Acute effects of hypertonic saline inhalation on nitric oxide pulmonary diffusing capacity in healthy adults.

We investigated acute effects of inhalation of hypertonic saline solution (HSS) and oxygen (O2, control exposure) on pulmonary diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO). In a randomized crossover study, 20 healthy, non-smoking subjects were allocated to short-term inhalation of HSS or O2. Spirometry [(forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)] and combined single-breath DLNO-DLCO measurements were performed before and immediately after inhalation of either HSS or O2. Percent changes were presented as median values (interquartile range). After HSS inhalation, DLNO, FEV1 and FVC were decreased by -3.0% (-7.3, 0.5), -3.1% (-4.2, -1.6) and -1.2% (-3.3, 0.6), respectively (all P < 0.05), without significant effect on DLCO. No changes in spirometry and diffusing capacity were observed following O2 inhalation. Acute inhalation of HSS causes a slight decrease in membrane conductance, probably as a result of fluid imbalance at the alveolar surface and interstitial fluid accumulation, both of which could impair gas exchange.

[Standardization of spirometry: 2015 update. Published by German Atemwegsliga, German Respiratory Society and German Society of Occupational and Environmental Medicine]. / Leitlinie zur Spirometrie. Leitlinie der Deutschen Atemwegsliga, der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin zur Spirometrie.

Spirometry is a simple test and considered the gold standard in lung function. An obstructive ventilatory defect is a disproportionate reduction of maximal airflow from the lung in relation to the maximal volume that can be displaced from the lung. It implies airway narrowing and is defined by a reduced FEV1/FVC ratio below the 5th percentile of the predicted value (lower limit of normal, LLN). A restrictive disorder may be suspected when vital capacity (FVC) is reduced and FEV1/FVC is normal. It is definitely proven, however, only by a decrease in TLC below the 5th percentile of predicted value (LLN). The measurement of TLC by body plethysmography is necessary to confirm or exclude a restrictive defect or hyperinflation of the lung when FVC is below the LLN. 2012 a task force of the ERS published new reference values based on 74,187 records from healthy non-smoking males and females from 26 countries. The new reference equations for the 3-95 age range are now available that include appropriate age-dependent mean values and lower limits of normal (LLN). This presentation aims at providing the reader with recommendations dealing with standardization and interpretation of spirometry.

[Work and cancer]. / Verdacht auf berufsbedingte Krebserkrankung. Im Zweifelsfall immer melden!

A cancer that develops due to work-related noxae is usually first recognized only after decades. It is then very important for the patients that the treating doctor thinks of this possibility at all and consequently performs a comprehensive occupational medical history. Generally it is better to report one too many suspicions to the responsible insurance carrier than to overlook a work-related cause of cancer.

[Lung cancer screening -- state of the art]. / Screening des Lungenkarzinoms -- aktueller Stand.

Besides smoking as the main risk factor for lung cancer several occupational risk factors like exposure to asbestos, polycyclic aromatic hydrocarbons, uranium and dust containing nickel or silica have to be considered. Due to lack of effort in smoking prevention and cessation, lung cancer screening is an important issue. A number of pitfalls has to be considered when evaluating the efficacy of screening procedures. In this paper, we summarize the results of the major studies including chest X-ray, sputum cytology and low dose computed tomography. Randomized controlled studies involving low dose CT in about 100 000 subjects are on the way. Around the year 2010 we will be able to define whether or not lung cancer screening including new techniques and standardized algorithms yields a decrease in mortality. If diagnostic algorithms are used which have been applied in published feasibility studies, the mean percentage of invasive diagnostic measures revealing benign lesions is about 34 % and thus below those obtained in, e. g., breast cancer screening trials.