American Thoracic Society/European Respiratory Society Research Articles

Analyzing lung cancer risks in patients with impaired pulmonary function through characterization of gut microbiome and metabolites

BackgroundLung cancer (LC) is one of the most devastating diseases worldwide, there is growing studies confirm the role of impaired lung function in LC susceptibility. Moreover, gut microbiota dysbiosis is associated with LC severity. Whether alterations in gut microbiota and metabolites are associated with long-term lung dysfunction in LC patients remain unclear. Our study aimed to analyze the risk factors in LC patients with impaired pulmonary function based on the characteristics of the gut microbiome and metabolites.MethodsFecal samples from 55 LC patients and 28 benign pulmonary nodules patients were collected. Pulmonary ventilation function was graded according to the American Thoracic Society/ European Respiratory Society (ATS/ERS) method. LC patients were divided into 3 groups, including 20 patients with normal lung ventilation, 23 patients with mild pulmonary ventilation dysfunction and 12 patients with moderate or above pulmonary ventilation dysfunction. The fecal samples were analyzed using 16 S rRNA gene amplicon sequencing and metabolomics.ResultsThe gut microbiome composition between LC patients and benign pulmonary nodules patients presented clearly differences based on Partial Least Squares Discriminant Analysis (PLS-DA). Pulmonary ventilation function was positively correlated with LC tumor stage, the richness and diversity of the gut microbiota in LC patients with moderate or above pulmonary ventilation dysfunction increased significantly, characterized by increased abundance of Subdoligranulum and Romboutsia. The metabolomics analysis revealed 69 differential metabolites, which were mainly enriched in beta-Alanine metabolism, styrene degradation and pyrimidine metabolism pathway. The area under the curve (AUC) combining the gut microbiome and metabolites was 90% (95% CI: 79-100%), indicating that the two species and four metabolites might regarded as biomarkers to assess the prediction of LC patients with impaired pulmonary function.ConclusionsOur results showed that microbiome and metabolomics analyses provide important candidate to be used as clinically diagnostic biomarkers and therapeutic targets related to lung cancer with impaired pulmonary function.

Characteristics of patients with severe asthma in primary and secondary care settings considered eligible for biological therapy - the Bulgarian RECOGNISE study.

Asthma is a major non-communicable disease. It affects both children and adults, but is the most common chronic condition among the former. While inhaled controller drugs stabilize the disease in most asthma patients, there are a certain number of people who suffer from severe asthma, which requires treatment escalation. Oral corticosteroids are usually added, but they are associated with various side effects that may limit their application. The introduction of biologicals targeting inflammatory mediators has opened a new era of asthma treatment highlighting the importance of patient characterization.

DLCO Biologic Quality-Control Findings From a Multi-Center Global Study.

The 2017 American Thoracic Society/European Respiratory Society (ATS/ERS) diffusing capacity of the lung for carbon monoxide (DLCO) standards specify a control rule for assessing biologic quality control (BioQC) but have limited guidance on how to establish expected values for control rule variables. This study aimed to determine expected values for DLCO BioQC using coefficient of variation (CV) and compare that the mean ± 2 SD control rule yields the same precision as mean ± 12% of the mean. DLCO BioQC data were collected from a multi-center inhaled medication study. This descriptive study spanned 42 months ending in 2018. The annual DLCO CV was based upon 10 DLCO values separated by at least 5 d. The root mean square CV (RMSCV) was computed for each year and Friedman test evaluated within subject annual CV changes. Ninetieth percentile values were computed for annual control rule limits/mean DLCO. Of 217 BioQCs, the study's first year had 168 subjects with fewer in subsequent years. Annual CV values from RMSCV were 5.3, 4.5, and 4.6% in years 1, 2, and 3, respectively. No change was seen in the CV for those subjects with data for all 3 years, n = 24, P = .07. The 90th percentile of measurements 2 SD/mean DLCO were 15, 12.4, and 11% in years 1, 2, and 3, respectively. A DLCO BioQC CV ≤ 6% is achievable across multiple sites, technologists, and brands of equipment. This CV value assures that measurements for control rule variables emerge from an expected range. A control rule of mean ± 2 SD appeared to yield similar results as the mean ± 12% of the mean rule reported in the 2017 ATS/ERS DLCO standards.

