Bilevel exercise training and directed breathing relieves exertional dyspnea for male smokers.

Objective: The purpose of this study was to compare the effects on exertional dyspnea and exercise capacity of square wave (bilevel) cycle ergometry endurance exercise training (SWEET) and comprehensive directed breathing vs. walking while pushing an OxCar and traditional diaphragmatic breathing for male smokers with normal spirometry but reduced exercise capacity.

Design: This was a prospective randomized trial of 24 unmedicated men with exertional dyspnea assigned to SWEET or OxCar groups.

[Social and housing conditions of patients with chronic respiratory failure treated in the ANTADIR Federation].

Introduction: Chronic respiratory failure (CRF) has an impact on quality of life because of respiratory handicap.

Methods: The purpose of this study was to analyse the daily life and social activities of patients with CRF. A questionnaire was addressed to over 9000 patients being cared for in the ANTADIR homecare network, with over a 60% response rate.

[Familial diffuse interstitial fibrosis of prolonged onset worsening during pregnancy].

Introduction: Familial idiopathic interstitial pulmonary fibrosis is rare. In this case report the diagnosis was confirmed histologically in four members of the same family.

Case Report: A woman whose father and two paternal uncles had developed pulmonary fibrosis was hospitalised from birth on account of delayed growth and dyspnoea.

[Diffuse pulmonary lymphangiomatosis in a young adult].

We report a new case of diffuse pulmonary lymphangiomatosis in a 22 year-old man with a dysmorphic syndrome. The disease started with dyspnea which became rapidly disabling. The diagnosis was established from a pulmonary biopsy.

Interpretation of high wedge pressure on exercise in patients with chronic obstructive pulmonary disease.

In a retrospective review of patients subjected to right heart catheterization, case records from 109 consecutive patients with chronic obstructive pulmonary disease (COPD) and wedge pressure > or =15 mm Hg on exercise were analyzed. Patients were separated into group 1, resting wedge pressure (P macro w) <15 mm Hg and difference between P macro w and right atrial pressure (P macro ra) change on exercise <5 mm Hg (n = 54), group 2, same P macro w at rest but increase in macro on exercise > or =5 mm Hg, being higher than that of P macro ra (n = 34), and group 3, P macro w > or =15 mm Hg at rest (n = 21). The occurrence of left heart disease increased from group 1 to group 3 (19, 53 and 71%, respectively), and the slope of the P macro w/stroke index relationship was lowest in group 3.

[Diagnosis and evaluation of chronic respiratory insufficiency].

Chronic respiratory failure is defined by the inability of the respiratory system to carry out the gas exchange needed to fulfill the body needs. Its diagnosis is based on arterial blood gas measurements. It is possible, however, for the physician to assume it from clinical symptoms.

[Home ventilation after intensive care].

In the course of chronic respiratory insufficiency, acute episodes often require the use of mechanical ventilation. Failure of weaning, or worsening of alveolar hypoventilation, results in long term ventilatory assistance with the need of overall care of the patient. The pneumologist has a key role in the choice of indications, devices and mode of home mechanical ventilation.

[Sinobronchial syndrome].

The sinobronchial syndrome consists of chronic sinusitis and chronic nonspecific inflammation of the lower airways, typically chronic bronchitis, bronchiectasis and diffuse panbronchiolitis. This airway disease of unknown etiology is not related to smoking. It is common in Japan and is poorly described in western countries.

[Lung transplantation: indications, techniques and results].

Lung transplantation is proposed for young patients with a severe disease that can be expected to be fatal within less than two or three years. The main indications are chronic respiratory failure induced by chronic obstructive lung disease, cystic fibrosis or pulmonary fibrosis, and severe primary or secondary (Eisenmenger syndrome) pulmonary hypertension. The type of transplantation, determined after an exhaustive work-up ruling out all contraindications, is generally a single lung transplantation if there is no bronchial infection or two-lung transplantation or heart-lung transplantation in case of bronchiectasis or pulmonary artery hypertension.

Endurance training in patients with chronic obstructive pulmonary disease: a comparison of high versus moderate intensity.

Purpose: To create a maximum tolerated 45-minute aerobic training program for patients with chronic obstructive pulmonary disease (COPD) and to compare its outcomes with those of commonly prescribed moderate exercise.

Design: Prospective, randomized trial.

Setting: A work physiology laboratory.

[Association of sarcoidosis and hemorrhagic rectocolitis in an insulin-dependent diabetic].

Ulcerative colitis and sarcoidosis are seldom associated. A 33-year-old diabetic man developed simultaneously a rectitis and a non-productive cough leading to the diagnosis of ulcerative colitis and sarcoidosis. These diagnoses are discussed because of the possible gastrointestinal lesions from sarcoidosis or the respiratory disorders due to ulcerative colitis.

[Hepatopulmonary syndrome: physiopathology of impaired gas exchange].

