Baseline Pulmonary Function Tests Research Articles

An a Priori Approach to Small Airway Dysfunction in Pediatric Asthmatics.

Small airway dysfunction remains a stepchild in the pediatric asthma care pathway. In brief, elements of the pulmonary function test (PFT) concerning smaller airway data remain less utilized. To further the value of the standard PFT we underwent a prospective Proof of Concept (POC) project, utilizing the outpatient performance of PFT tests in children 6–18 years during a 15-month period. The goal of the study was to determine if a priori the PFT represented a small airway disease pattern or not. Only the pulmonary function was used to make that distinction. Children 6–18 years with asthma who completed a PFT had their PFT as being characterized with or without a small airway dysfunction (SAD) designation, coded in the electronic medical record as an a priori decision using the code J98.4 (other disorders of lung) as a marker for electronic medical records retrieval. Subsequently, the results were analyzed between a group of 136 children designated (a priori) as having no small airway dysfunction in comparison to 91 children a priori designated as having small airway dysfunction. The a priori designation groups were post hoc compared for large and smaller airway function differences. Both large and smaller airway dysfunction were highly significantly different between the 2 groups, based solely on the initial division of the total group based on the decision the PFT represented a small airway pattern. We concluded the baseline pulmonary function test used in the evaluation of pediatric asthma has readily identifiable information regarding the presence of small airway dysfunction, and we characterized what was unique on the PFT based on that SAD classification

Protective Effects of BNT162b2 Vaccination on Aerobic Capacity Following Mild to Moderate SARS-CoV-2 Infection: A Cross-Sectional Study Israel.

Patients previously infected with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may experience post-acute adverse health outcomes, known as long COVID. The most reported symptoms are fatigue, headache and attention/concentration issues, dyspnea and myalgia. In addition, reduced aerobic capacity has been demonstrated in both mild and moderate COVID-19 patients. It is unknown whether COVID-19 vaccination mitigates against reduced aerobic capacity. Our aim was to compare the aerobic capacity of vaccinated and unvaccinated individuals previously infected with SARS-CoV-2. Methods: Individuals aged 18 to 65 years with laboratory-confirmed mild to moderate COVID-19 disease were invited to Ziv Medical Centre, Israel, three months after SARS-CoV-2 infection. We compared individuals unvaccinated at the time of infection to those vaccinated in terms of aerobic capacity, measured using symptom-limited cardiopulmonary exercise test (CPET). Results: We recruited 28 unvaccinated and 22 vaccinated patients. There were no differences in baseline demographic and pulmonary function testing (PFT) parameters. Compared with unvaccinated individuals, those vaccinated had higher V’O2/kg at peak exercise and at the anaerobic threshold. The V’O2/kg peak in the unvaccinated group was 83% of predicted vs. 100% in the vaccinated (p < 0.002). At the anaerobic threshold (AT), vaccinated individuals had a higher V’O2/kg than those unvaccinated. Conclusions: Vaccinated individuals had significantly better exercise performance. Compared with vaccinated individuals, a higher proportion of those unvaccinated performed substantially worse than expected on CPET. These results suggest that vaccination at the time of infection is associated with better aerobic capacity following SARS-CoV-2 infection.

Effect of yoga on bronchial asthma

Introduction-Asthma is a disease affecting the lungs causing airway obstruction, dyspnoea and cough with restlessness. Patients use multiple medications to control their symptoms but still, they are not relieved. Yoga has been used as a complementary therapy but many people fail to use it because of difficulty in performing it. This study was done with the aim to use four simple yoga exercises to find if any reduction in symptoms and benefits to the patients. Material &amp; Method- 80 asthmatic patients were selected and placed randomly into two groups, the Case Group and Control group, with 40 subjects in each. The baseline Pulmonary Function Tests(PFT) parameters like Forced Expiratory Volume in 1 second(FEV1), Forced Vital Capacity(FVC), FEV1/FVC and Peak Expiratory Flow Rate(PEFR) are measured in both the groups. Also, the Absolute Eosinophil Count(AEC) was measured in all participants. The number of patients suffering from acute exacerbation was counted and noted in each group. Then the Case Group participants were asked to perform Yoga for 4 months under the supervision of a Yoga Instructor. The Control Group was asked to take medicine as before and report after 4 months.

Paraesophageal hernia repair with laparoscopic Toupet fundoplication: impact on pulmonary function, respiratory symptoms and quality of life.

