Methacholine bronchial provocation test for assessment of bronchial hyperresponsiveness in preschool children.

BACKGROUND: Bronchial hyperresponsiveness (BHR) has not been extensively performed in preschool children, possibly because of the difficulty in cooperating with the tests. We sought to determine the usefulness and safety of methacholine bronchial provocation test (MCh-BPT) for BHR assessment in preschool children. METHODS: We recruited 252 preschool children (190 healthy and 62 with wheezing) who underwent MCh-BPT at baseline. MCh-BPT was re-scheduled in case initial attempts failed. Forced expiratory volumes in 0.5 (FEV0.5), 0.75 (FEV0.75) and one second (FEV1) were measured. We recorded the provocative dose causing 15% (PD15) or 20% reduction (PD20) in FEV0.5, FEV0.75 and FEV1, thus allowing for comparison of the diagnostic value of PD15 and PD20. RESULTS: A total of 209 children [156 (82.1%) healthy, 53 (85.5%) with wheezing] successfully completed MCh-BPT. Compared with healthy children, a significantly greater proportion of children with wheezing had measurable PD15FEV0.5, PD15FEV0.75 and PD15FEV1 (P<0.01), and PD20FEV0.5, PD20FEV0.75 and PD20FEV1 (P<0.05). The sensitivity was 92.5% and 94.3% for PD20FEV1, and PD15FEV1 and the specificity was 93.6% and 93.6% respectively, for discriminating asthmatic from healthy children. CONCLUSIONS: Most preschool children successfully and safely complete MCh-BPT, with higher success rate in larger age group. PD20FEV0.5 and PD20FEV0.75 can be surrogates of PD20FEV1 among children whose expiration lasted for less than one second. PD15 has a good diagnostic value as PD20 for diagnosing of BHR in preschool children, which are also more suitable for children five years old or elder.

Correlation between upper and lower airway inflammations in patients with combined allergic rhinitis and asthma syndrome: A comparison of patients initially presenting with allergic rhinitis and those initially presenting with asthma.

Allergic rhinitis (AR) and asthma often coexist. The terminology combined allergic rhinitis and asthma syndrome (CARAS) was introduced to describe patients with combined AR and asthma. The aim of the present study was to evaluate the correlation between eosinophilic inflammation in the upper and lower airways of patients with CARAS. Stable patients with CARAS initially presenting with AR or asthma were recruited. Healthy subjects and patients with AR alone were recruited as controls. Clinical characteristics, including disease history, lung function, nasal airway inspiratory resistance and upper and lower airway eosinophilic inflammation were evaluated and compared. A total of 73 subjects (22 patients with CARAS initially presenting with AR, 15 patients with CARAS initially presenting with asthma, 25 patients with AR alone and 11 healthy subjects) were studied. The nasal symptoms visual analogue scale scores at the week prior to enrollment and nasal airway inspiratory resistances were comparable among the groups. The percentage of predicted forced expiratory volume in 1 sec and percentage of predicted maximal middle expiratory flow in patients with CARAS initially presenting with asthma were significantly lower compared with the other three groups (P<0.05). No significant different in the percentage of eosinophils in the nasal lavage was observed between patients with CARAS and those with AR only; however, it was significantly increased compared with healthy subjects (P<0.05). The fractional concentration of exhaled nitric oxide and percentage of eosinophils in the sputum were significantly increased in patients with CARAS compared with those in the AR only and healthy subject groups (P<0.05). The difference in the percentage of eosinophils in the nasal lavage and sputum between patients with CARAS initially presenting with AR and initially presenting with asthma was not significant; however, a positive correlation between the percentage of eosinophils in the upper and lower airways was present in patients with CARAS initially presenting with AR only (r=0.526, P=0.030).

Adenosine monophosphate is not superior to histamine for bronchial provocation test for assessment of asthma control and symptoms.

