Rune Lundgren

Prevalence of Chronic Obstructive Pulmonary Disease according to BTS, ERS, GOLD and ATS Criteria in Relation to Doctor’s Diagnosis, Symptoms, Age, Gender, and Smoking Habits

Background: Guidelines and standards for diagnosis and management of chronic obstructive pulmonary disease (COPD) have been presented by different national and international societies, but the spirometric criteria for COPD differ between guidelines. Objectives: To estimate prevalence of COPD using the guidelines of the British Thoracic Society (BTS), the European Respiratory Society (ERS), the Global Initiative for Chronic Obstructive Lung Disease (GOLD), and the American Thoracic Society (ATS). Further, to evaluate reported airway symptoms, contacts with health care providers, and physician diagnosis of COPD in relation to the respective criteria, and gender differences. Method: In 1992 a postal questionnaire was sent to a random sample of adults aged 20–69 years, 4,851 (85%) out of 5,681 subjects responded. In 1994–1995 a random sample of the responders, 970 subjects, were invited to a structured interview and a lung function test; 666 (69%) participated. Results: The prevalence of COPD was 7.6, 14.0, 14.1, 12.2 and 34.1% according to BTS, ERS, GOLD, clinical ATS (with symptoms or physician diagnosis), and spirometric ATS criteria, respectively. Prevalent COPD was related to age, smoking habits and family history of obstructive airway disease but not to gender. Physician diagnosis of chronic bronchitis or emphysema was only reported by 16.3, 12.2, 11.0, 23.4 and 8.2% of subjects fulfilling the respective criteria, though a majority reported airway symptoms. Conclusion: The main determinants for prevalent COPD were age, smoking habits and spirometric criteria of COPD. Though a majority reported airway symptoms and contact with health care providers due to respiratory complaints, only a minority was diagnosed as having COPD, indicating a large underdiagnosis.

Physical training with and without oxygen in patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia

A randomized, controlled, single-blind study was performed on 20 patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia. Ten patients each were randomly assigned to one of two groups, one training with air and the other training with oxygen. There were no significant differences between the groups regarding values measured prior to the study. The patients trained 3 times per week for 30 minutes each time for a duration of 8 weeks. The training consisted of interval walking on a treadmill (intensity set according to Borg ratings) with either air or oxygen administered through a nasal cannula at a rate of 5 l/min. Training significantly improved the 6-minute walking distance by 20% and 14% in the air and oxygen group, respectively, when the patients were tested on air. In the same test the air group significantly decreased Borg ratings for perceived exertion. Borg ratings for dyspnoea and perceived exertion significantly decreased in the oxygen group when they were tested on oxygen. It was concluded that oxygen supplementation did not further improve the training effect, compared with training with air, in patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia.

Tuberculosis infection transmitted at autopsy

Tuberculosis can be a risk to staff and students in the autopsy room. We report three medical students and one technician who were infected with tuberculosis during two autopsies. In both cases pulmonary tuberculosis had not been diagnosed before death.

Increased Hyaluronan (Hyaluronic Acid) Levels in Bronchoalveolar Lavage Fluid after Histamine Inhalation

Hyaluronan (hyaluronic acid) appears in low concentrations in bronchoalveolar lavage fluid from healthy individuals, while increased amounts have been reported in lavage fluid from patients with interstitial lung diseases and allergic asthma. We have earlier reported a strong correlation between the appearance of lavage fluid mast cells and hyaluronan in patients with sarcoidosis and extrinsic allergic alveolitis. The central role of the mast cell in allergic asthma is well documented. In this study we have investigated if challenge with inhaled histamine, a major mast cell component, could influence the appearance of hyaluronan in bronchoalveolar lavage fluid. A more than twofold increase of hyaluronan was seen 24 h after challenge with histamine. This increase correlated with a less pronounced increase of albumin in lavage fluid. Histamine challenge also induced an increase of mast cells, lymphocytes, and granulocytes in the lavage fluid. The observed histamine effect on the hyaluronan recovery during lavage might be explained by a histamine-mediated leakage of interstitial fluid, rich in hyaluronan, to the alveolar space. Mast cell degranulation of histamine may partly underlie the appearance of increased amounts of hyaluronan in lavage fluid from patients with interstitial lung diseases and allergic asthma.

Bronchoalveolar Lavage Is Better than Gastric Lavage in the Diagnosis of Pulmonary Tuberculosis

Bronchoalveolar lavage was performed in 62/63 patients with suspected pulmonary tuberculosis and gastric lavage in 60 of the 63. Mycobacteria could be cultured from 14 of the patients. Cultures on bronchoalveolar lavage were positive in 13 of them, while gastric lavage was positive in only 7. Our conclusion is that bronchoalveolar lavage should be performed instead of gastric lavage when pulmonary tuberculosis is suspected.