Nasal nitric oxide in healthy Chinese children aged 6-18 years.

To obtain the normal values of fractional concentration of nasal nitric oxide in Chinese children aged 6-18 years, so as to provide reference for clinical diagnosis. 2,580 out of 3,200 children (1,359 males and 1,221 females), whom were included from 12 centers around China were taken tests, their height and weight were also recorded. Data were used to analyze the normal range and influencing factors of fractional concentration of nasal nitric oxide values. Data was measured using the Nano Coulomb Breath Analyzer (Sunvou-CA2122, Wuxi, China), according to the American Thoracic Society/European Respiratory Society (ATS/ERS) recommendations. We calculated the normal range and prediction equation of fractional concentration of nasal nitric oxide values in Chinese children aged 6-18 years. The mean FnNO values of Chinese aged 6-18 yrs was 454.5 ± 176.2 ppb, and 95% of them were in the range of 134.5-844.0 ppb. The prediction rule of FnNO values for Chinese children aged 6-11 yrs was: FnNO = 298.881 + 17.974 × age. And for children aged 12-18 yrs was: FnNO = 579.222-30.332 × (male = 0, female = 1)-5.503 × age. Sex and age were two significant predictors of FnNO values for Chinese children(aged 12-18 yrs). Hopefully this study can provide some reference value for clinical diagnosis in children.

Does the severity of asthma affect exercise capacity and daily physical activity?

Objective Exercise capacity, daily physical activity, and psychological profile are crucial aspects in the management of asthmatic patients. Whether these features are expressed in a different way in mild-moderate (MMA) and severe asthma (SA) is unknown. Methods In this observational cross-sectional study, patients matching the American Thoracic Society/European Respiratory Society (ATS/ERS) definition for SA underwent incremental cardiopulmonary exercise testing (CPET), full lung function testing, and an evaluation of daily step count and physical activity. Questionnaires on quality of life, general fatigue, and presence of anxiety and depression traits (Hospital Anxiety and Depression Scale - HADS) were administered. Patients were compared with a cohort of age- and gender-matched MMA patients. Results We enrolled 16 SA, 17 MMA patients, and 16 healthy subjects. Compared to MMA, SA subjects showed a median (interquartile range) reduced peak oxygen consumption during CPET (20.4 (17.2-23.3) vs. 25.6 (18.5-30.3) ml/min/kg; p = 0.019), a reduced resting lung function (FEV1% of predicted 77 (67-84) vs. 96 (84-100); p < 0.001) and a pronounced anxiety trait at HADS (9.5 (3-11.7) vs. 4.0 (2.0-7.5); p = 0.023). In addition, SA patients showed a significantly higher reduction in inspiratory capacity from rest to peak (310 (160-520) vs. 110 (-65-325) ml; p = 0.031). We found no significant differences in mean daily step count or quality of life. Conclusions Compared to MMA, SA patients present a reduced exercise capacity and a more pronounced anxiety trait, but not worse daily physical activity or quality of life. These aspects should be considered in the clinical management and research development of SA.