The hepatopulmonary syndrome (HPS) consists of a triad of liver dysfunction, increased alveolar-arterial oxygen gradient and intrapulmonary vascular dilations. The mechanisms of impaired arterial oxygenation are still debated but the multiple inert gases elimination technique and more recently contrast echocardiography, greatly facilitated the investigation of such mechanisms. Subsequently the cause of hypoxemia can be attributed to several mechanisms such as ventilation-perfusion mismatch, right-to-left intrapulmonary shunts and alveolar-to-capillary diffusion defect, variously implicated in the severity of the disease.

Validity of transcutaneous oxygen/carbon dioxide pressure measurement in the monitoring of mechanical ventilation in stable chronic respiratory failure.

The accuracy and precision of transcutaneous pressure measurements of oxygen (Ptc,O2) and carbon dioxide (Ptc,CO2) in the monitoring of nocturnal assisted ventilation in adult patients were evaluated. Transcutaneous measurements obtained with two analysers, Radiometer TINATCM3 (R) and Kontron MicroGas-7650 (K), were compared with arterial blood gases analysed in blood samples withdrawn simultaneously in 10 patients. Sensors were heated to 43 degrees C.

Health-related quality of life in long-term oxygen-treated chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) induces changes in daily activities and mood. Health-related quality of life (HRQL) measures are of particular relevance in the management of such patients, but predictors of HRQL have rarely been investigated. The aim of this study was to seek factors predicting HRQL in severe COPD patients under long term oxygen therapy (LTOT).

Frequency dependence of specific airway resistance in a commercialized plethysmograph.

Specific airway resistance (sRaw) measured by body plethysmography has been shown to decrease markedly with decreasing breathing frequency when the inspired air is not conditioned to body temperature, atmospheric pressure and saturation with water vapour (BTPS). The phenomenon has been attributed to noninstantaneous gas warming and wetting in the airways. The aim of this investigation was to assess whether the phenomenon was also present in a commercialized plethysmograph featuring an "electronic BTPS correction".

Effects of rhDNase on purulent airway secretions in chronic bronchitis.

Recombinant human deoxyribonuclease (rhDNase) has been demonstrated to reduce in vitro the viscosity and to improve the transport capacity of purulent respiratory mucus in cystic fibrosis. During episodes of exacerbation of chronic bronchitis, the patients generally expectorate purulent mucus. Purulence of mucus is associated with an increased deoxyriboneucleic acid (DNA) concentration.

Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical ventilation. A 10-year analysis of ANTADIR Observatory.

Study Objective: To analyze predictors of survival for patients receiving home long-term oxygen therapy (LTOT) or prolonged mechanical ventilation (PMV) according to the cause of chronic respiratory insufficiency (CRI) and the patients physiologic data.

Design: Analysis of a nationwide database (ANTADIR Observatory).

Setting: The national nonprofit network for home treatment of patients with CRI Association Nationale pour le Traitement a Domicile de lInsuffisance Respiratoire Chronique (ANTADIR); founded in France in the 1980s.

[Evaluation of smoking in chronic severe respiratory insufficiency patients treated with long-term oxygen at home].

Two hundred and fifty patients with chronic respiratory insufficiency (202 men and 48 women), being treated by oxygen therapy at home were included in a study, which aim was to estimate the proportion of patients who were either smokers or exposed to passive smoking, by the use of a questionnaire and measurement of cotininuria. Urinary sample and autoquestionnaire collection was carried out by the nurses of the Lorraine's association of home respiratory assistance. Urinary continine was measured by radio immuno assay.

[Fibrosing pneumopathy caused by labetalol].

A diffuse interstitial pulmonary fibrosis occurred in a 74-year-old woman treated for ten years with labetalol for systemic hypertension. Bronchoalveolar lavage (BAL) revealed lymphocytic and neutrophilic alveolitis. The lack of another etiologic factor and the spontaneously favorable course after withdrawal of the drug support the hypothesis of a labetalol induced pulmonary fibrosis.

Evaluation of efficacy and safety of erdosteine in patients affected by chronic bronchitis during an infective exacerbation phase and receiving amoxycillin as basic treatment (ECOBES, European Chronic Obstructive Bronchitis Erdosteine Study).

An international multicentric study was conducted with the aim of demonstrating that erdosteine improves the efficacy of amoxycillin in the treatment of infective exacerbation of chronic bronchitis mainly on the clinical symptomatology (primary objective), on spirometric tests and body temperature, without negatively influencing the tolerance (secondary objectives). The study was conducted as a prospective evaluation, with 2 comparative groups treated with erdosteine (300 mg x 2/day) or placebo in association with amoxycillin (1500 mg/day) for a maximum of 10 days. The design of the trial was double-blind and parallel group with 2 subgroups.

Effect of acute hypercapnia on alpha atrial natriuretic peptide, renin, angiotensin II, aldosterone, and vasopressin plasma levels in patients with COPD.

Disturbances in hormonal systems involved in sodium and water homeostasis are common during respiratory insufficiency. To investigate the role of hypercapnia, we designed a study to examine the hormonal response to acute hypercapnia induced at constant cardiac filling pressures and without hypoxemia. Seven sedated patients with COPD receiving mechanical ventilation were studied during five successive periods.