Change In FVC Research Articles

CLAD Phenotypes Determined by Change in Spirometric Index Associate with Quantitative Image Analyses

Purpose Accurate phenotypes of chronic lung allograft dysfunction (CLAD) are critical to study disease mechanisms and ensure homogenous populations for clinical trials, but the optimal classification method is unknown. A restrictive CLAD phenotype involves parenchymal disease similar to pulmonary fibrosis. The Center for Computer Vision and Imaging Biomarkers at UCLA has established CT based computer aided diagnosis (CAD) scores for pulmonary fibrosis. We applied CT CAD scores to CLAD and compared 2 previously described methods for CLAD classification. Methods The cohort includes 73 lung recipients; 44 no CLAD and 29 with a CT done within 90 days of CLAD onset. The FVC loss method defines restrictive-CLAD (RCLAD) as a ≥20% decline in FVC from baseline at CLAD onset. The spirometric change method uses relative change in FVC divided by relative change in FEV1 from baseline to CLAD onset, and a value >0.5 is classified as restrictive allograft syndrome (RAS). For both methods, when RCLAD or RAS is not established, the default is bronchiolitis obliterans syndrome (BOS). We compared the quantitative CT CAD scores for QLF (fibrosis), QGG (ground glass), and QILD (QLF + QGG), expressed as a percentage of total lung involvement at TLC, between CLAD phenotypes using Dunn's multiple comparisons tests. Results Of the 29 CLAD cases, 15 were classified as RCLAD and 19 as RAS. The classification methods agreed in 21 cases: 13 RCLAD/RAS and 8 BOS/BOS. The methods disagreed in 8 cases: 2 RCLAD/BOS and 6 BOS/RAS. RCLAD was not associated with differences in QLF, QGG, or QILD. However, RAS was associated with significantly increased QLF, QGG, and QILD scores as compared to BOS and to no CLAD (Figure). Conclusion The spirometric change method for CLAD phenotype classification is associated with radiographic parenchymal lung disease, suggesting it is a better method to distinguish CLAD phenotypes. Our study is limited by small sample size and we have not yet incorporated features of air trapping from RV series.

Predominant spirometric pattern in patients with chronic airflow obstruction due to pulmonary Tuberculosis sequelae

Objective: The objective of this study is to determine the predominant spirometric pattern in patients with chronic airflow obstruction (CAO) due to pulmonary tuberculosis (PTB) sequelae (CAO-PTB) in family health center of La Florida, Talca. Methods: Descriptive study of 17 patients (5 men, 12 women), with a mean age±SD of 72•8±8•4 years, with a CAO-PTB diagnostic, who underwent a basal and post bronchodilator spirometry. The measured variables were: basal and post bronchodilator FEV1/FVC, FEV1, FVC, FEF 25-75%, and change in FEV1 and FVC, measured in percentage and ml. The statistical analysis was made using the software SPSS, version 23. Results: Of the 17 evaluated patients, 13 showed an obstructive spirometric pattern (76•5%), 3 a normal spirometric pattern (17•6%) and 1 a restrictive spirometric pattern (5•9%). Of the 13 patients with obstructive spirometric pattern, 7 presented a normal FVC (53•9%), and 6 a diminished FVC (46•1%). Regarding the changes post bronchodilator, 6 patients showed significant changes (35•3%), which were all obstructive, and 11 patients had no significant changes (64•7%), being 7 obstructive, 3 normal, and 1 restrictive. Conclusion: The predominant spirometric pattern of the evaluated patients with CAO-PTB, in the family health center La Florida, Talca, was the obstructive with normal FVC, and no significant changes post bronchodilator were found.

The King’s Brief Interstitial Lung Disease (KBILD) questionnaire: an updated minimal clinically important difference

IntroductionThe King’s Brief Interstitial Lung Disease (KBILD) is a 15-item validated health-related quality of life (HRQOL) questionnaire. The method of scoring the KBILD has recently changed to incorporate a logit-scale...

