March 1994 Volume 39, Number3 RE/PIRiKTORy A MONTHLYSCIENCEJOURNAL 39TH YEAR—ESTABLISHED 1956 DecreasingtheWorkofBreathing: Callfor How Much ofaChange Is Important? 1994Open ForumAbstracts RelativeAgreementbetween Raman and MassSpectrometryforMeasuring End-Tidal Carbon Dioxide CPAP PerformanceCharacteristicsof the Puritan-Bennett7200aand a Prototype Continuous Pressure-Regulating Ventilator Evaluation ofan Educational Program forAsthmaticChildren Ages4-8and Their Parents Symposium Papers: Cost-Effectiveness of RespiratoryCare inthe ICU j^ MobilizationofSecretionsinICUPatients ManagingthePatient-VentilatorSystem: 40thAnnualConventionand Exhibition SystemChecksandCircuitChanges December10-13, 1994•LasVegas, Nevada RETROSPECTROSCOPE REDUX: What Makesthe SkyBlue? LISTEN...Everyone is talking about the V.I.P. BIRD... the only ventilator designed specifically for neonatal, infant, and pediatric patients. 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BirdProducts otlifwesoliatrteertsv.hoeTlhuhiteisaorvntaalrovyfe BCircd'OisMcMoImTmiMtEtNeTdtocontinuous P((168a110l090m0))3BS72ip78rr8d-i-4nC71ge2.sn03tC90eAr•TD9Lr2iX2v6e92103805605 features. Precision improvement.Injusteighteen Leak(Mtnpensation months,theV.I.P. BIRDhasbeen BirdProductsCorporation, Europe allowssensitvitytobeoptimized enhancedseveraltimes.Recently Molenstraat 15 withoutautocycling.Adaptive addedfeaturesextendpediatric 2513BH's-Gravenhage,TheNetherlands PressureSupportmodifiesflow applicationandsoon...theV.I.P. TTeelleefpahxo(n3e1)(3710)3760036691081727 Technology and Value Circle110onreaderservicecard A Special Conference presented by the American Association for Respiratory Care Friday and Saturday • May 13-14, 1994 Dallas, Texas Therapist-DrivenProtocols: TheState-of-the-Artisa2-dayconferencepresenting acurrentandcomprehensivereviewoftherapist-drivenprotocolsinthreeparts. InPartIoftheconference,expertsfromabroadrangeofcentersandsettingspresent toyoutherationale, the spectrumoftypes,andtheefficacyoftherapist-driven protocols. Part IIpresentspracticalaspectsofimplementingtherapist-drivenprotocols. Part IIIconsistsofa seriesofstate-of-the-artreportsontherapist-drivenprotocolsthatarecunently being usedat seveninstitutions. The sessionisfollowedby apanel discussiongivingyoutheopportunityforinterchange anddebate withthepresenters. Continuing Education Credit The AmericanAssociationforRespira^toryCarehasapprovedthisconference forupto 12hoursofContinuingRespiratoryCareEducation (CRCE)credit. For Further Information Pleasecontactthe AARCConventionDepartment, 11030AbiesLane, Dallas,Texas75229-4593. Telephone: (214)243-2272; Fax: (214)484-2720. Hi v/ir patients are mastering SMI tlierapy in almost no time. That's wliy I'll choose Coach® every time. Thanks, DHD." BrendaKalette,RRT Withthe DHDCoach mcenti\'e spirometer, accurateSMI therapyis -?. simphfied forrespiratorypatientsandcliniciansalike. Anexclusi\'ecombinationoffeatureshelps "coach"patientstoinhaleproperly,maintain