Clinical Pulmonary Function Tests Research Articles

A case-control study on asthma and obese patients: Influence of lifestyle patterns, serum trace elements, heavy metals, and total antioxidants

Background and aimAsthma is a chronic airway hyperresponsiveness disorder and Obese people have greater rates of asthma incidence and prevalence. Obesity, a complex condition, can cause nutritional metabolic problems that change trace elements and minerals. Trace element and antioxidant levels affect asthma aetiology. In this study, we aim to determine the serum levels of trace elements Zn, Fe, Cu, Mg, Co, Ni, Pb, Cd, and Cr, total antioxidants (TAS), and lifestyle that determine specific clinical conditions in asthma and obesity patients from Vellore City (Tamil Nadu, India). MethodsA case-control study to determine the level of the serum trace elements with 838 subjects (n = 242 asthma patients, n = 140 asthmatic obese, n = 185 obese patients, and n = 271 controls) between the ages of 20 and 60 years was carried out. Asthma was diagnosed based on the clinical examination and pulmonary function tests. Trace element levels were determined by atomic absorption spectrophotometry (AAS) in serum, and a DPPH-free radical scavenging assay was used to determine the total antioxidant capacity level in serum. ResultIn asthma male patients, serum levels of Zn, Fe, Cu, Mg, and TAS were significantly lower and Pb, Cd, and Cr significantly higher, whereas in female asthma patients, serum levels of Zn, Fe, Mg, and TAS were significantly lower and Pb significantly higher. In asthmatic obese male patients, Fe, Cu, and TAS were significantly lower, and Pb, Cd, and Co were significantly higher; in asthmatic obese female patients, Zn, Fe, Cu, Mg, and TAS were significantly lower, and Ni was significantly higher. In obese male patients, Zn, Fe, Cu, and TAS were significantly lower and Cd was significantly higher, and in obese female patients, Zn, Fe, Cu, Mg, and TAS were significantly lower. ConclusionThe influence of the level of trace elements, heavy metal, total antioxidant, and the lifestyle patterns, may increase the risk of asthma and obesity.

METTL3 mediates SOX5 m6A methylation in bronchial epithelial cells to attenuate Th2 cell differentiation in T2 asthma

ObjectiveAsthma, a chronic inflammatory disease in which type 2 T helper cells (Th2) play a causative role in the development of T2 asthma. N6-methyladenosine (m6A) modification, an mRNA modification, and methyltransferase-like 3 (METTL3) is involved in the development of T2 asthma by inhibiting Th2 cell differentiation. Sex determining region Y-box protein 5 (SOX5) is involved in regulating T cell differentiation, but its role in T2 asthma was unclear. The objective of this study was to explore the role of METTL3 and SOX5 in T2 asthma and whether there is an interaction between the two. Materials and methodsAdults diagnosed with T2 asthma (n = 14) underwent clinical information collection and pulmonary function tests. In vivo and in vitro T2 asthma models were established using female C57BL/6 mice and human bronchial epithelial cells (HBE). The expressions of METTL3 and SOX5 were detected by Western blot and qRT-PCR and Western blot. Th2 cell differentiation was determined by flow cytometry and IL-4 level was detected by ELISA. m6A methylation level was determined by m6A quantitative assay. The relationship between METTL3 expression and clinical parameters was determined by Spearman rank correlation analysis. The function of METTL3 and SOX5 genes in asthma was investigated in vitro and in vivo. The RNA immunoprecipitation assay detected the specific interaction between METTL3 and SOX5. ResultsPatients with T2 asthma displayed lower METTL3 levels compared to healthy controls. Within this group, a negative correlation was observed between METTL3 and Th2 cells, while a positive correlation was noted between METTL3 and clinical parameters as well as Th1 cells. In both in vitro and in vivo models representing T2 asthma, METTL3 levels decreased significantly, while SOX5 levels showed the opposite trend. Overexpression of METTL3 gene in HBE cells significantly inhibited Th2 cell differentiation and increased m6A methylation activity. From a mechanism perspective, low METTL3 negatively regulates SOX5 expression through m6A modification dependence, while high SOX5 expression is positively associated with T2 asthma severity. Cell transfection experiments confirmed that METTL3 regulates Th2 cell differentiation and IL-4 release through SOX5. ConclusionsOverall, our results indicate that METTL3 alleviates Th2 cell differentiation in T2 asthma by modulating the m6A methylation activity of SOX5 in bronchial epithelial cells. This mechanism could potentially serve as a target for the prevention and management of T2 asthma.

