Bronchial Dilation Test Research Articles

Effects of type 2 inflammation on bronchodilator responsiveness of large and small airways in chronic obstructive pulmonary disease

To investigate the impact of type 2 inflammation markers blood eosinophils (EOS) and fractional exhaled nitric oxide (FeNO) on bronchodilator responsiveness (BDR) in patients with chronic obstructive pulmonary disease (COPD). This study was conducted among 389 patients with an established diagnosis of COPD in our hospital from October, 2019 to October, 2023, who all underwent bronchial dilation test (BDT) of the large and small airways. Based on smoking history, blood EOS, and FeNO, these patients were divided group A (blood EOS < 300/μL + FeNO < 35 ppb + smoking history < 20 pack-years), group B (blood EOS < 300/μL+FeNO < 35 ppb+smoking history ≥20 pack-years), group C (blood EOS ≥300/μL or FeNO≥35 ppb+smoking history ≥20 pack-years), and group D (blood EOS ≥300/μL or FeNO ≥35 ppb+smoking history < 20 pack-years) for analyzing the relationship between clinical indexes and BDR. BDR evaluation based on forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and maximum mid-expiratory flow (MMEF) yielded consistent results, all showing a younger mean age, higher FeNO levels, and higher blood EOS counts and percentages in patients positive for BDT (P < 0.05). The improvement value and improvement rate of FEV1 were significantly lower in group A than in group D. The improvement value and improvement rate of FEV1 as well as the improvement rate of MMEF were significantly lower in group B than in group D. In the overall patients, age and FeNO were significantly correlated with the improvement value and improvement rate of FEV1 and the improvement rate of MMEF (P < 0.05). Type 2 inflammation markers have different effects on BDR in the large and small airways of COPD patients, and their clinical significance needs further investigation.

Effect of overweight/obesity on relationship between fractional exhaled nitric oxide and airway hyperresponsiveness in Chinese elderly patients with asthma.

Purpose: This retrospective study investigates the influence of overweight and obesity status on pulmonary function, airway inflammatory markers, and airway responsiveness in elderly asthma patients. Methods: Patients with asthma older than 65years old who completed a bronchial provocation test (BPT) or bronchial dilation test (BDT) and a fractional exhaled nitric oxide (FeNO) test between December 2015 and June 2020 were identified retrospectively for this study. All of the patients were categorized into overweight/obesity and non-obesity groups based on their BMI. Pulmonary function test (PFT) and FeNO measurements were accomplished according to the 2014 recommendations of the Chinese National Guidelines of Pulmonary Function Test and American Thoracic Society/European Respiratory Society recommendations, respectively. Results: A total of 136 patients with an average age of 71.2 ± 5.40years were identified. The average BMI was 23.8 ± 3.63, while the value of FeNO was 42.3 ± 38.4 parts per billion (ppb). In contrast to the non-obesity group, which had a value of 48.8 ± 43.1 ppb for FeNO, the overweight/obesity group had a significant lower value of 35.4 ± 31.4 ppb. There was no significant difference in the proportion of individuals with high airway hyperresponsiveness between the overweight/obesity and non-obesity groups (96 patients in total). Multiple linear regression analysis established an inverse correlation between FeNO and Provocation concentration causing a 20% fall in FEV1(PC20) but excluded significant relationships with age and BMI. The model's R is 0.289, and its p value is 0.045. Conclusion: The elderly Chinese Han asthmatics with overweight/obesity had lower FeNO levels than those with non-obese according to our findings. In addition, the FeNO level was inversely correlated between FeNO levels and PC20 in elderly asthmatics.

Small Airway Dysfunction Measured by Impulse Oscillometry and Fractional Exhaled Nitric Oxide Is Associated With Asthma Control in Children.

BackgroundImpulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) are sensitive and non-invasive methods to measure airway resistance and inflammation, although there are limited population-based studies using IOS and FeNO to predict asthma control.ObjectiveThis study aimed to investigate the utility of IOS and FeNO for assessing childhood asthma control in terms of small airway dysfunction and airway inflammation.MethodsThis prospective observational cohort study enrolled 5,018 school children (aged 6–12 years), including 560 asthmatic children and 140 normal participants. FeNO, spirometry, IOS, bronchial dilation test, total IgE, and childhood asthma control test (C-ACT) were measured. FeNO, IOS, spirometry, and C-ACT results were correlated with childhood asthma with and without control.ResultsUncontrolled asthmatic children had abnormal FeNO, IOS, and spirometric values compared with control subjects (P < 0.05). IOS parameters with R5, R5-R20, X5, Ax, △R5, and FeNO can predict lower C-ACT scales by the areas under receiver operating characteristic curves (AUCs) (0.616, 0.625, 0.609, 0.622, 0.625, and 0.714). A combination of FeNO (>20 ppb) with IOS measure significantly increased the specificity for predicting uncontrolled asthma patients compared with FeNO alone (P < 0.01). A multiple regression model showed that small airway parameter (R5-R20) was the strongest risk factor [OR (95% CI): 87.26 (7.67–993.31)] for uncontrolled asthma patients. Poor control with lower C-ACT scales correlated with high FeNO (r = −0.394), R5 (r = −0.106), and R5-R20 (r = −0.129) in asthmatic children (P < 0.05).ConclusionA combined use of FeNO and IOS measurements strongly predicts childhood asthma with or without control.

Effect of a Single Simulated 500m Saturation Dive on Lung Function.

Background: Whether deep saturation diving causes injury to lung function remains controversial and the mechanism is unclear. The present study aimed to evaluate the effects of a 500 m simulated single saturation dive on lung function. Methods: A retrospective study was performed in nine professional divers who spent 176 h in a high-pressure environment simulating a depth of 500-m saturation dive (51 atm, 5.02 Mpa). Pulmonary function parameters were investigated and compared before and on 3 days after the dive. Results: Nine professional divers aged (36 ± 7) years were enrolled. Three days after the dive, the parameters related to expiratory flow (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)) were decreased; the parameters related to small airway function (forced expiratory flow at 50%, 75% of FVC exhaled and forced mid-expiratory flow) were decreased compared with those before the dive (both p < 0.05). Additionally, after the dive, the parameters related to pulmonary diffusion function were decreased compared with those before the dive (both p < 0.05). The parameters related to lung volume (residual volume, vital capacity and total lung volume) and those related to respiratory exertion (peak expiratory flow and forced expiratory flow at 75% of FVC exhaled) were not significantly different between after and before the dive. Two divers with small airway dysfunction before the dive had obstructive ventilatory dysfunction after the dive. Additionally, mild obstructive ventilatory dysfunction in three divers before the dive became severe after the dive. After a bronchial dilation test, five divers showed improvement of FEV1, which ranged from 0.10 to 0.55 L. Chest radiographs and echocardiography of all divers were normal after diving. Conclusion: 500 m simulated saturation diving induces a decrease in small airway function and diffusion function. This injury may be associated with small airway and diffusion membrane lesions.

Effects of Inhaled Corticosteroids on Lung Function in Children With Post-infectious Bronchiolitis Obliterans in Remission.

BackgroundPost-infectious bronchiolitis obliterans (PIBO) is a rare and irreversible chronic obstructive pulmonary disease with no specific treatment, especially for patients with PIBO in remission. In this study, we evaluated the effects of continuous inhaled corticosteroids (ICSs) and intermittent ICSs on lung function in the remission of PIBO.MethodsThis was a retrospective study, and all the subjects we included were divided into continuous ICS group and intermittent ICS group according to treatment regimens. Patients in continuous ICS group received continuous ICSs (2 times a day), and patients in intermittent ICS group received intermittent ICSs (inhaled corticosteroids after acute respiratory tract infection or wheezing). Different lung function tests were performed at different ages. Tidal breathing lung function tests were performed in patients with PIBO aged ≤ 5 years, and the lung ventilation function test and the bronchial dilation test were performed in patients with PIBO aged more than 5 years. Lung function was assessed at the beginning of follow-up and at the end of follow-up (1 year of ICSs).ResultsAfter 1 year of ICSs, patients aged more than 5 years, forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1) were significantly higher than at the beginning of follow-up. After 1 year of ICSs, the difference in VT/Kg, TPTEF/TE, and VPEF/VE between the end and the beginning of follow-up in continuous ICS group shows an upward trend. But those showed a downward trend in intermittent ICS group. FVC, FEV1, and maximal mid-expiratory flow velocity 25–75% (MMEF25–75%) of continuous ICS group were significantly higher than at the beginning of follow-up. The difference in FEV1 and MMEF25–75% between the end of follow-up and the beginning of follow-up in continuous ICS group was significantly higher than that in intermittent ICS group. A total of 52.94% of patients with PIBO aged more than 5 years were positive for bronchial dilation tests.ConclusionInhaled corticosteroids can effectively improve lung function and relieve airway obstruction in patients aged more than 5 years in PIBO remission, especially continuous ICSs. Patients with PIBO may have reversible airflow limitations.

