Lack of bronchial hyperresponsiveness to methacholine and to isocapnic dry air hyperventilation in heart/lung and double-lung transplant recipients with normal lung histology. The Paris-Sud Lung Transplant Group.

To investigate whether survivors of heart/lung and double-lung transplantations have normal or increased nonspecific bronchial responsiveness, nine heart/lung and four double-lung transplant recipients with normal lung histology underwent methacholine challenge and voluntary isocapnic dry air hyperventilation (VIH) in a randomized order at a mean time of 14.8 +/- 12.1 months after surgery. Transplant recipients were compared with 10 normal subjects and 11 patients with mild asthma. Asthmatic patients had a mean provocative concentration of methacholine inducing a 20% fall (PC20) in FEV1 of 3.4 +/- 3.6 mg/ml (SD). Seventy seven percent of the transplant recipients and 70% of the normal subjects had PC20 superior to 32 mg/ml. The percentage fall from baseline FEV1 after VIH was 12.6 +/- 10.4% in asthmatic patients as compared with 1.9 +/- 2.9% in transplant recipients (p = 0.002) and 0.45 +/- 1.2% in normal subjects (p = 0.001). The decrease in FEV1 after VIH was similar in transplant recipients and normal subjects (p = 0.14). These results show that heart/lung or double-lung transplant recipients with normal lung histology have a normal response to nonspecific bronchial stimulation.

Comparison of human bronchial muscle responses to histamine in vivo with histamine and isoproterenol agonists in vitro.

In an effort to explain the large variation of airway reactivity to histamine in human subjects in vivo, we have examined the relationship between histamine responses in vivo and isoproterenol in vitro. The bronchial reactivity in patients with lung carcinoma was assessed prior to surgery by measuring the provocative concentration of histamine that resulted in a 20 or a 40% reduction in either forced expiratory volume in one second or specific airway conductance (SGaw). We also determined the pD2 value (-Log EC50 molar) to histamine and isoproterenol in isolated bronchial muscle preparations from these subjects. A wide range of histamine responsiveness was observed in vivo for the 17 patients (PC40 SGaw: 1.3 to greater than 64 mg/ml of histamine). There was no correlation between this latter parameter and the bronchial histamine sensitivity in vitro. However, isolated bronchial muscle preparations from asthmatic subjects were less sensitive to isoproterenol than were those preparations from nonasthmatic subjects.

[What interview methods can one propose in respiratory insufficiency before rehabilitation?]. / Quelles méthodes d'interrogatoire peut-on proposer dans les insuffisances respiratoires avant réadaptation?

In view of the readaptation of patients with respiratory insufficiency, the interrogation should aim at a clinical synthesis and define the sociological, familial and psychological context. It can be done by two ways; both with their pros and cons: 1) directed or self interrogation; 2) free talk or open questions. The first way is more specific, scientific, but less personal while the second is more personal though less objective. The latter is to be prefered, but a certain neutrality should be kept.

[Results of rehabilitation in pneumonectomy patients]. / Les résultats de la réadaptation chez les pneumonectomisés.

Up to now, there is in France no rehabilitation program after pneumonectomy but social security and kinesitherapy. Medical, functional and economical survey of 219 subjects operated 1 to 20 years earlier shows that, as far as return to work and psychological adaptation are concerned, these factors weight at least as much as severe respiratory insufficiency. Before setting up a program of rehabilitation one should study these factors and others that may eventually influence psychological equilibrium.