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Osteoporosis has recently been recognized as a major comorbidity in chronic obstructive pulmonary disease (COPD). We conducted a cross-sectional study in a cohort of 136 Japanese males with COPD to evaluate the prevalence of vertebral fracture (VF) and to explore its relationship with pulmonary function parameters. VFs were present in 108 (79.4 %); multiple and severe (SQ grade 2 or 3) VFs were found in 77 (56.6 %) and 25 (18.4 %), respectively. Multivariate logistic regression analyses revealed that decrease in forced expiratory volume in one second (FEV1.0)/forced vital capacity (FVC) [odds ratio (OR) 0.963, 95 % confidence interval (CI) 0.929–998, p = 0.036] was associated with the presence of VF after adjustment for age and that FVC (OR 0.462, 95 % CI 0.220–0.968, p = 0.041) and current smoking (OR 2.992, 95 % CI 1.128–7.940, p = 0.028) were associated with VF severity (grade 2–3 vs. 1). We also found that FEV1.0 was the sole independent determinant of the number of VFs by stepwise multivariate linear regression (p

Chronic respiratory disease, such as chronic obstructive pulmonary disease(COPD)continues to cause a heavy health and economic burden in the world. Lower-limb muscle dysfunction is a prominent and major extrapulmonary features in individuals with moderate-to-very severe COPD and has important clinical implications, such as reduced exercise tolerance, activity of daily living(ADL), health related quality of life(HRQOL)and even survival. Osteoporosis is also an important systemic feature of COPD. Osteoprotic fracture cause many symptoms and complications, including the impairment of ventilation, and create a heavy economic burden. Comprehensive treatments(drug medication and non-drug treatment)for these impairments, such as pulmonary rehabilitation, are recommended. Pulmonary rehabilitation improves dyspnea, exercise capacity, ADL, and HRQOL, each of which is recognized predictors of mortality.

A systematic autonomic dysfunction observed among patients with dementia with Lewy bodies (DLB) has recently attracted close attention. Here, we compare cardiovascular and pulmonary autonomic functions among patients with DLB, patients with Alzheimer's disease, and healthy control subjects. All 15 DLB patients demonstrated severely low ventilatory response to hypercapnia, whereas none of the other subjects demonstrated abnormal results. The majority of the DLB patients showed impaired heart rate variability, low uptake on (123)I-metaiodobenzylguanidine myocardial scintigraphy, and orthostatic hypotension. Ventilatory response to hypercapnia as a marker of respiratory autonomic function is a promising diagnostic tool for DLB.

The purpose of this study was to evaluate whether strength or recreational activities are a useful addition to aerobic training in patients with chronic obstructive pulmonary disease (COPD). Thirty-three patients with moderate to severe COPD were randomly assigned to 12 weeks of aerobic combined with strength training (AERO+ST) or combined with recreational activities (AERO+RA). The AERO regimen consisted of three weekly 20-min walking exercise sessions; the ST regimen included three series of 10 repetitions of four exercises; and the RA regimen consisted of training using exercise balls to perform smoothly for instrumental activity of daily living. Baseline and after-training measurements of peripheral muscular strength and endurance, cardio respiratory fitness, and 6-min walking distance were obtained, whereas quality of life was assessed with the Short Form 36 questionnaire. Change in grip strength showed a significant difference between the AERO+ST group (8.3+/-6.7%) and the control group (-1.3+/-10.5%), and AERO+RA group (-4.7+/-5.6%) (P

We report on an obese man with sleep stage-dependent apnea. His type of apnea was predominantly central during non-rapid eye movement (NREM) sleep, while it was obstructive during rapid eye movement (REM) sleep. We found significantly more and more severe apneas during REM sleep compared to NREM sleep. His apneas were remarkably reduced by position adjustment, suggesting that upper airway collapse played a key role in the induction of both types of apnea. As his apneic patterns were dependent on the sleep stages, we assumed that the balance between upper airway obstruction and instability of central respiratory control might be important in determining the expression types.