Asthma attacks: Patients who survived paraquat poisoning.

A patient who survived acute paraquat (PQ) poisoning for more than 5 years was followed up in the emergency room. The patient had recurrent coughing and wheezing one month after discharge. Re-examination of chest CT showed increased dual lung texture. Spirometry suggested severe ventilatory dysfunction while bronchial dilation test was positive. The serum IgE level was significantly high. It is considered that patients with acute PQ poisoning may develop asthma in the long term.

Clinical analysis of hypereosinophilic syndrome first presenting with asthma-like symptoms

Introduction Clinical manifestations of hypereosinophilic syndrome (HES) are diverse. This study aimed to summarise these clinical characteristics with asthma-like onset as the first symptom, and compare these characteristics and treatment strategies between idiopathic and parasitic HES. Materials and methods We retrospectively analysed 36 HES patients with asthma-like symptoms as the first episode, between January 2013 and October 2019. Data of patients with HES of an unknown cause (idiopathic HES) and parasitic infection (parasite HES) were analysed. Results The idiopathic and parasite HES groups included 16 and 20 patients, respectively, with more males in the parasite HES group (p < .05). Wheezing and dry rales was the most common symptom and signs, with no significant differences in symptoms and signs between the groups. The most often misdiagnosed disease was bronchial asthma. The peripheral blood eosinophil count was significantly increased compared with normal counts in both groups (p > .05). Abnormal pulmonary function is mainly manifested as obstructive ventilatory disorder and mixed ventilatory disorder. Chest computed tomography showed extensive ground-glass exudation, patches, consolidation, nodules, and pleural effusion. Histopathological examination showed eosinophilic infiltration without vasculitis or granuloma. Glucocorticoids had a significant therapeutic effect, and the parasite HES group required combined deworming drugs. The duration of corticosteroids therapy in the idiopathic HES group was significantly longer than that in the parasite HES group (p < .05). The overall prognosis was good, and 81.25% of the patients were clinically cured in the parasite HES group; however, relapse occurred easily in the idiopathic HES group. Conclusions Asthma-like symptoms, obstructive ventilatory disorder or positive bronchial dilation test, and poor response to inhaled corticosteroids are not necessarily indicative of refractory asthma; HES should be considered. The clinical characteristics of HES of different aetiologies are similar. Systemic corticosteroid therapy is preferred for idiopathic and parasitic infections. Idiopathic HES is treated with prolonged corticosteroids and relapses easily. Key Messages Asthma-like symptoms, obstructive ventilatory disorder or positive bronchial dilation tests, and poor responses to inhaled corticosteroids are not necessarily indicative of refractory asthma, and hypereosinophilic syndrome should be considered. The clinical characteristics of hypereosinophilic syndrome of different aetiologies are similar, and systemic glucocorticoid therapy is preferred for both idiopathic and parasitic infections. Idiopathic hypereosinophilic syndrome is treated with prolonged corticosteroids and relapses easily.

Correlation between bronchial dilation test and asthma control level in children with asthma

OBJECTIVE To study the correlation between the bronchial dilation test (BDT) and asthma control level in children with asthma. METHODS A total of 153 children with asthma, aged 5-14 years, who attended the outpatient service from March 2016 to March 2018 were enrolled. According to the presence or absence of atopic constitution, they were divided into an allergic group with 79 children and a non-allergic group with 74 children. The correlation between BDT and Childhood Asthma Control Test (C-ACT) scores was analyzed for both groups. RESULTS All basic pulmonary function parameters were positively correlated with C-ACT scores in the non-allergic group (P < 0.05). Except the forced vital capacity, peak expiratory flow and maximal expiratory flow at 25% vital capacity in percent predicted values, the other pulmonary function parameters were positively correlated with C-ACT scores in the allergic group (P < 0.05). The improvement rates of all BDT parameters (except maximal expiratory flow at 25% vital capacity in the allergic group and maximal expiratory flow at 50% vital capacity in the non-allergic group) were negatively correlated with C-ACT scores in the two groups (P < 0.05). CONCLUSIONS The improvement rate of BDT is well correlated with C-ACT scores in children with asthma, suggesting that BDT can be used as an index for predicting asthma control level.

