phenylephrine-hydrochloride and Lung-Diseases--Obstructive

The use of positive-pressure nasal ventilation in combination with LTOT in stable COPD patients with hypercapnic respiratory failure controls hypoventilation and improves daytime ABGs, sleep, and quality of life. Nasal ventilation in COPD is unlikely to produce benefit unless used with supplemental oxygen therapy at night. The patients who show the greatest reduction in overnight PaCO2 with ventilation are the patients most likely to benefit from long-term ventilatory support. Although there is now evidence for short-term benefit from NPPV in hypercapnic COPD, large multicenter studies with survival, exacerbations, and hospital admissions as the primary end points are required to evaluate longer-term effects of this potentially important intervention.

Topics: Bronchiectasis; Cystic Fibrosis; Home Care Services; Humans; Hypercapnia; Long-Term Care; Lung Diseases, Obstructive; Nose; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Respiratory Mechanics; Ventilators, Negative-Pressure

Topics: Acute Disease; Chronic Disease; Female; Humans; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Pregnancy; Pregnancy Complications; Pulmonary Edema; Respiratory Insufficiency; Ventilator Weaning

The upper airways play a crucial role in respiration, as pathway for gases, modulator for airflow, and filter for particulate matter. This article describes the anatomy and physiology of the trachea and upper airways and imaging of the upper airways in patients with chronic obstructive airway disease.

Topics: Adult; Child; Diagnostic Imaging; Humans; Lung Diseases, Obstructive; Magnetic Resonance Imaging; Nose; Pharynx; Pulmonary Ventilation; Respiration; Sleep Apnea Syndromes; Tomography, X-Ray Computed; Trachea; Tracheal Diseases; Tracheobronchomegaly

Topics: Acute Disease; Ambulatory Care; Blood Pressure; Brain; Chronic Disease; Diphosphoglyceric Acids; Erythrocytes; Follow-Up Studies; Humans; Hypertension, Pulmonary; Hypoxia; Intubation; Lung Diseases, Obstructive; Nose; Oxygen; Oxygen Inhalation Therapy; Partial Pressure; Physical Exertion; Polycythemia; Prognosis; Psychology; Respiratory Insufficiency; Spirometry; Vascular Resistance

The efficiency of nebulised aerosol delivery is limited due to drug retained within the nebuliser, and due to a poor ratio between inspiratory drug delivery and expiratory drug loss. Several technical approaches have improved the ratio between inspiratory aerosol delivery and expiratory aerosol loss. In our pilot study we aimed to investigate if wearing a noseclip during inhalation therapy improves the inspiratory versus expiratory ratio and hence, improves nebulised aerosol delivery.. Drug delivery was measured in thirteen subjects (7 males; age range 23-36 years) inhaling in random order nebulised aerosol through a mouthpiece once while wearing a noseclip and once without.. Wearing a noseclip leads to an increase of 113% (SEM 23.5) in drug delivery and improves the inspiratory versus expiratory ratio (ratio 2.07 versus 0.75).. We have shown that aerosol delivery is increased due to an improved inspiratory versus expiratory ratio when wearing a noseclip.

Topics: Administration, Inhalation; Adult; Aerosols; Albuterol; Bronchodilator Agents; Female; Humans; Lung Diseases, Obstructive; Male; Nasal Cavity; Nebulizers and Vaporizers; Nose; Surgical Instruments; Treatment Outcome

To evaluate the short-term physiologic effects of two settings of nasal pressure-support ventilation (NPSV) in stable COPD patients with chronic hypercapnia.. Randomized controlled physiologic study.. Lung function units and outpatient clinic of two affiliated pulmonary rehabilitation centers.. Twenty-three patients receiving domiciliary nocturnal NPSV for a mean (+/- SD) duration of 31 +/- 20 months.. Evaluation of arterial blood gases, breathing pattern, respiratory muscles, and dynamic intrinsic positive end-expiratory pressure (PEEPi,dyn) during both unassisted and assisted ventilation. Two settings of NPSV were randomly applied for 30 min each: (1) usual setting (U), the setting of NPSV actually used by the individual patient at home; and (2) physiologic setting (PHY), the level of inspiratory pressure support (IPS) and external positive end-expiratory pressure (PEEPe) tailored to patient according to invasive evaluation of respiratory muscular function and mechanics.. All patients tolerated NPSV well throughout the procedure. Mean U was IPS, 16 +/- 3 cm H(2)O and PEEPe, 3.6 +/- 1.4 cm H(2)O; mean PHY was IPS, 15 +/- 3 cm H(2)O and PEEPe, 3.1 +/- 1.6 cm H(2)O. NPSV was able to significantly (p < 0.01) improve arterial blood gases independent of the setting applied. When compared with spontaneous breathing, both settings induced a significant increase in minute ventilation (p < 0.01). Both settings were able to reduce the diaphragmatic pressure-time product, but the reduction was significantly greater with PHY (by 64%; p < 0.01) than with U (56%; p < 0.05). Eleven of 23 patients (48%) with U and 7 of 23 patients (30%) with PHY showed ineffective efforts (IE); the prevalence of IE (20 +/- 39% vs 6 +/- 11% of their respiratory rate with U and PHY, respectively) was statistically different (p < 0.05).. In COPD patients with chronic hypercapnia, NPSV is effective in improving arterial blood gases and in unloading inspiratory muscles independent of whether it is set on the basis of patient comfort and improvement in arterial blood gases or tailored to a patient's respiratory muscle effort and mechanics. However, setting of inspiratory assistance and PEEPe by the invasive evaluation of lung mechanics and respiratory muscle function may result in reduction in ineffective inspiratory efforts. These short-term results must be confirmed in the long-term clinical setting.

Topics: Aged; Carbon Dioxide; Chronic Disease; Diaphragm; Female; Follow-Up Studies; Home Care Services; Humans; Hypercapnia; Inhalation; Lung; Lung Diseases, Obstructive; Male; Maximal Voluntary Ventilation; Nose; Oxygen; Positive-Pressure Respiration; Positive-Pressure Respiration, Intrinsic; Pressure; Respiration; Respiratory Mechanics; Respiratory Muscles

The aim of this study was to assess the effects of short-term exposure to low levels of nitrogen dioxide (NO2) on airway inflammation. We studied seven normal, eight mild asthmatic and seven chronic obstructive pulmonary disease (COPD) subjects. All subjects were exposed to air or to 0.3 parts per million (ppm) NO2 for 1 h, with moderate intermittent exercise, on different days and in random order. Before and 2 h after exposure, symptom score and results of pulmonary function tests (PFTs) were assessed. All subjects performed nasal lavage and hypertonic saline (HS) inhalation to collect sputum 2 h after both exposures. Asthmatic subjects had a higher percentage of eosinophils than normal and COPD subjects in HS-induced sputum after air (asthmatics: median 13 (range 0.4-37)%; normals: 0 (range 0-2)%; COPD 1.8 (range 0.1-19)%), whilst COPD patients showed a higher percentage of neutrophils than the two others groups. No significant differences in PFT values or percentages of inflammatory cells were observed in nasal lavage and in HS-induced sputum in normal, asthmatic and COPD subjects after NO2 exposure compared to air exposure, except for a mild decrease in forced expiratory volume in one second (FEV1) 2 h after NO2 exposure in COPD patients. Symptom score showed a mild increase after NO2 exposure both in normal subjects and in COPD patients. We conclude that short-term exposure to 0.3 ppm nitrogen dioxide does not induce an early detectable acute inflammation in proximal airways of normal subjects or of patients with asthma or chronic obstructive pulmonary disease.

