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Claudio Tantucci - One of the best experts on this subject based on the ideXlab platform.
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expiratory flow limitation is associated with Orthopnea and reversed by vasodilators and diuretics in left heart failure
Chest, 2005Co-Authors: E Boni, Michela Bezzi, L Carminati, Luciano Corda, V Grassi, Claudio TantucciAbstract:Background In patients with acute left heart failure (LHF), Orthopnea has also been related to the occurrence or worsening of expiratory flow limitation (EFL) in the supine position. We wished to assess whether short-term treatment with vasodilators and diuretics was able to abolish supine EFL and whether this could help to control Orthopnea in patients with acute LHF Methods In nine nonobese ( ie , mean [± SD] body mass index, 24 ± 5 kg/m 2 ), never-smoker patients (two men and seven women; mean age, 77 ± 7 years) with acute LHF (mean ejection fraction, 43 ± 15%), we assessed EFL by the negative expiratory pressure method and dyspnea by the Borg scale, with patients in both the seated and supine positions, before and after short-term treatment with vasodilators and diuretics until hospital discharge. Orthopnea was defined as a positive difference in the Borg score between measurements made with the patient in the supine and seated positions. Postural variations in the end-expiratory lung volume were inferred from changes in inspiratory capacity (IC) that were measured under the same circumstances Results Before treatment, with the patient in the seated position the mean dyspnea score was 1.5 ± 0.5, the mean IC was 1.49 ± 0.38 L, seven patients were non-flow-limited, and two patients were flow-limited. During recumbency, the mean dyspnea score was 2.7 ± 0.5 (p Conclusions Our results indicate that short-term treatment with vasodilators and diuretics is able to control Orthopnea and to remove supine EFL in most patients with acute LHF, suggesting a posture-related increase in bronchial obstruction as the main mechanism of EFL, which appears to play a role in the occurrence and severity of Orthopnea in these circumstances
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expiratory flow limitation and Orthopnea in massively obese subjects
Chest, 2001Co-Authors: Anna Ferretti, J Milicemili, Pietro Giampiccolo, Alberto Cavalli, Claudio TantucciAbstract:Background: Morbidly obese subjects, who often complain about breathlessness when lying down, breathe at low lung volume with a reduced expiratory reserve volume (ERV). Therefore, during tidal breathing the expiratory flow reserve is decreased, promoting expiratory flow limitation (EFL), which is more likely to occur in the supine position, when the relaxation volume of the respiratory system, and hence the functional residual capacity (FRC), decrease because of the gravitational effect of the abdominal contents. Purpose: The aim of the study was to assess EFL and Orthopnea in massively obese subjects and to evaluate whether Orthopnea was associated with the development of supine EFL. Methods: In 46 healthy obese subjects (18 men) with a mean (6 SD) age of 44 6 11 years and a mean body mass index (BMI) of 51 6 9 kg/m 2 , we assessed EFL in both the seated and the supine positions by the negative expiratory pressure method and assessed postural changes in FRC by measuring the variations in the inspiratory capacity (IC) with recumbency. Simultaneously, dyspnea was evaluated in either position using the Borg scale dyspnea index (BSDI) to determine the presence of Orthopnea, which was defined as any increase of the BSDI in the supine position. Results: Partial EFL was detected in 22% and 59%, respectively, of the overall population in seated and supine position. The mean increase in the supine IC amounted to 120 6 200 mL (4.1 6 6.4%), indicating a limited decrease in FRC with recumbency in these subjects. Orthopnea, although mild (mean BSDI, 1.7 6 1.3), was claimed by 20 subjects, and in 15 of them EFL occurred or worsened in the supine position. Orthopnea was associated with lower values of seated ERV (p < 0.05) and was marginally related to supine EFL values (p 5 0.07). No significant effect of age, BMI, obstructive sleep apnea-hypopnea syndrome, FEV1, and forced expiratory flow at 75% of vital capacity was found on either Orthopnea or EFL. Conclusion: In morbidly obese subjects, EFL and dyspnea frequently occur with the subject in the supine position, and both supine EFL and low-seated ERV values are related to Orthopnea, suggesting that dynamic pulmonary hyperinflation and intrinsic positive end-expiratory pressure may be partly responsible for Orthopnea in massively obese subjects. (CHEST 2001; 119:1401‐1408)
