Peak expiratory flow rate control chart in asthma care: chart construction and use in asthma care

We have analyzed X-chromosome inactivation patterns in lymphocytes of 264 females from 38 families not known to have any genetic disease. Quantitative measures of X-inactivation showed strong sister-sister correlation in the degree of departure from equal numbers of cells having each X chromosome active, suggesting heritability of this phenotype. Strong sister-sister correlation was also observed for the fraction of cells having the same parent's X chromosome active, consistent with the possibility that this trait might be controlled by a cis-acting, X-linked gene. We used a sib-pair approach to determine whether X-inactivation phenotype was linked to loci in any region of the X chromosome. Both quantitative and discrete measures of X-inactivation phenotype showed evidence of linkage to markers in the region of the X inactivation center (XIC). The quantitative measure of X-inactivation phenotype used in our study also showed linkage to loci at Xq25-q26. This study provides the first evidence for X-linked inheritance of X chromosome inactivation phenotype derived from linkage analysis in phenotypically normal human families.     

Peak expiratory flow rate in school-going children

Two members of a unique class of natural antibodies have been identified in all of a large cohort of sera from clinically normal humans of broad age distribution. By means of a series of 10-12 mer peptides the epitope for each of those antibodies was characterized with regard to amino acid identity and conformation. Similar epitope specificity was revealed for the IgM isotopes of cord blood and early post natal sera and for IgM and IgG of adult sera, suggesting that the class of natural antibodies represented by the two identified in this study includes those genomically coded for at their effector level of maturation in the B cells of the neonate. Assay of series of specimens from each of four clinically normal adults revealed that those two natural antibodies are present at relatively constant titer, unique to each individual, over four to five and a half year periods. Those observations imply that the primary function of that class of natural antibodies may be related to maintenance of homeostasis and the molecular identity of each of the two epitopes suggests a role, for each, as monitor or control in intracellular traffic. The previous identification of those epitopes in a conserved protein of HIV also provides support for the proposition that a secondary function of natural antibodies, arising from fortuitous coincidence of the identity of the epitopes, may be that of early defense against infectious invaders.     

Peak expiratory flow in healthy Turkish children

This study was conducted on 1359 healthy, non-smoking Turkish children (727M, 632F) with a mean age of 11.7 +/- 3.4 (6-17) years, in order to determine the normal values of peak expiratory flow (PEF) in Turkish children and to compare various peak-flow meters (PEFMs). PEF values increased with age and height in boys and girls. The relative increase in boys was significantly higher at puberty (p < 0.01). The values of Turkish children were found to be similar to those of Europeans. The results obtained from the three PEFMs were closely correlated.     

Peak expiratory flow variability, bronchial responsiveness, and susceptibility to ambient air pollution in adults

Bronchial hyperresponsiveness (BHR) and peak expiratory flow (PEF) variability are associated expressions of airway lability, yet probably reflect different underlying pathophysiologic mechanisms. We investigated whether both measures can be used interchangeably to identify subjects who are susceptible to ambient air pollution. Data on BHR (>= 20% fall in FEV1), PEF variability (ampl%mean PEF > 5% on any day during an 8-d period with low air pollution levels) and diary data on upper and lower respiratory symptoms, cough, and phlegm were collected in 189 subjects (48-73 yr). The acute effects (lag0) of particulate matter with a diameter less than 10 micrometers (PM10), black smoke, SO2 and NO2 on the prevalence of symptoms were estimated with logistic regression. In subjects with airway lability, both when expressed as PEF variability (69%) and BHR (28%), the prevalence of symptoms increased significantly with increasing levels of air pollution, especially in those with the greater PEF variability (n = 55, 29%). We found no such consistent positive associations in adults without airway lability. PEF variability, and to a smaller extent BHR, can be used to identify adults who are susceptible to air pollution. Though odds ratios were rather low (ranging from 1.13 to 1.41), the impact on public health can be substantial because it applies to large populations.     