Topics: Administration, Inhalation; Adult; Asthma; Bronchitis; Bronchoalveolar Lavage; Environmental Exposure; Eosinophils; Female; Forced Expiratory Volume; Humans; Leukocyte Count; Lung; Lung Diseases, Obstructive; Male; Middle Aged; Neutrophils; Nitrogen Dioxide; Nose; Oxidants, Photochemical; Physical Exertion; Saline Solution, Hypertonic; Single-Blind Method; Sputum; Time Factors; Vital Capacity

Non-invasive ventilation has been used in chronic respiratory failure due to chronic obstructive pulmonary disease (COPD), but the effect of the addition of nasal positive-pressure ventilation to long-term oxygen therapy (LTOT) has not been determined. We report a randomized crossover study of the effect of the combination of nasal pressure support ventilation (NPSV) and domiciliary LTOT as compared with LTOT alone in stable hypercapnic COPD. Fourteen patients were studied, with values (mean +/- SD) of Pao2 of 45.3 +/- 5.7 mm Hg, PaCO2 of 55.8 +/- 3.6 mm Hg, and FEV1 of 0.86 +/- 0.32 L. A 4 wk run-in period (on usual therapy) was followed by consecutive 3-mo periods of: (1) oxygen therapy alone, and (2) oxygen plus NPSV in randomized order. Assessments were made during run-in and at the end of each study period. There were significant improvements in daytime arterial PaO2 and PaCO2, total sleep time, sleep efficiency, and overnight PaCO2 following 3 mo of oxygen plus NPSV as compared with run-in and oxygen alone. Quality of life with oxygen plus NPSV was significantly better than with oxygen alone. The degree of improvement in daytime PaCO2 was correlated with the improvement in mean overnight PaCO2. Nasal positive-pressure ventilation may be a useful addition to LTOT in stable hypercapnic COPD.

Topics: Aged; Carbon Dioxide; Cross-Over Studies; Exercise Test; Female; Follow-Up Studies; Forced Expiratory Volume; Humans; Hypercapnia; Hypoxia; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Quality of Life; Respiratory Insufficiency; Sleep; Vital Capacity

Evaluation of the effectiveness of chronic nightly mechanical ventilation through a nasal mask system in patients with neuromuscular diseases or patients with thorax malformations or COPD.. Centre for Home Mechanical Ventilation, University Hospital Utrecht.. Retrospective study.. During the period June 1988-May 1993, 64 patients (11-69 years old) were treated with nasal mask ventilation during the night: 37 men (most of whom had Duchenne's disease (18) and 27 women (most of whom had (post-polio) kyphoscoliosis (n = 13). The effects on arterial blood gases were analysed. Complications during use of the nasal mask systems were recorded.. The duration of the nasal mask ventilation was 2 to 56 months. Arterial PCO2 and PO2 improved during the night as well as by day during spontaneous respiration. The most common problems were necrosis of the skin of the bridge of the nose, leakage of air through the mouth or insufflation of air into the stomach. After the start of the mechanical ventilation quality of life improved considerably.. Nasal ventilation at night is sufficient and simple. The installation of a tracheostoma can be postponed or avoided with this non-invasive kind of ventilation.

Topics: Adolescent; Adult; Aged; Child; Female; Home Care Services; Humans; Lung Diseases, Obstructive; Male; Masks; Middle Aged; Neuromuscular Diseases; Nose; Positive-Pressure Respiration; Postpoliomyelitis Syndrome; Respiratory Insufficiency; Retrospective Studies

Acute exacerbations of chronic obstructive airways disease (COAD) are a common cause of admission to hospital, and have a high mortality. Nasal intermittent positive pressure ventilation (NIPPV) has been used successfully in patients with respiratory failure due to neuromuscular and skeletal disorders, but the outcome of treatment in patients with COAD is less well known. We carried out a prospective randomised controlled trial of conventional treatment versus conventional treatment plus NIPPV, in 60 patients with acute ventilatory failure due to exacerbations of COAD. For the NIPPV group there was a rise in pH, compared with a fall in the controls (mean difference of change between the groups 0.046 [95% CI 0.06-0.02, p < 0.001]), and a larger fall in PaCO2 (mean difference in change between the groups 1.2 kPa [95% CI 0.45 to 2.03, p < 0.01]). Median visual analogue scores over the first 3 days of admission showed less breathlessness in the NIPPV group (2.3 cm [range 0.1-5.5]) than in the control group (4.5 cm [range 0.9-8.8]) (p < 0.025). Survival rates at 30 days were compared for intention-to-treat and efficacy populations. In the efficacy mortality comparison, mortality in the NIPPV group was reduced: 1/26 vs 9/30 (relative risk = 0.13, CI = 0.02-0.95, p = 0.014). This effect was less in the intention-to-treat analysis: 3/30 vs 9/30 (relative risk = 0.33, CI = 0.10-1.11, p = 0.106). In patients with acute ventilatory failure due to COAD who received NIPPV there was a significant rise in pH, a reduction in PaCO2 and breathlessness, and reduced mortality.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Blood; Bronchodilator Agents; Carbon Dioxide; Doxapram; Humans; Hydrogen-Ion Concentration; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Oxygen; Prospective Studies; Respiratory Insufficiency; Risk; Survival Rate

In mucopolysaccharidoses, upper airway obstruction has multiple causative factors and progressive respiratory disease may severely affect morbidity and mortality. In a cross-sectional study over 2 years we evaluated upper airway obstructive disease through overnight polysomnography, upper airway computed tomography and nasal endoscopy in 5 children and 6 adults with mucopolysaccharidoses of various types. Measurements of apnoea and apnoea-hypopnoea index, arousal index, and sleep efficiency were obtained through polysomnography. Retropalatal and retroglossal spaces were calculated through computed tomography, and the degree of adenoid hypertrophy was assessed through endoscopy. Apnoea index and apnoea-hypopnoea index were significantly higher in children than in adults with mucopolysaccharidoses (p = 0.03 and p = 0.03, respectively). Compared to healthy controls, retropalatal and retroglossal spaces were significantly smaller in children (p = 0.03 and p = 0.004, respectively) or adults with mucopolysaccharidoses (p = 0.004 and p = 0.004, respectively). All subjects had adenoid hypertrophy causing first-degree (36%) or second-degree (64%) obstruction at endoscopy. Overnight polysomnography, upper airway computed tomography and nasal endoscopy are useful tools for diagnosing obstructive sleep apnoea syndrome in mucopolysaccharidoses, and identifying the site and severity of airway obstruction.

