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哮喘患者在二氧化氮环境中运动后的肺功能、气道反应性及呼吸道症状

Pulmonary function, airway responsiveness, and respiratory symptoms in asthmatics following exercise in NO2.

作者信息

Roger L J, Horstman D H, McDonnell W, Kehrl H, Ives P J, Seal E, Chapman R, Massaro E

机构信息

Clinical Research Branch, US Environmental Protection Agency, Research Triangle Park, NC.

出版信息

Toxicol Ind Health. 1990 Jan;6(1):155-71. doi: 10.1177/074823379000600110.

Abstract

Two experiments were conducted to determine respiratory responses of persons with asthma performing intermittent moderate exercise while exposed to low concentrations of NO2. In the first, preliminary experiment, 13 male subjects, aged 19-35, with mild asthma were exposed on separate days in a chamber (natural breathing, 20 degrees C, 40% RH) to 0.30 ppm NO2 and to a control or "clean air" exposure (0.0 ppm NO2). Exposure included three 10-min periods of moderate treadmill exercise (VE = 44.5 liter/min), each followed by symptom measurement and pulmonary function testing. The average decrease in FEV1 following the initial 10 min exercise in 0.30 ppm was 11% which was significantly greater (p less than 0.05) than that observed in clean air (7%). Differences in FVC and SRaw were not significantly different at this time. Slight cough and dry mouth and throat were apparent only after the first exercise in NO2. After the second and third exercises, decreases in FEV1 and FVC and increases in SRaw were significantly greater in 0.30 than in 0.0 ppm NO2. Individual subject responses were variable. These results suggested that some asthmatics who perform moderate exercise while exposed to 0.30 ppm NO2 may experience bronchoconstriction and reduction in spirometric performance. Because of these preliminary findings, a more comprehensive, concentration-response experiment was conducted. Twenty-one male volunteers with mild asthma were exposed for 75 min with natural breathing to 0.0, 0.15, 0.30, and 0.60 ppm NO2. Exposure included three 10-min periods of moderate treadmill exercise (VE = 43 liter/min), each exercise followed by symptoms measurement and pulmonary function testing. In addition, airway responsiveness was measured two hr after each exposure by methacholine bronchial challenge testing. In the control exposures (0.0 ppm NO2), the exercise alone caused substantial decrements in pulmonary function. These decrements (as measured by decreases in FEV1 and FVC, and increases in SRaw) were not increased relative to the control exposure after any exercise session in any concentration of NO2. Furthermore, there was no overall group-averaged indication of a concentration-related effect of the NO2 on pulmonary function. Likewise, symptoms reported after NO2 exposure were not significantly different from those reported in clean air. Group-averaged airway responsiveness after exercise in NO2 was also not different from responsiveness after exercise in clean air. For only two subjects was there any indication of a concentration-related increase in airway responsiveness due to exposure to NO2.(ABSTRACT TRUNCATED AT 400 WORDS)

摘要

进行了两项实验,以确定哮喘患者在暴露于低浓度二氧化氮(NO₂)的情况下进行间歇性适度运动时的呼吸反应。在第一个初步实验中,13名年龄在19至35岁之间的轻度哮喘男性受试者,在不同日期于一个舱室(自然呼吸,20摄氏度,40%相对湿度)中分别暴露于0.30 ppm的NO₂以及对照或“清洁空气”暴露(0.0 ppm NO₂)。暴露过程包括三个10分钟的适度跑步机运动时段(每分钟通气量[VE]=44.5升),每个时段之后进行症状测量和肺功能测试。在0.30 ppm环境中最初10分钟运动后,第一秒用力呼气量(FEV₁)的平均下降为11%,这显著大于(p<0.05)在清洁空气中观察到的下降(7%)。此时用力肺活量(FVC)和比气道阻力(SRaw)的差异无统计学意义。仅在NO₂环境中的第一次运动后出现了轻微咳嗽以及口干和咽干。在第二次和第三次运动后,0.30 ppm环境中FEV₁和FVC的下降以及SRaw的增加显著大于0.0 ppm NO₂环境中的情况。个体受试者的反应存在差异。这些结果表明,一些哮喘患者在暴露于0.30 ppm NO₂的情况下进行适度运动时,可能会出现支气管收缩以及肺量计测量表现的下降。基于这些初步发现,进行了一项更全面的浓度-反应实验。21名患有轻度哮喘的男性志愿者在自然呼吸状态下暴露于0.0、0.15、0.30和0.60 ppm的NO₂中75分钟。暴露过程包括三个10分钟的适度跑步机运动时段(VE = 43升/分钟),每次运动后进行症状测量和肺功能测试。此外,在每次暴露后两小时通过乙酰甲胆碱支气管激发试验测量气道反应性。在对照暴露(0.0 ppm NO₂)中,仅运动就导致肺功能大幅下降。在任何浓度的NO₂环境中,任何运动时段后这些下降(通过FEV₁和FVC的下降以及SRaw的增加来衡量)相对于对照暴露均未增加。此外,没有总体的组平均数据表明NO₂对肺功能有浓度相关效应。同样,NO₂暴露后报告的症状与清洁空气中报告的症状无显著差异。在NO₂环境中运动后的组平均气道反应性也与清洁空气中运动后的反应性无差异。只有两名受试者有任何迹象表明由于暴露于NO₂而出现与浓度相关的气道反应性增加。(摘要截选至400字)

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