Regional lung function in patients with bronchial asthma.

The regional distribution of pulmonary ventilation and perfusion and regional alveolar ventilation/perfusion ratios were measured with radioactive xenon ((133)xenon) in 10 patients with asthma in remission. Four subjects had normal ventilation distribution, four had hypoventilation in some regions and normal ventilation in others, and two patients had abnormal ventilation in almost all lung regions. The lung bases were involved most frequently and the middle zones least frequently. Correlation was good between the degree of over-all ventilatory impairment calculated from (133)xenon values and measurement of the maximal midexpiratory flow rate the same day. Regions which were hypoventilated had low ventilation/perfusion ratios and also tended to be hypoperfused. In the eight subjects who had been studied similarly 5 yr previously, changes in regional function correlated in general with changes in over-all function.

Immunological studies in sarcoidosis: a comparison of in vivo and in vitro Kveim tests.

No migration inhibition was observed in the 46 patients or the 12 controls when the Danish Kveim antigen was used in the LMAT. No migration inhibition was found in 23 of the same patients when the LMT was employed using the same antigens (Table 3).

Immunological studies in sarcoidosis: a comparison of disease activity and various immunological parameters.

We found it valuable to separate the heterogeneous types of sarcoidosis into more homogeneous groups on the basis of activity and duration of the disease. This view is supported in the present study by the finding of a marked depression of T-cell function in patients with chronic-active sarcoidosis. Patients with acute or chronic-inactive disease had only moderately depressed T-cell function as measured by tuberculin skin test and DNCB index. These results are in agreement with those of some previous investigations. The remainder of the abnormal findings, particularly low total number of circulation T lymphocytes, elevated serum IgG levels, and presence of autoantibodies, could not be correlated to disease activity, extent of the disease, or T-cell function. We have found no explanation for the presence of autoantibodies but suspect that they may be nonspecifically related to the disease process.

Long-range correlations of serial FEV1 measurements in emphysematous patients and normal subjects.

In obstructive lung disease the annual change in lung function is usually estimated from serial measurements of forced expiratory volume in 1 s (FEV1). Frequent measurements in each patient may not improve this estimate because data are not statistically independent; i.e., the measurements are autocorrelated. The purpose of this study was to describe the correlation structure in time series of FEV1 measurements. Nineteen patients with severe alpha1-antitrypsin deficiency (phenotype PiZ) and moderate to severe emphysema and two subjects with normal lungs were followed for several years with daily self-administered spirometry. FEV1 measurements fulfilling standard criteria were detrended, and the autocorrelation profile and the power spectrum were calculated. On average the subjects were followed for >3 yr and performed >1,000 acceptable spirometries. The autocorrelation of FEV1 measurements in the emphysematous patients was approximately 0.35 for short intervals and decreased almost exponentially with a half time of 38 days. Between 3 and 4 mo, the autocorrelation function became negative. It reached a minimum of -0.1 at approximately 8 mo and then increased toward zero over the following 12 mo. The autocorrelation function in the two normal subjects showed a similar pattern, but with a faster decay toward zero. In the patients, the power spectrum had a peak at 1 cycle/wk and showed a 1/f pattern, where f is frequency, with a slope of -0.88 at lower frequencies. We conclude that serial spirometric measurements show long-range correlations. The practical implication is that FEV1 need not be measured more often than once every 3 mo in studies of the long-term trends in lung function.

[Observer variation of the radiographic assessment of pulmonary changes caused by asbestos]. / Observatørvariationen ved røntgenologisk bedømmelse af asbestfremkaldte lungeforandringer.

Assessment was undertaken of 165 x-ray photographs of the thorax originating from 165 men with varying degrees of exposure to asbestos: 37 were workers in an eternite factory, 65 insulation workers, 42 were plumbers and 21 were patients from the Lung Clinic in Bispebjerg Hospital. Assessment of the x-rays was carried out according to the directives established by the International Workers' Organisation (ILO) by three experienced specialists who had no knowledge of the individual person's exposure to asbestos or smoking habits. In order to investigate not only inter- but also intra observer variation, the three medical specialists described the material on two occasions with an interval of several days. Analysis of the descriptions revealed that there was considerable inter- and intra-observer variation in assessment of the changes caused by asbestos. Description of the parenchymatous changes was associated with slightly greater variation than description of the pleural changes. A partial analysis of smokers who had not had occupational exposure to asbestos showed a not inconsiderable occurrence (5-33%) of parenchymatous changes which could not be differentiated from changes caused by asbestos. It is concluded, that the diagnosis of pulmonary disease caused by asbestos should not be based on radiographic examination alone.

