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The 12-s maximum voluntary ventilation (MVV) provides an estimate of the ventilatory reserves available to meet the physiologic demands of exercise. Earlier studies established a general relationship between MVV and FEV1. We hypothesized that the resting maximum inspiratory flow rate (MIFR) also serves as a clinically useful predictor of the MVV. A total of 105 subjects, 45 women and 60 men (age 57 +/- 5 yr, mean +/- SD), with expiratory impairment categories of severe (n = 26), moderate (n = 22), mild (n = 18), and normal (n = 39) based on FEV1 (percentage of predicted), comprised the study samples. The ratio MVV/FEV1 averaged 41 +/- 7 overall. The FEV1 correlated with MVV in normal subjects (p < 0.05, r2 = 0.642) and patients (p < 0.05, r2 = 0.787) better than MIFR (p < 0.05, r2 > or = 0.480). MIFR joined with FEV1 in multiple linear regression to significantly improve the description of MVV:MVV L/min = 30.77FEV1 (L) + 5.94MIFR (L/s) - 4.77 (n = 105; p < 0.05, r2 = 0.849). The 95% confidence limits for MVV varied from 90 to 110% of predicted from the equation for this sample. The factors sex and impairment category did not reduce the unexplained variability in MVV after inclusion of FEV1 and MIFR as covariates in ANOVA (p > 0.05). Addition of MIFR to the model with FEV1 produced greater improvement in r2 than PImax. We conclude that MIFR, although secondary in importance to FEV1, is a significant determinant of MVV in patients with COPD and normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Little is known about the clinical manifestations and correlates of osseous sarcoidosis and few data exist to guide pulmonologists in their evaluation of patients for possible osseous involvement. To determine the relationship between pulmonary and osseous sarcoidosis, and to develop an algorithm for use by pulmonologists in assessing patients with suspected osseous sarcoidosis, we conducted a retrospective, case control study of patients with pulmonary sarcoidosis and musculoskeletal complaints who were evaluated for osseous disease. All patients underwent a standard evaluation to include physical examination, chest radiograph (CXR), spirometry (PFTs), bone scintigraphy and plain radiographs of the hands and feet. Patients completed a health assessment questionnaire and serum angiotenisin converting enzyme, erythrocyte sedimentation rate, and C-reactive protein were measured. Patients eventually diagnosed with osseous sarcoidosis were compared to those lacking osseous involvement. Osseous involvement in patients with pulmonary sarcoidosis and musculoskeletal symptoms was common and seen in 38.9% of subjects. Patients with osseous sarcoidosis were more likely to concomitantly suffer from cutaneous sarcoidosis and to have elevated ACE levels and ESRs. No measure of pulmonary involvement (CXR stage, PFTs or symptoms) differentiated patients with osseous sarcoidosis from those without this condition. In cases of osseous sarcoidosis, bone scintigraphy identified a mean of four sites of osseous involvement, some of which would have been missed with the use of plain radiographs limited to the hands and feet. We conclude that in patients with pulmonary sarcoidosis who have significant musculoskeletal complaints, osseous involvement is frequent. Pulmonary features of sarcoidosis do not differ between patients with and without osseous disease. Bone scintigraphy aids in the evaluation of these patients.