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Abstract Introduction: Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. Objective: To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. Method: Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxons test. Results: Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. Conclusion: HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.
Resumen Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es el problema respiratorio de mayor prevalencia en el mundo. Los pacientes con infección por virus de la inmunodeficiencia humana (VIH) tienen mayor prevalencia de tabaquismo e infecciones pulmonares recurrentes y mayor riesgo de EPOC. Objetivo: Determinar la prevalencia de la EPOC en pacientes con diagnóstico de VIH referidos a un hospital de infectología. Método: Se incluyeron individuos con infección por VIH sin tratamiento antirretroviral previo o actual, con sintomatología respiratoria crónica, con o sin antecedentes de exposición para desarrollar EPOC. Se realizó espirometría pre y posbroncodilatación, tomografía computarizada de alta resolución, determinación de carga viral y conteo de CD4. Las mediciones espirométricas se compararon con prueba de Wilcoxon. Resultados: Se incluyeron 66 pacientes con diagnóstico de VIH, con edad de 31.5 años; 64 hombres y dos mujeres. La prevalencia de EPOC fue de 7.6 %. El grupo con obstrucción presentó menor conteo de CD4 (27.3 versus 225.9) y mayor carga viral (165 000 versus 57 722), en comparación con el grupo sin obstrucción. Se observó correlación positiva entre menor carga viral y mayor relación de volumen espiratorio forzado al primer segundo/capacidad vital forzada. Conclusión: Los pacientes VIH-positivos con menor conteo de CD4 y mayor carga viral presentan disminución de los valores espirométricos.
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Humans , Male , Female , Adult , Smoking/epidemiology , HIV Infections/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Spirometry , Tomography, X-Ray Computed , HIV Infections/virology , Vital Capacity , Forced Expiratory Volume , Prevalence , Cross-Sectional Studies , Risk Factors , CD4 Lymphocyte Count , Viral LoadABSTRACT
OBJECTIVE: To investigate the factors influencing the improvement of tidal lung function bronchodilation test,and to provide evidence for the diagnosis of infant asthma. METHODS: Totally 71 infant patients diagnosed with asthma were included from clinic of Children's Hospital of Capital Institute of Pediatrics and alternativley assigned into two groups,who respectively received bronchodilator via pM DI(pMDI group)or nebulization(nebulization group),and bronchodilation test was performed. The effects of drug delivering methods on the bronchodilation test was compared,and the main observation indexes were respiratory rate(RR),VT/kg,inspiratory time(Ti),expiratory time(Te),Ti/Te,time to peak tidal expiratory flow as a proportion of expiratory time(TPTEF/TE),volume to peak expiratory flow as a proportion of exhaled volume(VPEF/VE)and peak tidal expiratory flow(PTEF). Further analysis was carried within each group. RESULTS: Twenty patients received bronchodilator via pM DI,and fifty-one patients received bronchodilator via nebulization. After drug delivery,the RR of the children in the pMDI group decreased significantly(P=0.003),and the Ti increased significantly(P=0.011). The VT/kg,Ti,Ti/Te,TPTEF/TE and VPEF/VE increased significantly in nebulization group(all P<0.05). In the nebulization group,the improvement rate of TPTEF/TE and VPEF/VE were significantly higher than that of pMDI group(all P<0.05). In the pMDI group,the Te,Ti/Te,TPTEF/TE and VPEF/VE significantly improved in patients with severe airway obstruction(all P<0.05). The above parameters also improved after bronchodilation test in nebulization group. Compared in difference age groups,TPTEF/TE and VPEF/VE in children over 2 years improved more significantly than those in children under 1 year(all P<0.05). CONCLUSION: The effects of nebulization are better than pMDI in tidal lung function bronchodilation test. The improvement rate of tidal lung function is related to the degree of airway obstruction and the age of patients.
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Objective To explore the main influential factors of bronchodilation test positive results in mechanically ventila-ted patients with chronic obstructive pulmonary disease(COPD).Methods A total of 55 inpatients with acute exacerbation of COPD(AECOPD)receiving the invasive ventilation from June 2015 to March 2016 were collected.The accurate respiratory mechan-ics monitoring was performed before and after using the bronchodilator.The airway resistance reduction over 12% after inhaling bronchodilator served as the judgment criteria,the patients were divided into the bronchodilation test positive or negative groups, then the influential factors were compared and statistical analysis was performed.Results Twenty-nine cases(52.7%)showed the positive reaction and 26 cases(47.2%)were negative.After univariate analysis,results of heart rate,SaO2,fungal infection,horm-onotherapy,CKMB,lactic acid and BNP were brought into the multivariable Logistic regression analysis(P< 0.1).The analysis found that fungal infection was an independent factor affecting the results of the bronchodilation test(P<0.05).Conclusion Fun-gal infection is an independent influential factor of the bronchodilation test positive in COPD patients receiving invasive ventilation.
