/T(T)) 100, where P(awo) is the mean airway pressure measured at the mouth, MIP the maximal inspiratory pressure, and T(I)/T(T) the inspiratory time (T(I)) to total cycle length (T(T)) ratio. Controls were 30 normal volunteers with similar anthropome…

The Effect of Spirometry on Bronchial and Alveolar Nitric Oxide in Subjects with Asthma

The effect of spirometric maneuvers on exhaled nitric oxide (NO) at the constant flow rate of 50 ml/s (FE(NO)) has been studied with equivocal results. Furthermore, the effects of spirometry on bronchial NO flux (J'aw(NO)) and alveolar NO (CA(NO)), two measurements increasingly being used in clinical and research protocols, are unknown. The aim of this study was to evaluate the effect of spirometry on FE(NO), J'aw(NO), and CA(NO) in adults with asthma.Forty-four adults with asthma were studied. To assess the impact of exhaled NO measurement itself on exhaled NO values, FE(NO), J'aw(NO), and CA(NO) were obtained twice, at baseline and after a resting period of 10 min. Then spirometry (with o…

Kyphoscoliotic Ventilatory Insufficiency

Objectives: To determine the effects of long-term nocturnal intermittent positive-pressure ventilation (NIPPV) on symptoms, pulmonary function test results, sleep, and respiratory muscle performance in patients with ventilatory insufficiency due to severe kyphoscoliosis. Design: A prospective study in which 16 severe kyphoscoliotic patients were treated with NIPPV delivered by volume-cycled and pressure-cycled ventilators, over a period of 36 months. Interventions and measurements: At baseline, pulmonary function tests, blood gas measurements, polysomnography, and respiratory muscle strength (measured by noninvasive indexes) were obtained. Symptoms and the number of hospitalizations in the …

Exhaled Nitric Oxide Measurement Is Not Useful for Predicting the Response to Inhaled Corticosteroids in Subjects With Chronic Cough

Background Increased concentrations of exhaled nitric oxide (ENO) are identified predominantly in subjects with chronic cough due to conditions that habitually respond well to therapy with inhaled corticosteroids (ICSs). The aim of this study was to assess the usefulness of ENO in predicting the response to ICS therapy in subjects with chronic cough and to determine the relationship between either methacholine or adenosine 5′-monophosphate (AMP) responsiveness and the response to ICS therapy. Methods A total of 43 patients with chronic cough were studied. During the baseline period, ENO measurement, spirometry, and concentration-response studies with both methacholine and AMP were performed…

Relationship between airway sensitivity to adenosine 5' monophosphate and the shape of the concentration-response curve to methacholine in subjects with allergic rhinitis.

Abstract The objective of this study was to determine differences in airway sensitivity to adenosine 5′-monophosphate (AMP) between allergic rhinitis subjects with plateau and those without evidence of plateau on the concentration–response curves to methacholine. A total of 51 adults (38 subjects with allergic rhinitis and 13 healthy controls) were challenged with increasing concentrations of methacholine and AMP. The methacholine challenge was terminated when there was a 40% or more decrease in forced expiratory volume in 1 sec (FEV 1 ), whereas the AMP challenge was stopped when FEV 1 had fallen by more than 20%. A plateau for methacholine was detected in all 13 healthy controls and in 27…

The effect of different periods of argon deaeration on exhaled breath condensate pH.

Exhaled breath condensate (EBC) pH has been considered as a biomarker of airway inflammation in asthma. However, little information is available on the duration of argon deaeration required to achieve a stable pH in EBC samples.To identify differences in EBC pH after argon deaeration for 2, 4, and 8 min.EBC pH was determined in EBC samples from 48 subjects with allergic rhinitis (11 asthmatics) and 14 healthy volunteers without deaeration and after argon deaeration for 2, 4, and 8 min.The mean (95% CI) pH values obtained from samples analyzed after 4 min [7.66 (7.52-7.80)] and 8 min [7.70 (7.55-7.85)] of argon deaeration were significantly less acidic (p.001) than those identified after 2 m…