Prediction Equations for Spirometry in Adults from Northern India

Most of the Indian studies on prediction equations for spirometry in adults are several decades old and may have lost their utility as these were carried out with equipment and standardisation protocols that have since changed. Their validity is further questionable as the lung health of the population is likely to have changed over time. To develop prediction equations for spirometry in adults of north Indian origin using the 2005 American Thoracic Society/European Respiratory Society (ATS/ERS) recommendations on standardisation. Normal healthy non-smoker subjects, both males and females, aged 18 years and above underwent spirometry using a non-heated Fleisch Pneumotach spirometer calibrated daily. The dataset was randomly divided into training (70%) and test (30%) sets and the former was used to develop the equations. These were validated on the test data set. Prediction equations were developed separately for males and females for forced vital capacity (FVC), forced expiratory volume in first second (FEV1), FEV1/FVC ratio, and instantaneous expiratory flow rates using multiple linear regression procedure with different transformations of dependent and/or independent variables to achieve the best-fitting models for the data. The equations were compared with the previous ones developed in the same population in the 1960s. In all, 685 (489 males, 196 females) subjects performed spirometry that was technically acceptable and repeatable. All the spirometry parameters were significantly higher among males except the FEV1/FVC ratio that was significantly higher in females. Overall, age had a negative relationship with the spirometry parameters while height was positively correlated with each, except for the FEV1/FVC ratio that was related only to age. Weight was included in the models for FVC, forced expiratory flow (FEF75) and FEV1/FVC ratio in males, but its contribution was very small. Standard errors of estimate were provided to enable calculation of the lower limits of normal and standardised residuals for these parameters. The equations were found to be valid on the test dataset, and therefore, may be extended to general population. Comparison with the 1960s equations revealed lack of good agreement, and substantially higher predicted FVC with the current equations, especially in the forty-years-plus age group, in both males and females. Even in the age group upto 40 years, the level of agreement was clinically not acceptable. Validated prediction equations have been developed for spirometry variables in adults of north Indian origin using the current ATS/ERS spirometry standardisation recommendations. The equations suggest an improvement in the lung health of the population over time in the middle-aged and the elderly. These equations should address a long-felt unmet need and enable a more appropriate evaluation of spirometry data in different chest diseases in Indian subjects.

Regression Equations for Spirometry in Children Aged 6 to 17 Years in Delhi Region

Most of the studies carried out in India to develop regression equations for spirometry in children are now several years-to-decades old and had used equipment and measurement protocols that have since changed. Prediction equations using the current standardisation protocols for spirometry are not available. The lung health of the population may have changed too. To develop regression equations for spirometry for children aged 6 to 17 years of north Indian origin in Delhi region. School children of north Indian origin, as determined by mother tongue and parentage, aged 6 to 17 years were screened by a health questionnaire and physical examination and those found "normal" underwent spirometry according to the standardised procedure recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) task force in 2005. Pearson's correlation analysis was carried out to identify the predictor variables for spirometric parameters. Prediction equations were developed using the multiple linear regression procedure. The independent variables were entered in sequence of height, age and weight. R2, adjusted R2 and R2 change, standard errors of the estimate (SEE), and estimates of regression coefficients were obtained and the goodness of fit was examined. Data was obtained in 365 boys and 305 girls. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) peak expiratory flow rate (PEFR), forced expiratory flow rate at 50% and 75% exhalation of vial capacity (F50 and F75) and mean forced expiratory flow rate over the middle 50% of the vital capacity (F25-75) showed moderate to strong correlations with age, height and weight in both boys and girls. In both genders, the equations explained very high variability of FVC, FEV1 and PEFR as shown by the R2 values. The explained variability for flow rates was lesser, with that for F75 being the least. Regression equations for spirometry variables for children of north Indian origin in Delhi region have been developed. These represent the first such effort from India after the publication of the ATS/ERS task force 2005 guidelines on standardisation of spirometry.

Comparison of Two Protocols for the Assessment of Maximal Respiratory Pressures: Spanish Society of Pulmonology and Thoracic Surgery Versus American Thoracic Society/European Respiratory Society.

BackgroundThe measurement of maximal respiratory pressures (MRPs) is commonly used to assess respiratory muscle strength. However, in Spain, there is no consensus on which is the most adequate measurement protocol, as theSpanish Society of Pneumology and Thoracic Surgery (SEPAR) protocol differs from the one endorsed by the American Thoracic Society/European Respiratory Society(ATS/ERS). This study compared the absolute and predictive values of maximal expiratory and inspiratory pressures (MEP and MIP) in healthy adults obtained with the two protocols.MethodsA cross-sectional study with a sample of healthy adults was conducted. Lung function and MRPs were assessed. MEP and MIP were measured using a digital manometer according to the SEPAR and ATS/ERS. Protocols were applied in random order by the same trained physiotherapist. The comfort experienced with each protocol was assessed through a short questionnaire. Paired t-tests were used to compare the results from both protocols.ResultsA total of 31 subjects (mean age 35.7±12.4 years; 14 females; FEV1=108.3±10.5%; FVC=103.7±10%) were included. There was a significant difference between MRPs favouring the SEPAR protocol, with the mean difference being 34.9±28.1 cmH2O (p˂0.001) for MEP and 8±11.6 cmH2O (p=0.001) for MIP. ATS/ERS protocol was, however, considered more comfortable than SEPAR (p<0.005).ConclusionsThis study shows that, in healthy adults, higher MRPs are obtained using the SEPAR protocol. Yet, the ATS/ERS protocol is experienced as more comfortable. Future studies are needed to analyse the application of both protocols in other populations and their associated comfort.

