Effects of short-term pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease.

Although the rehabilitation of patients with chronic obstructive pulmonary disease (COPD) improves both exercise capacity and quality of life, a standard protocol for COPD patients has not been established. To clarify whether physiologic and quality-of-life improvements can be achieved by an inpatient pulmonary rehabilitation program 5 days per week for 3 weeks, 18 patients with COPD were enrolled in a rehabilitation program. The physical exercise training regimen consisted of respiratory muscle stretch gymnastics and cycle ergometer exercise training. Pulmonary function tests, an incremental ergometer exercise test, a 6-min walking test, and a quality of life assessment by the Chronic Respiratory Questionnaire were administered before and after the program. The peak VO2, an indicator of maximal exercise capacity, did not increase, although the 6-min walking distance, an indicator of functional exercise capacity, increased significantly after rehabilitation. There was a significant improvement in the quality of life in terms of dyspnea, fatigue, and emotional state. These findings suggest that even a 3-week program may be beneficial for COPD patients. Increases in functional exercise capacity, even without an increase in maximal exercise capacity, are helpful for reducing dyspnea and improving quality of life parameters in patients with COPD.</p

CYTOLOGICAL STUDIES ON BRONCHOALVEOLAR LAVAGE FLUID IN INFLAMMATORY AND GRANULOMATOUS RESPIRATORY DISEASES

Cytological studies were performed on bronchoalveolar lavage(BAL) fluid in 7 cases with hypersensitivity pneumonitis, 6 with sarcoidosis, 6 with chronic bronchitis and 5 with bronchiolitis. In the cases with hypersensitivity pneumonitis and bronchiolitis, cytological studies of BAL fluid were compared with the histological findings of lungs. Furthermore, animal models of hypersensitivity pneumonitis were made and examined likewise. The results were as follows. 1) In the cases with hypersensitivity pneumonitis, a marked increase in the lymphocyte count in BAL fluid was characteristic. These cases showed an increase in the percentage of T lymphocytes in BAL fluid as compared with healthy subjects. In the cases with sarcoidosis, an increase in the number of lymphocytes was also found and especially the ratio of the percentage of T lymphocytes to that of B lymphocytes was much higher than those of the other diseases and healthy subjects. 2) An increased number of neutrophils in BAL fluid was observed in the cases with chronic bronchitis. In the cases with bronchiolitis, a marked increase in the neutrophil count was characteristic. 3) A common histological finding in hypersensitivity pneumonitis was mononuclear cell infiltration into alveolar septa and most of the cells in BAL fluid were lymphocytes. In bronchiolitis, mononuclear cell infiltration into and around the bronchiolar walls was found commonly and neutrophils were found increased in BAL fluid. 4) In experimental hypersensitivity pneumonitis, mononuclear cell infiltration into septa closely paralleled the lymphocyte appearance in BAL fluid

Correlation between cellular components and infiltrating cells in the lung tissue of asthmatics

Cell components in the peripheral lung area were examined in 24 asthmatic subjects by bronchoalveolar lavage (BAL) and transbronchoscopic lung biopsy (TBLB). In cases with increased percentage of lymphocytes in bronchoalveolar lavage fluid (BALF), the infiltration of eosinophils and mononuclear cells in the peripheral lung tissue was observed with a high frequency. The increased percentage of eosinophils in BALF correlated with the infiltration of eosinophils and neutrophils in the bronchiolo-alveolar region. A reverse correlation was observed between the macrophage count in the alveolar region and the percentage of eosinophils and lymphocytes in BALF. No significant correlation was present between the percentage of neutrophils in BALF and the infiltration of any type of cell in the lung tissue

Nocturnal hypercapnia with daytime normocapnia in patients with advanced pulmonary arterial hypertension awaiting lung transplantation

Background: Pulmonary arterial hypertension (PAH) is frequently complicated by sleep disordered breathing (SDB), and previous studies have largely focused on hypoxemic SDB. Even though nocturnal hypercapnia was shown to exacerbate pulmonary hypertension, the clinical significance of nocturnal hypercapnia among PAH patients has been scarcely investigated. Method: Seventeen patients with PAH were identified from 246 consecutive patients referred to Kyoto University Hospital for the evaluation of lung transplant registration from January 2010 to December 2017. Included in this study were 13 patients whose nocturnal transcutaneous carbon dioxide partial pressure (PtcCO2) monitoring data were available. Nocturnal hypercapnia was diagnosed according to the guidelines of the American Academy of Sleep Medicine. Associations of nocturnal PtcCO2 measurements with clinical features, the findings of right heart catheterization and pulmonary function parameters were evaluated. Results: Nocturnal hypercapnia was diagnosed in six patients (46.2%), while no patient had daytime hypercapnia. Of note, nocturnal hypercapnia was found for 5 out of 6 patients with idiopathic PAH (83.3%). Mean nocturnal PtcCO2 levels correlated negatively with the percentage of predicted total lung capacity (TLC), and positively with cardiac output and cardiac index. Conclusion: Nocturnal hypercapnia was prevalent among advanced PAH patients who were waiting for lung transplantation, and associated with %TLC. Nocturnal hypercapnia was associated with the increase in cardiac output, which might potentially worsen pulmonary hypertension especially during sleep. Further studies are needed to investigate hemodynamics during sleep and to clarify whether nocturnal hypercapnia can be a therapeutic target for PAH patients