Flexible fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Abstract In this study 30 out of 120 patients with pulmonary tuberculosis were examined by flexible fiberoptic bronchoscopy (FFB). In 25 of the 30 patients culture of bronchial secretion aspirate showed Mycobacterium tuberculosis. In 11 of the patients this was the only source of positive culture.

Group training in patients with COPD - long-term effects after decreased training frequency.

Purpose. To investigate effects of decreased training frequency in patients with COPD. Methods. Forty-three COPD patients participated in a controlled study. The intervention group (30 patients) trained 3 times a week during 3 months and once a week during 6 months. Before, after 3 and 9 months all patients performed walking tests, cycle ergometer tests and responded questionnaires on health-related quality of life (HRQoL) (SGRQ, SF-36). Results. At 9 months compared to 3 months there were no changes in distance walked in the groups. Both groups decreased their VO2peak and the training group deteriorated in HRQoL. At 9 months compared to baseline the training group showed increased distance walked compared to the control group. In the disease-specific SGRQ the training group tended to improve their activity score while the control group tended to deteriorate in total score. In SF-36 the control group decreased their physical component score. Conclusion. Training once a week does not seem to be sufficient to maintain the level achieved after the 3-month period of training in COPD patients. However, training once a week during 6 months preceded by 3 months of high frequency training seems to prevent deterioration in physical capacity and HRQoL compared to baseline. Further studies are needed to investigate how to best sustain the benefits gained after physical training.

Muscle performance in patients with chronic obstructive pulmonary disease – Effects of a physical training programme

The main aim was to evaluate how thigh muscle performance in patients with chronic obstructive pulmonary disease (COPD) is affected after a 3-month training programme. Another aim was to investigate if responders to training could be discriminated from non-responders. Thirty patients participated in high-intensity physical training in water or on land, three times per week, and 13 patients constituted a non-training control group. Maximal dynamic strength and endurance in thigh muscles were tested in an isokinetic dynamometer (KinCom) before and after training. At baseline, physical and pulmonary function were tested and used in the analysis of responders/non-responders. Maximal knee flexion strength improved in both training groups, whereas knee extension was improved in the land and control group. Sixty-four percent of all patients were not able to complete the muscle endurance test at baseline and no change was seen in muscle endurance after training within or between groups. A normal body mass index seemed to predict an improvement in muscle performance in responders. We conclude that physical training in water and on land is effective regarding maximal thigh muscle strength in COPD patients. BMI seems to be a discriminating factor for an increased muscle strength. Thigh muscle endurance was decreased in the majority of the patients and did not improve with the evaluated training programme.

Changes in body weight and physical performance after receiving dietary advice in patients with chronic obstructive pulmonary disease (COPD): 1-year follow-up

Nutritional studies in patients with chronic obstructive pulmonary disease (COPD) are often based on oral nutritional supplementation and are of short duration. Our aim was to study the changes in body weight and physical performance in COPD patients after receiving the dietary advice for 1 year. Thirty-six patients with COPD as a primary diagnosis (mean age: 68.5±7.8 years), referred to a pulmonary rehabilitation program were studied. Each patient received dietary advice individually. Body weight had increased significantly by 1.3 kg (p=0.02) and walking distance by 83.2 m (p=0.007) after 1 year. There was an increase in mean handgrip strength after 1 year (1.6 kg, p=0.07). The mean intake of energy and protein expressed as percent of energy and protein requirement had increased after 1 year (15%, p<0.001, and 5.6%, p=0.09, respectively). Handgrip strength correlated significantly with energy (r=0.53, p=0.002), fat (r=0.50, p=0.02) and protein intake (r=0.41, p=0.002) after 1 year. In conclusion, positive effects on body weight, handgrip strength and walking distance in patients with COPD were seen after receiving dietary advice with a 1-year follow-up.

Effect of certirizine on histamine-induced bronchoconstriction and bronchoalveolar cells

The effect of the histamine H1 receptor antagonist (cetirizine) on histamine‐induced bronchoconstriction and inflammatory cells in bronchoalveolar lavage fluid was studied in 12 healthy volunteers. In previous studies we have observed an increased number of inflammatory cells, albumin and hyaluronan in the bronchoalveolar lavage (BAL) fluid 24 h after an inhalation challenge test with histamine‐chloride. In the present study certirizine blocked the histamine‐induced bronchoconstriction but did not influence the cell counts in the bronchoalveolar lavage fluid. Our result suggests that the histamine‐induced bronchoconstriction but not the recruitment of inflammatory cells in the BAL fluid is mediated by histamine HI receptors.