Validation of the Serbian version of the Asthma Control Test

Background/Aim. Asthma still remains poorly controlled in the majority of patients. The Asthma Control Test (ACT) is a short and useful patient-administered questionnaire for identification of patients with poor asthma control in clinical settings. The aim of this study was to validate a Serbian version of the ACT in the adults with asthma. Methods. A total of 250 consecutive adult asthmatic patients were recruited in a prospective observational study. The exclusion criteria were chronic respiratory disease and acute respiratory tract infection in preceding 4 weeks. Results. The spirometry and ACT questionnaire were performed on the baseline visit and 6 months later. The ACT test was completed by 98.8% of patients with the mean time of completion of 4.5 minutes. The correlation of ACT score and lung function parameters (forced expiratory volume in 1 second ? FEV1 and forced vital capacity ? FVC) was significant (p = 0.016 and p = 0.002, respectively). A change in the ACT scores between baseline and 6- months visit was not associated with a change in FVC and FEV1. The ACT score had excellent diagnostic accuracy according to the physicians asthma control classification and even outstanding accuracy according to the patients? classification. Conclusion. The results of this study confirm the reliability, validity and accuracy of Serbian version of the ACT, contributing to established value of original ACT test and with consistent findings as the previously reported validity of ACT in other languages. Therefore, it should be utilized more in everyday clinical practice as a useful and reliable tool of asthma control assessment.

Serum AGE/RAGEs as potential biomarker in idiopathic pulmonary fibrosis

BackgroundThe soluble receptor for advanced glycation end-products (sRAGE) has been suggested that it acts as a decoy for capturing advanced glycation end-products (AGEs) and inhibits the activation of the oxidative stress and apoptotic pathways. Lung AGEs/sRAGE is increased in idiopathic pulmonary fibrosis (IPF). The objective of the study was to evaluate the AGEs and sRAGE levels in serum as a potential biomarker in IPF.MethodsSerum samples were collected from adult patients: 62 IPF, 22 chronic hypersensitivity pneumonitis (cHP), 20 fibrotic non-specific interstitial pneumonia (fNSIP); and 12 healthy controls. In addition, 23 IPF patients were re-evaluated after 3-year follow-up period. Epidemiological and clinical features were recorded: age, sex, smoking habits, and lung function. AGEs and sRAGE were evaluated by ELISA, and the results were correlated with pulmonary functional test values.ResultsIPF and cHP groups presented a significant increase of AGE/sRAGE serum concentration compared with fNSIP patients. Moreover, an inverse correlation between AGEs and sRAGE levels were found in IPF, and serum sRAGE at diagnosis correlated with FVC and DLCO values. Additionally, changes in serum AGEs and sRAGE correlated with % change of FVC, DLCO and TLC during the follow-up. sRAGE levels below 428.25 pg/ml evolved poor survival rates.ConclusionsThese findings demonstrate that the increase of AGE/sRAGE ratio is higher in IPF, although the levels were close to cHP. AGE/sRAGE increase correlates with respiratory functional progression. Furthermore, the concentration of sRAGE in blood stream at diagnosis and follow-up could be considered as a potential prognostic biomarker.

Quantitative CT analysis using functional imaging is superior in describing disease progression in idiopathic pulmonary fibrosis compared to forced vital capacity

BackgroundIdiopathic pulmonary fibrosis (IPF) is chronic fibrosing pneumonia with an unpredictable natural disease history. Functional respiratory imaging (FRI) has potential to better characterize this disease. The aim of this study was to identify FRI parameters, which predict FVC decline in patients with IPF.MethodsAn IPF-cohort (treated with pamrevlumab for 48 weeks) was retrospectively studied using FRI. Serial CT’s were compared from 66 subjects. Post-hoc analysis was performed using FRI, FVC and mixed effects models.ResultsLung volumes, determined by FRI, correlated with FVC (lower lung volumes with lower FVC) (R2 = 0.61, p < 0.001). A negative correlation was observed between specific image based airway radius (siRADaw) at total lung capacity (TLC) and FVC (R2 = 0.18, p < 0.001). Changes in FVC correlated significantly with changes in lung volumes (R2 = 0.18, p < 0.001) and siRADaw (R2 = 0.15, p = 0.002) at week 24 and 48, with siRADaw being more sensitive to change than FVC. Loss in lobe volumes (R2 = 0.33, p < 0.001), increasing fibrotic tissue (R2 = 0.33, p < 0.001) and airway radius (R2 = 0.28, p < 0.001) at TLC correlated with changes in FVC but these changes already occur in the lower lobes when FVC is still considered normal.ConclusionThis study indicates that FRI is a superior tool than FVC in capturing of early and clinically relevant, disease progression in a regional manner.

Mycophenolate therapy in interstitial pneumonia with autoimmune features: a cohort study.