Major basic protein and other native cationic proteins increase airway hyperresponsiveness when administered to the luminal surface of the airways in vitro. To determine whether the same applies in vivo, we assessed airway responsiveness in rats challenged with both aerosolized and intravenously infused methacholine. We partitioned total lung resistance into its airway and tissue components using the alveolar capsule technique. Neither poly-l-lysine nor major basic protein altered baseline mechanics or its dependence on positive end-expiratory pressures ranging from 1 to 13 cmH2O. When methacholine was administered to the lungs as an aerosol, both cationic proteins increased responsiveness as measured by airway resistance, tissue resistance, and tissue elastance. However, responsiveness of all three parameters was unchanged when the methacholine was infused. Together, these findings suggest that cationic proteins alter airway responsiveness in vivo by an effect that is apparently limited to the bronchial epithelium.

We performed lung volume reduction surgery (LVRS) in an experimental model using a simple stapling technique (SST) for pulmonary emphysema. The technique uses a stapler to isolate the affected lung from the remaining lung instead of removing it. We performed the present experiment using dogs to study the effects and safety of LVRS using the SST.Pulmonary emphysema was induced in 12 dogs with papain. They were divided into three groups: those operated on with SST composed the operation (Op) group; those receiving an experimental thoracotomy composed the sham-operation (Sham-op) group; and those not operated on composed the nonoperation (Non-op) group. Respiratory function was compared among the groups before induction of emphysema (baseline), after induction of emphysema (preoperation), and at 8 weeks after the operation (postoperation Op and Sham-op groups only). The lung was removed and histologically examined 8 weeks after the SST operation.In the Op group, alteration in forced expiratory volume (FEV) 0.5%, airway resistance (Raw) and specific airway conductance (sGaw) showed significantly favorable results. Histologically, the isolated area was widely replaced by fibrous tissue with numerous blood vessels in the circumference in the Op group; no signs of infection such as polykaryoleukocytes or microabscesses were observed in any of the samples.The LVRS for pulmonary emphysema using a simple stapling technique improved the expiratory flow and alleviated airway resistance. The isolated remaining lung was well organized without any infectious events or secondary adversity, thus demonstrating the safety of this technique. From these results, this technique is therefore suggested to be effective and applicable to clinical use.

To study the effect of aging on orexin-A, we measured plasma orexin-A concentrations in 82 healthy volunteers (55 men and 27 women) over a wide range of ages (mean 50.2 +/- 13.9 years, ranging from 23 to 79 years). Correlation analyses revealed that plasma orexin-A concentrations correlated with age (r = 0.50, P0.01). When comparing three age groups, it appeared that the concentrations in the group of more than 60 years were significantly higher than those in the group of less than 39 years in both genders (P0.05). These findings suggest that orexin-A could be involved in aging in a healthy population.

We inspire air and get oxygen, and the storaging conditions of the oxygen in the blood are gas and solid (Hb-O2) type. To measure the gas type oxygen in the blood, we use blood gas analyzing meters, and we also can measure solid type oxygen by this method. From this method, we can get arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), pH, HCO3(-), and so on. By the way, pulse oximeter is an equipment to measure percutaneous arterial oxygen saturation (SpO2). Although the PaO2 and SpO2 are essential parameters to know the clinical conditions of COPD patients, we should be aware of the primary differences between them, and use these parameters effectively.

Objectives: The aim of this study was to clarify the chronic toxicological effects of indium-tin oxide (ITO) and indium oxide (In2O3) on laboratory animals. Methods: Male Syrian golden hamsters were intratracheally administered 3 mg/kg or 6 mg/kg of ITO particles, or 2.7 mg/kg or 5.4 mg/kg of In2O3 particles, containing 2.2 mg/kg or 4.5 mg/kg of indium, twice a week, for 8 wk. Control hamsters were given vehicle of distilled water only. The hamsters were euthanized serially up to 78 wk after the final instillation and the toxicological effects were determined. Results: Body weight gain was significantly suppressed in the ITO 6 mg/kg-treated hamsters compared with the control group, but not in the ITO 3 mg/kg-treated or In2O3-treated hamsters. Relative lung weights among all the indium-treated groups were significantly increased compared to that in the control group throughout the observation period. The serum indium concentration among all the indium-treated groups gradually increased up to the end of the observation period. Histopathologically, foci of slight to severe pulmonary inflammatory response with diffuse alveolar or bronchiolar cell hyperplasia, expansion of the alveolar spaces and interstitial fibrotic proliferation were present in all the indium-treated hamsters and the severity of these lesions worsened with the passage of time. Lung benign adenomas were only manifest in 3 out of 15 of the ITO 6 mg/kg-treated hamsters. Conclusions: The present results clearly demonstrate that ITO and In2O3 particles caused chronic pulmonary toxicity when repeated intratracheal instillations were given to hamsters.