Topics: Adenoids; Adolescent; Adult; Case-Control Studies; Child; Child, Preschool; Cross-Sectional Studies; Endoscopy; Female; Fiber Optic Technology; Humans; Hypertrophy; Lung Diseases, Obstructive; Male; Mucopolysaccharidoses; Nose; Patient Care Team; Polysomnography; Predictive Value of Tests; Severity of Illness Index; Sleep; Sleep Apnea, Obstructive; Tomography, X-Ray Computed; Wakefulness

Obstructive Sleep Apnea (OSA), Obesity-Linked Hypoventilation (OLH)--a hypoventilation which is independent of apneas and increased by sleep--, and COPD are mechanisms for respiratory failure in obese patients. We thought nasal bi-level positive airway pressure to be a suitable treatment: EPAP is useful to maintain upper airway patency and IPAP-EPAP difference to correct OLH and COPD hypoventilation. Our purpose is to report the results of such a therapeutic approach. We included 41 patients that we first treated by nasal bi-level positive airway pressure for a respiratory failure with an uncompensated respiratory acidosis. The initial setting was about 4 cm H2O for EPAP and 16 for IPAP. Under supervision of a real-time printed oximetry tracing, we furthermore increased EPAP until disappearance of repetitive dips in oxygen saturation (that we assimilated to obstructive events) and IPAP until obtaining an acceptable level of steady saturation (we assimilated a low level to a steady hypoventilation). Age (mean +/- SD) was 63 +/- 11 years, BMI 42 +/- 9 kg/m2, pH 7.32 +/- 0.04, PaCO2 71 +/- 13 mmHg, PaO2 45 +/- 7 mmHg. Thirty-nine out of 41 patients returned home without need for tracheal intubation. At 7 days of treatment, PaCO2 was 50 +/- 6 mmHg. Thus, nasal bi-level position airway pressure appears to be an efficient treatment in these patients.

Topics: Acidosis, Respiratory; Adult; Age Factors; Aged; Body Mass Index; Carbon Dioxide; Female; Humans; Hypoventilation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Obesity; Oxygen; Oxygen Inhalation Therapy; Peak Expiratory Flow Rate; Polysomnography; Positive-Pressure Respiration; Respiratory Insufficiency; Sleep Apnea Syndromes

An effective treatment of advanced states of chronic obstructive pulmonary disease (COPD) has yet to be established. We report the case of a COPD patient with severe hypoxemia (pO2 = 32.0 mm Hg) and hypercapnia (pCO2 = 90.0 mm Hg) who was successfully treated for 8 months with nasal intermittent positive-pressure ventilation (NIPPV) plus supplemental O2 in a domiciliary treatment. The reduction of hypoxemia parallel to the alleviation of hypercapnia reversed the patient's continuously declining condition.

Topics: Blood Gas Analysis; Home Care Services; Humans; Hypercapnia; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen Inhalation Therapy

In subjects with normal lung mechanics, inspiratory muscle strength can be reliably and easily assessed by the sniff nasal inspiratory pressure (SNIP), which is the pressure measured in an occluded nostril during a maximal sniff performed through the contralateral nostril. The aim of this study was to assess the validity of the SNIP in patients with chronic obstructive pulmonary disease (COPD), where pressure transmission from alveoli to upper airways is likely to be dampened. Twenty eight patients with COPD were studied (mean forced expiratory volume in one second (FEV1) = 36% of predicted). The SNIP and the sniff oesophageal pressure (sniff Poes) were measured simultaneously during maximal sniffs, and were compared to the maximal inspiratory pressure obtained against an occlusion (MIP). All measurements were performed from functional residual capacity in the sitting position. The ratio SNIP/sniff Poes was 0.80, and did not correlate with the degree of airflow limitation. The ratio MIP/sniff Poes was 0.87, and the ratio SNIP/MIP was 0.97. Inspiratory muscle weakness, as defined by a low sniff Poes, was present in 17 of the 28 patients. A false diagnosis of weakness was made in eight patients when MIP was considered alone, in four when SNIP was considered alone, and in only three patients when MIP and SNIP were combined. We conclude that both the sniff nasal inspiratory pressure and the maximal inspiratory pressure moderately underestimate sniff oesophageal pressure in chronic obstructive pulmonary disease. Although suboptimal in this condition, the sniff nasal inspiratory pressure appears useful to complement the maximal inspiratory pressure for assessing inspiratory muscle strength in patients with chronic obstructive pulmonary disease.

Topics: Adult; Aged; Aged, 80 and over; Female; Forced Expiratory Volume; Humans; Inhalation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Pressure; Pulmonary Ventilation; Respiratory Muscles

Our study was to assess whether there were differential effects of nasal continuous positive airway pressure (nCPAP) on different kinds of obstruction in either upper or lower airways in patients with chronic obstructive pulmonary disease (COPD). nCPAP (6 cmH2O for ten minutes) was applied to 7 patients with reversible extrathoracic upper airway obstruction (RUAO) and 3 patients with fixed extrathoracic upper airway obstruction (FUAO). Eighteen stable asthmatics, receiving methacholine challenge to induce a more than 20% reduction in FEV1, were randomly investigated for the effect of nCPAP or sham pressure on reversible lower airway obstruction. Nine stable COPD patients were enrolled to study the effect on irreversible lower airway obstruction. Maximal expiratory and inspiratory flow volume curves and dyspnoea scores were obtained before and after immediate withdrawal of nCPAP. In the RUAO group, nCPAP significantly improved stridor and dyspnoea scores, decreased the ratio of FEF50/FIF50 from 2.05 +/- 0.25 to 1.42 +/- 0.16, and increased peak inspiratory flow (PIF) as well as forced inspiratory vital capacity by 26 +/- 8% and 9 +/- 4%, respectively. In expiratory phase, there was no significant change in pulmonary functions. In asthmatics, nCPAP significantly reversed methacholine-induced bronchoconstriction increasing forced vital capacity by 10 +/- 3%, FEV1 by 15 +/- 4% and PIF by 32 +/- 11%. nCPAP significantly increased the response to bronchodilators. The improvement in airflow rate persisted for at least 5 min after nCPAP withdrawal and was highly correlated with the response to bronchodilators. There was no significant effect of nCPAP on airflow rate in COPD patients. Subjective dyspnoea score changes paralleled the pulmonary function improvement. We conclude that there are differential effects of nCPAP on airflow rates in patients with different nature of airway obstruction. Patients with airway obstruction caused by structural changes may not benefit from the use of nCPAP in improving airflow rates.

