[A comparative study of pulmonary elasticity and diffusion through the alveolocapillary membrane in major collagenoses with lung involvement]. / Studiu comparativ al elasticitatii pulmonare si al difuziunii prin membrana alveolocapilara în colagenozele majore cu determinari pulmonare.

UNLABELLED: We studied 60 patients with collagen-vascular diseases with pulmonary manifestations (SLE-25; SSc-13; mixed connective tissue disease-12; RA-6; PD-DM-3; ankylosing spondylitis-1), 54 females and 6 males, mean age 42.4 +/- 9.9 years. We measured lung volumes (total lung capacity-TLC) by spirography (Flowscreen Jaeger) and body plethysmography (Bodyplethismograph Jaeger); compliance of the lungs (CL) and elastic recoil pressures at 100%, 80% and 70% TLC (PL,el 100%, 80%, 70% TLC) by the esophageal catheter method; diffusing capacity of the lungs by the single-breath method (DL,COSB) (Alveo-Diffusionstest Jaeger). DL,CO was diminished in 45 (75%) of cases. 11 patients (18.3%) had an increased elastic recoil, equally distributed between mild and severe decrease of DL,CO. Statistical significant correlations were found between TLC-DL,CO (r = 0.63; p < 0.001) and TL-CL (r = 0.49; p < 0.001). No correlations were found between DL,CO and PL,el 100, 80, 70% TLC. The results are expressed as percent of predicted value (% pred.). The mean values and standard deviation (X +/- sd) were calculated. CONCLUSIONS: I) DL,CO is the most frequent altered pulmonary function test in collagen-vascular diseases with pulmonary manifestations; it seems to be a sensible parameter for diagnosing these diseases. 2) The alteration of DL,CO,CL and PL,el appears to be rather as a result of "shrinking lungs" due to respiratory muscle involvement than to an interstitial lung disease. 3) Elastic recoil pressures and compliance should be considered as routine pulmonary function test, important for the evaluation of treatment and prognosis.

[Functional study of the respiratory muscles in patients with diffuse interstitial pneumopathies (DIP)]. / Studiul functiei muschilor ventilatori la bolnavii cu pneumopatii interstitiale difuze (PID).

The aim of the study was to evaluate the function of the respiratory muscles in patients with diffuse interstitial lung diseases (DILD) by measuring the maximal static inspiratory (MIPS) and expiratory (MEPS) pressures and to find out a possible relationship between these pressures and some parameters of the respiratory function of the lung. The battery of functional tests consisted in: lung volumes, flow rates, lung elasticity and arterial partial pressure of oxygen at rest and on exercise. MIPS and MEPS were measured using the Black and Hyatt method. 82 patients with DILD of different etiologies were studied, 39 males and 43 females, with a mean age of 33.6 +/- 8.74 years. The results signaled the decrease of MIPS in 29 cases--35.3% (the mean value in % predicted and the standard deviation: 47.0 +/- 9.75) and of MEPS in 47 cases--57.3% (the mean value in % predicted and the standard deviation 49.7 +/- 9.3). No relationship has been found between the low values of MIPS and MEPS on one hand and the altered values of some parameters of the lung function (diminished lung volumes, increased elastic recoil, hypoxemia on exercise) on the other. The peak expiratory flow rate--PEF--was significantly greater in patients with normal values of MIPS and MEPS than in those with decreased ones, which confirms the dependence of PEF on the force of the respiratory muscles. In our study, despite previous published data, the decrease of the force of respiratory muscles in patients with DILD seems to appear with a rather high frequency.

[The clenbuterol treatment of patients with the chronic obstructive syndrome]. / Tratamentul cu Clenbuterol al bolnavilor cu sindrom obstructiv cronic.