Markers of Inflammation, Tissue Damage, and Fibrosis in Individuals Diagnosed with Human Immunodeficiency Virus and Pneumonia: A Cohort Study.

Previous studies have noted that persons living with human immunodeficiency virus (HIV) experience persistent lung dysfunction after an episode of community-acquired pneumonia (CAP), although the underlying mechanisms remain unclear. We hypothesized that inflammation during pneumonia triggers increased tissue damage and accelerated pulmonary fibrosis, resulting in a gradual loss of lung function. We carried out a prospective cohort study of people diagnosed with CAP and/or HIV between 2016 and 2018 in three clinical institutions in Medellín, Colombia. Clinical data, blood samples, and pulmonary function tests (PFTs) were collected at baseline. Forty-one patients were included, divided into two groups: HIV and CAP (n = 17) and HIV alone (n = 24). We compared the concentrations of 17 molecules and PFT values between the groups. Patients with HIV and pneumonia presented elevated levels of cytokines and chemokines (IL-6, IL-8, IL-18, IL-1RA, IL-10, IP-10, MCP-1, and MIP-1β) compared to those with only HIV. A marked pulmonary dysfunction was evidenced by significant reductions in FEF25, FEF25-75, and FEV1. The correlation between these immune mediators and lung function parameters supports the connection between pneumonia-associated inflammation and end organ lung dysfunction. A low CD4 cell count (<200 cells/μL) predicted inflammation and lung dysfunction. These results underscore the need for targeted clinical approaches to mitigate the adverse impacts of CAP on lung function in this population.

Correlation between chest computed tomography findings and pulmonary function test results in the post-recovery phase of COVID-19.

The radiological and functional lung sequelae in COVID-19 survivors remain unclear. We compared the chest computed tomography findings of COVID-19 patients with normal and abnormal pulmonary function test results in the post-recovery phase. The data of consecutive patients who underwent pulmonary function tests and chest computed tomography within 14 days after recovery from COVID-19 at two medical centers between May and October 2020 were collected retrospectively. Two thoracic radiologists who were blinded to the clinical information and pulmonary function test results classified the patients according to the computed tomography features, evidence of fibrotic-like changes, and semi-quantitative quantification of the extent of pulmonary abnormalities. The clinical characteristics and computed tomography findings of patients with normal pulmonary function test results were compared with those of patients with abnormal results. A total of 101 COVID-19 survivors, comprising 48 ambulatory and 53 hospitalized patients, were included at a median of 95 days from initial symptom onset. Computed tomography revealed fibrotic-like changes in 10.9% of patients. A reduction in the diffusion capacity of carbon monoxide was the most common lung function abnormality (19.8%). Abnormal diffusion capacity of carbon monoxide was associated with the presence and extension of lung opacities on chest computed tomography scans and fibrotic pulmonary abnormalities. The sensitivity, specificity, and accuracy of reduced diffusion capacity of carbon monoxide for detecting fibrotic-like pulmonary changes on chest computed tomography scans were 72.7%, 87.8%, and 86.1%, respectively. Our study suggests that the presence of an abnormal diffusion capacity of carbon monoxide in the post-recovery phase of COVID-19 is associated with a greater risk of long-term parenchymal lung disease, as evidenced by the presence of fibrotic-like changes on chest computed tomography scans, such as traction bronchiectasis and architectural distortion.

Thoracic ultrasonographic and clinical findings at 12-month follow-up of patients admitted with COVID-19

ABSTRACT Introduction Thoracic ultrasound (TUS) has proven useful in the diagnosis, risk stratification and monitoring of disease progression in patients with coronavirus disease 2019 (COVID-19). However, utility in follow-up is poorly described. To elucidate this area, we performed TUS as part of a 12-month clinical follow-up in patients previously admitted with COVID-19 and correlated findings with clinical assessment and pulmonary function tests. Methods Adult patients discharged from our hospital following admission with COVID-19 during March to May 2020 were invited to a 12-month follow-up. Enrolled patients were interviewed regarding persisting or newly developed symptoms in addition to TUS, spirometry and a 6-min walk test. Patients were referred to high-resolution computed tomography (HRCT) of the lungs if suspicion of pulmonary fibrosis was raised. Results Forty patients were enrolled in the study of whom had 13 developed acute respiratory distress syndrome (ARDS) during admission. Patients with ARDS were more prone to experience neurological symptoms at follow-up (p = 0.03) and showed more B-lines on TUS (p = 0.008) but did not otherwise differ significantly in terms of pulmonary function tests. Four patients had pathological findings on TUS where subsequent diagnostics revealed that two had interstitial lung abnormalities and two had heart failure. These four patients presented with a significantly lower diffusing capacity of lung for carbon monoxide (p=0.03) and 6-min walking distance (p=0.006) compared to the remaining 36 patients without ultrasound pathology. No significant difference was observed in spirometry values of % of predicted FEV1 (p=0.49) or FVC (p=0.07). No persisting cardiovascular pathology was observed in patients without ultrasonographic pathology. Conclusion At 12-month after admission with COVID-19, a follow-up combining TUS, clinical assessment, and pulmonary function tests may improve the selection of patients requiring further diagnostic investigations such as HRCT or echocardiography.

