Decrease In Peak Expiratory Flow Research Articles

The relationship between changes in peak expiratory flow and asthma exacerbations in asthmatic children

BackgroundAsthma is one of the most common chronic airway diseases in children. Preventing asthma exacerbation is one of the objectives of all asthma action plans. In patients with poor perception, it is difficult to identify acute asthma exacerbations by clinical asthma score, asthma control test or asthma control questionnaire. The aim of this study is to analyze whether children with asthma have changes in peak expiratory flow(PEF)before an acute asthma exacerbation and to evaluate the relationship between PEF and asthma exacerbation.MethodsBasic information (including sex, age, atopy, etc.) and clinical information of asthmatic children who registered in the Electronic China Children’s Asthma Action Plan (e-CCAAP) from 1 September 2017 to 31 August 2021 were collected. Subjects with 14 consecutive days of PEF measurements were eligible. Subjects in this study were divided into an exacerbation group and a control group. We analyzed the relationship between changes in PEF% pred and the presence of asthma symptoms.ResultA total of 194 children with asthma who met the inclusion criteria were included, including 144 males (74.2%) and 50 females (25.8%), with a male-to-female ratio of 2.88:1. The mean age of the subjects was 9.51 ± 2.5 years. There were no significant differences in sex, age, allergy history or baseline PEF between the two groups. In children with and without a history of allergy, there was no significant difference between the variation in PEF at 14 days. Patients who only had a reduced in PEF but no symptoms of asthma exacerbation had the greatest reduction in PEF compared to the other groups. The most common cause of acute exacerbations of asthma is upper respiratory tract infection. Among the causes of acute exacerbations of asthma, the variation in PEF caused by air pollution was significantly higher than that of other causes (P < 0.05). In acute exacerbations, the decrease in PEF was significantly greater in the exacerbation group than in the control group. In children with asthma symptoms, there was a decrease in PEF approximately 1.34 days before the onset of symptoms.ConclusionChildren with asthma show a decrease in PEF 1.34 days before the onset of asthma symptoms. We recommend that asthmatic children who show a decrease in PEF should step-up asthma therapy. The most common cause of acute exacerbations of asthma was upper respiratory tract infections, and the variation in PEF caused by air pollution was significantly higher than that caused by other factors.

Relation of changes in PEF and FEV1 in exercise challenge in children.

Decrease in forced expiratory volume in one second (FEV1 ) of 10% or 15% in exercise challenge test is considered diagnostic for asthma, but a decrease of 15% in peak expiratory flow (PEF) is recommended as an alternative. Our aim was to assess the accuracy of different PEF cut-off points in comparison to FEV1 . We retrospectively studied 326 free running exercise challenge tests with spirometry in children 6-16 years old. FEV1 and PEF were measured before and 2, 5, 10 and 15 min after exercise. Receiver operating characteristics (ROC) analysis, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and ϰ-coefficient were used to analyse how decrease in PEF predicts decrease of 10% or 15% in FEV1 . In the ROC analysis, areas under the curve were 0.851 (p < 0.001) and 0.921 (p < 0.001) for PEF decrease to predict a 10% and 15% decrease in FEV1 , respectively. The agreement between changes in PEF and FEV1 varied from slight to substantial (ϰ values of 0.199-0.680) depending on the cut-points. Lower cut-off for decrease in PEF had higher sensitivity and NPV, while higher cut-off values had better specificity and PPV. Decrease of 20% and 25% in PEF seemed to be the best cut-offs for detecting 10% and 15% decrease in FEV1 , respectively. Still, a fifth of the positive findings based on PEF were false. Change in PEF is not a precise predictor of change in FEV1 in exercise test. The currently recommended cut-point of 15% decrease in PEF seems to be too low and leads to high false positive rate.