Peak expiratory flow and the resistance of the mini-wright peak flow meter

The purpose of this study was to examine whether the resistance of the peak flow meter influences its recordings. One hundred and twelve subjects, (healthy nonsmokers and smokers and subjects with lung diseases) performed three or more peak expiratory flow (PEF) manoeuvres through a Fleisch pneumotachograph with and without a mini-Wright peak flow meter added in random order as a resistance in series. The results were as follows. In comparison with a pneumotachograph alone, peak flow measured with an added mini-Wright meter had a smaller within-test variation, defined as the difference between the highest and second highest values of PEF in a series of blows. The mean (SE) variation was 14 (1.3) L.min-1 and 19 (1.5) L.min-1 with and without meter added, respectively. In comparison with the pneumotachograph alone, the addition of the mini-Wright meter caused PEF to be underread, especially at high flows. The difference (PEF with meter minus PEF without meter) = -0.064 (average PEF) -8 L.min-1; R2 = 0.13. The mean difference was -7.8 (1.1) %, and increased numerically for a given PEF, when maximal expiratory flow when 75% forced vital capacity remains to be exhaled (MEF75%FVC) decreased. The reproducibility criteria for repeated measurements of peak flow are more appropriately set at 30 L.min-1 than the commonly used 20 L.min-1, because a within-test variation of less than 30 L.min-1 was achieved in 76% of the subjects without PEF meter inserted and in 88% with meter inserted, with no difference between healthy untrained subjects and patients. The resistance of the peak expiratory flow meter causes less variation in recordings but reduces peak expiratory flow, especially at high values and when the peak is large as compared with the rest of the maximal expiratory flow-volume curve.     

Peak expiratory flow rate in Nigerian school children

Peak expiratory flow rate (PEFR) was measured using the Wright's peak flow meter in 263 school boys and 275 school girls living in Lagos, Nigeria. Their ages ranged from 6.0 years to 19.0 years (mean 11.9 +/- 3.8 yrs. for boys and 11.8 +/- 3.9 yrs. for girls). Mean PEFR was 359.2 +/- 102.0 L/min (range 160.0-610.0 L/min) in boys and 327.7 +/- 81.3 L/min (range 160.0-500.0 L/min) in girls. Apart from ages 17, 18 and 19, peak expiratory flow rates were similar in both boys and girls. In both sexes, PEFR correlated positively and significantly with age, height, weight and body surface area. Also in both sexes and in all age groups studied, PEFR was significantly higher than predicted values obtained from previous Nigerian and caucasian prediction equations. When compared with values obtained from a second caucasian prediction equation, observed values were significantly higher in the 6-10 years and 16-19 years age groups in boys and 11-15 years and 16-19 years age groups in girls. New prediction equations for calculating PEFR in Nigerian boys and girls are presented. Observed PEFR may be due to enhanced stature in Nigerian children resulting from improved environment and genetic factors.     

Obstruction of the small airways in the spirometric diagnosis of occupational bronchial asthma

BACKGROUND: Previous studies have noted the prevalence of errors in journal reference lists, including nursing journals, but an in-depth study of nursing research journals has not been repeated. OBJECTIVES: The purpose of this study was to determine the number and types of errors in nursing research journal reference lists. METHOD: A stratified random sample of 262 references from three nursing research journals was obtained. References were compared with the actual articles, books, and chapters cited, or with photocopies obtained via interlibrary loan. Error rates were calculated. RESULTS: The overall error rate was 45.8%; 38.3% of all references contained at least one major error, and 13.8% of all references contained at least one minor error. CONCLUSIONS: The overall rate of reference errors falls within the range exhibited by recent studies of the medical and dental literature but exceeds the rates found in studies of nursing journals and veterinary medicine journals. Researchers need to consider the number and types of errors involved when using reference lists in their research.     

Measuring peak flow in bronchial asthma

From a series of 26 diabetics selected for combined pancreas and kidney transplantations 9 died before surgery was scheduled, one died after surgery and 4 rejected the transplants. The effect of pancreas or kidney transplantation or both on vibratory perception and thermal thresholds, various motor and sensory conduction parameters were studied in 9 of the remaining 12 patients. In 6 both the pancreatic and renal grafts were functioning, in 2 the pancreas was rejected, and in 1 the kidney. At an average follow-up of 41 months after surgery, the mean total score of clinical and electrophysiological improvement in 6 patients with successful combined transplantation was 5.5 +/- 1.6 compared with -4.3 +/- 2.5 in 3 patients with one surviving transplant (P < 0.001). Similarly, the average increase in nerve conduction velocity was 5.8 +/- 1.1 m/s in patients with two functioning grafts whereas it decreased 2.9 +/- 0.7 m/s in those with only one (P < 0.001). The quality of life was considered improved in patients with successful outcome of the two organ transplantations in contrast to the statements of those with only one.     

