Basic Spirometry Research Articles

Basic spirometry and advanced pulmonary function tests – NATCON 2022

At the 77th National Conference on Tuberculosis and Chest Diseases, which took place on February 27, 2023, a pre-conference workshop on Basic Spirometry and Advanced Pulmonary Function Tests was held under the auspices of NATCON-2022.With the assistance of highly experienced faculty who are national and international level experts in their fields, the workshop covered all important aspects of basic spirometry and advanced Pulmonary Function Tests.

Influences of Breathing Exercises and Breathing Exercise Combined with Aerobic Exercise on Changes in Basic Spirometry Parameters in Patients with Bronchial Asthma

Scientific evidence shows that breathing or aerobic programs can improve the quality of life of asthma patients. The aim of this work was to find out the influences of breathing exercises and breathing exercises combined with aerobic exercise on changes in spirometry parameters in patients with bronchial asthma. Participants: The group consisted of 33 women with bronchial asthma—mild to moderate persistent levels of FEV1 reduction (80–50%)—with a mean age of 34.73 ± 1.53 years. They were randomly assigned to experimental group 1 (EX1), experimental group 2 (EX2) or the control group (CG). Materials and methods: Changes in spirometry parameters were evaluated over a 16-week period in the three groups: CG (placebo), EX1 (breathing exercises) and EX 2 (combination of breathing exercises with an aerobic program). To evaluate the pre-training and post-training diagnostics, we used MIR Spirobank II. The influences of the experimental and control factors were assessed using the following dependent variables: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), Tiffeneau–Pinelli index (FEV1/FVC ratio), peak expiratory flow (PEF) and forced mid-expiratory flow (FEF25–75%). We used the Wilcoxon t-test and the Kruskal–Wallis test to evaluate the differences in the measured parameters. To examine the effect of our protocols, we used effect size (ES). Results: In CG we observed improvements in: FVC—(5%; p < 0.05; ES = 0.437). FEV1—(7.33%; p < 0.01; ES = 0.585). FEV1/FVC ratio (5.27%; p < 0.01; ES = 0.570). PEF (11.22%; p < 0.01; ES = 0.448). FEF25–75% (7.02%; p < 0.01; ES = 0.628). In EX1 we observed improvements in: FVC (5.23%; p < 0.01; ES = 0.631), FEV1 (20.67%; p < 0.01; ES = 0.627), FEV1/FVC ratio (16.06%; p < 0.01; ES = 0.628), PEF (13.35%; p < 0.01; ES = 0.627) and FEF25–75% (13.75%; p < 0.01; ES = 0.607). In EX2 we observed improvements in: FVC (9.12%; p < 0.01; ES = 0.627), FEV1 (27.37%; p < 0.01; ES = 0.626), FEV1/FVC ratio (15.32%; p < 0.01; ES = 0.610), PEF (30.66%; p < 0.01; ES = 0.626) and FEF25–75% (58.99%; p < 0.01; ES = 0.626). Significant differences compared to the control group were observed in EX1 for FEV1 (p < 0.05) and FEV1/FVC ratio (p < 0.01); and in EX2 for FEV1 (p < 0.05), FEV1/FVC ratio (p < 0.01), PEF (p < 0.05) and FEF (p < 0.05). A significant difference between EX1 and EX2 was observed in PEF (p < 0.05). Conclusions: It appears to be that combination of breathing exercises with aerobic activities is a more beneficial option for patients with bronchial asthma.

Breathlessness and Respiratory Disability After Kidney Transplantation

Dyspnea is a common symptom in patients with end-stage kidney disease being treated with dialysis. This study aimed to ascertain the level of respiratory disability in patients after kidney transplantation through assessing a cohort of kidney allograft recipients for respiratory compromise and thereby identifying a potential target for therapeutic intervention. Kidney transplant recipients who were under active observation in a single tertiary referral center were invited to take part in this prevalence study at the time of clinic follow-up. All patients agreed to take part in the study, which involved completing a Medical Research Council (MRC) dyspnea scale, completing the St George's Respiratory Questionnaire, and performing basic spirometry. An MRC score of ≥2 and/or a forced expiratory volume in 1 second <90% predicted prompted formal clinical assessment by a respiratory physician. This study enrolled 103 patients; 35% of all patients reported breathlessness, and 56% of all patients warranted formal respiratory medicine review. After completion of their investigations, 33 patients were found to have an underlying condition accounting for their symptoms. Our study highlights the issues of respiratory disability and breathlessness in patients who have undergone kidney transplantation. Although extensive cardiologic evaluation is performed routinely and can rule out many causes of dyspnea, respiratory assessment is not a preoperative prerequisite. This study could suggest that a formal pulmonological evaluation and basic spirometry should be part of the pretransplant evaluation of the kidney transplant recipient.