THE EFFECT OF BUTEYKO BREATHING EXERCISE ON INCREASING PEAK EXPIRATIONAL FLOW IN THE ELDERLY AT THE TRESNA WERDHA BUDI MULIA III SOCIAL HOME

Background: Aging is the cause of widespread progressive changes in all aspects of biology that result in susceptibility to various diseases. The changes seen in the decrease in peak expiratory flow due to age often cause less air to enter the body. A decrease in peak expiratory flow will result in hypoxemia and hypercapnia which will lead to respiratory failure.. Buteyko Breathing Exercise is an intervention that supports increasing peak expiratory flow so that it can open the breathing path. Objective: Knowing the Effect of Buteyko Breathing Exercise on Increasing Peak Expiratory Flow in the Elderly. Method: This study uses the type of experimental research with one group pretest - posttest which is carried out at the Tresna Budi Mulia III Social Institution. In this study using 13 respondents who were selected using the Random Sampling Technique. Measurement of Peak Expiratory Flow using a Peak Flow Meter on baseline and final data after intervention for 4 weeks with a frequency of 2 times a week. Results: Changes in the increase in peak expiratory flow before and after the intervention obtained a value of p = 0.000 (p &lt; 0.05). Conclusion: There is an effect of Buteyko Breathing Exercise on Increasing Peak Expiratory Flow in the Elderly at Tresna Werdha Budi Mulia III Social Home.

Short-term effects of the chemical components of fine particulate matter on pulmonary function: A repeated panel study among adolescents

The effects of the chemical components of fine particulate matter (PM2.5) have been drawing attention. However, information regarding the impact of low PM2.5 concentrations is limited. Hence, we aimed to investigate the short-term effects of the chemical components of PM2.5 on pulmonary function and their seasonal differences in healthy adolescents living on an isolated island without major artificial sources of air pollution. A panel study was repeatedly conducted twice a year for one month every spring and fall from October 2014 to November 2016 on an isolated island in the Seto Inland Sea, which has no major artificial sources of air pollution. Daily measurements of peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1) were performed in 47 healthy college students, and the concentrations of 35 chemical components of PM2.5 were analyzed every 24 h. Using a mixed-effects model, the relationship between pulmonary function values and concentrations of PM2.5 components was analyzed. Significant associations were observed between several PM2.5 components and decreased pulmonary function. Among the ionic components, sulfate was strongly related to decreases in PEF and FEV1 (−4.20 L/min [95 % confidence interval (CI): −6.40 to −2.00] and − 0.04 L [95 % CI: −0.05 to −0.02] per interquartile range increase, respectively). Among the elemental components, potassium induced the greatest reduction in PEF and FEV1. Therefore, PEF and FEV1 were significantly reduced as the concentrations of several PM2.5 components increased during fall, with minimal changes observed during spring. Several chemical components of PM2.5 were significantly associated with decreased pulmonary function among healthy adolescents. The concentrations of PM2.5 chemical components differed by season, suggesting the occurrence of distinct effects on the respiratory system depending on the type of component.

The acute effects of particulate air pollution on lung function in asthmatic children: A multicenter study with intensively repeated measurements

Evidence on the comparative effects of fine particulate matter (PM2.5) and coarse particulate matter (PM10-2.5) on the lung function of asthmatic children remained limited and inconsistent. This study aims to explore the acute effect of PM2.5 and PM10-2.5 on dynamic forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) among asthmatic children. We conducted a multicenter study and obtained intensively repeated measurements of FEV1 and PEF of clinically diagnosed asthmatic children in 89 Chinese cities from January 2017 to May 2021. Linear mixed-effects models combined with a polynomial distributed lag model were employed to evaluate the cumulative lag effect of PM2.5 and PM10-2.5 on daily FEV1 and PEF among asthmatic children. We also evaluated the effect modifications by sex, age, testing time, season, and region. A total of 590 clinically diagnosed asthmatic children with over 0.18 million dynamic lung function records were included in this study. The adverse effect of particulate matter on lung function occurred in a short term and could last for around one week. Specifically, both PM10-2.5 and PM2.5 were associated with decreases in PEF, but only PM10-2.5 could impair the measurements of FEV1. We found that an interquartile range increase in PM10-2.5 and PM2.5 were associated with 5.40 [95% confidence interval (CI): 0.88, 9.92] mL/s and 10.48 (95%CI: 5.14, 15.81) mL/s decrease in PEF, 6.46 (95%CI: 4.53, 8.40) mL and 0.25 (95%CI: −2.03, 2.54) mL decreases in FEV1, respectively. And the estimated effect of PM10-2.5 was stronger than PM2.5 on FEV1. Besides, these changes were larger in the evening and the south region of China. In conclusion, short-term exposure to both PM2.5 and PM10-2.5 could decrease the daily lung function of asthmatic children. The impact of PM10-2.5 was more hazardous than PM2.5.