Density dependence of expiratory flow and bronchodilator response in asthma

Change in the magnitude of density dependence of the maximal expiratory flow (D/MEF) following inhalation of isoproterenol was used as a test for predicting the long term response to isoproterenol vs atropine in 24 adult patients with longstanding asthma. Eleven subjects showed a decrease in D/MEF manifested by increase in volume of isoflow (VisoV) and/or decrease in Vmax50 Helox/air following isoproterenol inhalation (group 1). Thirteen subjects manifested an opposite response (group 2). Atropine sulphate (0.08 mg/kg) and isoproterenol hydrochloride (2.5 mg) were then administered by inhalation, each four times a day for seven days in a randomized double-blind cross over fashion to all subjects. One of group 1 but ten of group 2 subjects had a greater subjective and objective improvement with atropine than with isoproterenol (P less than .005). An increase in D/MEF following isoproterenol can be used as a test to predict a better response to atropine than to isoproterenol over a one week period. Such a response occurs in almost half of the adult chronic asthmatic patients. The results are consistent with a preferential dilatation of the large airways by atropine.     

Changes in respiratory rate affect tidal expiratory flow indices in infants with airway obstruction

Among the tidal expiratory flow measurements that have been suggested as surrogate tests for airway obstruction, a short time to reach peak tidal expiratory flow (t(pef)) is the most widely used. Time to peak expiratory flow is most often expressed as the ratio between t(pef) and total expiratory time (t(e)). As te strictly depends inversely on respiratory rate (RR), we studied the hypothesis that an increase in RR (and a fall in t(e)) with the development of airway obstruction during methacholine or histamine challenge in infants could mask a decrease of t(pef) when expressed as t(pef)/t(e). Thirty-three infants (ages 6.5-23 months) with recurrent wheeze were studied during sedated sleep. Runs of tidal breathing and maximal expiratory flow at FRC (V(maxFRC)) measured by the squeeze technique were obtained before and after the challenge. All infants responded to the challenge: the median fall in P(tCO2) was 25%, and it was 43% in V(maxFRC). RR increased from a median value of 31.1 to a median of 35.1 breaths/min. Both t(pef) and t(e) were significantly shorter after the challenge (P < 0.001 and 0.004, respectively); however, the decrease in t(pef)/t(e) was not significant (P=0.081). The change in t(pef)/t(e) was positively correlated with the change in RR (r = 0.51, P = 0.003). To analyze better the effect of changes in RR on various indices, we divided the patients into two groups: in 17 subjects with a small increase in RR (< 10%), t(e) did not change significantly, while t(pef) and t(pef)/t(e) did; in 16 subjects with a more marked increase in RR (> or = 10%), the shortening of te masked the simultaneous shortening of t(pef), so that t(pef)/t(e) did not change. These data demonstrate that t(pef)/t(e) cannot be reliably used to evaluate changes in airway obstruction when concomitant changes in RR occur.     

Quantitative versus qualitative analysis of peak expiratory flow in occupational asthma

BACKGROUND: Peak expiratory flow rates (PEF) are often used to confirm the diagnosis of occupational asthma. The records are usually analysed qualitatively, and this may lead to interobserver disagreement. In this study the diagnostic value of a qualitative assessment of change in PEF was compared with objective measures of change in PEF and the results of a specific inhalation challenge test with plicatic acid. METHODS: Twenty five patients with possible red cedar asthma recorded PEF six times a day for three weeks at work and for two weeks away from work and underwent a challenge test with plicatic acid at the end of the recording period. Patients were considered to have cedar asthma if the FEV1 after inhalation of plicatic acid was 15% or more below that on the control day. PEF was plotted against time and assessed qualitatively by three physicians. The graph was considered positive for cedar asthma if two of the three physicians agreed that PEF was lower at work than away from work. The 95% confidence interval for variation in PEF between periods at work and away from work was also obtained from 15 asthmatic patients without occupational asthma. Differences in PEF between periods at work and away from work were considered positive for occupational asthma in the patients exposed to cedar when they were outside the 95% confidence interval for variations in PEF in the 15 patients whose asthma was nonoccupational. RESULTS: Of the 25 men studied, 15 had a positive response to plicatic acid. The qualitative PEF analysis had a sensitivity of 87% and a specificity of 90% in confirming red cedar asthma as diagnosed by the specific challenge test. Among the objective methods tested, only the difference in mean PEF between the maximum PEF at weekends and the minimum PEF on working days had a sensitivity (93%) greater than that of the qualitative method and a similar specificity. CONCLUSIONS: The qualitative assessment of PEF is a good diagnostic test for cedar asthma. Only one objective method of PEF analysis proved to be slightly more sensitive than the qualitative method and similar in specificity.     