correctinspiratoryflowrate,andeasilymonitor theirownprogress.Formoreinformationon Coach,afreepatienttraining\'ideo,orthe entirelineofDHDqualityrespiratorycare products,pleasecallDHDtoll-freeat 1'800'847'8000 ODHD DIEMOLDINGHEALTHCAREDIVISION CnnoilolQ,NY13032USA 1800184/8000FAX131516978083 (315)6972221 Circle94onreaderservicecard RE/PIRATORy CARE AMonthlyScienceJournal.Established 1956.OtticialJournalottheAmericanAssociationtorRespiratoryCare. EDITORIALOFFICE CONTENTS March 1994 D1a1l0l3a0sATbXie7s5L2a2n9e Volume39,Number3 (214)243-2272 MANAGINGEDITOR RayMasferrerBARRT EDITORIALS EDITOR 187 DecreasingtheWorkofBreathing:HowMuchofaChangeIs PAKaaSlySeBOrWoCeuIbgAheeTrrEMBSEADRRIRRTTTOR bIympRoircthaantr?dDBranson—Cincinnati, Ohio ASSISTANTEDITOR ORIGINALCONTRIBUTIONS DonnaStephensBBA EDITORIALBOARD 190 RelativeAgreementbetweenRamanandMassSpectrometryfor TDRihecaohnmaarHsdesDAsBBMraEarnndessoRnRETRd,RDCTRhaRiTrman Ml}eyaJsouhrninMgGErnda-yThiedaailaCnadrbGaoinfiDeilodxiBdeRussell—Hershey,Pennsylvania CrystalLDunlevyEdDRRT CThhaormlaessGDDEuarsbtiPnhJDrMD 195 AComparisonofCPAPPerformanceCharacteristicsofthe NeilRMaclntyreMD Puritan-Bennett7200aandaPrototypeContinuousPressure-Regulating JJSohaesmleelpsehyKLCSRtMaoiluslehProheMDDMRERdTRRT bVyenRtoilnaatlodrLTobiaandRussellJFischer—MurrayHill,NewJersey CONSULTINGEDITORS FrankEBiondoBSRRT 204 EvaluationofanEducationalProgramforAsthmaticChildrenAges4-8 HRoobwearrtdLJCBhiartenbbuamunRiRMTD andTheirParents PDaotnraiclidaRAnEnltDoonoMrlDeyMSRRT b\Danie—lADetwiler,LindaMurphyBoston,andStevenJ RobertRFluckJrMSRRT Verhulst Springfield,Illinois RonaldBGeorgeMD JamesMHurstMD SYMPOSIUMPAPERS CharlesGIrvinPhD MRoSbeJratstMremKsakcimaMrDekPhDRRT 213 MobilizationofSecretionsinICUPat—ients HughSMathewsonMD byMarcAJudsonandStevenASahn Charleston,SouthCarolina MichaelMcPeckBSRRT JDoahvnidShJiPgieeorksaonMMDD 227 ManagingthePatient-VentilatorSystem:SystemChecksandCircuit JackWangerMBARPFTRRT Changes JeffreyJWardMEdRRT — byRobertSCampbell Tampa,Florida JOURNALASSOCIATES StephenMAyresMD ReubenMCherniackMD CLASSICREPRINTS DonaldFEganMD GarethBGishMSRRT 237 RetrospectroscopeREDUX:WhatMakestheSkyBlue? GAekoergGreeGnrveigkoMryDMD bvJuliusHComroeJr(reprinted, withpermission,fromtheAmericcm HFrederickHelniholzJrMD ReviewofRespiratoryDisease1976:113:219-222) JohnEHodgkinMD TWihlolmiaasmLFMPeitltlyerMMDD TESTYOURRADIOLOGICSKILL AHleannniKngPiPeorncteoMppDidanMD 242 HemoptysisandDyspneainaYoungWoman JBoahrrnyWASSehvaepriirnoghMaDusMD bLyasPkaouwlskLia—ngeCl,evKeelvainnd,McOChairothy,JcmiesKStoller,andDaniel PRODUCTIONSTAFF LindaBarcus DonnaKnauf SteveBowden JeannieMarchant BillCryer RespiratoryCare(ISSN009891421isamonthlypublicationofDaedalusEnterprisesIncfortheAmericanAssociationforRespiratoryCare.Copyright"^1994byDaedalusEn- terprisesInc.11030AbiesLane.DallasTX75229.Allrightsreserved.Reproductioninwholeorinpartwithouttheexpress,writtenpermissionofDaedalusEnterpnsesInc.is prohibited.TheopinionsexpressedinanyarticleoreditorialarethoseoftheauthoranddonotnecessarilyreflecttheviewsofDaedalusEnterprisesInc,theEditorialBoard,or theAmericanAssociationforRespiratoryCare.NeithercanDaedalusEnterprisesInc,theEditorialBoard,ortheAmercianAssociationforRespiratoryCareberesponsiblefor theconsequencesoftheclinicalapplicationsofanymethodsordevicesdescribedherein.PrintedinUSA. RespiratoryCareisindexedinHospitalLileralureImliwandinCumulaliveIndextoNursingandAlliedHealthLiterature. SSuebcsocnndptCiloanssRaPloesst:a$g5e.0p0aipderatcoDpayl;la$s5,0T.X00.pPeOrSyeTaMrA(S12TiEssRu:es)SeinntdheadUdSr;es$s70c.h0a0nginesalltootRheesrpcioruanttorrieysC(aarded.$D8a4e.d0a0lufosrEanirtmeariplr)i.ses,Inc.,11030AbiesLane,DallasTX75229. RESPIRATORYCARE•MARCH'94Vol39No3 171 PLEASE VISIT US AT THE AARC AT BOOTH #432 NE\^ from SECHRIST SYNCHRONIZED ASSISTED VENTILATION OF INFANTS EVEN THE SMALLEST ONES Total Synchrony SAVI Help your patients breathe more easily with Synchronized inhalation and exhalation-on- the new Sechrist SAVI™ Total Synchrony™ demand means less oxygen exposure, lower System, available only with the Sechrist IV-200 ventilator pressures, and less time on ventilatory Infant Ventilator. Sensitivity and rapid response support. Even the smallest babies breatheeasier make it the only electronic trigger system and are more tranquil. The Sechrist SAVI Total that works consistently with Very Low Birth Synchrony System is the one and only. Even Weight (VLBW) infants, because it lets infants the babies know. — control their own rate of respiration both SAVI inhalation and exhalation. SAVI is the closest • the on/yelectronictriggersystem. thing to natural breathing. •the on/ysystemthatprovidesTotal Synchrony. • the on//systemforVLBWinfants. SAVI. SYNCHRONIZED ASSISTED VENTILATION OF INFANTS s^^^ Si-ihrisl liuluslrii.'s.liH, iJi'ii;.I.Ml'alinaAvf.,.An;!!!^!!!!.(",A 92807 • I'lionc:(^li)'i^y-HlOO • |-a\:CIi)S-'O-OSli Forcustomerservice,calltoU-frcc: 1-800-SECHRIST(1-800-732-4747) S^.cllri^ti:uro|x-.l-raiihi>lzMi- ')H.(;il-(,i22Sli-incn,Suit/I'll.irul • I'liciiii.-: 11-1.-(-il 2.-(-2.-^ • I'.ix: il-i.-i-il-2.V(it) .Scchri.MUilinAmerica. 11110N, KcTitlallDr...Siiilr loi,Miami, l-l. .-(.•iPli • I'Iidik':i.SIIt)=i';(i-W(r • l-a.\;(.SOS)S'JS-^ISO I'/NKXll.-W)Kiv Circle127onreaderservicecard MANUSCRIPTSUBMISSION CONTENTS, March 1994 InnesatrrutchteioennsdloofrRAeustphiorrastoaryndCaTryepiosntsaisquparritenrtleyd Volume39,Number3 basis(Jan,Apr.July.Nov). PHOTOCOPYING&QUOTATION BOOKS,FILMS,TAPES,&SOFTWAREREVIEWS PHOTOCOPYING. Anymaterialinthisjournal 251 CriticalCare,editetibyJosephMCivettaMD,RobertWTaylorMD, tpmhoaastyesisboecfosppcyhireointtgoihcftioecpdioerbdyedDfuoacraetdinaoolnnuacslomEanmdteverarinpccriiesamelesn.tp.uIrn-c arenvdiReowbeedrbtyKRiorbbeyrMtDH.arwwiothod1—31Atcloannttrai.buGteorosrgia QsiUonO,TqAuTotIeONup.toAn5y0o0newormdasy,ofwmiattheoruitalpeinrmtihsi-s 252 PulmonaryDiseaseintheElderly,editedbyDonaldAMahler,with jpcorouimrsmenesarlcIintcha,altpuirssoe.vcioadpneyddripgtrhhoetveidqdueobdtyaRtkDisaopenidraaitslourfs'oirEnCntaoernre-- 2r5evcioenwterdibbuytoSrhsirleyMPfister—Denver, Colorado iscredited.Longerquotationrequireswrittenap- provalbytheauthorandpublisher. 