Changes in Inspiratory and Expiratory Flow Rates with Sustained Hand Grip and their Correlation with Fat Free Mass Index in Healthy Young Adults

Introduction: Aerobic exercises which are isotonic in nature have been proved to be beneficial in a number of cardiovascular and lifestyle diseases. But the effect of isometric exercises on cardiovascular and respiratory system is not fully evaluated. Existing literature on effect of isometric exercise on respiratory flow parameters are scanty and needs to be studied. Further, the impact of muscle mass on respiratory flow parameters need to be evaluated. Aim: To investigate the change in respiratory flow parameters (Peak Inspiratory Flow (PIF), Maximal Inspiratory Flow (MIF) 50, Peak Expiratory Flow (PEF), Maximum Expiratory Flow (MEF) 25-75, MEF 25, MEF 50 and MEF 75) in response to Sustained hand grip exercise and to find out any correlation between these flow parameters and Fat Free Mass Index (FFMI). Materials and Methods: A cross-sectional study was conducted at Department of Physiology, MKCG Medical College, Berhampur University, Odisha between October 2011 and August 2014. A total of 150 healthy volunteers aged between 17 to 25 years were included in the study. Anthropometric measurements were recorded using standardised instruments. Body fat percentage was measured by Bioelectric Impedance Analysis technique and then Fat Free Mass (FFM) and FFMI were calculated using standard formulae. Respiratory Flow parameters were assessed using Flow handy Spirometer as per the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. Sustained hand grip exercise was performed with Physilab Grip Dynamometer. IBM SPSS Statistics Version 24.0, was used for statistical analysis. Paired sample t-test was used to compare lung volumes at baseline and after 3 minutes of sustained hand grip exercise. The p-value &lt;0.05 was considered statistically significant. Karl Pearson Correlation coefficient was used to study the linear relationship between FFMI and various inspiratory and expiratory flow rates. Results: The mean values of all respiratory flow parameters under study decreased at 3 minutes of sustained hand grip exercise as compared to baseline values. This change was statistically significant for PEF (p-value 0.012), MEF 25-75 (p-value 0.041), MEF 50 (p-value 0.001), MEF 75 (p-value 0.012) and MIF50 (p-value 0.004) (p&lt;0.05). All the flow rates studied except MEF 25 showed significant positive correlation with FFMI (r-values between 0.231 to 0.380, p&lt;0.05) but the strength of association was low. Conclusion: There was a statistically significant reduction in both inspiratory and expiratory flow parameters with isometric sustained hand grip exercise. So, isometric exercises should be avoided in patients with obstructive airway diseases. But muscle mass should be improved for better ventilation as authors observed a positive correlation between FFMI and respiratory flow rates.

Evaluation of Fractional Exhaled Nitric Oxide in Pediatric Asthma and Allergic Rhinitis.

Fractional exhaled nitric oxide (FeNO) is a non-invasive test for evaluating the degree of airway inflammation and for the diagnosis, evaluation, and treatment of asthma. We attempted to measure FeNO levels in Korean children with asthma and determine its cutoff value for diagnosing asthma. We enrolled 176 children and adolescents between the ages of 5 and 18 years, who visited for the evaluation of chronic cough, shortness of breath, and wheezing. Among them, 138 patients who underwent skin prick tests or inhalation Immuno CAP (UniCAP; Pharmacia, Uppsala, Sweden) tests for allergy testing together with a pulmonary function test were included. FeNO was measured using a NIOX MINO (Aerocrine AB, Solna, Sweden) instrument according to the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. There were 29 patients with asthma, 43 with rhinitis, and 38 with asthma and allergic rhinitis. In the asthma group, FeNO levels significantly correlated with total immunoglobulin E (r = 0.572, p < 0.001), but did not show significant correlation with pulmonary function test parameters (forced vital capacity—FVC, forced expiratory volume in one second—FEV1, FEV1/FVC) or PC20 (provocative concentration of methacholine causing a 20% fall in FEV1). The FeNO cutoff values obtained in the asthma and asthma rhinitis groups were 16.5 ppb and 18.5 ppb, respectively. Hence, we provide a FeNO cutoff value according to the presence or absence of rhinitis in pediatric patients with asthma.