Effect of Acute PM2.5 Exposure on Lung Function in Children: A Systematic Review and Meta-Analysis.

The objective of this study was to conduct a systematic review and meta-analysis to identify the adverse effects of acute PM2.5 exposure on lung function in children. Systematic review and meta-analysis. Setting, participants and measures: Eligible studies analyzing PM2.5 level and lung function in children were screened out. Effect estimates of PM2.5 measurements were quantified using random effect models. Heterogeneity was investigated with Q-test and I2 statistics. We also conducted meta-regression and sensitivity analysis to explore the sources of heterogeneity, such as different countries and asthmatic status. Subgroup analyses were conducted to determine the effects of acute PM2.5 exposure on children of different asthmatic status and in different countries. A total of 11 studies with 4314 participants from Brazil, China and Japan were included finally. A 10 μg/m3 increase of PM2.5 was associated with a 1.74L/min (95% CI: -2.68, -0.90) decrease in peak expiratory flow (PEF). Since the asthmatic status and country could partly explain the heterogeneity, we conducted the subgroup analysis. Children with severe asthma were more susceptible to PM2.5 exposure (-3.11 L/min per 10 μg/m3 increase, 95% CI -4.54, -1.67) than healthy children (-1.61 L/min per 10 μg/m3 increase, 95% CI -2.34, -0.91). In the children of China, PEF decreased by 1.54 L/min (95% CI -2.33, -0.75) with a 10 μg/m3 increase in PM2.5 exposure. In the children of Japan, PEF decreased by 2.65 L/min (95% CI -3.82, -1.48) with a 10 μg/m3 increase of PM2.5 exposure. In contrast, no statistic association was found between every 10 μg/m3 increase of PM2.5 and lung function in children of Brazil (-0.38 L/min, 95% CI -0.91, 0.15). Our results demonstrated that the acute PM2.5 exposure exerted adverse impacts on children's lung function, and children with severe asthma were more susceptible to the increase of PM2.5 exposure. The impacts of acute PM2.5 exposure varied across different countries.

Reduced peak expiratory flow predicts increased risk of cardiovascular disease: A 10-year prospective cohort study in Eastern China

BackgroundThe correlation between impaired lung function and cardiovascular diseases (CVD) has attracted more and more attention. We aimed to assess the longitudinal association between decreased peak expiratory flow (PEF) and cardiovascular risk among Eastern Chinese general population. MethodsIn total, 6295 participants aged>30 years and free of CVD at baseline were followed for up to 10 years in Eastern China. The adjusted hazard ratios (HRs) for CVD and mortality associated with decreased PEF were analyzed. ResultsAmong all participants, 421 CVD incident events were reported during 10-year follow-up, and a total of 272 participants died during the follow-up period, 94 of them from CVD. The HRs in the lowest group of PEF (PEF ≤218.33 L/min) were 1.31 (95% confidence interval [CI]:1.01 to 1.68) for high CVD incidence (172 vs 116), 2.43 (95% CI:1.72 to 3.42) for all-cause mortality (156 vs 48), and 3.94 (95% CI:1.96 to 7.92) for CVD mortality (59 vs 10) when compared with the highest group (PEF ≥321.68 L/min). ConclusionThe decreased PEF was associated with increased CVD incidence, CVD and all-cause mortality in Eastern Chinese general population.

