Abnormal FVC Research Articles

Functional capacity and quality of life in patients with vascular ring.

Vascular rings are congenital anomalies of the aortic arch that compress the trachea and esophagus and may require corrective surgery. Data about the long-term effects of vascular rings are scarce. We aimed to evaluate the long-term cardiorespiratory, exercise capacity, and quality of life of vascular ring patients. A single center prospective study evaluating spirometry, echocardiography, six-minute walk test (6MWT), cardiopulmonary exercise testing (CPET), and quality of life questionnaire (SF36) in patients with a diagnosis of vascular ring, with or without corrective surgery. Twenty-seven patients participated (11.9 ± 6 years, 52% males). The most common diagnosis was double aortic arch (16 patients, 59%). Nineteen patients had corrective surgery (O) and 8did not (NO). Pulmonary function tests were within normal range in both groups (FEV1 % predicted O = 87.6 ± 16.5, NO = 83 ± 10.8%). However, 11/27 had abnormal FEV1 , 5had abnormal FVC, and 13 (48%) had flattening of the expiratory curve. 6MWD and oxygen uptake were similarly mildly reduced in both groups; (6MWD O = 80.1 ± 10.7% predicted, NO = 74.1 ± 10.9%and oxygen uptake O = 78.5 ± 23.2% predicted, NO = 73.4 ± 14.3%). Peak O2 pulse (V̇O2 /HR% predicted) was mildly reduced in the NO group (O = 88.4 ± 17.3%, NO = 75.8 ± 16.2%). Echocardiogram and SF36 scores were normal in all patients. Long-term evaluation of patients born with vascular rings revealed mild pulmonary impairment, reduction in 6MWD, and oxygen uptake. The NO group had also mild reduced peak O2 pulse. Larger, long-term studies assessing functional parameters in operated and non-operated patients are needed to assess disease/surgery limitation in patients with vascular rings.Clinical trial registration number: NCT04781738.

Functional Capacity And Quality Of Life In Patients With Vascular Ring

Background: Vascular rings are congenital anomalies of the aortic arch that compress the trachea and esophagus and may require corrective surgery. Data about the long-term effects of vascular rings are scarce. We aimed to evaluate the long-term cardiorespiratory, exercise capacity and quality of life of vascular ring patients. Methods: A single center prospective study evaluating spirometry, echocardiography, six-minute walk test (6MWT), cardiopulmonary exercise testing (CPET) and quality of life questionnaire (SF36) in patients with a diagnosis of vascular ring, with or without corrective surgery. Results: Twenty-seven patients participated (11.9 ± 6 years, 52% males). The most common diagnosis was double aortic arch (16 patients, 59%). Nineteen patients had corrective surgery (O) and eight did not (NO). Pulmonary function tests were within normal range in both groups (FEV1% predicted O = 87.6 ± 16.5, NO = 83 ± 10.8%). However, 11/ 27 had abnormal FEV1, five had abnormal FVC and 13 (48%) had flattening of the expiratory curve. 6MWD and oxygen uptake were similarly mildly reduced in both groups; (6MWD O = 80.1 ± 10.7% predicted, NO = 74.1 ± 10.9% and oxygen uptake O = 78.5 ± 23.2% predicted, NO = 73.4 ± 14.3%). Peak O2 pulse (V̇O2/HR% predicted) was mildly reduced in the NO group (O = 88.4 ± 17.3%, NO = 75.8 ± 16.2%). Echocardiogram and SF36 scores were normal in all patients. Conclusions: Long-term evaluation of patients born with vascular rings revealed mild pulmonary impairment, reduction in 6MWD and oxygen uptake. The NO group had also mild reduced peak O2 pulse. Larger, long-term studies assessing functional parameters in operated and non-operated patients are needed to assess disease/surgery limitation in patients with vascular rings.

Decrements in lung function and respiratory abnormalities associated with exposure to diacetyl and 2,3-pentanedione in coffee production workers.