Evolución de las características epidemiológicas de la tuberculosis en el Área 15 de la Comunidad Valenciana en el período 1987-2001

Objetivos Valorar la evolucion de las caracteristicas epidemiologicas de la enfermedad tuberculosa (TB) en el Area 15 de la Comunidad Valenciana. Material y metodos Mediante busqueda activa se identificaron todos los casos de TB diagnosticados en el area desde enero de 1987 a diciembre de 2001. Se recogio informacion clinica y epidemiologica de la historia clinica y de la entrevista con el paciente. Resultados Se diagnosticaron 476 casos de micobacteriosis (459 TB, 16 atipicas y una mixta), de los cuales eran residentes en el area 423 casos de TB. La tasa media annual fue de 24,6/105, con un descenso del 41,5% desde 1990. Los factores de riesgo mas frecuentes fueron: tabaquismo en el 38%, e…

Trichosporon beigelii pneumonia in a neutropenic patient.

A case of pulmonary infection caused by Trichosporon beigelii is reported in an asthmatic patient undergoing steroid treatment who developed fever and lung infiltrates. Arthroconidia and blastoconidia were isolated from repeated sputum, bronchial aspirate and telescopic catheter samples. The infection coincided with neutropenia resulting from pyrazolone treatment. The response to amphotericin B treatment was favourable.

Differences In Methacholine- And Adenosine 5-Monophosphate-Induced Changes In Forced Vital Capacity Between Methacholine-Responsive Subjects With Allergic Rhinitis And Patients With Asthma

Non-invasive management of an acute chest infection for a patient with ALS.

We describe a man diagnosed with non-bulbar amyotrophic lateral sclerosis (ALS) who uses 24-h non-invasive ventilator at home, and assisted cough through the use of the mechanical insufflation-exsufflation (MAC) device (CoughAssist, J.H. Emerson). This was essential for the removal of bronchial secretions in order to provide successful non-invasive management (and indeed less suffering for the patient) during an acute respiratory tract infection with hypoxemia and failure of manually assisted cough.

Bulbar impairment score predicts noninvasive volume-cycled ventilation failure during an acute lower respiratory tract infection in ALS.

Amyotrophic lateral sclerosis (ALS) patients can suffer episodes of lower respiratory tract infections (LRTI) leading to an acute respiratory failure (ARF) requiring noninvasive ventilation (NIV).To determine whether clinical or functional parameters can predict noninvasive management failure during LRTI causing ARF in ALS.A prospective study involving all ALS patients with ARF requiring NIV in a Respiratory Care Unit. NIV was provided with volume-cycled ventilators.63 ALS patients were included (APACHE II: 14.93±3.56, Norris bulbar subscore (NBS): 18.78±9.68, ALSFRS-R: 19.90±6.98, %FVC: 40.01±18.07%, MIC: 1.62±0.74L, PCF 2.51±1.15L/s, PImax -34.90±19.44cmH2O, PEmax 51.20±28.84cmH2O). In 73…

Contestación a la carta de los Dres. F. Barbé, B. Togores y A.G.N. Agustí

Effects of allergen exposure on methacholine and AMP-induced air trapping in pollen-sensitive subjects

Summary Background The effect of pro-inflammatory stimuli on bronchoconstrictor-induced air trapping has not been studied. Objective To determine the effect of natural allergen exposure, a pro-inflammatory stimulus, on methacholine- and adenosine 5′-monophospate (AMP)-induced air trapping. Methods Airway responsiveness to methacholine and AMP before and during the pollen season was obtained in 25 subjects with pollen allergy and in 10 healthy controls. The response was expressed by the sensitivity (PC 20 value) and by the slope and intercept of the FVC values recorded at each step of the challenge against the corresponding FEV 1 values. Results The slope and intercept FVC versus FEV 1 value…

Mortalidad por cáncer de pulmón en España

Effect of lung mechanics on mechanically assisted flows and volumes.