The incidence of dementia with Lewy bodies (DLB) is increasing rapidly due to the increasing longevity of the population. In DLB, autonomic dysfunction, such as sleep disorders, and cardiopulmonary arrest, together with unconsciousness, can occur. Such cases have poor prognosis and may have dysfunction of chemosensitivity in the respiratory center. We have assessed the function of the respiratory center, especially chemosensitivity to hypercapnia. Twelve probable DLB patients (Group 1) and twelve age-matched healthy subjects (Group 2) were examined. Chemosensitivities to hypercapnia expressed by delta expiratory volume/delta partial pressure of carbon dioxide/body surface area: mean 0.16 (1/min/Torr/m(2)) in Group 1 and 0.49 in Group 2. Thus, patients with DLB had a subnormal hypercapnic response in chemosensitivity of the respiratory center, suggesting dysfunction of the respiratory center. Respiratory center dysfunction may be related to cardiopulmonary arrest together with unconsciousness, so, patients with DLB should not use drugs affecting the respiratory center.

Objective: The purpose of this study was to examine whether activities parallel to daily living (APDL) constitute a determinant index of cardiorespiratory fitness in patients with chronic obstructive pulmonary disease (COPD). Methodology: Four functional physical fitness parameters were investigated in 38 male patients (mean age 69.8 ± 6.7 years) with moderate to severe COPD. The parameters measured were muscular strength (grip strength), muscular endurance strength (arm curl, keeping a half-squat position) and regulation (walking around two cones). In addition, cardiorespiratory fitness was measured using a 6-min walking distance test (6MWD) and peak oxygen uptake (VO2peak) was measured during bicycle ergometer testing. Maximal inspiratory pressure (MIP) and maximal expiratory pressure were measured so as to quantify respiratory muscle strength. Results: There were significant correlations (P

To examine the efficacy of the circuit training in elderly patients with chronic obstructive pulmonary disease (COPD), we evaluated muscle forces of the upper and lower extremities and respiratory muscles, exercise tolerance and quality of life (QOL) before and after the circuit training in 10 male patients with mild to severe COPD. The circuit training improved muscle forces of the upper and lower extremities and abdominal muscles (P < 0.05), and 6 min walking distance (P < 0.05). Emotional function and mastery in the Chronic Respiratory Disease Questionnaire scores (P < 0.05) were also improved after the circuit training. The circuit training designed in the present study was effective to improve the QOL in elderly COPD patients.

Study objectives The purpose of this study was to investigate the effect of heavy-ion radiotherapy on pulmonary function in patients with clinical stage I non-small cell lung cancer (NSCLC) patients. Design Retrospective study. Setting Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan. Patients From a total of 81 patients who were not candidates for surgical resection due to medical reasons or patient refusal, and who were treated with carbon beam radiotherapy from October 1994 to February 1999, the 52 patients who had completed the repeat overall pulmonary function tests at 6 and 12 months after undergoing heavy-ion radiotherapy were examined. The total heavy-ion irradiation dose ranged from 59.4 to 95.4 photon gray equivalents (GyE), with a mean dose of 76.2 GyE. Interventions and measurement Pulmonary function was evaluated prior to heavy-ion radiotherapy and at 6 and 12 months after heavy-ion radiotherapy. Comparisons of all pulmonary function indexes between, before, and at 6 and 12 months after heavy-ion radiotherapy were made using repeated-measures analysis of variance using the Dunnett test for post hoc comparison. Results A statistically significant decrease in FEV1 and total lung capacity was detected at both 6 and 12 months after the patient had undergone heavy-ion radiotherapy. No significant decreases in other pulmonary function indexes in patients were observed at either 6 or 12 months after heavy-ion radiotherapy. The magnitude of the decrease in all pulmonary function indexes was Conclusions These findings suggest that heavy-ion radiotherapy is feasible for stage I NSCLC patients without a severe loss of pulmonary function.

