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Study objectives: To assess (1) the possibility of predicting long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (VO[sub 2]max) as a criterion for operability and as a predictor of long-term disability. Design: Prospective study. Setting: Outpatients and inpatients of a university hospital. Participants: Sixty-two consecutive patients (mean ± SD age, 62 ± 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]). Measurements: Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV[sub 1] (ppoFEV[sub 1]) was < 40%, patients underwent exercise testing; if VO[sub 2]max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study. Results: All the patients with ppoFEV[sub 1] &Ge; 40%—even those patients (26%) with FEV[sub 1] < 80%— underwent thoracotomy without further tests. Seven patients with ppoFEV[sub 1] < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV[sub 1] ≥ 40%. ppoFEV[sub 1] significantly underestimated the actual postoperative FEV[sub 1] (poFEV[sub 1]; p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV[sub 1] after lobectomy. Two patients with predicted postoperative VO[sub 2]max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living. Conclusions: ppoFEV[sub 1] ≥ 40% reliably identifies patients not requiting further tests and not at long-term risk of respiratory disability. VO[sub 2]max, effective for defining the immediate surgical risk, is not useful in... [ABSTRACT FROM AUTHOR]

The effects of inhaled bronchodilators at rest and during exercise were studied in 15 subjects with chronic obstructive pulmonary disease. In a crossover study against placebo, albuterol caused a significant increase in expiratory flow and reduced lung hyperinflation and dyspnea at rest, but this was not associated with differences in symptoms with exercise or any relevant parameter of physical performance. Dynamic hyperinflation occurred during exercise similarly after placebo or albuterol and was associated with a reduction of forced expiratory flows. This, in turn, was correlated with the bronchoconstrictor effect of deep inhalation determined at rest. In a parallel group study, expiratory flow was increased by 3-wk treatment with salmeterol (n = 9) but not with placebo (n = 6). However, in neither group was the response to exercise different from baseline. These results suggest that in chronic obstructive pulmonary disease effective pharmacological bronchodilation at rest may not be predictive of benefits of exercise tolerance. This may be related to the occurrence of airway narrowing during exercise, particularly when a deep inhalation at rest is followed by a decrease in expiratory flow.