Characterization of adolescents with functional respiratory disorders and prior history of SARS-CoV-2

BackgroundThe SARS-CoV-2 pandemic has caused significant pulmonary morbidity and mortality in the adult population. Children and adolescents typically show milder symptoms; however, a relevant proportion of them report persistent pulmonary symptoms even after mild SARS-CoV-2 infection. Functional respiratory disorders may be relevant differential diagnoses of persistent dyspnea. This study aims at characterizing functional respiratory disorders that may arise after SARS-CoV-2 infection regarding their clinical presentation and pulmonary function tests as well as gaining insights into the clinical course after initiation of appropriate therapy.MethodsThis study retrospectively identified all patients referred to an outpatient clinic for pediatric pulmonology with functional respiratory disorders manifesting after proven SARS-CoV-2 infection between January 1, 2022, and October 31, 2022. Clinical history, thorough clinical examination regarding breathing patterns, and pulmonary function tests (PFTs) were taken into consideration to diagnose functional respiratory disorders.ResultsTwenty-five patients (44% female) with mean (m) age = 12.73 years (SD ± 1.86) who showed distinctive features of functional respiratory disorders after SARS-CoV-2 infection (onset at m = 4.15 (± 4.24) weeks after infection) were identified. Eleven patients showed thoracic dominant breathing with insufficient ventilation, and 4 patients mainly had symptoms of inducible laryngeal obstruction. The rest (n = 10) showed overlap of these two etiologies. Most patients had a flattened inspiratory curve on spirometry and slightly elevated residual volume on body plethysmography, but values of PFTs were normal before and after standardized treadmill exercise testing. Patients were educated about the benign nature of the condition and were offered rebreathing training. All patients with follow-up (n = 5) showed normalization of the breathing pattern within 3 months.ConclusionsFunctional respiratory disorders are important differential diagnoses in persisting post-SARS-CoV-2 dyspnea in adolescents. A combination of clinical history, detailed examination of breathing patterns, and pulmonary function tests are helpful to correctly diagnose these conditions. Reassurance and rebreathing training are the mainstay of the therapy. The clinical course is favorable.

VEGF-A plasma levels are associated with impaired DLCO and radiological sequelae in long COVID patients.

Long COVID, also known as post-acute sequelae of COVID-19 (PASC), is characterized by persistent clinical symptoms following COVID-19. To correlate biomarkers of endothelial dysfunction with persistent clinical symptoms and pulmonary function defects at distance from COVID-19. Consecutive patients with long COVID-19 suspicion were enrolled. A panel of endothelial biomarkers was measured in each patient during clinical evaluation and pulmonary function test (PFT). The study included 137 PASC patients, mostly male (68%), with a median age of 55years. A total of 194 PFTs were performed between months 3 and 24 after an episode of SARS-CoV-2 infection. We compared biomarkers evaluated in PASC patients with 20 healthy volunteers (HVs) and acute hospitalized COVID-19 patients (n = 88). The study found that angiogenesis-related biomarkers and von Willebrand factor (VWF) levels were increased in PASC patients compared to HVs without increased inflammatory or platelet activation markers. Moreover, VEGF-A and VWF were associated with persistent lung CT scan lesions and impaired diffusing capacity of the lungs for carbon monoxide (DLCO) measurement. By employing a Cox proportional hazards model adjusted for age, sex, and body mass index, we further confirmed the accuracy of VEGF-A and VWF. Following adjustment, VEGF-A emerged as the most significant predictive factor associated with persistent lung CT scan lesions and impaired DLCO measurement. VEGF-A is a relevant predictive factor for DLCO impairment and radiological sequelae in PASC. Beyond being a biomarker, we hypothesize that the persistence of angiogenic disorders may contribute to long COVID symptoms.

