BACKGROUND: Bronchial reactivity is known to be a component of airway hyperresponsiveness, a cardinal feature of asthma, with bronchial sensitivity, and is increments in response to induced doses of bronchoconstric tors as manifested by the steepest slope of the dose-response curve. However, there is some controversy regarding methods of measuring bronchial reactivity and clinical impact of such measurements. The purpose of this study was to evaluate the clinical significance and assess the clinical use by analyzing the relationship of the bronchial sensitivity, the clinical severity and the changes in pulmonary function with bronchial reactivity. METHOD: A total of 116 subjects underwent a methacholine bronchial provocation test. They were divided into 3 groups : mild intermittent, mild persistent, moderate and cough asthma. Severe patients were excluded. Methacholine PC20 was determined from the log dose-response curve and PC40 was determined by one more dose inhalation after PC20. The steepest slope of log dose-response curve, connecting PC20 with PC40, was used to calculate the bronchial reactivity. Body plethysmography and a single breath for the DLCO were done in 43 subjects before and after methacholine test. RESULTS: The average bronchial reactivity was 38.0 in the mild intermittent group, 49.8 in the mild persistent group, 61.0 in the moderate group, and 41.1 in the cough asthma group. There was a weak negative correlation between PC20 and bronchial reactivity. A heightened bronchial reactivity tends to produce an increased clinical severity in patients with a similar bronchial sensitivity and basal spirometric pulmonary function. There were significant correlations between the bronchial reactivity and the initial pulmonary function before the methacholine test in the order of sGaw, Raw, FEV1/FVC, MMFR. There were no correlations between the bronchial sensitivity and the % change in the pulmonary function parameters after the methacholine test. However, there were significant correlations between the bronchial reactivity and the PEF, FEV1, DLCO. CONCLUSION: There was weak significant negative correlation between the bronchial reactivity and the bronchial sensitivity, and the bronchial reactivity closely reflected the severity of the asthma. Accordingly, measuring both the bronchial sensitivity and the bronchial reactivity can be of assistance in assessing of the ongoing disease severity and in monitoring the effect of therapy.
Asthma ; Bronchial Provocation Tests ; Cough ; Humans ; Inhalation ; Maximal Midexpiratory Flow Rate ; Methacholine Chloride* ; Plethysmography

BACKGROUND: Pleural effusion is a common disease in clinical practice but its effect on pulmonary function and altered pulmonary mechanics after removal of effusion are not still largely understood. Previous studies have shown that there is little or a relatively small improvement in pulmonary function and arterial blood oxygenation after therapeutic thoracentesis. The present study was designed to assess the effect on pulmonary function of pleural effusion and to test whether there was a significant improvement in pulmonary function and arterial oxygenation after thoracentesis and to observe long term effect after thoracentesis. METHOD: We examined flow-volume curve, body box and arterial blood gas analysis according to severity of effusion, present symptom, and symptom duration. Then, we measured changes of pulmonary function after thoracentesis and observed longterm effect after thoracentesis. RESULT: 1) Pleural effusion cause restrictive pulmonary insufficiency. Not only functional impairment of small airway but also large airway is provoked. 2) MMFR, FEV1, Raw, PO2 are earlier improved than FVC and TLC after thoracentesis and patients without complication have mild restrictive pulmonary insufficiency after longterm observation 3) FVC, FEV1, & TLC are similarly restricted as severity of pleural effusion and PO2 is relatively decreased. 4) Cases with symptom duration 1 week or less and cases with dyspnea have more severe pulmonary insufficiency than others. 5) The flow volume curves show a relatively greater improvement in flow rates at large lung volumes than small airway. 6) Significant relationship is shown between first thoracentesis amount and changes of FEV1, FVC, TLC. CONCUSION: Pleural effusion cause restrictive pulmonary insufficiency and not only functional impairment of small airway impairment but also large airway is provoked. Then, Pulmonary function is progressively improved after thoracentesis and remained mild restrictive pulmonary insufficiency after recovery
Blood Gas Analysis ; Dyspnea ; Humans ; Lung ; Maximal Midexpiratory Flow Rate ; Mechanics ; Oxygen ; Pleural Effusion* ; Tuberculosis, Pleural*

OBJECTIVEAsthma is the most common chronic respiratory disease of children. The association between asthma and bronchial hyperresponsiveness (BHR) has been well-demonstrated. The objective of the study was to investigate relationship between the bronchial responsiveness and the peripheral obstruction in stable asthmatic children.