Asbestos exposure and aspergillus infection.

Four cases of asbestos-related changes of the lung complicated by aspergillus infection are described. In such cases, the resulting clinical and radiological picture can give rise to some confusion. It is suggested that exposure to asbestos leads to changes in the bronchi and the lung parenchyma which can facilitate growth of the fungus. It is also possible that asbestos can affect the immune system in such a way that the body's anti-fungal defences are weakened. The aspergillus infection can mimic a tumor and/or lead to obstructive symptoms, and in one of the cases described an infected empyema was found.

Abacillary pulmonary tuberculosis.

In Copenhagen, a city with a low incidence of tuberculosis, 72 patients with discrete pulmonary infiltrates on the chest X-ray had a tentative diagnosis of tuberculosis. All were sputum smear negative for acid-fast bacilli. A prospective randomised study was carried out to determine whether these patients would benefit from chemotherapy. Out of the 72 patients, 22 (30.6%) had positive cultures initially and were treated. Of the remaining 50 patients, 22 received chemotherapy and 28 were untreated controls. Among the untreated patients 8 (29%) later became culture positive for M. tuberculosis, whereas none of the treated patients developed culture positive tuberculosis during the follow-up period of 5 years.

Effect of terbutaline on exercise capacity and pulmonary function in patients with chronic obstructive pulmonary disease.

The objective of this study was to investigate the effects of a single dose of a beta2-agonist, terbutaline (Bricanyl Turbuhaler), on resting lung function and exercise capacity in patients with chronic obstructive lung disease. Using a double-blind, placebo-controlled, randomized crossover study and outpatients from a department of pulmonary medicine at a major inner-city hospital, we examined 26 individuals with chronic obstructive lung disease who met the criteria of 40%

Tuberculosis treated with rifampicin, ethambutol and isoniazid: Danish tuberculosis trial 1972-1974.

A total of 577 Danish patients with tuberculosis were observed for a period of 5 years. A primary phase of treatment with 300 mg Isoniazid (INH), 450 mg Rifampicin (RMP) and 1200 mg Ethambutol (EMB) daily for 3 months was followed by administration of either INH+RMP or INH+EMB for 12 or 18 months after conversion. During the initial period the number of bacteria decreased rapidly, even in patients with the most severe tuberculosis, and all patients became culture negative. There was no significant difference in efficacy of RMP and EMB in the secondary phase. One of the 577 patients again became positive during the follow-up period, but there were no bona fide cases of relapse among patients who completed the treatment.

A randomized clinical trial of alpha(1)-antitrypsin augmentation therapy.

We have investigated whether restoration of the balance between neutrophil elastase and its inhibitor, alpha(1)-antitrypsin, can prevent the progression of pulmonary emphysema in patients with alpha(1)-antitrypsin deficiency. Twenty-six Danish and 30 Dutch ex-smokers with alpha(1)-antitrypsin deficiency of PI*ZZ phenotype and moderate emphysema (FEV(1) between 30% and 80% of predicted) participated in a double-blind trial of alpha(1)-antitrypsin augmentation therapy. The patients were randomized to either alpha(1)-antitrypsin (250 mg/kg) or albumin (625 mg/kg) infusions at 4-wk intervals for at least 3 yr. Self-administered spirometry performed every morning and evening at home showed no significant difference in decline of FEV(1) between treatment and placebo. Each year, the degree of emphysema was quantified by the 15th percentile point of the lung density histogram derived from computed tomography (CT). The loss of lung tissue measured by CT (mean +/- SEM) was 2.6 +/- 0.41 g/L/yr for placebo as compared with 1.5 +/- 0.41 g/L/yr for alpha(1)-antitrypsin infusion (p = 0.07). Power analysis showed that this protective effect would be significant in a similar trial with 130 patients. This is in contrast to calculations based on annual decline of FEV(1) showing that 550 patients would be needed to show a 50% reduction of annual decline. We conclude that lung density measurements by CT may facilitate future randomized clinical trials of investigational drugs for a disease in which little progress in therapy has been made in the past 30 yr.