Quantification of the Relationship of Pyridoxine and Spirometry Measurements in the United States Population

BackgroundThere has been evidence to suggest associations between vitamins and lung function. ObjectiveThis study aimed to examine the association between vitamin B6 and spirometry values. MethodsA cross-sectional study was done using National Health and Nutritional Examination Surveys (NHANES) 2007–2012, which is a nationally representative, modern cohort. Spirometry, a clinical pulmonary function test, measured the amount and speed of air a person could exhale after taking the deepest possible breath after forceful expiratory volume at 1 s (FEV1) and forced vital capacity (FVC). After determination of the relationship of the linearity of variables, univariable and multivariable models were fitted to investigate the effect of vitamin B6 on FEV1 and FVC. The National Center for Health Statistics Ethics Review Board granted permission for the study’s data collection and analysis. ResultsOf 19,160 individuals who had complete information on vitamin B6 intake, FEV1, and FVC, it was found each mg of vitamin B6 intake was associated with increase in 166.41 mL of FEV1 (95% CI: 156.71, 176.12; P < 0.01) and 221.6 mL of FVC (95% CI: 209.62, 233.57; P < 0.01). After controlling for potential confounders (age, race, sex, body mass index, education, and income), multiple linear regression found that each mg of vitamin B6 was associated with increase in 25.98 mL of FEV1 (95% CI: 19.15, 32.80, P < 0.01) and 38.97 mL of FVC (95% CI: 30.65, 47.30, P < 0.01). ConclusionIncreased vitamin B6 intake is associated with improvement in lung function. Further prospective studies are required to ascertain whether increased vitamin B6 can lead to increased long-term spirometry measurements and the specific therapeutic dose–response relationship.

Clinical course and risk factors for development and progression of interstitial lung disease in primary Sjögren’s syndrome

This single-center, retrospective study aimed to investigate the course and prognostic factors of patients with primary Sjögren syndrome-associated interstitial lung disease (pSS-ILD). We included 120 pSS patients who underwent at least two high-resolution computed tomography (HRCT) scans between 2013 and 2021. Clinical symptoms, laboratory data, HRCT findings, and pulmonary function test results were collected. Two thoracic radiologists reviewed the HRCT findings. In patients with pSS without ILD at baseline (n = 81), no development of ILD was found on follow-up (median, 2.8 years). In patients with pSS-ILD (n = 39), total disease extent, extent of coarse reticulation, and traction bronchiectasis increased on HRCT, whereas the extent of ground glass opacity (GGO) decreased at follow-up (median, 3.2 years) (each p < 0.001). In progressive group of pSS-ILD (48.7%), the extent of coarse reticulation and coarseness score of fibrosis were increased at follow-up (p < 0.05). Usual interstitial pneumonia pattern on CT (OR, 15.237) and follow-up duration (OR, 1.403) were independent risk factors for disease progression in patients with pSS-ILD. In both progressive and non-progressive pSS-ILD, GGO decreased, whereas the extent of fibrosis increased even after treatment with glucocorticoid and/or immunosuppressants. In conclusion, progression occurred in approximately half of the pSS-ILD patients with slow gradual deterioration. Our study identified a definite group of progressive pSS-ILD who did not respond to current anti-inflammatory treatment.

Descriptive Study to Assess Post-acute COVID-19 Complications in Patients Presenting at a Teaching Hospital in North India.

Introduction Coronavirus disease 2019 (COVID-19) caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported at the end of 2019 in Wuhan, Hubei Province, People's Republic of China, at a cluster of unusual pneumonia patients. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 by World Health Organization. We are receiving patients in our OPD (Out Patient Department) with a new set of health complications having been infected with COVID-19. We planned to collect our data and try to find by various statistical methods, quantify the complications, and assess how we can deal with the new set of complications we are witnessing in this post-acute COVID-19 group of patients. Materials and methods The study was conducted by enrolling the patients at OPD/IPD (In Patient Department) by conducting a detailed history and clinical examination, routine investigations, 2D echocardiography (2D Echo), and pulmonary function test (PFT). The study assessed the worsening of symptoms, new onset symptoms, or the symptoms that continued even in the post-COVID-19 status as post-COVID-19 sequelae. Results Maximum cases were male and most of them were asymptomatic. The most common post-COVID-19 symptom that persisted was fatigue. 2D Echo and spirometry were done and changes were noticed even in those subjects who were asymptomatic. Conclusion Since significant findings were seen on clinical evaluation accompanied by 2D Echo and spirometry, it is essential to screen all presumed and microbiologically proven cases for long-term follow-up.

Can Speckle Tracking Of Right Ventricle Add Value For Evaluation Of Asthma Severity In Children?