The Correlation of Peak Expiratory Flow Rate and Hand Dynamometry in Chronic Obstructive Pulmonary Disease Patients A Case Control study

Objectives: To determine the correlation of peak expiratory flow rate and hand dynamometry in patients with chronic obstructive pulmonary disease and to find out the differences between hand grip in cases and control group Methodology: This study was carried out in the Department of Physiology and Department of Chest Medicine, Liaquat National Hospital and Medical College between July 1st 2019 and June 30th 2020 after the approval of the research and ethical committee of the same hospital. We used purposive sampling technique. Total 100 consenting individuals were recruited that were equally divided into control group and chronic obstructive pulmonary disease group. Anthropometric measurements alongwith peak expiratory flow rate and hand dynamometry values were measured. Results: We found significant difference in hand grip strength and peak expiratory flow rate between the case and control groups, chronic obstructive pulmonary disease patients have decreased peak expiratory flow rate and handgrip strength. Weak correlation exists between peak expiratory flow rate and hand grip strength with significant p value. No relationship was found between waist hip ratio and hand grip. Also, body mass index showed a weak negative but statistically significant correlation with hand grip strength. Conclusion: In chronic obstructive pulmonary disease patients, hand grip strength is decreased and determining hand grip strength may ensures quick assessment of quality of life.

Personal PM2.5-bound PAH exposure and lung function in healthy office workers: A pilot study in Beijing and Baoding, China

The effect of short-term exposure to polycyclic aromatic hydrocarbons (PAHs) on the respiratory system among healthy residents is unclear. Beijing and Baoding are typical polluted cities in China, and there is little research on PAH exposure and its health effects at the individual level. Fourteen healthy female office workers were recruited in urban Beijing and Baoding, China, in 2019. The personal exposure to fine particulate matter (PM2.5)-bound PAHs and lung function were seasonally monitored. The relationships between PAH exposure and lung function were determined by a generalized mixed linear model. Subjects were exposed to high levels of PAH, in which the benzo[a]pyrene (BaP) level (1.26 ng/m3) was over than Chinese national indoor standard (1 ng/m3). All PAHs concentration was higher in winter than that in summer and autumn. Only benz[a]anthracene (BaA) and chrysene (Chr) exposure showed weak relations with decreased lung function, i.e., a 0.58% and 0.73% decrease in peak expiratory flow at lag 2 day, respectively (p < 0.05). PAHs may not be suitable exposure indicators for short-term change in lung function. Our findings highlight the importance of reducing PAH pollution for public respiratory health protection in heavy-polluted cities of China. This pilot study also provides experience on personal PAH assessment such as estimation of the number of repeated measurements required, which is helpful to determine the relationship between PAH exposure and health effect.

Changes in Cough Airflow and Acoustics After Injection Laryngoplasty.

We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology. Prospective interventional study. Subjects with glottic insufficiency secondary to unilateral vocal fold paresis, paralysis, or atrophy, and scheduled for injection laryngoplasty completed an instrumental assessment of voluntary cough airflow using a pneumotachometer and a protocolized voluntary cough sound recording. A Wilcoxon signed-rank test was used to compare the differences between pre- and post-injection laryngoplasty in airflow and acoustic measures. A Spearman rank-order correlation was used to evaluate the association between airflow and acoustic cough measures. Twenty-five patients (13F:12M, mean age 68.8) completed voluntary cough airflow measurements and 22 completed cough sound recordings. Following injection laryngoplasty, patients had a statistically significant decreased peak expiratory flow rise time (PEFRT) (mean change: -0.03 s, SD: 0.06, p=0.04) and increased cough volume acceleration (mean change: 13.1 L/s2 , SD: 33.9, p=0.03), suggesting improved cough effectiveness. Correlation of cough acoustic measures with airflow measures showed a weak relationship between PEFRT and acoustic energy (coefficient: -0.31, p=0.04) and peak power density (coefficient: -0.35, p=0.02). Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds. 3 Laryngoscope, 133:S1-S14, 2023.

