Assessment Of Pulmonary Function Research Articles

Pilot study of paediatric regional lung function assessment via X-ray velocimetry (XV) imaging in children with normal lungs and in children with cystic fibrosis

IntroductionCystic fibrosis (CF) is a life-limiting autosomal recessive genetic condition. It is caused by mutations in the gene that encodes for a chloride and bicarbonate conducting transmembrane channel. X-ray velocimetry...

NLRP3 inflammasome mediates abnormal epithelial regeneration and distal lung remodeling in silica‑induced lung fibrosis.

NOD-like receptor protein 3 (NLRP3) inflammasome is closely related to silica particle‑induced chronic lung inflammation but its role in epithelial remodeling, repair and regeneration in the distal lung during development of silicosis remains to be elucidated. The present study aimed to determine the effects of the NLRP3 inflammasome on epithelial remodeling and cellular regeneration and potential mechanisms in the distal lung of silica‑treated mice at three time points. Pulmonary function assessment, inflammatory cell counting, enzyme‑linked immunosorbent assay, histological and immunological analyses, hydroxyproline assay and western blotting were used in the study. Single intratracheal instillation of a silica suspension caused sustained NLRP3 inflammasome activation in the distal lung. Moreover, a time‑dependent increase in airway resistance and a decrease in lung compliance accompanied progression of pulmonary fibrosis. In the terminal bronchiole, lung remodeling including pyroptosis (membrane‑distributed GSDMD+), excessive proliferation (Ki67+), mucus overproduction (mucin 5 subtype AC and B) and epithelial‑mesenchymal transition (decreased E‑Cadherin+ and increased Vimentin+), was observed by immunofluorescence analysis. Notably, aberrant spatiotemporal expression of the embryonic lung stem/progenitor cell markers SOX2 and SOX9 and ectopic distribution of bronchioalveolar stem cells were observed in the distal lung only on the 7th day after silica instillation (the early inflammatory phase of silicosis). Western blotting revealed that the Sonic hedgehog/Glioma‑associated oncogene (Shh/Gli) and Wnt/β‑catenin pathways were involved in NLRP3 inflammasome activation‑mediated epithelial remodeling and dysregulated regeneration during the inflammatory and fibrotic phases. Overall, sustained NLRP3 inflammasome activation led to epithelial remodeling in the distal lung of mice. Moreover, understanding the spatiotemporal profile of dysregulated epithelial repair and regeneration may provide a novel therapeutic strategy for inhalable particle‑related chronic inflammatory and fibrotic lung disease.

Assessment of pulmonary function and respiratory symptoms among INDIAN textile sizing mill workers.

Textile-sizing mill workers are exposed to various hazards in the sizing units during their working hours and are at risk of acquiring lung impairments due to the usage of sizing chemicals in the sizing process. The main aim of this study is to assess the influence of cotton dust and sizing agents on lung function and breathing difficulties among Indian textile sizing mill workers. This cross-sectional study was carried out at a textile-sizing mill from August 2022 to September 2022. A modified questionnaire based American Thoracic Society's standard was used to assess respiratory symptoms among sizing mill workers and the pulmonary function test was conducted Spirometry. The chi-square test was used to find the difference between respiratory symptoms and the t-test was used to find the difference between spirometric parameters. Textile sizing mill workers showed significant (P < 0.0001) decline in peak expiratory flow rate, forced vital capacity (FVC), ratio of FEV1 and forced vital capacity, and forced expiratory volume in 1 s (FEV1). There was an association between symptoms and duration of exposure to pulmonary abnormality. Sizing mill workers showed a significant decline in lung functions and an increase in pulmonary symptoms. As the service duration of exposure in terms of years increased, respiratory symptoms increased and spirometric abnormality also increased. This study confirms that sizing agents such as polyvinyl alcohol (PVA), emulsifier, wax, carboxymethyl cellulose (CMC), and starch used in sizing mills are also responsible for respiratory illness and lung impairment among textile workers.