To investigate myocardial deformation by tracking speckles along with evaluation of cardiac function using conventional and tissue Doppler imaging. The case-control study was conducted at Kafrelsheikh University Hospital, Egypt, from September 2019 to May 2022, and comprised asthmatic children and healthy controls matched for age and gender. After taking family history of asthma, assessments were made for bronchial asthma treatment and severity. Clinical examination and pulmonary function tests were performed along with tissue Doppler imaging and speckle tracking. Global left ventricular and right ventricular strains were measured. Data was analysed using SPSS 22.. Of the 120 subjects, 60(50%) were cases; 33(55%) males and 27(45%) females with mean age 9.4±2.91 years. The remaining 60(50%) were controls; 34(56.7%) males and 26(43.3%) females with mean age 9.7±2.99 years(p>0.05). Among the cases, 36(60%) had moderate severity and 24(40%) had mild asthma. Family history was positive in 11(18.3%) cases and negative in 49(81.7%). There was no significant difference in terms of conventional echocardiography between the groups (p>0.05). There was impairment in right ventricular diastolic function in the cases, with lateral tricuspid E` velocity significantly lower (p<0.05) and isovolumetric relaxation time significantly higher than the controls(p=0.001). There wasimpairment ofsystolic function of the right ventricle in the cases compared to the controls(p=0.001). Right ventricular peak longitudinalsystolic stress cut-off value distinguishing the controlsfrom the cases was -20.4 with sensitivity 85% and specificity 63%. The cut-off value distinguishing mild from moderate asthmatic cases was -19.8 with sensitivity 83% and specificity 91%. Speckle tracking echocardiography could detect very early subtle right ventricular systolic dysfunction. Right ventricle dysfunction worsened with the severity of asthma.

Clinical Profile and Pulmonary Function Tests among Females Exposed to Household Fuel Smoke in Bhavnagar, Gujarat: A Cross-Sectional Study

Background: Studies from developing countries, suggest that exposure to smoke from household fuels like wood, animal dung, and kerosene used for domestic cooking, may be a risk factor for airway diseases among women. This study aims to find the effect of household fuel smoke among them through clinical profile and pulmonary function test.&#x0D; Methods: A cross-sectional study was conducted in respiratory medicine outpatient department of Sir T Hospital in Government Medical College, Bhavnagar. Female participants were interviewed with pretested semi-structured questionnaires. They included respiratory symptoms, housing condition, kitchen environment, type of household fuels, habits and history of passive smoking, the number of hours per day and the number of years spent for cooking (biomass exposure index). Chest x-ray and pulmonary function tests like spirometry and diffusion capacity of lungs were performed. Through purposive sampling, 100 female participants were included in the study, and data were analyzed using SPSS version 17.0 versions and Chi-square test.&#x0D; Results: The total number of participants was 100 with a mean age of 46.89±12. Three out of 10 had a history of passive smoking. Most of the patients suffered from dyspnea (84%) and cough (76%) as the main symptoms. Nearly half (43%) of them had a runny nose. 30% were passive smokers and 70% were nonsmokers. The patients’ cough and expectoration had a significant association with forced expiratory volume (FEV1)/ Forced Vital Capacity (FVC) &gt; 70 (P=0.02). The study suggested that with aging, the odds for Fev1/FVC becoming &lt;70 (OR: 4.24; 95% CI: 1.14-15.72, p=0.03) goes higher. The patients who had a history of exposure to smoking had higher odds of having FEV1/FVC&lt;70 (OR: 4.000; CI: 1.4851 to 10.7739, p=0.006).&#x0D; Conclusion: The findings suggest that clinical symptoms like dyspnea and cough are significant when there is exposure to household fuels like kerosene, animal dung and wood usage. Smoke emitted from such fuels play an important role in deterioration of lung functions. Efforts should be made to create awareness regarding household fuel smoke effect on health and reduction of their use.

Itraconazole Improved Bronchial Wall Thickness in Severe Persistent Asthma: A Double-blind Placebo-controlled Randomized Clinical Trial.

