Quality of life of COPD patients treated by long-term oxygen.

The three main dimensions of quality of life (physical function, social activities, and psychological status) were evaluated by a questionnaire in 41 COPD patients with severe respiratory failure treated by long-term oxygen. The results were compared with those obtained in patients suffering from COPD without chronic respiratory failure and in patients suffering from severe diabetes and/or atherosclerosis. A relevant impairment of the indexes of quality of life was found in the group of subjects with chronic respiratory failure. The extent of the impairment was significantly higher in these subjects than in the two other groups of patients.

Clinical and hormonal conditions associated with sodium retention in cirrhotic patients with ascites. Evaluation by univariate and multivariate analyses.

Using multiple regression analysis, we have evaluated the clinical and hormonal conditions associated with impaired urinary sodium excretion in normoazotemic patients with cirrhosis and ascites. We retrospectively identified 13 patients with a urinary sodium excretion lower than 15 mmol/day and 13 patients with a sodium excretion higher than 15 mmol/day. Using univariate analysis, all the patients with poor sodium excretion had abnormally high levels of plasma renin activity, plasma aldosterone, and arginine vasopressin. In addition, they had a diastolic blood pressure lower than patients with high urinary sodium excretion, although otherwise were comparable as regards clinical and biochemical data. The consistency of the above associations was then tested by multiple-regression analysis in an attempt to control for potentially confounding factors and to identify only true, independent associations. After a discriminant stepwise procedure, we found that low diastolic blood pressure (P less than 0.01) and high plasma aldosterone levels (P less than 0.05) were the only two conditions independently associated with abnormally low urinary sodium excretion. These findings are consistent with the view that sodium retention in decompensated cirrhosis results from a concomitant severe contraction in the effective blood volume and an increased production and/or retention of aldosterone. The concordance between our results and several pathophysiological findings supports the validity of this statistical approach to confirm physiological and/or clinical predictions.

Lung mechanics in subjects showing increased residual volume without bronchial obstruction.

Fourteen subjects showing an increase of residual volume (RV) without any clinical or functional signs of bronchial obstruction were studied. Maximum expiratory flow volume (MEFV) curves were obtained with a pressure-corrected volume plethysmograph. Static pressure-volume curves were obtained by stepwise interruption of a slow expiration from total lung capacity (TLC) to RV. Static compliance was measured by the slope of pressure-volume curve between functional residual capacity (FRC) and FRC+20% of TLC. Maximum flow static recoil (MFSR) curves were constructed by plotting MEF obtained from MEFV curves against elastic pressure (Pst) obtained from pressure-volume curves at the same lung volumes. Most patients demonstrated a decrease of MEF 50% and 25% of VC. From the MFSR curves it was clear that this reduction was not the result of increased airways resistance, but rather of loss of elastic recoil. Most patients showed a significant decrease of Pst at different volumes and changes seem likely to be evidence of emphysema.

The capnogram in the study of chronic obstructive lung disease.

The purpose of this study is: 1) to emphasize the importance of the capnogram in the investigation of ventilatory disorders of the obstructive type; 2) to propose a numerical parameter representative of the capnogram; 3) to ascertain, by means of this parameter, possible correlations between capnogram changes and other tests of lung function. This parameter enables a quantitative criterion to be substituted for a descriptive one in assessment of the capnogram; The study covered 245 patients with chronic obstructive lung disease; We observed that as the capnographic tracing becomes more and more pathological, the lung function tests show progressive deterioration.