To correlate the air flows generated by mechanical insufflation-exsufflation as a function of pressure delivery in a lung model at two pulmonary compliance and three airway resistance settings.With each combination of pulmonary compliances of 25 and 50 ml/cm H2O and airway resistances of 6, 11, and 17 cm H2O/liter/sec, ten cycles of mechanical insufflation-exsufflation were applied using pressure deliveries of 40 to -40, 50 to -50, 60 to -60, and 70 to -70 cm H2O. The resulting peak exsufflation flows and volumes were recorded.In a multivariate analysis, the pulmonary compliance, airway resistance, and pressure delivery were all found to significantly affect exsufflation flows and volumes s…

Noninvasive respiratory muscle aids during PEG placement in ALS patients with severe ventilatory impairment.

Abstract Although no clear recommendations are given about when percutaneous endoscopic gastrostomy (PEG) should be placed in amyotrophic lateral sclerosis (ALS) patients, some experts underline the risk of respiratory complications when patients had severe ventilatory muscle impairment (SVMI). Aim To evaluate the efficacy of noninvasive ventilation (NIV) and mechanically assisted cough (MAC) to avoid respiratory complications related to PEG placement in ALS patients with SVMI. Material and methods Prospective study including ALS patients who had chosen to have PEG placement timed by swallowing dysfunction with the aid of NIV and MAC if needed. PEG was carried out under volume-cycled NIV th…

Efficacy of Mechanical Insufflation-Exsufflation in Medically Stable Patients With Amyotrophic Lateral Sclerosis

Objective: To determine under what circumstances the use of mechanical insufflation-exsufflation (MI-E) can generate clinically effective expiratory flows for airway clearance (> 2.7 L/s) for clinically stable patients with amyotrophic lateral sclerosis (ALS). Materials and method: Twenty-six consecutive patients with ALS were studied, 15 with severe bulbar dysfunction. Using a pneumotachograph and with the aid of an oronasal mask, we measured FVC, FEV1, peak cough flow (PCF), maximum insufflation capacity (MIC), PCF generated from a maximum insufflation MIC (PCFMIC), and PCF generated by MI-E (PCFMI-E). MI-E was delivered at 40 cm H2O. Maximum inspiratory pressure (PImax) and maximum expir…

Exercise causes blood glutathione oxidation in chronic obstructive pulmonary disease: prevention by O2 therapy

Viña, José, Emilio Servera, Miguel Asensi, Juan Sastre, Federico V. Pallardó, José A. Ferrero, JoséGarcı́a-de-la-Asunción, Vicente Antón, and Julio Marı́n. Exercise causes blood glutathione oxidation in chronic obstructive pulmonary disease: prevention by O2therapy. J. Appl. Physiol. 81(5): 2199–2202, 1996.—The aim of the present study was to determine whether glutathione oxidation occurs in chronic obstructive pulmonary disease (COPD) patients who perform exercise and whether this could be prevented. Blood glutathione red-ox ratio [oxidized-to-reduced glutathione (GSSG/GSH)] was significantly increased when patients performed exercise for a short period of time until exhaustion. Their res…

Insuficiencia respiratoria aguda como primera manifestación de lesiones del tronco cerebral

We describe three patients with different brainstem lesions (bulbar angioma, bulbar infarct, and Arnold-Chiari malformation) who debuted with acute respiratory insufficiency. Other neurological manifestations had gone unobserved in all three cases. Respiratory insufficiency worsened notably during sleep to the point that mechanical ventilation was required or death occurred (Ondine s curse). The patient with a bulbar angioma is stable with only assisted ventilation by a nasal route at night, with good quality of life. Our conclusions are that: a) central nervous system anomalies need to be investigated as possible causes of respiratory insufficiency when lungs are normal; b) the respiratory…

Secretion Management Must Be Considered When Reporting Success or Failure of Noninvasive Ventilation

Factores predictivos de reingreso hospitalario en la agudización de la EPOC moderada-grave

