CIBA Foundation Symposium on Pulmonary Structure and Function

By A. V. S. De Reuck; Maeve O'Connor | Go to book overview

CONTROL OF RESPIRATION IN RELATION TO LUNG PATHOLOGY

J. E. COTES Pnemnoconiosis Research Unit of the Medical Research Council, Llandough Hospital, near Penarth, Glamorganshire.

HYPOVENTILATION is a feature of chronic non-specific lung disease ( Fletcher, 1959), which has attracted the attention of research workers since Scott ( 1920) demonstrated a reduced ventilatory response to carbon dioxide and Christie ( 1934) pointed the way to study of the lungs' mechanical properties. Sustained hypoventilation is most commonly seen during the course of an acute chest illness when it may be precipitated by oxygen administration ( Donald, 1949; Comroe, Bahnson and Coates, 1950), but it is then difficult to investigate in detail. With clinical improvement this effect of oxygen at rest diminishes until, as in normal subjects, it may only occur during the first few breaths ( Dripps and Comroe, 1947; Dejours, 1959). However, a sustained reduction in" ventilation may still occur on exercise.

The factors contributing to hypoventilation when oxygen is being breathed at rest and on exercise are probably related, since, once an acute episode of hypoventilation has occurred with oxygen at rest, it is invariably found subsequently on exercise; the converse does not always hold but patients who hypoventilate with oxygen, either at rest or on exercise, have a poor prognosis by comparison with others equally disabled whose ventilation is unaffected. In one series, amongst subjects who developed hypoventilation on exercise, the 12-month mortality was 33.8 per cent; the corresponding figure was 2.3 per cent amongst subjects'who were apparently similar except that they did not

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