Ratio of Maximal Inspiratory to Expiratory Flow Aids in the Separation of COPD from Asthma

Patients who have chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA) share symptoms such as, dyspnoea, cough and wheeze. Differentiating these diseases in the ambulatory setting can be challenging especially in older adult smokers who are being treated with a variety of medications. The objective of this study was to test the value of adding a maximal inspiratory manoeuvre to basic spirometry to differentiate COPD and BA. One hundred forty-three COPD patients and 142 BA patients had measurements of maximal inspiratory and expiratory flow during routine spirometry. Parameters from these tests were used to assess diagnostic accuracy using receiver-operating characteristic (ROC) analyses followed by logistic regression. The association of two independent parameters were analyzed using linear regression analyses. Results show that forced expiratory volume in one second/forced vital capacity (FEV1/FVC%) <62.4 was the best independent predictor to diagnose COPD. The combination of FEV1/FVC% <62.4 and the ratio of peak inspiratory flow/maximal expiratory flow at 50% FVC (PIF/MEF50) >3.06 significantly predicted COPD. Post-test probability for prediction of COPD was 82.0% when patients had both parameters. When asthmatic patients with a smoking history were compared with COPD patients, FEV1/FVC% <63.4 and PIF/MEF50 >3.29 were both independent predictors of COPD. The post-test probability for COPD was 94.4% when patients had both parameters. The association between FEV1/FVC% and PIF/MEF50 was significantly different between COPD and BA. In conclusion, the addition of the maximal inspiratory effort to routine pulmonary function measurements provides a simple test to help differentiate COPD and BA.

Isolated Small Airway Dysfunction and Ventilatory Response to Cardiopulmonary Exercise Testing.

The effect of isolated small airway dysfunction (SAD) on exercise remains incompletely characterized. We sought to quantify the relationship between isolated SAD, identified with lung testing, and the respiratory response to exercise. We conducted a prospective evaluation of service members with new-onset dyspnea. All subjects underwent plethysmography, diffusing capacity of the lung for carbon monoxide (DLCO), impulse oscillometry, high-resolution computed tomography (HRCT), and cardiopulmonary exercise testing (CPET). In subjects with normal basic spirometry, DLCO, and HRCT, SAD measures were analyzed for associations with ventilatory parameters at submaximal exercise and at maximal exercise during CPET. We enrolled 121 subjects with normal basic spirometry (ie, FEV1, FVC, and FEV1/FVC), DLCO, and HRCT. Mean age and body mass index were 37.4 ± 8.8 y and 28.4 ± 3.8 kg/m2, respectively, and 110 (90.9%) subjects were male. The prevalence of SAD varied from 2.5% to 28.8% depending on whether FEV3/FVC, FEF25-75%, residual volume/total lung capacity, and R5-R20 were used to identify SAD. Agreement on abnormal SAD across tests was poor (kappa = -0.03 to 0.07). R5-R20 abnormalities were related to higher minute ventilation ([Formula: see text]) and higher [Formula: see text]/maximum voluntary ventilation (MVV) during submaximal exercise and to lower [Formula: see text] during maximal exercise. After adjustment for differences at baseline, there remained a trend toward a relationship between R5-R20 and an elevated [Formula: see text]/MVV during submaximal exercise (β = 0.04, 95% CI -0.01 to 0.09, P = .10), but there was no significant association with [Formula: see text] during submaximal exercise or with [Formula: see text] during maximal exercise. No other SAD measures showed a relationship with ventilatory parameters. In 121 subjects with normal basic spirometry, DLCO, and HRCT, we found poor agreement across tests used to detect SAD. Among young, healthy service members with postdeployment dyspnea, SAD as identified by lung function testing does not predict changes in the ventilatory response to exercise.