BACKGROUND: Adenosine monophosphate (AMP) may reflect airway inflammation and hyperresponsiveness, but relationship between AMP and histamine (His, a conventional stimulus) bronchial provocation test (BPT) in asthma is not fully elucidated. OBJECTIVES: To compare both BPTs and determine their utility in reflecting changes of asthmatic symptoms. METHODS: BPTs were performed in a cross-over fashion, at 2-4 day intervals. Cumulative doses eliciting 20% FEV1 fall (PD20 FEV1 ), diagnostic performance and adverse events (AEs) were compared. Patients with PD20 FEV1 lower than geometric mean were defined as responders, otherwise poor responders. Patients with uncontrolled and partly controlled asthma, who maintained their original inhaled corticosteroids therapy, underwent reassessment of airway responsiveness and asthmatic symptoms 3 and 6 months after. RESULTS: Nineteen uncontrolled, 22 partly controlled and 19 controlled asthmatic patients and 24 healthy subjects were recruited. Lower PD20 FEV1 geometric means were associated with poorer asthma control in His-BPT (0.424 µmol vs 1.684 µmol vs 3.757 µmol), but not AMP-BPT (11.810 µmol vs 7.781 µmol vs 10.220 µmol). Both BPTs yielded similar overall diagnostic performance in asthma (area under curve: 0.842 in AMP-BPT vs 0.850 in His-BPT). AEs, including wheezing and tachypnea, were similar and mild. Ten patients with uncontrolled and 10 partly controlled asthma were followed-up. At months 3 and 6, we documented an increase in PD20 FEV1 -AMP and PD20 FEV1 -His, which did not correlate with reduction asthmatic symptom scores. This overall applied in responders and poor responders of AMP-BPT and His-BPT. CONCLUSION: Despite higher screening capacity of well-controlled asthma, AMP-BPT confers similar diagnostic performance and safety with His-BPT. AMP-BPT might not preferentially reflect changes asthmatic symptoms.

Leukotriene D4 inhalation challenge for predicting short-term efficacy of montelukast: a pilot study.

INTRODUCTION: The convenient measure to predict efficacy of leukotriene receptor antagonist is lacking. OBJECTIVES: To determine if leukotriene D4 inhalation challenge predicts short-term efficacy of montelukast in asthma. METHODS: In this open-labelled 28-day trial, 45 patients with asthma were allocated to leukotriene-sensitive and leukotriene-insensitive group to receive montelukast monotherapy (10 mg, once daily) based on the positive threshold of leukotriene D4 inhalation challenge test (4.800 nmol). Miscellaneous measurements comprised fractional exhaled nitric oxide, methacholine inhalation challenge, Asthma Control Test and Asthma Quality of Life Questionnaire. Peak expiratory flow was self-monitored throughout the treatment. End point assessments were performed 3 to 5 days after montelukast withdrawal. RESULTS: Twenty-three patients in leukotriene-sensitive group and 10 leukotriene-insensitive group completed the study. Both groups differed neither in 28-day peak expiratory flow rate nor in maximal weekly peak expiratory flow (both P > 0.05). However, minimal weekly peak expiratory flow was significantly higher in leukotriene-insensitive group throughout the treatment course (all P < 0.05) except for week 1 (P > 0.05). Both groups did not differ statistically in the post-treatment improvement in forced expiratory volume in 1 s (FEV1 ) predicted% prior to inhalation challenge, fractional exhaled nitric oxide or the airway responsiveness to leukotriene D4 or methacholine (all P > 0.05). There was a marked increase in Asthma Control Test score and the symptom score of Asthma Quality of Life Questionnaire in both groups (both P < 0.05). The overall significance of Logistic regression model was unremarkable (P = 0.467). CONCLUSION: Responsiveness to inhaled leukotriene D4 alone might not be sufficient to predict the short-term efficacy of montelukast monotherapy in patients with asthma.

Response--dose ratio is a surrogate of cumulative provocative dosage for bronchial provocation tests in asthma.