Topics: Adolescent; Adult; Airway Obstruction; Airway Resistance; Asthma; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Nasal Obstruction; Nose; Positive-Pressure Respiration; Respiratory Function Tests; Treatment Outcome

Long-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD), though the addition of assisted ventilation may control the nocturnal hypoventilation and correct blood gases. Although early experiences with ventilation in COPD was disappointing, the introduction of nasal positive pressure ventilation has been shown to improve blood gases, sleep quality and quality of life. The improvement in blood gases was related to the reduction of overnight Pa,CO2 with ventilation. Compliance with nasal ventilation was increased, compared to that with earlier modes of ventilation. Nasal ventilation is beneficial in carefully selected patients with hypercapnic COPD.

Topics: Humans; Hypercapnia; Lung Diseases, Obstructive; Masks; Nose; Positive-Pressure Respiration; Treatment Outcome

History of a middle aged obese male, presenting with severe obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is described. Provisionally patient was started on CPAP and long-term domiciliary oxygen therapy (LTOT). OSA was successfully treated by surgical repair of nasal patency and partial uvulectomy. There was also remarkable improvement in ventilatory indices after steroid therapy. There was no further need for CPAP and LTOT.

Topics: Humans; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Positive-Pressure Respiration; Remission Induction; Sleep Apnea Syndromes

We measured with a laser velocimeter granulometric deposit of an aerosol anti-infectious agent, fusafungin, administered with a controlled inhalator. Total drug deposit was determined on the basis of a granulometric spectrum of the polydispered aerosol (mass mean aerodynamic diameter (MMAD) = 2.8 +/- 1.7 microns) and dispersion in the airways was estimated using the Stahlhofen model. We first compared deposits obtained with oral inhalation in 19 normal subjects and 20 patients with chronic obstructive lung disease. Total deposit in the airways of patients with chronic obstructive lung disease (82%) was not significantly different from that in normal subjects (85%). Estimated dispersion in normal airways was 27% in the alveoles, 8.4% in the tracheobronchic region and 23.5% in the extrathoracic regions. We then compared deposits after nasal inhalation in 22 normal subjects and 21 patients with rhinitis: nasal deposit was significantly greater in patients with rhinitis (54.5%) than in controls (44.7%). We conclude that such an inhalator can be adapted for local treatment of ENT infections and upper respiratory infections. Deposit is not modified in case of obstructive bronchopathy.

Topics: Adult; Aerosols; Anti-Bacterial Agents; Depsipeptides; Fusarium; Humans; Lung Diseases, Obstructive; Middle Aged; Models, Biological; Nose; Particle Size; Research; Rheology; Rhinitis

To evaluate the efficacy of nasal mechanical ventilation in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure and to identify predictors of success or failure of nasal mechanical ventilation.. Prospective case series.. Medical intensive care unit in Veterans Administration Medical Center.. Twelve chronic obstructive pulmonary disease patients treated during 14 episodes of hypercapnic respiratory failure.. Nasal mechanical ventilation in addition to conventional therapy to treat hypercapnic respiratory failure. Patients underwent nasal mechanical ventilation for at least 30 mins, or longer if the therapy was tolerated. Responses to therapy and arterial blood gases were monitored.. Half of the episodes were successfully treated with nasal mechanical ventilation. There were no differences in age, prior pulmonary function, baseline arterial blood gases, admission arterial blood gases, or respiratory rate between those patients successfully treated and those patients who failed nasal mechanical ventilation. Unsuccessfully treated patients appeared to have a greater severity of illness than successfully treated patients, as indicated by a higher Acute Physiology and Chronic Health Evaluation II score (mean 21 +/- 4 [SD] vs. 15 +/- 4; p = .02). Unsuccessfully treated patients were edentulous, had pneumonia or excess secretions, and had pursed-lip breathing, factors that prevented adequate mouth seal and contributed to greater mouth leaks than in successfully treated patients (the mean volume of the mouth leak was 314 +/- 107 vs. 100 +/- 70 mL; p < .01). Successfully treated patients were able to adapt more rapidly to the nasal mask and ventilator, with greater and more rapid reduction in PaCO2, correction of pH, and reduction in respiratory rate.. Patients who failed nasal mechanical ventilation appeared to have a greater severity of illness; they were unable to minimize the amount of mouth leak (because of lack of teeth, secretions, or breathing pattern) and were unable to coordinate with the ventilator. These features may allow identification of poor candidates for nasal mechanical ventilation, avoiding unnecessary delays in endotracheal intubation and mechanical ventilation.

Topics: Acute Disease; Aged; Blood Gas Analysis; Female; Forced Expiratory Volume; Humans; Hypercapnia; Lung Diseases, Obstructive; Male; Masks; Nose; Positive-Pressure Respiration; Prospective Studies; Respiration; Respiratory Insufficiency; Severity of Illness Index; Survival Rate; Tidal Volume; Treatment Outcome; Vital Capacity

Pulse delivery (PD) of oxygen was compared with continuous flow (CF) utilizing transtracheal oxygen catheter (TTO) and nasal cannula (NC) in 20 stable patients with chronic hypoxemia. Oxygen saturation, respiratory rate, and accuracy of pulsed oxygen delivery were measured during sleep studies and these parameters, as well as arterial blood gases, were evaluated during rest and exercise. Additionally, bulk liquid oxygen use was measured under each condition, for a period of 1 month. Pulse delivery NC was evaluated in six subjects, CF NC in 14 subjects, and PD and CF TTO in 20 subjects over the 1-month period. Results showed that, as a group, patients were adequately oxygenated when utilizing the PD with both NC and TTO as assessed by arterial blood gases, oximetry, and hematocrit. However, four subjects could not be adequately oxygenated on PD NC during exercise even at the maximum liter per minute setting and could not be studied with this mode of therapy. The PD settings in the remaining subjects were equivalent to continuous flow settings for TTO and NC as assessed by PaO2 for rest and SaO2 for exercise and sleep. Compared with standard CF NC, the daily bulk oxygen use was decreased by 29.4 percent with CF TTO, by 48.2 percent with PD NC, and by 49.9 percent with PD TTO. We conclude that, compared with CF NC, PD of oxygen via TTO or NC by this method appears to be a safe, reliable, effective, and cost-effective method of oxygen delivery in the majority of subjects when used with proper screening.