Paraesophageal hiatal hernia (PEH) is characterized by protrusion of intra-abdominal organs into the posterior mediastinum. Respiratory symptoms and reduced pulmonary function have been described as possibly related to lung compression. To assess the effect of laparoscopic Toupet fundoplication (LTF) for PEH repair on pulmonary function, measured with pulmonary function tests (PFTs), and respiratory symptoms. Retrospective, single-center, cohort study (November 2015-2020). All patients that completed pre- and postoperative (12months) PFTs assessment were included. The gastroesophageal reflux disease health-related quality of life (GERD-HRQL), reflux symptom index (RSI) and short form-36 (SF-36) were used. Overall, 71 patients were included. The median age was 67.1years and the majority were females (78.8%). Baseline PFTs were within normal limits in 91% of patients. At 12month follow-up, total lung capacity (TLC) (4.77 vs. 5.07 L; p = 0.0251), vital capacity (VC) (2.97 vs. 3.31 L; p = 0.0065), forced expiratory volume in one second (FEV1) (2.07 vs. 2.44 L; p < 0.001) and forced vital capacity (FVC) (2.78 vs. 3.19 L; p < 0.001) were significantly improved. No significant differences were found for diffusing capacity of lung for carbon monoxide (DLCO) (17.09 vs. 17.24; p = 0.734), and FEV1/FVC (0.77 vs. 0.77; p = 0.967). Interestingly, improvements were more pronounced in patients with large PEH (type IIIb and IV). At 12month follow-up, both gastrointestinal and respiratory symptoms were significantly improved and 94% of patients were satisfied with the operation. The GERD-HRQL (18.1 ± 7.9 vs. 4.01 ± 2.4; p = 0.001), RSI (37.8 ± 9.7 vs. 10.6 ± 8.9; p < 0.001) and all SF-36 items were improved. LTF for the treatment of PEH is safe and seems to be effective up to 12month follow-up with improved lung volumes, spirometry values, quality of life, gastrointestinal and respiratory symptoms.

Swyer-James-MacLeod syndrome in pregnancy: A case report.

Scant literature is available regarding pregnancy outcomes in women with Swyer-James-MacLeod syndrome, a rare obstructive lung disease. We present a case of a woman with this syndrome in pregnancy. Her baseline pulmonary function tests (PFT) demonstrated moderate airflow obstruction however she had excellent functional status and exercise tolerance. Her disease remained clinically stable in pregnancy. PFTs demonstrated slight worsening of her obstruction with forced expiratory volume in one second (FEV1). 59% and FEV1/FVC ratio 64%. She was diagnosed with gestational diabetes requiring metformin and insulin. Her labor and delivery was uncomplicated with vaginal delivery of a live male at term with no maternal respiratory complications. She did have a delayed postpartum hemorrhage requiring a D&C procedure. This case report demonstrates women with Swyer-James-MacLeod syndrome can have a successful pregnancy and need not avoid pregnancy if desired.

Comparative efficacy of interferential therapy, bronchodilators, and body positioning on asthma control and quality of life of patients with bronchial asthma: A study protocol

Interferential Therapy (IFT) is the application of two medium frequency currents to the skin to stimulate and activate different systems in the body using specific frequencies and frequency ranges. The aim in applying IFT is to reduce myalgia in the chest and upper back, reduce muscular fatigue, and induce mucus expectoration. This study is designed to test the efficacy of IFT in reducing the symptoms frequently experienced by patients with bronchial asthma. Forty-eight (48) patients aged 18 and above with bronchial asthma attending the respiratory clinic at the Lagos State University Teaching Hospital, Ikeja (LASUTH) will be assessed for eligibility. The study design will be a double-blinded, randomized control trial with four intervention groups and four parallel placebo control groups. IFT will be administered as an intervention to patients on short and longacting bronchodilators in an assigned fundamental body position for 20 minutes. Six continuous outcome variables at different points will be utilized as outcome measures. A baseline Pulmonary Function Test (PFT) will be conducted on entry into the study while quality of life and asthma control will be evaluated every two (2) weeks during the study. Data obtained will be analyzed using descriptive and inferential statistics of repeated ANOVA; P&lt;0.05. The study outcome will compare the efficacy of IFT on bronchial asthma, identify its effect in different body positions, and compare the relationship between its application and the bronchodilator medication frequently used by the patients.

