Differences In Pulmonary Function Tests Research Articles

Long-term lung function follow-up of preterm infants less than 32 weeks of gestational age.

Preterm infants, particularly those with bronchopulmonary dysplasia (BPD), are at risk of lung development problems. Over the last decades, lung protective strategies have been used, decreasing the risk of chronic lung disease. To evaluate the pulmonary function test (PFT) of preterm infants born after the introduction of lung protective strategies and to assess perinatal determinants of impaired lung function in this population. A prospective, observational, single-center study was conducted in the neonatal unit of a high-complexity hospital. The study included newborns withless than 32 weeks gestational age born between 2012 and 2014, who were followed up until they reach school age. For the main outcome, two groups were stablished: no BPD or grade 1 BPD (no BPD/1) and grade 2 or 3 BPD (BPD 2/3). Out of 327 patients, 116 were included. BPD was diagnosed in 49.1% (47), with 50.9% (29) classified as grade 1, 35.1% (20) as grade 2, and 14.0% (8) as grade 3. Mean age at PFT was 8.59 years (SD 0.90). Mean FEV1% was 95.36% (SD 13.21) and FEV1 z-score -0.36 (SD 1.12); FVC% 97.53% (SD 12.59) and FVC z-score -0.20 (SD 1.06); FEV1/FVC ratio 85.84% (SD 8.34) and z-score -0.24 (SD 1.34). When comparing patients with no BPD/1 and BPD 2/3, we observed differences in all pulmonary function parameters, which persisted after adjusting for gestational age. No differences in PFT were observed between patients without BPD and those with grade 1 BPD. Most patients (76.7%, 89) had normal spirometry pattern, with obstructive pattern observed in 12.9% (15), restrictive pattern in 9.5% (11), and mixed pattern in 0.9% (1) of patients. Preterm infants with BPD 2/3 showed a decrease in all pulmonary function parameters compared to preterm infants with no BPD/1; an effect that was independent of gestational age. Among patients with BPD who had an altered PFT pattern, the most common pattern was obstructive, followed by restrictive and then, mixed.

Comparative analysis of pulmonary function in school-going adolescents: Examining the impact of depression and anxiety

Objectives: Given the rising concern over depression and anxiety among adolescents, this study aims to investigate their potential impact on respiratory health by comparing pulmonary function test (PFT) parameters between healthy adolescents and those with either depression or anxiety or those exhibiting symptoms of both depression and anxiety. Materials and Methods: In this cross-sectional study, a random sample of school-going adolescents aged 13–18 years from various schools in Sikkim, both males and females, were selected. Depression and anxiety were assessed using the Revised Children’s Anxiety and Depression Scale-25, and pulmonary function was measured using a computerised spirometer-Spirolab III. The recorded variables included forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), FEV1/FVC ratio, peak expiratory flow rate (PEFR) and forced expiratory flow at 25–75% (FEF 25–75%). Results: Significant differences emerged in FVC (P = 0.034), PEFR (P = 0.013) and FEF 25–75% (P = 0.023) between healthy and depressed adolescents aged 13–18 years. Similarly, a significant difference was observed in PEFR (P = 0.022) and FEF 25–75% (P = 0.002) between healthy adolescents and those with symptoms of both depression and anxiety. These differences were more pronounced among students in higher grades. Furthermore, significant differences in PEFR (P = 0.015) and FEF 25–75% (P ≤ 0.001) were found while comparing healthy males and males with symptoms of both depression and anxiety. However, no such disparities were seen in girls. There was no significant difference in any of the parameters when compared between the healthy group and those with anxiety. Conclusion: Depressed adolescents exhibited significantly reduced FVC, PEFR and FEF 25–75% compared to their healthy counterparts, despite being otherwise healthy. This negative association was more pronounced in the higher age group. However, anxious adolescents did not show any significant difference in PFT compared to healthy peers.

Can Blood Biomarkers Be Used to Assess Oxidative Stress in COPD Patients After Pulmonary Rehabilitation.

To determine the level of oxidative stress in the body due to pulmonary rehabilitation (PR) with thiols and disulfide and to investigate their relationship with indirect markers such as creatine kinase (CK), creatine kinase - MB (CK-MB), and lactate dehydrogenase (LDH), which show cell destruction. Patients with chronic obstructive pulmonary disease (COPD) are included in inpatient and outpatient care. They were evaluated before and after for PR, and an exercise program was prescribed. In addition, native thiol (NT), total thiol (TT), disulfide (DS), LDH, CK, and CK-MB values were tested. The mean age of 21 patients was 63±7.31 years. Eleven of them were outpatients and 10 of them were inpatients. Most of the patients were male (M/F=20/1, 95.2/4.8%). There was a significant difference in pulmonary function tests (PFT), St. George Respiratory Questionnaire (SGRQ), and 1 repetition maximum (1RM) before and after the treatment (p<0.001). There was a correlation between PFT and 1RM upper extremity. While there was no significant difference between thiols and disulfide, according to GOLD scores, there was a significant difference in patients with level 3-MMRC. No correlation was found between LDH, CK, CK-MB, and thiols, DS. ΔCK was found to be associated with ΔDS, and ΔCK-MB with ΔNT, and ΔTT. PR contributes to the antioxidant process by improving respiration and reducing oxidative stress. The decrease in LDH, CK with PR, increase in CK-MB, and correlation of CK with thiols and DS gave a different interpretation. In this case, it should be considered that oxidative stress may also be increased in people with high CK values.