Assessment of Pulmonary Function in COVID-19 Recovered Health Science Students: A Descriptiv Cross-sectional Study

Introduction: Coronavirus Disease-2019 (COVID-19) impacts multiple organs like the kidneys, heart, and liver, but primarily affects the respiratory system, leading to symptoms such as cough with sputum production, fever, and in severe cases, respiratory failure. Research on Severe Acute Respiratory Syndrome (SARS)-Coronavirus-2 (CoV-2) has revealed impairments in lung function during the early recovery phase following COVID-19 infection. The aim is to understand the virus’s impact and identify any obstructive, restrictive, or mixed pulmonary alterations in medical professionals six weeks after recovery. Aim: To assess Pulmonary Function Tests (PFTs) six weeks after COVID-19 recovery in health science students at a medical college in North Karnataka. Materials and Methods: A descriptive cross-sectional study was conducted in the Department of Physiology at Jawaharlal Nehru Medical College in North Karnataka, India, from January 2021 to December 2021. A total of 155 COVID-19-recovered health science students were included, and their anthropometry, physiological parameters, and pulmonary parameters were recorded. The “Spirometer Helios 401” was used to estimate an individual’s PFT. Data were analysed using independent sample t-tests, with a p-value &lt;0.05 considered statistically significant. Results: The mean age of the participants was 21.73±3.04 years. The Mean±Standard Devaiation (SD) of Forced Vital Capacity (FVC) (L), Forced Expiratory Volume (FEV) at the end of one second (L), Peak Expiratory Flow Rate (L), forced mid expiratory flow 25-75 (L/s), forced mid expiratory flow 25% (L/s), forced mid expiratory flow 50% (L/s), forced mid expiratory flow 75% (L/s), Inspiratory Reserve Volume (IRV) (L), Expiratory Reserve Volume (ERV) (L), Inspiratory Capacity (IC) (L), and Maximum Voluntary Ventilation (MVV) (L) ± SD of post-COVID-19 subjects were less compared to their corresponding predicted values. The Mean±SD of FEV1/FVC (%) and tidal volume (L) of COVID-19 recovered subjects were higher than their corresponding expected value. The FEV, Forced Expiratory Flow (FEF), and FEV1 values were significantly less in females compared to males. Conclusion: Coronavirus Disease-19-recovered subjects showed altered respiratory functions even after six weeks, with the majority having restrictive disease, followed by a mixed pattern and obstructive diseases, while the remaining showed no changes in lung function. Altered pulmonary functions in COVID-19 patients may be due to alveolar destruction or pulmonary interstitial fibrosis.

Pulmonary function assessment after COVID-19 in vaccinated healthcare workers

COVID-19 typically presents with flu-like symptoms due to the viral infection itself. The most severe cases are characterised by lung damage, an important factor in fatal outcome due to alveolar damage. In some cases, patients develop a long COVID with persistent symptoms of chest pain and fatigue. Causes, including organ damage or inflammation, are being investigated. Clinical outcomes are variable and permanent lung damage is not fully understood, while vaccination is effective against severe infection but its effect on respiratory function in mild cases remains uncertain. This retrospective study aims to analyse changes in lung function in HCWs who had COVID-19 between 2020 and 2022, comparing their spirometric test results before and after the pandemic and taking into account their vaccination status. 321 HCWs were included in the study. The study examined spirometric parameters both before and after the pandemic, and all measured outcomes except the FEV1/FVC ratio showed a significant decrease during the study period. We then assessed the association between SARS-CoV-2 infection and changes in lung function parameters, analysing infections in 2020, 2021 and 2022 separately. We found a statistically significant difference in Forced vital capacity (FVC) between infected and non-infected subjects in 2020 and 2021, but not in 2022. To evaluate the protective effect of SARS-CoV-2 vaccination on respiratory function, a linear regression analysis was performed using changes in FVC, Forced expiratory volume in 1 s (FEV1), FVC/FEV1 ratio and Peak expiratory flow (PEF) as dependent variables. The analysis showed that the decline in FVC was significantly lower in subjects who had been vaccinated prior to infection. The study concludes that subclinical SARS-CoV-2 infections in 2020 and 2021 worsened respiratory parameters (FVC and FEV1), but vaccination protected against these effects. Even healthy individuals with previous infections showed respiratory changes, with vaccination providing protection, especially for FVC decline. This highlights the importance of vaccinating healthcare workers against COVID-19.