253 PulmonaryDiseasesandDisorders.2ndedition.Companion SUBSCRIPTIONS/CHANGESOF Handbook,editedbyAlfr—edPFishmanMDandRobertM KotloffMD ADDRESS reviewedbyKayeWeber Dallas, Texas RespiratoryCare 11030AbiesLane DallasTX75229-4593 LETTERS (214)243-2272 254 AnAccurateAssessmentofPeakFlow — aSPruUeeBr$St5oC0R.RI0ic0PoT.pIe$Or7Ny0Se..a0r0I(pn1de2irviiysdesuauarelsi)snuibanlslctnhopetthUie.orSn.croaautnne-ds bryesLpconnisreenbyZiMeaglrekrSainmdmSohnelsl—eyYoFrrki,edPenCnesdylavraGnrioave,NewJersey:with tries;$95.00for2yearsintheU.S.andPuerto — Rfinoircaol3l.yo$et1ahr3esr5.ci0no0utnhtienriUea.lslS.(oatadhndedr$8Pc4uoe,ur0ni0torpiReeirsc;yoe.aan$rd2f0o$0r1.a40i00r 255 TbhyeJruadpiysTti-eDtrsiovretnaPnrdotDoecnonliss—CAlifDfiofrfde—reWntheVaitewRi?dge, Colorado:with mail). Annual organizational subscriptions are responsebyJamesKStoller Cleveland. Ohio offeredtomembersofassociationsaccordingto their membership enrollment as follows: 101- 500 members—$5.00. 501-1,500 members— ABSTRACTS $4.50. 1,501-2,500 members—$4.25, 2,501- 5,000 members—$4.00, 5,001-10,000 mem- 174 SummariesofPertinentArticlesfromOtherJournals bers—$3.00,andover10,000members—$2.50. S$i7n.g0l0eaicropmiaeisl,powshteangeatvoaiolvaebrlsee,ascocsotun$t5r.i0es0.;add CALLFORABSTRACTS CHANGEOFADDRESS.Sixweeksnoticeis 259 CallforOpenForumAbstracts requiredtoeffectachangeofaddress.Noteyour syuobusrcrniaptmieo,nannudmbboetrh(ofldromandthenemwaialdidnrgessl,abeiln-) NOTICES cnluumdbiengrzoinptchoedeesn.vePlloepaes.eCnootpeieysouwrillsunbostcribpetiroen- 257 ExaminationDates,Notices,Prizes placedwithoutchargeunlessrequestisreceived within60daysofthemailingintheU.S.orwith- CALENDAROFEVENTS in90daysinothercountries. MARKETINGDIRECTOR 258 MeetingDates,Locations,Themes DaleGnlTiths NEWPRODUCTS ADVERTISINGASSISTANT BethBinkley 262 UnionTeeFitting 262 Pet-AllergyRelief AarDrVaEngReTdISwiItNhG.theDisapdlvaeyrtiasdivnegriirseipnrgessehntoautlidvebse. 262 VideoTargetsMyths RespiratoryCaredoesnotpublish aclassified 262 NewHEPAFilter adveriisingcolumn. 262 OximetrySensor PRODUCTADVERTISING: 263 Hand-HeldPulseOximeter RATES&MEDIAKITS 263 CPRPrompter AriesAdvertisingRepresentatives 4OrchardHillRoad 263 Point-of-CareTesting (M9ar0l8b)o9r4o6-N1J22047746 263 PatientMonitorInterface fax(908)946-1229 INDEXES RECRUITMENTADVERTISING: BethBinkley 264 AuthorsinThisIssue R1h1s0p3iK0ATAibiiReisCLaarnee 264 AdvertisersinThisIssue DallasTX75229-4593 182 AdvertiserHelpLines (214)243-2272 fax(214)484-6010 RESPIRATORYCARE•MARCH "94Vol39No3 173 G Abstracts SummariesofPertinentArticlesinOtherJournals Editorials,Commentaries,andReviewsToNote Excessive Daytime Sleepiness, Upper A—irway Resis- Hemodynamic Monitoring: A New Day Dawning (ed- tance,and Nocturnal Arousals (editorial) JW Shepard. itorial)—LDNelson.CritCareMed 1993;2I(11):I626. Chest 1993;104:665. (PeilalnstoGuillemitiaultetal paper abstractedonPage 175.) Death Due To Asthma: New Insights into Sudden Un- expectedDeaths,buttheFocusRemainsonPrevention (editorial)—RCStrunk.AmRevRespirDis 1993;148:550. Pressure-Controlled Inverse Ratio Ventilation: What Have We Learned? (editorial)—MJ Gurevitch. Chest Allergen-Specific Treatment for Asthma: HI (editori- 1993:104:664.