Impact of Fuel Exposure on Ventilatory Function among Petrol Pump Attendants in Thies, Senegal

Introduction: Petrol pump attendants are exposed to toxic substances in fuels. The release of petrol fumes during fuel refuelling is a repeated and often harmful source of exposure for petrol pump attendants. The purpose of our study was to evaluate the ventilatory disorders related to fuel exposure among petrol pump attendants. Materials and Method: Forty petrol pump attendants have been recruited. The study included a medical survey with a questionnaire that examined anthropometric characteristics, seniority, smoking habits and working conditions. The study included a medical survey with a questionnaire that examined anthropometric characteristics, seniority, smoking habits and working conditions. All our subjects received a basic and post-bronchodilator spirometry. The targeted respiratory functional disorders were bronchial obstruction, restrictive syndrome and mixed syndrome. Obstructive syndrome has been reported on the basis of: FEV1/ FVC and/or FEF25-75% less than 80%. Functional restriction was defined on the basis of a decrease in FVC <80% and the normal FEV1/FVC ratio. The mixed syndrome was retained firstly before the combination of the two obstructive and restrictive spirometric anomalies. Results: We noted 20% of active smokers and 25% of ex-smokers. The average length of service was 9.4 ± 7.05 years. All of the petrol pump attendants used incomplete means of protection. No employee was receiving medical follow-up. Most subjects (52.5%) were unaware of the risks associated with fuel exposure. Respiratory functional disorders were dominated by isolated obstructive ventilatory disorder (OVD) in 45% of subjects and were mainly located in the distal bronchi (65%). Besides, 12.5% of subjects had an isolated restrictive functional disorder (RFD) and a mixed syndrome in 27.5% of cases. Obstructive and mixed ventilatory disorders were more important according to smoking status. The different ventilatory disorders (VD) appeared from the beginning of exposure with a predominance of obstructive ventilatory disorders. Mixed ventilatory disorders increased significantly after 10 years of exposure. Conclusion: Exposure to petrol / diesel fumes has harmful effects on the ventilatory function of petrol pump attendants.

Lung Function of Traditional Bakers and Pastry Makers Expsosed to Flour Dust in the City of Thies, Senegal

Introduction: Cases of restrictive and obstructive diseases have been reported in workers exposed to flour dust. In Senegal, studies on the lung function of bakery-pastry employees are rare. The purpose of our study was to evaluate the clinical respiratory manifestations and ventilatory disorders (VD) related to flour dust exposure among traditional bakers and pastry makers in the city of Thies, Senegal. Materials and Method: A descriptive cross-sectional study was conducted. Forty subjects were recruited. Subjects received a basic and post-bronchodilator spirometry. The targeted respiratory functional disorders were bronchial obstruction, functional restriction and mixed syndrome. Results: The average length of service at the workplace was 7±6,7 years. Smokers represented 17,5%. A respiratory symptoms were found in 65% of our subjects. Coughing, sneezing and rhinorrhea were more frequent with 50%, 24% and 17% respectively. The most common ventilatory disorders among exposed bakers were of the mixed type (22,5%). On the other hand, 12,5% had an isolated obstructive ventilatory disorder (OVD) and a restrictive functional disorder (RFD) was found in 10%. The obstructive ventilatory disorders were dominated by obstruction of the small airways (80%). The severity of ventilatory disorders was of a moderate deficit type (87% and 62% respectively). Respiratory function abnormalities were more common in the smokers with a prevalence of ventilatory disorders that increased with age of employment. However, the effect of exposure appears to be clear because among non-smokers, 12,13 % of the exposed patients had respiratory functional abnormalities with isolated restrictive functional disorder type. Conclusion: This study showed that bakery and pastry workers have various respiratory symptoms and ventilatory disorders. Smoking and job tenure remain factors that increase these flour dust-related risks.

Positive Expiratory Pressure (PEP) versus Conventional Chest Physiotherapy in Pediatric Patients with Acute Exacerbation of Cystic Fibrosis

Background Pulmonary involvement is the main cause of mortality in cystic fibrosis (CF). Airway clearance techniques are non-pharmacological complement options for CF patients. The aim of this study was to evaluate the short-term outcome of airway cleaning treatment in patients with cystic fibrosis in a children's hospital. Materials and Methods This clinical trial study conducted on 40 CF patients referring to the specialized lung clinic of Tabriz Pediatric Center in Tabriz, Iran from April 2016 to April 2017. Patients were randomly divided into two equal case (PEP), and control (conventional) groups. The basic spirometry parameters were measured on the European Respiratory Society criteria. After therapeutic intervention, the patients were followed for the next six months and the number of hospital admissions were recorded. Results The mean of FEV1, FEV1/FVC and FEF25%-75% in the control group after treatment were 62.60±20.39, 86.70±19.39 and 55.20±32.78, respectively. Comparison of the control group means of FEV1, FEV1/FVC, and FEF25%-75% in the case group after intervention (57.52±14.62, 76.80±21.83 and 59.8±28.71, respectively) showed significant differences (p<0.05). The number of re-hospitalization during the following six months in the case and the control groups were 1.4±1.23 and 2.00±0.64, respectively, which was significantly different (p = 0.00). Conclusion The patients undergoing treatment (PEP and control groups) showed better spirometry results. In the PEP group, the number of re-hospitalizations was significantly lower than the control group.

