Abstract
Cases of chronic pulmonary emphysema accompanied with paroxysmal dyspnea attacks are often misdiagnosed as bronchial asthma. These patients repeatedly fall into a state of life-threatening respiratory failure. We must make an accurate diagnosis of emphysema to provide care of them. To clarify the possibility of doing this, we investigated the clinical and physiological features (primarily respiratory function) of emphysema. We observed twenty-five patients with chronic pulmonary emphysema and with chronic bronchial asthma, previously confirmed by selective alveolo-bronchogram (SAB); this technique reliably diagnoses emphysema, but often induces dyspnea attacks due to the stimulation resulting from intratracheal and intrabronchial procedures. In eight patients, chronic pulmonary emphysema was accompanied by an attack of paroxysmal wheezing and dyspnea; chronic pulmonary emphysema with wheezing (WPE). In eight other patients, chronic pulmonary emphysema was present without such attacks; usual pulmonary emphysema (UPE). In the final nine patients, chronic bronchial asthma (CBA) was present, while emphysema was ruled out by means of SAB. In all patients, we measured respiratory function before and after the combination therapy of intravenous aminophylline and subcutaneous epinephrine, which followed daily oral administration of prednisolone (PAE-treatment).
In the WPE group, significant increases in measurement of various respiratory functions, including VC, RV, RV/TLC%, FVC, FEV1.0, PFR and V75 (p<.05 excluded in FEV1.0 and PFR were p<.01), were found after the PAE-treatment, compared with the values revealed before the treatment. In the UPE group, there were few changes in respiratory function. In the WPE group, significant lower values in several parameters of respiratory function, including %-FEV1.0, FEV1.0%, %-MMF, %V75, %V50, %-V25, %-DLco and %-DLco/VA (p<.01 excluded in %-FEV1.0 was p<.05 and in %-V75 and %-DLco/VA were p<.001) were demonstrated after the PAE-treatment, compared with the results from the CBA group. Therefore, we concluded that there is a reversibility, similar to that of asthma, in the airway obstruction in patients with WPE; however, it might be possible to distinguish WPE from CBA, based on several respiratory function parameters, including %-DLco and especially %-DLco/VA, FEV1.0%, %-PFR, %-V75, %-MMF and %-V50, after the recovery from dyspnea attacks. An additional study on a larger number of cases will be required to establish an accurate method to diagnose such cases.