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expiratory flow limitation as a determinant of Orthopnea in acute left heart failure
Journal of the American College of Cardiology, 2000Co-Authors: Alexandre Duguet, Claudio Tantucci, Olivier Lozinguez, Richard Isnard, Daniel Thomas, Marc Zelter, Jeanphilippe Derenne, J Milicemili, Thomas SimilowskiAbstract:Abstract OBJECTIVES To assess the contribution of expiratory flow limitation (FL) in Orthopnea during acute left heart failure (LHF). BACKGROUND Orthopnea is typical of acute LHF, but its mechanisms are not completely understood. In other settings, such as chronic obstructive pulmonary disease, dyspnea correlates best with expiratory FL and can, therefore, be interpreted as, in part, the result of a hyperinflation-related increased load to the inspiratory muscles. As airway obstruction is common in acute LHF, postural FL could contribute to Orthopnea. METHODS Flow limitation was assessed during quiet breathing by applying a negative pressure at the mouth throughout tidal expiration (negative expiratory pressure [NEP]). Flow limitation was assumed when expiratory flow did not increase during NEP. Twelve patients with acute LHF aged 40–98 years were studied seated and supine and compared with 10 age-matched healthy subjects. RESULTS Compared with controls, patients had rapid shallow breathing with slightly increased minute ventilation and mean inspiratory flow. Breathing pattern was not influenced by posture. Flow limitation was observed in four patients when seated and in nine patients when supine. In seven cases, FL was induced or aggravated by the supine position. This coincided with Orthopnea in six cases. Only one out of the five patients without Orthopnea had posture dependent FL. Control subjects did not exhibit FL in either position. CONCLUSIONS Expiratory FL appears to be common in patients with acute LHF, particularly so when Orthopnea is present. Its postural aggravation could contribute to LHF-related Orthopnea.
J Milicemili - One of the best experts on this subject based on the ideXlab platform.
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Orthopnea and tidal expiratory flow limitation in chronic heart failure
Chest, 2006Co-Authors: Roberto Torchio, Alberto Perboni, Carlo Gulotta, Heberto Ghezzo, Pietro Grecolucchina, Luigina Avonto, J MilicemiliAbstract:Background Tidal expiratory flow limitation (FL) is common in patients with acute left heart failure and contributes significantly to Orthopnea. Whether tidal FL exists in patients with chronic heart failure (CHF) remains to be determined. Purpose To measure tidal FL and respiratory function in CHF patients and their relationships to Orthopnea. Methods In 20 CHF patients (mean [± SD] ejection fraction, 23 ± 8%; mean systolic pulmonary artery pressure [sPAP], 46 ± 18 mm Hg; mean age, 59 ± 11 years) and 20 control subjects who were matched for age and gender, we assessed FL, Borg score, spirometry, maximal inspiratory pressure (Pimax), mouth occlusion pressure 100 ms after the onset of inspiratory effort (P 0.1 ), and breathing pattern in both the sitting and supine positions. The Medical Research Council score and Orthopnea score were also determined. Results In the sitting position, tidal FL was absent in all patients and healthy subjects. In CHF patients, Pimax was reduced, and ventilation and P 0.1 /Pimax ratio was increased relative to those of control subjects. In the supine position, 12 CHF patients had FL and 18 CHF patients claimed Orthopnea with a mean Borg score increasing from 0.5 ± 0.7 in the sitting position to 2.7 ± 1.5 in the supine position in CHF patients. In contrast, Orthopnea was absent in all control subjects. The FL patients were older than the non-FL patients (mean age, 63 ± 8 vs 53 ± 12 years, respectively; p 0.1 /Pimax ratio and the effective inspiratory impedance increased more in CHF patients than in control subjects. The best predictors of Orthopnea in CHF patients were sPAP, supine Pimax, and the percentage change in inspiratory capacity (IC) from the seated to the supine position ( r 2 = 0.64; p Conclusions In sitting CHF patients, tidal FL is absent but is common supine. Supine FL, together with increased respiratory impedance and decreased inspiratory muscle force, can elicit Orthopnea, whom independent indicators are sPAP, supine Pimax and change in IC percentage.