(PertainstoMercatelalpaperabstractedon al)—TAEPlatts-Mills.AmRevRespirDis 1993:148:553. Page 181.) The Imniunoevasive Activities of Pseudomonas ae- TNreemaatnm.eNntEnogflJMuMletdidr1u99g3-:R3e2s9i:s7t8a4n.t Tuberculosis—MD rruegviinewo)sa—:AReBluerveta.ncAeWforCriCpypsst.icAFmibRreos\isRe(ssptiarte-Doifs-th1e9-9a3r:t 148:793. The Use ofPulse Oximetry during Conscious Sedation Regional Blood Flow and Oxygen Transport: Implica- — — (council report) Council on Scientific Affairs, American tionsfortheTherapyoftheSepticPatient(editorial) MedicalAssociation.JAMA 1993:270(12):1463. Gutierrez.CritCareMed 1993;21(9):1263. Occurrence ofOccupational Asth- occupational asthma. After adjusting Various human pulmonary diseases — ma STimmer, KRosenman. Chest for the difference in response rate arecharacterizedbyan increasedox- 1993:104:816. among patients from the three hos- idant burden on the respiratory epi- pitals, the percentage of adult asth- thelial surface. As a step toward de- To estimate the percentage of adult matics in Michigan whose asthma is veloping a therapy to augment the asthmatics with occupational asthma causedbyworkexposureisestimated antioxidant defenses of respiratory inMichigan,asampleof94patients. tobebetween3%and20.2%. Incon- epithelial lining fluid (ELF) of the aged 20 to 65 years, who were dis- trast, 25.5% of the patients stated human lung, we have evaluated the charged from one ofthree Michigan their asthma was caused by bad feasibility of aerosolizing a human hospitals in 1990 with the primary working conditions. If these per- protein antioxidant to the respiratory diagnosis of asthma were inter- centages were generalizable to the epithelial surface ofan experimental viewed. The patients were classified whole state, then according to our animal sufficiently large to permit using the National Institute for Oc- survey330to2,222orbyself-reports repetitive sampling of ELF. To cupational Safety and Health (NI- of the patients, 2,800 of the 11,000 accomplish this, recombinant human OSH) criteria as having either prob- hospitaldischarges peryearin Mich- Cu*^fZn**superoxidedismutase(iSOD) able occupational asthma, possible igan for asthma among adults could wasaerosolizedtosheep,andthelev- occupational asthma, or not having beattributedtoaworkexposure. els of human superoxide dismutase occupational asthma. Three percent (SOD) and antisuperoxide anion of the adult asthmatics interviewed (O; ) capacity were quantified in met the criteria for having probable Aerosolization of Superoxide Di.s- ELFovertime.In-vitroaerosolization