The purpose of this study was to evaluate the effect of 8 months of treatment with itraconazole on airway wall thickness in patients with severe persistent asthma. It was a double-blind, randomized, placebo-controlled clinical trial (IRCT20091111002695N9). Seventy-five subjects with severe persistent asthma received itraconazole (100 mg), prednisolone (5 mg), or placebo twice a day for eight months in three treatment groups (n=25 in each group). The primary objective was to improve the right upper lobe apical segmental bronchus (RB1) wall thickness percentage measured by high-resolution computed tomography scan of the lungs. Other morphometric measurements of RB1, asthma control test (ACT) score, presence of wheezing, dyspnea severity, rate of asthma exacerbation, fractional exhaled nitric oxide (FeNO), and expiratory volume in 1 second (FEV1) were set as the secondary outcomes. Wall thickness percentage reduced significantly from 46% to 43.7% from pre- to post-treatment in the itraconazole-treated subjects. Similarly, lumen area and radius increased significantly in both the prednisolone and itraconazole groups. Itraconazole led to a significant improvement in wheezing, dyspnea severity, FEV1, ACT score, and FeNO. Although prednisolone was also effective in improving pulmonary function tests and ACT scores, it was associated with significantly more side effects than itraconazole. Long-term treatment with itraconazole resulted in a significant reduction in bronchial wall thickness and improvements in clinical findings and pulmonary function tests. Thus, itraconazole could be a helpful add-on treatment option for severe persistent asthma patients to achieve better disease control.

Nintedanib in Idiopathic Pulmonary Fibrosis: Tolerability and Safety in a Real Life Experience in a Single Centre in Patients also Treated with Oral Anticoagulant Therapy.

Idiopathic pulmonary fibrosis (IPF) is a rare and severe disease with a median survival of ~3 years. Nintedanib (NTD) has been shown to be useful in controlling interstitial lung disease (ILD) in IPF. Here we describe the experience of NTD use in IPF in a real-life setting. Objective. Our objective was to examine the safety profile and efficacy of nintedanib even in subjects treated with anticoagulants. Clinical data of patients with IPF treated with NTD at our center were retrospectively evaluated at baseline and at 6 and 12 months after the introduction of NTD. The following parameters were recorded: IPF clinical features, NTD tolerability, and pulmonary function tests (PFT) (i.e., Forced Vital Capacity (FVC) and carbon monoxide diffusing capacity (DLCO)). In total, 56 IPF patients (34% female and 66% male, mean onset age: 71 ± 11 years, mean age at baseline: 74 ± 9 years) treated with NTD were identified. At enrollment, HRCT showed an UIP pattern in 45 (80%) and a NSIP in 11 (20%) patients. For FVC and FEV1 we found no significant change between baseline and 6 months, but for DLCO we observed a decrease (p = 0.012). We identified a significant variation between baseline and 12 months for FEV1 (p = 0.039) and for DLCO (p = 0.018). No significant variation was observed for FVC. In the cohort, 18 (32%) individuals suspended NTD and 10 (18%) reduced the dosage. Among individuals that suspended the dosage, 14 (78%) had gastrointestinal (GI) collateral effects (i.e., diarrhea being the most common complaint (67%), followed by nausea/vomiting (17%) and weight loss (6%). Bleeding episodes have also not been reported in patients taking anticoagulant therapy. (61%). One patient died within the first 6 months and two subjects died within the first 12 months. In a real-life clinical scenario, NTD may stabilize the FVC values in IPF patients. However, GI side effects are frequent and NTD dose adjustment may be necessary to retain the drug in IPF patients. This study confirms the safety of NTD, even in patients treated with anticoagulant drugs.

Clinical, radiological outcomes and pulmonary function tests in patients recovered from COVID-19 in a three-month follow-up

Introduction: Long-term pulmonary consequences of coronavirus disease 2019 (COVID-19) are unknown. Objectives: The aim of this study was the clinical and radiologic consequences and pulmonary function test in the cured COVID-19 patients in a three-month follow-up. Patients and Methods: Patients with laboratory-confirmed COVID-19 infection by a reverse transcription polymerase chain reaction (RT-PCR) assay were recruited in this prospective descriptive epidemiological study. Computerized tomography (CT) scan and blood oxygen measurement were performed before and three months after discharge for all the patients. Spirometry test and 6-minute walk test (6MWT) were conducted to determine the levels of dyspnea and persistent respiratory symptoms. Results: Eighty patients were recruited in this study. At the 3-month follow-up, oxygen saturation was higher than the time of discharge from the hospital. Chest CT scan showed abnormal results in 66.3% of patients. The pulmonary function test results indicated that only 27 (35.75%) of patients had abnormal test. The median distance in the 6MWT was 325 meters (interquartile range, 96-480 m). Conclusion: Follow-up of COVID-19 patients revealed radiological abnormalities in most cured COVID-19 patients, indicating the need for more extended follow-up periods for investigating the long-term consequences of COVID-19.

Combination of echocardiography and pulmonary function tests could predict no complication of pulmonary hypertension during 5 years in patients with systemic sclerosis.