ObjectivesInternational experts recently characterized interstitial pneumonia with autoimmune features (IPAF) as a provisional diagnosis for patients with interstitial lung disease who have characteristics of autoimmune disease but do not meet criteria for a specific autoimmune disease. We describe clinical characteristics of IPAF patients and examine responses to mycophenolate as a therapy for IPAF.MethodsThis retrospective cohort included adult patients meeting European Respiratory Society/American Thoracic Society classification criteria for IPAF. Sociodemographic, clinical, and pulmonary function test data were abstracted for patients with and without mycophenolate treatment and followed longitudinally from interstitial lung disease diagnosis for change in pulmonary function test results.ResultsWe identified 52 patients who met criteria for IPAF. Of 52 IPAF patients, 24 did not receive mycophenolate and 28 did, with median time to mycophenolate treatment 22 months. Changes in FVC% and percentage predicted lung diffusion capacity for carbon monoxide (DLCO%) between the mycophenolate-treated and untreated groups were not significantly different (FVC% change P=0.08, DLCO% change P=0.17). However, there was a trend toward more rapid baseline decline of both FVC% and DLCO% in the mycophenolate-treated cohort before vs after mycophenolate therapy. The slope of both FVC% and DLCO% values improved after onset of mycophenolate exposure for the treated group, although this finding was not statistically significant.ConclusionPatients with IPAF might benefit from mycophenolate therapy. Larger prospective clinical trials are needed to evaluate the efficacy of mycophenolate for patients who meet criteria for IPAF.

Randomized, Double-Blind, Placebo-Controlled, Phase 2 Trial of BMS-986020, a Lysophosphatidic Acid Receptor Antagonist for the Treatment of Idiopathic Pulmonary Fibrosis

Idiopathic pulmonary fibrosis (IPF) causes irreversible loss of lung function. The lysophosphatidic acid receptor 1 (LPA1) pathway is implicated in IPF etiology. Safety and efficacy of BMS-986020, a high-affinity LPA1 antagonist, was assessed vsplacebo in a phase 2 study in patients with IPF. IM136003 was a phase 2, parallel-arm, multicenter, randomized, double-blind, placebo-controlled trial. Adults with IPF (FVC, 45%-90%; diffusing capacity for carbon monoxide, 30%-80%) were randomized to receive placebo or 600mg BMS-986020 (once daily [qd] or bid) for 26weeks. The primary end point was rate of change in FVC from baseline to week26. Of 143 randomized patients, 108 completed the 26-week dosing phase. Thirty-five patients discontinued prematurely. Patient baseline characteristics were similar between treatment groups (placebo: n= 47; 600mg qd: n= 48; 600mg bid: n= 48). Patients treated with BMS-986020 bid experienced a significantly slower rate of decline in FVC vsplacebo (-0.042 L; 95%CI,-0.106 to-0.022 vs-0.134 L; 95%CI,-0.201 to-0.068, respectively; P= .049). Dose-related elevations in hepatic enzymes were observed in both BMS-986020 treatment groups. The study was terminated early because of three cases of cholecystitis that were determined to be related to BMS-986020 after unblinding. BMS-986020 600mg bid treatment for 26weeks vsplacebo significantly slowed the rate of FVC decline. Both regimens of BMS-986020 were associated with elevations in hepatic enzymes. ClinicalTrials.gov; No.: NCT01766817; URL: www.clinicaltrials.gov.

DMD CLINICAL THERAPIES II: P.125Eteplirsen treatment attenuates respiratory decline in ambulatory and non-ambulatory patients with Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) patients experience progressive degeneration of skeletal muscles including those involved in respiration. Well characterized respiratory decline in glucocorticoid-treated DMD patients includes forced vital capacity % predicted (FVC%p) decline ≥5% per year between the ages of 10 and 18 years. We evaluated eteplirsen treatment effect on FVC%p annual change in three eteplirsen clinical trials compared to well-matched natural history controls from the Cooperative International Neuromuscular Research Group (CINRG). Age-based mixed model analyses were conducted to determine FVC%p annual change (slope) for eteplirsen-treated patients and CINRG controls. Patients in the CINRG control (n=20) were amenable to exon 51 skipping, on glucocorticoids, and had FVC%p assessments between the ages of 10 and 18 years. Patients in the eteplirsen clinical trials (n=74) were amenable to exon 51 skipping, on glucocorticoids, and only FVC%p assessments between the ages of 10 to 18 years were included in the analysis. Study 201/202 was conducted over 216 weeks and enrolled ambulatory patients. Study 204 was conducted over 96 weeks and enrolled primarily non-ambulatory patients. Study 301 is an ongoing study which enrolled ambulatory patients; an interim week 96 analysis is presented. In Study 201/202 the annual change in FVC%p in (n=12) eteplirsen-treated patients was -2.19% compared to -6.00% in CINRG controls (p<0.001). In study 204 annual change in FVC%p in (n=20) eteplirsen-treated patients was -3.66% compared to -6.00% in CINRG controls (p=0.004). In an interim analysis of Study 301 annual change in FVC%p in (n=46) eteplirsen-treated patients was -3.79% compared to -6.00% in CINRG controls (p=0.017). Significant and clinically meaningful attenuation of FVC%p decline was seen in eteplirsen-treated patients compared to CINRG controls across three clinical trials in both ambulatory and non-ambulatory DMD patients.

