A general purpose microprocessor for spirometry.

A portable, inexpensive microprocessor is described for on-line spirographic analysis of FVC and its time derivatives and MVV, using a primary flow or volume signal. Resolution is +/- 0.02 L and maximal collection time 66 seconds. Algorithms according to the Snowbird Conference recommendations include back extrapolation, "end of test" determination and the selection criteria for satisfactory tests, and best FVC, FEV1 and other flow rates. Differentiation is digital and flow-volume outputs are available. Actual, predicted and percent predicted values for children or adults are displayed, or can be printed together with an interpretation and a flow-volume loop. Four hundred tests with a Stead-Wells spirometer, a pneumotachograph and a turbinometer using an explosive decompression FVC simulator showed standard deviations of +/- 0.04 L or L/sec or less, except for peak flow. Differences between microprocessor values and tracing analyses were less than 0.04 L. MVV with a reciprocating pump equalled exactly the MVV calculated from stroke volume and frequency (r = .999) from 8 to 325 L/min. Tests of 168 patients were comparable to the calibration devices.

Calibration of time derivatives of forced vital capacity by explosive decompression.

A simple, portable, inexpensive device is described that simulates expiratory flow curves for calibration of spirometers. A 4-L metal cylinder filled with copper mesh is fitted with a precision manometer. The pressure is increased to twice atmospheric and released by explosive decompression through 4 easily interchangeable resistors. The ratio of forced expiratory volume in one second to forced vital capacity ranged from 0.80 to 0.25, thus encompassing the range from normal to severe obstruction. Accuracy was defined by 25 measurements of forced vital capacity that differed by no more than 0.5% from the actual cylinder volume. Repeatability was reflected by a standard deviation of at most 0.04 L/s for one-second forced expiratory volume, mid-expiratory flow, and instantaneous flows at 50 and 25% of the forced vital capacity. Peak flow was less reproducible. Calibrations of a water spirometer at increased altitude and at temperatures from 4 degrees to 37 degrees C revealed no significant changes in volume or flow rates. Standard values have remained unchanged for 2.5 yr. Three volume spirometers and 2 primary flow devices were tested extensively.

Pleuropericardial reaction to treatment with dantrolene.

Chronic pleural effusion occurred in three patients, one of whom also developed acute pericarditis. A fourth patient developed both pleural and pericardial effusions. All patients had been receiving dantrolene sodium for at least two months. The pleural fluid was a sterile exudate with pleural and peripheral blood eosinophilia in all patients. No pulmonary parenchymal involvement was apparent. Pleural biopsy specimens showed nonspecific inflammation. Resolution of the pleural process was prolonged after dantrolene therapy was discontinued. Although a causal relationship between dantrolene and serosal inflammation remains unproved, this association in four patients warrants careful observation of others receiving long-term dantrolene therapy.