HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Boni, E. Articles by Tantucci, C. Search for Related Content PubMed PubMed Citation Articles by Boni, E. Articles by Tantucci, C.

Expiratory Flow Limitation Is Associated With Orthopnea and Reversed by Vasodilators and Diuretics in Left Heart Failure^*

*From the Department of Internal Medicine, Respiratory Medicine, University of Brescia, Brescia, Italy.

Correspondence to: Claudio Tantucci, Clinica di Medicina Interna I, University of Brescia, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25100 Brescia, Italy; e-mail: tantucci{at}med.unibs.it

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/m²), 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 < 0.01 vs seated position values), the mean IC was 1.66 ± 0.45 L, and seven patients exhibited EFL. After a mean duration of 17 ± 8 days of treatment (range, 7 to 28 days), EFL was detected in two patients only in the supine position, IC increased both in the seated position (1.65 ± 0.34 L; p < 0.01) and the supine position (1.81 ± 0.41 L; p = 0.07) position, and, although only two patients denied orthopnea, the mean dyspnea score during recumbency actually decreased to 1.9 ± 1.0 (p < 0.05).

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.

Key Words: diuretics • expiratory flow limitation • left heart failure • orthopnea • vasodilators

This article has been cited by other articles:

				R. Torchio, C. Gulotta, P. Greco-Lucchina, A. Perboni, L. Avonto, H. Ghezzo, and J. Milic-Emili Orthopnea and tidal expiratory flow limitation in chronic heart failure. Chest, August 1, 2006; 130(2): 472 - 479. [Abstract] [Full Text] [PDF]

				R. Torchio, C. Gulotta, P. Greco-Lucchina, A. Perboni, L. Montagna, M. Guglielmo, and J. Milic-Emili Closing Capacity and Gas Exchange in Chronic Heart Failure Chest, May 1, 2006; 129(5): 1330 - 1336. [Abstract] [Full Text] [PDF]