Decrease In Forced Vital Capacity Research Articles

The relationship between pulmonary ventilation function and bone marrow hematopoietic function: A mendelian randomization analysis

Background: In recent years, the comorbidity between respiratory and hematopoietic system diseases has emerged as a new challenge. However, the potential genetic link between the ventilatory function of the respiratory system and the hematopoietic function of the bone marrow remains unclear. In this study, we conducted a comprehensive investigation into the possible genetic connection between lung ventilatory function and bone marrow hematopoietic function. Methods: We selected two exposure factors, Forced Expiratory Volume in 1 second (FEV1) and Forced Vital Capacity (FVC), which represent pulmonary ventilation function, and two outcome indicators, Immature Fraction of Reticulocytes (IFR) and Reticulocyte Count (RC), which represent bone marrow hematopoiesis function, from published genome-wide association studies. Based on the three core assumptions of Mendelian randomization analysis, we extracted Single Nucleotide Polymorphism (SNPs) associated with FEV1 and FVC as instrumental variables for the exposure factors. We then conducted two-sample Mendelian randomization analyses using inverse variance weighted (IVW), weighted median, and MR-Egger regression methods. Lastly, we assessed the reliability of the testing results through MR-Egger, Cochran’s Q test, and the leave-one-out test. Through these steps, we aimed to explore the causal relationship between pulmonary ventilation function and the outcome of bone marrow hematopoiesis function and evaluated the reliability of the testing results using methods such as MR-Egger, Cochran’s Q test, and the leave-one-out test. Results: The IVW method revealed that a decrease in FEV1 is associated with an increase in IFR (β = −0.072, 95% CI: −0.131 to −0.014, p = 0.01), and the results from MR-Egger regression showed a similar association (β = −0.169, 95% CI: −0.342 to −0.004, p = 0.05). Furthermore, a decrease in FEV1 is associated with an increase in RC (β = −0.143, 95% CI: −0.198 to −0.087, p =4.00E-07), and MR-Egger regression yielded consistent results (β = −0.216, 95% CI: −0.381 to −0.541, p=1.07E-02). Similarly, a decrease in FVC is associated with an increase in IFR (β = −0.073, 95% CI: −0.116 to −0.031, p = 6.17E-04), and MR-Egger regression showed a similar trend (β = −0.046, 95% CI: −0.160 to −0.067, p=0.42). Additionally, a decrease in FVC is associated with an increase in RC (β = −0.173, 95% CI: −0.221 to −0.125, p = 2.33E-12), and MR-Egger regression yielded consistent results (β = −0.142, 95% CI: −0.272 to −0.012, p = 3.32E-02). The reliability tests indicated heterogeneity in the above MR analyses but no evidence of horizontal pleiotropy. Therefore, a fixed-effect model IVW was used to explore the causal relationships, which were found to be robust and reliable with no outliers or significant bias in this study. Conclusion: This study indicates that there is a negative causal relationship between pulmonary ventilation function and bone marrow hematopoietic function. A decrease in pulmonary ventilation function stimulates bone marrow hematopoiesis. However, further research is needed to elucidate this mechanism.

Usefulness of monitoring mycophenolic acid exposure in systemic sclerosis-related interstitial lung disease: a retrospective cohort study

BackgroundSystemic sclerosis-related interstitial lung disease (SSc-ILD) represents a significant cause of morbidity and mortality in Systemic Sclerosis (SSc). Mycophenolate mofetil (MMF) is currently the first line treatment for SSc-ILD. There is no recommendation on the dosage of mycophenolic acid (MPA) blood concentrations, so we aimed to study the correlation between MPA exposure and respiratory outcomes in this population.MethodsWe conducted a retrospective cohort study of SSc-ILD patients treated with MMF in our center. According to our policy, a complete patient evaluation was performed approximately one year after MMF initiation, during which the mycophenolic acid (MPA) residual rate (RR) was measured. We analyzed the association between RR and changes in forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) over time.ResultsForty-three SSc-ILD patients were included. Patients with higher RR levels (≥ 1.5 mg/L) had a significantly better FVC evolution with a higher proportion of stabilization and lower proportion of FVC decrease (p = 0.024). RR above 1.5 mg/L was a predictive factor of reduced FVC decline compared with lower RR levels adjusting for MMF dose and duration of MMF exposure (p = 0.008). There was no difference regarding DLCO outcome.ConclusionOur study suggests that optimal MPA exposure, as indicated by RR levels, may better protect against FVC decline in SSc-ILD patients treated with MMF. Routine monitoring of MPA exposure could be beneficial in optimizing treatment outcomes. Prospective, multicenter studies are needed to further explore the relationship between MPA exposure and clinical outcomes in SSc-ILD.

