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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.06.041 Byline: Bartolome R. Celli (a), R.J. Halbert (b), Robert J. Nordyke (c), Brigitte Schau (d) Keywords: Environmental exposure; Obstructive lung diseases; Prevalence; Risk factors; Socioeconomic factors; Smoking Abstract: Chronic obstructive pulmonary disease (COPD) is usually described as a disease of cigarette smoking. COPD is rarely considered in persons with no smoking history except in the context of another exposure. Accordingly, the disease has not been well characterized in these 'never smokers.' Author Affiliation: (a) Caritas St. Elizabeth's Medical Center, Tufts University Medical School, Boston, Mass (b) Cerner Health Insights, Beverly Hills, and Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, Calif (c) Department of Health Services, UCLA School of Public Health, Los Angeles, Calif (d) Boehringer Ingelheim International GmbH, Ingelheim, Germany Article History: Received 17 February 2005; Revised 17 June 2005; Accepted 17 June 2005 Article Note: (footnote) This project was supported by Boehringer Ingelheim International GmbH and Pfizer Inc.

Objectives: To compare gender differences in the clinical expression of COPD patients attending a pulmonary clinic. Materials and methods: We compared 53 [FEV.sub.1]-matched men and women with COPD attending a [...]

Objective: To contribute to the knowledge on the therapeutic value of lung volume reduction surgery (LVRS). Design: Two similar, independently conceived and conducted, multicenter, randomized clinical trials. Setting: The Canadian [...]

Study objective: This study was designed to investigate the extent of clinical muscle dysfunction in stable patients with COPD who were attending an out-patient pulmonary clinic compared with that of [...]

Study objectives: The health-related quality of life of smokers without COPD and that of ex-smokers has not been defined. If abnormal, the role of small airways disease and that of [...]

Tobacco smoking is the main cause of COPD, and encouragement and support in smoking cessation is the best way to help the patient with COPD. The three major goals of [...]

Background and objectives: Lung volume reduction surgery (LVRS) improves ventilatory function in selected patients with severe COPD. The reasons for the observed benefits include the following: increased elastic recoil, improved [...]

Some patients with chest wall diseases (CWD) without respiratory failure manifest important alterations in nocturnal gas exchange, as a previous stage to the future development of daytime respiratory failure. The [...]

Life-threatening infections, acute exacerbations, surgery, impaired sleep, psychosocial problems, end-of-life decisions-- these clinical and ethical concerns commonly arise in the care of patients with GOPD. Last in a three-part series. [...]

Preserving functional capacity and quality of life requires long-term commitments by the physician and the COPD patient. Smoking cessation, pulmonary rehabilitation, and medication are only the start. Second of three [...]

COPD is fourth among all causes of death in this country, and smoking is its major precipitator. With early detection and intervention, you can significantly improve both the course of [...]

The ability to successfully exercise has been used to assess the cardiopulmonary risk of thoracotomy for lung cancer. Because of musculoskeletal, neurologic, peripheral vascular, or behavioral problems, not all patients [...]

Recent studies have used preoperative cardiopulmonary exercise testing to improve risk assessment of pulmonary resection for lung cancer. These studies have demonstrated inconsistent correlation between peak oxygen uptake ([Vo.sub.2]) and [...]

Continuous irrigation-suction catheter (Irri-cath) is a double-lumen device that allows for simultaneous saline solution infusion and aspiration. This system may theoretically be more effective than conventional dry intermittent suction due [...]

Simple arm elevation results in increased metabolic and ventilatory requirements in patients with chronic airflow obstruction (CAO). These demands contribute to the dyspnea that is frequently reported when these patients [...]

Despite the fact that the arms used extensively in daily life and that some of the muscles of the shoulder girdle share both a respiratory and a positional function for the arms, surprisingly little is known about the respiratory response to unsupported upper extremely activity. To determine the respiratory consequences of simple arm elevation during tidal breathing, we measured minute ventilation ([V.sub.E]), tidal volume ([V.sub.t]), respiratory rate (f), heart rate (HR), oxygen uptake (Vo.sub.2), and carbon dioxide production (Vco.sub.2) in 22 normal subjects seated with arms elevated in front of them to shoulder level (AE) for 2 min and down at the sides (AD) for the same time period. The sequence was randomized. Compared with AD, during AE there were significant increases in [Vo.sub.2] (336 ± 18 vs 289 ± 14ml/ min, p, Despite the fact that the arms are used extensively to perform both simple and complex everyday tasks, and that some of the muscles such as the trapezius, pectoralis minor, scalene, [...]