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expiratory flow limitation and Orthopnea in massively obese subjects
Chest, 2001Co-Authors: Anna Ferretti, J Milicemili, Pietro Giampiccolo, Alberto Cavalli, Claudio TantucciAbstract:Background: Morbidly obese subjects, who often complain about breathlessness when lying down, breathe at low lung volume with a reduced expiratory reserve volume (ERV). Therefore, during tidal breathing the expiratory flow reserve is decreased, promoting expiratory flow limitation (EFL), which is more likely to occur in the supine position, when the relaxation volume of the respiratory system, and hence the functional residual capacity (FRC), decrease because of the gravitational effect of the abdominal contents. Purpose: The aim of the study was to assess EFL and Orthopnea in massively obese subjects and to evaluate whether Orthopnea was associated with the development of supine EFL. Methods: In 46 healthy obese subjects (18 men) with a mean (6 SD) age of 44 6 11 years and a mean body mass index (BMI) of 51 6 9 kg/m 2 , we assessed EFL in both the seated and the supine positions by the negative expiratory pressure method and assessed postural changes in FRC by measuring the variations in the inspiratory capacity (IC) with recumbency. Simultaneously, dyspnea was evaluated in either position using the Borg scale dyspnea index (BSDI) to determine the presence of Orthopnea, which was defined as any increase of the BSDI in the supine position. Results: Partial EFL was detected in 22% and 59%, respectively, of the overall population in seated and supine position. The mean increase in the supine IC amounted to 120 6 200 mL (4.1 6 6.4%), indicating a limited decrease in FRC with recumbency in these subjects. Orthopnea, although mild (mean BSDI, 1.7 6 1.3), was claimed by 20 subjects, and in 15 of them EFL occurred or worsened in the supine position. Orthopnea was associated with lower values of seated ERV (p < 0.05) and was marginally related to supine EFL values (p 5 0.07). No significant effect of age, BMI, obstructive sleep apnea-hypopnea syndrome, FEV1, and forced expiratory flow at 75% of vital capacity was found on either Orthopnea or EFL. Conclusion: In morbidly obese subjects, EFL and dyspnea frequently occur with the subject in the supine position, and both supine EFL and low-seated ERV values are related to Orthopnea, suggesting that dynamic pulmonary hyperinflation and intrinsic positive end-expiratory pressure may be partly responsible for Orthopnea in massively obese subjects. (CHEST 2001; 119:1401‐1408)
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expiratory flow limitation as a determinant of Orthopnea in acute left heart failure
Journal of the American College of Cardiology, 2000Co-Authors: Alexandre Duguet, Claudio Tantucci, Olivier Lozinguez, Richard Isnard, Daniel Thomas, Marc Zelter, Jeanphilippe Derenne, J Milicemili, Thomas SimilowskiAbstract:Abstract OBJECTIVES To assess the contribution of expiratory flow limitation (FL) in Orthopnea during acute left heart failure (LHF). BACKGROUND Orthopnea is typical of acute LHF, but its mechanisms are not completely understood. In other settings, such as chronic obstructive pulmonary disease, dyspnea correlates best with expiratory FL and can, therefore, be interpreted as, in part, the result of a hyperinflation-related increased load to the inspiratory muscles. As airway obstruction is common in acute LHF, postural FL could contribute to Orthopnea. METHODS Flow limitation was assessed during quiet breathing by applying a negative pressure at the mouth throughout tidal expiration (negative expiratory pressure [NEP]). Flow limitation was assumed when expiratory flow did not increase during NEP. Twelve patients with acute LHF aged 40–98 years were studied seated and supine and compared with 10 age-matched healthy subjects. RESULTS Compared with controls, patients had rapid shallow breathing with slightly increased minute ventilation and mean inspiratory flow. Breathing pattern was not influenced by posture. Flow limitation was observed in four patients when seated and in nine patients when supine. In seven cases, FL was induced or aggravated by the supine position. This coincided with Orthopnea in six cases. Only one out of the five patients without Orthopnea had posture dependent FL. Control subjects did not exhibit FL in either position. CONCLUSIONS Expiratory FL appears to be common in patients with acute LHF, particularly so when Orthopnea is present. Its postural aggravation could contribute to LHF-related Orthopnea.
Joseph Milicemili - One of the best experts on this subject based on the ideXlab platform.
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Orthopnea and tidal expiratory flow limitation in patients with stable copd
Chest, 2001Co-Authors: Loubna Eltayara, Heberto Ghezzo, Joseph MilicemiliAbstract:Background: Orthopnea is a common feature in COPD patients, although its nature is poorly understood. Objective: To study the role of tidal expiratory flow limitation (FL) in the genesis of Orthopnea in patients with stable COPD. Measurements: Tidal FL was assessed in 117 ambulatory COPD patients in sitting and supine positions using the negative expiratory pressure method. The presence or absence of Orthopnea was also noted. Results and conclusions: In patients with stable COPD with tidal expiratory FL in seated and/or supine position, there is a high prevalence of Orthopnea, which probably results in part from increased inspiratory efforts due to dynamic pulmonary hyperinflation and the concomitant increase in inspiratory threshold load due to intrinsic positive end-expiratory pressure. Increased airway resistance in supine position due to lower end-expiratory lung volume probably also plays a role in the genesis of Orthopnea. (CHEST 2001; 119:99 ‐104)
Heberto Ghezzo - One of the best experts on this subject based on the ideXlab platform.