Blood cadmium concentration and pulmonary function injury: potential mediating role of oxidative stress in chronic obstructive pulmonary disease patients

BackgroundExposure to cadmium (Cd) is associated with a reduction in lung function among patients with chronic obstructive pulmonary disease (COPD). The longitudinal relationship and mechanism underlying the link between Cd exposure and lung function changes among COPD patients are yet unknown.MethodsThe cohort study included 259 eligible patients who underwent regular professional follow-ups. Blood Cd levels and serum 8-iso-prostaglandin F2 alpha (8-iso-PGF2α) levels were assessed. Lung function was determined at baseline and follow-up research. The associations between changes in lung function and blood Cd concentration were analysed using multivariate linear and logistic regression models.ResultsEach 1-ppb elevation in blood Cd content resulted in a 0.420 L decrease in forced vital capacity (FVC), a 0.424 L decrease in forced expiratory volume in 1 s (FEV1), a 4.341% decrease in FEV1/FVC%, and a 8.418% decrease in FEV1% predicted in patients with COPD. Blood Cd concentration showed a positive correlation with serum 8-iso-PGF2α levels in a specific range. The relative contribution of increased serum levels of 8-iso-PGF2α to Cd-induced declines in FEV1, predicted FEV1%, and FEV1/FVC% were 2.08%, 8.08%, and 13.19%, respectively.ConclusionBlood Cd levels are associated with lung function changes in COPD patients. Oxidative stress is thought to be an important mediator in Cd-induced reduction of pulmonary function.

Prognostic performance of Krebs von den Lungen-6, surfactant protein A, surfactant protein D levels in the serum and bronchoalveolar lavage fluid in chronic fibrosing interstitial pneumonia: a retrospective study

BackgroundThe serum markers Krebs von den Lungen-6 (KL-6), surfactant protein A (SP-A), and surfactant protein D (SP-D) have been used for the diagnosis, differential diagnosis, and prognosis prediction of interstitial pneumonia. However, the significance of measuring the serum and bronchoalveolar lavage fluid (BALF) KL-6, SP-D, and SP-A levels in predicting the prognosis of chronic fibrosing interstitial pneumonia (CFIP), idiopathic pulmonary fibrosis, and idiopathic nonspecific interstitial pneumonia remains unclear. We aimed to clarify the significance of measuring the serum and BALF KL-6, SP-A, and SP-D levels in predicting the prognosis of patients with CFIP.MethodsAmong 173 patients who were diagnosed with CFIP between September 2008 and February 2021, 39 who underwent bronchoalveolar lavage were included in this study. Among these, patients experiencing an annual decrease in forced vital capacity (FVC) of ≥10% or those facing challenges in undergoing follow-up pulmonary function tests owing to significant deterioration in pulmonary function were categorized as the rapidly progress group. Conversely, individuals with an annual decrease in the FVC of <10% were classified into the slowly progress group. The serum and BALF KL-6, SP-D, and SP-A levels, as well as BALF/serum SP-D and SP-A ratios were compared between the two groups.ResultsAmong the patients with CFIP, the BALF SP-D level (p=0.0111), BALF SP-A level (p<0.0010), BALF/serum SP-D ratio (p=0.0051), and BALF/serum SP-A ratio (p<0.0010) were significantly lower in the rapidly than in the slowly progress group (p<0.0010). The receiver operating characteristics analysis results demonstrated excellent performance for diagnosing patients with CFIP, with the BALF SP-D level (area under the curve [AUC], 0.7424), BALF SP-A level (AUC, 0.8842), BALF/serum SP-D ratio (AUC, 0.7673), and BALF/serum SP-A ratio (AUC, 0.8556). Moreover, the BALF SP-A level showed a notably superior CFIP diagnostic capability. Survival analysis using the Kaplan–Meier method revealed that patients with a BALF SP-A level of <1500 ng/mL and BALF/serum SP-A ratio of <15.0 had poor prognoses.ConclusionsOur results suggest that BALF SP-A measurement may be useful for predicting the prognosis in patients with CFIP.

Impact of Postoperative Prolonged Air Leakage on Long-Term Pulmonary Function after Lobectomy for Lung Cancer.

