Reference spirometric values for healthy lifetime nonsmokers in Thailand.

The normal spirometric reference values for Thai people are still not yet available. The aim of this study was to establish standard spirometric equations for Thai people. Subjects 10 years of age and over were selected and their demographic distributions represented that of the population of the whole country. Inclusion criteria were strictly lifetime nonsmokers, no history of chronic cardiopulmonary disease (using a modified ATS--DLD 78 respiratory adult questionnaire), normal standard chest radiograph and unremarkable physical examination. They had to be without respiratory symptoms at the time of the study. Spirometric values were obtained by 5 turbine system 'Pony graphic' (Cosmed, Italy) spirometers which met ATS recommendations. A normal group of 2299 women and 1655 men were selected. Regression analyses using sex, height and age as independent variables were used to provide equations for predicted values. The results were: [table: see text] FVC and FEV1 from this study are close to the Chinese but are 8-20 per cent lower than the Caucasians. These predicted equations are recommended to be used for future reference values in the Thai population.

When should we order preoperative chest radiography: A systematic review and clinical practice guidelines.

Routine preoperative investigation consumes much resource while Thailand suffers severe financial crisis. Objectives of the study were to apply a systematic review to answer the question whether routine preoperative investigation affected health outcomes; and to construct clinical practice guidelines for preoperative chest radiography (CXR). The guidelines were prepared for elective, non-cardiothoracic surgery in adult patients. Methods of the study were Medline search (1980-1998) and search from studies published in Thailand. Criteria for high validity and reliability were applied to paper selection. The results of the systematic review were discussed among anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from the systematic review, there were no randomized controlled trials to answer the question and no studies reported health outcomes. Routine preoperative investigations yielded few positive results and were not very useful for patient care. From this review and the consensus, we proposed the guidelines, which consisted of a history questionnaire, physical examination and indication for investigation. For the preoperative CXR the indications were: age > 45 years, history of cardiovascular and respiratory diseases, autoimmune deficiency syndrome (AIDS), heavy smoking, chronic cough or fever, malignancy and findings of abnormal breath sounds on examination. This study recommends and prefers preoperative CXR as indicated by history and physical examination to routine.

Effect of salbutamol on oxygen saturation in COPD.

The effect of nebulized salbutamol on oxygen saturation in COPD was evaluated in this study. Twenty patients aged 56-75 years with stable COPD were recruited to the study. All patients received 5 mg of salbutamol nebulizer driven by oxygen at 8 L/min. The SaO2 was then measured continuously and readings were taken before and every minute after salbutamol inhalation by face mask. Following treatment, mean SaO2 was significantly lower than preinhalation values. The desaturation occurred from 3 minutes and reached the maximum desaturation at 15 minutes postinhalation. At 30 minutes, SaO2 had returned to baseline values. The findings suggest that salbutamol nebulization induced prolonged desaturation in COPD.

Effect of paper spacer (spader) in conjunction with procaterol metered dose inhaler in the treatment of acute asthma.

Thirty acute asthmatic patients (mean age 35.6 +/- 13.5 years, mean FEV1 0.97 +/- 0.95 L) in the emergency room were evaluated for airway response to procaterol administered by metered-dose inhaler (MDI) compared to MDI with auxiliary device (a paper spacer) in a randomised cross over study. Bronchodilator response to procaterol delivered by MDI, with paper spacer was significantly greater than that by MDI without spacer (mean maximal increment of FEV1, 0.67 +/- 0.46 vs 0.59 +/- 0.46 L, p = 0.016, mean maximal increment of PEFR, 112 +/- 62.3 vs 86.7 +/- 61.3 L/min, p = 0.003) but there was no difference in dyspnoea score, wheezing score and heart rate. This collapsible and portable auxiliary device (paper spacer) can increase therapeutic efficacy of bronchodilator response in asthmatic patients.

Is driving oxygen flow rate clinically important for nebulizer therapy in patients with COPD?

