Respiratory function in emphysema in relation to prognosis. Quart

IK the past few years many articles have appeared on the changes in pulmonary function that are found in chronic emphysema. Most of these have been con-cerned with the abnormalities of function found in patients with established emphysema compared with normal subjects (Baldwin, Coumand, and Richards, 1949), and few of them have dealt with the sequence of functional change as the disease progresses. Any study of a group of patients with emphysema over a period of years is faced with a number of problems, none of which can be solved entirely satisfactorily. One of these is the problem of selection of cases. Em-physema cannot be precisely defined clinically, radiological assessment is unsatisfactory, and to define emphysema in terms of function tests might well be considered premature. If, on the other hand, a rigorous clinical definition of emphysema is adopted, the cases selected will inevitably tend to be severe and advanced. The purpose of the present investigation was to select a group of patients, diagnosed according to the criteria set out below, and to follow this group over a period of years both from the clinical and from the functional viewpoint. The results so obtained have been analysed with particular problems in mind, which may be summarized as follows: 1. To confirm or disprove the accuracy of the clinical selection by careful follow-up and post-mortem analysis. 2. To determine the prognosis in emphysema uncomplicated by heart failure. 3. To relate the clinical course of the disease to changes in the function tests. The answers that have been obtained to some of these questions are suggestive rather than final or definite, but many of the results should be of assistance in planning future studies of this kind on patients with chronic respiratory dis-orders. Clinical Investigation Selection of cases. The criteria adopted in the selection of cases of emphysema to be included in this study were as follows: 1. A history of increasing dyspnoea on exertion, constantly present in both winter and summer. 2. No other apparent cause for dyspnoea. Subjects with a blood-pressure over 140/90 were excluded.