This study aimed to evaluate the long-term impact of postoperative prolonged air leak (PAL) on pulmonary function. We enrolled 1,316 patients with pathologic stage I-III lung cancer who underwent lobectomy. The cohort was divided into 2 groups: those who experienced PAL (n=55) and those who did not (n=1,261). Propensity score matching was conducted at a 1:4 ratio, resulting in 49 patients in the PAL group and 189 in the non-PAL group. Changes in pulmonary function were compared among preoperative, 6-month postoperative, and 12-month postoperative measurements between the 2 groups. The variables used for propensity score matching included age, sex, smoking history, body mass index, baseline pulmonary function, pathologic stage, and surgical approach. All standardized mean differences were less than 0.1. Six months postoperatively, the PAL group showed a greater reduction in both forced expiratory volume in 1 second (FEV1) (-13.0% vs. -10.0%, p=0.041) and forced vital capacity (FVC) (-15.0% vs. -9.0%, p<0.001) than the non-PAL group. In cases of upper lobectomy, there were no significant differences in FEV1 changes between the PAL and non-PAL groups at both 6 and 12 months. However, in lower lobectomy, the PAL group demonstrated a more pronounced decrease in FEV1 (-14.0% vs. -11.0%, p=0.057) and FVC (-20.0% vs. -13.0%, p=0.006) than the non-PAL group at 6 months postoperatively. Postoperative PAL delayed the recovery of pulmonary function after lobectomy. These effects were markedly more pronounced after lower lobectomy than after upper lobectomy.

A comparative study of respiratory effects of erector spinae plane block versus paravertebral plane block for women undergoing modified radical mastectomy

BackgroundInadequate acute postoperative pain control after modified radical mastectomy (MRM) can compromise pulmonary function. This work aimed to assess the postoperative pulmonary effects of a single-shot thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in female patients undergoing MRM.MethodsThis prospective, randomized comparative trial was conducted on 40 female American Society of Anesthesiologists (ASA) II-III, aged 18 to 50 years undergoing MRM under general anesthesia (GA). Patients were divided into two equal groups (20 in each group): Group I received ESPB and Group II received TPVB. Each group received a single shot with 20 ml volume of 0.5% bupivacaine.ResultsRespiratory function tests showed a comparable decrease in forced vital capacity (FVC) and forced expiratory volume (FEV1) from the baseline in the two groups. Group I had a lower FEV1/FVC ratio than Group II after 6 h. Both groups were comparable regarding duration for the first postoperative analgesic request (P value = 0.088), comparable postoperative analgesic consumption (P value = 0.855), and stable hemodynamics with no reported side effects.ConclusionBoth ultrasound guided ESPB and TPVB appeared to be effective in preserving pulmonary function during the first 24 h after MRM. This is thought to be due to their pain-relieving effects, as evidenced by decreased postoperative analgesic consumption and prolonged time to postoperative analgesic request in both groups.ClinicalTrials.gov IDNCT03614091 registration date on 13/7/2018.

Clinical profiles and treatment outcomes of outpatients with interstitial lung disease and mechanic's hands: A retrospective and observational cohort.

Idiopathic inflammatory myopathies, especially antisynthetase syndrome, often appear outside of the muscles as interstitial lung disease (ILD). Another typical finding is the presence of mechanic's hands. The aim of the present study was to describe the clinical, functional, tomographic, and serological data of patients with ILD and mechanic's hands and their response to treatment and survival rates. This is a retrospective study of ILD with concurrent myopathy. Among the 119 patients initially selected, 51 had mechanic's hands. All the patients were screened for anti-Jo-1 antibodies. An expanded panel of myopathy autoantibodies was also performed in 27 individuals. Of the 51 patients, 35 had 1 or more antibodies. The most common were anti-Jo-1, anti-PL-7, and anti-PL-12, while of the associated antibodies, anti-Ro52 was present in 70% of the 27 tested individuals. A significant response to treatment was characterized by an increase in predicted forced vital capacity (FVC) of at least 5% in the last evaluation done after 6 to 24 months of treatment. A decrease in predicted FVC of at least 5%, the need for oxygen therapy, or death were all considered treatment failures. All patients were treated with corticosteroids, and 71% with mycophenolate. After 24 months, 18 patients had an increase in FVC, 11 had a decrease, and 22 remained stable. After a median follow-up of 58 months, 48 patients remained alive and three died. Patients with honeycombing on high-resolution chest tomography (log-rank = 34.65; P < .001) and a decrease in FVC ≥5% (log-rank = 18.28, P < .001) had a poorer survival rate. Patients with ILD and mechanic's hands respond well to immunosuppressive treatment.

Pirfenidone and Nintedanib in Pulmonary Fibrosis: Lights and Shadows.