Basic spirometry testing and interpretation for the primary care provider.

Spirometry testing plays an important role in the diagnosis and management of COPD and asthma in the primary care setting. Verifying the accuracy of the spirometer, using accurate patient demographics and appropriate reference equations, and ensuring the competency of testing personnel are key components of spirometry test interpretation. Spirometry testing plays an important role in the diagnosis and management of lung disease in the primary care setting. Spirometry interpretation should include an assessment of test quality and be based on sound statistical principals.

Lung function assessment in preschool children; a review of the utility of basic spirometry, interrupter technique and forced oscillation technique

Objective lung function assessment in preschool children is a challenge; the mechanics of the lungs are changing rapidly with advancing age and maturation, the population is too old to ethically justify routine sedation prior to lung function assessment, as in infants, and also, they are too young to be able to focus sufficiently and perform elaborate respiratory manoeuvers required by commonly used lung function tests in older children and adults. But, clinically, a clear evidence based demarcation between isolated non-significant episodes of respiratory symptoms and pathognomonic symptoms is vital for the management. Even though many different lung function techniques are commonly used in the assessment of preschool children, the purpose of this review is to evaluate three commonly used pulmonary function tests, viz. basic spirometry, interrupter technique and forced oscillation technique in order to assess their usefulness in preschool children. We conclude that contrary to common misbelief, ample evidence exists that preschool children are capable of performing lung function tests. Basic spirometry, which stood the test of time, remains one of the most commonly used lung function tests. The interrupter technique and the forced oscillation techniques are quickly gathering reputation as reliable alternatives for lung function assessment in preschool children, especially due to the minimal co-operation required from the subject and the versatility of the test. These techniques will enable definitive diagnosis, assessment of severity and the therapeutic response of multiple, complex and often challenging clinical respiratory conditions to enable efficient management

The Role of Spirometry in the Diagnosis of Cough Variant Asthma in Children Aged 5 to 15 Years

Background Cough variant Asthma (CVA) is defined as chronic cough without wheezing, and may be precursor of typical asthma. Thus, the diagnosis of CVA and early intervention can partly inhibit asthma progression.This study aimed to evaluate the role of spirometry in diagniosis of Cough variant Asthma in Iranian Children. Materials and Methods This descriptive observational study included a total of 73 patients, who were referred to the specialized lung clinic of Tabriz Pediatric Center, Tabriz city, Iran. Patients were divided into two groups with classic asthma (n=37) and cough variant asthma (n=36) and basic spirometry parameters such as FEV1, FVC, FEV1/FVC, FEF 25-75% and PEF were measured, and the spirometry findings of each individual were measured based on the European Respiratory Society (ERS) criteria. Results The mean of FEV1 and FVC in the classic asthma group were 83.45 ± 20.49% and 86.45 ± 21.57%, respectively; and in the cough variant asthma group were 87.44 ± 13.99% and 86.8 ± 14.71%, respectively. There was no significant difference between the two groups for the basic spirometry parameters of FEV1 and FVC (p=0.343, P=0.916; respectively). The average FEV1/FVC parameter in the cough variant asthma group was 89.44±13.07, but it was 72.35±8.47 in the classic asthma group, with a significant difference between the two groups (p<0.05). Conclusion There was a significant difference in the FEV1 / FVC value between two groups of cough and classic asthma. Spirometry of patients with cough variant asthma showed the FEF values (25 -75%) were lower than expected; we suggest using spirometry in the diagnosis of cough variant asthma considering small airways changes.

