Relationship of cytomorphology to spirometric findings in cigarette smokers.

The objective of the study was to determine the relationship between sputum cytomorphology and pulmonary function. A cross-sectional correlation analysis of results from pulmonary function testing and eight cytomorphologic indices of inflammation and metaplasia was conducted in 143 smokers registered in a residential smoking-cessation program. Stepwise multiple regression analysis revealed that after adjusting for age and smoking history, lower levels of pulmonary function were related significantly to higher levels of macrophage pigmentation, neutrophils and metaplasia.

A study on the lung function in alpha 1-antitrypsin-deficient (PiMZ) patients.

Laurel and Eriksson published the first report indicating that alpha 1-antitrypsin deficiency predisposed patients to the development of Chronic Obstructive Pulmonary Disease (COPD). For the purpose of early detection, disturbances of pulmonary function in alpha 1-antitrypsin mild deficiency cases (PiMZ) were compared with those of normal cases (PiMM) in caucasian Americans. The marked results are as follows.

Reversibility of airways injury over a 12-month period following smoking cessation.

In this investigation, we examined changes in exfoliated tracheobronchial cells in sputum in 46 individuals (mean age = 49.2 years; mean packyears = 48.7) who discontinued smoking and 37 individuals (mean age = 54.

Bolus technique for assessing distribution of inspired gas during tidal breathing.

The washout of an insoluble tracer from the lung may be represented by a model with two ventilatory compartments representing poorly and better-ventilated regions. Using boli of a second insoluble gas delivered at a given point during inspirations of a multibreath washout test, the proportions of labeled inspired ventilation reaching the poorly and well-ventilated regions may be determined by analyzing the kinetics of the exhaled tracer. We studied eight normal subjects breathing through large-bore solenoid valves controlled to maintain tidal volume at 600 or 900 ml.

Aging of the lungs: speculation on the role of oxidants and proteases.

In most regards, aging of the human lungs mimics the development of emphysema. Various lines of evidence suggest that oxidants and proteases play an important role in the pathogenesis of emphysema. The disease seems to arise through a complex interplay of genetic and environmental factors.

A new pendant storage oxygen-conserving nasal cannula.

With increasing interest in reducing the cost of oxygen therapy, we recently designed an oxygen-conserving cannula. It reduces the oxygen supply flow necessary to achieve adequate oxygen saturation, but because it requires the use of a reservoir situated under the nose, some patients find it obtrusive. We therefore designed a similar system but displaced the reservoir away from the face and onto the anterior chest wall where it could be hidden from view by the patient's clothing.

Evaluation of a low-flow oxygen-conserving nasal cannula.

Oxygen therapy is one of the most frequently ordered therapies for patients with chronic obstructive pulmonary disease (COPD). In a large percentage of these cases, oxygen therapy is supplied via nasal cannula. With the rising cost of medical care and the search for more effective means of oxygen delivery, a new oxygen-conserving nasal cannula (CNC) that incorporates a closely coupled 20-ml reservoir was developed.

Collaborative study to assess risk of lung disease in Pi MZ phenotype subjects.

We studied 143 Pi MZ heterozygous (MZ) subjects from random populations that had been examined previously for alpha 1-antitrypsin phenotype. Each Pi MZ subject was closely matched with a Pi M control subject from the same population at each of 6 centers. An expanded National Heart, Lung and Blood Institute (NHLBI) respiratory symptom questionnaire was completed by each subject.

Factors affecting expired waveform for carbon monoxide.

We previously presented a method based on a computer lung model for determining the distribution of both specific ventilation and specific diffusing capacity. These argon and carbon monoxide (CO) washin and washout studies were obtained in 12 normal subjects and 24 patients with varying degrees of obstructive lung disease. In addition to end-tidal and mixed expired gas concentrations, the expired waveform for both gases was sampled.

Respiratory impairment in coke oven workers: relationship to work exposure and bronchial inflammation detected by sputum cytology.

Coke oven workers are at excess risk of developing lung cancer and may be at risk for chronic obstructive lung disease (COLD). We have studied 3799 male workers to assess the relationship between the two diseases. Repeated lung function and sputum cytology tests were obtained over a 3-year period.

Optimal inputs for parameter determination of inert gas washout from the lung.

The nitrogen washout test will yield more information about the distribution of pulmonary ventilation if a pattern of inspired gas concentrations is utilized other than the standard series of 100% oxygen breaths. The input breathing pattern which yields optimal results will vary with the specific features of the lung being studied but typically includes breaths of air, particularly in the last third of the washout. Using computerized, mathematical techniques, optimal inputs were selected for washout tests of duration 10, 20, 30 and 40 breaths for each of six lung models, ranging from a unicompartmental to a highly non-uniform 'diseased' lung.

Distribution of ventilation and diffusing capacity in the normal and diseased lung.

Conventional tests of diffusing capacity (DL) consider the lung to be a uniform structure with regard to both ventilation and diffusion. These assumptions are incorrect even in normal subjects. We present a method for determining the distribution of both specific ventilation (SV) and DL from the washin and washout of C18O and simultaneous washout of argon.

Risk factors for obstructive lung disease.

To assess the role of various risk factors in the pathogenesis of chronic obstructive lung disease (COLD), 163 men and women were followed for approximately 6 yr. Subjects were either community volunteers or relatives of patients with antitrypsin deficiency (PiZ or MZ phenotype). At the onset of the study no subject was receiving medical care for COLD.

Competitive inhibition of carbon monoxide transport: evidence against a carrier.

The existence of a saturable carbon monoxide (CO) carrier in the lung remains controversial. The carrier hypothesis was invoked to explain data that indicated that pulmonary diffusing capacity for CO (DLCO) decreases with increasing CO concentration. To test this hypothesis, we measured DLCO in 14 normal adult subjects at three alveolar CO concentrations (60, 660, and 2,060 ppm).

Familial temperature sensitive alpha 1 protease inhibitor (M1Anaheim).

An alpha 1 protease inhibitor which is sensitive to increased temperatures and which migrates in the same position as the normal M1 phenotype, has been identified. The sensitivity of the trypsin inhibitory capacity is an inherited characteristic, which is enhanced by acid conditions, as well as conditions during isoelectric focusing. Loss of the serum trypsin inhibitory capacity is not parallel to that of the serum elastase capacity, suggesting that the inhibitory sites for these proteases are oriented differently within the alpha 1 protease inhibitor molecule.