Development of spirometric reference equations for children living at high altitude.

This study was aimed to provide locally derived spirometric equations from a population of healthy children residing in Bogota, Colombia, a high-altitude city. Healthy children aged more than 6years up to less than 18years underwent spirometry from January 2017 to January 2018, following the recommendations made by the American Thoracic Society/European Respiratory Society (ATS/ERS) Task Force. We performed stepwise multiple regression analyses to predict each spirometric parameter. We also performed extensive residual analyses comparing the measured values with those calculated with our new spirometric equations and with other commonly used equations. Predictive equations for each spirometric variable were derived from 326 spirometric tests (149 boys, 177 girls). Our newly derived spirometric equations provided the minimum of median of prediction error for almost all spirometric indices measured. We recommend the newly developed spirometric equations for assessing the ventilatory function of children living in Bogota, Colombia.

Does spirometric tests meet the acceptability criteria? Data from a tertiary chest hospital in Turkey

First step is to evaluate the quality of the test in interpreting spirometries. International societies have defined the acceptability criteria for spirometric tests. With this study, it was aimed to evaluate spirometric tests in terms of compliance with international acceptability criteria and to determine error types. Spirometric manoeuvres held at a tertiary chest diseases hospital were evaluated as to whether the acceptability criteria of "American Thoracic Society/European Respiratory Society (ATS/ERS)" guideline were maintained or not. Errors determined were classified as unexplosive start of expiration, submaximal effort, cough, closure of glottis, missing closure of the loop ring and early termination of expiration. Among tests evaluated (n= 510), 276 (54.1%) belonged to female and 234 (45.9%) to male subjects. Average age of subjects was 56.1 ± 15.0 years. It was noted that 318 (62.4%) of the tests met acceptability criteria, whereas 192 (37.6%) did not. The most frequently noted error type is submaximal effort by 30.2% followed by missing closure of the loop, early terminaton of expiration, coughing, unexplosive start of expiration and closure of glottis. In the tests whose spirometric maneuvers did not meet the criteria, the mean age of the patients was significantly higher than in the appropriate tests. When the cases were grouped according to their age, it was observed that the rate of conformity of spirometric examinations decreased significantly as the age range increased. Within this study it is the first time in our country that evaluation of spirometric studies has been made to see the rate of conformity with international standarts. Although it is thought that spirometric examinations are not technically appropriate in clinical practice throughout our country, there is no data in the literature. Although the center where the study is conducted is a tertiary chest diseases hospital, the data obtained reveal that in spirometric evaluations, a substantially non-standard examination was performed.

Artificial intelligence as an emerging diagnostic approach in paediatric pulmonology.

Artificial intelligence as an emerging diagnostic approach in paediatric pulmonology.

Clinical features and prognosis of patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease.

<sec> <title>BACKGROUND</title> Idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD) share common risk factors. They could therefore be expressed in a single patient. However, the prevalence, clinical characteristics and prognosis of individuals with comorbid IPF and COPD are not known. </sec> <sec> <title>METHOD</title> From 2003 to 2007, the Korean Interstitial Lung Disease Study Group created a register for idiopathic interstitial pneumonia using 2002 ATS/ERS (American Thoracic Society/European Respiratory Society) criteria. Of the 1546 IPF patients assessed, 143 had decreased lung function consistent with COPD (IPF-COPD). COPD was diagnosed based on age (≥40 years) and pulmonary function (forced expiratory volume in 1 sec [FEV1]/forced vital capacity [FVC] ratio < 0.7). </sec> <sec> <title>RESULTS</title> The median age of the IPF-COPD group was 71.0 years (interquartile range 66.0-76.0); most patients were male (88.1%). FVC (%) was significantly higher in the IPF-COPD group; however, FEV1 (%) was significantly lower in the IPF-COPD group (P < 0.001). Diffusing capacity of the lung for carbon monoxide (DLCO) was not significantly different between the two groups. In survival analysis, age and FVC (%), but not COPD, were significantly associated with prognosis (respectively P = 0.003, 0.001 and 0.401). COPD severity was also not related to prognosis (P = 0.935). </sec> <sec> <title>CONCLUSION</title> The prevalence of IPF-COPD was estimated to be ∼9.2% among all IPF patients; prognosis of patients with IPF-COPD was not worse than those with IPF alone. </sec>.