BACKGROUND: Response-dose ratio (RDR) and cumulative provocative dosage (PD) are useful indices reflecting airway responsiveness in asthma. OBJECTIVES: To compare the diagnostic value of RDR and PD, by conducting leukotriene D4 (LTD4-BPT) and methacholine bronchial provocation test (MCh-BPT), in different asthma control levels. METHODS: Healthy subjects and asthmatic patients underwent LTD4-BPT and MCh-BPT, at 2-14-day interval. This entailed assessment of the distribution characteristics, correlation, and diagnostic value of PD inducing 20% fall in forced expiratory volume in one second (PD20FEV1) and the RDR, defined as FEV1 fall (%) at the final step divided by the corresponding provocative dosage. RESULTS: Twenty uncontrolled, 22 partly controlled, 20 controlled asthmatics, and 21 healthy subjects were enrolled. Log10RDR was positively correlated with log10PD20FEV1 in both BPTs (all P < 0.05). Poorer asthma control was associated with significantly lower PD20FEV1 and higher RDR (both P < 0.05). The differences in PD20FEV1 and RDR between partly controlled and controlled asthma were unremarkable (both P > 0.05). Compared with log10PD20FEV1, the log10RDR yielded similar diagnostic values in both BPTs. A lower percentile of RDR (≤ 25th percentile) was associated with higher baseline FEV1 (P < 0.05) and an increased proportion of well-controlled asthmatic patients. The combination of RDR and PD20FEV1 led to an increased diagnostic value compared with either parameter alone. CONCLUSIONS: RDR is a surrogate of PD20FEV1 for BPTs in asthma. This finding was not modified by different asthma control levels or the types of bronchoprovocants.

Vibration response imaging in idiopathic pulmonary fibrosis: a pilot study.

BACKGROUND: Vibration response imaging (VRI) is a novel imaging technique and little is known about its characteristics and diagnostic value in idiopathic pulmonary fibrosis (IPF). The aim of this study was to investigate the features of VRI in subjects with IPF. METHODS: We enrolled 23 subjects with IPF (42-74 y old) and 28 healthy subjects (42-72 y old). Subjects with IPF were diagnosed by lung biopsy and underwent VRI, spirometry, lung diffusion testing, and chest x-ray or computed tomography, which entailed assessment of the value of VRI indices. RESULTS: The total VRI score correlated statistically with single-breath carbon monoxide diffusing capacity percent predicted (r = -0.30, P = .04), but not with FVC percent predicted, FEV1 percent predicted, and FEV1/FVC (r = -0.27, -0.22, and 0.19; all P > .05). Compared with healthy subjects (17.9%), 20 subjects with IPF (86.96%, P < .01) presented with significantly increased crackles. The difference in quality lung data in all lung regions was unremarkable (all P > .05), except for the upper right and lower left lobes (P < .05). Overall, VRI parameters yielded acceptable assay sensitivity and specificity. Maximum energy frame was characterized by the highest diagnostic value (sensitivity, 1.00; specificity, 0.82), followed by presence of abundant crackles (sensitivity, 0.70; specificity, 0.96). Total VRI score was not a sensitive indicator of IPF, owing to low assay sensitivity (0.70) and specificity (0.64). CONCLUSIONS: VRI may be helpful to discriminate between IPF subjects and healthy individuals. Maximum energy frame and abundant crackles might serve as a diagnostic tool for IPF.

[Single-breath and rebreathing methods for measurement of pulmonary diffusing function: a comparative study].