Effects of bronchial provocation test and bronchial dilation test for the diagnosis of lung diseases

Aim Present study was performed to explore the effects of bronchial provocation test (BPT) and bronchial dilation test (BDT) for the diagnosis of lung diseases. Methods BPT and BDT results were respectively detected by methacholine and albuterol in patients with different lung diseases and non-lung diseases. BPT and BDT indexes including exhaled nitric oxide (ENO), forced expiratory volume of first minute (FEV1), forced vital capacity (FVC), diffusion of carbon monoxide in the lungs (DLCO) and eosinophilia (EOS) were compared by t-test between different groups. Results Positive and negative BPT indexes were significantly different in lung diseases, similar results of BDT results were also discovered in patients with lung diseases (p < .001). Obvious differences of ENO, FEV1/FVC and EOS levels were discovered in different BPT degrees (p < .05). FEV1, FVC and FEV1/FVC levels were distinctly higher in I BDT degree than II and III BDT degrees (p < .05) in lung diseases. Significant differences of BPT and BDT indexes were discovered between different lung diseases (p < .05). Conclusion BPT and BDT may be employed as the tools for diagnosis of lung diseases. Moreover, the patients with different lung diseases show significantly different BPT and BDT indexes.

Study on lung function and inflammatory indicators among infants with high-risk asthma

Objective To analyze the changes in lung function and inflammatory indicators such as eosinophils(EOS), Creola bodies and exhaled nitric oxide (FeNO), and to explore their value in early diagnosing asthma. Methods One hundred and thirty-five infants with high-risk asthma were selected as an observation group who were admitted to Department of Respiratory, Children′s Hospital of Soochow University from April 2016 to August 2017 due to asthmatic bronchitis and asthmatic bronchopneumonia, and a total of 200 non-asthmatic and non-allergic healthy children who were screened and followed up at the Department of Cardiology in the same period were selected as a healthy control group for the measurement of moist respiratory lung function and FeNO.In the observation group, the bronchial dilation test (BDT), EOS and Creola bodies were performed simultaneously.Classification of lung function: 23%≤time to peak ratio (TPTEF/Te)<28% had mild obstruction, 15%≤TPTEF/Te<23% had moderate obstruction, and TPTEF/Te<15% showed severe obstruction. Results The TPTEF/Te[17.20%(8.10%)], volume to peak ratio(VPEF/Ve)[21.20%(6.20%)], tidal volume per kilogram of body weight(VT/kg) [7.80(3.70)]and ratio of tidal expiratory flow 25% to peak tidal expiratory flow(25/PF) [0.54(0.20)]in the observation group were significantly lower than those in the healthy control group [22.30%(9.22%), 27.15%(7.10%), 8.90(3.17), 0.60(0.18)], and the differences were statistically significant(Z=-6.81, -9.35, -3.16, -3.52, all P 0.05). FeNO in the observation group [3.80(5.43) μg/L]was significantly lower than that in the healthy control group[9.60(11.3) μg/L], and the diffe-rence was statistically significant (Z=14.56, P 0.05). Conclusions In the acute phase of infant asthma attack, the pulmonary function presents different degrees of obstructive ventilation dysfunction, the higher the degree of obstruction, the higher the diagnostic value of BDT.The value of single FeNO measurement is limited, and continuous dynamic monitoring may be more mea-ningful in predicting the occurrence of asthma.Detection of Creola bodies may be helpful in predicting asthma. Key words: Infant; High risk; Asthma; Lung function; Eosinophils; Creola bodies; Exhaled nitric oxide

A New Evaluation and Diagnostic Significance of FEV1 and FVC After the Bronchial Dilation Test in Chronic Obstructive Pulmonary Disease

A New Evaluation and Diagnostic Significance of FEV₁ and FVC After the Bronchial Dilation Test in Chronic Obstructive Pulmonary Disease

Value of forced expiratory volume in 6 seconds (FEV(6)) in the evaluation of pulmonary function in Chinese elderly males