Surveillance Chest X-Ray and Pulmonary Function Testing in Patients Undergoing Intralesional Bleomycin in the Treatment of Vascular Malformations

Purpose: Bleomycin is an effective sclerosant in the treatment of vascular malformations; however, the risk of pulmonary toxicity remains a concern. This study analyzes the utility of routine chest x-ray (CXR) and pulmonary function testing (PFT) in a pediatric patient population receiving intralesional bleomycin sclerotherapy. Methods: Retrospective chart review of CXR and PFT results in patients who underwent bleomycin intralesional injection for the treatment of vascular malformations. Results: A total of 64 patients were identified with vascular malformations treated with intralesional bleomycin. The median cumulative bleomycin dose per patient was 10.9 U/m2 (range 1.8–106.8 U/m2 per patient). No difference was found in mean cumulative bleomycin dose between patients with a normal compared with abnormal CXR (32.4 versus 31.8 U/m2, P = 0.96). No patients had CXR findings which precluded the administration of bleomycin. Of 41 successfully completed PFTs, 39 (95.1%) were normal and 2 (4.9%) were abnormal with an obstructive pattern. There was no decrease in the mean DLCO (Hg) % predicted between baseline PFT and follow-up PFT groups (94.1 versus 101.8, P = 0.17). Linear regression was performed and no decrease in DLCO (Hg) % predicted with increasing cumulative bleomycin dose was identified (slope coefficient 0.37; 95% CI, –2.2 to 2.9; R2 = 0.01). Conclusion: Routine CXR for the surveillance of bleomycin-induced pulmonary toxicity seems to be of limited clinical utility. No diffusion abnormalities on PFT were seen in this patient cohort to date; however, as cumulative bleomycin doses increase, follow-up PFT monitoring will remain important.

Evaluation of Supranormal Spirometry Values With an Obstructive Ratio for Airway Hyperreactivity.

Published guidelines on spirometry interpretation suggest an elevated FVC and FEV1 > 100% of predicted with an obstructive ratio may represent a physiological variant. Further evidence is needed on whether this finding indicates symptomatic airways obstruction and what additional evaluation should be done. Participants were prospectively enrolled to undergo additional testing for a technically adequate spirometry study with an FEV1 > 90% of predicted, and FEV1/FVC below the lower limit of normal, based on 95th percentile confidence intervals. Further testing consisted of full pulmonary function testing, impulse oscillometry (IOS), post-bronchodilator testing, fractional exhaled nitric oxide (FeNO), and methacholine challenge testing (MCT). A total of 49 patients meeting entry criteria enrolled and completed testing. Thirty-three were considered symptomatic based on clinical indications for initial testing and 16 were considered asymptomatic. Baseline pulmonary function test values were not different between groups while IOS R5 values (% predicted) were higher in the symptomatic group (126.5 ± 0.37 vs 107.1 ± 0.31). Bronchodilator responsiveness on PFT or IOS was infrequent in both groups. There was a 29% positivity rate for MCT in the symptomatic group compared to one borderline study in asymptomatic participants. FeNO was similar for symptomatic, 26.17 ± 31.3 ppb, compared to asymptomatic, 22.8 ± 13.5 ppb (p = 0.93). The dysanapsis ratio was higher in the symptomatic (0.15 ± 0.03) compared to the asymptomatic (0.13 ± 0.02) (p < 0.05). Normal FEV1 > 90% of predicted and obstructive indices may not represent a normal physiological variant in all patients. In symptomatic patients, a positive MCT and elevated baseline IOS values were more common than in asymptomatic patients with similar PFT characteristics. These findings suggest that clinicians should still evaluate for airway hyperresponsiveness in patients with exertional dyspnea with airway obstruction and FEV1 > 90% of predicted and consider alternative diagnoses to include a normal physiologic variant if non-reactive.

Can saline injection protect phrenic nerve? - A randomised controlled study.

Background and Aims:Various methods were attempted to reduce the incidence of phrenic nerve palsy during interscalene brachial plexus nerve block. Mechanism of phrenic palsy was presumed to be due to the spread of local anaesthetic anterior to the anterior scalene muscle. We hypothesised that by injecting saline in this anatomical location prior to performing an interscalene block might reduce the incidence of phrenic palsy.Methods:This was a double-blinded randomised controlled study performed in a single-centre, university-teaching hospital. A total of 36 patients were randomised to either group C (conventional group) or group S (saline group). Ultrasound-guided interscalene block was administered with 20 ml of 0.25% levo-bupivacaine in both groups. Ten ml of normal saline was injected anterior to anterior scalene muscle in group S prior to performing interscalene block. A blinded radiologist performed diaphragmatic ultrasound pre- and post-operatively to document phrenic palsy. Bedside spirometry was used to perform baseline and post-operative pulmonary function test. The primary outcome was to look at the incidence of phrenic palsy as measured by diaphragmatic palsy on ultrasound performed by radiologist. Statistical Package for the Social Sciences (SPSS) version 25 was used for statistical analysis.Results:Significantly less patients in the saline group developed diaphragmatic paresis when compared to conventional group (44% vs. 94%, Chi-squared = 10.01, P = 0.002). There was no difference in post-operative pain, subjective sensation of dyspnoea or patient satisfaction between the groups.Conclusion:Injecting saline anterior to anterior scalene muscle reduces the incidence of diaphragmatic palsy when performing interscalene block.

