Global strategy for asthma management and prevention

SUMMARY OF APPROACH The approach to surgery in the patient with COPD is summa-rized below. Surgery Definitely indicated Lung resection. Pulmonary function studies should be performedbefore lung resection. Simple spirometry has the greatest utilityin documenting physiologic operability. FEV, > 2 L in an adultman or > 60% of predicted is acceptable for pneumonectomy.Values below this suggest that further studies, such as split func-tion assessment by quantitative lung scintigraphy and exercisetesting, are warranted.FEV, predicted after lung resection to be less than 40 to 50%of normal for the patient’s sex, age, and height suggests highermorbidity and mortality. An exercise 90, of less than 10 to 15ml/min per kg of body weight is associated with higher mor-bidity and mortality after lung resection.All elective surgery Prophylaxis against deep venous throm-bosis should be given before most procedures that will requirepostoperative bed rest or significantly reduce mobility. Heparinin low doses seems well accepted for most procedures. Externalpneumatic compression of the lower legs can be used when anti-coagulants are contraindicated.

/pdf/standards-for-the-diagnosis-and-care-of-patients-with-13vz6fyao0.pdf

Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

https://www.doils.net/v1/links/836150.pdf

n−3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases

ATS/ACCP statement on cardiopulmonary exercise testing.

THE PULMONARY SCAN with radioactive particulate material has been proved to be an effective and easy method to demonstrate the pulmonary blood flow by radioisotope scanning technique. 1 The major clinical usefulness has been in the investigation of pulmonary infarcts, but its usefulness is being extended to include investigation of a number of pulmonary problems. 2,3 The most common material used for this scanning procedure has been macroaggregated human serum albumin labeled with radioactive iodine ( 131 I), chromium ( 51 Cr), or technetium ( 99m Tc). These particles are nearly completely removed from the circulation by the small vessels in the lungs after intravenous injection and are then broken down to smaller particles which leave the lungs with half-times ranging between five and ten hours. 1 Clinical and experimental studies indicate that pulmonary emboli may cause significant physiological changes, with or without symptoms, in human subjects and animals. 45 Since radioisotope

Pulmonary-function response to radioisotope scanning of the lungs.

Prostaglandins are known to affect ion transport and mucus secretion in the trachea, and at least part of their effect is thought to be mediated by cyclic AMP. Because no prostaglandin receptor ass...

Prostaglandins and intracellular cyclic AMP in respiratory secretory cells.

Author(s): Arjomandi, Mehrdad; Haight, Thaddeus; Sadeghi, Nasrat; Redberg, Rita; Gold, Warren M | Abstract: RationaleFlight attendants who worked on commercial aircraft before the smoking ban in flights (pre-ban FAs) were exposed to high levels of secondhand smoke (SHS). We previously showed never-smoking pre-ban FAs to have reduced diffusing capacity (Dco) at rest.MethodsTo determine whether pre-ban FAs increase their Dco and pulmonary blood flow (Qc) during exercise, we administered a symptom-limited supine-posture progressively increasing cycle exercise test to determine the maximum work (watts) and oxygen uptake (VO2) achieved by FAs. After 30 min rest, we then measured Dco and Qc at 20, 40, 60, and 80 percent of maximum observed work.ResultsThe FAs with abnormal resting Dco achieved a lower level of maximum predicted work and VO2 compared to those with normal resting Dco (mean±SEM; 88.7±2.9 vs. 102.5±3.1%predicted VO2; p = 0.001). Exercise limitation was associated with the FAs' FEV(1) (r = 0.33; p = 0.003). The Dco increased less with exercise in those with abnormal resting Dco (mean±SEM: 1.36±0.16 vs. 1.90±0.16 ml/min/mmHg per 20% increase in predicted watts; p = 0.020), and amongst all FAs, the increase with exercise seemed to be incrementally lower in those with lower resting Dco. Exercise-induced increase in Qc was not different in the two groups. However, the FAs with abnormal resting Dco had less augmentation of their Dco with increase in Qc during exercise (mean±SEM: 0.93±0.06 vs. 1.47±0.09 ml/min/mmHg per L/min; pl0.0001). The Dco during exercise was inversely associated with years of exposure to SHS in those FAs with ≥10 years of pre-ban experience (r = -0.32; p = 0.032).ConclusionsThis cohort of never-smoking FAs with SHS exposure showed exercise limitation based on their resting Dco. Those with lower resting Dco had reduced pulmonary capillary recruitment. Exposure to SHS in the aircraft cabin seemed to be a predictor for lower Dco during exercise.

/pdf/reduced-exercise-tolerance-and-pulmonary-capillary-363uamhh1f.pdf

Reduced exercise tolerance and pulmonary capillary recruitment with remote secondhand smoke exposure.

Effect of inhaled ozone on lung histamine in conscious guinea pigs

Mast cells are believed to play an important role in the pathogenesis of asthma, and several investigators have suggested that increased numbers of mast cells in the airway lumen or increased releasability of histamine from these mast cells are responsible for chronic airway hyperreactivity. To determine whether mast cells in the lumen of the airways of hyperreactive Basenji greyhound (BG) dogs differ from those of mongrel dogs with normal airway reactivity, we investigated the morphologic and functional characteristics of mast cells recovered by bronchoalveolar lavage (BAL). BAL was performed in five BG and five mongrel dogs with 900 cc of a buffered salt solution. The recovered lavage fluid contained 115 +/- 19 X 10(6) and 116 +/- 14 X 10(6) (mean +/- SEM) cells in BG and mongrel dogs, respectively. The proportion of all mast cells within the recovered cell population as enumerated after fixation with basic lead acetate and staining with alcian blue was not different in BG and mongrel dogs and averaged 0.80 +/- 0.07% and 1.1 +/- 0.3%, respectively. Typical mast cells as identified after fixation with paraformaldehyde were rare; however, significantly more mast cells were found in mongrel (0.03 +/- 0.009%) than in BG dogs (0.004 +/- 0.002%; p less than 0.02). Mast cells recovered from BG and mongrel dogs were not different in their low spontaneous histamine release (2.0 +/- 0.5% and 2.9 +/- 0.8%), their histamine release on stimulation with the calcium ionophore A23187 (maximum release 44.8 +/- 5.7% and 41.5 +/- 3.9%), and their lack of response to compound 48/80 (maximum release 5.8 +/- 1.8% and 6.1 +/- 6.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Warren M. Gold

Papers

Pulmonary-function response to radioisotope scanning of the lungs.

Prostaglandins and intracellular cyclic AMP in respiratory secretory cells.

Reduced exercise tolerance and pulmonary capillary recruitment with remote secondhand smoke exposure.

Effect of inhaled ozone on lung histamine in conscious guinea pigs

Functional and morphologic characterization of mast cells recovered by bronchoalveolar lavage from Basenji greyhound and mongrel dogs.