Coffee production workers are exposed to complex mixtures of gases, dust, and vapors, including the known respiratory toxins, diacetyl, and 2,3-pentanedione, which occur naturally during coffee roasting and are also present in flavorings used to flavor coffee. This study evaluated the associations of these two α-diketones with lung function measures in coffee production workers. Workers completed questionnaires, and their lung function was assessed by spirometry and impulse oscillometry (IOS). Personal exposures to diacetyl, 2,3-pentanedione, and their sum (SumDA+PD) were assigned to participants, and metrics of the highest 95th percentile (P95), cumulative, and average exposure were calculated. Linear and logistic regression models for continuous and binary/polytomous outcomes, respectively, were used to explore exposure-response relationships adjusting for age, body mass index, tenure, height, sex, smoking status, race, or allergic status. Decrements in percent predicted forced expiratory volume in 1 second (ppFEV1) and forced vital capacity (ppFVC) were associated with the highest-P95 exposures to 2,3-pentanedione and SumDA+PD. Among flavoring workers, larger decrements in ppFEV1 and ppFVC were associated with highest-P95 exposures to diacetyl, 2,3-pentanedione, and SumDA+PD. Abnormal FEV1, FVC, and restrictive spirometric patterns were associated with the highest-P95, cumulative, and average exposures for all α-diketone metrics; some of these associations were also present among flavoring and non-flavoring workers. The combined category of small and peripheral airways plus small and large airways abnormalities on IOS had elevated odds for highest-P95 exposure to α-diketones. These results may be affected by the small sample size, few cases of abnormal spirometry, and the healthy worker effect. Associations between lung function abnormalities and exposure to α-diketones suggest it may be prudent to consider exposure controls in both flavoring and non-flavoring settings.

Comparative Performance of Different Respiratory Test Parameters for Detection of Early Respiratory Insufficiency in Patients With ALS.

To compare the performance of different respiratory function testing parameters in a multidisciplinary amyotrophic lateral sclerosis (ALS) clinic. Demographics, clinical data, and respiratory testing parameters were abstracted from the medical records of patients who attended a multidisciplinary ALS clinic from 2008 to 2016. We compared the performance of the 3 primary respiratory test parameters used by Medicare for the initiation of noninvasive ventilation (NIV) (forced vital capacity [FVC] < 50% predicted, maximum inspiratory pressure [MIP] < 60 cm H2O, and abnormal overnight pulse oximetry [OvOx]) on how they related to several clinically relevant attributes. Four hundred seventy-six patients were identified who underwent at least 1 respiratory test. Abnormalities of OvOx, MIP, and FVC occurred at a median of 1.6, 1.5, and 3.8 years from disease onset, respectively (p < 0.00001). Patients with bulbar-onset ALS exhibited earlier abnormalities in MIP and FVC than in spinal-onset ALS (p < 0.005). The median survival after an abnormal OvOx, MIP, or FVC test was 1.4, 1.4, and 0.9 years, respectively (p < 0.0001). Using the ALS Functional Rating Score respiratory subscales, at the time of reported respiratory symptoms there were abnormalities in OvOx (60%), MIP (69%), and FVC (19%). Conversely, when respiratory parameter abnormalities preceded reported respiratory symptoms, this occurred with frequencies in OvOx (79%), MIP (42%), or FVC (24%). Four hundred forty-three patients (93.1%) developed at least 1 abnormal respiratory measure meeting Medicare criteria for NIV consideration, but fewer than 50% in our cohort demonstrated NIV use. Improved survival in subjects using NIV was statistically significant in patients with bulbar-onset ALS. Abnormalities in OvOx and MIP perform better than FVC at early detection of neuromuscular respiratory weakness in ALS. Initiation of NIV in patients with respiratory insufficiency may improve the overall survival in ALS. In the setting of the COVID-19 pandemic, FVC and MIP have not been routinely performed because of infectious aerosol generation. OvOx, which we now routinely mail to patients' homes, has been used exclusively during the COVID-19 pandemic and allows for continued remote monitoring of the respiratory status of patients with ALS. This cohort study provides Class III evidence that in people with ALS, OvOx and MIP are valuable respiratory parameters for the detection of early respiratory insufficiency.