Longitudinal Assessment of Pulmonary Function and Bronchodilator Response in Pediatric Patients With Post-infectious Bronchiolitis Obliterans.

Backgroud: Postinfectious bronchiolitis obliterans (PIBO) is a rare respiratory disease. In recent years, the disease has been recognized and diagnosed increasingly in children. Pulmonary function is important for diagnosis, identifying the severity of the PIBO and monitoring progression. But there have been only a few studies that followed the evolution of PIBO on the basis of pulmonary function tests (PFTs).Objective: The study targeted the evolution of pulmonary function and bronchodilator response in a case series of Chinese children with PIBO.Methods: Twelve children between the ages of 6–99 months with PIBO were studied retrospectively from 2009 to 2019. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the FEV1/FVC ratio, and maximal midexpiratory flow velocity 25–75% (MMEF25−75%) were collected at each PFT, and bronchodilator responses were evaluated. Spirometric parameters were monitored over time, and generalized linear mixed models were used to analyze longitudinal panel data.Results: The median baseline PFT values for FVC, FEV1, the FEV1/FVC ratio, and MMEF25−75% were 41.6, 39.75, 90.7, and 22.2%, respectively. At the initial PFTs, 10 (83.3%) patients demonstrated a significant bronchodilator response. FVC and FEV1 increased by 8.212%/year and 5.007%/year, respectively, and the FEV1/FVC ratio decreased by an average of 3.537%/year. MMEF25−75% showed improvement at an average rate of 1.583% every year. Overall, FEV1 and MMEF25−75% showed different degrees of improvement after the use of inhaled bronchodilators at each PFT session for 10 patients, and FEV1 measures demonstrated significant (>12%) β2-bronchodilation in 56% of PFT sessions.Conclusions: Pediatric patients with PIBO showed an obstructive defect in pulmonary function. The FVC, FEV1, and MMEF25−75% improved as they grew older, while the FEV1/FVC ratio decreased. This may be due to the development of lung parenchyma more than airway growth. Airway obstruction in some patients improved with the use of β2 agonists.

POS0700 TREATMENT OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH PRIMARY SJOGREN SYNDROME: A SINGLE-CENTER RETROSPECTIVE ANALYSIS

Background:Interstitial lung disease (ILD) is one of the main contributor to morbidity and mortality in patients with primary Sjogren syndrome (pSS), and whether immunosuppressive treatments are effective for pSS-ILD is uncertain. Cyclophosphamide (CYC) and rituximab (RTX) are effective in stabilizing pulmonary function in patients with ILD caused by systemic sclerosis, inflammatory myositis, and rheumatoid arthritis1,2. Reports regarding the treatment response for cyclophosphamide or rituximab in pSS-ILD patients are lacking.Objectives:To investigate whether add-on CYC or RTX in addition to steroid and oral DMARDs leads to greater improvement in pulmonary function test than conventional treatment in patients with pSS-ILD with impaired baseline pulmonary function.Methods:pSS-ILD patients with ILD confirmed by a chest computed tomography were screened. Those with imparied baseline pulmonary function test (FVC&lt;80% and DLCO&lt;80%) and available results of pulmonary function tests at 6th-18th month post-treatment were retrospectively enrolled. The patients were clustered into two groups: steroid and oral DMARDs alone (steroid/oDMARD group), and add-on CyC and/or RTX (Add-on CyC/RTX group).Results:This study enrolled 22 patients. The median age of these patients was 65. Among them, 68% were female and 18% were smokers. The median baseline FVC was 63.5% and the median DLCO was 54.4%. The predominant CT pattern was NSIP (54%), followed by UIP (22%), LIP (13.6%) and OP (9%) (table 1).Five patients received steroid and oral DMARDs alone (hydroxychloroquine +/- azathioprine), while 17 patients received add-on CYC and/or RTX (8 patients received CYC, 3 received RTX, and 6 received CYC and RTX). There was no significant difference in baseline characteristic between these two groups (table 1).With a median follow-up period of 9.8 months (interquartile range 7.6 - 13.4 months) after treatment, the FVC improved significantly from 61.3% to 65.5% (p=0.013) in CYC/RTX group, while the FVC improvement was not significant in steroid/oDMARD group (figure 1A). In CYC/RTX group, patients with non-UIP pattern (NSIP, LIP and OP) on chest CT had significant FVC improvement (p=0.021), contrasting to the patients with UIP pattern on chest CT (figure 1B).Conclusion:In pSS patients with ILD and impairment of pulmonary function at baseline (FVC&lt;80%, DLCO&lt;80%), FVC improved significantly in patients received add-on cyclophosphamide and/or rituximab therapy.