occupational asthma. One patient mutase: Augmentation of Respira- did not alter the specific activity of from each hospital had probable oc- tory Kpithelial Lining Fluid Anti- rSOD (p > 0.5). In-vivo aerosoliza- cupational asthma. Fifteen of60 pa- oxidantScreenbyAerosoli/.ationof tionofrSOD(100mg) tosheep(n= t2i5entpsati(e2n5t%s)(1f2r7ofm) fHrosopmitHaolspAi,tal.3 Bo.f SRuepceormobxiindaentDi.Hsmuumtaasne—CAu'VGiZlnli*s*- 7m)anreCsuul'teVdZni"n pSeOakDainmoEuLnFtsofof3.1hu±- and 2 of the 9 patients (22%) from scn..IH Rouni. RF Hoyt, RGCrystal. 0.6 /ymol/L, with a parallel increase Hospital (' iiaci |in)bablc or possible Chest I993;i()4:81l. in the anli-O: capacity of ELF. For 174 RESPIRArORYCARE• MARCH "94Vol39No3 ABSTRACTS thedurationofthestudy(5h),levels abrupt but limited reduction in tidal metered dose inhaler and 40 others of SOD and anti-O:' in ELF re- volume (ie. abnormal increase in (FEV,: 1.08±0.52L: 35 ± 16% pre- mained elevated, with a value 50% upperairwayresistanceduringsleep). dicted) received wet nebulization. ofthe peak at5 h. Aerosolization of The arousal restores normal breath- RESULTS:Twenty-sixpatients(65%) phosphate-buffered saline (n=5) had ing. Snoringwasnotedinassociation receiving metered dose inhaler and no effect on SOD or anti-O:" levels with these transient arousals in 10of 30 (75%) receiving wet nebulization in ELF. In animals receiving rSOD, the 15 subjects: however, snoring achievedmaximalbronchodilationaf- there was no change in the specific was neither sufficient nor necessary ter two doses. Almost all reached apWllciaatevrriegevredicetodytnaoocnbftliyhumSedaOaseletDratrowrhtsiaieotntclghorvmteSaoprtOreetedDrhsieieancrlavEE(anLLptFFib>oecn0oo.fd4meo)--.af fsrsaoetynrupnadrdtiteroehsoemdemnyetis.edtudehbnaBjtiteoincftttiwhschaaestshiaeoafxmnfdeieslcodtuflwepyedptrhegeaerrbonceuaolqpiiru.nrmaiawlAclalla.yyll em000ss...ha.746ix1p98i)T.mh±LwaealA0fs.obF6rr1ssEoiemVngeLencntIiheffoiioridrcmneiapdlnwbrateotodttivolhoseinnednegebbariuybrnolyhiufarzpolees0uelr.rra7t(d(2iampoonesn±=-d-- sostpfaencStiiOfaiDlciannaccdrteitavhiseteyanintain-bd0o:t"htchtaahpteacaiatmyosucunabtn- Nptoraoeslsa,sluerel,cimoinuntsaietndeudouastsheapndosaiyettixivpmeeeriamsileernewtpaaiyl- tuoelfirzeeadrlbdruots=eer0o.iln9h8aa)lnebdretrcwh=eaen0n.g9et4h:eiwnleotgFEdnVoe|sb.-e be achieved fora period oftime ap- ness (multiple sleep latency mean About 1/6 the wet nebulizer dose of plicable to human therapy, support- score= 13.5 min), thetransientarou- albuterol was neededto achieve sim- ing the rationale for evaluation of sals (mean alpha EEG arousal index ilar response to the metered dose in- rSOD aerosol as an antioxidant in decreased from 31.3 ± 12.4 to 8 ± 2 haler.CONCLUSIONS: Albuterolby humanpulmonarydisease. perhourofsleep), and the abnormal metereddoseinhalerprovidedsimilar upperairwayresistance.Chronicday- bronchodilation to that achieved by A Cause of Excessive Daytime time sleepiness is a major cause of wet nebulization