Prolonged treatment with open-label pirfenidone in Hermansky-Pudlak syndrome pulmonary fibrosis

PurposeLimited information is available regarding chronic treatment with pirfenidone, an anti-fibrotic drug. Effects of long-term open-label pirfenidone were evaluated in a small cohort with Hermansky-Pudlak syndrome (HPS), a rare autosomal recessive disorder with highly penetrant pulmonary fibrosis. ResultsThree patients with HPS pulmonary fibrosis treated with open-label pirfenidone and twenty-one historical controls randomized to placebo were studied at a single center. Mean duration of treatment with pirfenidone for 3 patients with HPS pulmonary fibrosis was 13.1 years. Annual changes in FVC and DLCO with pirfenidone treatment were 0.46 and − 0.93% predicted, respectively. In comparison, historical controls randomized to receive placebo experienced mean annual changes in FVC and DLCO of −4.4 and − 2.3% predicted, respectively. High-resolution computed tomography (HRCT) scans revealed improved ground glass opacities with development of minimal interstitial reticulations in 1 patient after 12.8 years of treatment with pirfenidone. Slowly progressive increase in bilateral interstitial fibrosis developed in a different patient, who received pirfenidone for 18.1 years and died at 73 years of age due to HPS pulmonary fibrosis. Another patient treated with pirfenidone for 8.4 years had attenuated ground glass opacification on HRCT scan and improved oxygenation; this patient died due to chronic complications from colitis, and not pulmonary fibrosis. Adverse effects were generally limited to mild gastrointestinal discomfort and transient elevations of alanine aminotransferase in one patient. ConclusionsChronic treatment with pirfenidone may provide clinical benefit with few adverse effects for some patients with HPS pulmonary fibrosis. These results suggest that compassionate use of pirfenidone could be considered on a case-by-case basis for patients with HPS pulmonary fibrosis.

KL-6 But Not CCL-18 Is a Predictor of Early Progression in Systemic Sclerosis-related Interstitial Lung Disease.

The 2 pneumoproteins, KL-6 and CCL-18, are promising biomarkers in systemic sclerosis (SSc)-related interstitial lung disease (ILD). Our goal was to determine their predictive significance for forced vital capacity % (FVC%) decline within the first year of followup in patients with early SSc-ILD. Early SSc patients with imaging-verified ILD enrolled in the Genetics versus Environment in Scleroderma Outcome Study (GENISOS) cohort were included. Annualized rate of change in FVC% based on the baseline and followup measurement within 12-18 months was used as the surrogate outcomes for ILD progression. Eighty-two early SSc-ILD patients with mean disease duration of 2.3 years were investigated. FVC% change ranged from -23% to 38%. Baseline KL-6 levels were higher in patients than healthy controls (p < 0.0001). Higher KL-6 levels were predictive of faster FVC% decline at the 1-year followup (r = -0.23, p = 0.037). Upon categorizing KL-6 using a previously published cutoff of 1273 U/ml, its predictive significance remained in the univariable model (b = -0.07, p = 0.01), indicating that patients with positive KL-6 had on average 7% more decline in annualized percent change of FVC%. Moreover, KL-6 remained an independent predictor after adjustment for sex, disease type, anti-Scl-70, and immunosuppressive treatment status in multivariable models. Although CCL-18 was higher in patients than controls (p < 0.001), its levels did not predict FVC decline rate (p = 0.458). KL-6 but not CCL-18 is predictive of early SSc-ILD progression. KL-6 is a promising pneumoprotein that can contribute to SSc-ILD clinical trial enrichment.

Influence of Idiopathic Pulmonary Fibrosis Progression on Healthcare Resource Use.

