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The objective of this study was to assess the utility of forced inspiratory vital capacity (FIVC) to identify bronchodilator reversibility (BDR) for patients with obstructive lung disease (OLD) in relation to customary BDR criteria as defined by the American Thoracic Society (ATS). Concurrent data analysis was used in an academic medical center setting. Two hundred patients with OLD (including chronic obstructive lung disease and asthma) undergoing testing at the Pulmonary Function Laboratory at Cedars-Sinai Medical Center from January 1995 to December 1996 were identified. These 200 patients were categorized into four grades of obstruction by ATS-defined forced expiratory volume in 1 sec (FEV1) criteria (severe, moderately severe, moderate, and mild). Each of these groups was further subdivided into equal subgroups according to the presence (+) or absence (-) of BDR. Inspiratory flow-volume loops and FIVC were analyzed for each of these subgroups. Of the patients exhibiting BDR on the forced expiratory maneuver (FEM), FIVC correctly identified 53% of the cases. For patients not exhibiting BDR on FEM, FIVC identified an additional 12 cases. In 72% of cases, the maximal FIVC was not obtained from the maximal FEM flow-volume loop. FIVC inspection of the data (which were already available from standard spirometric testing) identified a subgroup of OLD patients with BDR not appreciated by FEV1 or FVC criteria, which may respond to bronchodilator therapy. The maximal FIVC value should be obtained by manual inspection to identify the best inspiratory flow-volume loop.

Objective: Our objective was to study the effects of extreme obesity on pulmonary function tests and the effects of smoking on these variables in a population group larger than has previously been reported., Design: Retrospective data analysis., Setting: Academic medical center., Patients: Forty-three patients with extreme obesity [ratio of weight in kilograms to height in centimeters greater than 0.9 (W/H)] who underwent pulmonary function testing at Cedars-Sinai on an out-patient or in-patient basis during the period of 1979 to 1 997., Measurements and Results: Patients underwent standard pulmonary function testing. The patients were divided into 2 groups based on the W/H ratio: group A (0.9-0.99) and group B (greater than 1.0). Chart review was performed to identify pertinent history/co-morbidities. The independent effects of smoking between each group's patients were assessed. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), expiratory reserve volume (ERV), functional residual capacity (FRC), maximum voluntary ventilation (MVV), and forced expiratory flow during midexpiratory phase (FEF25-75%,) were significantly reduced in both groups. Single-breath diffusing capacity for carbon monoxide (DLCO) and the volume of gas into which the single-breath of carbon monoxide and helium was diluted were not elevated. Smoking did not account for the results in group A but did seem to partially explain the decrease in FVC, FEV1, and FEF25-75% in group B., Conclusions: Extreme obesity is associated with a reduction in ERV, FVC, FEV1, FRC, FEF25-75%, and MVV. However, contrary to prior reports, D(LCO) is not elevated. These effects are only partially explained by smoking.

The aim of this study was to evaluate the cellular response of the diaphragm, extensor digitorum longus (EDL), and soleus (Sol) muscles to clinically relevant doses of cyclosporine administered to male rats over 4 wk. Control rats were provided with vehicle only. Muscle fiber types, cross-sectional areas, indexes of capillarity, and succinate dehydrogenase (SDH) activity were determined by quantitative histochemistry. Myosin heavy chain isoforms were identified by SDS-PAGE, and their proportions were measured by scanning densitometry. Serum cyclosporine level, 20-24 h after the last dose of cyclosporine, was 145 +/- 81 ng/ml. Final body weight and muscle mass were similar between the cyclosporine and control groups. In the diaphragm, EDL, and Sol, no differences were observed between the groups with regard to fiber type proportions, fiber cross-sectional areas, and proportions of myosin heavy chain isoforms. In the EDL, reductions, both in SDH activity in type I, IIx, and IIb fibers (-26 to -37%) and in indexes of capillarity (-18 to -37%), were noted. In the Sol, SDH activity and capillarity were similar between the groups. In the diaphragm of cyclosporine-treated rats, there was significant reduction in the number of capillaries around individual fibers (-5%), whereas levels of SDH activity tended to be lower. This suggests that activation history may in part determine muscle-specific responses to cyclosporine. We speculate that reduced oxidative activity and capillarity of some limb muscles contribute to reduced exercise capacity and the "deconditioned state" observed in patients receiving cyclosporine after successful solid-organ transplantation.