Assessment of Pulmonary Functions in COVID-19 Survivors and Their Clinical Correlation at the 6-month Follow-up: A Prospective, Observational Study

Assessment of Pulmonary Functions in COVID-19 Survivors and Their Clinical Correlation at the 6-month Follow-up: A Prospective, Observational Study

Effect of Wearing a Face Mask on the 6-Minute Walk Test in Healthy Volunteers

Objective: This study aimed to examine the influence of wearing different types of face masks on the results of the 6-Minute Walk Test (6MWT) in a cohort of healthy volunteers. Materials and Methods: Volunteers were partitioned into three groups (each comprising 36 individuals) with different mask-wearing conditions: NIOSH-approved N95 mask, and double-mask scenarios featuring two layers of surgical mask, and a combination of a surgical mask covered by a cloth face mask. Each participant performed two rounds of the 6MWT, one while wearing a mask and another without. Various metrics, such as the six-minute walk distance (6MWD), oxygen saturation (SpO2), and dyspnea and fatigue scores, were measured. Results: No significant differences were found in the 6MWD results between the mask-wearing and non-mask-wearing scenarios across all the mask types.Strong positive correlations were also established between the 6MWD results in the mask-wearing and non-mask-wearing conditions. However, a small cohort experienced dyspnea significantly more when wearing double surgical masks compared to not wearing a mask. Additionally, there were no major deviations in SpO2 levels or fatigue scores regardless of the type of mask used. Conclusion: The study indicated that wearing an N95 mask, or double surgical masks, or cloth-over-surgical face masks did not significantly influence the outcomes of the 6MWT in healthy individuals. However, caution is advised in the case of wearing double surgical masks, as this may induce a greater sense of dyspnea. This suggests that face masks can be worn safely during physical fitness and pulmonary function assessments, aligning with their essential role in viral spread prevention in daily life.

EP08.02-09 Comprehensive Assessment of Pulmonary Function in Patients Receiving Radical (Chemo)Radiotherapy for Carcinoma Lung

EP08.02-09 Comprehensive Assessment of Pulmonary Function in Patients Receiving Radical (Chemo)Radiotherapy for Carcinoma Lung

Pulmonary Function Assessment in Myasthenia Gravis Patients in a National Referral Hospital in Indonesia.

Myasthenia gravis (MG) can cause respiratory muscle weakness and the need of ventilator support. Spirometry as the gold standard for pulmonary function examination has limited availability, especially in our hospital which is only available in outpatient clinic during work hours (not in emergency room or patient room). Furthermore, all primary healthcare in Indonesia do not have spirometry equipment, thus other alternatives are required. This study aimed to analyze the relationship between a single breath counting test (SBCT), peak flow meter (PFM), and spirometry to assess pulmonary function in MG patients in a national referral hospital in Indonesia. A single-center, cross-sectional study was conducted and SBCT, PFM, and spirometry examination were performed in MG patients and healthy controls. Seventy patients, aged 47.7 ± 13.4 years old, participated in this study. SBCT, forced vital capacity first second (FVC1), and forced expiratory volume first second (FEV1) value between MG patients and healthy controls showed a significant difference, in which healthy controls have higher SBCT, FVC1, and FEV1 values (p = 0.000, p = 0.000 and p = 0.001 respectively). There was a significant difference between PFM with SBCT and FVC1 value in MG patients. Strong correlation was found between SBCT and FVC1 in MG patients. MG patients had worse pulmonary function compared to healthy controls. SBCT and PFM examination have a significant correlation with FVC1 in MG patients. Therefore, SBCT and PFM can be used as a bedside tool to detect respiratory impairment in MG patients.