Elderly patients with lung cancer tend to have significant coexisting diseases and less aggressive treatment is often required. To investigate the clinicopathological features of non-small cell lung cancer (NSCLC) in elderly patients who were treated with radiotherapy, we reviewed the medical records at our division. Among the 189 patients 70 years or older between 1992 and 2001, 28 (14.8%) patients were treated with radiotherapy (elderly group). In the elderly group, there was a medical history of chronic obstructive pulmonary disease (COPD) (57.1%), cardiovascular disease (32.1%), diabetes mellitus (18.5%), malignant disease (18.5%), or cerebrovascular disease (10.7%). Moreover, in the elderly group, 17 (60.7%) patients had two or three coexisting diseases. There was statistical difference between the elderly group and the younger group (less than 70 years patients) with regard to COPD (p

The aim of this study is to evaluate characteristics in lung cancer patients with chronic obstructive pulmonary disease (COPD). Among 966 lung cancer patients admitted to our division over a period of 24 years, 73 patients were diagnosed as having COPD. There were 68 (93.2%) men and 5 women; of the tumors 43 (58.9%) were squamous cell carcinomas. Although 41 (56.2%) patients had stage IA-IIIA, only 11 (15.1%) had surgery. Coexistence of COPD was proved to be a prognostic factor (p=0.0451). Adequate palliative care to provide quality survival would be the primary goal of therapy for lung cancer patients with COPD.

Bradykinin has an important role in asthma pathogenesis, but its site of action is unclear. It was previously reported by the authors that bradykinin causes a dose-dependent reduction in dynamic compliance but little change in total lung resistance. This suggested that bradykinin may have a preferential effect in the distant lung. The purpose of the current investigation was to better characterize the effects of bradykinin on pulmonary resistance in rodents and explore the role of nitric oxide release in modulating the effect of bradykinin. Airway constriction was induced in the rats by aerosol administration of bradykinin with or without treatments with the inhaled bradykinin-2 receptor antagonist, Hoe 140 or the nitric oxide synthase inhibitors N(G)-nitro-L-arginine methylester or N(G)-monomethyl-L-arginine. Total lung resistance was partitioned into tissue and airway resistance by using the alveolar capsule method. Bradykinin induced a significant increase in both resistances. Hoe 140 abolished the response to bradykinin. The nitric oxide synthase inhibitors enhanced the bronchoconstricting response. In conclusion, the bradykinin response in the rats was not only localized to conducting airways but also involved a relatively selective tissue reaction. Bradykinin-induced bronchospasm in the rat is solely due to activation of bradykinin-2 receptor. Further, it was shown that nitric oxide significantly modulates the bronchospasm caused by bradykinin, suggesting that nitric oxide is an important modulator of airways responsiveness to bradykinin.

It is considered that Kartagener's syndrome is caused by ciliary dysfunction. This syndrome is characterized by the clinical triad of bronchiectasis, sinusitis, and dextrocardia. We describe an elderly patient with Kartagener's syndrome who reached advanced age. We suppose that it may be possible for patients with Kartagener's syndrome to live a full span with optimal therapy for respiratory tract infection and control progression of this disease. Chronic Respiratory Disease 2007; 4: 75—76

We enrolled 22 patients with chronic obstructive pulmonary disease (COPD) and 20 normal subjects as controls. Using a hot-wire flow meter, we obtained tidal volume (VT), duty ratio (Ti/Ttot), and mean inspiratory flow (VT/Ti) as measures of respiratory pattern at two different respiratory rates; 0.5 Hz and 1.5 Hz. At 0.5 Hz, there were significant differences in Ti/Ttot and VT/Ti. At 1.5 Hz, patients with COPD had significantly lower values of VT and VT/Ti. Furthermore, we calculated the change ratios from 0.5 Hz to 1.5 Hz in these parameters as new parameters of respiratory pattern change by respiratory rate. VT0.5/1.5 and VT/Ti0.5/1.5 significantly correlated with FEV1.0/FVC. The findings suggest that the parameters of the respiratory pattern may change depending on respiratory rates, and that the ratios of those parameters obtained at two different rates could be helpful in diagnosing airflow obstruction.

Airway resistance was measured during spontaneous respiration in healthy smokers and patients with chronic obstructive pulmonary disease, and the relationship between the airway resistance and respiratory frequency was examined. No significant difference was observed between the airway resistance in smokers and nonsmokers. In the chronic obstructive pulmonary disease group, patients with pulmonary emphysema had highest airway resistance. The determination of airway resistance during spontaneous respiration appears to be a very useful, noninvasive method of pulmonary function testing.