PULMONARY INSUFFICIENCY III. A STUDY OF 122 CASES OF CHRONIC PULMONARY EMPHYSEMA

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Abstract
This paper classifies 122 patients with clinical, laboratory, and X-ray evidence of pulmonary emphysema into 4 groups, on the basis of the absence or presence and degree of decreased arterial O2 saturation and increased blood CO2 tension following standard exercise test: Group I[long dash]Arterial O2 saturation above 92%; Group II[long dash]Arterial O2 saturation below 92%, CO2 tension below 48 mm. Hg; Group III[long dash]Arterial O2 saturation below 92%, CO2 tension above 48 mm. Hg; Group IV[long dash]Same arterial O2 unsaturation as in Group HI, but CO2 tension further increased, both at rest and following exercise, and all cases exhibit evidence of chronic cardiac failure. Decreased exercise tolerance, limited thoracic expansion, rales, rhonchi, and repeated poorly tolerated respiratory infections common to all groups. Chronic cardiac failure, cardiomegaly, hepatomegaly, plethora, cyanosis, and edema present only in Group IV. Polycythemia only noted when evidence of chronic cardiac failure also present and conspicuous by absence in Group HI where decreased arterial O2 saturation and increased CO2 content present at rest and accentuated by exercise. All groups derived objectively measured benefit (increased maximum breathing capacity) following acute and chronic use of bronchodilator (vaponephrin) without adverse effects. Authors advocate more generalized use of bronchodilators in management of this disease in conjunction with usual measures including rest, elimination and prophylaxis of infection, restriction of physical activity, O2 therapy where indicated, and occasionally phlebotomy in cases of Group IV. Characteristic prototypes of each group presented in detail with autopsy findings appended in several cases.