Survival of patients with asbestosis can be assessed by risk-predicting models

ObjectivesOur aim was to investigate the pulmonary function test (PFT) results of patients with asbestosis and determine whether baseline PFTs and the risk-predicting models such as gender, age and physiologic...

Predictive Capacity of Pulmonary Function Tests for Acute Mountain Sickness.

Small, Elan, Nicholas Juul, David Pomeranz, Patrick Burns, Caleb Phillips, Mary Cheffers, and Grant S. Lipman. Predictive capacity of pulmonary function tests for acute mountain sickness. High Alt Med Biol. 22: 193-200, 2021. Background: Pulmonary function as measured by spirometry has been investigated at altitude with heterogenous results, though data focused on spirometry and acute mountain sickness (AMS) are limited. The objective of this study was to investigate the capacity of pulmonary function tests (PFTs) to predict the development of AMS. Materials and Methods: This study was a blinded prospective observational study run during a randomized controlled trial comparing acetazolamide, budesonide, and placebo for AMS prevention on White Mountain, CA. Spirometry measurements of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow were taken at a baseline altitude of 1,250 m, and the evening of and morning after ascent to 3,810 m. Measurements were assessed for correlation with AMS. Results: One hundred three participants were analyzed with well-matched baseline demographics and AMS incidence of 75 (73%) and severe AMS of 48 (47%). There were no statistically significant associations between changes in mean spirometry values on ascent to high altitude with incidence of AMS or severe AMS. Lake Louise Questionnaire scores were negatively correlated with FVC (r = -0.31) and FEV1 (r = -0.29) the night of ascent. Baseline PFT had a predictive accuracy of 65%-73% for AMS, with a receiver operating characteristic of 0.51-0.65. Conclusions: Spirometry did not demonstrate statistically significant changes on ascent to high altitude, nor were there significant associations with incidence of AMS or severe AMS. Low-altitude spirometry did not accurately predict development of AMS, and it should not be recommended for risk stratification.

Impact of CPAP treatment for a short period in moderate-to-severe OSAS patients: a randomized double-blind clinical trial

IntroductionObesity is the most frequent reversible agravating factor of obstructive sleep apnea syndrome, with physical activity very important for its control. Continuous positive air pressure during sleep is the “gold standard” treatment for obstructive sleep apnea syndrome. Objectivewe aimed to investigate if the use of continuous positive air pressure for a short period (7 days), would improve sleep quality, daytime sleepiness, and the disposition for physical activity. MethodsEighty obstructive sleep apnea syndrome patients were randomly assigned as follows: group I – continuous positive air pressure with a steady pressure of 4 cm H2O; group II – ideal therapeutic pressure. After filling out the questionnaires related to the studied variables (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index), patients underwent a baseline pulmonary function test and continuous positive air pressure titration. After continuous positive air pressure therapy for 4≥ hours a night for 7 consecutive days, patients returned and filled out new (International physical activity questionnaire long-form, Epworth sleepiness scale, Pittsburgh sleep quality index) forms. New spirometry was carried out. Results39 patients completed the study. The mean age was 52 ± 11 years old and 28 patients (71.79%) were obese. Both groups were similar for all variables studied at baseline. After Continuous positive air pressure use, patients of group II presented more significant improvements (p < 0.05) for sleep quality and diurnal sleepiness. Time spent with physical activities did not change. Spirometric data were at normal range at baseline. Solely the variable FEF 25%–75% was significantly enhanced (p < 0.05) in group II. ConclusionContinuous positive air pressure therapy for 1 week, with ideal pressure, improves daytime sleepiness and sleep quality, enhances pulmonary function, but does not change the mean time spent with physical activities.