Adiposity: Determinant of Peak Expiratory Flow Rate in Young Indian Adults Male

Although several factors such as respiratory muscle strength, lung compliance, resistance to airflow, and even obesity affect the lung functions, the nature of relationship with markers of adiposity is not clear. We hypothesised that central pattern of fat distribution is a significant predictor of decreased peak expiratory flow rate (PEFR). The present study was designed with the aim to examine the effects of adiposity on PEFR in males. One hundred young healthy male volunteers were analysed in the study. They were classified into non-obese, and obese groups based on body mass index (BMI) (obese > or = 30 Kg/m2 and non-obese < 30 Kg/m2). The PEFR was measured by using Wright's peak flow meter. Data was analysed using unpaired 't' test for statistical significance of differences between the non-obese and the obese, stratified into age groups of 20 to 30 years and 30 to 40 years. A partial correlation adjusted to age, height and BMI followed by regression analysis was conducted using adiposity markers as a predictor of PEFR. The model adjusted to age, height, weight and BMI revealed waist hip ratio (WHR) as the only parameter which shows significant variance in PEFR with a Pearson's r=-0.59, F (1, 100)=12.23, p=0.04. The resulting linear regression equation is y=-388.72xWHR+850.68. Our findings suggest that obesity itself and especially the pattern of body fat distribution have independent effects on PEFR. These results suggest that abdominal adiposity, measured as WHR, is a better predictor of expiratory flow than weight or BMI.

The impact of obstructive sleep apnea on quality of life in children with asthma

Background In children with asthma, obstructive sleep apnea (OSA) is a comorbidity of concern. The presence of OSA has been associated with asthma exacerbations and decreased quality of life. Leukotriene played a role in tonsil hypertrophy which is one of the risk factors for OSA.&#x0D; Objective To evaluate the influence of OSA on quality of life in children with asthma.&#x0D; Methods This cross-sectional study in asthmatic children aged 7?15 years was conducted from August 2020 to June 2021 at government elementary and primary high schools in Bandung, West Java, Indonesia. Asthma was diagnosed by peak expiratory flow rate (PEFR) and OSA was diagnosed by polysomnography. Leukotriene was examined by an ELISA method and quality of life assessed by the Pediatric Asthma Quality of Life Questionnaire (PAQLQ).&#x0D; Results Using the ISAAC questionnaire distributed through teachers to parents, 206 (6.9%) of 2,964 children stated that they had been diagnosed with asthma, 80 of whom were included in our study. Subjects’ mean age was 12 (SD 2) years and most were male. Intermittent asthma and history of allergy was dominant. Thirty-two children had OSA, mostly mild OSA. The mean level of leukotriene was not different between asthmatic children with and without OSA. The percentage of PEFR in asthmatic children with OSA was significantly lower than in those without OSA. The total PAQLQ score in asthmatic children with OSA and all PAQLQ domains were significantly lower than in those without OSA.&#x0D; Conclusion Obstructive sleep apnea in children with asthma is significantly associated with decreased peak expiratory flow rate and lower quality of life.

Identifying the threshold of outdoor PM2.5 reversing the beneficial association between physical activity and lung function: A national longitudinal study in China

BackgroundDespite cumulative evidence reports the interaction effects of physical activity (PA) and air pollution on lung function, the findings have been inconsistent. We aimed to identify the threshold values that reverse the beneficial effects of PA on lung function. MethodsThis multistage probability sampling study examined 13,032 individuals aged ≥45 years across China from 2011 to 2015. City-level particulate matter 2.5 μm or less in diameter (PM2.5) were estimated based on a two-stage machine learning model, with a spatial resolution of 0.1° × 0.1°. We assessed PA and a range of covariates using standardized self-reported questionnaires. The peak expiratory flow (PEF) was measured using a peak flow meter. We used mixed-effects linear regression models to examine the associations between PA and PM2.5, and their interactions with PEF. ResultsParticipants were 60.4 ± 9.4 years old [mean ± standard deviation (SD)]. The mean ± SD of PM2.5 and PEF was 54.4 ± 23.0 μg/m3 and 273 ± 116 L/min, respectively. Each 10 μg/m3 increase in PM2.5 was associated with a 1.27 L/min decrease in PEF. The PEF increased by 2.48 (95% confidence interval, CI: 0.40, 4.55) L/min, 0.74 (95% CI: −1.17, 2.66) L/min, and 1.99 (95% CI: 0.001, 3.99) L/min following a 10 h/week increment of walking, moderate intensity PA, and vigorous intensity PA, respectively. Detrimental associations between PM2.5 and PEF outweighed PA benefits for approximate PM2.5 concentrations >81 μg/m3 (95% CI: 58.9, 111) and >77 μg/m3 (95% CI: 39.7, 102) for walking and vigorous intensity PA, respectively. ConclusionsWe identified the threshold of ambient PM2.5 above which the beneficial association of PA with lung function may be reversed to an adverse one. Although the threshold may vary across populations and places, the findings suggested that reducing air pollution could enhance the benefits of PA on lung function.

