PHYSIOLOGIC FACTORS IN THE TREATMENT OF CHRONIC HYPERTROPHIC PULMONARY EMPHYSEMA

Abstract

In 21 patients with pulmonary emphysema, a significant fall in the resting pulmonary ventilation was observed while breathing 100% O2 in contrast to the normal controls who exhibited no change. This decrease in the minute ventilation offered an explanation for the elevation in the arterial CO2 concn. Four patients in this group exhibited mental changes, accompanied by a marked increase in the arterial CO2 tension and an acid shift in the blood pH. Analysis of previously published data, as well as the results of our own studies, would seem to indicate that respiratory acidosis is the critical factor in the alteration in mental function, rather than CO2 retention without acidosis. These studies confirm the desirability of a program of O2 treatment in which the percentage of O2 administered is gradually increased over a period of a week or 10 days in order to prevent respiratory acidosis and mental changes. Spirographic studies following the orad admn. of aminophyllin indicate that this drug is of value in the treatment of bronchospasm in most patients with pulmonary emphysema, provided it is administered on an empty stomach. An increase of 45.8% in maximal breathing capacity was demonstrated 1 hr. after ingestion in 15 patients. The beneficial results of inhalation of nebulized epinephrin were confirmed in this study. Various technics which tend to decrease overinf lation of the lungs were descr. including manual elevation of the diaphragm, pursed lip and diaphragmatic breathing, abdominal belts and pneumoperitoneum.