We have studied the effect of a new long acting bronchodilator: CLENBUTEROL, in 10 patients suffering from chronic obstructive diseases. All patients received 1 tablet of Clenbuterol, then we measured the following parameters in each patient, 2 and 6 hours after the drug administration: VC (vital capacity), FEV1 (forced expiratory volume in the first second of forced expiration), FEV1 x 100/VC, Raw (airways resistance), RV (residual volume). In all patients, excepting one of them, we registered a modification of all or some of the parameters 2 hours after drug administration. The bronchodilator effect was still present at 6 hours after drug administration. This data suggest that Clenbuterol induced a significant and long acting improvement of chronic obstruction; this drug might offer the advantage of sustained effect in patients suffering from chronic bronchospastic obstruction.

Flutter-VRP1 Desitin--a new physiotherapeutic device for the treatment of chronic obstructive bronchitis.

Techniques and therapies intended to assist in the removal of excessive mucus from the lungs are now receiving greater attention in the medical practice. Flutter-VRP1 Desitin is a new pocket-sized personal therapeutic device used in the adjuvant treatment of respiratory diseases characterized by different degrees of bronchial obstruction, mainly due to disturbances of bronchial clearance and mucostasis. Used in a group of 20 patients with chronic obstructive bronchitis in whom the clinical and functional parameters were determined before and after regular use of the device for periods varying between two and eight weeks. The Flutter-VRP1 proved as a very promising technique, which can significantly ameliorate the evolution of chronic obstructive bronchitis, especially in the cases with mild to moderate deterioration.

[The effects of corticotherapy by inhalation on the pulmonary functional parameters in bronchial asthma patients]. / Studiul efectelor corticoterapiei pe cale inhalatorie asupra parametrilor functionali pulmonari la bolnavii cu astm bronsic.

The study followed the effect of long term high doses of inhalational corticotherapy (ICT) in bronchial asthma patients. The studied group included 31 adults with confirmed bronchial asthma, 21 corticoid-dependent cases, which were submitted to ICT with 1000 mg beclometasone dipropionate (BDP) given daily during one year. The evolution was monitored by clinical and functional controls at 2-4 weeks (clinically: presence and severity of the symptoms: dyspnoea, cough, bronchial secretion by a score system; functionally: spirography, MEVS, body plethysmography-RV, SGaw, flux-volume curves, MEF50). The results evidenced improving of lung ventilation parameters in the majority of subjects (87.0%) up to normal figures excepted MEF50 (RV-70%, MEVS-60.0%, SGaw-60.0%). The good clinical and functional evolution is noted after the first month of treatment (statistically significant in comparison with the initial (values which is maintained during the whole year. The oral corticotherapy was suppressed in 52.4% of cases; no adverse systemic reactions were noted, only a few local ones (oral candidosis-9.7%, hoarseness-6.4%). The persistence of subnormal values of MEF50 at the end of ICT period reveals an obstructive distal process, most probably of inflammatory nature which could be an argument for the continuation of the treatment behind one year of ICT.

[The effect of a single dose of 50 micrograms of salmeterol (Serevent, Glaxo) on pulmonary functional parameters]. / Efectul unei doze unice de 50 micrograms salmeterol (Serevent, Glaxo) asupra unor parametri functionali pulmonari.

The study aimed at estimating the acting duration of salmeterol (Serevent, Glaxo), a long-term beta 2-agonist bronchodilator, when given in a single dose (50 micrograms). Two flow rates (FEV1, MEF50) the overall airways resistance to flow (Raw), and intrathoracic gas volume (ITGV) were measured at 15 minutes, then every two hours, up to 12 hours after salmeterol administration, in 8 asthma patients with ample reversible obstructive ventilation disfunction. Lung function parameters were quickly improved, and remained at higher values than the initial ones even at 12 hours after drug administration, the bronchodilating effect being of a similar amplitude for Raw, ITGV and MEF50, which suggests a favorable answer both in the whole bronchial tree and the peripheral airways segment.

[Clear diagnosis in an atypical case of bronchial asthma and treatment monitoring using pulmonary function tests]. / Elucidarea diagnosticului într-un caz atipic de astm bronsic si monitorizarea tratamentului cu ajutorul testelor de explorare functionala pulmonara.