Exposure to Pesticide and Its Association With Respiratory Health Among Paddy Farmers at TanjungKarang, Selangor

Pesticide has been used by paddy farmers in their agricultural activities to increase rice crop yield since past few decades. However, the usage of this chemical with limited knowledge of its deleterious effects on health, community and environment without proper consideration of safety may cause chronic health problems such as respiratory health problems and lung dysfunction. This paper was conducted to determine the association of exposure to pesticide with respiratory health among paddy farmers at TanjungKarang, Selangor as exposed group and office workers working in TanjungKarang town as the comparative group. The results showed that the duration of exposure to pesticide between both groups were mostly low (86%) and high duration for only 4% for paddy farmers and none of office workers. There were significant differences in cough and phlegm, as they were higher among paddy farmers compared to the comparative group at &amp;rho;&amp;lt;0.001. Paddy farmers who were exposed to high levels of pesticide were 2 times more likely to have cough and 3 times more likely to get phlegm. FVC% (t=-1.470, p=0.001) and FEV1% (t=-1.526, p=0.001) were lower among the exposed group compared to the comparative group. The prevalence of abnormal FVC were found at 80% in exposed group and 38% in comparative group andabnormal FEV1 were found at 89% and 31% of respondents in both study groups. There was a significant correlation between long abnormalities for FVC% and exposure duration (&amp;chi;2= 2.903, p= 0.001). This study concluded that the paddy farmers were at risk of respiratory symptoms, as reflected by the increase in the reported respiratory symptoms and lung function reduction.

Validation of the GLI-2012 spirometry reference equations in Argentinian children.

The Global Lung Function Initiative (GLI) has produced spirometry reference equations for use in different ethnic groups. Previous reports have shown that the GLI equations do not adequately describe lung function in all populations and that adopting the new equations into clinical practice can increase the number of patients considered to have abnormal lung function. Therefore, before adopting these equations into local practice it is necessary to establish how well the equations represent the local population. The present study was conducted to determine how well the GLI spirometry reference equations represented the young children in Argentina, a population not included in the GLI dataset. Spirometry was measured in 2072 healthy children (50.9% males) aged 3.0-12.4 years (mean 6.64 ± SD 1.39), with a height range of 93.0-158.5 cm and weight range from 13.1 to 54.7 kg. We used the GLI "Caucasian" and "other/mixed" race equations to create Z-scores. The Z-scores predicted by the Caucasian GLI equations did not differ from zero and fitted the data well. Z-scores calculated using "other/mixed race" fit less well. Using the GLI definition of low lung function (Z-score <1.65) 6.8% of our healthy population had abnormal FVC, 4.9% had abnormal FEV1, 5.9 % had abnormal FEV0.75, and 3.9% had abnormal FEF25-75 when using the "Caucasian" GLI equation. This compares well with the expected 5% below the lower limit of normal. We recommend the use of the GLI-2012 Caucasian equations for spirometry undertaken in Argentinian children.

Global Lung Function Initiative 2012 reference values for spirometry in South Italian children.

Despite the widespread use of the Global Lung Function Initiative (GLI) 2012 reference values, there is still the need of testing their applicability in local areas. The aims of this study are to evaluate applicability of GLI reference equations in a large population-based sample of normal schoolchildren from Sicily, and to compare GLI and previous prediction equations in terms of spirometry test interpretation. GLI equations were evaluated in 1243 normal schoolchildren, 49% males, aged 7-16 years, height 116-187cm. Normality assumptions for the GLI z-scores (FEV1, FVC, FEV1/FVC) were tested, and bootstrap confidence intervals for the mean (0 expected) and the variance (1 expected) were derived. GLI and other reference equations were compared in terms of probabilities to fall below the lower limit of normal (LLN). The GLI z-score normality assumption held for males but not for females (p<0.001). According to the mean z-score, predicted values were: slightly underestimated for FEV1 (0.15 in males, 0.07 in females); overestimated for FVC (-0.27 in males,-0.32 in females); highly underestimated for FEV1/FVC (0.75 in males, 0.81 in females). Variability was correctly estimated. The probability of FEV1<LLN correctly approached 0.05 when using GLI, Hankinson and Quanjer equations. Wang equations yielded correct probabilities of abnormal FVC; Pistelli equations yielded correct probabilities of abnormal FEV1/FVC for females. GLI 2012 references underestimate FEV1/FVC predicted values in a sample of normal South Italian children. Physicians interpreting spirometry should be aware to test reference values prior to their use in a local area.