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Children are prone to develop respiratory diseases during their infancy.As a noninvasive and safe method of detection,infant lung function test combined with bronchodilation test is of great significance to the assessment of lung development and the diagnosis of disease.Infant lung function test can measure the development of lung and airway,help to study the natural course of the disease,judge the location and type of the obstruction,and observe the effects of treatment.The bronchodilation test uses inhalation bronchodilator to relieve bronchial smooth muscle spasm and indicates the reversibility of airflow obstruction.This article reviews the operation techniques,evaluation parameters,cut-off value and clinical application of bronchodilation test in infants and young children.
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Objectives: The primary objective was to determine the association between beta-2 adrenergic receptor (ADRB2) gene polymorphism (rs1042713, c.46A>G, p.Arg16Gly) and the response to inhaled salbutamol in North Indian children aged 5 to 15 years, with mild to moderate exacerbation of asthma. Methods: This cross-sectional study was done at a tertiary-care hospital in Northern India from June 2011 to May 2013. 120 children with asthma with mild to moderate exacerbation underwent spirometry at baseline and after administration of three doses of salbutamol. An increase in FEV1 ³15% was considered as positive response. Blood samples from these children were analysed for ADRB2 polymorphism (p.Arg16Gly). 94 non-asthmatic adult controls were also studied to determine the prevalence of ADRB2 polymorphism. Results: In asthmatic children, the frequency of AA, GG, AG genotypes were 24.2%, 24.2% and 51.7% compared to 20.2%, 20.2 % and 59.6%, respectively in the non-asthmatic adults. Salbutamol responsiveness showed no correlation with the studied ADRB2 polymorphism (p= 0.55). A trend towards greater bronchodilator responsiveness amongst AA genotype, compared to GG genotype was observed (Median change in percent predicted FEV1 14.5% and 7.5%, respectively). Conclusions: No correlation was found between salbutamol responsiveness and ADRB2 genotype in Northern Indian children with asthma with mild-to moderate exacerbation.
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Objective To discuss the characteristics of pulmonary function in children patients with positive bronchodilating response using impulse oscillation system(IOS) and provide the evidence for clinical diagnosis and performing IOS.Methods Seventy children patients with bronchodilating response using IOS were recruited randomly for this study.Forty children patients with positive bronchodilating response were regarded as positive group and the other thirty children patients with negative bronchodilating response were regarded as negative group.The IOS parameters,for example,total respiratory impedance (Z5),respiratory resistance at 5 Hz(R5),reactance at 5 Hz(X5),peripheral respiratory resistance(Rp) in the two groups were analyzed.Results Z5,R5,X5 of the positive group [(123.45 ± 24.75)％,(120.09 ± 25.40)％,(138.62 ± 33.48)％] were higher than those of the negative group [(103.89 ± 16.30)％,(102.67 ± 18.16)％,(111.85 ± 14.93)％].There were significantly different between the two groups (P ＜ 0.05).Moreover,Rp ≥ 19.89 cmH2O/ (L·s)(1 cmH2O =0.098 kPa) in the positive group was 50.00％(20/40),which was higher than that in the negative group[23.33％(7/30)].There was significant difference between the two groups(P＜ 0.05).Conclusions The impedance of children patients with positive bronchodilating response using IOS is significantly increased,especially X5.When IOS parameters ≥ 100％,especially X5 ≥ 100％,which suggest that perform the bronchodilation test in order to decrease the rate of missed diagnosis of asthma.
