[The prevalence of respiratory symptoms, bronchial asthma and chronic bronchitis (simple and obstructive) in a representative sample of the adult rural population]. / Prevalenta unor simptome respiratorii, a astmului bronsic si a bronsitei cronice (simple si obstructive) într-un esantion reprezentativ pentru o populatie adulta rurala.

A representative sample of an adult population living in a rural area (1001 adult subjects aged 18 and above) was submitted to the ECHRS standardised questionnaire (administrated by interview) and performed lung function tests (ventilatory). The most frequent respiratory symptoms were chronic cough (especially in males and smokers) and intermittent dyspnoea (in females more prevalent than in males). All symptoms showed a higher frequency after 50 years. Obstructive ventilatory impairment was found in 12.29% of the subjects, more frequently in males, ex-smokers and above 50 years of age. The prevalence of asthma bronchiale was 4.09%; the subjects over 40 years of age, the non-smokers and the females showed higher figures. Chronic simple bronchitis was found in 5.69% of examined subjects, especially in males and smokers. The prevalence of chronic obstructive bronchitis was as high as 2.29%, more prevalent in males, smokers, over 40 years. The prevalence rates found in this study are higher than those observed in a rural population living in an unpolluted area: this fact may be ascribed to the noxious effect of the air pollution due to the chemical industrial plants situated in the vicinity of the studied population.

[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.

[The prevalence of bronchial asthma, chronic bronchitis and COBP in representative samples of the adult population]. / Prevalenta astmului bronsic, a bronsitei cronice si a BPOC pe esantioane reprezentative de populatie adulta.

In order to organize the management of asthma bronchiale and chronic bronchitis, in our country, it is compulsory to know the prevalence of these diseases in the autochthonous population. The ECRHS questionnaire (by interview) and lung function tests were applied in three random population samples aged by 18 years and over. The samples were selected from the electoral rolls and coming from three different economic and geographic regions of our country. The questionnaire were administered by trained pneumologists and lung function testing by well trained technicians. The results were stored and processed on computer using the EPI INFO program. The prevalence of asthma bronchiale was: 4.09%, 6.60%, 1.70%. The prevalence of chronic bronchitis was: 12.28%, 10.11%, 7.98%. The prevalence of chronic obstructive bronchitis was: 1.79%, 2.50%, 1.89%. Generally, the prevalence of asthma bronchiale was found close to the values obtained in other studies, of identical conditions. It was particularly close to the results of Italian researchers who studied a population aged by 20 years and over from the northern Italy. The prevalence of chronic bronchitis was near by the value mentioned by Scandinavian epidemiologists. Analytic epidemiology would specify the causes of the variations we founded in the three studied samples.

Pulmonary mechanics in patients with asthma bronchiale in symptom-free interval.

Pulmonary and airway mechanics were assessed in 30 patients with asthma bronchiale during a symptom-free interval, and with normal spirometry. Static expiratory pressure-volume (PV) curves and maximum expiratory flow-volume curves were obtained, and maximum flow-static recoil (MFSR) curves were drawn-up. In 11 patients elastic pressures were significantly lower than normal at all lung volumes, but the slope of the PV curve was normal; the loss in lung elastic recoil was not associated with an increase in lung volume, suggesting that surface forces acting in the alveoli may be responsible for the elastic abnormality. In 5 patients static pressures were increased at all lung volumes, possibly due to the increase in elastic pull exerted by the thorax on the lungs. Obstruction of small airways was present in most cases: MEF50 was lower than predicted in 70% of them, and in 73.3% the upstream resistance was increased. In 17 subjects, the MFSR curves showed increased pressures at given maximal flows suggesting that the airways obstruction was generated by an intrinsic mechanism. In 4 cases, an extrinsic mechanism might be responsible since the elastic pressures at given maximal flows were lower than normal.

[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.

[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.

[Effectiveness of salbutamol powder (Ventodisk Glaxo) compared to dosed aerosols (sultanol)]. / Studiu privind eficacitatea salbutamolului pulbere (Ventodisk Glaxo) comparativ cu aerosolii dozati (sultanol).

The study deals with the effect of salbutamol powder (Ventodisk) administered with Diskhaler device comparatively to salbutamol dosed aerosols. The analysis of PEF variations on morning and evening in a group of patients unable to use correctly the dosed aerosols leads to the conclusion that salbutamol powder succeeds in a higher effect since the administration by Diskhaler is far easier.