Risk factors for development of pulmonary arterial hypertension in Australian systemic sclerosis patients: results from a large multicenter cohort study

BackgroundPulmonary arterial hypertension (PAH) is the leading cause of mortality in patients with systemic sclerosis (SSc). We sought to determine the incidence, prevalence and risk factors for PAH development in a large Australian SSc cohort.MethodsPAH was diagnosed on right heart catheterisation (mPAP >25 and PAWP <15 mmHg at rest). Patients with PH secondary to interstitial lung disease (ILD; defined as abnormal HRCT scan and FVC < 60 %) were excluded. Summary statistics, chi-square tests, univariate and multivariable logistic regression along with post-estimation diagnostics were used to determine the associations of different combinations of risk factors with PAH.ResultsAmong 1579 SSc patients, 8.4 % (132 patients) were diagnosed with PAH over a mean (±SD) follow-up of 3.2 (±2.5) years. The incidence of PAH in this cohort was 0.7 % per annum. Of these, 68.9 % had limited disease subtype (lcSSc). In multivariable regression analysis, the presence of anti-centromere antibody (ACA) (OR 1.6, 95 % CI 1.1–2.5, p = 0.03), oesphageal stricture (OR 2.0, 95 % CI 1.2–3.3, p = 0.006), calcinosis (OR 1.9, 95 % CI 1.2–2.9, p = 0.003), sicca symptoms (OR 1.6, 95 % CI 1.1–2.5, p = 0.03), mild ILD (OR 2.3, 95 % CI 1.5–3.7, p < 0.001) and digital ulcers (OR 1.6, 95 % CI 1.0–2.4, p = 0.03) were predictive of PAH. This model had an area under the curve of 0.7 and concordance of 91.8 %. When analysed by disease subtype, the presence of calcinosis (OR 2.2, 95 % CI 1.4–3.7, p = 0.01), sicca symptoms (OR 2.6, 95 % CI 1.5–4.6, p = 0.001), mild ILD (OR 2.3, 95 % CI 1.4–3.8, p = 0.001) and digital ulcers (OR 1.9, 95 % CI 1.2–3.7, p = 0.01) were predictive of PAH in lcSSc; and oesophageal stricture (OR 4.4, 95 % CI 1.9–10.5, p = 0.001), mild ILD (OR 2.8, 95 % CI 1.2–6.8, p = 0.02) and ACA (OR 5.2, 95 % CI 1.8–14.8, p = 0.002) were predictive of PAH in dcSSc.ConclusionsThe incidence and prevalence of PAH in this cohort are 0.7 % per annum and 8.4 %, respectively. The clinical-serologic risk factors for PAH differ based on disease subtype. In both subtypes, mild ILD is associated with PAH, suggesting the possibility of common pathogenic mechanisms underlying both of these disease manifestations. This model identifies a subset of patients at an appreciably higher risk of developing PAH, who should be screened and would in future, benefit from preventative therapies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0296-z) contains supplementary material, which is available to authorized users.

Pulmonary Function after Treatment for Childhood Cancer. A Report from the St. Jude Lifetime Cohort Study (SJLIFE).

The relationship between treatment-related impairment of pulmonary function in adult survivors of childhood cancer and subsequent physical function has not been studied. In this prospective evaluation of 606 adult survivors of childhood cancer, we sought to determine the risk factors for, as well as the functional impact of, clinically ascertained pulmonary function impairment. We measured FEV1, FVC, total lung capacity (TLC), and single-breath diffusing capacity of the lung for carbon monoxide corrected for hemoglobin (DlCOcorr), expressing the results as percent predicted and lower limit of normal (LLN) values, and we also assessed functional exercise capacity (6-minute-walk distance). Lung radiation exposure was expressed as the estimated percentage of lung tissue that received at least 10 Gy (V10). Associations of clinical and treatment factors with pulmonary function measures were assessed using log-binomial regression to calculate relative risks and 95% confidence intervals. The participants' median age at evaluation was 34.2 years, and the median elapsed time from diagnosis was 21.9 years. Among the sample population, 50.7% had an FEV1 percent predicted less than 80%, 47.2% had an FVC percent predicted less than 80%, 31.2% had a TLC percent predicted less than 75%, and 44.6% had DlCOcorr percent predicted less than 75%. Also, 49.0% had FEV1 less than the LLN on the basis of the Global Lung Function Initiative (GLI) criteria, and 45.4% had FVC less than LLN. Obstructive lung defects (FEV1/FVC, <0.7) were found in 0.8%, but none had obstructive lung defects on the basis of the GLI criterion of FEV1/FVC less than the LLN. Restrictive lung defects (TLC, <75%) were found in 31.2% of participants. V10 and elapsed time since diagnosis were associated with abnormal FEV1 and FVC based on the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 criteria, and with abnormal FEV1 using the GLI criterion. Age at diagnosis was an additional risk factor for abnormal FVC based on the GLI criteria. Age at diagnosis and V10 were associated with abnormal TLC. Increased body mass index, V10, and elapsed time since diagnosis were risk factors for abnormal DlCOcorr. Abnormal pulmonary function tests were associated with decreased 6-minute walk distance. Impaired pulmonary function in adult survivors of childhood cancer is associated with decreased physical function. These patients may benefit from interventions designed to preserve and/or improve pulmonary function.