Objective: To evaluate the value of forced expiratory volume in 6 seconds (FEV(6)) in the evaluation of pulmonary function in Chinese elderly males. Methods: Pulmonary function tests of elderly who had received regular physical examination in Beijing Hospital from July 2003 to April 2015 were analyzed on subjects with the following characteristics: aged 60 years or older, completion of bronchial dilation test and able to exhale for at least six seconds. The included subjects were divided into 2 groups: 60-<80 years group and ≥80 years group. The association of FEV(6) with forced vital capacity (FVC), FEV(1)/FEV(6) with FEV(1)/FVC, the diagnostic efficiency and influencing factor of FEV(6) and FEV(1)/FEV(6) were analyzed; the value of FEV(6) in the evaluation of pulmonary function in the study population was evaluated. Results: A total of 475 elderly men aged 60 years or older were enrolled, with a mean age of (77.13±9.53) years. Totally there were 269 subjects in 60-<80 years group, which accounted for 56.6%; 206 subjects were in ≥80 years group, which accounted for 43.4%. There were 292 subjects with irreversible airflow obstruction, accounting for 61.5%. In all the included subjects, FEV(6) was significantly correlated with FVC and post-bronchodilator FEV(1)/FEV(6) was significantly correlated with post-bronchodilator FEV(1)/FVC(r=0.971, 0.978; both P<0.001), which were similar in 60-<80 years group and ≥80 years group (r=0.967, 0.974 and r=0.955, 0.967; all P<0.001). FEV(1)/FEV(6) showed excellent accuracy in diagnosing airflow obstruction[area under curve (AUC)=0.990(95%CI: 0.983-0.996); P<0.001]. Using FEV(1)/FVC<0.70 as a reference, FEV(1)/FEV(6)<0.73 had the best sensitivity (0.952) and specificity (0.945), and there was excellent agreement between the two diagnostic cutoffs (κ=0.891; P<0.001). When difference between before and after bronchial dilation test was analyzed, no correlation was observed between FEV(6) improvement and the improvement of forced expiratory time (r=0.089; P=0.053), but FVC improvement was significantly correlated with the improvement of forced expiratory time (r=0.460; P<0.001). Similar results were also found in subjects with irreversible airflow obstruction. Subjects with FEV(1)/FEV(6)≥0.70 and FEV(1)/FVC<0.70 were categorized as pulmonary function middle group, a total of 73 cases, which included 20 cases ≥80 years old. The proportion of middle group among ≥80 years group was significantly less than that of the 60-<80 years group (χ(2)=8.958; P=0.003). In pulmonary function middle group, FEV(1)/FEV(6) or FEV(1)/FVC had no correlation with inspiratory capacity or residual volume/total lung capacity (all P>0.05). Conclusions: FEV(6) and FEV(1)/FEV(6) are strongly correlated with FVC and FEV(1)/FVC, and there is excellent agreement between FEV(1)/FEV(6) and FEV(1)/FVC. FEV(6) is simple, easy to operate and with less influencing factors, which can be used as a valid alternative for FVC in diagnosing airflow obstruction in elderly males.

Investigation of Lung Cancer Patients Complicated with Chronic Obstructive Pulmonary Disease in Thoracic Surgical Department

背景与目的肺癌是慢性阻塞性肺疾病（慢阻肺）重要的合并症，会显著影响慢阻肺患者的预后。慢阻肺也会影响肺癌患者的术后并发症和复发。本研究旨在调查胸外科住院肺癌合并慢阻肺的情况。方法回顾性分析北京大学人民医院胸外科2015年1月-2015年12月收治的原发性非小细胞肺癌患者。通过查阅病历获取患者的性别、年龄、吸烟状况、有害职业史、症状、胸部计算机断层扫描（computed tomography, CT）、术后病理、出院诊断、全套肺功能及支气管舒张试验，当基础肺功能第一秒钟用力呼气容积（forced expiratory volume in one second, FEV1）占预计值＜70%时即行支气管舒张试验。结果703例肺癌患者进行了全套肺功能测定，其中67例进行支气管舒张试验，62例（92.5%）符合慢阻肺诊断。接受手术治疗的肺癌患者有677例，其中41例进行支气管舒张试验，38例（92.7%）符合慢阻肺诊断。在接受手术治疗的肺癌患者中合并慢阻肺者年龄≥65岁、男性、有吸烟史和非腺癌的比例高于未合并慢阻肺者，差异有统计学意义（P＜0.05）；男性和≥65岁者更易合并慢阻肺（OR: 2.807-2.374, 95%CI: 1.101-7.157）（P＜0.05）。住院前仅有3例（4.3‰）诊断慢阻肺并按慢阻肺规范治疗。出院时仅有5例（7.1‰）诊断慢阻肺。结论在胸外科住院肺癌患者中行常规肺功能及支气管舒张试验可提高肺癌合并慢阻肺的诊断；当前肺癌合并慢阻肺诊断和治疗严重不足，需要引起胸外科医生重视，与呼吸内科医生携手共同防治慢阻肺。

