Gastroesophageal reflux disease and pulmonary function: a potential role of the dead space extension.

BACKGROUND: To evaluate the differences in the existence and size of dead space in patients with and without Gastroesophageal Reflux Disease (GERD and non-GERD) expressed through the size of intrapulmonary shunt (QS/QT). MATERIAL/METHODS: The study enrolled 86 subjects - 43 patients referred for endoscopy because of symptoms of GERD (heartburn, acid regurgitation, dysfagia) and 43 healthy subjects with similar anthropometric characteristics without GERD symptoms. Based on endoscopy findings, patients were classified into the erosive reflux disease (ERD) group and non-erosive reflux disease (NERD) group. Spirometry values, single-breath diffusing capacity of the lung for carbon monoxide (DLCO) and intrapulmonary shunt (venous shunt - QS/QT) determined by the oxygen method were measured in all participants. RESULTS: Statistically significant differences between GERD and non-GERD groups in FVC (p=0.034), FEV1 (p=0.002), FEV1/FVC (p=0.001), and PEF (p=0.001) were observed. There were no statistically significant differences in FEF 25% (p=0.859), FEF 50% (p=0.850), and FEF 75% (p=0.058). Values of DLCO (p=0.006) and DLCO/VA (p=0.001) were significantly lower and QS/QT was significantly higher (p=0.001) in the GERD group than in the non-GERD group. However, in both groups the average values of DLCO and DLCO/VA expressed as a percentage of predictive values were within normal range, while the value of QS/QT in the GERD group showed pathological (6.0%) mean value (normal value ≤ 5.0%). There were no significant differences in respiratory function test results between patients with ERD and NERD. CONCLUSIONS: Our results suggest that microaspiration of stomach contents may cause surfactant damage, development of microatelectasis, and dead space expansion with consequent increase of intrapulmonary (venous) shunt.

Shunt in the diagnosis of initial lung lesion in smokers.

Cigarette smoking is an important risk factor for all respiratory tract diseases. Unfortunately, the symptoms develop slowly, thus patients feel the consequences of the slowly developing inflammation too late. The inflammation first develops in the area of respiratory bronchioles. In this stage, the disease is asymptomatic. The study included a sample of 31 smokers, mean age 36.38 years, with normal spirometry indices, acid-base status and arterial blood gases. The mean smoking index was 11.28 smoking/years. All subjects were healthy, without any subjective health problems or disease indicators. The aim was to define dead lung area (V/Q) as an early indicator of changes in smokers. Study results demonstrated the mean shunt value in smokers of 8.25%, which showed positive correlation with smoking. The shunt size yielded negative correlation with the forced expiratory volume in one second and midexpiratory flow in smokers. In conclusion, determination of lung shunt is a simple method that is sensitive enough in the diagnosis of initial lung lesion due to cigarette smoking.

[Lung function in children residentially exposed to asbestos]. / Plucna funkcija djece rezidencijalno izlozene azbestu.

Impairment of respiratory function is one of the most sensitive indicators used in the evaluation of the effects of air pollution on human health. We compared predicted values of flow-volume curve according to Knudson and the spirometry results in 81 healthy children; 40 girls and 41 boy, aged (10.69 +/- 2.24) years. We also measured the transfer factor of the lungs for carbon monoxide (TLCO) using the single-breath method and compared the results with reference values by Cotes. Patients were selected randomly among pre-school and elementary school children from the Split area, who were residentially exposed to asbestos. Children with atopic diseases, family history of atopy, history of severe respiratory diseases, and history of smoking were excluded from study. We found a statistically significant difference in FVC (p < 0.0001) from normal values according to Knudson, but when expressed in the percentage of the Knudson values, this difference was not significant (p > 0.05). No statistically significant difference was found for FEV1, FEF75, FEF50, FEF25, and FEV1/FVC. TLCO reached (107.37 +/- 20.50)% of normal values according to Cotes, and was not significantly different. At this point, it is hard to predict the consequences of exposure to low levels of asbestos in childhood, because it takes a long time for complications such as neoplasms, pulmonary fibrosis, or respiratory insufficiency to develop.

The effect of analgesics and physical therapy on respiratory function after open and laparoscopic cholecystectomy.