OBJECTIVE: To compare the difference of pulmonary diffusing capacity measured by single-breath (SB) and re-breathing (RB) in normal subjects, patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). METHODS: We enrolled a cohort of subjects from the Guangzhou Institute of Respiratory Disease between September 2011 and February 2012: control group 29 (male 9, female 20, 42-74 y), ILD group 32 (male 15, female 17, 41-72 y), COPD group 32 (male 28, female 4, 40-75 y). All subjects underwent pulmonary diffusing capacity test using SB or RB method according to random figures order list. Diffusing capacity of carbon monoxide per predicted measured by SB method (SB-DLCO%pred) of the normal group was used as the standard to adjust the diffusing capacity of carbon monoxide per predicted measured by RB method (RB-DLCO%pred) and diffusing capacity of carbon monoxide per liter of VA per predicted measured by RB (RB-DLCO/VA%pred) in the 3 groups, respectively. Comparisons between 2 groups were performed by using the independent-sample t test, among more than 2 groups by using the One-Way ANOVA test, while the ROC curve was used to calculate the area under curve (AUC) and its 95%CI. RESULTS: In the control group, 15 subjects' RB-DLCO%pred was lower than 80%, and the mean value (78.8 ± 2.1)% was also lower than 80%. Using SB-DLCO%pred of the normal group as a standard to adjust the RB-DLCO%pred, the corrected value was 1.097, and then this value was used to adjust RB-DLCO/VA%pred in the 3 groups, respectively. Before correction DLCO%pred [the control group: (91.2 ± 1.9)% vs (78.8 ± 2.1)%; the ILD group: (45.8 ± 2.6)% vs (60.0 ± 1.9)%;the COPD group: (66.3 ± 2.9)% vs (56.6 ± 1.6)%]and DLCO/VA%pred [the control group: (99.8 ± 2.3)% vs (84.6 ± 4.5)%; the ILD group: (75.9 ± 3.0)% vs (88.5 ± 5.4)%; the COPD group: (80.2 ± 3.7)% vs (50.6 ± 2.5)% ] between the SB and RB were statistically different among the 3 groups. After correction, only the DLCO%pred [(45.8 ± 2.6)% vs (65.8 ± 2.1)%], DLCO/VA%pred [ (75.9 ± 3.0)% vs (102.2 ± 6.2)%] of the ILD group and the DLCO/VA%pred [(80.2 ± 3.7) vs (58.3 ± 2.8)%] of the COPD group had significant difference between the 2 methods (t = -6.00-4.68, all P < 0.01) . The test time of re-breathing in the COPD group (106 ± 5) s was significant longer than that of the ILD group (73 ± 4) s and the control group (79 ± 5) s (F = 11.99, P < 0.01), and the correlation between DLCO/VA%pred and the test time(r = -0.661, P < 0.01) was higher than the relationship between DLCO%pred and the test time (r = -0.391, P < 0.01). Furthermore, in the ILD group, the area of RB-DLCO%pred under ROC was 0.893, 95%CI being 0.817-0.970. In the COPD group, the area of RB-DLCO/VA%pred under ROC was 0.895, 95%CI being 0.811-0.979. CONCLUSIONS: There were differences between re-breathing and single-breath in measuring diffusing capacity. The present predicted value of the re-breathing method needed further study to confirm its applicability. Re-breathing method was more consistent with the respiratory physiology, and might be a better method to detect diseased states.

Responsiveness to leukotriene D4 and methacholine for predicting efficacy of montelukast in asthma.

A lower responsiveness to leukotriene D4 (LTD4) or higher LTD4/[methacholine (MCh)] potency ratio might suggest preferable outcomes of short-term montelukast monotherapy in terms of airway inflammation and lung function in asthmatic patients.

Impulse oscillometry for leukotriene D4 inhalation challenge in asthma.

BACKGROUND: The value of impulse oscillometry (IOS) for bronchial provocation testing is poorly defined. We investigated the positive threshold derived from the parameters and diagnostic power of IOS for asthma with the leukotriene D(4) bronchial provocation test. METHODS: We enrolled 62 subjects with asthma and 21 healthy subjects. IOS was employed to perform the leukotriene D(4) bronchial provocation test, followed by spirometry. The positive threshold was determined based on the cutoff point in the receiver operating characteristic curve, from which the parameters with the highest diagnostic power were obtained. RESULTS: Airway impedance at 5 Hz (Z(5)), resistance at 5 Hz (R(5)), and resonance frequency had the highest diagnostic power (areas under curve 0.82, 0.82, and 0.81, respectively), with increases of 57%, 43%, and 63%, corresponding to a 20% decrease in FEV(1), respectively. IOS indices yielded assay sensitivity and specificity similar to that of spirometry. The positive threshold for IOS, defined as either a 57% increase in Z(5) or a 63% increase in resonance frequency in the bronchial provocation test, yielded an assay accuracy of 0.6 in subjects with asthma. CONCLUSIONS: IOS during the leukotriene D(4) bronchial provocation test has a diagnostic power similar to that of spirometry. Either a 57% increase in Z(5) or a 63% increase in resonance frequency may be regarded as a surrogate of FEV(1) decrease to determine airway hyper-responsiveness in asthma.