Determinants of tidal flow volume loop indices in neonates and children with and without asthma

Generalized progressive retinal atrophy (gPRA) represents a genetically heterogenous group of retinal degenerations affecting pedigree dogs. Currently, we are using a candidate gene approach in an attempt to identify mutations causing gPRA in dogs. Here we report the cloning, sequencing and analysis of canine rom-1, a structural gene of the rod photoreceptor. Single-stranded conformation polymorphism (SSCP) analysis was used to look for polymorphisms segregating with gPRA in the English cocker spaniel, Labrador retriever, miniature poodle, miniature long-haired dachshund, Tibetan terrier, miniature schnauzer, Cardigan Welsh corgi and Irish wolfhound. Further investigation involved DNA sequencing and restriction fragment length polymorphism (RFLP) analysis. Our studies revealed the presence of three polymorphisms, none of which segregated with disease phenotype. Haplotype analysis identified four rom-1 alleles. Our results indicate that rom-1 is unlikely to be a cause of gPRA in the breeds of dog examined.     

Rates of change in peak expiratory flow and in diurnal variation in peak flow in patients recovering from acute severe asthma

Reexpression of the insulin-like growth factor type II (IGF-II) gene has recently been described in hepatocellular carcinoma (HCC). In this study, we used a nonisotopic in situ hybridization method to analyze the expression of IGF-II mRNA in a series of 28 HCCs arising on cirrhotic and noncirrhotic livers. An immunohistochemical method was used to detect IGF-II peptide. Hepatitis B virus (HBV) status and the histological differentiation degree were also evaluated. Increased expression of IGF-II mRNA was found in 4 of 28 HCCs, and 7 of 17 cirrhotic patients showed IGF-II mRNA in the cirrhotic nodules surrounding the HCC. A slightly higher rate of positivity for IGF-II mRNA was found in the HBV-negative patients than in HBV-positive ones. Positive immunostaining for the IGF-II peptide in the HCC and/or in surrounding cirrhotic nodules was found in 10 of 28 cases. The normal hepatocytes of the noncirrhotic patients were always negative for IGF-II peptide and mRNA. The similarities between our results and those from experimental models in woodchucks seem to support the concept that heterogeneous phenotypic groups could exist in human HCCs.     

Specific bronchial provocation tests with flour in the diagnosis of occupational bronchial asthma

The gold standard in the diagnosis of occupational asthma is the specific bronchial provocation test (sBPT), but other diagnostic criteria have been proven to have a similar sensitivity, mainly in asthma due to high molecular weight compounds. In order to assess wether some clinical findings can predict the positive response to sBPT, we studied 37 subjects (14 millers and 23 bakers) with suspected occupational asthma who underwent sBPT with wheat flour dust (dust exposure in a small cabin: geometric mean 12.1 mg/m3 for up to 30 min). A positive response to sBPT (FEV1 > 20%) was elicited in 20 subjects (11 early, 4 late, and 5 dual responses). There was no significant difference between subjects with positive or negative sBPT as regards mean age, smoking, length of employment, duration of symptoms, atopy (skin positivity to one or more common allergens) and PD20FEV1 methacholine. The percentage of subjects with work-related symptoms was significantly higher in subjects with positive sBPT with respect to subjects with negative sBPT (81% versus 41.2%, p < 0.01 by chi 2 test); furthermore, FEV1 was significantly lower in subjects with positive sBPT. The percentage of positive skin response to wheat flour extract (mean wheal diameter > or = 3 mm) was mildly but not significantly higher in subjects with positive sBPT (68.4% versus 41.2%). None of the following clinical factors (age < 35 years, asthma symptoms pre-existing occupational exposure, non smokers, atopy and bronchial hyperresponsiveness to methacholine), alone or in combination, were associated with higher prevalence of positive sBPT. We conclude that the response to sBPT in subjects with suspected occupational asthma due to flour dust can not be adequately predicted by other clinical, allergologic and functional data. Therefore, sBPT with flour dust should always be performed in subjects with suspected occupational asthma.     