Objetivos: Conocer los factores asociados a la exacerbacion de la enfermedad pulmonar obstructiva (EPOC) es importante para mejorar la supervivencia de los pacientes y conseguir mayor efectividad en su tratamiento. El objetivo de este estudio es identificar las variables asociadas con el reingreso hospitalario en la agudizacion de la EPOC moderada-grave. Pacientes y metodos: Se estudio de forma prospectiva a 90 pacientes con EPOC moderada-grave ingresados de manera consecutiva en nuestro Servicio de Neumologia por exacerbacion de su enfermedad. En el momento del alta se evaluaron las variables clinicas, espirometricas y gasometricas, asi como el estado muscular, mediante medidas no invasiva…

[Risk factors of readmission in acute exacerbation of moderate-to-severe chronic obstructive pulmonary disease].

More effective management of chronic obstructive pulmonary disease (COPD) and improved survival of COPD patients requires a better understanding of the risk factors for exacerbation. The aim of this study was to identify factors related to readmission in patients with moderate-to-severe COPD.Ninety patients with moderate-to-severe COPD hospitalized consecutively for acute exacerbation were studied prospectively. At discharge, the following potential predictors were assessed: clinical and spirometric variables, arterial blood gases, and respiratory muscle strength determined noninvasively. The patients were followed for a period of 3 months. Readmission for exacerbation and time intervals fr…

Differences in sensitivity, maximal response and position of the concentration-response curve to methacholine between asthmatics, patients with allergic rhinitis and healthy subjects

The aim of this study was to detect differences in maximal response and position of the concentration-response curves to methacholine between asthmatics and subjects with allergic rhinitis. A total of 228 adults (107 mild asthmatics, 96 allergic rhinitics and 25 healthy control subjects) were challenged with methacholine. The test was interrupted when FEV1 dropped by more than 40% or when the highest concentration of methacholine (200 mg ml-1) had been administered. Concentration-response curves were characterized by their PC20 (concentration of methacholine that produced 20% fall in FEV1 = airway sensitivity), and if possible, by their EC50 (concentration of methacholine that produced 50% …

The beginning of the tobacco-related lung-cancer epidemic among Spanish women

Pseudomembranous invasive tracheobronchial aspergillosis.

Invasive aspergillus tracheobronchitis is a rare infectious complication in severely immunocompromised patients who are generally neutropenic with haematological diseases, AIDS, or after solid organ transplantation. However, a few cases have been reported with no apparent severe compromise in the host defences.1 Aspergillus tracheobronchitis varies from localised tracheobronchitis …

Effectiveness of assisted and unassisted cough capacity in amyotrophic lateral sclerosis patients.

Decreased cough capacity during a respiratory infection is one of the main causes of acute respiratory failure and hospitalisation in amyotrophic lateral sclerosis (ALS).To determine whether a respiratory measurement could identify the effectiveness of cough capacity in ALS during a respiratory infection.This was a prospective study of all ALS patients who were treated at a respiratory care unit due to a respiratory infection from 2012 to 2016. The effectiveness of unassisted and assisted coughing was evaluated and respiratory function tests were performed during the acute episode.Forty-eight ALS patients were enrolled, with only four having an effective unassisted cough. The variable which…

Assessment of Analysis of Urinary Pneumococcal Antigen by Immunochromatography for Etiologic Diagnosis of Community-Acquired Pneumonia in Adults

ABSTRACT The limitations of conventional microbiologic methods (CMM) for etiologic diagnosis of community pneumococcal pneumonia have made faster diagnostic techniques necessary. Our aim was to evaluate the usefulness of the immunochromatography (ICT) technique for detecting urinary Streptococcus pneumoniae antigen in the etiologic diagnosis of community-acquired pneumonias (CAP). This was a prospective study on in-patients with CAP in a tertiary hospital conducted from October 2000 to March 2004. Apart from using CMM to reach an etiologic diagnosis, we determined pneumococcal antigen in concentrated urine by ICT. We also determined the urinary pneumococcal antigen (UPA) content in patients…