Neoadjuvant immune checkpoint inhibitor therapy and chemotherapy improve pulmonary ventilation and diffusion function in patients with lung cancer.

To investigate changes of pulmonary ventilation function and diffusion function in lung cancer patients after neoadjuvant immune checkpoint inhibitors (ICIs) therapy combined with chemotherapy treatment. Patients with newly diagnosed lung cancer (Ⅱa-Ⅲb) admitted to Zhejiang Cancer Hospital from October 2021 to July 2022, who received ICIs combined with chemotherapy for more than two courses were enrolled. Patients underwent pulmonary ventilation function and diffusion function assessments before and after treatment. The demographic information, sizes and locations of cancer lesions, doses and duration of ICIs used, pulmonary function results before and after treatment, and the tumor regression were documented. The changes of pulmonary function parameters before and after the treatment were analyzed with paired t test and Wilcoxon rank-sum test. The factors influencing the pulmonary function changes were analyzed by multiple linear Lasso regression and ridge regression. Among the 52 patients, 50 cases were males (96.15%) and 43 cases were squamous carcinoma (82.69%). The medium age of the patients was 67 years. After neoadjuvant therapy, 36 patients (69.23%) showed remission of tumor lesions. After treatment, the parameters of pulmonary ventilation inspiratory vital capacity (IVC) and the area under the expiratory flow-volume curve (AREAex), and the parameter of pulmonary diffusion total lung capacity increased compared with the baseline (all P<0.05). Forced vital capacity (FVC) and forced expiratory volume in first second (FEV1) also showed an increasing trend. Multivariate linear Lasso regression and ridge regression showed that baseline IVC had a significant negative effect on IVC improvement (Beta=－0.435, t=－2.968, P<0.01), baseline TLC had a significant negative effect on the improvement of TLC (Beta=－0.266, t=－2.474, P<0.05), and the remission of obstructive pneumonia favored the improvement of TLC (Beta=0.308, t=2.443, P<0.05). After ICIs neoadjuvant treatment combined with chemotherapy, the lung ventilation and diffusion function can be improved in lung cancer patients, particularly for those with reduced baseline ventilation and diffusion function.

The Effects of Prenatal Pravastatin Treatment in the Rabbit Fetal Growth Restriction Model.

Fetal growth restriction (FGR) remains without an effective prenatal treatment. Evidence from murine FGR models suggests a beneficial effect of prenatal pravastatin. Since the rabbit hemodichorial placenta more closely resembles the human condition, we investigated the effects of prenatal maternal pravastatin administration in the rabbit FGR model. At a gestational age of 25 days (term 31d), pregnant dams underwent partial uteroplacental vessel ligation (UPVL) in one uterine horn to induce FGR, leaving the other horn as a control. Dams were randomized to either receive 5 mg/kg/d pravastatin dissolved in their drinking water or normal drinking water until delivery. At GA 30d, the rabbits were delivered and were divided into four groups: control without pravastatin (C/NoPrav), FGR without pravastatin (FGR/NoPrav), FGR with pravastatin (FGR/Prav), and controls with pravastatin (C/Prav). The newborn rabbits underwent pulmonary functional assessment and neurobehavioral assessment, and they were harvested for alveolar morphometry or neuropathology. The placentas underwent histology examination and RNA expression. Birth weight was lower in the FGR groups (FGR/Prav, FGR/NoPrav), but there was no difference between FGR/Prav and C/NoPrav. No differences were noted in placental zone proportions, but eNOS in FGR/Prav placentas and VEGFR-2 in FGR/Prav and C/Prav were upregulated. There were no differences in pulmonary function assessment and alveolar morphometry. FGR/Prav kittens had increased neurosensory scores, but there were no differences in neuromotor tests, neuron density, apoptosis, and astrogliosis. In conclusion, in the rabbit FGR model, pravastatin upregulated the expression of VEGFR-2 and eNOS in FGR placentas and was associated with higher neurosensory scores, without measurable effects on birthweight, pulmonary function and morphology, and neuron density.