To determine whether complications of pulmonary hypertension (PH) can be predicted by noninvasive screening tests in systemic sclerosis (SSc). Forty-seven of 113 SSc patients underwent right heart catheterization (RHC) during 2011-2014. Clinical data, hemodynamic features, echocardiography, and pulmonary function tests had been followed up from the first RHC until 5 years later. At the first RHC, out of 44 patients, 8 were diagnosed with pre-capillary PH (mean pulmonary arterial pressure [mPAP] > 20 mm Hg), and 36 patients were defined as no-PH (mPAP ≤ 20 mm Hg). Three patients with >15 mm Hg of pulmonary artery wedge pressure were excluded. Receiver operating characteristic analyses for pre-capillary PH using estimated systolic PAP (esPAP) revealed an area under the curve (AUC) of 0.736, with a sensitivity and specificity of 62.5% and 86.1%, respectively, at a cutoff level of 35.0 mm Hg. The predicted percentage diffusing lung capacity for carbon monoxide (DLCO%) revealed an AUC of 0.840, with a sensitivity and specificity of 85.7% and 80.0%, respectively, at a cutoff level of 70.0%. Six pre-capillary PH patients, including one who died from PH 14 months after the first RHC, indicated exacerbations of mPAP or esPAP within 5 years. When esPAP < 35.0 mm Hg and DLCO% > 70% were met as the cutoff, none had been newly diagnosed with PH over 5 years. The conventional screening tests may be useful for detecting pre-capillary PH with SSc, and both esPAP < 35.0 mm Hg and DLCO% > 70% indicated a lower risk of developing PH for at least 5 years.

Association of the Severity of Emphysema Based on HRCT Scoring System with Clinical Profile and Pulmonary Function Test Parameters: A Cross-sectional Study

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is commonly observed in middle aged and elderly individuals. Dyspnoea, with or without expectoration, or isolated dyspnoea, is the primary respiratory symptom. Clinical signs, symptoms, and Pulmonary Function Tests (PFTs) are non specific. Chest radiography poorly correlates with disease severity and extent compared to clinical and functional impairment. High-Resolution Computed Tomography (HRCT) has been widely adopted to detect, characterise, and quantify emphysema. HRCT scoring is a useful radiological method for assessing emphysema severity in COPD patients and can provide prognostic information. Aim: To assess the severity of emphysema based on the HRCT scoring system and its association with clinical profile and PFTs. Materials and Methods: The present cross-sectional observational study was conducted in the Department of Radiodiagnosis at Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, New Delhi, India. It included 30 clinically diagnosed COPD patients referred for HRCT lung scans from November 1,2018, to March 31, 2020. HRCT assessment was performed at three levels: carina, 5 cm above carina, and 5 cm below carina. The severity of lung parenchyma was evaluated using the “Sakai Scoring Method.” The emphysema score was correlated with clinical profile (duration of illness, COPD severity, smoking, and pack-years smoked) and PFT parameters (FEV1, FEV1/FVC). Results: The mean age of the cases was 60±9.44 years. There was a strong positive linear correlation between the duration of illness (r=0.67, p=0.001) and COPD severity (r=0.452, p=0.02) with HRCT emphysema score. Significant correlation was found between HRCT emphysema score and pack-years smoked (r=0.558, p=0.004). The emphysema score showed an inverse correlation with FEV1 (r= -0.56, p=0.002) but no correlation with Forced Expiratory Volume 1 / Forced Vital Capacity (FEV1/FVC) (r= -0.16, p=0.430). Conclusion: The HRCT semi-quantitative scoring system is valuable for the initial assessment of disease severity and is significantly correlated with the PFT parameter FEV1.

Safety and pulmonary function impact of surgical mask usage in stable COPD patients during the COVID-19 pandemic

There are hesitations about the use of surgical face masks, which are the main tools in protection from the COVID-19 pandemic, one of the biggest disasters of our age, in chronic airway diseases. The purpose of the study was to examine how stable patients with chronic obstructive pulmonary disease (COPD) responded to short-term surgical mask use in terms of in-mask air quality, oxygen saturation, and pulmonary function. Forty-one patients with stable COPD, by clinical presentation and pulmonary function tests (PFTs), were included in a quasi-experimental study. Stable COPD patients' PFTs, in-mask air quality, and pollution measures were collected before and after wearing surgical masks for two hours at rest. The findings of simultaneous tests of peripheral-blood-oxygen saturation were also recorded. The mean age of participants was 67.1 years and 87.8% were male. The pre- and post-mask PFTs parameters for GOLD (A+B) group were FEV1 (ml), FEV1 (%), FVC (ml), FVC (%), FEV1/FVC (%) and DLCO (%) (p=0.067, p=0. 065, p=0.062, p=0.083, p=0.083, p=0.269, p=0.956, respectively), whereas in GOLD (C+D) group (p=0.340, p=0.538, p=0.728, p=0.044, p=0.105, p=0.054, respectively). In post-mask measurements, the respiratory function was not impaired in GOLD-2022 (A-B-C-D) COPD subgroups. Oxygen and carbon-monoxide concentrations in exhaled air and oxygen saturation decreased after surgical mask use. The difference was statistically significant, but the difference was unimportant in terms of clinical implications. Surgical masks don’t appear to have a negative effect on pulmonary function and clinical parameters in stable COPD. This study may help provide evidence-based data to overcome hesitations in use of surgical masks in chronic airway diseases.