Our study suggests that the administration of bronchodilator drug via nebulizer powered by flow rate 6 L/min is more suitable in COPD patients. The oxygen flow rates should not be given more than 6 L/min. In this study, we recruited COPD patients in a stable stage, in whom the risk of hyperoxic induced hypercarbia is less than in the acute exacerbation stage. Thus, in acute exacerbation stage of the COPD patients, the rise of carbondioxide should be higher. We recommend that the COPD patients should receive bronchodilator drug via the nebulizer, especially in acute exacerbation stage, with oxygen flow rate not more than 6 L/min. The medical personnel must closely observe the clinical signs of the patients to prevent the hazard of carbondioxide retention.

Leiomyomas of the lower respiratory tract: a case report.

A rare case of leiomyoma of the left main bronchus in a 16-year-old female has been reported. Of the pulmonary leiomyomas reported, 18.3 per cent were found in the trachea, 33.8 per cent in the bronchi and 47.9 per cent in the parenchyma. Bronchial lesions tend to produce symptoms due to partial or complete obstruction of the affected bronchus, whereas, over 90 per cent of parenchymal lesions which are more common in women, are asymptomatic and usually discovered on routine chest radiographs. Tracheal lesions may present as bronchial asthma. The correct diagnosis is not usually made until the lesion has been resected. However, early and correct diagnosis may be made in suspicious cases by histological examination of bronchoscopic biopsy specimens or frozen section material obtained at thoracotomy. The surgical approach to these tumors is conservative but lobectomy or pneumonectomy is often necessary because of secondary pulmonary destruction.

Serum precipitins in pulmonary aspergillosis: preliminary results.

Definitive diagnosis of pulmonary aspergillosis is difficult to establish. Thus, confirmative evidence of active fungal aggression is imperative. In this study, an immunodiffusion test was carried out on 36 cases of pulmonary aspergillosis and two groups of subjects comprising 133 patients with non-fungal diseases and 134 healthy volunteers as controls. The test was positive in 92.3% of the patients with mycetoma, in 50% of the patients with allergic bronchopulmonary aspergillosis, and in 25% of the patients with invasive aspergillosis. Results were negative in all subjects in the two control groups. The findings indicate the efficacy of the test under study for supporting the diagnosis of pulmonary aspergillosis.

Dissertation of reported cases of nontuberculous mycobacteriosis in Thailand.

During the period from 1967 to 1988, there were 10 published reports of 44 patients from whom mycobacteria other than tubercle bacilli had been isolated clinic specimens. This communication presents results of a scrupulous review of each of the papers which revealed that some of the patients cited in the reports did not meet with the criteria for diagnosis, and some of the cases might have been the same patients as those documented by different investigators.

Treatment of community-acquired pneumonia with ofloxacin.

Our study of 28 carefully selected patients proved that ofloxacin is a safe and effective drug for mild to moderately severe community-acquired pneumonia. An effective oral antimicrobial drug such as ofloxacin can be used as an alternative to conventional therapy in community-acquired pneumonia.

Clinical assessment of respiratory impairment.

"Respiratory impairment" can be assessed roughly by clinical methods (symptom information and physical examination) and a simple bedside test ('match test'), and quantitatively and accurately by laboratory pulmonary function study (spirometry, arterial blood gas analysis and several other sophisticated tests). Whereas tests of respiratory impairment in a laboratory situation can predict dysfunction level reasonably well, a complete description of the function will depend in part on judgement, and in part on the motivation and attitude of the individual. Subject participation is an integral part of all evaluations.

Effect of s-carboxymethylcysteine in chronic bronchitis patients.

Drugs that modify the physico-chemical properties of bronchial secretions are widely used in the treatment of chronic airway diseases. S-carboxymethylcysteine is one among various mucolytic agents available. It acts directly on mucus gland and reduces the viscosity of viscous by breaking the disulphide bonding which crosslink the strands of mucus. A double-blind trial of S-carboxymethylcysteine, administered orally in a dose of 700 mg. three times daily for seven days, was compared with placebo in 20 patients with chronic bronchitis. S-carboxymethylcysteine resulted in a significant reduction in the pourability of sputum by 55.5 to 65 percent. No improvement was noted in the subjective measures of ease of expectoration, severity of coughing and sputum consistency. There was also no significant difference in the volumes of sputum expectorated and in ventilatory function (spirometry). No side effect of S-carboxymethylcysteine was seen.