Måns Arborelius

IMPROVEMENT AFTER TRAINING OF CHILDREN WITH EXERCISE-INDUCED ASTHMA

ABSTRACT. Fifty children with exercise‐induced asthma (EIA) volunteered to take part in a study of the influence of training on EIA. 1) Ten children did not change physical activity. 2) Twelve children trained after premedication with salbutamol inhalations. 3) Thirteen children trained after premedication with disodium chromoglicate (DSCG) and used that drug for treatment. 4) Fifteen children trained in their own regimen, commonly after premedication with salbutamol. Their training programme (groups 2‐3) consisted of high load exercise periods of two minutes interrupted by intervals of rest for two minutes during 30 minutes followed by interval swimming for another 30 minutes, twice a week for 3‐4 months. Before the training period the degree of EIA was tested with a battery of lung function tests before and after running for 6 minutes on a treadmill at heart rate 170. EIA after training was measured applying the same procedure. Cardiocirculatory performance was evaluated before and after training with work on a cycle ergometer and expressed as W/kg body weight at heart rate 170. The children in groups 2, 3 and 4 improved their physical working capacity by 11% (p<0.01), 21% and 11%, respectively, but no improvement was found in group 1. Significant improvements in EIA after the training periods were found in all training groups, but basal asthma improved most in group 3, probably due to the basal treatment with DSCG.

Lung function in adolescents with alpha 1-antitrypsin deficiency

Children with α1‐antitrypsin deficiency, screened at birth, were followed prospectively. At 16 years of age, 150 adolescents (103 PiZ, 1 PiZ‐, 1 PiS‐, 45 PiSZ) were interviewed using a standardized questionnaire and asked to participate in an extensive lung function study including part or all of the following tests: FVC, FEV1 before and 15 min after four inhaled doses of salbutamol, TLC, RV and FRC. Fifty age‐, sex‐ and height‐matched adolescents participated as controls. No significant differences in age, height or weight were found between the PiZ, PiSZ and control groups. No significant differences were found in respiratory symptoms, parental smoking history or the smoking habits of PiZ, PiSZ and control subjects. Asthma occurred in 10.7% of PiZ, 6.5% of PiSZ and 4% of control adolescents (p = 0.33). Only 3 of 100 PiZ and 1 of 45 PiSZ adolescents were smokers. No significant contribution of α1‐antitrypsin Pi‐type was found to explain the variation in lung function variables studied. We conclude that children with α1‐antitrypsin deficiency have a favourable prognosis and normal lung development up to 16 years of age. Anti‐smoking advice was found to be reasonably successful; only 3% of those answering the questionnaire had started to smoke.

Regional and Total Lung Function Studies in Patients with Hemidiaphragmatic Paralysis

Global and regional lung function were studied in 17 subjects with hemidiaphragmatic paralysis. Global lung function (VC, MVV, and FEV1) in the sitting postion was reduced by an average of about 25%. Regional lung function data in the same position showed a considerable decrease in perfusion (19%), ventilation (20%), and lung volume (7%) of the diseased side as compared to reference values obtained in healthy volunteers. Compared to the partition of function in the supine, the perfusion of the affected lung increased when it was lowermost in the lateral decubitus postion, while regional FRC decreased and ventilation changed little. When uppermost, perfusion and ventilation of the affected lung decreased while FRCr increased somewhat. The arterial oxygen tension was significantly below normal in the supine position but in the normal range in the sitting position. It increased further during exercise. Bronchography showed compression of the basal lung segments on the affected side in the erect, and kinking and obliteration of lower lobe bronchi in the supine position and still more when the lung was lowermost in the lateral decubitus position.

