Bulletin europeen de physiopathologie respiratoire最新文献

Reference values for respiratory impedances in children are scarce and limited to the situation where pressure is varied at the mouth. Total respiratory impedance was therefore measured from 4 to 30 Hz in 69 healthy children (9-13 yr) with both a pressure input at the mouth (input impedance, Zin) and a pressure input at the chest (transfer impedance, Ztr). Zin was characterized by the average resistance (R), the low-frequency limit of resistance (R0), the slope of the resistance-frequency curve (S), respiratory elastance (E) and respiratory inertance (I). Similar coefficients (R0', S', E', I'), some of which however have slightly different physiological meanings, were derived from Ztr. R, R0 and R0' were found to be significantly correlated to body height (p less than 0.001) and, independently, to age (p less than 0.05): R (kPa X l-1 X s) = 1.76-5.29 10(-3) height (cm) -4.13 10(-2) age (yr). Elastances were better correlated to height than to age: E (kPa X l-1) = 20.95-0.101 height (cm) and inertances better correlated to age than to height: I (Pa X l-1 X s2) = 4.39-0.128 age (yr). S and S' were not correlated to biometric variables. No difference was found between children living in polluted (n = 36) and nonpolluted (n = 33) areas, except for S which was significantly lower in the first group (p less than 0.01).

The mechanisms whereby arterial carbon dioxide tension (PaCO2) remains constant despite varying rates of CO2 production are poorly understood. During the gynaecological operation of laparoscopy, the abdominal cavity is filled with CO2. An increase in the rate of CO2 delivery to the lung (less than 50%) occurs as a result of venous CO2 absorption. Respiratory control in 39 anaesthetized but spontaneously breathing women was studied during such exogenous CO2 loading. End-tidal CO2 tension (PACO2 - rapid infrared analyser) and minute-ventilation (Wright respirometer) were measured before and at 5 min intervals after peritoneal insufflation. Ventilation increased and mean PACO2 remained constant in these patients. Inhalational anaesthetics depress respiration and this was confirmed by raised control PACO2 values in this study. However, it appears that mechanisms underlying PACO2 homeostasis in the presence of a CO2 load are not depressed by inhalational anaesthetic in this study. These patients were probably hyperoxic. Peripheral arterial chemoreflexes are thought to be eliminated by hyperoxia. Therefore, it is likely that neural stimuli, from exploration of the abdomen, drove breathing. Furthermore, the fact that there was not a large fall in PACO2 may have been due to feedback via the central (brainstem) chemoreceptor.

We present new lung function reference values based on an investigation of 1024 healthy subjects aged 6-81 years. The dependent variables, i.e. VC, FEV1, RV, FRC, TLC, PEF, MEF50 and MEF25 are expressed as transcendent functions of age, body height and mass. A single equation covers the age range from 6 to 81 years and reflects certain phenomena such as growth, maturation, ageing, sex differences and the undermass-overmass effect. This allows a more accurate determination of individualized reference values and normal limits.

The gas exchange at rest and during exercise was measured in 50 healthy men, 25 lifelong nonsmokers and 25 smokers, between 20 and 65 years of age. Arterial blood samples were taken and expired air was collected at rest, supine and sitting, and during graded exercise. Prediction formulas for various gas exchange variables were obtained by multiple regression. Optimal conditions for gas transfer were present at light exercise. The arterial oxygen tension (PaO2) remained approximately constant during exercise, although in individual smokers and nonsmokers it decreased by up to 1.8 kPa (13.5 mmHg) between a workload of 50 W and the maximal workload. The lower limit for PaO2 at maximal exercise was about 10.7 kPa (80 mmHg). The alveolo-arterial difference in oxygen tension (PA-aO2) increased considerably with increased workload, from 1.09 +/- 1.05 kPa at 50 W to 3.1 +/- 0.9 kPa at maximal exercise. Ageing and tobacco smoking were associated with a decrease in PaO2 and an increase in PA-aO2 at rest in the supine position, but at maximal exercise neither PaO2 nor PA-aO2 was significantly influenced by age or tobacco smoking. In contrast, the dead space and total ventilation were increased during exercise by ageing and tobacco smoking.