Influence of Schroth Best Practice Therapy on Ventilatory Function in Adolescent Idiopathic Scoliosis: Randomized Controlled Study Design

Introduction: Approximately 2%-3% of the population develops idiopathic scoliosis, making it the most prevalent structural spinal deformity in children as well as adolescents. Objective: To find out the efficacy of Schroth Best Practice therapy on pulmonary functions in adolescent idiopathic scoliosis. Methods: Sixty female subjects with adolescent idiopathic scoliosis were recruited from Outpatient Department at AlKasr Al-Ainy Hospital from May 2022 to July 2023 were enrolled in that study. They were randomized into two equivalent groups: Either the intervention group: Group A (Study group) consists of 30 subjects received the Schroth Best Practice exercises program for 18 weeks, or the control group Group B: consists of 30 subjects received traditional exercise program for 18 weeks. Both groups were given 3 sessions a week. Both groups received assessment of pulmonary functions: Forced Vital Capacity (FVC), forced expiratory volume in the first second (FEV1) As well as Peak Expiratory Flow (PEF) on 1st and 18th week. Measuring pulmonary function with digital handheld spirometer before and after treatment. These selective subjects were randomized into two equal groups. Results: There was a statistically significant difference (p&lt;0.05) among the two groups when comparing the mean values of all measured variables pre and post treatment. All analyses were performed at the 0.05 level of significance. With the initial alpha level set at 0.05, in favor of group A. Conclusion: Both Schroth Best Practice exercise program and traditinal exercise program have a significant effect in adolescent idiopathic scoliosis, and the integrated Schroth Best Practice exercise program was more effective than traditional exercise alone.

Assessment of Pulmonary Functions in COVID-19 Survivors and their Clinical Correlation at 6-month Follow-up

Background: Long term impact of COVID-19 on pulmonary functions is still an area of active research. Objective: To assess pulmonary functions and their relationship with clinical severity of disease among COVID-19 survivors at six-month follow-up after being discharged from the hospital. Methods: It was a hospital based prospective observational six-month follow-up study. After fulfillment of all inclusion and exclusion criteria, subjects underwent spirometry and diffusion capacity of lung for carbon monoxide (DLco). Ninety-six subjects had completed the tests and were enrolled for the study. Categorization of subjects was made based on their clinical disease severity profile according to Government of India guidelines. Test results were correlated with clinical severity of disease. Results: Of 96 subjects, 46 were mild, 28 were moderate, 18 were severe and 4 were critical cases. Majority of subjects had normal spirometry (65.6 %) and DLco (66.6 %). Among abnormal lung functions, the commonest was reduced DLco (33.3%) followed by restrictive (18.7%), small airway disease (10.4 %), obstructive (3.1 %) and mixed (2%) spirometry patterns. With the advancement of clinical disease severity, the frequency of restrictive pattern (P&lt;0.01) and reduced DLco increases significantly (P&lt;0.05). Conclusion: After six months, few COVID-19 survivors had residual lung function impairment in terms of reduced DLco and restrictive spirometry pattern. Hence, we recommend regular lung function assessment with various methods such as spirometry and DLco in COVID-19 survivors and advocate more large scale - long term follow-up studies to investigate the further progression or resolution in these abnormalities over the time.

Omalizumab for Chinese patients with moderate-to-severe allergic asthma in real-world clinical setting: a prospective, observational study

BackgroundWe aimed to investigate the effectiveness of omalizumab, a monoclonal anti-immunoglobulin E antibody, in Chinese patients with moderate-to-severe allergic asthma in real-world clinical practice.MethodsThis single-centre, prospective, observational study included Chinese...