METHODSThirty-nine children with stable asthma, 28 boys and 11 girls with a mean age of 128 (77 - 197) months, received the bronchial provocation test by the maximal expiratory flow-volume (MEFV) curve measurement. The children were divided into two groups: one with maximal mid-expiratory flow (MMEF) < 80% (n = 15) and the other with MMEF >/= 80% (n = 24). Positive rates of bronchial provocation test were compared between groups of MMEF < 80% and >/= 80% and between the children whose relief duration was 12 months (n = 13). Statistical analysis was performed by using Chi-square, rank sum test or t test (SPSS10.0), P values < 0.05 were considered significant.

RESULTSIn the 39 stable asthmatic children, 15 (38%) were detected MMEF < 80% and 28 (72%) had BHR. There was no significant difference in BHR between the children with MMEF < 80% and those with MMEF >/= 80% (P > 0.05). There was no significant difference in BHR between the children whose relief duration was 12 months (P > 0.05), either.

CONCLUSIONSThe stable asthmatic children still had peripheral obstruction and BHR, which indicated the presence of airway inflammation. There was no significant difference in BHR between the children whose relief duration was 12 months.

Asthma ; physiopathology ; Bronchial Hyperreactivity ; physiopathology ; Bronchial Provocation Tests ; Child ; Female ; Humans ; Male ; Maximal Midexpiratory Flow Rate

OBJECTIVETo evaluate the effects of indoor and outdoor PM2.5 (fine particulate matter, particulate matter with an aerodynamic diameter ≤ 2.5 µm) on lung function of college students in autumn and winter in Wuhan.

METHODSIn this panel study, 37 college students (excluded subject of respiratory disease and smoking history) aged 19 - 21 were investigated by cluster sampling in a university in Wuhan. The follow-up study lasted for 28 days in total, including two study periods, Oct. 29 to Nov. 11, 2009 (autumn) and Dec. 23, 2009 to Jan.5, 2010 (winter), the peak expiratory flow (PEF) of the college students were measured daily in the morning and evening in the university. PM10 and PM2.5 were monitored indoors and outdoors. The effects of PM on lung function of college students were analyzed by using generalized estimating equation (GEE).

RESULTSAverage daily concentrations of indoor, outdoor PM2.5 in autumn were (91.3 ± 43.7) and (104.2 ± 49.4) µg/m(3) respectively, while in winter the concentrations of indoor and outdoor PM2.5 were (110.6 ± 42.3) and (143.5 ± 51.2) µg/m(3). The single pollutant model showed that in winter, the evening PEF decrement was significantly associated with increasing outdoor PM2.5. With an increase of 10 µg/m(3) outdoor PM2.5, the PEF measured in the evening decreased 1.27 L/min (95%CI: 0.02 - 2.52 L/min, respectively). Meanwhile, the results showed that 2-days lagged outdoor PM2.5 was also significantly associated with morning PEF. An increase of 10 µg/m(3) 2-days lagged outdoor PM2.5 caused the decrease of 1.82 L/min (95%CI: -3.53 - -0.11 L/min) of PEF measured in the morning. Controlling the influence of gaseous pollutants and building the two pollutants models, the results indicated that no significant changes of PEF of students being exposed to PM2.5 on same day (lag 0) were observed. However, under consideration of SO2 effect, significant association between an increase of 10 µg/m(3) 2-days lagged outdoor PM2.5 and changes of morning PEF (-1.81 L/min, 95%CI: -3.51 - -0.11 L/min, P = 0.037) was found. The relationship between changes of concentrations and PEF was not observed in autumn in this study.

CONCLUSIONIn our panel study, exposure to outdoor PM2.5 is significantly associated with PEF among college students in winter, but not in autumn.