Gambaran Arus Puncak Ekspirasi Pada Penderita Asma Di Wilayah Kerja Puskesmas Mujur

Asthma is one of lung diseases caused by inflammation, it causes the asthma sufferers to experience breath difficulty which results in the decrease of PEF (Peak Expiratory Flow) scores. The purpose of this research was to obtain knowledge about PEF on asthma sufferers in Puskesmas Mujur. The method of this research was descriptive with design cross sectional. There were 38 respondents as samples of this research for two weeks. An instrument applied in this research was peak flow meter to measure PEF scores of patients. The result of this research showed that twenty-five respondents PEF scores (65.6%) are in red zone (&lt;50%) and thirteen people (34.4%) are in yellow zone (50%). The conclusion of this research is that peak expiratory flow decreases in patients suffering asthma.

Decreased peak expiratory flow rate associated with mortality in idiopathic pulmonary fibrosis: A preliminary report.

ObjectivesThe peak expiratory flow rate (PEFR) is known to decrease in patients with sarcopenia. However, little is known about the clinical impact of the PEFR in idiopathic pulmonary fibrosis (IPF). This study aimed to confirm whether a decrease in PEFR over 6 months was associated with survival in IPF patients.MethodsConsecutive IPF patients who had been assessed at a single center were retrospectively analyzed. The relative decline in PEFR over 6 months was assessed. Survival analyses were performed by univariate and multivariate Cox proportional hazard models.ResultsA total of 61 eligible cases (average age 70 years) were examined, and 21 patients (34.4%) died. The univariate Cox regression analysis showed that the body mass index, baseline % predicted forced vital capacity (FVC), baseline % predicted PEFR, % predicted diffusion capacity for carbon monoxide (DLCO), relative decline in FVC, and relative decline in PEFR were prognostic factors. On multivariate analyses, relative decline in PEFR (hazard ratio [HR] 1.037, p < .05) and baseline % predicted FVC (HR 0.932, p < .001) were independent prognostic factors, whereas relative decline in FVC was not.ConclusionA decrease in PEFR after 6 months may predict worse survival in patients with IPF.

Abstract 10313: Gender and Strain Background Affect Cardiopulmonary Function in Col4a3 -/- Alport Mice

Background: Alport syndrome (AS) is a hereditary form of chronic kidney inflammation that results in renal failure (RF). We previously reported that Col4a3 -/- 129J mice, a model of AS and RF, exemplified multiple features of heart failure with preserved ejection fraction (HFpEF). This study investigates the effect of 3 different genetic backgrounds on cardiopulmonary function in Col4a3 -/- mice. Methods: Male and female Col4a3 -/- (Alport) and WT mice from 129x1/SvJ, C57Bl/6 and BALBC strain were examined using echocardiography, whole body plethysmography (WBP) and pressure-volume (PV) loop analysis. Ttest was used for statistical analysis. Four groups per strain were used (n= 4-15/group). Results: Compared with their respective age-matched WT controls, male and female 8-week-old Col4a3 -/- 129x1/SvJ mice demonstrated impaired systolic function (EF of 56 to 43.7%, p=.002 for females and 50.9 to 42% for males, p=.044; SV, CO, p&lt;.05) and diastolic dysfunction (increased IVRT from 15.3 to 21.7ms, p=.0009 for females; 16.6 to 26.2ms, p&lt;.0001 for males; increased MPI, P&lt;.05). Additionally, PV loop analysis showed an increased EDPVR and end diastolic pressure, prolonged time constant of LV relaxation, and decreased CO and SV (p&lt;0.05). For Col4a3 -/- BalbC and Col4a3 -/- C57Bl/6 strains, only females exhibited systolic (BalbC: EF% 51 to 45.66%, p=0.106 for females and 43.5 to 40.8% for males, p=.51; B6: EF% 51.3 to 40.8% p=.02 for females and 48.4 to 40.9%, p=.31 for males; SV, CO, p&lt;.05) and diastolic dysfunction (IVRT from 16 to 24.1ms for BalbC and 18.20 to 25.63ms for B6, p&lt;0.05). Male Col4a3 -/- BalbC had an increase in minimum and end-systolic pressures, and an increased pressure at dV/dt-max. Male Col4a3 -/- C57Bl/6 mice had an increased ESPVR slope (p&lt;.05). All strains except BalbC males demonstrated alterations (p&lt;.05) in pulmonary function including decreased ventilation rate (MV) and respiratory frequency, decreased peak expiratory flow, EF50, increased expiratory time, relaxation time, inspiratory time, and time of pause at end-of-expiration. Conclusion: Both male and female Col4a3 -/- 129x1/SvJ mice demonstrated impaired cardiopulmonary viability. However, Col4a3 -/- mice on BalbC or C57Bl/6 strains had cardiopulmonary deficits only in females.