ISRIB inhibits the senescence of type II pulmonary epithelial cells to alleviate pulmonary fibrosis induced by silica in mice

The role and mechanisms of integrated stress response inhibitor (ISRIB) on silicosis are still not well defined. In the present study, the effects of ISRIB on cellular senescence and pulmonary fibrosis in silicosis were evaluated by RNA sequencing, micro-computed tomography, pulmonary function assessment, histological examination, and Western blot analysis. The results showed that ISRIB significantly reduced the degree of pulmonary fibrosis in mice with silicosis and reduced the expression of type I collagen, fibronectin, α-smooth muscle actin, and transforming growth factor-β1. Both in vivo and in vitro results showed that ISRIB reversed the expression of senescence-related factors β-galactosidase, phosphor-ataxia telangiectasia mutated, phosphor-ataxia telangiectasia and Rad3-related protein, p-p53, p21, p16, and plasminogen activator inhibitor type 1. The aforementioned results were consistent with the sequencing results. These findings implied that ISRIB might reduce the degree of pulmonary fibrosis in mice with silicosis by inhibiting the cellular senescence of alveolar epithelial cell type II.

Safety of Lumason® (SonoVue®) in special populations and critically ill patients.

Evidence for the safe use of Lumason® (SonoVue®), an ultrasound enhancing agent (UEA), in special patient populations is critical to enable healthcare professionals to make informed decisions concerning its use in such patients. Herein, we provide insight on the safety and tolerability of Lumason® in special patient populations. Findings are presented from clinical pharmacology studies conducted in patients with compromised cardiopulmonary conditions, from a retrospective study performed in critically ill patients, and from post-marketing surveillance data from over 20 years of market use of Lumason® (SonoVue®). No detrimental effects of Lumason® on cardiac electrophysiology were observed in patients with coronary artery disease (CAD), and no significant effects on pulmonary hemodynamics were noted in patients with pulmonary hypertension or congestive heart failure. Similarly, no effects on several assessments of pulmonary function (e.g., FVC) were observed in patients with chronic obstructive pulmonary disease (COPD), and no clinically meaningful changes in O2 saturation or other safety parameters were observed after administration of Lumason® to patients with diffuse interstitial pulmonary fibrosis (DIPF). The retrospective study of critically ill patients revealed no significant difference for in-hospital mortality between patients administered Lumason® for echocardiography versus those who had undergone echocardiography without contrast agent. Post-marketing surveillance revealed very low reporting rates (RR) for non-serious and serious adverse events and that serious hypersensitivity reactions were rare. These findings confirm that Lumason® is a safe and well tolerated UEA for use in special populations and critically ill patients.

Cardiovascular Prognosis of Subclinical Chronic Obstructive Pulmonary Disease in Patients with Suspected or Confirmed Coronary Artery Disease.

Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD. This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015-January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test. COPD patients were older (p=0.028), had a greater frequency of diabetes (p=0.026), were more likely to be smokers (p<0.001), and had higher modified Medical Research Council scores (p<0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all p<0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (p<0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29-11.50; p<0.0001). COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.

Congenital Lung Malformations: Pulmonary Function Assessment Before and After Surgery

