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 less than .05 excluded in FEV1.0 and PFR were p less than .01), were found after the PAE-treatment, compared with the values revealed before the treatment. In the UPE group, there were few changes PAE-treatment, compared with the values revealed before the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)