Pirfenidone and Nintedanib are specific drugs used against idiopathic pulmonary fibrosis (IPF) that showed efficacy in non-IPF fibrosing interstitial lung diseases (ILD). Both drugs have side effects that affect patients in different ways and have different levels of severity, making treatment even more challenging for patients and clinicians. The present review aims to assess the effectiveness and potential complications of Pirfenidone and Nintedanib treatment regimens across various ILD diseases. A detailed search was performed in relevant articles published between 2018 and 2023 listed in PubMed, UpToDate, Google Scholar, and ResearchGate, supplemented with manual research. The following keywords were searched in the databases in all possible combinations: Nintedanib; Pirfenidone, interstitial lung disease, and idiopathic pulmonary fibrosis. The most widely accepted method for evaluating the progression of ILD is through the decline in forced vital capacity (FVC), as determined by respiratory function tests. Specifically, a decrease in FVC over a 6-12-month period correlates directly with increased mortality rates. Antifibrotic drugs Pirfenidone and Nintedanib have been extensively validated; however, some patients reported several side effects, predominantly gastrointestinal symptoms (such as diarrhea, dyspepsia, and vomiting), as well as photosensitivity and skin rashes, particularly associated with Pirfenidone. In cases where the side effects are extremely severe and are more threatening than the disease itself, the treatment has to be discontinued. However, further research is needed to optimize the use of antifibrotic agents in patients with PF-ILDs, which could slow disease progression and decrease all-cause mortality. Finally, other studies are requested to establish the treatments that can stop ILD progression.

E038 Predictors for pulmonary function decline in interstitial lung disease

Abstract Background/Aims Interstitial lung disease (ILD) is commonly associated with a decline in forced vital capacity (FVC). The most substantial loss of lung function typically occurs early in the course of the disease. The natural history of ILD varies among individuals. Several studies have employed FVC decline as the primary endpoint and NICE has recently approved antifibrotics based on this as an endpoint. An FVC reduction exceeding 10% has consistently been shown to correlate with poorer survival, leading to evidence-based guidelines recommending, an absolute decrease in FVC of 10% can be used as a surrogate marker of mortality. Aim: To obtain insights into the decline in lung function in patients with ILD, by comparing FVC measurements at baseline and 52 weeks. We hypothesised that the rate of absolute decline is increased with higher age, active smoking, sex, duration of ILD and comorbidities. Methods This was a retrospective study conducted at Southend University Hospital, involving a single-centre cohort of ILD patients identified from the ILD multidisciplinary team from 2016-June 2023. Data collection included parameters such as age at ILD onset, gender, occupation, smoking history, serial pulmonary function tests, imaging, comorbidities, survival outcomes, causes of death, and treatment regimens. Results Data from 197 patients were included in this study. Mean age of the cohort at diagnosis was 74. Men 112 (57%) and females 85 (43%). Among the study population 128 had a history of ex or current smoking. Mean duration of ILD was 40 months, ranging from 2 to 168 months. Of the participants 115 were deceased &amp; 83 remained alive. We included most common conditions in the analysis: idiopathic pulmonary fibrosis (IPF) = 65, RA = 22, idiopathic pulmonary fibrosis with autoimmune features (IPAF) =15, hypersensitivity pneumonitis (HP) = 20, unclassified=25, SSc-ILD = 13, Sjogren’s = 2, myositis = 1, vasculitis = 3 and sarcoidosis = 7. For analysis, we included RA, SSc, Sjogren’s, vasculitis, ankylosing spondylitis, myositis, and sarcoidosis in the CTD -ILD group. 23 were excluded from analysis (COOP, OP, CPFE, PPFE and drug induced pneumonitis). We categorised disease progression as severe, if FVC decline exceeded 10%. This was achieved as follows; 3/36 in CTD -ILD, 2/10 in IPAF, 6/16 in HP, 5/19 unclassified in ILD and 14/47 in IPF (χ²=7.5, p = 0.109). Moderate disease progression was defined as an FVC decline between 5- 10%. It was achieved in 6/36 in CTD -ILD, 3/16 in HP, 1/19 in unclassified and 5/47 in IPF (χ²=3.8, p = 0.439).In univariate analysis, none of the predictors achieved significance for severe or moderate progression among subgroups. In multivariate analysis, only the disease subgroup achieved significance in predicting significant lung function decline progression. Conclusion The rate of decline in lung function during follow-up differed across the subgroups based on clinical factors and demographics. This data supports the unpredictable nature of ILD. Disclosure G.M. Koduri: Corporate appointments; NONE. Consultancies; NONE. Shareholder/stock ownership; NONE. Royalties; NONE. Honoraria; NONE. Member of speakers’ bureau; NONE. Grants/research support; NONE. Other; NONE.