Air Pollutants ; China ; epidemiology ; Environmental Exposure ; Female ; Humans ; Male ; Maximal Midexpiratory Flow Rate ; Particulate Matter ; Respiratory Function Tests ; Seasons ; Students ; Young Adult

PURPOSE: To evaluate the HRCT findings of hypersensitive pneumonitis and to correlate the findings with the results of the pulmonary function test (PFT). MATERIALS AND METHODS: Seven patients in whom hypersensitive pneumonitis was histologically confirmed (by transbronchial lung biopsy in two, thoracoscopic lung biopsy in one, open lung biopsy in two, and typical clinical and laboratory findings in two) were involved in this study. Their radiological patterns were assessed by HRCT and the extent of each finding was evaluated semi-quantitatively and correlated with the results of the pulmonary function test. RESULTS: The HRCT findings were as follows: lobular overinflation (n = 7), ground glass attenuation (n = 7), centrilobular nodule (n = 6), reticular opacity (n = 5), interlobular septal thickening (n = 3), consolidation (n = 2), and irregular subpleural line (n = 1). Five patients showed lower lung predominance and two, middle lung predominance. In all, a restrictive pattern and diminished diffusion capacity was noted. The grade score of reticular opacity showed significant correlation with forced vital capacity and forced expiratory volume. There was, however, no significant correlation between other HRCT findings and PFT results. Two patientsin whom lobular overinflation associated with parenchymal fibrosis was noted showed a decreased maximal midexpiratory flow rate of 25 -75. CONCLUSION: Lobular overinflation, ground-glass attenuation and centrilobular nodules are commonly observed in hypersensitive pneumonitis. The only significant correlation between each HRCT finding and the pulmonary function test was that between reticular opacity and both forced expiratory volume and forced vital capacity. In cases of chronic hypersensitive pneumonitis presenting as pulmonary fibrosis, associated lobular overinflation could be helpful for differential diagnosis.
Alveolitis, Extrinsic Allergic* ; Biopsy ; Diagnosis, Differential ; Diffusion ; Fibrosis ; Forced Expiratory Volume ; Glass ; Humans ; Hypersensitivity* ; Lung ; Maximal Midexpiratory Flow Rate ; Pneumonia ; Pulmonary Fibrosis ; Respiratory Function Tests* ; Vital Capacity

OBJECTIVEImpulse oscillation system (IOS) as an approach to lung function determination is suitable for children, especially for preschool children in that it only requires the individual to be examined to breathing stably with tidal volume. However, until now there have been no uniformly agreed criteria for positive bronchial reversibility test in clinical practice. A screening method was applied to seek for answer when this question in the hope of providing objective evidence for clinical diagnosis of respiratory diseases, esp. asthma.

METHODSOne hundred and fifty-six children patients during asthma attack were recruited randomly for this study from January to December, 2004. These patients included 103 boys and 53 girls aged from 5 to 18 years with mean age of 8.84 +/- 2.58 years, who visited the doctors in the Clinical and Educational Centre for Asthma, Capital Institute of Pediatrics and were diagnosed as asthma. Maximal expiratory flow volume and IOS lung function were determined followed by bronchodilator reversibility test in all patients. The sensitivity and specificity of IOS parameters, total respiratory impedance (Zrs), respiratory resistance at 5 Hz (R5) and reactance at 5 Hz (X5) for diagnosing asthma at different improvement levels after inhalation of bronchodilator were calculated respectively using forced expiratory volume in first second (FEV(1)) and maximal mid-expiratory flow (MMEF) as gold standard. And the regression equation between parameters of lung function which were determined with the two different methods was analyzed.

RESULTSAfter inhalation of bronchodilator, the lung function of the children was improved significantly (P < 0.01), with the FEV(1), MMEF increase and Zrs, R5, and X5 decrease. There were significantly positive correlations (P < 0.01) between the improvement rate of parameters of lung functions determined with the two methods, and the highest correlation coefficients existed between X5 and FEV(1) and MMEF (respectively 0.676, 0.571), correlation coefficients between X5 and Zrs ranked second (0.519 and 0.505, respectively). When an increase of FEV(1) equal to or greater than 15%, or increase of MMEF equal to or greater than 30% was used as reference for positive bronchial reversibility, the sensitivity and specificity were relatively high for considering positive bronchial reversibility test with at least 20% decrease of Zrs, R5, and 30% decrease of X5 with IOS lung function. The sensitivity and specificity of Zrs, R5 and X5 calculated from FEV(1) were 0.62, 0.51; 0.49, 0.54; 0.70, and 0.54, respectively. The sensitivity and specificity of Zrs, R5 and X5 calculated from MMEF were 0.63, 0.54; 0.53, 0.60; 0.60, and 0.58, respectively. The regression equation showed that the decrease of Zrs, R5 and X5 corresponding to 15% increase of FEV(1) and 30% increase of MMEF were 21.7%, 21.3%; 19.9%, 19.5%; 30.1%, and 29.6%, respectively.