Relationship of Right Ventricular Size and Function with Respiratory Status in Duchenne Muscular Dystrophy.

The relationship between pulmonary function and right ventricle (RV) in Duchenne muscular dystrophy (DMD) has not been evaluated. Using cardiac magnetic resonance (CMR), we describe the relationship of RV size and function with spirometry in a DMD cohort. Fifty-seven boys undergoing CMR and pulmonary function testing within 1month at a single center (2013-2015) were enrolled. Comparisons of RV ejection fraction (RVEF) and end-diastolic volume index (RVEDVI) were made across categories of percent forced vital capacity (FVC%), and relationships were assessed. Mean age was 15.5±3.5years. Spirometry and CMR were performed within 3.9±4.1days. Median FVC% was 92.0% (67.5-116.5%). Twenty-three (40%) patients had abnormal FVC% (<80%) of which 13 (57%) had mild (FVC% 60-79%), 6 (26%) had moderate (FVC% 40-59%), and 4 (17%) had severe (FVC <40%) reductions. Mean RVEF was 58.3±3.7%. Patients with abnormal FVC% were older and had lower RVEF and RVEDVI. Both RVEF and RVEDVI were significantly associated with FVC% (r=0.31, p=0.02 and r=0.39, p=0.003, respectively). In a large DMD cohort, RVEF and RVEDVI were related to FVC%. Worsening respiratory status may guide monitoring of cardiac function in these patients.

The effect of applying ethnicity-specific spirometric reference equations to Asian migrant workers in Korea.

ObjectivesAsian migrant workers in Korea have various ethnicities. The purpose of this study was to evaluate the difference in spirometric interpretation made using the set of third National Health and Nutrition Examination Survey (NHANES III) reference equations and the relevant ethnicity-specific reference sets.MethodsSpirometry was performed on 166 migrant and 498 Korean male workers between March and November 2012. We analyzed the spirometric data of healthy never-smokers. Spirometric patterns were evaluated using the NHANES III reference set and some relevant ethnicity-specific equations (Eom’s equation for Koreans, Ip’s equation for East Asians, Crapo’s equation for Central Asians, Memon’s equation for South Asians, and Gnanou’s equation for Southeast Asian people).ResultsIn all migrant groups except the Central Asian group, the forced expiratory volume in 1 second percentage (FEV1%) and forced vital capacity percentage (FVC%) calculated using each of the ethnicity-specific reference equations considered were significantly higher than those calculated using the NHANES III reference set. This study showed that in the evaluation of the spirometric result of subjects from Southeast Asia or South Asia, the percentage of cases with an abnormal FEV1 or FVC increased when the NHANES III set of equations was used as compared to when the ethnicity-specific equations were used.ConclusionsWe found that the spirometric results of all ethnic groups were higher and the composition of the abnormal spirometric result was lower when the ethnicity-specific reference equations were used instead of the NHANES III reference set.