Abstract P390: Gender And Strain Background Affect Cardiopulmonary Function In Col4a3 -/- Alport Mice

Background: Alport syndrome (AS) is a hereditary form of chronic kidney inflammation that results in renal failure (RF). Our group previously reported that Col4a3 -/- mice, a model of AS and RF, on 129J background exemplified multiple features of heart failure with preserved ejection fraction (HFpEF). This study investigates the effect of 3 different genetic backgrounds on cardiopulmonary function in Col4a3 -/- mice. Methods: Male and female Col4a3 -/- (Alport) and WT mice on 3 different genetic backgrounds, 129x1/SvJ, C57Bl/6 and BALBC, were examined using echocardiography, whole body plethysmography (WBP) and pressure-volume (PV) loop analysis. Ttest was used for statistical analysis. Four groups per strain were used (n= 4 to 15 per group). Results: Compared with their respective age-matched WT controls, both male and female 8-week-old Col4a3 -/- 129x1/SvJ mice demonstrated impaired systolic function (EF of 56% to 43.7%, p=0.0018 for females and 50.9% to 42% for males, p=0.044; SV, CO, p&lt;0.05) and diastolic dysfunction (increased IVRT from 15.32ms to 21.72ms, p=0.0009 for females; 16.57ms to 26.21ms, p&lt;0.0001 for males; increased MPI, P&lt;0.05). Additionally, PV loop analysis showed an increased EDPVR and end diastolic pressure, prolonged time constant of LV relaxation, and decreased CO and SV (p&lt;0.05). However for Col4a3 -/- BalbC (8-week-old) and Col4a3 -/- C57Bl/6 (20-week-old) strains, only females exhibited systolic (BalbC: EF% 51% to 45.66%, p=0.106 for females and 43.5% to 40.8% for males, p=0.508; B6: EF% 51.30% to 40.80% p=0.024 for females and 48.43% to 40.91%, p=0.3098 for males; SV, CO, p&lt;0.05) and diastolic dysfunction (IVRT from 15.96ms to 24.91ms for Balb/C and 18.20ms to 25.63ms for B6, p&lt;0.05). Male Col4a3 -/- BalbC had an increase in minimum pressure and end-systolic pressure, and an increased pressure at dV/dt-max. Male Col4a3 -/- C57Bl/6 mice had an increased ESPVR slope (p&lt;0.05). All strains except BalbC males demonstrated alterations (p&lt;0.05) in pulmonary function including decreased ventilation rate (MV, mL/min) and respiratory frequency (BPM), decreased peak expiratory flow, EF50, increased expiratory time, relaxation time, inspiratory time, and time of pause at end-of-expiration. Conclusion: Both male and female Col4a3 -/- 129x1/SvJ mice demonstrated impaired cardiopulmonary viability. However, Col4a3 -/- mice on BalbC or C57Bl/6 strains had cardiopulmonary deficits only in females.

