副鼻腔気管支炎

呼吸機能と咳嗽機転からの検討

抄録

Sinobronchitis is the term which means a combined condition of both chronic sinusitis and bronchitis. The real meaning of the word, however, has been understood as a syndrome resulted from chronic diseases of the upper and lower airways. Etiology, symptomatology and epidemiology of the disease have minutely been studied by many investigators. A recent report which described a high prevalence of chronic sinusitis in patients with panbronchiolitis implied close relationships between small airway obstruction and sinusitis. The present investigation was intended from the viewpoint of respiratory physiology of the small airways and aerodynamics of coughing.
The flow rate was measured by a hot wire flow meter. Actually expired air was measured by a Krogh spirometer. Volume change of a subject was measured by a body plethysmograph.These three variables were simultaneously recorded on a photocorder. Maximum expirations and voluntary coughs were repeated 3 times respectively on 20 male patients with chronic sinusitis aged 16 to 40. Forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1.0), maximum midexpiratory flow (MMF), maximum flows on the FV curve at 75%, 50% and 25% of the vital capacity (V75, V50, V25), their corrected values by body height (V75/Ht, V50/Ht, V25/Ht) and MMF in coughing were calculated from the recorded data. The variables were widely scattered but the most impressive tendency was the decrease of V25/Ht in these patients.
Low velocities in coughing, characterized by low MMF in coughing, are correlated with decreased V25/Ht. This is explained from the following facts. Firstly, coughing air is usually expired under two-thirds of the vital capacity. Secondly, the FV curve of coughing can well be superimposed on that of maximum expiration at their descending limbs except a temporary excess of the former at the beginning of the expiratory phase.
Decreased V5o or V25 in patients with chronic sinusitis suggests that some changes occur in the small airways. These changes might be functional or organic. The mechanism of these changes is beyond the present paper. It should further be studied from various aspects such as infection, allergy, predisposition, naso-pulmonary reflex, aging, smoking and air pollution. Low expiratory velocities in coughing due to changes in small airways surely impair the efficiency of cough. Insufficiency of coughing accumulates the secretions in the airways. This may deteriorate changes in the small airways or elongate chronic inflammation, and thus result in an increase in the bronchial secretions.
These observations suggest that chronic obstructive changes of the respiratory system in such ways progressively develope from latent into manifest conditions in patients with chronic sinusitis