Clinical and Treatment Management Decisions in Two Asymptomatic Late-Onset Pompe Disease Siblings – Further Evidence of Scoliosis as a Clinical Sentinel Sign for Juvenile Pompe Disease

disease patient was identifi ed by chance through his dermatologist due to partial alopecia. Through high CK (1,310 IU/L) and muscle/hepatic biomarkers (AST, 162 IU/L; ALT, 189 IU/L) a muscle biopsy was performed revealing vacuolated muscle pathology with H-E and PAS stains. A compound heterozygote pathogenic GAA genotype was detected (-32-13 T>G/ c.2560C>T). A series of clinical and laboratory evaluations identifi ed several abnormal clinical signs, despite the absence of clinical symptoms. As the patient had a positive DBS, diminished GAA activity in leukocytes (0.56 nml/h/mg protein – RV: 1.0–5.9), high urinary GLc4 levels on HPLC, abnormal FVC drop during sitting–supine transition (>14%), and abnormalities on his tongue and edema of his thighs, seen on MRI, the decision was taken to initiate enzymatic replacement therapy (ERT) with 20 mg/kg rhGAA (Myozyme®), even though no subjective clinical symptoms were present. After 4 years on ERT treatment and motor/respiratory rehabilitation programs, all clinical parameters worsened, especially CK levels, muscle MRI with an overall muscle substitution for fat with muscle mass volume reduction; and a higher FVC drop during sitting–supine transiti on (>18%) were noted. Based on these clinical and laboClinical and Treatment Management Decisions in Two Asymptomatic Late-Onset Pompe Disease Siblings – Further Evidence of Scoliosis as a Clinical Sentinel Sign for Juvenile Pompe Disease

Pulmonary survival study in 91 patients with systemic sclerosis

In systemic sclerosis (SSc), major determinant of morbidity and mortality is pulmonary complication including pulmonary interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). In this study, the natural course of pulmonary involvement in SSc patients was investigated. This was a historical cohort study of SSc patients at a referral center for SSc in Iran between February 1998 and December 2007. Patients had a standardized initial evaluation, and interstitial pulmonary involvement was established by high-resolution CT scan (HRCT). Pulmonary hypertension was assessed by tricuspid gradient on echocardiography. Development of abnormal FVC or DLCO was considered as secondary outcome. Analysis of pulmonary survival was performed for primary and secondary outcomes. Ninety-one SSc patients were included in the study with the mean age of 44.1 (14.8). Among these, 65 (71.4%) patients were classified as limited subtype (lcSSc) and 84 (93.3%) were women. PAH was investigated in 8 (8.2%) patients, 1 (6.7%) in dcSSc and 7 (15.9%) in lcSSc subtype of disease. ILD had developed after a median of 107 (SE = 24.4) months after the first symptom of SSc, and 29 patients (31.9%) developed pulmonary fibrosis. Alveolitis and fibrosis had developed after a median of 129.0 (22.9) and 259.0 (74.2) months, respectively. There was a significant difference in Alveolitis-free pulmonary survival between two subgroups of the disease, which showed pulmonary alveolitis developed later in limited SSc (P = 0.03). The difference was not significant in two subtypes when Cox regression model was used to identify the effect of other prognostic factors on pulmonary survival in patients. In the present study, clinical manifestations of two subtypes of disease were divergent at first; however they became convergent in late stages, and this was the same as results in previous studies. Echocardiography for evaluation of pulmonary hypertension and pulmonary function tests for early detection of ILD and PAH is recommended for SSc patients to detect early stages of pulmonary involvement before significant vascular and fibrotic changes occur.

Respiratory impairment in Brazilian foundry workers exposed to sand

Foundries date back to the 16th century in Brazil and still constitute a strong economic activity today. Workers are at risk of respiratory diseases due to various exposures such as polycyclic aromatic hydrocarbons, pyrolysis degradation products, mineral dust, organic dust, resin, and isocyanates. We evaluate respiratory morbidity among workers in foundries using sand. Six foundries with sand molding operations were selected. Length of exposure in years was utilized as a surrogate for exposure. The medical evaluation consisted of a respiratory symptoms questionnaire, occupational history, spirometry, and chest X-rays. Additionally, workers exposed to resins and a control group underwent bronchial provocation tests. A sample of 598 male workers with a mean age of 36.5 years (SD = 10.0) was analyzed. The mean length of exposure was 10.1 years (SD = 7.4). The overall prevalence of pneumoconiosis was 4.5%. Chronic bronchitis (CB) and X-ray profusion were significantly related to the quartiles of length of exposure (trend tests: P = 0.0055 and P < 0.001, respectively). There was a significant risk of having an abnormal FVC and FEV(1) with the presence of pneumoconiosis (OR = 4.63 CI 1.40-13-23, OR 3.34 CI 1.03-9.26, respectively). Workers exposed to resins compared with controls showed no differences in relation to spirometry, respiratory symptoms and bronchial reactivity. There were significant associations between length of exposure CB and prevalence of profusion 1/0 or above. There was also a significant association for pneumoconiosis versus and abnormal FVC and FEV(1). Foundry workers currently exposed to resins did not show an excess of respiratory symptoms, abnormal spirometry or increased bronchial reactivity.