Utility of Mid‐Upper Arm Circumference in Diagnosing Malnutrition in Children With Cystic Fibrosis

Standardized diagnostic indicators for malnutrition using growth percentile z-scores (weight for length or body mass index [BMI]) and mid-upper arm circumference (MUAC) z-scores are being used in clinical practice; however, their application to the pediatric cystic fibrosis (CF) population is not well described. In this study, we aim to compare growth percentile z-scores and MUAC z-scores in diagnosing and classifying malnutrition in children with CF and assess the relationship between their degree of malnourishment and corresponding pulmonary function tests (PFTs). In this retrospective observational outpatient study of 49 pediatric CF patients, data were collected on baseline characteristics, anthropometrics, and PFTs over 12 months. Agreement in malnutrition diagnoses was quantified by Cohen κ statistics. Pearson test assessed the correlation between MUAC and BMI z-scores as well as PFTs and anthropometrics. Serial anthropometrics and PFTs were obtained and compared for a subset of patients (n = 28). Growth percentile and MUAC z-scores were positively correlated in diagnosing malnutrition (Pearson correlation r = 0.87), but MUAC z-scores identified more patients as malnourished compared with growth percentile z-scores (49% vs 12%, Cohen κ of 0.22 [95% CI, 0.04-0.40]). There was no significant relationship between anthropometrics and PFTs. MUAC z-scores increased significantly over time, but BMI z-scores did not show this trend. Our small-scale data suggest a promising role for MUAC z-scores in classifying malnutrition and in measuring changes in nutrition status over time in pediatric CF.

SHORT-TERM PULMONARY FUNCTION TEST CHARACTERISTICS IN PATIENTS DIAGNOSED WITH E-CIGARETTE- OR VAPING-ASSOCIATED LUNG INJURY

SESSION TITLE: Tobacco Cessation and Prevention Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The E-cigarette, or vaping, associated lung injury (EVALI) outbreak in 2019 caused many young people to be hospitalized with severe lung disease. What, if any, residual pulmonary abnormalities assessed by pulmonary function tests (PFTs) remain at short term follow-up in patients with EVALI is unknown. METHODS: We studied all patients who presented with EVALI at Intermountain Healthcare facilities between June 1, 2019 and January 13, 2020. We reviewed PFTs on all patients who were at least 30 days post discharge. We included PFTs with spirometry, lung volume, and/or diffusing capacity for carbon monoxide (DLCO) corrected for hemoglobin and reported patterns of abnormalities for all abnormal PFTs. RESULTS: 114 patients presented with EVALI and 111 were alive at least 30 days post-discharge. 28% (31/111) had at least one PFT performed at a median of 36 days (IQR 17 – 53) post-discharge. 52% (16/31) of patients with PFTs performed had abnormal PFTs. 2 of the 16 patients (13%) with abnormal PFTs at follow-up had abnormal PFTs at baseline. 65% (20/31) of patients had PFTs performed with spirometry, single-breath total lung capacity testing, and DLCO testing. 19% (6/31) had PFTs with spirometry, total lung capacity testing with plethysmography, and DLCO testing. 16% (5/31) had PFTs with spirometry only. There were six patterns of abnormalities. 19% (6/31) had obstruction only, 16% (5/31) had DLCO reduction only with normal spirometry, 6% (2/31) had obstruction with DLCO reduction. 3% (1/31) had restriction and DLCO reduction, 3% (1/31) had obstruction and suggested restriction, and 3% (1/31) had DLCO reduction and suggested restriction. The patients with suggested restriction had a low forced expiratory volume in one second (FEV1) and low forced vital capacity (FVC) without TLC plethysmography measurement. 44% of patients with abnormal PFTs (7/16) had a second, follow up PFT at a median of 135 days (IQR 79 - 145) post-discharge. None of these 7 patients had baseline PFTs prior to their EVALI diagnosis. 43% (3/7) of these follow up PFTs improved to normal, the other 4 had residual abnormalities. CONCLUSIONS: Many patients with EVALI had abnormal PFTs at least 30 days post-discharge with the most common abnormalities being obstruction only, DLCO reduction only, and obstruction with DLCO reduction. Patients who had PFT abnormalities continued to improve (some to normal predicted values) with subsequent testing. CLINICAL IMPLICATIONS: Many patients diagnosed with EVALI have persistent PFT abnormalities at follow up. Further study of the long-term effects of EVALI on pulmonary function is needed. DISCLOSURES: No relevant relationships by Braden Anderson, source=Web Response No relevant relationships by Denitza Blagev, source=Web Response No relevant relationships by Colin Grissom, source=Web Response No relevant relationships by David Guidry, source=Web Response No relevant relationships by Dixie Harris, source=Web Response No relevant relationships by Michael Lanspa, source=Web Response No relevant relationships by Susan Rea, source=Web Response

Does thoracoplasty adversely affect lung function in complex pediatric spine deformity? A 2-year follow-up review.