Lung Function in Cystic Fibrosis

Pulmonary function tests including spirometry, N2 washout and volume of trapped gas (VTG) were obtained in 12 children with cystic fibrosis (CF), 6–18 years of age, before

Respiratory Function in Esophageal Hiatus Hernia. I. Spirometry, Gas Distribution, and Arterial Blood Gases

As a part of a preoperative investigation, spirometry and blood gas tensions were studied in 64 subjects with X-ray-verified hiatus hernia (34 sliding, 22 mixed, and 8 of paraesophageal variety). According to the transverse diameter of the hernia. They were divided into 3 groups, small (2-5.9 cm), medium (6-9.9 cm), and large (10-17 cm) hernias. No correlation between the size of the hernia, reflux incidence, and spirometric findings could be demonstrated. A significant reduction of the arterial oxygen tension was found in small hernias and in vital capacity and maximal voluntary ventilation (MVV) in medium-sized hernias. Significant reduction in MVV was noted in the large hernia group. A common spirometric finding in all groups was a significant increase in residual volume and wash-out volume. The incidence of restrictive or obstructive pulmonary impairment was high in large (39%) and small (32%) hernias and relatively low in medium-sized hernias (8%). Roentgenological fibrosis was not found in any of the patients, while 4 showed emphysematous changes.

Haemodynamic changes at different lung volumes.

In 17 healthy males pulmonary blood flow distribution (PBFD), pulmonary artery pressure (PAP), wedge pressure (Pw), and cardiac output were measured at different lung volumes and body positions. The PBFD became more even and PAP increased at RV in the sitting position as compared to at FRC. PAP also increased at TLC, but PBFD became more uneven.In the lateral position the increased PAP at RV caused only a minor change in PBFD. In both erect and lateral position at RV the Pw close to the diaphragm increased more than did PAP.

Features of carotid artery flow velocity in healthy subjects and consequences for evaluating stenosis in the internal carotid artery

C-W-Doppler analysis of flow velocity in the carotid arteries was performed in 98 healthy volunteers, age 16-74 years, 49 of each sex, and in 23 subjects with carotid disease. Maximum frequency shift (MFS) and total band-width in the healthy proximal internal carotid artery were negatively correlated to age in both sexes (p less than 0.001). MFS was lower in the normal proximal internal carotid artery than in the common carotid artery in both sexes. Minimum frequency shifts were more often, and more negative in the proximal than in the distal part of the internal carotid artery (p less than 0.001 in men and less than 0.01 in women) and still more so in the proximal part of the pathological internal carotids as compared with the normal ones (p less than 0.001). The computer-fitted regression between MFS and the degree of angiographic stenosis in the subjects with carotid artery disease was nearly identical with the mathematically calculated relationship for an ellipsoid stenosis. There is reason to believe that the degree of area stenosis calculated from frequency shift and predicted normal values gives a more true interpretation of functional stenosis than angiography, while the latter might be superior for evaluating vascular patho-anatomy, giving information also about intrathoracic and intracranial vessels, which also is important for evaluating patients with TIA and related symptoms.

Respiratory Function in Esophageal Hiatus Hernia. II. Regional Lung Function

64 subjects with hiatus hernia (34 sliding, 22 mixed, and 8 of paraesophageal variety) were divided into 3 groups according to the transverse diameter of the thoracic loculus and examined by 133Xe-radio-spirometry in the supine position. 48 subjects (22 sliding, 18 mixed, and 8 or paraesophageal variety) showed a significant reduction in the regional ventilation, perfusion or lung volume. Significant correlations were found between the diameter of the thoracic loculus and the reduction in these vairables of the affected lung.

Changes of Volume of Trapped Gas after Bronchodilation in Subjects with Suspected Subclinical Emphysema

We studied the volume of trapped gas (VTG), using a nitrogen washout method, before and after bronchodilation in four groups with theoretically increasing risk of developing pulmonary emphysema: (1) nonsmoking healthy controls (PiMn), (2) nonsmoking subjects with an intermediate alpha 1-antitrypsin deficiency (PiMZn), (3) smoking subjects with normal concentration of alpha 1-antitrypsin, and (4) smoking PiMZ subjects. VTG was the only lung function variable that showed a significant difference between PiMZn and PiMn subjects but only after bronchodilation. Some conventional lung function tests also distinguished smokers from nonsmokers of both genotypes but VTG was the most sensitive test. VTG decreased after salbutamol inhalation in the control group but showed a consecutively larger increase with more risk factors of developing emphysema. An increase in VTG after bronchodilation may be a sign of alveolar abnormality preceding development of clinical lung emphysema.

Regional lung function and central haemodynamics in the right lateral body position during hypoxia and hyperoxia.

In 13 healthy males pulmonary blood.flow distribution (PBFD), pulmonary artery pressure (PAP), and cardiac output (Q) were measured in the right lateral body position during 10 and 100% O2