LUNG FUNCTION INDICES IN MALE WOODWORKERS AND HEALTHY WORKERS IN CENTRAL INDIA – A COMPARATIVE STUDY

Objectives: The objectives of the study were comparison of lung function indices in woodworkers and age, height, and weight-matched healthy workers other than woodworkers and comparison of lung function indices among woodworkers about the duration of exposure. Methods: A comparative study of spirometry was performed on 60 male woodworkers from the Lakadganj area of Nagpur city and 60 males of age, height, and weight-matched healthy workers other than woodworkers aged from 25 to 40 years. The study was performed in the laboratory of the Physiology Department, IGGMC Nagpur from January 2012 to September 2013. The Institute Ethics Committee approved the present study and it was completed in IGGMC Nagpur. Data collection from each individual was performed using a health history questionnaire, estimation of height (cm) with roll ruler wall mounted roll ruler wall mounted stature meter, weight (kg) with weight measuring device, and well-calibrated Spirometry device Physiopac Windows-based computerized Polygraph. Age, height, weight, body mass index, and lung function indices forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), forced expiratory flow25-75% (FEF25-75%), FEV1/FVC, and maximum voluntary ventilation (MVV) were included in the present study. Data analysis was performed using analysis of variance, unpaired t-test, and the Pearson correlation coefficient. Results: Comparison of FVC, FEV1, peak expiratory flow rate, FEF25-75%, FEV1/FVC (p&lt;0.001), and MVV (p&lt;0.05) shows statistical significance between woodworkers and healthy workers. A negative correlation was found between FVC and all groups (Group A [−0.28], Group B [−0.33], and Group C [−0.46]). A negative correlation was found for FEV1 in Group A (−0.08), and Group B (−0.20). A positive correlation was found for FEV1 in Group C (0.14). FEF25-75% showed a negative correlation in Group I (−0.03), and Group III (−0.19). Conclusion: FVC, FEV1, FEF25-75%, FEV1/FVC, and MVV decreased significantly in woodworkers as compared to age, height, and weight-matched healthy workers other than saw-mill workers. There was a significant decrease in FVC, FEV1, and FEF25-75% as the duration of exposure increased but had no significant effect on FEV1/FVC and MVV.

Respiratory function in adult patients with spinal muscular atrophy treated with nusinersen - a monocenter observational study.

Insufficiency of respiratory muscles is the most important reason for mortality in the natural history of SMA. Thus, improvement or stabilization of respiratory function by disease-modifying therapies (DMT) is a very important issue. We examined respiratory function using forced vital capacity (FVC) in 42 adult SMA patients (2 SMA type 1, 15 SMA type 2, 24 SMA type 3, 1 SMA type 4, median age 37 years, range 17-61 years) treated with nusinersen for a median of 22.1 months (range 2.1 to 46.7 months). Change in FVC was assessed using mixed effects linear regression models. Baseline FVC differed significantly between SMA type 1 (4.0, 8.0%), 2 (median 22.0%, IQR 18.0-44.0), 3 (median 81.0%, IQR 67.0-90.8) and, respectively, type 4 (84.0%) patients reflecting the heterogeneity of respiratory impairment based on the SMA type in adulthood (p < 0.0001). FVC remained stable during follow-up (mean -0.047, 95% CI -0.115 to 0.020, p = 0.17); however, subgroup analysis showed an increase in FVC of type 2 patients (mean 0.144, 95% CI 0.086 to 0.202, p < 0.0001) and a decrease in FVC of type 3/4 patients (-0.142, 95% CI -0.239 to -0.044, p = 0.005). The observed improvement in FVC in patients with SMA type 2 can be seen as a therapeutic response differing from the progressive decline typically seen in the spontaneous course. For SMA type 3/4 patients approaching normal spirometry at baseline, FVC may only be of limited use as an outcome parameter due to ceiling effects.

Quantifying Regional Radiation-Induced Lung Injury in Patients Using Hyperpolarized 129Xe Gas Exchange Magnetic Resonance Imaging

PurposeRadiation-induced lung injury (RILI) has been shown to alter regional ventilation and perfusion in the lung. However, changes in regional pulmonary gas exchange have not previously been measured. MethodsTen patients receiving conventional radiation therapy (RT) for lung cancer underwent pre-RT and 3-month post-RT MRI using an established hyperpolarized-129Xe gas exchange technique to map lung function. Four patients underwent an additional 8-month post-RT MRI. The MR signal from inhaled xenon is measured in three pulmonary compartments: the lung airspaces, the alveolar membrane tissue, and the pulmonary capillaries (interacting with red blood cells, RBCs). Thoracic 1H MRI scans were acquired, and deformable registration was used to transfer 129Xe functional maps to the RT planning CT. The RT-associated changes in ventilation, membrane uptake, and RBC transfer, were computed as a function of regional lung dose (equivalent dose in 2-Gy fractions, EQD2). Pearson correlation and t-tests were used to determine statistical significance, and weighted sum of squares linear regression subsequently characterized the dose-dependence of each functional component. Pulmonary function testing (PFT) metrics forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) were also acquired at each timepoint. ResultsCompared to pre-RT baseline, 3-month post-RT ventilation decreased by an average of -0.24±0.05 %/Gy (ρ=-0.88; P<.001), membrane uptake increased by 0.69±0.14 %/Gy (ρ=0.94; P<.001), and RBC transfer decreased by -0.41±0.06 %/Gy (ρ=-0.92; P<.001). Membrane uptake maintained a strong positive correlation with regional dose at 8 months post-RT, demonstrating an increase of 0.73±0.11 %/Gy (ρ=0.92; P=.006). Changes in membrane uptake and RBC transfer appeared greater in magnitude (%/Gy) for subjects with low heterogeneity in their baseline lung function. An increase in whole-lung membrane uptake showed moderate correlation with decreases in FVC (ρ=-0.50; P=0.17) and DLCO (ρ=-0.44; P=0.23), with neither correlation reaching statistical significance. ConclusionHyperpolarized-129Xe MRI measured and quantified regional, RT-associated, dose-dependent changes in pulmonary gas exchange. This tool could enable future work to improve our understanding and management of RILI.