BackgroundDisease progression and acute exacerbations in patients with idiopathic pulmonary fibrosis (IPF) are associated with high morbidity and mortality. They usually require a visit to a specialist or a general practitioner (GP) in less severe cases or hospitalisation in more severe cases.ObjectiveThe objective of this study was to identify factors that influence resource use in IPF.MethodsClinical and healthcare resource use data were collected in two large, international, multi-centre, randomised controlled trials (RCTs) that studied nintedanib for the treatment of IPF (INPULSIS-1 and -2). The pooled data of nintedanib and placebo included 1014 patients followed for 12 months. The trial data were analysed in 3-month intervals. We studied two dependent variables: the occurrence of all-cause hospitalisation and visits to a physician (GP or specialist). The independent variables included the change in forced vital capacity percent predicted (FVC%pred), investigator-reported acute exacerbation events, age, time since diagnosis, smoking status, and sex.ResultsHospitalisation during a 3-month interval was significantly associated with a drop of at least 5 or 10 points in FVC%pred (odds ratios [ORs] 1.58 [p = 0.009] and 2.62 [p < 0.001]) and associated with the occurrence of at least one acute exacerbation (OR 14.44; p < 0.001) during the same interval. The above factors remained significant when repeating the analysis for hospitalisation based on change in FVC%pred or events occurring during the previous 3 months interval. Smoker status and a unit change in FVC%pred during the previous interval were added to the significant factors. Physician visits during a 3-month interval were significantly associated with a lower FVC%pred at the start of the interval (per 10-point decrement, OR 1.05; p = 0.040) and with the change in FVC%pred during the same interval (per 10-point loss, OR 1.13; p = 0.042). Visits were also associated with a 5-point drop in FVC%pred (OR 1.23; p = 0.020), age (per 5-year increments OR 1.07; p = 0.028), and female sex (OR 1.32; p = 0.017). Nevertheless, the predictive power of the models was considered poor for both outcomes (hospitalisation and physician visits).ConclusionsDisease progression and acute exacerbation events are significantly associated with hospitalisation of patients with IPF. Outpatient visits to physicians are associated with disease progression, baseline FVC%pred, age and sex.

Variation in lung function and alterations in cardiac structure and function-Analysis of the UK Biobank cardiovascular magnetic resonance imaging substudy.

BackgroundReduced lung function is common and associated with increased cardiovascular morbidity and mortality, even in asymptomatic individuals without diagnosed respiratory disease. Previous studies have identified relationships between lung function and cardiovascular structure in individuals with pulmonary disease, but the relationships in those free from diagnosed cardiorespiratory disease have not been fully explored.MethodsUK Biobank is a prospective cohort study of community participants in the United Kingdom. Individuals self-reported demographics and co-morbidities, and a subset underwent cardiovascular magnetic resonance (CMR) imaging and spirometry. CMR images were analysed to derive ventricular volumes and mass. The relationships between CMR-derived measures and spirometry and age were modelled with multivariable linear regression, taking account of the effects of possible confounders.ResultsData were available for 4,975 individuals, and after exclusion of those with pre-existing cardiorespiratory disease and unacceptable spirometry, 1,406 were included in the analyses. In fully-adjusted multivariable linear models lower FEV1 and FVC were associated with smaller left ventricular end-diastolic (−5.21ml per standard deviation (SD) change in FEV1, −5.69ml per SD change in FVC), end-systolic (−2.34ml, −2.56ml) and stroke volumes (−2.85ml, −3.11ml); right ventricular end-diastolic (−5.62ml, −5.84ml), end-systolic (−2.47ml, −2.46ml) and stroke volumes (−3.13ml, −3.36ml); and with lower left ventricular mass (−2.29g, −2.46g). Changes of comparable magnitude and direction were observed per decade increase in age.ConclusionsThis study shows that reduced FEV1 and FVC are associated with smaller ventricular volumes and reduced ventricular mass. The changes seen per standard deviation change in FEV1 and FVC are comparable to one decade of ageing.

Air Pollution Exposure Is Associated With Lower Lung Function, but Not Changes in Lung Function, in Patients With Idiopathic Pulmonary Fibrosis

Air pollution exposure is associated with acute exacerbation, disease progression, and mortality in patients with idiopathic pulmonary fibrosis (IPF). The objective of this study was to describe the impact of air pollution exposures on disease severity, as well as changes in lung function, in patients with IPF. Using home spirometers and symptom diaries, 25 patients with IPF prospectively recorded FVC weekly for up to 40weeks. Residential addresses were geocoded to estimate weekly mean air pollution exposures for ground-level ozone (O3), nitrogen dioxide (NO2), and particulate matter< 2.5 or 10 μm in aerodynamic diameter (PM2.5 and PM10, respectively). The dependence of weekly clinical measurements on preceding levels of each pollutant was assessed with the use of linear mixed models, yielding beta-coefficients with 95%CIs, using varying lag times. Lower mean FVC %predicted was consistently associated with increased mean exposures to PM10 in the 2 to 5weeks preceding clinical measurements (range, -0.46 to -0.39 [95%CI, -0.73 to -0.13]; P< .005). Lower mean FVC %predicted over the study period was inversely related to mean levels of NO2 (-0.45 [95%CI, -0.85 to -0.05]; P= .03), PM2.5 (-0.45 [95%CI, -0.84 to -0.07]; P= .02), and PM10 (-0.57 [95%CI, -0.92 to -0.21]; P=.003), averaged over the study. Weekly changes in FVC and changes over 40weeks were independent of pollution exposures. Higher air pollution exposures were associated with lower lung function, but not changes in lung function, in patients with IPF. Further studies are needed to characterize the mechanisms underlying this relationship.