[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.

[Pulmonary involvement in scleroderma]. / Determinari pulmonare în cadrul sclerodermiei.

The paper deals with 3 cases of sclerodermia with pulmonary determinations detected by clinical, radiological, functional and histopathological means, of diffuse interstitial fibrosis type. The association with bronchopulmonary cancer is pointed out in one case only.

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 value of the spirographic examination in the follow-up with time of the lung functional states in children with bronchial asthma]. / Valoarea examenului spirografic pentru urmarirea în timp a starii functionale pulmonare la copiii cu astm bronsic.

28 Children with bronchial asthma, aged 6-18 years, were followed up for varying time intervals, between 3 months and over 5 years. In the cases studied, 7-8 functional tests were used under different clinical conditions: asymptomatic, manifested clinical form of the bronchial asthma, crisis of expiratory dyspnea in various severeness degrees. For an easy use of the method in the pediatric network, the lung functional investigation consisted only of spirographic examination (CV (vital capacity), VEMS (max. expir. ventilation per second) VEMS/CV ratio). The study has to show which of the lung functional parameters, measured on the maximum and forced spirogram, are the most useful for the best evaluation of the functional state of the asthmatic child. The VEMS value proved to be the most correct one for appreciating the presence and severeness degree of the obstructive syndrome The slight variation of the VEMS/CV ratio showed that the information given by this parameter cannot reveal enough the alteration of the lung function in child. For a better evaluation of the lung functional state in the asthmatic child, the routine spirographic examination, has to be completed with more "sensible" tests, such as FEF25-755 and MEF59 and with other functional parameters measured by plethysmographic examination (VGT, Raw).

[The time variations in pulmonary functional parameters in children with bronchial asthma]. / Studiul variatiilor în timp ale unor parametri functionali pulmonari la copii cu astm bronsic.

28 children with bronchial asthma, between 6 and 18 years old, were followed by a varied period of time - 3 months - 5 years. 7-8 functional tests were carried out. The cases were studied in different clinical phases: asymptomatic, manifest, crisis of bronchial asthma. The functional pulmonary investigation included: spirographic examination [vital capacity (VC), maximum expiratory volume per second (MEVS) the VC/MEVS ratio], plethysmographic examination (VGT, Raw), measurement of the maximum instantaneous expiratory flows on the flux-volume curve (MEF50). The average value, standard residual deviation and the variation coefficient were calculated for each parameter studied in different clinical moments. The results are presented on 3 groups: per total, symptomatic and asymptomatic. The analysis of the data found showed that the variation of the parameters measured during repeated functional examinations in children with bronchial asthma ranges within broad limits (2.9%-11.5%); the broadest variation was recorded for Raw followed by MEF50 and the slightest variation was that of the VC/MEVS ratio. This indicated the lower value of the information furnished by this ratio in children, in appreciating the presence or severeness degree of the obstructive syndrome.

[Pulmonary functional criteria for evaluating the evolution of diffuse interstitial pneumopathy under treatment]. / Criterii functionale pulmonare de evaluare a evolutiei pneumopatiei interstitiale difuze sub tratament.

It was studied the variation of the pulmonary volumes, of the gaseous transfer through the alveolocapillary membrane and of the indications of pulmonary elasticity on 40 patients with diffuse interstitial lung disease (PID), examined at intervals of 3-6 months, for 2-3 years during the treatment. The levels of the pulmonary elasticity parameters have signaled more frequently the modification (improvement or worsening) of the pulmonary functional state than those of the pulmonary volumes or of the gaseous transfer. Hence the proposal of including the tests for elastic recoil within the ensemble of pulmonary functional investigations through which are studied the effects of the treatment prescribed in PID.

[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.

Pulmonary mechanics in patients with diffuse interstitial lung disease and normal lung volume.

Static expiratory pressure-volume curves obtained in 20 patients with diffuse interstitial lung disease and lung volume within normal ranges (i.e. in patients in an early stage of the disease) showed different patterns of abnormal lung elastic recoil: 1) P-V curves with normal shape but shifted to the right, which suggest an overdistension of a reduced number of functioning alveoli ("lung shrinkage") and 2) flattened P-V curves (i.e. with low static compliance) also shifted to the right, which argue for an abnormal distensibility of most alveoli or a more diffuse spreading of lesions. These patterns suggest a multifactorial genesis of the increased elastic recoil in diffuse interstitial lung disease.