Factors related to lung function outcomes in critically ill COVID-19 patients in South Korea.

New variants of the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic continue to emerge. However, little is known about the effect of these variants on clinical outcomes. This study evaluated the risk factors for poor pulmonary lung function test (PFT). The study retrospectively analyzed 87 patients in a single hospital and followed up by performing PFTs at an outpatient clinic from January 2020 to December 2021. COVID-19 variants were categorized as either a non-delta variant (November 13, 2020-July 6, 2021) or the delta variant (July 7, 2021-January 29, 2022). The median age of the patients was 62 years, and 56 patients (64.4%) were male. Mechanical ventilation (MV) was provided for 52 patients, and 36 (41.4%) had restrictive lung defects. Forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO ) were lower in patients on MV. Male sex (odds ratio [OR], 0.228) and MV (OR, 4.663) were significant factors for decreased DLCO . The duration of MV was associated with decreased FVC and DLCO . However, the type of variant did not affect the decrease in FVC (P=0.750) and DLCO (P=0.639). Among critically ill COVID-19 patients, 40% had restrictive patterns with decreased DLCO . The reduction of PFT was associated with MV, type of variants.

Spirometric Assessment of Pulmonary Function Tests in Asthma Patients.

Asthma is a chronic airway inflammatory disorder that imposes substantial morbidity and mortality. Spirometry is a significant tool for the objective measurement ofobstruction amongasthmatics. The present study was conducted to assess the pulmonary function test parameters among asthmatics and compare the observed and predicted values. This cross-sectional research was performed on 120 asthmatic patients who attended a tertiary care healthcare center and underwent spirometry evaluation. The spirometry indices such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, peak expiratory flow rate (PEFR), and maximal voluntary ventilation (MVV) were recorded. Further, a gender-wise comparisonof spirometry indices was also done. There was a substantial decrease in FVC (2.05 ± 0.12 vs. 2.75 ± 0.24 L/sec; p = 0.02), FEV1 (1.78 ± 0.16 vs. 2.38 ± 0.32 L/sec; p = 0.01), FEV1/FVCratio (74 ± 4.38 vs. 83 ± 5.76 %; p = 0.01), PEFR (4.76 ± 0.42 vs. 5.82 ± 0.65 L/sec; p = 0.03), and MVV (78.65 ± 28.45 vs. 115.87 ± 32.15 L/min; p = 0.001) for observed andpredicted values.Female asthmatic patients displayed a substantial decline in FVC (p = 0.001), FEV1 (p = 0.006), FEV1/FVC (p = 0.001), and MVV (p = 0.01) when compared to males. This study suggests that asthmatic individuals had impaired lung function upon initial assessment.Female asthmatic patients studied are at increased risk of asthma severity when compared to males.

The effectiveness of early administration of antifibrotic therapy as a reflection of properly organized medical care for patients with progressive pulmonary fibrosis

The issues of organization of medical care and early administration of antifibrotic therapy in patients with progressive fibrotic phenotype require in-depth study and implementation in real clinical practice.The aim of this paper is to provide a rationale for the early administration of antifibrotic drugs in patients with various forms of interstitial lung disease.Results. The article addresses organizational issues in the medical care for interstitial lung disease with a progressive fibrotic phenotype. Topical epidemiological problems are also addressed, in particular the high mortality rate in this disease. The main risk factors of the disease are considered. Diagnostic markers for the fibrosis progression are analyzed. Data from large-scale studies on the early initiation of antifibrotic therapy and its effect on disease outcomes are presented.Conclusion. The main reasons for early initiation of therapy in a progressive fibrotic phenotype are presented: an unfavorable prognosis, an unpredictable course, a progressive decrease in forced vital capacity, and the association of changes in FVC with an increase in mortality. Using the Chelyabinsk region as an example, a model of care for patients with interstitial lung diseases is considered, with a brief analysis of the effectiveness of antifibrotic therapy, its early initiation and the impact on mortality in patients with this disease.