Entrenamiento de los músculos ventilatorios

Ventilación asistida vía máscara nasal en pacientes hospitalizados en una sala de neumología por descompensación de su obstrucción crónica al flujo aéreo

Our aim was to evaluate the efficacy of assisted ventilation through a nasal mask (AVN) in treating chronic obstructive pulmonary disease (COPD) patients who were admitted to a pneumology ward due to decompensation, with PaCO2 > 60 mmHg and pH < 7.35. We studied 13 COPD patients who were first observed for 1-2 days until adaptation and then given 2 daily sessions of AVN lasting 4 hours with double positive pressure (DP90) devices through Sullivan mask with a cannula for hyperoxia. Gasometric readings were recorded, along with subjective assessment of condition and problems with the mask. Gasometric readings were taken as follows: the first upon admission to the ward (AW), the second with AV…

Alternatives to Endotracheal Intubation for Patients with Neuromuscular Diseases

To evaluate the usefulness of continuous noninvasive mechanical ventilation and mechanical coughing aids to avoid endotracheal intubation and tracheostomy during episodes of acute respiratory failure in patients with neuromuscular disease.We conducted a prospective cohort study at the respiratory medicine ward of a university hospital to study the success rate of the use of continuous noninvasive mechanical ventilation and manually and mechanically (CoughAssist) assisted coughing to avert endotracheal intubation in 24 consecutive episodes of acute respiratory failure for 17 patients with neuromuscular disease. The noninvasive mechanical ventilation and coughing aids were used to reverse dec…

Bronchoconstriction induced by inhaled adenosine 5′-monophosphate in subjects with allergic rhinitis

Adenosine and its related nucleotide, adenosine 5′-monophosphate (AMP) induce bronchoconstriction in asthmatics, probably caused by histamine release from airway mast cells. The objective of this study was to determine the effect of inhaled AMP on lung function in subjects with allergic rhinitis.A total of 52 adults (28 subjects with allergic rhinitis, 14 asthmatics and 10 healthy subjects) were challenged with increasing concentrations of AMP and methacholine. Airflow was assessed after each concentration and the response to each bronchoconstrictor agent was measured by the provocative concentration required to produce a 20% fall (PC20) in forced expired volume in one second (FEV1).All 14 …

[Tuberculosis epidemiology in area 15 of the Spanish autonomous community of Valencia: evolution from 1987 through 2001].

Objectives TO describe the evolution of tuberculosis epidemiology in Area 15 of the Autonomous Community of Valencia. Material and Methods Cases of tuberculosis were identified by active case finding in Area 15 from January 1987 through December 2001. Clinical and epidemiological data were extracted from case records and a patient interview. Results Four hundred seventy-six diagnosed cases of mycobacterial infection were identified (459 tuberculosis, 16 atypical, and 1 mixed); 423 tuberculosis patients were residents of Area 15. The mean annual incidence rate was 24.6/100 000 population, representing a rate decrease of 41.5% from 1990. The most frequent risk factors were smoking (38%), alco…

Modifications in FVC during AMP Induced Bronchoconstriction in Asthma: Relationship with the Response to Methacholine and Influence of Inhaled Corticosteroids.

Tolerance of Volume Control Noninvasive Ventilation in Subjects With Amyotrophic Lateral Sclerosis.

BACKGROUND: Noninvasive ventilation (NIV) tolerance has been identified as an independent predictor of survival in amyotrophic lateral sclerosis (ALS). Volume control continuous mandatory ventilation (VC-CMV) NIV has been associated with poor tolerance. The aim of this study was to determine the tolerance of subjects with ALS to VC-CMV NIV. METHODS: This was a prospective study involving subjects with ALS who were treated with VC-CMV NIV. Respiratory and functional parameters were recorded when the subjects began ventilatory support. NIV tolerance was evaluated after 3 months. RESULTS: Eighty-seven subjects with ALS were included. After 3 months, 80 subjects (92%) remained tolerant of NIV. …

Modifications in forced vital capacity during adenosine monophosphate-induced bronchoconstriction in asthma: relationship with the response to methacholine and the effect of inhaled corticosteroids.