The paper deals with a bronchial asthma case whose anamnesis and clinical data plead rather for a chronic obstructive bronchitis (COPD). The diagnosis is elucidated through the pulmonary function tests performed both before and after a treatment which suppresses the inflammation and oedema of the mucous membrane with hypercrinia and discrinia, thus allowing the hyperreactivity of bronchial smooth muscles to become evident. Taking into account that more than 50% of the asthmatic persons have not a correct perception of the airway obstruction, treatment effect evaluation on the basis of clinical data only may lead to an early treatment stepping which can favour the development of a chronic inflammation and a "basic" obstructive syndrome resulting in a pulmonary insufficiency later on. Pulmonary function tests are therefore useful in monitoring the treatment whose efficacy is proved by the achievement of normal pulmonary function (or at least as close to normal as possible) and not only by the suppression of clinical symptoms.

[Clinico-functional changes during inhalational corticotherapy (beclomethasone dipropionate) in children with severe forms of bronchial asthma]. / Modificari clinico-functionale sub corticoterapie inhalatorie (beclometazona dipropionat) la copii cu forme severe de astm bronsic.

In 14 children with corticoid-dependent severe forms of bronchial asthma, inhaled corticotherapy with beclomethasone dipropionate (BDP) was administered for 6 months. Pulmonary functional investigations were performed before, at 1 as well as 6 months from treatment start. Functional pulmonary tests included lung volume and flow measurements. The results showed a remarkable improvement of the mean percentage values of tested functional parameters, and even a significant percentage of normalization concerning the same parameters (excepting MEF50) after 6 months of treatment.

[The routine diagnosis of the distal obstructive syndrome (DOS)]. / Diagnosticul de rutina al sindromului obstructiv distal (SOD).

The diagnosis of distal obstructive syndrome (DOS) is based on the test of lung ventilation function. The tests applied (FEF25-75, MEF50, MEF25) are more sensible than in the routine spirography exploration (FEV1, FEV1.0 x 100/VC), because they evaluate the efficiency of ventilation in those conditions in which the force of the respiratory muscles plays a secondary part and, therefore, cannot hide a flow decrease caused by the obstruction of small pathways (less than 2 mm in diameter). FEF25-75 is measured on the same forced maximum expirogram as FEV1.0. MEF50 and MEF25 are parameters derived from the flow-volume curve. The introduction of these tests into the routine exploration of pulmonary ventilation will improve considerably the diagnosis of early COPD forms.

Clinical management of bronchial asthma with inhaled high-dose beclomethasone dipropionate (Beclomet 250--Orion).

The efficacy of inhaled high-dose beclomethasone dipropionate (BDP) in intrinsic and cortico-dependent asthma was studied in 12 asthmatics (3 males and 9 females), average age 39 years (range 17-62 years), with a mean duration of the disease of 9 years (range 2-20 years). The patients were instructed to use one actuation (250 micrograms), three times daily or two actuations three times daily in severe cases in which dyspnoea persisted during the intake of oral corticosteroids. The results during the 6 month follow-up period were: Clinical: dyspnoea, wheeze and cough disappeared or diminished, oral administration of corticosteroids stopped or the daily dose was reduced, the intake of beta-agonists decreased; Functional: after 2-4 weeks, in almost all cases, the base line values of FEV 1.0 and Raw were normal and hyperinflation significantly diminished after the first month of BDP therapy. Clinical and functional improvement were maintained during the follow-up period; no side-effects were revealed.

[The relation of severe obstructive disorders to ventilation found in young patients with bronchitis and bronchopulmonary diseases in childhood]. / Studiul relatiilor dintre tulburarile obstructive severe ale ventilatiei întîlnite la bronsitici tineri si afectiunile bronhopulmonare în copilarie.

Of the patients with chronic obstructive pulmonary disease (COLD) and severe obstructive syndrome, 39 whose age was under 40 were selected. In 23 of them, the anamnesis revealed bronchopulmonary affections in childhood, that required admission into the hospital (19 were non-smokers). Of the rest of 16 patients, 14 were hard smokers that started to smoke before the age of 14. The functional picture was severely modified, similarly to that of the COLD patients in the 6th decade of life. This suggests that the degradation process started in the childhood, and that the chronic respiratory diseases and/or smoking at an early age had an important role.