Correlation of Indoor Air Pollutants with Pulmonary Function Test in Children Residing in Biomass Fuel Using Rural Houses of Central Karnataka

Abstract Background and Objectives: Approximately half the world uses biomass fuel for domestic energy, resulting in widespread exposure to indoor air pollution from biomass smoke. It is not clear what relationship exists between biomass use and pulmonary function. The aim of this study was to evaluate the effects of chronic exposure to biomass fuel smoke in children on pulmonary function test (PFT) parameters and its association with the particulate matter load. Materials and Methods: Children residing in rural houses in Central Karnataka using biomass fuel for cooking and heating water were selected and evaluated for PFTs by RMS Helios 401 spirometer. Particulate matter &lt;2.5 (PM2.5) concentrations were measured using an air quality pollution monitor. The association between PM2.5 and lung functions was studied. Results: A total of 150 children were included in the study. The study participants were assessed for the amount of exposure to particulate matter. Significant exposure to PM2.5 and hydrocarbons with a mean exposure of 42.25 mcg/m3 and 160.47 mg/m3, respectively, was recorded. Exposure to formaldehyde in the kitchen and living area showed a statistically significant decrease in forced vital capacity (FVC) and forced expiratory volume 1 (FEV1) and a normal FEV1/FVC ratio indicating a restrictive pattern. It also showed a statistically significant effect on forced expiratory flow 25%–75% indicating a small airway obstructive pattern. Conclusion: Long-term exposure to PM2.5 and formaldehyde from biomass fuel burning is associated with reduced lung function. This study reinforces the urgency of global strategies to mitigate indoor air pollution for the improvement of pulmonary health.

An Evaluation of the Impact of Air Pollution on the Lung Functions of High School Students Living in a Ceramic Industrial Park Zone

Santa Gertrudes (SG) and Rio Claro (RC), Sao Paulo, Brazil, are located in a ceramic industrial park zone, and their particulate matter with an aerodynamic diameter of less than 10 µm (PM10) concentration levels has been among the highest in recently monitored cities in Brazil. Local PM10 was mostly composed of silica. A cross-sectional study was designed to evaluate the lung functions of public high school students in SG, RC, and São Pedro (SP) (control location), Brazil, in 2018. The prevalence of asthma, mean PM10, FVC (forced vital capacity), and FEV1 (forced expiratory volume in the first second) were compared between the locations, and regression analyses were performed. A total of 450 students were included (SG: 158, RC: 153, and SP: 139). The mean FVC% (SG: 95.0% ± 11.8%, RC: 98.8% ± 12.9%, SP: 102.4% ± 13.8%, p &lt; 0.05), the mean FEV1% (SG: 95.7% ± 10.4%, RC: 99.7% ± 12.0%, SP: 103.2% ± 12.0%, p &lt; 0.05) and the mean PM10 (SG: 77.75 ± 38.08 µg/m3, RC: 42.59 ± 23.46 µg/m3, SP: 29.52 ± 9.87 µg/m3, p &lt; 0.01) differed between locations. In regression models, each increase in PM10 by 10 µg/m3 was associated with a decrease in FVC% by 1.10% (95% CI 0.55%–1.65%) and a decrease in FEV1% by 1.27% (95% CI 0.75%–1.79%). Exposure to high levels of silica-rich environmental PM10 was found to be associated with lower FVC and FEV1.

Cross-sectional and longitudinal associations of dichlorodiphenyltrichloroethane (DDT) metabolites exposure with lung function alternation in the Chinese general adults

Exposure of dichlorodiphenyltrichloroethane (DDT) pesticide was suggested to be associated with adverse effects on the respiratory system. However, the effects of DDT exposure on lung function remain unclear. Our objectives were to investigate the potential associations of internal levels of DDT and its metabolites including dichlorodiphenyldichloroethylene (DDE) and dichlorodiphenyldichloroethane (DDD) with lung function. Serum DDT, DDE, and DDD concentrations and lung function were measured among 3968 general adults from the Wuhan-Zhuhai cohort. The cross-sectional and longitudinal associations of serum DDT and its metabolites with lung function were assessed using linear mixed models. The results showed negative dose-response relationships of serum DDT, DDE, and DDD levels with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). In the cross-sectional analyses, each 1-unit increase in natural log-transformed values of p,p′-DDE, o,p′-DDT, o,p′-DDE, or p,p′-DDD was significantly associated with a 25.77-, 44.84-, 51.13-, or 43.44-mL decrease in FVC, respectively. Each 1-unit increase in natural log-transformed values of o,p′-DDT, o,p′-DDE, o,p′-DDD, or p,p′-DDD was significantly associated with a 35.72-, 31.87-, 29.54-, or 36.80-mL decrease in FEV1, respectively. In the three-year longitudinal analyses, each 1-unit increase in natural log-transformed serum p,p′-DDT and p,p′-DDE was significantly associated with a 35.10 mL and 36.38 mL decrease in FVC, and a 26.32 mL and 32.37 mL decrease in FEV1, respectively. In conclusion, DDT and its metabolites exposure were associated with lung function decline in the general Chinese adult population.