in patients with a- Sleepiness: The Up—per Airway social, economic, and medical im- cute asthma. The cumulative dose- Rnaeuslits.tRancSteooShysn,dAroCmleerk,CMGuCieltleelm,iP- pdariormmeenta.ndRietcsocganuisteionis iomfpotrhtiasnts,yna-s rtheespoenmseergteenchcnyiqudeepiasrtampepnlticasbeltetinign Maistros.Chest 1993:104:781. specific treatments can be developed and is helpful in comparing the rela- toeliminatetheproblem. tive utility of various bronchodilator Subjects with isolated complaints of regimens. chronicdaytimesleepinessareusual- A Comparison of Albuterol Ad- ly classified as "idiopathic hyper- ministered by Metered Dose In- Environmental Tobacco Smoke somniacs" and treated symptomat- haler (and Holding Chamber) —or ConcentrationsinNo-Smokingan—d ically. Agroupofthese subjectswas Wet Nebulizer in Acute Asthma SmokingSectionsofRestaurants investigated during nocturnal sleep A Colacone, M Afilalo, N Wolkove, WE Lambert, JM Samet, JD Spen- and daytime naps. In a subgroup of HKreisman.Chest 1993:104:835. gler. Am J Public Health 1993:83: them, sleep was fragmented by very 1339. shortalphaEECarousalsthroughout BACKGROUND: Comparative stud- the sleeping period. These short ies of albuterol by wet nebulizer or Tocharacterizetheeffectivenessofa arousals are usually ignored in sleep metered dose inhaler have tested localordinancethatrestrictssmoking analyses, but their impact is sig- fixeddosesofmedications. Wecom- inrestaurantstoonethirdoftheseat- nificant (inthe 15 subjects identified pared the dose-response relationship ing area, this study made simultane- with the syndrome, the mean sleep to albuterol by wet nebulization or ous measurements oftwo markers of latency in multiple sleep-latency tests metereddoseinhalerinacuteasthma. environmentaltobaccosmoke,respir- was5.1 ± 1 min).These arousalsare METHODS: Randomized, double- ablesuspendedparticlesandnicotine, directly related to an abnormal in- blind, placebo-controlled trial. Pa- in the smoking and no-smoking sec- crease in respiratory efforts during tients with acute asthma received ei- tions ofseven restaurants. The mean sleep (the mean peak inspiratory ther albuterol, 0.4 mg, by metered concentrations of respirable sus- esophagealpressure measured in our dose inhaler (and holding chamber) pended particles and nicotine were subjects in the respiratory cyclejust oralbuterol,2.5 mg,bywetnebulizer 40% and 65% lower, respectively, in preceding a transient arousal was every 30 min until maximal bron- the no-smoking than in the smoking -33±7cmH:0).Typically,anarou- chodilation. Forty patients (forcedex- sections, indicating substantial but saloccurswithinonetothreebreaths piratoryvolumein 1 s[FEV|]: 1.15± not complete protection against ex- of flow limitation associated with 0.43 L: 36± 12%predicted)received posure. RESPIRATORYCARE• MARCH'94Vol39No3 175 An Soluhon Innovative The New TruZone™ Peak Flow Meter True Versatility! 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