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Objective To explore the linearic regularity of airways′ spasm and spasmolysis in hyperreactive guinea pigs.Methods Asthmatic guinea pig models were established with acetylcholine(Ach).Then the animals inhaled salbutamol.At 0,15,30 min and 1 h after inhalation of salbutamol,the animals were sacrificed,and the small and large airways were fixed with formaldehyde and embedded in paraffin wax to acquire the consecutive slides.The pathologic changes of both the large and small airways were observed and the caliber changes of the airways were determined.Results The diameters of small and large airways of the control guinea pig models(0.41?0.10 and 1.78?0.41 mm,respectively) were significantly short than that in normal(0.55?0.20 and 2.41?0.50 mm,respectively)(P
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Objective To explore the linearic regularity of airways′ spasm and spasmolysis in asthmatic patients,and provide theory bases for clinic treatment.Methods After regular bronchodilation test,the pulmonary function in(16 asthmatic) patients and 14 volunteers were examined 15 min,30 min, 1 h,2 h and 4 h later,respectively.The indexes included forced vital capacity(FVC),forced expiratory flow in one second(FEV_1),peak expiratory flow(PEF),maximal midexpiratory flow(MMEF),expiration of 50% FVC(V_(50)) and expiration of 75% FVC(V_(25)).Results 2 h after bronchodilation test,the big airways dilated completely(P
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BACKGROUND: Volatile anesthetics are potent bronchodilators of airway smooth muscle. Bronchodilation is occured by depressing reflex neural pathways innervating airway smooth muscle and by acting directly on the smooth muscle cell. We studied the direct relaxation effect and their potency of halothane, isoflurane and desflurane on isolated rat distal bronchial segment of fourth order precontracted with acetylcholine. METHODS: Isolated Sprague-Dawley rat bronchial rings were suspended in tissue bath with modified- Krebs's solution. Based on the dose-response curve, the ED50 of acetylcholine (ACh) was calculated for fourth bronchial segment and administered to each tissue bath, after which the stabilized response was recorded. After then each bronchial segment with intact epithelium was exposed to increasing concentration of halothane, isoflurane and desflurane (1.0, 1.5 and 2.0 MAC)and the relaxant responses were recorded by polygraph. RESULTS: Halothane, isoflurane and desflurane produced concentration-dependent bronchodilation (P<0.05 for either anesthetics; 22 4%, 18 6%, 24 5% for halothane, isoflurane and desflurane at 1.5 MAC, 32 6%, 27 7%, 38 5% for halothane, isoflurane and desflurane at 2.0 MAC). Overall, desflurane had a significantly greater relaxing effect as compared with halothane, isoflurane at 1.5 MAC and 2.0 MAC during ACh-mediated contraction. CONCLUSION: The mechanism of halothane, isoflurane and desflurane-mediated bronchodilation is not known, but may be due to an epithelium dependent effect. The potency of relaxing the ACh precontracted isolated rat bronchial smooth muscle is desflurane, halothane, isoflurane in ordered.
Subject(s)
Animals , Rats , Acetylcholine , Anesthetics , Baths , Bronchi , Bronchodilator Agents , Epithelium , Halothane , Isoflurane , Muscle, Smooth , Myocytes, Smooth Muscle , Neural Pathways , Rats, Sprague-Dawley , Reflex , RelaxationABSTRACT
BACKGROUND: Volatile anesthetics are potent bronchodilators of airway smooth muscle. Bronchodilation is occured by depressing reflex neural pathways innervating airway smooth muscle and by acting directly on the smooth muscle cell. We studied the direct relaxation effect and their potency of halothane, isoflurane and desflurane on isolated rat distal bronchial segment of fourth order precontracted with acetylcholine. METHODS: Isolated Sprague-Dawley rat bronchial rings were suspended in tissue bath with modified- Krebs's solution. Based on the dose-response curve, the ED50 of acetylcholine (ACh) was calculated for fourth bronchial segment and administered to each tissue bath, after which the stabilized response was recorded. After then each bronchial segment with intact epithelium was exposed to increasing concentration of halothane, isoflurane and desflurane (1.0, 1.5 and 2.0 MAC)and the relaxant responses were recorded by polygraph. RESULTS: Halothane, isoflurane and desflurane produced concentration-dependent bronchodilation (P<0.05 for either anesthetics; 22 4%, 18 6%, 24 5% for halothane, isoflurane and desflurane at 1.5 MAC, 32 6%, 27 7%, 38 5% for halothane, isoflurane and desflurane at 2.0 MAC). Overall, desflurane had a significantly greater relaxing effect as compared with halothane, isoflurane at 1.5 MAC and 2.0 MAC during ACh-mediated contraction. CONCLUSION: The mechanism of halothane, isoflurane and desflurane-mediated bronchodilation is not known, but may be due to an epithelium dependent effect. The potency of relaxing the ACh precontracted isolated rat bronchial smooth muscle is desflurane, halothane, isoflurane in ordered.