Validity of Spirometry for Diagnosis of Cough Variant Asthma

Background Cough variant asthma (CVA) is a chronic or recurrent cough without wheezing accompanied by bronchial hyper-responsiveness and eosinophilic inflammation of the airways. This study aimed to evaluate the validity of spirometry in the diagnosis of CVA, as well as determining the specificity and sensitivity of spirometry parameters in CVA. Materials and Methods This descriptive observational study was conducted from March 2015 to February 2016. The subjects were 73 patients 5 to 15 years of age who referred to the pulmonology clinics of Tabriz Pediatric Center, Tabriz city, Iran. The patients were divided into two groups of classic asthma (n=37), and CVA (n=36). Basic spirometry parameters such as FEV1/FVC and FEF25-75% were measured and the spirometry findings of each individual were measured based on European Respiratory Society (ERS) criteria. After intervention (β2 (beta2) adrenergic receptor agonists as bronchodilator test), in two groups, spirometry was again performed. The FEV1/FVC and FEF 25-75% parameters were examined for intervention. Data analysis was performed using SPSS (version 16.0). Results Cut-off points for the diagnosis of CVA and classic asthma were obtained using FEV1/FVC and FEF 25-75% spirometry. The cut-off point for FEV1/FVC for the diagnosis of CVA was calculated to be 80%. When the FEV1/FVC ratio was higher than 80%, diagnosis of CVA was possible with a specificity of 94.59%, and sensitivity of 66.67%. These findings suggest a specificity and sensitivity of 94.59%, and 66.67%, respectively, for the diagnosis of classic asthma (with an FEV1/FVC ratio of below 80%). Analysis showed a positive predictive value of 100% for CVA at FEF 25-75% with a negative predictive value of 55.4%. Conclusion Spirometry can be a sensitive method for the diagnosis of CVA at a FEF 25-75% below 65%; however, it lacks the specificity for accurate diagnosis of CVA.

Relationship between Vitamin D, Inflammation and Lung Function In Patients with Severe Uncontrolled Asthma.

BACKGROUND:Recently epidemiological studies showed that low vitamin D is linked to airway hyperresponsiveness, decreased lung function, poor asthma control, and steroid–resistant asthma.AIM:We investigated the relationship between Vitamin D, inflammation with circulating IL-33 and lung function in 30 patients with severe uncontrolled asthma.MATERIALS AND METHODS:The study included 30 patients with severe uncontrolled asthma. In each of them were measured serum levels of IL-33 and Vitamin D by the ELISA method. The pulmonary function is measured by basic spirometry parameters, FEV1. The results were statistically elaborated according to the Pearson’s Correlation Tests.RESULTS:The results showed statistically insignificant correlation between Vitamin D and IL-33, and Vitamin D with FEV1 (Vit.D/IL-33; r = 0.11323, p = 0.551); (Vit.D/FEV1; r = -0.1005; p = 0.597) Correlation between IL-33 and FEV1 is negative but statistically significant (IL-33/FEV1; r = -0.5248; p = 0.003).CONCLUSION:Because there are little studies about the link between vitamin D and asthma, further research to clarify the mechanism how vitamin D control the activity of CD4+ T cells and the related Th2-type cytokines in the parthenogenesis of asthma.

Evaluating the appropriateness of hospital doctors’ requests for pulmonary function tests beyond basic spirometry: results from a prospective observational study

ABSTRACTObjectives: Hospitalists request ‘complete’ pulmonary function tests (PFTs), typically comprising of spirometry, diffusion capacity of the lung for carbon monoxide (DLCO) and absolute lung volumes (ALVs), the results of which assist in the management of patients with respiratory disorders. Recently, concerns have been raised about over-requesting of ‘complete’ PFTs, but there is a paucity of information on the proportion of requests that can be considered clinically inappropriate. This study prospectively evaluated the ‘complete’ PFTs requested in a hospital service and assessed the impact of medical review of the requests.Methods: A six-month prospective study on requests to two teaching hospital PFT laboratories from non-respiratory doctors was undertaken. Requests at one laboratory underwent review by a respiratory doctor (‘intervention laboratory’) while requests at the second laboratory were not reviewed (‘control laboratory’). The appropriateness of requests was measured against pre-specified criteria.Results: PFT requests for 335 subjects were included in the study. In the intervention laboratory, 8 of 110 ALV and 122 of 134 DLCO requests fulfilled pre-specified criteria for appropriate test indications. Fewer ALV (7% vs. 100%, p < 0.001) and DLCO tests (91% vs. 100%, p = 0.031) could have been performed in the intervention laboratory compared to the control laboratory.Conclusion: A considerable proportion of ‘complete’ PFT requests from non-respiratory hospital doctors may be unwarranted. Using a simple screening method, the number of unnecessary PFTs could be reduced, resulting in substantial time and cost savings for hospital PFT laboratories.