Topics: Aged; Analysis of Variance; Bronchiectasis; Catheterization; Chronic Disease; Evaluation Studies as Topic; Exercise Test; Female; Humans; Hypoxia; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen Inhalation Therapy; Polysomnography; Trachea

Topics: Humans; Hydrogen-Ion Concentration; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Prognosis; Respiratory Insufficiency; Treatment Failure

Topics: Acute Disease; Humans; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Respiratory Insufficiency

To determine whether a reservoir nasal cannula (RNC) (Oxymizer) provides an arterial hemoglobin oxygen saturation as measured by pulse oximetry (SpO2) equivalent to that provided by the standard nasal cannula (SNC) during sleep in hypoxemic patients with COPD while reducing oxygen flow requirement and cost.. The study took place in a sleep laboratory for three nights, with the first night for acclimatization to the new sleeping environment. In a repeated-measures design, on the second and third nights, subjects used the SNC for one night and the RNC on another night. The order in which they received the two devices was counterbalanced.. The subjects were patients with COPD who had a stable PaO2 of 55 mm Hg or less or had a value of 56 to 59 mm Hg with evidence of cor pulmonale or polycythemia (or both) and an FEV1/FVC of less than 70 percent.. A pulse oximeter was used to measure SpO2. An arterial blood gas measurement was taken on each night while the patients with COPD were receiving oxygen therapy via the assigned device. An EEG machine was used to record measurements of electro-oculography, chin electromyography (EMG), anterior tibialis EMG and EEG.. There was a statistically significant difference between mean SpO2 during sleep (RNC, 91 percent; SNC, 93 percent; F = 7.89; p = 0.01). Nocturnal SpO2 was less than 90 percent for 24.2 percent of the time with the RNC and for 17.5 percent of the time with the SNC (F = 5.41; p = 0.03), but there was no significant difference in the amount of time that SpO2 was less than 85 percent. Compared to the SNC, in 4 of 26 patients with COPD, the RNC performed better; in 12 patients with COPD, the RNC performed the same, and in 10 patients with COPD the RNC performed worse during sleep. Sleep parameters were not significantly different between the two devices.. The difference of 2 percent in mean SpO2 is within the range of SpO2 measurement error. Therefore, the two devices are equally effective when the sample is considered as a whole. Nighttime oximetry is necessary prior to prescription, since nighttime efficacy of the RNC cannot be predicted on the basis of daytime pulse oximetry.

Topics: Aged; Hemoglobins; Humans; Intubation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oximetry; Oxygen; Oxygen Inhalation Therapy; Sleep

Nasal pressure support ventilation (NPSV) has been shown to be useful in the treatment of acute and chronic pulmonary failure. However, little is known about respiratory muscle activity during NPSV in stable patients with COPD. The aim of this study was to test the effect of two levels (10 and 20 cm H2O) of NPSV on diaphragmatic activity, in a group of seven stable, severe COPD patients (FEV1 20 percent +/- 7 of pred, FEV1/FVC 35 percent) with hypercapnic respiratory insufficiency. Since these patients had an intrinsic PEEP (PEEPi) of 2.6 +/- 1.3 cm H2O, we also investigated the effect of adding 5 cm H2O external PEEP (PEEPe) during NPSV. Blood gases, ventilatory pattern by inductive plethysmography, integrated electromyogram of the diaphragm (Edi), transdiaphragmatic pressure (Pdi), and the diaphragmatic pressure time product (PTPdi) were recorded during randomized 15-min runs of both levels of NPSV with and without the addition of PEEPe. Minute ventilation did not change with the application of NPSV, but a significant decrease in breathing frequency with a parallel increase in tidal volume was observed, so that blood gas determinations improved at the higher levels of support. A marked statistically significant reduction in diaphragmatic activity, as assessed by a decrease in Pdi swings, PTPdi, and Edi, was detected at the levels of 10 and 20 cm H2O; a further significant decrease in these values was observed when PEEPe was added. PEEPi decreased significantly only with the application of PEEPe, resulting in a small increase in end-expiratory lung volume. We conclude that NPSV improves diaphragmatic function in patients with severe stable COPD; this effect may be enhanced by the applications of external PEEP.

Topics: Aged; Carbon Dioxide; Diaphragm; Electromyography; Energy Metabolism; Esophagus; Female; Functional Residual Capacity; Humans; Inhalation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Oxygen Consumption; Positive-Pressure Respiration; Pressure; Pulmonary Ventilation; Respiration; Respiration, Artificial; Stomach; Tidal Volume

Effective intermittent positive pressure ventilation can be achieved noninvasively using a nasal mask, but patient comfort may be compromised and respiratory effort increased unless the trigger threshold is low and the response time of the ventilator short. The effect of nasal ventilation upon inspiratory muscle effort and the functional characteristics of the trigger of a purpose-built ventilator were evaluated in five patients with chronic obstructive airways disease. A measure of inspiratory muscle effort, the average pressure time integral per minute, decreased by at least 80% in four patients and by 50% in one. Only two patients had significant numbers of triggered breaths (17% and 47% of total) during 1 h of ventilation with settings as used at home. Therefore trigger function was evaluated when the patients were made to trigger the ventilator by slowing the control rate. A high resting end-expiratory intrathoracic pressure decreased the effective trigger sensitivity so that a mean (SD) change in oesophageal pressure of 14.8 cmH2O was required to lower mask pressure by 2.4 (0.3) cmH2O and activate the trigger. Even under these conditions of lowest trigger sensitivity inspiratory muscle effort was not increased compared to spontaneous ventilation.

Topics: Carbon Dioxide; Esophagus; Evaluation Studies as Topic; Female; Humans; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Male; Masks; Middle Aged; Nose; Oxygen; Pressure; Respiratory Mechanics; Respiratory Muscles

A 60-year-old woman with respiratory failure required ventilatory support using a continuous positive airway pressure face mask. She developed extensive necrosis of the skin of the bridge of the nose. A number of precipitating factors are discussed and suggestions made to minimise the risk of this complication.

Topics: Facial Dermatoses; Female; Humans; Lung Diseases, Obstructive; Masks; Middle Aged; Necrosis; Nose; Positive-Pressure Respiration; Pressure; Skin; Time Factors

The purpose of this study was to compare the efficacy of transtracheal (TT) oxygen delivery to that of nasal cannula delivery in subjects with chronic obstructive pulmonary disease (COPD). Twenty subjects (14 men, 6 women) were followed for 6 months during nasal cannula delivery. A TT catheter was then inserted, and measurements were repeated during TT use. With TT delivery, subjects required 45% less oxygen at rest and 39% less during exercise (p less than 0.0001). Oxygen use, measured by pounds of oxygen delivered to the home, also decreased, but the magnitude of change was less than anticipated (mean, 14%; range, +4% to -32%). Hospital days decreased from 12 +/- 10 during nasal cannula use to 4 +/- 6 during TT use (p less than 0.002). Exercise tolerance, as measured by a 12-min walk distance, was greater during TT use (p less than 0.0001). No change was seen in spirometry or acid-base balance. Also, no change was seen in Profile of Mood States, Sickness Impact Profile or Katz Adjustment Scale scores. Some problems were encountered relating to use of the catheter (displacement, mucus balls), but they were minor, and most were confined to the initial 2 months of TT use when the tract was immature. Our experience suggests that, in addition to decreasing oxygen flow rate, use of TT delivery may confer benefits that result in improved exercise tolerance and decreased hospitalization in patients with COPD.