Analysis of pulmonary function characteristics for asthma and chronic obstructive pulmonary disease overlap syndrome in the elderly males

Objectives To investigate the incidence rate of asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome(ACOS)in elderly male patients with stable COPD by following-up, and to explore the characteristics and clinical significance of pulmonary function for ACOS. Methods According to GOLD and Spain's guidelines for the diagnosis and treatment of COPD, we screened ACOS patients in 299 elderly male patients with stable COPD by following up in Beijing Hospital between 2003 and 2014.All patients were divided into 2 groups of 51 ACOS patients and 248 non-ACOS patients with COPD.All patients underwent pulmonary function tests and bronchial dilation test in the stable condition.The differences in pulmonary functions were compared between stable ACOS patients and non-ACOS patients with COPD. Results Among 299 elderly male patients with stable COPD, ACOS patients accounted for 17.1%(51/299). Compared with non-ACOS patients with stable COPD, ACOS patients had significantly lower baseline values in forced expiratory volume in 1 seconds(FEV1)〔(61.0±14.5)% pred vs.(74.4±20.0)% pred〕, in forced expiratory volume in 3 seconds(FEV3) 〔(71.6±14.3)% pred vs.(82.7±19.6)% pred〕and in forced vital capacity(FVC) 〔(84.6±16.4)% pred vs.(93.8±20.6)% pred〕, and also had significantly higher values in residual volume(RV)〔(139.4±55.8)% pred vs.(118.8±46.6)% pred〕and in RV/total lung capacity(TLC)〔(52.7±10.7)% pred vs.(48.1±10.9)% pred〕, all P<0.05. After bronchodilation test, there was no significant difference in FEV1, FEV3 and FVC between the two groups(all P>0.05). Patients with stable ACOS had lower value in forced expiratory flow rat(FEF25%-75%)than those with non-ACOS in baseline 〔FEF25%-75%% pred(26.8±11.5)% vs.(36.1±17.5)%(P<0.05)〕, and the improvement of small airway function was significantly better in ACOS patients than in non-ACOS patients after bronchodilation test(P<0.05). Conclusions ACOS is very common in the elderly patients with COPD, stable ACOS patients have lower time vital capacity as compared with non-ACOS patients with stable COPD.But after bronchodilation test, the two groups have similar ventilation function, and the small airway function in ACOS patients improves more significantly.The ACOS patients have unique characteristics of pulmonary functions and suitable treatment may improve the prognosis. Key words: Asthma; Pulmonary disease, chronic obstructive; Respiratory function tests

The Lung Function Impairment in Non-Atopic Patients With Chronic Rhinosinusitis and Its Correlation Analysis.