Chronic airflow obstruction (CAO) is a condition that limits the amount of air that can enter the lungs. This makes breathing more difficult and has important consequences on the ability to breath while performing normal daily activities, especially during exercise. Patients with CAO have difficulty performing daily activities that require prolonged use of the arms. Just raising the arms can cause severe and disabling dyspnea (shortness of breath). To determine how raising the arms affects the ability to breath, 20 patients with CAO were studied. The patients performed an arm exercise (AE) that required the arms to be held out straight at shoulder level for two minutes. Before and after the exercise, lung function was determined by measuring the amount of oxygen taken in (VO2), the amount of carbon dioxide formed (VCO2), and the volume of gas exhaled from the lungs during a one minute period (VE). Within 30 seconds of beginning the AE, VO2, VCO2, and VE increased. AE caused the patients to breathe faster, but the amount of air inhaled and exhaled during a single breath did not change. Further studies showed that raising the arms to shoulder level not only requires the use of arm muscles, but also requires the use of diaphragm and rib cage muscles that are used during breathing. This means that these muscles have to work harder to maintain normal breathing while the arms are lifted. These findings help to explain why patients with CAO have difficulty breathing while performing daily activities that require arm movement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Certain factors have been shown to influence the function of the diaphragm, the muscle separating the chest cavity from the abdominal cavity, in patients with chronic airflow obstruction (CAO), which is long-term blockage of the airways. Under normal conditions, the diaphragm contracts with inhalation of air, and permits the bottom portions of the lungs to descend. With exhalation, the diaphragm relaxes and the chest cavity returns to its normal size and inverted basin-like shape. CAO may be associated with hyperinflation of the lungs; decreased strength due to muscle weakness; malnutrition; and hypercarbia, or increased carbon dioxide in the blood, and these factors may affect the diaphragm's function. As the function of the diaphragm becomes more impaired, other muscles must become involved in the breathing process. The interaction between forces from different muscle groups and altered movement of the chest wall and lungs contribute to changes in chest and abdominal movements of patients with CAO. Studies examining the relation between breathing patterns and airway obstruction have produced inconsistent results. The patterns of ventilatory muscle recruitment (VMR), or use of accessory breathing muscles, were assessed in patients with varying degrees of CAO. The results show that with increasing severity of CAO, the pattern of VMR changes from one in which effective ventilatory pressures are produced by the diaphragm, to one in which pressure is produced by the rib cage inspiratory and expiratory muscles. VMR patterns appear to change in relation to airway obstruction, hyperinflation, and weakness of the diaphragm, but not with sex, age, nutritional condition, or blood gas levels in the arteries. (Consumer Summary produced by Reliance Medical Information, Inc.)

The purpose of this study was to determine the relationship between recruitment of the DI and SM muscles measured as EMG signal amplitudes, the pattern of respiratory muscle recruitment measured [...]

(CHEST 1996; 110:835-37) A 38-year-old woman had a history of intermittent chest discomfort and dyspnea over many years. She never sought medical attention for these symptoms. Her only chest radiograph [...]

Study objectives: To assess the effectiveness of nasal noninvasive mechanical ventilation (NIMV) in patients with obesity hypoventilation syndrome (OHS). Design: Clinical assay that compares two groups of patients with hypercapnic [...]

Study objectives: To determine the 1-year efficacy of noninvasive positive pressure ventilation (NPPV) added to long-term oxygen therapy (LTOT) in patients with stable severe COPD. Patient selection and methods: We [...]

(CHEST 2000; 117:1778-1781) A 63-year-old woman with asthma presented with a 1-week history of increasing dyspnea, wheezing, and a productive cough. The patient stated that her grandchild was sick at [...]

Bilateral paralysis of the diaphragm is either idiopathic or associated with several medical conditions, including trauma or thoracic surgery, viral infections, and neurologic congenital or degenerative disorders. We describe the [...]

Effect on Approach to Management COPD is characterized by airflow limitation. The diagnosis is suggested by history and physical examination and is confirmed by spirometry (ie, a low [FEV.sub.1] level [...]

Background: The reasons for exertional dyspnea in severe COPD are not well established, but they are not solely related to the mechanical load. We tested the hypothesis that breathlessness may [...]

Since the studies of Fletcher and colleagues, (1) the natural history of COPD has been associated with the accelerated progressive decline of FE[V.sub.1]. FE[V.sub.1] became the defining feature of the [...]

PURPOSE: To determine if cardiorespiratory fitness decreases in medical interns during their first year of training. METHODS: Incoming medical interns at Caritas St. Elizabeth's hospital were asked to participate in [...]

The presence of a peripheral myopathy in hypothyroidism has been well recognized. Involvement of the diaphragm has been suggested recently but the clinical spectrum never clearly defined. We studied three [...]