Topics: Catheterization; Exercise; Female; Hospitalization; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Oxygen Inhalation Therapy; Trachea

1. The influence of nedocromil sodium on the nasal and bronchial effects induced by allergen, platelet-activating factor (PAF), capsaicin, histamine and bradykinin aerosol challenge in ascaris-sensitized and pentobarbitone-anaesthetized pigs was studied. Blood flow changes in the bronchial and nasal circulation were measured with ultrasonic flow probes around the supplying arteries, and vascular resistance was calculated. Changes in pulmonary resistance (Rpulm), dynamic compliance (Cdyn), mean arterial pressure (MAP) and heart rate (HR) were also determined. 2. Allergen and PAF aerosol challenge in the lung produced similar effects consisting of both bronchial and nasal vasodilatation, bronchoconstriction (increase in Rpulm and decrease in Cdyn) and increases in MAP and HR. Local pretreatment with nedocromil sodium (80 mg, aerosol) reduced the peak and duration of both the bronchial vasodilatation and increase in Rpulm, while only the duration of the change in Cdyn was significantly decreased. Nedocromil sodium did not alter the increases in MAP and HR. The nasal vasodilatation evoked by PAF, but not allergen, challenge in the lung was reduced by nedocromil sodium. 3. Allergen challenge in the nose induced vasodilatation of long duration which was reduced by local nedocromil sodium pretreatment (50 micrograms kg-1, intra-arterially). 4. The vasodilator response to histamine aerosol was attenuated in the nasal, but not the bronchial circulation by local nedocromil sodium pretreatment. Histamine-induced bronchoconstriction was not altered by nedocromil sodium. 5. Bradykinin aerosol-induced vasodilatation in the nasal and bronchial circulation was markedly and equally reduced by local nedocromil sodium and systemic capsaicin (50 mg kg-1, s.c. 2 days before) pretreatment. 6. In conclusion, nedocromil sodium blocks some local vascular and bronchial effects, but not increases in MAP and HR, induced by allergen and PAF aerosol in the pig. Bradykinin-induced vasodilatation in the airways, which seems to be largely dependent on capsaicin-sensitive sensory nerves, is markedly inhibited by nedocromil sodium pretreatment, whereas capsaicin-induced vasodilatation is not affected by nedocromil sodium. It may be suggested that nedocromil sodium acts by inhibiting some common process involved in the release of mediators from inflammatory cells (when stimulated by allergen and PAF) and sensory nerves (when stimulated by bradykinin and histamine, but not capsaicin).

Topics: Allergens; Animals; Anti-Inflammatory Agents, Non-Steroidal; Bradykinin; Bronchi; Capsaicin; Histamine Antagonists; Lung Diseases, Obstructive; Nedocromil; Nose; Platelet Activating Factor; Quinolones; Regional Blood Flow; Swine; Vasodilation

A 57 year old man with chronic bronchitis sought a consultation for dyspnoea at rest associated with an absolute inability to lie flat. Examination revealed paradoxical respiration and respiratory function testing revealed a mixed ventilation disturbance, which was predominantly obstructive and was aggravated in the dorsal decubitus position. Radiology revealed bilateral diaphragmatic paralysis, which was confirmed on measurement of transdiaphragmatic pressure. The patient benefited from assisted ventilation by the nasal route with an excellent result in both the short and the medium term. Investigation into the cause was negative, in particular there was no evidence of any neuromuscular abnormality. This case recalls the role of the diaphragm in acute respiratory failure and shows the value of mechanical ventilation by the nasal route in the treatment of certain types of diaphragmatic paralysis.

Topics: Bronchitis; Chronic Disease; Humans; Lung Diseases, Obstructive; Male; Masks; Middle Aged; Nose; Respiration, Artificial; Respiratory Insufficiency; Respiratory Mechanics; Respiratory Paralysis

We reviewed the Mayo Clinic experience with nocturnal nasal ventilation (NNV) and retrospectively assessed the clinical benefits, patient compliance, and complications. NNV had been instituted in 26 patients with daytime hypercapnia and nocturnal hypoventilation due to neuromuscular diseases or chronic obstructive pulmonary disease. After initiation of NNV, 21 of 26 patients continued to use this treatment regularly (81% compliance rate) and considered their life-style improved. In this subset of patients, the arterial partial pressure of carbon dioxide during unassisted breathing decreased from 64 +/- 13 to 51 +/- 7 mm Hg, and the arterial partial pressure of oxygen increased from 58 +/- 12 to 68 +/- 8 mm Hg. No significant change was noted in the forced vital capacity or maximal respiratory pressures. Four of the five patients in whom NNV had been discontinued cited discomfort related to the mask or severity and poor prognosis of the underlying illness as reasons for cessation of treatment. We conclude that NNV is well tolerated by most patients and may improve alveolar ventilation and arterial oxygenation in patients with chronic respiratory failure.

Topics: Adolescent; Adult; Aged; Carbon Dioxide; Chronic Disease; Female; Humans; Hypercapnia; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Patient Compliance; Positive-Pressure Respiration; Pulmonary Gas Exchange; Respiratory Insufficiency; Respiratory Muscles; Retrospective Studies

We performed cytologic evaluations of 6116 nasal and/or bronchial smears from 4510 patients (average age: 7.6 years; 3 months--17 years) suffering from different kinds of chronic nonspecific respiratory diseases (CNSRD); in 137 children (average age: 4.8 years) undergoing bronchologic examinations under general anesthesia we compared the findings with those for bronchoalveolar lavage (BAL). Nasal smears of 77 healthy children at a day care center (control group) were analysed four times per year for "significant secretory eosinophilia" (SEE; i.e. more than 13% eosinophils). We found: 1. Healthy children do not have such "SSE" in contrast to children with CNSRD who show different frequencies of "SSE" depending on the age of the child and the specific kind (diagnosis) of CNSRD. 2. 4.6% of infants (first year of life) were found to have SSE with a statistically significant correlation to increase in the following 10 years up to 50% of all children (p less than 0.001). 3. We found SSE in 4.41% of cases with relapsing bronchitis, in 7.14% (8.3% resp.) with chronic bronchitis, in 6.49% (9.2% resp.) with relapsing or chronic obstructive bronchitis and in 46.05% (55.3% resp.) with bronchial asthma (p less than 0.001). 4. The intensity of obstructive symptoms (nose: rhinitis; bronchus: dyspnoea) did not correlate with the number of eosinophils in the secretions. 5. Only the smear cytograms (nose/bronchus) enabled us to detect "SSE" whereas BAL cytograms were too insensitive (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Asthma; Bronchi; Bronchitis; Bronchoalveolar Lavage Fluid; Child; Child, Preschool; Eosinophils; Exudates and Transudates; Humans; Infant; Lung Diseases, Obstructive; Nose