Effects of Environmental Tobacco Smoke on Respiratory Symptoms and Pulmonary Function

The aim of this study was to examine the effects of environmental tobacco smoke (ETS) on pulmonary function and respiratory symptoms. During periodic medical examination, 392 French nonsmokers responded to an interviewer-administered questionnaire. Then spirometry was performed to assess pulmonary function. All of the subjects were carefully examined by two occupational physicians. ETS exposure at the workplace was more common than this exposure at home (20% vs. 5%). ETS exposure was significantly associated with forced vital capacity (FVC; −3.16%; 95% CI: −5.67 to −0.64) and forced expiratory volume in 1s (FEV1; −2.90%; 95% CI: −5.59 to −0.23). Abnormal FVC results were significantly increased in exposed subgroup [odds ratio = 2.71 (95% CI: 1.09 to 6.75)]. We did not find any significant dose-response relationship between ETS exposure and lung function results. The effects of ETS exposure on respiratory symptoms and diseases (asthma, wheezing, chronic bronchitis, and dyspnea) were not significant. Thus, this study showed that there was a significant inverse association between exposure to ETS and pulmonary function. Even pulmonary function results inferior to the lower limit of normal may be possible. A stricter legislation against ETS is proposed.

Prevalence and Reversibility of Pulmonary Dysfunction in Refractory Systemic Lupus: Improvement Correlates With Disease Remission Following Hematopoietic Stem Cell Transplantation

To report the prevalence and reversibility of pulmonary function test (PFT) abnormalities among systemic lupus erythematosus (SLE) patients, refractory to therapy, undergoing hematopoietic stem cell transplantation (HSCT).Thirty-four SLE patients received 200 mg/kg cyclophosphamide and 90 mg/kg equine antithymocyte globulin followed by HSCT. PFTs were performed prior to, at 6 months, and yearly following HSCT.The prevalence of significant PFT abnormalities was high (97%). Low FEV(1) and FVC occurred in 26 of 34 patients (76%). A significant abnormality in diffusion capacity of the lung for carbon monoxide (Dlco) occurred in 26 of 32 individuals able to complete Dlco testing (81%). Dlco <or= 50% of predicted occurred in 18 of 32 patients (56%). Of these 18 patients, 4 had no thoracic diagnosis and 7 had no pulmonary diagnosis. For 3 of 11 patients with a Dlco <or= 50% of predicted and a prior pulmonary diagnosis, the only diagnosis had been pleurisy. Ten of the 34 patients (29%) identified the lung as a target organ of the lupus and carried a pulmonary diagnosis, as indicated in Table 1 . Three patients had acute alveolar hemorrhage, four patients had acute lupus pneumonitis, two patients had shrinking lung syndrome (SLS), and one patient had SLE-related pulmonary hypertension. Of these 10 patients, 4 had received prior mechanical ventilation, and 7 had required home supplemental inspired oxygen. Patients have been monitored <or= 77 months, and 28 patients have been monitored > 18 months after HSCT. Five of 28 patients had a normal entry FVC; for each, the FVC remains normal. Of the 23 patients with an abnormal baseline FVC, 18 have improved, 15 completely and 3 partially. Eight of these 18 patients also have improved Dlco. The two patients with a diagnosis of SLS and one patient with SLE-related pulmonary hypertension improved in both parameters. Only 5 of 23 patients with an abnormal FVC did not improve. Each of these five patients retained active lupus in spite of HSCT.The prevalence of lung impairment among SLE patients requiring long-term immune suppression is high. Following HSCT, pulmonary impairments can improve, which is sustained if disease control is sustained.