Reference values for spirometric parameters in healthy children living in a Colombian city located at 2640 m altitude.

To identify the spirometric equations that are most appropriate for use in children and adolescents living in Bogota, Colombia after evaluating a set of relevant previously-developed equations, including the Global Lung Function Initiative (GLI) 2012 spirometry reference equations. Healthy children aged between 6 and 17 years that were attending two randomly-selected schools in Bogota were invited to participate in the study, from January 2017 to January 2018. All participants underwent spirometry, following the procedures recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) Task Force. To identify the model or group of models that best predict each spirometric parameter in our population, we performed extensive residuals analyses and constructed Bland-Altman plots. Three hundred twenty-six spirometric tests (149 boys, 177 girls) formed the reference data set. Knudson and GLI-2012 spirometry reference equations proved to be the most accurate in predicting the majority of spirometry parameters in both sexes and both age groups, each providing the lowest median prediction error in the residual analyses or the narrowest limits of agreement in the Bland-Altman plots in approximately one-third of the spirometry parameters analyzed. For the majority of spirometry parameters, we recommend the use of Knudson and GLI-2012 spirometry reference equations for evaluating the respiratory function of children living in Bogota, Colombia, a city located at an altitude of 2640 m. Future investigations should target additional spirometric equations from Latin American populations living at moderate to high altitude to improve the GLI-2012 equations.

Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies.

Chronic obstructive pulmonary disease (COPD) is a major incurable global health burden and is currently the 4th largest cause of death in the world. Importantly, much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction) and infective viral and bacterial acute exacerbations (AECOPD). Current pharmacological treatments for COPD are relatively ineffective and the development of effective therapies has been severely hampered by the lack of understanding of the mechanisms and mediators underlying COPD. Since comorbidities have a tremendous impact on the prognosis and severity of COPD, the 2015 American Thoracic Society/European Respiratory Society (ATS/ERS) Research Statement on COPD urgently called for studies to elucidate the pathobiological mechanisms linking COPD to its comorbidities. It is now emerging that up to 50% of COPD patients have metabolic syndrome (MetS) as a comorbidity. It is currently not clear whether metabolic syndrome is an independent co-existing condition or a direct consequence of the progressive lung pathology in COPD patients. As MetS has important clinical implications on COPD outcomes, identification of disease mechanisms linking COPD to MetS is the key to effective therapy. In this comprehensive review, we discuss the potential mechanisms linking MetS to COPD and hence plausible therapeutic strategies to treat this debilitating comorbidity of COPD.

Quality of spirometry testing in a community setting: A study among elderly persons in a rural area of Haryana.

Introduction:Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Early diagnosis and management of COPD require good quality spirometry testing, which is currently not available at primary care level in India. This study reports the quality of spirometry testing at the community level among elderly persons in a rural area.Materials and Methods:A community-based cross-sectional study was conducted among 449 elderly persons in a rural area of Ballabgarh block of Haryana state by a trained investigator. A portable spirometer (MIR Spirolab®) was used. House-to-house visits were undertaken. A self-developed pretested semistructured interview schedule was administrated and spirometry was done according to the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines.Results:Acceptable quality of spirometry tests was found among 87.3% (95% CI: 84.2%–90.4%) participants. Poor quality of spirometry was associated with low Body Mass Index (BMI) (aOR = 0.49, 95% CI = 0.26–0.93) and age ≥ 70 years (aOR = 0.45, 95% CI = 0.21–0.94) in multivariable analysis.Conclusion:Acceptable quality of spirometry can be performed in community settings by using a portable spirometer.