BackgroundThe management of asymptomatic congenital lung malformations (CLM) is debated, and pulmonary function of patients with CLM is seldom discussed. Short-term respiratory outcome in patients operated for CLM was assessed in order to better define surgical impact. MethodsA retrospective study on patients operated for CLM between 2012 and 2021 was performed. Respiratory function was assessed with tidal breath analysis (TBA) in spontaneous sleep within 2 years of life. Patients with comorbidities affecting pulmonary function were excluded. Three variables were studied: tPTEF/tE (time to peak tidal expiratory flow/total expiratory time), tV (tidal volume), RR (respiratory rate). Results were assessed as z-score (normal ±1.64) and expressed as median (range). Pre- and post-operative results were compared, as well as post-operative results of disease and surgery type subgroups. ResultsThirty-nine patients were included. Median pre- and post-operative tPTEF/tE were normal (pre: −0.32 (−2.12; +1.56); post: −0.18 (−1.62; +2.43)). Patients with extralobar sequestration had pre-operative high median RR, which improved after sequestrectomy (pre: +1.99 (−2.49; +7.43); post −0.22 (−3.01; +1.18)). All groups had reduced pre-operative median tV, which restored after surgery (pre: −2.15 (−9.75; +0.91); post: −0.35 (−6.65; +3.14)). Patients undergoing lobectomy and patients with intralobar sequestration showed greater improvement. Median post-operative TBA results were normal for all sub-groups except for reduced tV in patients operated with thoracotomy (−2.27 (−6.12; +5.26)). ConclusionsPatients with clinically asymptomatic CLM can have pathologic pulmonary function tests, which improve after surgery. These results add to the elements in favor of an interventional approach. Level of evidenceIII, Treatment study.

Evaluation of Respiratory Muscle Strength in Patients with Heart Failure

Context: The estimated prevalence of heart failure (HF) is around 1% of the total population in India which is close by to 8–10 million individuals. Due to metabolic and structural skeletal muscle dysfunctions, peripheral muscles are impaired in the early stages of chronic HF (CHF). In experiments on rats with CHF, biopsies of respiratory muscles revealed histological abnormalities, such as atrophy of type 1 diaphragm fibers, resulting in decreased respiratory muscle strength and endurance. Aim: To determine the strength of respiratory muscle and pulmonary function in individuals having Class II and Class III HF. Settings and Design: Descriptive, observational, case–control study design. Subjects and Methods: Subjects included 37 HF patients having Class II and Class III in one group and controls in another group. The respiratory muscle strength (maximal inspiratory pressure [MIP] and maximal expiratory pressure [MEP]) was evaluated using respiratory pressure meter (RPM) and pulmonary function (forced expiratory volume at the end of 1 s [FEV1] and forced-vital capacity [FVC]) assessment using spirometry-Schiller (micro RPM). Statistical Analysis Used: Median and IQR were used to describe the study variables MIP, MEP, FVC, and FEV1, and the Mann-Whitney U test to compare the study variables between the two groups. Results: The outcomes were interpreted as the median values. The MIP and MEP were 59 and 70 cmH2O, respectively, in HF as compared to 97 and 96 cmH2O in the control group, significant at P &lt; 0.001. The FEV1 and FVC in HF were 114 and 88% sequentially as compared to 130 and 99% in the control group, significant at P &lt; 0.05. Conclusions: The respiratory muscle strength and pulmonary functions are impaired in individuals having Class II and Class III HF.

Assessment of Nasal Obstruction Symptoms and Pulmonary Function Following Functional Endoscopic Sinus Surgery (FESS) in Chronic Rhinosinusitis with Nasal Polyps.

The upper and lower airways are typically subjected to identical inflammatory stimuli and comprise a single organ that is functionally connected. 40 patients with chronic rhinosinusitis with nasal polyps who had failed medical treatment and undergone FESS participated in our study. Prior to surgery and three months after surgery, nasal obstruction symptoms were measured using the NOSE score system and pulmonary function tests were evaluated using spirometry. The mean Nose Score was 70 before surgery but dropped to 4 afterward, with a p value < 0.001 showing a statistically significant improvement in the nasal symptoms following FESS. The mean pre-operative FVC, FEV1, and FEV1/FVC% values were 3.19, 2.53, and 78.81%, respectively, while the mean post-operative values were 3.14, 2.5, and 79.01%. Following FESS, there wasn't a statistically significant change in lung function tests. Our study showed that percentage of change of total NOSE score has a statistically significant Negative correlation with percentage of change of pulmonary function tests parameters. This study demonstrates the positive effects of FESS on nasal polyposis patients' quality of life and nasal obstruction symptoms without having any negative impacts on the lower airways.