Retrospective review of prospective multi-center cohort. To investigate the impact of thoracoplasty on pulmonary function at 2-year follow-up among complex pediatric spine deformity patients. Complex pediatric spine deformities may be associated with significant rib prominence causing body image concerns. Surgical correction of spine deformity may include thoracoplasty to correct the rotational prominence. Some surgeons refrain from performing thoracoplasty due to its purported negative effect on pulmonary function. There is paucity of literature on the effect of thoracoplasty on pulmonary function at 2-year follow-up in pediatric patients with complex spine deformity. We reviewed data of 312 patients (> 100°, with or without vertebral column resection (VCR)) or (< 100° with VCR)) from an international multicenter database. Data of 106 patients with complete radiographic and pulmonary function test (PFT) assessment with a minimum of 2-year follow-up was analyzed. Paired t test was performed to compare pre-op and 2-year PFT results. PFT comparison was stratified based on thoracoplasty status (thoracoplasty: Group 1 vs. no thoracoplasty: Group 2). 106 patients (61 patients Group 1 vs. 45 in Group 2). The average age and gender ratio were similar in both groups (p > 0.05). Group 1 had significantly lower body mass index (BMI) compared to Group 2 (18.4kgm-2 ± 2.8 vs. 19.9kgm-2 ± 4.8, p = 0.0351). The average baseline coronal and sagittal Cobbs were larger for Group 1 relative to Group 2 (p <0.05). The distribution of deformity etiology and curve types, and apices were similar between the two groups (p > 0.05). The rate of pre-op utilization of halo gravity traction (HGT) was 52.5% vs. 26.7% (p = 0.008), at an average duration of 103days vs. 47days, p = 0.0001. The rate of surgical osteotomies was similar in both groups. Estimated blood volume (EBV) loss was greater in Group 1 (63.1% vs. 43.1%, p = 0.0012). Post-op coronal and sagittal Cobb correction was similar in both groups. The incidence of post-op pulmonary complication was similar in both groups (8.2% vs. 8.9%, p = 0.899). Baseline and 2-year follow-up PFT did not differ significantly between and within the groups. Vertebral column resection (VCR) did not negatively affect PFT in both groups. Despite higher curve magnitudes in patients undergoing surgical correction and thoracoplasty for complex pediatric spine deformity, our findings revealed that thoracoplasty does not negatively affect pulmonary function at 2-year follow-up.

Evaluating the Clinical Outcomes of Three Medication Regimens for Treating a Sample of Iraqi Persistent Asthmatic patients

Abstract&#x0D; Asthma is a complex disease defined by chronic airway inflammation and airflow limitation causing variable respiratory symptoms which include shortness of breath (SOB), wheezing, chest tightness and cough. Asthma guidelines advocate adding a second long acting bronchodilator to medium doses of inhaled corticosteroids (ICS) rather using high doses of ICS alone to control moderate to severe persistent asthma. The aim of this study was to evaluate the clinical outcomes of three medication regimens indicated for Iraqi patients suffering from persistent asthma. &#x0D; This study was interventional randomized clinical study conducted on a sample of adult Iraqi asthmatic patients in Baghdad City. The study composed of three visits distributed over eight weeks; baseline visit followed by first follow up and second follow up visits after four and eight weeks respectively. The study enrolled 78 adult patients with moderate to severe persistent asthma as diagnosed by specialist physician according to patient history and baseline pulmonary function test (PFT) and allocated them randomly to three groups (each group included 26 patients) to receive equivalent medium doses of budesonide inhaler in addition to either formoterol inhaler, oral modified release aminophylline tablets or tiotropium inhaler (first, second and third group respectively). Sixty four patients completed this study. The mean ages of patients were above 35 years with slightly more male predominance.&#x0D; The study groups developed significant increase of peak expiratory flow rate (PEFR) and forced vital capacity (FVC) values at the first follow up visit compared to baseline values (p&lt;0.001). Thereafter, the first and third groups achieved significant higher values at the second follow up visit compared to first follow up visit (p&lt;0.001), while second group produced no change. All the groups developed significant improvement of Mini asthma quality of life questionnaire (MiniAQLQ) scores and percentage of symptom free days (SFD) at first follow up visit and continued further significant improvement at the second follow up visit (p&lt;0.001). Generally, between groups comparison according to extent of change of study parameters revealed that third group produced the greatest improvement over the entire study period followed by the first group, whereas the second group was associated with the least extent of improvement.&#x0D; This study concluded that all groups caused significant improvement in study parameters compared to baseline values and also concluded that the third group of inhaled [tiotropium/budesonide] was associated with the highest extent of improvement followed by first group, while the second group was the least. &#x0D;