Tocilizumab in Patients with Systemic Sclerosis-associated Interstitial Lung Disease: A Systematic Review and Meta-Analysis.

Background: The American Thoracic Society (ATS) convened an international, multidisciplinary panel to develop clinical practice guidelines for the treatment of systemic sclerosis-associated interstitial lung disease (SSc-ILD). Objective: To conduct a systematic review and evaluate the literature to determine the impact of treating patients with SSc-ILD with tocilizumab on prespecified critical and important outcomes determined by the ATS guideline panel. Data Sources: A literature search was conducted across MEDLINE, EMBASE, and Cochrane databases through June 2022 for studies using tocilizumab to treat patients with SSc-ILD. Data Extraction: Mortality and disease progression were determined to be critical outcomes of focus, with quality of life and adverse events important outcomes. Data on these outcomes were extracted and meta-analyses performed using the generic inverse variance method when possible. The Grading of Recommendations, Assessment, Development, and Evaluation Working Group method was used to assess the quality of evidence. Synthesis: The literature review resulted in five studies for inclusion. The absolute decrease from baseline in forced vital capacity (FVC) for the tocilizumab arm was 118 ml, 241 ml, and 129 ml less than the placebo arm at 24, 48, and 96 weeks, respectively, favoring tocilizumab. The mean decrease in FVC% predicted at 48 weeks was 6.50% less and the risk of decrease >10% was 66% less in the tocilizumab arm, whereas patients were 1.97 times more likely to have any increase in FVC% predicted if they received tocilizumab in place of placebo. When the placebo arm was given tocilizumab from 48 to 96 weeks, the mean change in absolute FVC was 54.90 ml less and the mean change in FVC% predicted was 1.30% less. For diffusing capacity of the lung for carbon monoxide (DlCO)% predicted, at 48 weeks there was 1.50% less change and from 48 to 96 weeks there was 5.40% less change in the tocilizumab arm. Quantitative Interstitial Lung Disease scores and Quantitative Lung Fibrosis scores at 48 weeks and modified Rodnan skin scores at 72 weeks all favored the tocilizumab arm, as did several adverse event parameters, including serious adverse events (mean difference, -27.40; 95% confidence interval, -30.10 to -24.70). The quality of evidence was very low grade. Conclusions: Tocilizumab use in patients with SSc-ILD is associated with less disease progression and a better toxicity profile than placebo. However, the quality of evidence is very low, and large prospective studies dedicated to assessing tocilizumab specifically for SSc-ILD are needed.

Impact of chronic fibrosing interstitial lung disease on healthcare use: association between fvc decline and inpatient hospitalization

BackgroundMany types of interstitial lung diseases (ILDs) may transition to progressive chronic-fibrosing ILDs with rapid lung function decline and a negative survival prognosis. In real-world clinical settings, forced vital capacity (FVC) measures demonstrating progressive decline may be linked to negative outcomes, including increased risks of costly healthcare resource utilization (HRU). Thus, we assessed the relationship between rate of decline in lung function and an increase in HRU, specifically inpatient hospitalization, among patients with chronic fibrosing ILD.MethodsThis study utilized electronic health records from 01-Oct-2015 to 31-Oct-2019. Eligible patients (≥ 18 years old) had ≥ 2 fibrosing ILD diagnosis codes, clinical activity for ≥ 15 months, and ≥ 2 FVC tests occurring 6 months apart. Patients with missing demographic data, IPF, or use of nintedanib or pirfenidone were excluded. Two groups were defined by relative change in percent of predicted FVC (FVC% pred) from baseline to 6 months: significant decline (≥ 10%) vs. marginal decline/stable FVC (decrease < 10% or increase). The primary outcome was defined as the occurrence of an inpatient hospitalization 6 months after the first FVC value. Descriptive and multivariable analysis was conducted to examine the impact of FVC decline on occurrence of inpatient hospitalization.ResultsThe sample included 566 patients: 13% (n = 75) with significant decline and 87% (n = 491) with marginal decline/stable FVC; their mean age (SD) was 65 (13.7) years and 56% were female. Autoimmune diagnoses were observed among 40% of patients with significant decline, and 27% with marginal decline/stable FVC. The significant decline group had better lung function at baseline than the marginal/stable group. For patients with FVC% <80% at baseline, reduction of FVC% ≥10% was associated with significantly increased odds of an inpatient hospitalization (odds ratio [OR] 2.85; confidence interval [CI] 1.17, 6.94 [p = 0.021]).ConclusionDecline in FVC% ≥10% was associated with increased odds of inpatient hospitalization among patients with reduced lung function at baseline. These findings support the importance of preserving lung function among patients with fibrosing ILD.