Clinical presentation and pulmonary function tests in post-acute COVID-19 patients.

The study analysed post-acute COVID-19 symptoms and the pulmonary function test (PFT) results in patients surviving the native strain of the virus. The study was prospective; the inclusion criteria were positive PCR test for SARS-CoV-2 and age 18-100. Exclusion criteria were active respiratory infection, known or suspicious pre-existing pulmonary disease, cardiac failure, recent or acute pulmonary embolism, anaemia, and neuromuscular diseases. The recruitment period was 1st March 2020 - 25th December 2020. The initial examination was performed 4-12 weeks after the disease onset. All subjects underwent physical examination, anamnesis, chest x-ray and PFT. The study involved 785 subjects (345 male) mean age 53.8 (SD 14.6). The disease severity groups were: mild (G1), moderate (G2) and severe/critical (G3). Anosmia was present in the acute disease phase in 45.2% of G1 patients, but only in 4.5% of G3 patients. Dyspnoea occurred frequently in more severe groups (40%, 51.8% and 63.7% for G1, G2 and G3 respectively), while cough and fatigue showed no relationship to disease severity. Females were more likely to experience persistent symptoms. PFT results were significantly decreased in more severe groups compared to the mild COVID-19 patients, diffusing capacity was 86.3%, 79% and 68% of predicted values in G1, G2 and G3 respectively. Anosmia during the acute phase was associated with mild disease, persisting dyspnoea was more frequent after more severe COVID-19. Females tended to have persisting symptoms in post-acute phase more frequently. PFT results showed decrease with disease severity.

Interstitial lung disease in patients with connective tissue disease: Subtypes, clinical features and comorbidities in the Western Cape, South Africa.

Background Interstitial lung disease (ILD) is highly prevalent in patients with connective tissue disease (CTD) and is poorly characterised in South Africa. Objectives To describe the clinical, serological and radiological features of CTD-ILD and their associations in patients attending a tertiary referral hospital. Methods A cross-sectional study collating clinical, serological and radiological features of CTD-ILD in patients attending rheumatology and respiratory outpatient clinics in a tertiary referral hospital. ResultsOf 124 CTD-ILD patients, 37 (29.8%) had rheumatoid arthritis (RA), 32 (25.8%) systemic sclerosis (SSc) and 55 (44.4%) other autoimmune connective tissue diseases (OCTD). Most patients were female (86.3%), of mixed racial ancestry (75.0%), and the median age was 55 years. Nonspecific interstitial pneumonia (NSIP) was the most common ILD pattern (63.7%), followed by usual interstitial pneumonia (UIP) (26.6%). Overall, 60.5% were current or past smokers, 33.1% had previous pulmonary tuberculosis infection, and 75.6% had gastro-oesophageal reflux disease. Patients with RA were older, had similar frequencies of NSIP and UIP, and had significantly better pulmonary function tests than the SSc and OCTD groups. Within three years of CTD diagnosis, two-thirds of the SSc and OCTD patients and almost half of the RA patients had developed ILD. Clinical features, chest X-rays and pulmonary function tests correlated poorly with high-resolution computerised tomography (HRCT). No case of acute pneumonitis was documented in CTD-ILD patients treated with methotrexate (MTX). Conclusion We suggest routine HRCT in all newly diagnosed CTD patients, particularly those with SSc and OCTD, where more than two-thirds of the patients had developed ILD within three years of their CTD. The use of MTX was not associated with the development of acute pneumonitis in patients with ILD. Key points Clinical features, chest X-rays and pulmonary function tests correlated poorly with high-resolution computerised tomography (HRCT).Smoking, environmental toxins, gastro-oesophogeal reflux and previous pulmonary tuberculosis infection were significant comorbidities in CTD-ILD patients.Early screening of ILD with HRCT is recommended, particularly in SSc.Use of MTX before and after ILD diagnosis was not associated with acute pneumonitis.