Objectives Chronic rhinosinusitis (CRS) is common disease in otorhinolaryngology and will lead to lower airway abnormality. However, the only lung function in CRS patients and associated factors have not been much studied.Methods One hundred patients with CRS with nasal polyps (CRSwNP group), 40 patients with CRS without nasal polyps (CRSsNP group), and 100 patients without CRS were enrolled. The difference in lung function was compared. Meanwhile, CRSwNP and CRSsNP group were required to undergo a bronchial provocation or dilation test. Additionally, subjective and objective outcomes were measured by the visual analogue scale (VAS), 20-item Sino-Nasal Outcome Test (SNOT-20), Lund-Mackay score, Lund-Kennedy endoscopic score. The correlation and regression methods were used to analyze the relationship between their lung function and the above parameters.Results The forced expiratory volume in 1 second (FEV1) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) of CRSwNP group were significantly lower than other groups (P<0.05). On peak expiratory flow, there was no difference between three groups. In CRSwNP group, FEV1 was negatively correlated with peripheral blood eosinophil count (PBEC) and duration of disease (r=–0.348, P=0.013 and r=–0.344, P=0.014, respectively), FEF25-75 negatively with VAS, SNOT-20 (r=–0.490, P=0.028 and r=–0.478, P=0.033, respectively) in CRSsNP group. The incidence of positive bronchial provocation and dilation test was lower in CRSwNP group (10% and 0%, respectively), with both 0% in CRSsNP group. The multiple linear regression analysis indicated that change ratio of FEV1 before and after bronchial provocation or dilation test were correlated with PBEC in CRSwNP group (β=0.403, P=0.006).Conclusion CRS leading to impaired maximum ventilation and small airway is associated with the existence of nasal polyp. Lung function impairments can be reflected by PBEC, duration, VAS, and SNOT-20. In CRSwNP patients, PBEC is independent predictor of FEV1 change ratio.

Occupational asthma: an analysis of two cases

To investigate the incidence of occupational asthma induced by occupational exposure to detergents and spices. The occupational history, case data, and results of auxiliary examinations were collected from patients with asthma induced by occupational exposure to detergents and spices and submitted to the expert group for diagnosis of occupational diseases to obtain the diagnostic results. Both patients with asthma were exposed to asthmogenic substances in the working environment and developed the symptoms of asthma after a certain latency period. In case 1, the patient had positive results from bronchial dilation test and peak expiratory flow test; in case 2, the patient had positive results from allergen skin prick test for spices and essence and allergen bronchial provocation test. Therefore, the possibility of asthma induced by occupational factors could not be excluded. Occupational exposure to detergents and spices can induce occupational asthma.

Effects and significance of methacholine bronchial provocation tests and salbutamol bronchial dilation test on measurements of fractional exhaled nitric oxide in patients with asthma

To study the effects and significance of methacholine (Mch) bronchial provocation tests and salbutamol bronchial dilation test on measurements of fractional exhaled nitric oxide (FeNO) in patients with asthma. This was a prospective study conducted between November 2014 and August 2015. A total of 135 patients with asthma visiting the respiratory clinic of Zhujiang Hospital were enrolled. The patients received either Mch bronchial provocation test or salbutamol bronchial dilation test based on their FEV1/FVC values and cooperative degree. Mch bronchial provocation test was performed by using Astograph Jupiter-21 (Astograh group) or APS-Pro airway reaction testing apparatus (APS group), and salbutamol bronchial dilation test was performed by using Jaeger spirometer (Dilation group). We compared the differences between FeNO values measured before examinations (Pre-FeNO) and 5 min after completion of these examinations (Post-FeNO). The geometric mean of Pre-FeNO and Post-FeNO was 28.07 ppb and 24.08 ppb respectively in the Astograh group, with a significant decrease of the FeNO value after the examination (Z=-3.093, P=0.002). A significant difference between Pre-FeNO and Post-FeNO was found in patients who had positive provocation results in the Astograh group (Z=-2.787, P=0.005), but not in the patients with negative results (Z=-1.355, P=0.176). The geometric mean of FeNO in the APS group decreased significantly from 27.95 ppb to 23.15 ppb after the examination was completed (Z=-5.170, P=0.000); both in patients with positive saline or Mch provocation results and in patients with negative provocation results, the differences between Pre-FeNO and Post-FeNO in the APS group being significant (Z=-2.705, -3.709, -2.371, P=0.002, 0.000, 0.018). No difference of FeNO change(ΔFeNO) was observed between the 2 Mch bronchial provocation test groups (U<918.000, P=0.117). The geometric mean of Pre-FeNO was 36.74 ppb and that of Post-FeNO was 34.79 ppb in the Dilation group; the difference being not significant (Z=-1.281, P=0.200). Our results confirm that salbutamol bronchial dilation test has minor effect on the measurement of FeNO, but Mch bronchial provocation tests can significantly decrease measured FeNO value in patients with asthma, and therefore Post-FeNO values should be interpreted with caution.

Bronchodilator response in adults with bronchiectasis: correlation with clinical parameters and prognostic implications.