[Investigation on quality of spirometry in 36 large hospitals in China].

OBJECTIVE: To assess the current status of quality control of spirometry reports in China. METHODS: Spirometry case reports from January 2008 to October 2008 were collected from pulmonary function testing laboratories in 36 large hospitals (provincial or municipal) in China. The quality analysis was performed according to ATS/ERS standardization for measurement of spirometry. The number of reports that met the criteria for quality control was expressed as percentages. RESULTS: A total of 345 spirometry test reports were collected. 82.5% (282/342) met the start-of-test criteria for quality control. 333 reports could be analyzed for free of artifacts, of which 65.8% (219/333) were consistent with the criteria of smooth expiration; the remaining reports (114) failed to meet the criteria, for reasons including cough (29/333, 8.7%), premature glottis closure (8/333, 2.4%), gas leakage (29/333, 8.7%), early termination of expiration (26/333, 7.8%), mouthpiece obstruction (6/333, 1.8%), and incomplete exertion of efforts (49/333, 14.7%). 235 reports were analyzed for end-of-test criteria, with 50.6% (119/235) complying to criteria. 22.6% (78/345) of the reports were tested for more than 3 times, among which 65 reports with the data of each manoeuvre could be analyzed for repeatability. 95.4% (62/65) of the reports met the repeatability criteria, which accounted for 18.0%(62/345)of the total reports collected. The rate of the 2 highest FVC (forced vital capacity) and FEV(1) (forced expiratory volume in one second) of less than 150 ml was 95.4% (62/65) and 100.0% (65/65), respectively. The rate of the 2 highest FVC and FEV(1) of less than 100 ml was 92.3% (60/65) and 87.7% (57/65), respectively. Only 7.2% of the reports (25/345) met all of the 4 criteria listed above. CONCLUSIONS: The quality of spirometry tests in large (provincial or municipal) hospitals in China needs to be improved in the future.

[Comparison of high-intensity and anaerobic threshold programs in rehabilitation for patients with moderate to severe chronic obstructive pulmonary disease].

OBJECTIVE: To compare two training programs in rehabilitation for patients with moderate to severe chronic obstructive pulmonary disease (COPD). METHODS: Of the 54 patients who entered the study, 41 completed the rehabilitation program. Thirty-two COPD patients were randomly assigned to either the anaerobic threshold group (AT, n = 15) or the high-intensity group (HI, n = 17). Another group was the control group (NT, n = 9). Bicycle exercise training was conducted for 2 days each week for a period of 12 weeks. The HI group received the highest level of intensity that could be tolerated. The AT group received a training intensity corresponding to the anaerobic threshold. Main assessments included lung function test, cardiopulmonary exercise testing, the St George's Respiratory Questionnaire and the Borg dyspnea scale before and after the rehabilitation program. The data of the baseline clinical characteristics of groups were presented as (-x) +/- s. Comparison within two means were analysed through one-sample t test or paired t test. One-way analysis of variance was used to compare multiple means. The rates were analysised by Fish exact probabilities. The Wilcoxon rank sum test was used for comparisons within the groups and the Mann-Whitney u test for intergroup comparisons. RESULTS: Both the AT and HI groups showed significant improvement in Vo(2peak)% pre after rehabilitation, with the former increasing from (61 +/- 11)% to (69 +/- 14)%, and the latter increasing from (72 +/- 12)% to (79 +/- 13)%. The degree of improvement of both groups (AT and HI) were (14 +/- 17)% and (12 +/- 13)%, the difference being not significant (z = -0.180, P > 0.05). At 56 W work rate, the minute ventilation decreased from (36 +/- 4) L/min to (33 +/- 5) L/min (t = 6.167, P < 0.01), the breathing frequency decreased from (32 +/- 1) beats/min to (31 +/- 3) beats/min (t = 2.876, P < 0.05), and the tidal volume increased from (1.2 +/- 0.3) L to (1.3 +/- 0.3) L (t = 2.587, P < 0.05) in the HI group. After rehabilitation the heart rates [(109 +/- 39, 110 +/- 25) beats/min] were significantly lower than those of the baseline [(116 +/- 39, 114 +/- 42) beats/min] respectively in the AT and the HI groups. Oxygen pulse increased significantly from baseline (9.6 +/- 3.7, 8.5 +/- 4.3) ml/beat to (10.4 +/- 4.0, 9.0 +/- 3.2) ml/beat. This level of exertional dyspnea (DeltaBorg/DeltaVo(2)) was significantly improved from (8.6 +/- 3.2, 6.5 +/- 2.6) to (7.4 +/- 2.5, 5.6 +/- 2.4) in both the HI and the AT group (both P < 0.05). The between-group difference for the change in DeltaBorg/DeltaVo(2), however, was not significant (z = -0.378, P > 0.05). CONCLUSIONS: Both the HI and the AT groups had significant improvements in exercise capacity and dyspnea after pulmonary rehabilitation. The degree of improvement in both groups was similar. But the HI group showed significant improvement in the anaerobic threshold and decrease in ventilatory requirement.