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Orthopnea and tidal expiratory flow limitation in chronic heart failure
Chest, 2006Co-Authors: Roberto Torchio, Alberto Perboni, Carlo Gulotta, Heberto Ghezzo, Pietro Grecolucchina, Luigina Avonto, J MilicemiliAbstract:Background Tidal expiratory flow limitation (FL) is common in patients with acute left heart failure and contributes significantly to Orthopnea. Whether tidal FL exists in patients with chronic heart failure (CHF) remains to be determined. Purpose To measure tidal FL and respiratory function in CHF patients and their relationships to Orthopnea. Methods In 20 CHF patients (mean [± SD] ejection fraction, 23 ± 8%; mean systolic pulmonary artery pressure [sPAP], 46 ± 18 mm Hg; mean age, 59 ± 11 years) and 20 control subjects who were matched for age and gender, we assessed FL, Borg score, spirometry, maximal inspiratory pressure (Pimax), mouth occlusion pressure 100 ms after the onset of inspiratory effort (P 0.1 ), and breathing pattern in both the sitting and supine positions. The Medical Research Council score and Orthopnea score were also determined. Results In the sitting position, tidal FL was absent in all patients and healthy subjects. In CHF patients, Pimax was reduced, and ventilation and P 0.1 /Pimax ratio was increased relative to those of control subjects. In the supine position, 12 CHF patients had FL and 18 CHF patients claimed Orthopnea with a mean Borg score increasing from 0.5 ± 0.7 in the sitting position to 2.7 ± 1.5 in the supine position in CHF patients. In contrast, Orthopnea was absent in all control subjects. The FL patients were older than the non-FL patients (mean age, 63 ± 8 vs 53 ± 12 years, respectively; p 0.1 /Pimax ratio and the effective inspiratory impedance increased more in CHF patients than in control subjects. The best predictors of Orthopnea in CHF patients were sPAP, supine Pimax, and the percentage change in inspiratory capacity (IC) from the seated to the supine position ( r 2 = 0.64; p Conclusions In sitting CHF patients, tidal FL is absent but is common supine. Supine FL, together with increased respiratory impedance and decreased inspiratory muscle force, can elicit Orthopnea, whom independent indicators are sPAP, supine Pimax and change in IC percentage.
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Orthopnea and tidal expiratory flow limitation in patients with stable copd
Chest, 2001Co-Authors: Loubna Eltayara, Heberto Ghezzo, Joseph MilicemiliAbstract:Background: Orthopnea is a common feature in COPD patients, although its nature is poorly understood. Objective: To study the role of tidal expiratory flow limitation (FL) in the genesis of Orthopnea in patients with stable COPD. Measurements: Tidal FL was assessed in 117 ambulatory COPD patients in sitting and supine positions using the negative expiratory pressure method. The presence or absence of Orthopnea was also noted. Results and conclusions: In patients with stable COPD with tidal expiratory FL in seated and/or supine position, there is a high prevalence of Orthopnea, which probably results in part from increased inspiratory efforts due to dynamic pulmonary hyperinflation and the concomitant increase in inspiratory threshold load due to intrinsic positive end-expiratory pressure. Increased airway resistance in supine position due to lower end-expiratory lung volume probably also plays a role in the genesis of Orthopnea. (CHEST 2001; 119:99 ‐104)
Loubna Eltayara - One of the best experts on this subject based on the ideXlab platform.
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Orthopnea and tidal expiratory flow limitation in patients with stable copd
Chest, 2001Co-Authors: Loubna Eltayara, Heberto Ghezzo, Joseph MilicemiliAbstract:Background: Orthopnea is a common feature in COPD patients, although its nature is poorly understood. Objective: To study the role of tidal expiratory flow limitation (FL) in the genesis of Orthopnea in patients with stable COPD. Measurements: Tidal FL was assessed in 117 ambulatory COPD patients in sitting and supine positions using the negative expiratory pressure method. The presence or absence of Orthopnea was also noted. Results and conclusions: In patients with stable COPD with tidal expiratory FL in seated and/or supine position, there is a high prevalence of Orthopnea, which probably results in part from increased inspiratory efforts due to dynamic pulmonary hyperinflation and the concomitant increase in inspiratory threshold load due to intrinsic positive end-expiratory pressure. Increased airway resistance in supine position due to lower end-expiratory lung volume probably also plays a role in the genesis of Orthopnea. (CHEST 2001; 119:99 ‐104)
