4P
Medical Research Society
SRIlUMd, ANTITRYFSIN FUNCTION I N CIPEONIC
BRONCHITIS: COMPARISON WITH LUNG LAVAGE AND
THE EFFECT OF CORTIWSTEROIDS
H. M. K)RRISON, S. C.
AFFl)RD
AND R. A. SlDCKLEX
The General Hospital, Birmingham
Alphal a n t i t r y p s i n (dlAT) i s thought t o be t h e
main a l v e o l a r i n h i b i t o r and a major bronchial
i n h i b i t o r of p r o t e o l y t i c enzymes. It t h e r e f o r e
plays an important r o l e i n t h e p r o t e c t i o n of
lung t i s s u e from damage by p r o t e o l y t i c enzymes.
R e v i o u s s t u d i e s (Wiggins e t al, Thorax 1982;
652) have shown t h a t c o r t i c o s t e r o i d s reduce
t h e concentration o f d AT i n lung secretions.
The present study was Aesigned t o i n v e s t i g a t e
the i n h i b i t o r y f u n c t i o n ofJIAT before and
during s t e r o i d therapy and compare sputum
r e s u l t s with those obtained from bronchoalveolar lavage f l u i d s (BAL) i n t h e same subjects.
Secretions from 21 p a t i e n t s with chronic obstru c t i v e b r o n c h i t i s were assessed f o r t h e i r a b i l i t y t o i n h i b i t porcine p a n c r e a t i c e l a s t a s e
(PPE) and expressed as t h e amount inhibited/pg
AT using t h e s y n t h e t i c s u b s t r a t e Succ Ala
pha. The average i n h i b i t o r y a c t i v i t y of t h a
sputum samples f p a l l a t i e n t s w a s 0.199 pg
PPE/wdlAT (SD
0.145f.
For t h e 11 p a t i e n t s
studied before and.during s t e r o i d therapy (40
m g Rednisons/day) t h e i n h i b i t o r y c a p a c i t y rose
2p(+O.O5) within 6 days from 0.165 d p g d AT
[SD 0.098) t o 0.283 pg/pg 4 AT (SD 0.206)
suggesting a b e n e f i c i a l e f f e c i of s t e r o i d s on
t h e i n h i b i t o r y f u n c t i o n ofdIAT. I n t h e rema i n i n g 10 p a t i e n t s t h e i n h i b i t o r y f u n c t i o n was
compared i n sputum and BAL'fluids c o l l e c t e d on
t h e same day. The i n h i b i t o r y c a p a c i t y w a s
found t o be higher i n sputum t h a n BAL ( ~ 4 0 . 9 5 )
with average values of 0.236
4 AT (SD
0.183) and 0.102 p&gd AT &
y
0
.
1
0
4
)
r e s p e c t i v e l y suggesting d i f f e r e n t f a c t o r s ina c t i v a t e l u n g d l A T i n d i f f e r e n t regions of t h e
bronchial t r e e .
x,
-
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-
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10
LmwrcRIsco r ~ ~ s
OF w
FIJAVVOWA~
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L(xIL.S KU M E I H PWS;EiWXPlcXJ .\A
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3. J. JUINGS, M A . KING, J .B.b~M&?d
AN0 I;.Pl.CXHRANe:
Dep'i. of R s p i r s t o r y A e i c i n e
Guy's i l o s p i t a l , London 521 9Ri'
Flow/volume ( f / v ) loops,
r e s i d u a l volume
and t o t a l lung capacity a r e useful wnen
assessing lung function. ;qe have d e v e l o p 3 a
computer
program wnicn
grescnts
tnzs;.
quancities
together i n 9 graphical
form,
highlighting v a r i a t i o n from predict53 values
an4 the e f f e c t s of b r o n c n o j i l a t o r s . t i ? have
a l s o t r i e d to overcome the d i f € i c u l t i c s of
o o t a i n i n g rcproduciole f/v loops froin p t i e n t s
unfamiliar w i t h the necessary .nmo?uvro.
(RV)
OJC
progr.in plots two 3r3pns,
e3.x
WltO
t n e b s e l i n e (pce-bronznoiliator) f / v loop a t
the. c o r r e c t p s i t i o n on tne v0~01u.m~a x i s (RV
measured s e p a r a t e l y ) . Ihe p a t i e n t ' s predicted
loop is superimposed on the f i r s t graph and the
post-bronchodilator
loop on the second. .mese
graphs a r e p r i n t e d w i t h the f u l l lung function
r e p o r t on A4 paper. .&ring measurement e i g h t
loops may be stored and compared to ensure t h s t
the loop recorded is r e p r d u c i b l e .
Whilst
recording a f t e r bronchodilation t h e b a s e l i n e
loop may be r e c a l l e d .
The system, which uses no more equipnent
than a complterised plethysmograph, has been
working r e l i a b l y f o r s e v e r a l months. With t h i s
p r e s e n t a t i o n , changes i n lung function a r e
r e a d i l y appreciated, even by m n s p e c i a l i s t s .
'The ease w i t h which f/v loops a r e o b t a i n 4 and
compared enables the technician to concentrate
on p a t i e n t technique.
11
IDIOSYNCRATIC RESPONSE
TO HIGH ALTITUDE
A.R.
BRADWELL AND P.J.G.
FORSTER
Department of Immunology, Birmingham
Medical School, Birmingham B15 and
Department of Pathology, Royal Liverpool
Hospital, Liverpool L69
Anecdotal r e p o r t s have i n d i c a t e d t h a t
i n d i v i d u a l s react t o high a l t i t u d e exposure i n
an i n h e r e n t l y c h a r a c t e r i s t i c manner: t h i s has
proved d i f f i c u l t t o s u b s t a n t i a t e under
c o n t r o l l e d conditions.
The response t o successive high a l t i t u d e
a s c e n t s has been studied i n personnel manning
t h e United Kingdom I n f r a r e d Telescope on Mauna
Kea ( e l e v a t i o n 4 2 0 0 m ) . Telescope s t a f f l i v e
a t sea l e v e l and work f o r f i v e day ' s h i f t s '
on t h e mountain.
Although some w o r k e r s were symptom free,
w h i l s t o t h e r s s u f f e r e d a c u t e mountain sickness
(AMS), t h e r e was a s i g n i f i c a n t c o r r e l a t i o n i n
t h e rank order OC eighteen s u b j e c t s l i s t e d
according t o AMS symptom scores on t w o
s e p a r a t e ' s h i f t s ' (P <0.001: Kendall's rank
correlation).
A r t e r i a l oxygen l e v e l s (Pa021 were
measured on t h e f i r s t and l a s t days of twc
'shifts'.
There was no d i f f e r e n c e within an
individual for Pa02 values between t h e two
a s c e n t s (paired t - t e s t ) , despite a range of
Pa02 recorded i n t h e group of 4.4-7.6 kPa on
Day 1 and 4.9-7.8 kPa on Day 5. There w a s a
s i g n i f i c a n t c o r r e l a t i o n between t h e s h i f t
workers' Pa02 rank order on t h e two a s c e n t s
(P < 0 . 0 5 ) .
Within each s u b j e c t , t h e r e was concordance
i n t h e psychometric t e s t s c o r e s (Wechsler d i g i t
s p a n ) and physiological chanqes (systemic blood
pressure, r e s p i r a t o r y r a t e , pulse r a t e , blood
and u r i n e pH) recorded on each a s c e n t .
We conclude t h a t sea l e v e l r e s i d e n t s show
a n i d i o s y n c r a t i c r e s w n s e t o t h e hypcxia of
hich altitude.