[Peak inspiratory flow generated through different analogue dry powder inhalers in Shenzhen healthy preschool children].

OBJECTIVE: Dry powder inhalers (DPIs) are increasingly being used to deliver drugs for the treatment of asthma. It is known that DPIs require a crucial minimal inspiratory flow. Previous studies have demonstrated that the peak inspiratory flow (PIF, L/min) through a DPI is dependent on the type of device, the age of the patient, and the level of bronchial obstruction. However, the peak inspiratory flow of healthy preschool children in China remains scant in the literature. The present study aimed to analyze the ability of inspiring flow through the resistance state of ordinary use inhaler in Shenzhen healthy preschool children by measuring the peak inspiratory flow through the different analogue dry powder inhalers and go further into the relationship between it and the age, weight and forced expiratory volume of the children. METHOD: A survey in 370 healthy preschool children aged 3 to 6 years (75 children aged 3 years, 104 children aged 4 years, 100 children aged 5 years and 91 children aged 6 years) was carried out in Shenzhen. Peak inspiratory flow (PIF) was measured without and with resistances, which mimicked the internal resistances of several inhalers, Diskus, Turbuhaler, Autohaler, Surehaler by PIF meter (In-check DIAL) and then data PIF-N, PIF-D, PIF-T, PIF-A and PIF-S were obtained. Peak expiratory flow (PEF) was measured by PEF meter (MicroPeak, USA). These two measurements were made in a well-controlled setting, and at least three attempts were recorded to establish maximum achievement. Six spirometry parameters forced vital capacity (FVC), forced expiratory volume at 0.5 second (FEV 0.5), forced expiratory volume at 0.75 second (FEV 0.75), forced expiratory volume at one second (FEV1), maximal mid expiratory flow rate (FEF 25 - 75, PEF were measured by using COSMED spirometry of Italy and the FVC measurements should be around the quality control for spirometry in preschool children which we suggested and published in 2005. All data were expressed as mean +/- SD and analyzed with the statistical software SPSS 12.0 for Windows. Pearson's test was used for calculation of the significances of the correlation coefficients. Variance analysis was used for analysing the variability of inspiratory flows through the inhalers. RESULTS: Results were obtained from 295 children aged 3 - 6 years who successfully finished the tests. The PIF-N, PIF-D, PIF-T, PIF-A and PIF-S were significantly different among the groups aged 3 yrs, 4 yrs, 5 yrs and 6 yrs. The peak inspiratory flow significantly increased with age. The PIF-N, PIF-D, PIF-T, PIF-A and PIF-S in the children of 110 cm height and above were significantly higher than those in the children below 110 cm height, so were the parameters between the children of 120 cm height and above and the children below 120 cm. PIF correlated significantly with age, height and weight and the Pearson coefficient was 0.3 - 0.5. The PIFs in different inhalers varied because of the different inner resistances. The minimum and optimum PIFs in resistances of Diskus, Autohaler and Surehaler could be achieved in almost all subjects, but those in resistances of Turbuhaler could be achieved in only 87.5% subjects, most of whom aged 3 yrs or below 100 cm height. There were good correlations between the PIFs in different resistances and main parameters of ventilation function (FVC, FEV 0.5, FEV 0.75, FEV1, FEF 25 - 75, PEF), PEF was the best among them (Pearson correlative coefficient was 0.6). CONCLUSION: The inspiratory ability of the children can be predicted and assessed by using routine measurement of lung function of normal pre-school children. As to the pre-school children of varying ages, the variety of inspiratory ability should be considered completely in the selection of inhaler used during the treatment. The best inhaler suitable for them should be selected properly in order to obtain the best efficacy of treatment individually.