Patients with chronic obstructive pulmonary disease [COPD] breath at large lung volumes because of dynamic hyperinflation. Their end-tidal lung volumes will then be much above the equilibrium position of the respiratory system and the elastic recoil pressure would be above zero at end-tidal exhalation. This auto or intrinsic positive end-expiratory pressure [auto-PEEP] contributes to the elastic work of inspiration and the sensation of dyspnoea. The purpose of this study was to offset the auto-PEEP in patients with exacerbated chronic airflow obstruction by applying continuous positive airway pressure via the nose [nasal-CPAP]. Nine out of 14 patients experienced alleviation of dyspnoea while on nasal-CPAP [4 to 8 cmH2O]. These 9 patients had significantly more severe hyperinflation than the 5 patients who did not respond positively to nasal-CPAP. While there is a complex relationship between intrinsic and extrinsically applied PEEP in patients with COPD, the result of this study is consistent with the notion that CPAP may alleviate dyspnoea by reducing auto-PEEP, improving lung mechanics and unloading the inspiratory muscles. Nasal-CPAP may have a potential therapeutic role in exacerbations of COPD.

Topics: Dyspnea; Female; Humans; Lung Diseases, Obstructive; Lung Volume Measurements; Male; Masks; Maximal Expiratory Flow Rate; Nose; Positive-Pressure Respiration; Respiratory Mechanics

Topics: Female; Humans; Hypercapnia; Lung Diseases, Obstructive; Nose; Oxygen Inhalation Therapy

A noseclip and low resistance mouthpiece are often used to monitor exhaled gases during exercise. Because otolaryngologic studies suggest that 50% of airway resistance is in the nose and mouth, it was hypothesized that patients with advanced chronic obstructive pulmonary disease might be artifactually limited by exercise testing with a noseclip and mouthpiece. Accordingly, 12 patients with stable chronic obstructive pulmonary disease performed identical symptom-limited supine bicycle exercise tests with and without noseclip and mouthpiece. Right-sided cardiac hemodynamic measurements, radionuclide ventriculography and arterial and mixed venous gas sampling were performed during each exercise test. Exhaled gases were analyzed during the noseclip/mouthpiece exercise. The order of exercise tests was alternated. Comparing exercises with and without a noseclip, there were significant reductions in exercise duration (397 +/- 270 vs 300 +/- 230 seconds, p less than 0.01), exercise oxygen consumption (780 +/- 279 vs 638 +/- 200 ml/min, p less than 0.01) and exercise cardiac output (8.4 +/- 2.7 vs 7.3 +/- 2.0 liters/min, p less than 0.05), an increase in right ventricular ejection fraction (0.39 +/- 0.08 vs 0.43 +/- 0.08, p less than 0.01) and no change in exercise heart rate (106 +/- 14 vs 106 +/- 14), right-sided cardiac pressures or arterial and mixed venous blood gases. These data suggest that a noseclip/mouthpiece can limit exercise tolerance in advanced chronic obstructive pulmonary disease patients. This limitation may result from decreased right-sided cardiac preload (venous return).

Topics: Adult; Aged; Airway Resistance; Blood Pressure; Cardiac Output; Exercise; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Mouth; Mouth Protectors; Nose; Oxygen Consumption; Prospective Studies; Spirometry; Stroke Volume; Vital Capacity

We compared the effectiveness of transtracheal oxygen delivery with that of nasal cannula delivery in 10 subjects with severe hypoxemia who had previously used a portable liquid oxygen system for 20 +/- 12 months. Arterial blood gas measurements, spirometry, and an exercise test were performed prior to catheter insertion and at 2 and 6 months after insertion. With transtracheal oxygen delivery, subjects significantly (p less than 0.0001) reduced their oxygen requirement while maintaining previous exercise capacity. No change occurred in pH, PaCO2, or in spirometry. Of the 10 subjects, 4 have continued catheter use with excellent acceptance. Three experienced complications after insertion, which necessitated catheter removal. Two elected to discontinue the catheter despite subjective improvement in dyspnea. One subject died after an exacerbation of COPD. Our experience confirms findings of others that transtracheal oxygen delivery significantly reduces oxygen requirement. However, in this study, we encountered complications requiring removal of the catheter and variability in patient acceptance. Results indicate the need for additional controlled studies to identify which patients will benefit most from those potentially promising system for delivery of chronic oxygen therapy.

Topics: Catheterization; Evaluation Studies as Topic; Humans; Hypoxia; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Oxygen Inhalation Therapy; Time Factors; Trachea

The cholinergic motor component of the parasympathetic nervous system supplies several structures which may be important in determining the resistance of normal and diseased airways. Lower airway smooth muscle. Here the nervous control is predominantly cholinergic and vagal, as shown by nerve and field stimulation experiments, and by inhibition of contraction by atropine. The cholinergic motor system can be driven reflexly, and most bronchoconstrictor reflexes have been established as vagal and cholinergic. The importance of other innervations, adrenergic and non-adrenergic, non-cholinergic, has not been established. Mucus secretion. As for smooth muscle, this has multiple innervation but, at least in health, the dominant control is vagal and cholinergic, and blocked by atropine. The importance of mucus secretion in causing airway obstruction has yet to be quantified. Sub-mucosal tissues. The effect of cholinergic nerves on the airway vasculature, and on associated structures such as mast cells, is a possibility requiring study. The larynx. Several recent studies have shown that laryngeal constriction occurs in lower airways disease, and must contribute to the changes in total airway resistance. This constriction would be cholinergic but atropine-resistant. The nose. Cholinergic parasympathetic nerves cause nasal congestion and secretion, and therefore changes in nasal airflow resistance. This is a potentially important factor in changing the balance between nasal and oral breathing and thus affecting the conditioning of inspired air.