In this study we present prospective clinical trial included 100 patients. One half of the patients underwent open cholecystectomy, whereas laparoscopic cholecystectomy was performed in the other half Spirometric parameters, arterial blood gases, acid-base balance, were determined preoperatively, and then at 6 h, 24 h, 72 h and 144 h postoperatively. The impact of physical therapy on the respiratory parameter patterns, VAS-pain score and use of tramadol were studied after cholecystectomy. Significantly lower VAS-pain score and less tramadol use, higher values and faster recovery of ventilation parameters and PaO2 were recorded after laparoscopic cholecystectomy than after open cholecystectomy (p = 0.001 for both). Physical therapy resulted in a significant improvement in the values of respiratory parameters in the open cholecystectomy group within a short time (30 min) after therapy was performed. Physical therapy failed to produce any improvement of respiratory parameters in laparoscopic cholecystectomy, whereas in open cholecystectomy group who had a favorable although transient effect, strictly limited to the short time from its application. (p = 0.005). The patients operated on by open cholecystectomy had statistically significantly more pronounced disturbances including hypoxia, hypocapnia and hyperventilation when compared to the group submitted to laparoscopic cholecystectomy. It is recommended that physical therapy be more frequently performed during the postoperative period in patients submitted to open cholecystectomy.

[Asbestosis--physical examination and symptoms]. / Fizikalni nalaz pluca i simptomi kod azbestne bolesti.

The study included 318 asbestos exposed workers. The aim was to investigate the symptomatology and clinical findings over an average period of ten years. We took in cosideration quantitative data and analyzed them by statistical methodology of univariate and multivariate data analysis and chi2-test. Chest radiography, clinical and functional findings were used as a diagnostic tool. The most common finding was dyspnea, then cough and chest pain. Clinical symptoms were more common in workers exposed to crysotile asbestos than in those exposed to crocidolite asbestos. There is strong evidence for association between the symptoms and the duration of asbestos exposure. The symptoms were not specific for asbestosis. A significant positive correlation was found between physical examination and duration of asbestos exposure. Basal rales and pleural rub were recorded in 72% of exposed workers.

Dynamics of the lung function in asbestos pleural disease.

As a rule, asbestosis is a disease of workers who are occupationally exposed to inhalation of asbestos dust, leaving permanent alterations on the lung parenchyma or pleura. In our ten-year study, we investigated 318 workers with pleural asbestosis from whom we took medical history which included occupational exposure to asbestos, radiological examinations and lung function, which is mandatory for the diagnosis and the follow up of the disease. We analysed functional parameters such as forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) and intermediate forced expiratory flow at 25% to 75% (FEF25%-75%). In addition, we investigated the predicted values of functional parameters according to smoking and non-smoking habits. We found a significant reduction in vital capacity, particularly in smokers after 25 years of exposure to asbestos. During the first 15 years, values of vital capacity on the group basis remained inside the 80% of the normal values and were not significant for assessing the dynamics of the lung function. To better assess the effects of occupational asbestos exposure, it is necessary to interpret lung function data not only on the group basis, but also for each subject individually.

Pulmonary function in military divers: smoking habits and physical fitness training influence.

Pulmonary function (PF) tests are procedures that measure the function of the lungs, revealing problems in breathing, and therefore are highly important in diving. In this article, we studied the PF in military divers and defined the differences between (A) males (n = 32) and females (n = 27), (B) male smokers and nonsmokers, and (C) female smokers and non-smokers. PF was established by measuring: the large airway variables: inspiratory-vital capacity, forced-vital capacity, 1-second forced-expiratory volume, and 1-second forced-expiratory volume:forced-vital capacity ratio; and small airway variables: peak-expiratory flow, maximal-mid-expiratory flow, and maximal-expiratory flow after 50% and 75% of exhalation, all in absolute and relative (predicted for age and stature) values. The t test showed a significant (p < or = 0.05) difference between smokers and nonsmokers, but only in the relative inspiratory-vital capacity. A multivariate analysis of the variance revealed significant differences between smokers and nonsmokers in large airway variables for males and females. The possible explanations regarding the metrics, the variable relationships, and the influence of physical fitness training are discussed.

Influence of passive smoking on basic anthropometric characteristics and respiratory function in young athletes.