The experiments were performed with thirteen anaesthetized rabbits breathing spontaneously through the larynx. Phrenic output was measured during tidal respiration in control conditions and in the course of progressive denervation of the laryngeal and tracheobronchial compartments. We have analysed changes in amplitude and the rate of rise of the integrated phrenic neurogram as well as the changes in TI, TE, TT and f of the respiratory timing after superior laryngeal nerves (SLN-s) section, section of the recurrent laryngeal nerves (RLN-s) and step-wise complete midcervical vagotomy. Nerve sections were performed by two methods: 1) bilateral SLN-s, RLN-s and cervical vagal neurotomy (horizontal method); 2) right-sided neurotomies of SLN, RLN and vagus followed by left-sided neurotomies of these nerves (vertical method). Laryngeal deafferentation did not greatly affect respiratory variables. Unilateral and especially bilateral vocal cord paralysis prolonged the respiratory cycle with enhanced TI/TT ratio, increased amplitude and rate of rise of the integrated phrenic neurogram. Maximum values of all parameters (the rate of rise excluded) were achieved after complete midcervical vagotomy. Of the two methods of denervation, the right-sided followed by left-sided denervation led to better adaptation of the organism to the respiratory disturbance (smaller changes in TI and TE compared with the control values). Denervation by the 'horizontal' method (paired section of the nerves) led to an abrupt failure of effective ventilation.

Alveolar macrophages (AM) from control (n = 12) and atopic patients (n = 19, 12 without treatment, 4 treated with theophylline and 3 with theophylline and corticosteroid) were compared for their capacity to release mediators. AM were purified by 2 h adherence and challenged with either ubiquitous allergen, specific sensitizing allergens, anti-IgG or anti-IgE serum. The release of paf-acether, lyso paf-acether and beta-glucuronidase was measured. Paf-acether and its lyso derivative were assayed on washed rabbit platelets. Enzyme and mediator releases were obtained after specific allergenic or anti-IgE serum challenge of AM from untreated atopic patients. No release of paf-acether was detected from AM, from control or treated atopic patients after in vitro immunological challenge, whereas that of lyso paf-acether was greatly reduced in both treated groups. Release was obtained by immunological challenge of AM from control patients after passive sensitization with atopic serum. The release of mediators with bronchoconstriction activity by AM could represent an alternative causal pathway in human asthma.

The need for performance control of spirometers has been studied in Helsinki hospitals. The performance of 27 instruments was measured using 11 technical test parameters. The performance was assessed by calculating figures of merit (FM) determined as a weighted sum of the test results. 55% of the devices failed the test. Performance was specific for each instrument, was dependent on maintenance but independent of instrument age. Specific attention to accuracy is recommended in measuring rapid forced expiratory parameters with wedge-type volume meters sealed with bellows. Although daily calibration is helpful, it is not sufficient to maintain optimal performance. Device maintenance should start from acceptance trials to detect manufacturing problems and be complemented by periodic technical performance tests.

We tested the flow-impeding properties of the nasopharynx in 27 healthy subjects with normal nasal resistance (mean +/- SD: 2.45 +/- 1.92 cmH20.l-1 X s). While the subjects inspired and expired deliberately through a rubber mouth-piece, a tight-fitting nose-mask was supplied with 100% O2 from a filled 30-1 rubber bag. Recording instantaneous FEO2 at the mouth was a sensitive indicator of whether nasal flow was present during the preceding inspiration. On a theoretical basis, we are describing a method of calculating the mean percentage of nasal admixture during inspiration. Fluctuations in FEO2 in relation to time revealed varying nasal flow in some individuals. The mean nasal admixture differed considerably between all subjects (mean +/- SD: 20.9 +/- 16.5%; range: 1-70%), showing no correlation to nasal resistance. Five of 27 subjects with a history of habitual mouth breathing had a significantly lower nasal admixture (2.5 +/- 1.7% vs 25.1 +/- 15.4%; p less than 0.005), with no statistical difference in nasal resistance. Present data indicate that upper airway patency is variable in normals during voluntary mouth breathing. We suggest that habitual mouth breathing with absence of nasal obstruction may be associated with velopharyngeal narrowing.