A cross sectional study of the morbidity pattern among stone quarry workers and their associated risk factors

Background: Construction sector is a thriving industry which comprises most of the unorganized workers and providing widespread opportunities for employment of most of the poorest and marginalized sections of society in India. The workers are more susceptible to various occupational hazards due to working conditions in dusty environment. This study is proposed to identify the morbidity pattern, availability and usage of safety measures, health care seeking behaviour and health care facilities at the quarry site.Methods: A cross sectional study was conducted among the stone quarry workers of Maduranthakam area in Kancheepuram district from February 2018 to May 2018. The sample size was calculated as 94 and five quarries were selected randomly. The study tool was interview based semi structured questionnaire and clinical examination. Appropriate descriptive and inferential statistics like Chi square test, Fischer’s exact test was done to determine significant association (p&lt;0.05).Results: The common morbidities among the participants were abdominal conditions (54%), injuries (34%) and musculoskeletal disorders (27%). One in five individuals had respiratory problems and those with breathing difficulty had decreased peak expiratory flow rate. Usage of personal protective equipments is low and about 63.8% of them were using government health care facilities.Conclusions: Increasing demand for stone and aggregates has led to extensive stone quarrying operations. Awareness and enforcement of personal protective equipment, vaccination against diseases like tetanus, periodic health check- ups should be enforced for people working in quarries.

Evaluation of muscle-skeletal strength and peak expiratory flow in severely malnourished inpatients with anorexia nervosa: A pilot study

ObjectivesAnorexia nervosa is a complex psychiatric disorder that can lead to specific somatic complications. Malnutrition is frequent and can involve a decrease of mobility, up to functional impotence, in individuals with extremely severe cases. The aim of this pilot study was to examine muscle strength and peak expiratory flow (PEF) in severely undernourished patients with anorexia nervosa at admission and after 5 wk of renutrition by tube feeding, and to find the clinical and biological correlates of muscle-strength impairment. MethodsA prospective observational study was conducted over 6 mo. Manual muscle testing, measures of PEF, and clinical and biologic assessments were performed at baseline and after 5 wk of renutrition. ResultsTwenty-three extremely malnourished female participants (mean body mass index: 11.4 ± 1.3 kg/m2) were included. All participants had global impairment in muscle strength (manual muscle testing: 37.7 ± 7.7) and PEF (253.3 ± 60 mL/min) at admission. Muscle weakness was higher in axial than peripheral muscle groups (P < 0.01), with no significant difference between proximal and distal muscles (P > 0.05). Muscle strength at admission was significantly associated with severity of undernourishment (body mass index and albumin) and transaminitis (P < 0.05). At follow-up, musculoskeletal strength and PEF were significantly improved after partial weight recovery (P < 0.01). ConclusionsExtremely undernourished people with anorexia nervosa present a decrease of PEF and musculoskeletal strength predominant on axial muscles. Both are associated with severity of malnutrition and liver damage. Partial recovery was observed after 5 wk of enteral nutrition.

The effect of acute outdoor air pollution on peak expiratory flow in individuals with asthma: A systematic review and meta-analysis

ObjectivesAcute exposures to outdoor air pollution have been shown to reduce lung function in children with asthma, but the effect on adults with asthma has not been established in a meta-analysis. The objective of this study was to conduct a systematic literature review and meta-analysis of studies that assessed the relationship of outdoor air pollution and peak expiratory flow (PEF) in adults with asthma. MethodsStudies that contained data on outdoor air pollution levels (PM10, PM2.5, or NO2) and PEF in adults with asthma were eligible for inclusion. Effect estimates were quantified for each air pollution measure using random effects models. Heterogeneity was investigated with the Q-test and I2 statistics. Meta-regression and subgroup analyses were conducted to determine differences in effect by air pollution measures and the inclusion of smokers. ResultsA total of 22 effect estimates from 15 studies were included in this review. A 10 μg/m3 increase in acute PM10 exposure was associated with a −0.19 L/min (95% CI: 0.30, −0.09) change in PEF. For both PM10 and PM2.5, the inclusion of current smokers was a significant source of heterogeneity among studies (meta-regression: p = 0.04 and p = 0.03). Among studies that only included non-smokers, a 10 μg/m3 increase in acute exposure to PM10 and PM2.5 was associated with changes in PEF of −0.25 L/min (95% CI: 0.38, −0.13) and −1.02 L/min (95% CI: 1.79, −0.24), respectively. ConclusionsThis study provides evidence that acute increases in PM10 and PM2.5 levels are associated with decreases in PEF in adults with asthma, particularly among non-smokers.