The primary objective of this study is to investigate the maintenance difference in basic anthropometric characteristics and to outline the dynamics of respiratory function change in youngsters athletes exposed to passive smoking (PS) and athletes not exposed to passive smoking in their families (NPS). High and weight were determined as basis anthropometric characteristics. Measured parameters for respiratory function were vital capacity (VC), forced expiratory volume in the first second (FEV1), maximum expiratory flow (PEF), forced expiratory flow at 50% forced vital capacity (MEF 50) and forced expiratory flow at 25% forced vital capacity (MEF 25). Significant statistical differences in separate spirometric variable were found in three variables (FEV1, MEF50, and MEF25) for group older youngsters. Analysis of variance showed statistical differences between athletes unexposed to passive smoking (NPS) and athletes exposed to passive smoking (PS) in even four spirometric variables (VC, FEV1, MEF50 and MEF25).

Pulmonary function in persons who are professionally exposed to formaldehyde fumes.

The present study examines long-term effects of occupational exposure to formaldehyde fumes on lung function. Forced spirometry and diffusing lung capacity were measured in 16 health-service professionals (8 medical doctors and 8 laboratory technicians) working at the pathoanatomic laboratory for at least 4 years with daily exposure 8 +/- 1 hours. Control group employed 16 males, which were matched by age and stature to members of the exposed group. Only non-smokers were included in the study. Spirometric parameters in study participants exposed to formaldehyde fumes compared to control group were not significantly different indicating absence of restrictive and/or obstructive deterioration of lung function in exposed group. The only parameter differing in two groups was blood volume of pulmonary capillaries (Vc') which was significantly larger in a group exposed to formaldehyde fumes. The possibility that the hyperemic lung reaction is the consequence of the exposure to formaldehyde fumes should be further explored.

Pulmonary alveolar microlithiasis in childhood: clinical and radiological follow-up.

This report describes a case of pulmonary alveolar microlithiasis that was diagnosed in an 8.5-year-old girl by high-resolution computed tomography (CT) and open lung biopsy. Presence of symptoms (productive cough, fever), their periodic occurrence (lasting up to 1 week), and comparatively long asymptomatic periods should be emphasized. Despite extensive X-ray abnormalities, tests of pulmonary interstitium involvement and exercise tests revealed normal results. A therapeutic regimen, including disodium etidronate, was administered for 18 months with no significant clinical or radiological improvement.

Lung function changes in pleural asbestosis.

The aim of this study was to examine the relationship between radiographically detectable pleural changes and lung function in pleural asbestosis. One hundred and twenty chrysotile asbestos-exposed workers were enrolled in this retrospective study. For each examinee the length of asbestos exposure and the degree of dust cover at the workplace were assessed as well as the radiological and functional tests has been performed. The examinees were divided into two groups based on radiologically detectable changes: a) group with pleural changes (29%) and b) group without perceived pleural changes (71%). The obtained results indicate association between the length of asbestos exposure, pleural changes and the impairment of lung function.

Interobserver variations in diagnosing asbestosis according to the ILO classification.

Inhalation of asbestos fibres leads to asbestosis of the pleura and the lung, with possible progression to lung cancer and malignant pleural or peritoneal mesothelioma. Asbestosis remains difficult to diagnose, especially in its early stages. The most important role in its diagnosis is that of chest radiographs. The aim of this cross-sectional study was to address interobserver variations in interpreting chest radiographs in asbestos workers, which remain to be an issue, despite improvements in the International Labour Office (ILO) classification system. In our ten-year study, we investigated 318 workers occupationally exposed to asbestos, and in 210 workers with diagnosed asbestos-related changes we compared interpretations of chest radiographs according to ILO by two independent radiologists. The apparent degree of interobserver variation in classifying lung fibrosis was 26.66% for the diameter of changes and 42.2% for the profusion of the changes. In cases with diffuse pleural thickening, the interobserver variation using ILO procedures was 34.93%. This investigation raises the issue of standardisation and objectivity of interpretation of asbestosis according to the ILO classification system. This study has revealed a significant disagreement in the estimated degree of pleural and parenchymal asbestos pulmonary disease. This is why we believe high-resolution computed tomography (HRCT) should also be used as a part of international classification.