CONCLUSIONWhen lung function is determined with IOS in children, only when decrease of Zrs and R5 is equal to or more than 20% and decrease of X5 is 30% or more after inhalation of bronchodilator, can the bronchial reversibility test be considered as positive.

Adolescent ; Asthma ; diagnosis ; Bronchodilator Agents ; administration & dosage ; Child ; Child, Preschool ; Female ; Forced Expiratory Volume ; Humans ; Male ; Maximal Midexpiratory Flow Rate ; Regression Analysis ; Respiratory Function Tests ; methods ; Sensitivity and Specificity

OBJECTIVETo investigate the changes of pulmonary function and fractional exhaled nitric oxide (FeNO) in the standardized treatment of bronchial asthma in children.

METHODSA total of 254 children who were newly diagnosed with acute exacerbation of bronchial asthma were selected as asthma group, and they were divided into two subgroups: asthma with concurrent rhinitis and asthma without concurrent rhinitis. All patients received the standardized management and treatment for one year. The pulmonary function parameters included forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and mid-expiratory flow at 25%, 50%, and 75% of vital capacity (MEF25, MEF50, and MEF75). The FeNO levels were measured before treatment and at 3, 6, 9, and 12 months after treatment. Another 62 healthy children were selected as the control group, and the pulmonary function and FeNO levels were measured only once.

RESULTSDuring one year of standardized treatment, FEV1, PEF, MMEF, MEF25, MEF50, and MEF75 gradually increased, and FeNO levels gradually decreased (P<0.05). Indicators of large airway function, such as FEV1 and PEF, almost returned to normal after 6 months of treatment; indicators of small airway function, such as MMEF, MEF25, MEF50, and MEF75 almost returned to normal after 9 months of treatment; there were no significant differences in the above indices between the asthma group and the control group after one year of treatment (P>0.05). However, the asthma group had a significantly higher FeNO levels than the control group after one year of treatment (P<0.05). The asthmatic patients with concurrent rhinitis had significantly higher FeNO levels than those without concurrent rhinitis before treatment and 3 months after treatment (P<0.05). Before treatment, there was a significant negative correlation between FeNO levels and pulmonary function parameters (P<0.05).

CONCLUSIONSWith the standardized treatment of bronchial asthma in children, pulmonary function parameters gradually increase and FeNO levels gradually decrease. The recovery of large airway function occurs earlier than the recovery of small airway function. Furthermore, the effect of rhinitis on airway responsiveness should be noted.

Asthma ; physiopathology ; therapy ; Breath Tests ; Child ; Female ; Forced Expiratory Volume ; Humans ; Lung ; physiopathology ; Male ; Maximal Midexpiratory Flow Rate ; Nitric Oxide ; analysis ; Rhinitis ; physiopathology

The purpose of this study is to establish COPD animal model by intra-tracheal instillation of bleomycin (BLM) once and exposure to cigarette smoke for continuous 27 d, and to observe the effects of the inhalation on the model. At the 29th day, blood samples were taken from cervical artery for blood-gas analysis and parameters of lung function were recorded. Bronchoalveolar lavage fluid (BALF) was collected to measure intercellular adhesion molecule-1 (ICAM-1) concentration. The results showed that atomization inhaled resveratrol could alleviate rat COPD lung injury accompanied by amelioration of pathological changes, increase the ratio of forced expiratory volume in 0.3 s (FEV0.3) and forced vital capacity (FVC), and decrease the ICAM-1 level in BALF. The ultimate reduction of inflammatory factors was involved, at least in part, in the mechanism of resveratrol effects.
Animals ; Bleomycin ; Blood Gas Analysis ; Bronchoalveolar Lavage Fluid ; chemistry ; Disease Models, Animal ; Female ; Forced Expiratory Volume ; drug effects ; Intercellular Adhesion Molecule-1 ; metabolism ; Lung ; pathology ; Lung Compliance ; drug effects ; Male ; Maximal Midexpiratory Flow Rate ; drug effects ; Pulmonary Disease, Chronic Obstructive ; chemically induced ; metabolism ; pathology ; physiopathology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Smoking ; Stilbenes ; pharmacology