Assessment of FVC, FEV1, FEV1/FVC% of Adult Smokers and Compare with that of Nonsmokers

Smoking is most common in Libya state, where about two thirds of all adults Smoke tobacco; cigarette smoking is by far the most common. SHby far the most common. Smoking is the primary cause of chronic obstructive lung disease, chronic bronchitis and piratory symptoms. Many studies have shown a nificant change of FVC, FEVI &amp; FEV1/FVC% in adult smokers. Obje kers. Objective: To assess the change of FVC, FE &amp; FEV1/FVC% in adult male smokers. Method: This cross-sectiond: This cross-sectional comparative study was carried out the Department of Physiology, Medical faculty, Benghazi and Chelty, Benghazi and Chest clinic Benghazi Medical center (BMC), 1 February 2012 orary, 2017 to 30th August, 2017. For this purpose. 90 adult male subjects ranging from 18 to 52 years 4. The subjects were divided into two groups - A and B. Group A consisted of 30 apparently healthy adult male non-smokers. Group B consisted of 60 apparently healthy adult ently healthy adult male smokers. The experimento group was again subdivided into group B1 consisting of 20 smokers consuming consuming 2-10 cigarettes/day for more than 5 years, group B2 consisting of 20 smokers cons, group B2 consisting of 20 smokers consuming 11-20 cigarettes/ day for more than 5 years an sroup B3 consisting of 20 smokers consuming &gt;20 cigarettes/day for more the dove for more than 5 years. Analysis of data wae one with the help of com With the help of computers by SPSS 16,0 programmers and significant tests were done by unpaired student's "t" test. Results: There were no statistically significant an there were no statistically significant differences of PVC, FEV1 in group A vs. Rroun R group B2 vs. group B3. The mean FVC, FEV1 were significantly lower (&lt;0.05) in group A vs. group B, group A vs. group B2, group A vs. group B3, group B1 vs. group B2 &amp; group Bl vs. group B3. There were no statistical significant differences of&#x0D; can't differences of FEV1/ FVC% among different groups. Conclusion: From the statistical analysis of the results obtained in the present study and their comparison with those of published reports, it may be concluded that smoking causes significant change of PVC FEV1 among the smokers and no significant chanen of FEV1/FVC% who consumed more than 10 cigarettes per day for more than five years.

Predictors of asthma-chronic obstructive pulmonary disease overlap syndrome in patients with chronic obstructive pulmonary disease from a tertiary care center in India.

Background:There is dearth of literature on asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) in India. The aim was to compare clinical characteristics between patients with ACOS and non-ACOS COPD and to identify clinical predictors of ACOS in patients with COPD.Methods:We conducted a retrospective study by reviewing data collected from patients performing spirometry at our hospital. Those with postbronchodilator FEV1/FVC <70% were included in the study. Among them, those with significant reversibility (change in FEV1 or FVC by 12% and 200 ml postbronchodilator) were diagnosed with ACOS and the rest were considered to have non-ACOS COPD. Data on the 2 groups were compared and statistical analysis was performed.Results:Out of a total of 324 patients, 100 of them had postbronchodilator FEV1/FVC <70%. Of them, 45 and 55 were diagnosed with ACOS and non-ACOS COPD, respectively. Patients with ACOS had significantly higher postbronchodilator FVC volumes and FVC % predicted values (P < 0.05), had higher reported wheeze (P = 0.02) and ankle edema (P < 0.05), were more likely to be smokers (P = 0.01) with lower smoking index (P = 0.03), and had frequent (≥2) ER visits (P = 0.04). However, very frequent (≥3 per year) hospital admissions (P < 0.01) with higher rates of invasive mechanical ventilation (P = 0.02), and pulmonary hypertension diagnosed by two-dimensional echocardiography (P < 0.01) were significantly higher in the non-ACOS group. The two groups did not differ with respect to history of atopy, family history of wheeze, compliance to inhaler therapy, or blood absolute eosinophil counts.Conclusion:Our study highlights how the ACOS phenotype may clinically differ from their counterparts elsewhere, making it a clinical challenge to identify them in India.