Injury patterns in interstitial lung diseases

Interstitial lung diseases (ILD) consist of acomplex group of hundreds of non-neoplastic pulmonary diseases with divergent clinical presentation, morphology and progression tendency. This great number of clinical entities contrasts with alimited number of injury patterns. By definition, an adequate classification requires asynopsis of the clinical, radiological and morphological findings. The ATS/ERS (American Thoracic Society/ European Respiratory Society) guidelines recommend an open lung biopsy if high-resolution computed tomography does not provide conclusive results. Due to the focal nature and overlapping features of injury patterns, microscopic categorization is not always possible. In order to broaden the diagnostic criteria by using molecular patterns the Lung Research Working Group of the Institute of Pathology of Hannover Medical School, Europe's leading transplant center, is working up fresh explanted human lungs in astandardized manner. These fresh specimens are used for translational research by means of functional, morphological and molecular techniques in order to identify disease-specific regulatory processes and to make them usable diagnostically and therapeutically.

Ethnic differences in lung functions of children in the Colombo District, Sri Lanka

Reference values of lung functions vary with age, height, ethnicity and sex of the reference population. Global Function Initiative 2012 compared reference equations for Sri Lankan children with those of South Indian and South East Asian equations. Sri Lanka has a multi-ethnic society comprising of Sinhalese, Tamils, Moors and other ethnic minorities. Applicability of existing Sri Lankan equations to children from different ethnic groups in the country has not been adequately verified. Our aim was to investigate the effect of ethnicity on spirometry parameters in school aged children. We enrolled healthy boys and girls between 9-15 years of age from 6 schools in Colombo District using stratified cluster sampling. A pretested self-administered questionnaire collected details on demography, respiratory health and other chronic illnesses. Anthropometric measurements (standing height and weight) were collected. Spirometry was performed with a flow sensing spirometer that complies with American Thoracic Society/European Respiratory Society (ATS/ERS) standards adopted for children. Highest FVC and FEV1 values were obtained from 2 repeatable tests. Spirograms of 849 students were analysed. Majority (n=496) were Sinhalese. There were 240 Tamils and 113 Moors. Multiple regression found that height, age and sex were significantly associated with lung functions (p<0.05). Ethnicity was not significantly associated with parameters measured in spirometry when the regression was performed controlling for height and age. The same spirometry reference equations could could be used for children of all ethnic groups in Sri Lanka aged 9-15 years.

The Prevalence of Smoking among Sample of Kuwait Asthmatics and Its Impact on the Response of the Treatment

Background: Bronchial asthma is one of the most common diseases in Kuwait. Smoking also is on the rise in Kuwait. We therefore conducted this study to at prevalence of smoking among sample of Kuwaiti patients and the impact on asthma control. Methods: Descriptive study of 50 outpatients who were prospectively assessed from single center (Al-Jahra Hospital) that diagnosed recently as bronchial asthma using American Thoracic Society/European Respiratory Society (ATS/ERS) criteria definitions of asthma between the period of 1st of April and 20th may 2013. Patients were divided into two groups: Group A smokers and Group B non-smokers. Pulmonary function test using spirometer and asthma control test (ACT) was done for every patient at the time of visit and after 4 weeks to determine the effect of smoking on asthma control as a primary outcome using GINA guidelines definition for Asthma control and treatment. Results: At study entry 30% of sample size were smoker asthmatics. Smokers showed worse symptoms of wheezing, cough, and shortness of breath compared to non-smokers asthmatics whereas non-smokers asthmatics were more likely to have seasonal symptoms and use salbutamol MDI. Both groups showed similar spirometry findings at study entry. At 4 weeks from the first visit there was a significant difference in symptoms and signs of bronchial asthma between the 2 groups. Both measures of asthma control test and spirometer results favoured non-smokers. Smokers asthmatics were more likely to use rescue salbutamol MDI and non-compliant. No hospital admissions or acute exacerbations during the period of the study. Conclusion: Smoking was associated with worse asthma control and poor compliance among asthmatics.