Peak expiratory flow rate (PEF) and serum eosinophil cationic protein (ECP) changes in nocturnal asthmatics

We have investigated the serum ECP and peak expiratory flow rate in 20 patients with nocturnal asthma. Changes of PEF were measured in every 2 hours around the whole day, and the blood samples were obtained at 4:00 and 16:00 to measure the serum ECP level and the peripheral Eo numbers. In addition, 10 asthmatics as well as normal subjects received methacholine challenge at 4:00 and 16:00. It was found that the PEF reached the lowest point at 4:00 and obviously less than that at 16:00 (187.50 +/- 120.31 L/min vs 313.00 +/- 108.14 L/min, P < 0.05), that the airway reactivity at 4:00 was significantly higher than at 16:00 (P < 0.05) and the difference of MCH-PC20 between the two time points was 0.34 +/- 0.31 mg/ml, that the serum ECP level at 4:00 was obviously higher than that at 16:00 (11.14 +/- 7.40 micrograms/ml vs 5.49 +/- 4.12 micrograms/ml, P < 0.05). The change rate of PEF markedly related to the change of serum ECP between the two time points (r = 0.61, P < 0.05). The findings suggested that the activation of Eo and its release of ECP might be effect of the circadian-rhythmic change of pulmonary functions in nocturnal asthma.     

Psychopathology and psychotherapy in bronchial asthma

The Chinese medicinal herb Chueh-ming-tzu, seeds of Cassia tora (Leguminosae) Linn., elicits hypotensive effects in anesthetized rats. Experimental results indicate that the hypotensive effect of the Cassia tora extract possibly involves a vagal reflex which reciprocally alters the vasomotor tone of the centrally emanating sympathetic nervous system. It is shown that the capacity of the Cassia tora extract to reduce blood pressure is significantly reduced in vagotomized rats and that hypotensive effects are greatly antagonized in rats whose sympathetic nervous systems are interrupted by transection of the spinal cord.     

Influence of antimicrobial chemotherapy on spirometric parameters and pro-inflammatory indices in severe pulmonary tuberculosis

Several proteins, which are recognized components of serum, are not resolved by two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) under standard conditions. One major example is fibronectin, which is detected in fairly high concentration (milligram range) by immunoassays, while undetectable in 2D-PAGE gels. Following several experiments with a combination of zwitterionic and chaotropic substances we obtained a good resolution of the protein in gels containing 0.5 M thiourea plus 8 M urea. By this technique, fibronectin was, for the first time, found to be microheterogeneous between pl values of 5.3 and 5.6. Besides fibronectin we detected three other families of uncharacterized proteins with Mr of 130000, 110000 and 34000 respectively, whose identity and function are currently under investigation.     

Advances in the management of bronchial asthma

The ultrastructure of rat precorneal tear film was visualized by the quick freezing-freeze substitution (QF-FS) method and the conventional fixative method under the scanning electron microscope (SEM). In the QF-FS method, the eyeballs of rats were quickly frozen with an isopentane-propane mixture cooled by liquid nitrogen applied directly to the eyes. After enucleating the eyes and fracturing the frozen corneas, the corneas were prepared for SEM observation. In contrast to the conventional fixative method, by which the microvilli of the surface epithelial cells could be visualized clearly, a very thin membrane-like structure was observed to cover the corneal surface in the eyes prepared by the QF-Fs method. Between the membrane-like structure and corneal surface, a homogeneous and fine network-like structure was observed. The results suggest that the structure of the tear film might be different from the one we have believed to consist of three layers until now. The QF-FS method is considered to be useful for the morphological study of the precorneal tear film.