Characteristics of Bronchial Obstruction in Patients with Chronic Obstructive Pulmonary Disease, Depending on the Comorbidity with CHD

The objective: to study the basic spirometry and pneumotachometry in patients with isolated COPD and patients with COPD combined with coronary artery disease. Patients and methods. A total of 3 groups of patients: group 1 – 43 patients with stage II COPD and concomitant coronary heart disease, stable exertional angina (SEA) FC II, group 2 – 47 patients with stage II COPD and group 3 – 26 patients with coronary artery disease, CCH FC II. Results. It is found that in COPD presence of coronary artery disease associated with a statistically significant lower rates VC, PIF, MIF at 25%, 50%, 75% FVC as well as a statistically significant reduction MEF in the interval from 25% to 75% FVC compared with those of patients with isolated over COPD. Conclusion. The presence of coronary artery disease, stable angina FC II patients with COPD II stage. It is associated with more severe bronchial hyperresponsiveness and more pronounced decrease in VC, FVC, FEV1, ratios of FEV1/FVC, and significantly more pronounced changes in bronchial obstruction in the form of reduced rates of PIF, MIF25, MIF50, MIF75, MEF25-75 compared with their values in patients with COPD isolated passage.

Large airways nodularity secondary to tracheobronchopathia osteochondroplastica

A 74-year-old retired librarian was referred for assessment after a full-body CT, performed to investigate a 3-month history of persistent nausea and weight loss, incidentally identified a 10 mm left...

Lung function abnormalities among service members returning from Iraq or Afghanistan with respiratory complaints

BackgroundService members deploying to Afghanistan (OEF) and Iraq (OIF) often return with respiratory symptoms. We sought to determine prevalence of lung function abnormalities following OEF/OIF. MethodsWe identified OEF/OIF patients who had unexplained respiratory symptoms evaluated using lung function testing. Lung function data were summarized and analyzed for associations with demographic and deployment characteristics. ResultsWe found 267 patients with unexplained cough or dyspnea, lung function testing and a history of OEF/OIF deployment. All patients had basic spirometry performed and 82 had diffusion capacity for carbon dioxide (DLCO) measured. The median (IQR) number of deployments and total days deployed were 1 (1–2) and 352.0 (209–583), respectively. There were 83 (36.6%) patients with abnormal spirometry, 53 (63.9%) of whom had an abnormal FEV1/FVC. Only one (1.2%) patient had an abnormal DLCO adjusted for alveolar volume. Of 104 patients who had post bronchodilator (BD) testing performed, six (5.8%) had a positive response by ATS criteria. We found no relationships between lung function and time in theater, deployment location, deployment frequency, or land based-deployment. Dyspnea and enlisted rank were associated with tobacco use and lower FEV1, and cough was associated with total number of deployments. ConclusionsService members with respiratory complaints following OEF/OIF have a high prevalence of abnormalities on spirometry. Tobacco use, enlisted rank and total number of deployments were associated with symptoms or spirometric abnormalities.

Strategies To Teach Physiology in An Era of Declining Lecture Attendance

Lecture simulcasts and web‐based archiving have reduced class attendance among preclinical medical students, even as labs and demos decline. Thus while the basic science years of MD education have historically been the primary arena for physiology instruction, its content experts increasingly face empty seats. In 16 years of running a Respiratory Module for MD‐2 students (175/yr), we have resisted this trend via a menu of opportunities to engage students. Of these, four draw more students than the 30‐40% at lectures. By attendance and student evaluations, the most popular are two where groups of &lt;18 perform: 1) a Pulmonary Function Test (PFT) for basic spirometry and plethysmography and then join pulmonologists to discuss new PFT cases (&gt;95% attend); 2) a 7‐stage Human Patient Simulation (HPS) to diagnose and treat a ‘penetrating chest wound of unknown etiology’ (&gt;90% attend). While voluntary, many students attend twice; enthusiastic evaluations lead later classes to arrive with positive expectations. Then all lectures, labs, PFT, and HPS are revisited at weekly Structured Speed Reviews (SSR) summarizing each hour of content in 10 min and are recorded like lectures by Tegrity; &gt;65% attend. Finally, we hold 2‐3 Facilitated Peer‐to‐Peer (FPTP) lunch hours per week. Attended by 15‐20% of students, FPTPs are guided by faculty but students identify concepts to review, complete practice problems, and explore tangential topics of mutual interest. Costs (personnel, facilities, time) and benefits of the PFT, HPS, SSR, and FPTP are evaluated yearly.

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Can We Predict Pulmonary Complications After Thoracic Surgery?

Can We Predict Pulmonary Complications After Thoracic Surgery?