EP29 An evaluation of the use of baseline pulmonary function tests in the detection of interstitial lung disease in patients newly diagnosed with rheumatoid arthritis

Abstract Background Interstitial lung disease (ILD) is a serious extra-articular manifestation of rheumatoid arthritis (RA). Risk factors include smoking, the presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (CCP). Pulmonary function tests (PFT) show reduced carbon monoxide diffusion capacity (DLCO) early and reduced forced vital capacity (FVC) later in disease. HRCT is the gold standard diagnostic test while chest X-ray (CXR) has low sensitivity. PFT are routinely performed in the majority of RA patients at baseline at our tertiary centre. The aim of this study was to evaluate the frequency of abnormal PFT, specificity for ILD and influence on subsequent decision-making in patients newly diagnosed with RA. Methods A retrospective analysis was undertaken of patients with a new diagnosis of RA between January 2016 and December 2017. Patients meeting the ACR (2010) criteria for RA, with baseline PFT data available were included. Clinic letters and the hospital electronic records were used to obtain the data. Results 139 patients were included in the data analysis (Table 1). 23 patients had DLCO &amp;lt;70% predicted, while 7 patients had an FVC &amp;lt;80% predicted. Patients with abnormal PFT were more likely to be older, female, seropositive and to have smoked. Of the patients with DLCO &amp;lt;70%, CXR was abnormal in 6 patients with changes suggesting ILD in 2 patients. 13 patients had HRCT and 7/13 patients had evidence of ILD and 6/13 patients had significant emphysema on CXR or HRCT. 1 patient with DLCO of 82% had changes of ILD on a CT scan organised for another reason. Methotrexate was commenced in 19/23 patients with DLCO&amp;lt;70% and discontinued in 2 patients for respiratory reasons. Conclusion This evaluation suggests baseline PFT are more sensitive than baseline CXR in detecting ILD but that a DLCO &amp;lt;70% is not specific for this diagnosis. The abnormal PFT lead to HRCT being requested in 13/24 patients, of whom 7 had ILD which had not been identified by CXR in 5 patients. Baseline PFT are also useful as a reference point in patients who go on to develop respiratory symptoms at a later point in their illness. Disclosures A. Haque None. R. Kilding None. R. Smith None. S. Khalid None. R. Sandler None. M. Cox None. T. Hendry None. A. Flores-martin None. K. Lindop None. J. Maxwell None.

Predictors of mortality in interstitial lung disease patients without pulmonary hypertension.

BACKGROUND:There is a paucity of information regarding prognostic factors associated with reduced survival in interstitial lung disease (ILD) patients without pulmonary hypertension (PH).AIMS:The aim of this study was to determine physiological and hemodynamic parameters that impact survival among ILD patients without PH based on right heart catheterization (RHC).METHODS:Consecutive ILD patients who underwent RHC (n = 169) at one center were included. The information analyzed included demographics and physiological and hemodynamic parameters. Cox regression models were used to identify independent predictors of survival.RESULTS:The mean age was 55.0 years, and 49.7% of the patients were females. Thirty-three patients died, and two underwent transplantation. Patients with predicted diffusion capacity of the lung for carbon monoxide <35%, walking distance <300 m, and 6-min walk test (6MWT) final oxygen saturation measured by pulse oximetry (SpO 2) <85% were significantly associated with an increased mortality risk (P = 0.022, P < 0.0001, and P = 0.049, respectively; all by log-rank analysis). Advanced age, idiopathic pulmonary fibrosis diagnosis, reduced forced vital capacity, and low cardiac index were independent predictors of increased mortality in the ILD cohort.CONCLUSIONS:Our study demonstrates that parameters obtained from baseline pulmonary function tests and 6MWTs are important determinants of survival in ILD patients without PH. Importantly, cardiac index was the only hemodynamic variable independently associated with survival. Thus, in the absence of PH, when ILD patients perform poorly during the 6MWT manifested as reduced walking distance and desaturation at the end of the test, cardiovascular impairment must be ruled out.