[Evaluation of correlation between pulmonary function testing and high resolution computed tomography in pulmonary alveolar proteinosis].

OBJECTIVE: Pulmonary alveolar proteinosis (PAP) is a rare respiratory disorder featured by lipoproteinaceous material accumulation within alveoli. Pulmonary function testing (PFT) and quantitative high resolution computed tomography (HRCT) are used in evaluation of the severity, development and treatment effects of PAP. METHODS: Seventeen patients (10 males, 7 females), aged from 15 to 51 years old, with PAP histopathologically proven by positive periodic acid Schiff reaction were studied in our institute from 2004 to 2007. PFTs and HRCT were performed in all patients. The quantitative parameters of HRCT included total lung volume (TLV), total lung mass (TLM), air-filling lung volume (AFLV), averaged lung density (ALD) and the ratio of air-filling lung volume to total lung volume (AFLV/TLV). The parameters of PFT included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, diffusion capacity of carbon monoxide (D(L)CO), the ratio of D(L)CO to alveolar volume (D(L)CO/V(A)), total lung capacity (TLC), residual volume (RV), RV/TLC. A total of 24 dataset of the PFT and HRCT were collected. The correlation and regression between PFTs and HRCT were analyzed. PFT and HRCT parameters were compared before and after treatment with whole lung lavage in 6 of these patients. The data were expressed with mean +/- standard deviation and analyzed with SPSS 13.0 software. RESULTS: Restrictive ventilation function disorder and diffusion function disorder were found in patients with PAP, with more significant decline in D(L)CO (46.1% of predicted and abnormal rate 94.1%). Correlation between PFTs and HRCT parameters were found, with significance in ALD and FVC (r = -0.469, P = 0.021), TLM and FEV1 (r= -0.482, P = 0.017), AFLV/TLV and PEF (r = 0.511, P = 0.011), D(L)CO and D(L)CO/V(A) (r = 0.659, 0.692, P = 0.000, respectively). The highest correlation was found between D(L)CO/V(A) and AFLV (r = 0.525; P < 0.05). D(L)CO was markedly improved after the treatment of whole lung lavage, simultaneously found with varied improvement of quantitative parameters of HRCT measurements. CONCLUSIONS: Pulmonary function was impaired and correlated with abnormal appearance in HRCT in patients with PAP. Quantitative HRCT may be helpful in prediction of pulmonary function changes. Both techniques are important for the prognosis, outcome and follow-up studies of the disease.

[Evaluation of exercise intensity for pulmonary rehabilitation in patients with chronic obstructive pulmonary disease].