Bronchial dilation testing is an important tool to assess airway reversibility in adults with bronchiectasis. This study aims to investigate the association of bronchodilator response (BDR) and clinical parameters in bronchiectasis, and the utility of BDR to indicate lung function decline and risks of bronchiectasis exacerbations (BEs). We recruited 129 patients with clinically stable bronchiectasis. Baseline measurements included assessment of sputum inflammation and matrix metalloproteinase-8 and -9, sputum bacterial culture, spirometry, bronchial dilation test (for baseline FEV1 less than 80% predicted only) and chest high-resolution computed tomography (HRCT). Bronchiectasis patients were followed-up for 1 year to determine the incidence of BEs and lung function trajectories. Significant BDR was defined as FEV1 improvement from pre-dose value by at least 200 mL and 12%. Clinical trial registry No.: NCT01761214; URL: www.clinicaltrials.gov. BDR was negatively correlated with baseline FEV1 percentage predicted, but not blood or sputum eosinophil count. Significant BDR was not associated with greater proportion of never-smokers, poorer past history, greater HRCT scores, poorer diffusing capacity or increased sputum matrix metalloproteinases (all P>0.05). There was a trend towards higher bronchiectasis severity index (BSI) and greater proportion of patients with Pseudomonas aeruginosa isolation or infection. Significant BDR at baseline was linked to poorer spirometry, but not more rapid lung function decline, throughout follow-up. Patients with significant BDR demonstrated non-significantly lower risks of experiencing the first BEs than those without (P=0.09 for log-rank test). Significant BDR is associated with poorer lung function compared with non-significant BDR. Whether BDR predicts future risks of BEs needs to be tested in a larger cohort.

An epidemiology study of bronchial asthma in the Li ethnic group in China

Objective To investigate the prevalence and risk factors of bronchial asthma in the Li ethnic group in Hainan, China. Methods This study employed a stratified random sample design using custom-designed questionnaires. Subjects with asthma-like symptoms were first identified by two rounds of surveys and then confirmed by respiratory physicians using pulmonary function test, bronchial dilation test and challenge test. Demographic data, information on family history of asthma, history of allergies, smoking habits, domestic cooking fuel and other potential risk factors were collected. Logistic regression was performed to evaluate risk factors for asthma. Results The prevalence of asthma in the Li ethnic group was 3.38%, much higher than the national average level in China. Aging, agriculture industry (the rubber industry in particular), rural residence, family history of asthma, history of allergies, cold air, inhalation of dust and irritant gases, smoking, domestic cooking fuel and living environment were associated with increased risk of asthma. Conclusions The high prevalence of asthma in the Li ethnic group highlights the importance of asthma prevention and treatment in this population. Risk factors indentified in this study warrant special attention. Elevating public awareness about asthma in local communities will benefit the prevention of the disease.

Comparison of lung volume response with airflow response to bronchodilator in patients with chronic obstructive pulmonary disease

the reversibility of chronic obstructive pulmonary disease (COPD) is evaluated mainly by FEV(1) after bronchodilators. However, lung volumes also change significantly in COPD, but few studies addressed the characteristics of the changes in post bronchodilator airflow and lung volume in patients with COPD. This study was carried out to evaluate the difference of FEV(1) response and forced vital capacity (FVC) response to bronchodilators in patients with COPD as well as the impact of severity of COPD on the flow and volume reversibility. 465 patients with COPD (male 426, female 39), aged 67.1 +/- 8.3 (42 approximately 86) yrs were enrolled from Jan. 2006 to Aug. 2008. The severity of COPD was graded according to the GOLD criteria. The change and rate of change of FVC and FEV(1) 20 minutes after inhalation of salbutamol 400 microg via spacer were measured and compared. Positive response to the bronchodilator was determined as FEV(1) or FVC increased 12% as well as 200 ml or above. The impacts of severity on flow and volume response were also studied. post-bronchodilator FEV(1) increased 117 ml with a 13.2% improvement on average compared with baseline. Post-bronchodilator FVC increased 258 ml and improved by 14.0% on average. The rate of positive reversibility in FEV(1) and FVC was 18.7% (87/465) and 44.1% (205/465), respectively. The improvement of FEV(1) decreased as a function of the severity of COPD. In contrast, the improvement of FVC was increased in those with more severe disease. the improvement of lung volume is more significant and maybe more important than airflow response in patients with COPD, especially in those with severe disease. In addition to FEV(1), the reversibility of COPD should also be evaluated by FVC.