Topics: Animals; Blood Vessels; Bronchi; Humans; Laryngeal Nerves; Lung Diseases, Obstructive; Mucous Membrane; Muscle, Smooth; Nose; Parasympathetic Nervous System; Respiratory System; Trachea

A reservoir nasal cannula which stores oxygen during exhalation and delivers it as a bolus during inhalation has been reported to conserve oxygen delivery in patients with chronic obstructive pulmonary disease (COPD) at rest. We compared the effects upon arterial oxygen saturation (SaO2) of the reservoir cannula and a standard nasal cannula in hypoxemic obstructed and restricted patients at rest and during exercise. The SaO2 was monitored by ear oximeter. While at rest, 13 obstructed and four restricted patients breathed oxygen from the reservoir cannula at 0.5, 1.0, 1.5, and 2.0 L/min and from a standard cannula at 0.5, 1.0, 2.0, 3.0, and 4.0 L/min. Mean SaO2 was significantly higher with the reservoir cannula compared to the standard cannula at 1.0 and 2.0 L/min (p less than 0.0006) and tended to be higher at 0.5 L/min (p less than 0.1). Seven obstructed patients walked on a level treadmill at 0.75 mph while breathing oxygen at 0.5 and 1.5 L/min from the reservoir cannula and at 1.0 and 3.0 L/min from the standard cannula. The SaO2 during exercise with the reservoir cannula was comparable to that with the standard cannula at approximately half of the oxygen flow rate. The ratio of the oxygen flow rate of the standard to the reservoir cannula to produce 90 percent saturation was estimated and found to be 2.5 +/- 0.8 (mean +/- SD) for patients at rest and 2.9 +/- 1.8 during exercise. We conclude that in hypoxemic patients at rest and during exercise, the reservoir cannula uses less than half the oxygen of a standard cannula to produce similar improvement in SaO2 and thus has advantages of a reduced cost of ambulatory therapy with low-flow oxygen and a longer time permitted away from a stationary source of oxygen.

Topics: Carbon Dioxide; Carboxyhemoglobin; Catheterization; Forced Expiratory Volume; Humans; Hypoxia; Lung Diseases, Obstructive; Nose; Oximetry; Oxygen; Oxygen Inhalation Therapy; Physical Exertion; Rest; Vital Capacity

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. We evaluated this pendant conserving nasal cannula (PNC) in seven hypoxemic patients with chronic obstructive pulmonary disease. We compared oxygen saturations achieved using the PNC vs the standard steady flow nasal cannula (SNC) at 0.5 through 4 L/min. The mean improvement in oxygen saturation using the PNC vs the SNC was 3.3 percent at 0.5 L/min, 4.3 percent at 1 L/min and 3.1 percent at 2 L/min. These differences were statistically significant (p less than 0.001). The saturation achieved by the PNC at 0.5 L/min was equivalent to that achieved by the SNC at 1.8 L/min. We conclude that the PNC provides effective oxygen delivery to patients at supply flows substantially less than the SNC. The device is aesthetically acceptable to patients and its widespread use in patients requiring chronic oxygen therapy could bring about significant financial savings.

Topics: Adult; Aged; Catheterization; Costs and Cost Analysis; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Oxygen Inhalation Therapy

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. Oxygen is stored in the reservoir during exhalation so that 20 ml of approximately 85% oxygen is the first gas inhaled. To test the hypothesis that the CNC is more efficient than the standard nasal cannula (SNC), 20 patients with COPD were evaluated. All patients were chronically hypoxemic at rest. Results indicate that when the CNC was compared with the SNC, arterial oxygen saturation levels were significantly different (p less than 0.001) at flow rates of 0.5, 1.0, and 2.0 L/min. Oxygen saturation were 2.9% higher at 0.5 L/min, 2.9% higher at 1 L/min, and 2.6% higher at 2 L/min for the CNC than for the SNC. In summary, the CNC offers a more efficient oxygen delivery system for those patients requiring supplemental oxygen administration by nasal cannula.

Topics: Aged; Catheterization; Evaluation Studies as Topic; Female; Humans; Intubation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Oxygen Inhalation Therapy

In two studies the authors want to confirm experimentally what is assumed in every day ENT-practice: otitis and sinusitis are not infrequent complications of swimming. The first study, involving 60 children with chronic non-specific lung diseases shows that swimming in a sea water pool increases the nasal airway resistance during two days. In the second study, performed in 32 normal children swimming in a chlorous pool, a negative relationship is found between the number of days after the swimming and the increased nasal airway resistance. Probably other factors also play a part in this phenomenon. Due to the too small number of children showing an otitis media with effusion, the influence of swimming on the function of the Eustachian tube could not be determined.

Topics: Acoustic Impedance Tests; Adolescent; Airway Resistance; Child; Eustachian Tube; Humans; Lung Diseases, Obstructive; Manometry; Nose; Prospective Studies; Seawater; Swimming; Time Factors

During pursed-lips (PL) breathing, even though expiratory air-flow resistance is probably higher than during nasal breathing, there is no air flow through the nose. This should imply an active mechanism that prevents air from escaping through the nares. In 6 patients with chronic obstructive lung disease (FEV1/FVC 34.5 +/- 11.8%; mean +/- 1 SD), nasal resistance averaged 2.6 +/- 0.5 cm H2O.L-1.s-1, whereas translabial resistance (during PL expiration) was 5.7 +/- 0.7 cm H2O.L-1.s-1 (p less than 0.005 by paired t test). Nasal air flow during PL expiration was zero. In all patients, cineradiographic studies showed during the expiratory phase of PL breathing that the soft palate rose to closely contact the posterior pharyngeal wall, completely occluding the entrance to the nasopharynx. This upward movement of the soft palate was of active nature. The palate muscles should be considered as accessory respiratory muscles.

Topics: Aged; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Middle Aged; Nose; Palate, Soft; Pulmonary Ventilation; Respiration

The values of nasal resistance measured by passive, anterior rhinomanometry are reported. The results of measurements on a group of healthy probands correlate significantly with those gained by wholebody-plethysmography. Three of four patients with bronchial hyperreactivity, on acetylcholine, had an increase of nasal resistance after endonasal application of this agents. Ten patients with 'COLD' had normal nasal resistance values; no increase of the values could be demonstrated, after local acetylcholine application.

Topics: Acetylcholine; Administration, Intranasal; Airway Resistance; Bronchial Diseases; Humans; Lung Diseases, Obstructive; Manometry; Nasal Mucosa; Nose; Reference Values

Topics: Animals; Catheterization; Chronic Disease; England; France; Hemodynamics; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Lung Diseases, Obstructive; Masks; Nose; Oxygen; Oxygen Inhalation Therapy; Physical Exertion; Respiratory Insufficiency; United States

Topics: Adult; Aged; Carbon Dioxide; Epistaxis; Female; Hemostasis; Humans; Hypoxia; Ligation; Lung Diseases, Obstructive; Male; Maxillary Artery; Middle Aged; Nose; Oxygen