OBJECTIVE: To investigate proper methods and parameters of exercise intensity in pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD). METHODS: Symptom-limited cardiopulmonary exercise test (CPET) was performed in 30 male patients with moderate to severe COPD by cycle ergometer. Exercise intensity parameters, including the measured heart rate reserve (HRR%meas), the predictive heart rate reserve (HRR%pred) and the Borg scale were obtained. The distribution of these parameters ranged from 10% to 90% VO2max were compared. Multiple regression analysis was applied to analyze the relationship among heart rate (HR), the Borg scale and VO2max%. RESULTS: The HRR%meas was close to VO2max%. The coefficient of variation (CV) of HRR%meas was larger than HRR%pred. The larger was the Borg scale, the smaller was the distribution of VO2max%. While the Borg scale were 3, 4, and 5, the exercise intensity achieved 60%, 72%, and 78% VO2max, respectively. Predicted equation (VO2max%=1.026xHR+27.688xBorg-0.179xHRxBorg-63.313, r=0.920, P=0.00) was obtained. CONCLUSION: HRR%meas was a better parameter than HRR%pred for prescribing the exercise intensity. The Borg scale is a simple and applicable method to prescribe and monitor the exercise intensity. It is suggested that Borg scale should reach 4 (moderate dyspnea) in pulmonary rehabilitation for the male patients with moderate to severe COPD. Predicted equation for VO2max% is recommended for monitoring the exercise intensity.

[Feasibility and predicted equations of spirometry in Shenzhen preschool children].

UNLABELLED: Morbidity of chronic lung disease in young children is relatively high, and could increase in the future. Pulmonary function testing is used for clinical assessment of patients with suspected or obvious pulmonary disease to assess the severity of dysfunction and to evaluate therapeutic effectiveness. In the recent few years, forced expiratory parameters assessing lung function have been measured in older children. In order to assess abnormalities of lung function in preschool patients with respiratory disorders based on changes of forced expiratory parameters, adequate reference values are needed. However, such data in healthy preschool children remain scant in the literature. OBJECTIVE: The aim of this study was to characterize the spirometry of preschool children and establish the normal lung function prediction equations for Chinese preschool children. METHODS: A survey in 343 healthy preschool children (184 boys and 159 girls) aged 3 to 6 years (73 children aged 3 years, 96 children aged 4 years, 91 children aged 5 years and 83 children aged 6 years) was carried out in Shenzhen in 2004. Eleven flow volume tests parameters, i.e., forced vital capacity (FVC), forced expiratory volume at 0.5 second (FEV(0.5)), forced expiratory volume at 0.75 second (FEV(0.75)), forced expiratory volume at one second (FEV(1)), maximal mid expiratory flow rate (FEF(25%-75%)), peak expiratory flow (PEF), forced expiratory time (FET100%) were measured by using COSMED spirometry produced in Italy. Stepwise multiple regressions and non-linear regressions were carried out with the statistical software SPSS10.0 for Windows to identify the best predictors of lung function parameters using standing height, weight, age and gender as potential determinants. RESULTS: Spirometric tests could be successfully carried out by using imagery methods in the following percentages of children: 69.9% of 3 to 4 years old, 70.8% of 4 to 5 years old, 92.3% of 5 to 6 years old and 91.6% of 6 to 7 years old children, 77.7% of the selected population (217/279) of children performed at least two acceptable tests respectively. The average forced expiratory time (FET) was 1.61 +/- 0.52 sec (x +/- s), the 5th percentile value was 0.9 sec, 18 of 279 (6.5%) children produced a FET less than 1 second. Forced expiratory volume in 0.50 and 0.75 sec (FEV(0.5), FEV(0.75)) were thus measured necessary in preschool children. All lung volumes and flow rates increased with age, height as well as weight growth in both gender groups. The correlation among most lung function parameters was higher in height than in age and weight in boys. Whereas the correlation among most lung function parameters was higher in age than in height and weight in girls. The regression equations of lung function were established. By comparison with the equations derived from this study and from studies by Nystad, it was found that there was a difference between the predicted values. CONCLUSION: Spirometric testing is feasible in preschool children by using imagery methods and may be useful for both clinical practice and research. The correlation among most lung function parameters was higher in height than in age and weight in boys. Whereas the correlation among most lung function parameters was higher in age than in height and weight in girls.