Background The effect of adenosine monophosphate (AMP) on forced vital capacity (FVC) has never been systematically investigated. Objective To compare methacholine- and AMP-induced changes in FVC, as a marker of air trapping, in asthmatic patients treated and not treated with inhaled corticosteroids (ICSs). Methods Airway responsiveness to equipotent concentrations of AMP and methacholine was obtained in asthmatic patients treated (n = 32) and not treated (n = 18) with ICSs. The response was expressed by the provocation concentration of agonist that caused a decrease in forced expiratory volume in 1 second (FEV 1 ) of 20% (PC 20 ) and by the slope of the FVC values recorded at each step of …

Noninvasive Ventilatory Assistance During Exercise for Patients with Kyphoscoliosis

The goal was to determine whether noninvasive ventilatory assistance (NIV) could facilitate exercise performance and benefit physiologic parameters for eight hypercapnic kyphoscoliosis patients using a cycloergometer for 6-min periods at a constant power (20 W). The exercise protocols were performed in random order while breathing unaided (spontaneous breathing test or SBT) and also while receiving NIV (NIV test or NIVT). The NIV was pressure support (15 cm H2O) plus positive end expiratory pressure (PEEP) (4 cm H2O) via a nasal mask. Of the compared parameters, heart rate was not significantly different, but acidosis (pH = 7.32 +/- 0.04 vs. 7.36 +/- 0.04), hypoxia (PaO2 = 61.5 +/- 15.9 vs.…

Predictors of need for noninvasive ventilation during respiratory tract infections in medically stable, non-ventilated subjects with amyotrophic lateral sclerosis.

BACKGROUND: Acute lower respiratory infections can impair muscle strength in patients with amyotrophic lateral sclerosis (ALS). When associated with an increase in load on the respiratory system, this situation may precipitate hypercapnic respiratory failure in non-ventilated patients with ALS. The aim of this study was to determine whether a clinical or functional parameter can predict the need for noninvasive ventilation (NIV) during an acute respiratory infection for medically stable, non-ventilated patients with ALS. METHODS: This was a prospective study involving all non-ventilated subjects with ALS admitted due to an acute respiratory infection to a respiratory care unit from a tertia…

The effect of challenge method on methacholine-induced changes in sensitivity and air trapping

Summary Background The methacholine challenge test performed with the tidal breathing method induces a greater fall in FEV 1 than the dosimeter method; however, the effect of the challenge method on methacholine-induced fall in FVC has not been investigated. Objective To determine the influence of the challenge method on methacholine-induced changes in FEV 1 and FVC. Methods Airway responsiveness to methacholine was determined by dosimeter method and tidal breathing method in 37 subjects with suspected asthma. The dosimeter was modified to deliver an identical volume to that obtained with the tidal breathing method and the same nebulizer model was used for the two challenges. The response w…

[Lung cancer mortality in Spain].

Evolución de la declaración de la tuberculosis en un área sanitaria de la Comunidad Valenciana desde 1987 hasta 1999

Objetivos La infradeclaracion de la tuberculosis (TBC) es un hecho frecuente a escala mundial que ha sido escasa-mente estudiado en nuestro pais. El objetivo de nuestro es-tudio fue conocer el estado de la declaracion de los casos de TBC en nuestra area sanitaria Material y metodo Desde 1987 a 1999 se estudio de for-ma directa la incidencia y el estado de declaracion de los casos de TBC en nuestra area (censo: 106.632 habitantes). Los casos se obtuvieron desde el registro de EDO, anatomia patologica y bacteriologia, con posterior revision de la historia clinica Resultados Se diagnosticaron 410 casos de TBC, de los cuales 378 eran recientes del area (incidencia media anual: 27 por 100.000 ha…