Toda M, Motojima S, Fukuda T, Makino S
Department of Medicine and Clinical Immunology, Dokkyo University School of Medicine, Tochigi, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1991 Apr;29(4):460-8.
Cases of chronic pulmonary emphysema accompanied with paroxysmal dyspnea attacks are often misdiagnosed as bronchial asthma. These patients repeatedly fall into a state of life-threatening respiratory failure. We must make an accurate diagnosis of emphysema to provide care of them. To clarify the possibility of doing this, we investigated the clinical and physiological features (primarily respiratory function) of emphysema. We observed twenty-five patients with chronic pulmonary emphysema and with chronic bronchial asthma, previously confirmed by selective alveolo-bronchogram (SAB); this technique reliably diagnoses emphysema, but often induces dyspnea attacks due to the stimulation resulting from intratracheal and intrabronchial procedures. In eight patients, chronic pulmonary emphysema was accompanied by an attack of paroxysmal wheezing and dyspnea; chronic pulmonary emphysema with wheezing (WPE). In eight other patients, chronic pulmonary emphysema was present without such attacks; usual pulmonary emphysema (UPE). In the final nine patients, chronic bronchial asthma (CBA) was present, while emphysema was ruled out by means of SAB. In all patients, we measured respiratory function before and after the combination therapy of intravenous aminophylline and subcutaneous epinephrine, which followed daily oral administration of prednisolone (PAE-treatment). In the WPE group, significant increases in measurement of various respiratory functions, including VC, RV, RV/TLC%, FVC, FEV1.0, PFR and V75 (p less than .05 excluded in FEV1.0 and PFR were p less than .01), were found after the PAE-treatment, compared with the values revealed before the treatment. In the UPE group, there were few changes PAE-treatment, compared with the values revealed before the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
伴有阵发性呼吸困难发作的慢性肺气肿病例常被误诊为支气管哮喘。这些患者反复陷入危及生命的呼吸衰竭状态。我们必须准确诊断肺气肿以便为他们提供护理。为了明确这样做的可能性，我们研究了肺气肿的临床和生理特征（主要是呼吸功能）。我们观察了25例慢性肺气肿患者以及慢性支气管哮喘患者，这些患者先前已通过选择性肺泡支气管造影（SAB）确诊；该技术能可靠地诊断肺气肿，但由于气管内和支气管内操作的刺激常诱发呼吸困难发作。8例患者慢性肺气肿伴有阵发性喘息和呼吸困难发作；即喘息性肺气肿（WPE）。另外8例患者有慢性肺气肿但无此类发作；即普通肺气肿（UPE）。最后9例患者患有慢性支气管哮喘（CBA），通过SAB排除了肺气肿。对所有患者，在每日口服泼尼松龙后进行静脉注射氨茶碱和皮下注射肾上腺素的联合治疗（PAE治疗）前后测量呼吸功能。在WPE组，与治疗前的值相比，PAE治疗后各项呼吸功能指标测量值显著增加，包括肺活量（VC）、残气量（RV）、残气量/肺总量百分比（RV/TLC%）、用力肺活量（FVC）、第1秒用力呼气量（FEV1.0）、最大呼气中期流速（PFR）和75%肺活量时的流速（V75）（FEV1.0和PFR中p小于0.05的情况除外，其p小于0.01）。在UPE组，与治疗前的值相比，PAE治疗后变化不大。（摘要截断于250字）