ASSOCIATION OF LUNG FUNCTION WITH ATHEROSCLEROTIC RISK FACTORS AMONG JAPANESE AMERICANS: SEATTLE NIKKEI HEALTH STUDY

1. Impaired lung function has been reported to be associated with mortality from all causes, cardiovascular disease (CVD) and aortic pulse wave velocity (PWV). The aim of the present study was to examine the association between impaired lung function and atherosclerotic risk factors, including PWV, blood pressure, lipids, smoking and alcohol intake, among Japanese Americans. 2. The study subjects were 678 adult Japanese Americans who participated in CVD screening conducted under the Seattle Nikkei Health Study. Subjects with abnormal lung function were defined as those with forced vital capacity (FVC%) < 80% of predicted or forced expiratory volume in 1 s (FEV1%) < 80% of predicted. We conducted logistic regression analyses by using abnormal lung function as dependent variables. 3. The significant predictors positively associated with abnormal FVC% were age (60 years or older) and hypertension. Being a current drinker or an ex-drinker was independently and negatively associated with abnormal FVC%. The significant predictors positively associated with abnormal FEV1% were age (60 years or older), sex (male), hypertension and being a current smoker. Being a current drinker was independently and negatively associated with abnormal FEV1%. 4. In conclusion, the present study does not support the previously reported association of abnormal lung function with PWV. However, our findings imply that light and moderate drinking may be a protective factor of lung function and that hypertension and smoking may impair lung function.

Effect of Occupational Silica Exposure on Pulmonary Function

To assess the effect of occupational silica exposure on pulmonary function. Epidemiologic evaluation based on employee interview, plant walk-through, and information abstracted from company medical records, employment records, and industrial hygiene measurements. Drawn from 1,072 current and former hourly wage workers employed before January 1, 1986. Thirty-six individuals with radiographic evidence of parenchymal changes consistent with asbestosis or silicosis were excluded. In addition, eight individuals whose race was listed as other than white or black were excluded. Analysis of spirometry data (FVC, FEV1, FEV1/FVC) only using the test results that met American Thoracic Society criteria for reproducibility and acceptability shows decreasing percent-predicted FVC and FEV1 and decreasing FEV1/FVC in relationship to increasing silica exposure among smokers. Logistic regression analyses of abnormal FVC and abnormal FEV1 values (where abnormal is defined as < 95% confidence limit for predicted using the Knudson prediction equations) show odds ratios of 1.49 and 1.68, respectively, for occurrence of abnormal result with 40 years of exposure at the Occupational Safety and Health Administration (OSHA)-allowable level of 0.1 mg/m3. Longitudinal analyses of FVC and FEV1 measurements show a 1.6 mL/yr and 1.1 mL/yr, respectively, decline per milligram/cubic meter mean silica exposure (p = 0.011 and p = 0.001, respectively). All analyses were adjusted for weight, height, age, ethnicity, smoking status, and other silica exposures. Systematic problems leading to measurement error were possible, but would have been nondifferential in effect and not related to silica measurements. There is a consistent association between increased pulmonary function abnormalities and estimated measures of cumulative silica exposure within the current allowable OSHA regulatory level. Despite concerns about the quality control of the pulmonary function measurements use in these analyses, our results support the need to lower allowable air levels of silica and increase efforts to encourage cessation of cigarette smoking among silica-exposed workers.

Respiratory health in chrysotile asbestos miners in British Columbia: a longitudinal study.

A respiratory survey was undertaken in chrysotile asbestos miners in British Columbia consisting of a questionnaire, spirometry, chest radiography, and physical examination. The tests were performed in 1977 and again in 1983. The population groups studied included 63 "exposed" (working in the plant more than nine years), 52 "controls" (working in the plant less than five years), and 38 residents of the village at the minesite. A subset of 39 was identified with high exposure (worked in the mill more than five years). Measured levels of environmental particulates were similar over the entire period of operation of the plant (1.4 to 14.0 million particles per cubic foot and 0.7-88.0 fibres/cc in the mill; 0.2 to 2.7 mpcf and 0.6 to 9.3 f/cc in the mine). The exposed groups were more likely to report cough and breathlessness than the two other groups and were also more likely to have abnormal FVC and chest x ray films (the latter not significant, p greater than 0.05) and to be more likely to have a combination of these abnormalities. There was no trend to progression in the combination of abnormalities associated with exposure on follow up. The heavily exposed group showed a significantly worse trend in FVC. This adverse trend was confined to those with initial abnormalities. Tobacco smoking did not increase the trend to progression in this group.