Effect of Education on Asthma Control in Children: A Quasi- Experimental Study

Introduction: The prevalence of asthma has increased significantly in recent decades1 especially in lower socioeconomic groups and in minority populations. Because of the increasing prevalence of asthma among children in worldwide and Iran, the importance of timely control of the disease after its diagnosis and few studies on the effect of education on asthma control in Iran, the aim of this study was to investigate the effect of education on asthma control in children. Methods: In this quasi-experimental study, 104 Iranian children (6-14 years old) with asthma referred to asthma and allergy clinic of Children's Medical Center in Tehran were studied via convenience sampling method. Recruitment was occurred between 2011 to 2014. Subjects randomly were divided into two equal groups of intervention and control. For intervention group, common education as well as special education in format of booklet, pamphlets, CD and group training sessions were applied every two weeks within the first two months of follow up and every two months then after. While, the control group received usual careResults: The means of FEV1/ FVC change, frequency of admission to the ED, hospitalization and absence from school and use of steroids were significantly different before and after education in the intervention group. While changes among measured parameters in the control group were not significantly different.Conclusion: The results of this study showed that specific education has significant helpful effect on asthma attack control in children.

Everolimus as a Calcineurin Inhibitor-Sparing Immunosuppressive Agent in Lung Transplant Recipients With Renal Impairment

SESSION TITLE: Transplant SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Calcineurin inhibitors (CNI) are considered a key component of maintenance immunosuppression following lung transplantation. However, CNI nephrotoxicity is a common and serious problem amongst lung transplant recipients. Everolimus (ERL), an inhibitor of the mechanistic target of rapamycin (mTOR), has been used as a CNI sparing immunosuppressive agent to allow renal recovery in patients with progressive renal impairment. Nevertheless, there is limited evidence to support the efficacy of this strategy to prevent rejection. This study aimed to evaluate the effect of ERL on renal and lung function in lung transplant recipients. METHODS: We conducted a retrospective analysis within a state-wide lung transplant service in Australia. Medical and pharmacy records were used to identify lung transplant recipients who were commenced on ERL from 2004 to 2015. Patients who received at least 6 consecutive months of ERL therapy during this period were included in the analysis. We recorded renal function and lung function 6 months before and 6 months after the initiation of ERL. Creatinine clearance (CrCl), derived from the Cockroft-Gault equation, was used as a measure of renal function. Lung function was reported as the percent predicted FEV1 and FVC. RESULTS: 44 patients were included in the analysis. The mean age was 49 ± 15 years. ERL was initiated at a median of 476 days (interquartile range 219-1247) post-transplant. The indication for ERL was renal impairment in 94%, malignancy in 4% and CNI related neurotoxicity in 2% of patients. After initiating ERL, 46% of patients had CNI ceased and the rest had a substantial dose reduction. At ERL initiation, mean CrCl was 52.6 ± 3.3 ml/min, mean percent predicted FEV1 70 ± 3% and FVC 77 ± 3%. In the 6 months prior to commencing ERL, there was a mean change in CrCl of -8.9 ± 2.4 ml/min (P=0.003), FEV1 -3.4 ± 1.9% (p=0.696), and FVC -1.2 ± 1.5% (p=1.000). 6 months after initiating ERL, the mean change in CrCl was +11.2 ± 2.4 ml/min (p<0.0001), FEV1 -5.3 ± 1.7% (p=0.024), and FVC -3.9 ± 1.4% (p=0.049). Excluded from the analysis were 8 patients who were on ERL for less than 6 months. 6 patients had ERL ceased; 2 for rejection, 2 for suspected pneumonitis, 1 for drug intolerance and 1 to aid wound healing after a motor vehicle accident. There were 2 deaths during this period; one due to chest sepsis and the other from liver failure, neither of which could be directly related to toxicity from ERL. These 8 patients received ERL for at least 3 months and were included in a 3-months analysis. At 3 months, there was a similar increase in CrCl of +11.6 ± 2.3 ml/min (p<0.0001) and no significant change in FEV1 and FVC. CONCLUSIONS: In lung transplant recipients with renal impairment, the use of ERL as a CNI sparing agent is associated with improvement in renal function. However, the efficacy of this maintenance immunosuppression strategy in preventing rejection requires elucidation with further studies. CLINICAL IMPLICATIONS: The use of ERL allows CNI withdrawal and renal recovery in lung transplant recipients with renal impairment. These patients should be closely followed up with frequent monitoring of lung function. DISCLOSURE: The following authors have nothing to disclose: Shaun Yo, Tim Coughlan, Steve Ivulich, Eldho Paul, Gregory Snell, Solomon Menahem No Product/Research Disclosure Information

Evidence of a greater functional sympatholysis in habitually aerobic trained postmenopausal women.

Habitual aerobic exercise attenuates elevated vasoconstriction during acute exercise (functional sympatholysis) in older men; however, this effect remains unknown in postmenopausal women (PMW). This study tested the hypothesis that PMW who participate in habitual aerobic exercise demonstrate a greater functional sympatholysis compared with their untrained counterparts. Nineteen PMW (untrained n = 9 vs. trained n = 10) performed 5 min of steady-state (SS) forearm exercise at relative [10% and 20% of maximum voluntary contraction (MVC)] and absolute (5 kg) contraction intensities. Lower-body negative pressure (LBNP) was used to increase sympathetic vasoconstriction during rest and forearm exercise. Brachial artery diameter and blood velocities (via Doppler ultrasound) determined forearm blood flow (FBF; ml/min). Forearm muscle oxygen consumption ([Formula: see text]; ml/min) and arteriovenous oxygen difference (a-vO2diff) were estimated during SS-exercise and SS-exercise with LBNP. Forearm vascular conductance (FVC; ml·min-1·100 mmHg-1) was calculated from FBF and mean arterial pressure (MAP; mmHg). Vasoconstrictor responsiveness was determined as the %change in FVC during LBNP. The reduction in FVC (% change FVC) during LBNP was lower in trained compared with untrained PMW at 10% MVC (-7.3 ± 1.2% vs. -13.0 ± 1.1%; P < 0.05), 20% MVC (-4.4 ± 0.8% vs. -8.6 ± 1.4%; P < 0.05), and 5 kg (-5.3 ± 0.8% vs. -8.9 ± 1.4%; P < 0.05) conditions, whereas there were no differences at rest (-32.7 ± 4.4% vs. -33.7 ± 4.0%). Peripheral (FVC, FBF, and [Formula: see text]) and the magnitude change in systemic hemodynamics (heart rate and MAP) did not differ between groups during exercise. Collectively, the findings present the first evidence suggesting that PMW who participate in aerobic exercise demonstrate a greater functional sympatholysis compared with untrained PMW during mild to moderate forearm exercise. NEW & NOTEWORTHY Habitual aerobic exercise attenuates the elevated sympathetic nervous system-induced vasoconstriction during an acute bout of exercise (improved functional sympatholysis) in aging men; however, this effect remains unknown in postmenopausal women (PMW). The novel findings of this study suggest that habitual aerobic exercise results in an enhanced functional sympatholysis in PMW. Conversely, habitual aerobic exercise does not alter blood flow and oxygen utilization during acute forearm exercise compared with PMW who do not habitually exercise.

Results of quantitative chest-CT in chronic pulmonary graft-vs.-host disease (cGvHD) 3 years after allogeneic stem cell transplantation.

To quantify lung parenchymal changes in symptomatic patients with chronic pulmonary graft-versus-host disease 3 years after allogeneic stem cell transplantation (allo-SCT) by means of CT-densitometry (CTD) and to compare results with those of established pulmonary function tests (PFT). The study group consisted of 26 patients with pulmonary cGvHD (19 males, 7 females; mean age, 49.29±15.89; range, 19-72 years). The diagnosis was based on clinical symptoms, PFT and chest-CT findings. CTD and PFT were performed both in the pre- and post-transplantation setting and results compared with each other. CT scans were obtained during suspended deep inspiration including the whole lungs. The mean lung attenuation (MLD), low attenuation values (LAV) and distribution of focal parenchymal abnormalities compatible with emphysema (HU <-950) were quantitatively calculated with histograms and graphics. On PFT, total lung capacity (TLC), residual volume (RV), vital capacity (VC), forced expiratory volume in 1 s (FEV1s) and diffusion capacity for carbon monoxide (DLCOSB) were registered. Changes in end-inspiratory lung volume and density (MLD and LAV) in symptomatic cGvHD patients in mean three years after allo-SCT proved all not significant, but there was a clear trend towards an increase in lung volume and a decrease in lung attenuation. These results were similar throughout all classes of bronchiolitis obliterans (BO) by cGvHD. PFT showed a significant decrease in VC, FEV1s but only a minimal decrease in DLCOSB. Changes in FVC after stem cell transplantation correlated with changes in LAV (r=0.649, P=0.031). Predicted VC correlated with changes in LAV (r=0.771, P=0.005). There was a correlation between the absolute difference of FEV1 and DLCOSB (r=0.64, P=0.14) before and after stem cell transplantation. End-inspiratory phase CT lung parenchyma quantification in symptomatic patients with pulmonary cGvHD 3 years after allo-SCT shows discrete changes over the pre-transplantation setting representing airway obstruction, mirroring airflow limitation on PFT. Its use enables exclusion of relevant parenchymal destruction (emphysema-equivalent lung density) at this time.