Comparison of Changes in Pulmonary Function After Stereotactic Body Radiation Therapy Versus Conventional 3-Dimensional Conformal Radiation Therapy for Stage I and IIA Non-Small Cell Lung Cancer: An Analysis of the TROG 09.02 (CHISEL) Phase 3 Trial

The [Anonymized for Review] trial compared conventional radiotherapy (CRT) with stereotactic body radiation therapy (SBRT) in patients with inoperable early-stage non-small cell lung cancer. Patients randomised to SBRT had less local failure and improved overall survival. This analysis reports differences in pulmonary function tests (PFTs) and the six-minute walk test (SMWT) between patients who received SBRT and those who received CRT. We analyzed the PFTs and SMWT of all patients recruited to the [Anonymized for Review] trial. During this trial, patients underwent serial PFTs. Linear regression models were used to compare parameters between SBRT and CRT at 3 and 12-months post-treatment. 101 patients were enrolled, 33 patients were treated with CRT, 61 with SBRT and 7 did not receive treatment. Primary tumor size was similar between arms, SBRT 25mm (SD 9mm) and CRT 28mm (SD 9mm). On regression analysis, at 3 and 12 months, there was no evidence of a difference between arms in PFT decline or distance walked in the SMWT. PTV size was significantly larger in the CRT arm, 142.79 cc (SD 61.14cc) compared to the SBRT group 46.15 cc (SD 23.39 cc). The mean Biological Equivalent Dose (BED) received by the target was significantly larger in the SBRT group 125.92 Gy (SD 21.58 Gy) compared to CRT 65.49 Gy (6.32Gy). Mean dose to the lungs - iGTV was 8.9 Gy (SD 2.34 Gy) in the CRT group and 4.37 Gy (SD 1.42 Gy) in the SBRT group. Despite the considerably higher biologically effective doses delivered to the tumor in SBRT, there was no difference in decline in respiratory function observed between the two groups.

Cystic fibrosis exacerbations treated with medical therapy with and without concurrent sinus surgery

ObjectiveThis analysis investigates any potential differences in pulmonary function test (PFT) outcomes among pediatric patients with cystic fibrosis (CF) receiving both medical management (MM) and functional endoscopic sinus surgery (FESS) versus MM alone for CF exacerbation. Study designProspective cohort. SettingPediatric tertiary care facility. MethodsThe data was prospectively collected from July 2011 to March 2020. Diagnosis of CF and age ≤ to 18 were required. All patients were hospitalized and treated for CF exacerbations with both FESS with MM and MM alone at variable time intervals, although the order of initial treatment received differed. Two-way ANOVA with repeated measures were used to determine the effect of receiving FESS with MM versus MM alone on PFT outcomes over time (during admission, at discharge, at 3 months, at 6 months, and at 12 months). Results13 pediatric patients, 7 of which had FESS with MM initially and 6 who had MM alone initially, and 20 events of both FESS and MM were included for analysis. For PFT outcomes, there was no statistically significant two-way interaction between treatment type and time following treatment, p = 0.492. The main effect of treatment did not show a statistically significant difference in FEV1 between treatment types, p = 0.737. There was no statistically significant association between treatment type and time between hospital readmission in months, p = 0.111. ConclusionThere was no significant difference between PFT outcomes in pediatric patients hospitalized for CF exacerbation treated with MM with or without FESS at any time interval.

Correlation of Gut Microbiota, Vitamin D Status, and Pulmonary Function Tests in Children With Cystic Fibrosis.

BackgroundChildren with cystic fibrosis (CF) are expected to have suboptimal serum vitamin D status and altered gut microbiota. The altered gut microbiota is hypothesized to have a pro-inflammatory effect that further complicates the existing respiratory inflammation. Emerging evidence suggests an association between vitamin D and gut microbiota. The aim of this study was to assess the relationships between 25-hydroxyvitamin D [25(OH)D] status, pulmonary function, and fecal bacteria in children with CF.MethodsIn this cross-sectional study, a total of 35 children with CF (8.7 ± 2.83 years) and 24 controls without CF (9 ± 2.7 years) were included in this study. Serum 25(OH)D status was measured using the Elecsys vitamin D total II assay. In the CF group, gut microbiota composition was assessed using real-time PCR analysis. Pulmonary function tests (PFTs) were measured using spirometry. Comparisons between the CF and non-CF controls were conducted using the independent sample t-test. In the CF group, one-way analysis of variance (ANOVA) was used to assess differences in PFTs and gut microbiota composition across the three vitamin D subgroups. The correlations between 25(OH)D status and PFTs, or gut microbiota composition, and PFTs with gut microbiota composition were analyzed using the Pearson's correlation coefficient test.ResultsChildren with CF had significantly lower serum 25(OH)D levels compared with children without CF (44.3 ± 22.4 vs. 59 ± 25.5, respectively, P = 0.026). Children with CF with optimal serum 25(OH)D level had significantly higher levels of Bacteroidetes, Firmicutes, and total bacteria (P = 0.007, P = 0.007, and P = 0.022, respectively). The level of Firmicutes was found to be significantly higher in mild forced expiratory volume in 1 s (FEV1) compared with moderate FEV1 (P = 0.032), whereas the level of the other bacteria species was comparable across FEV1 severity groups.ConclusionOur findings may encourage studies that target and modify gut microbiota to potentially achieve better outcomes in terms of respiratory function in CF.

Study of pulmonary function tests and muscle strength in sportsmen of tribal region of Gujarat

Introduction -Regular exercise has a direct association with pulmonary function measures. When compared to non-exercising persons, athletes have greater lung capacity as a result of frequent exercise. Muscle strength is defined as the maximum force created during a maximal voluntary contraction under a certain set of circumstances. The researchers wanted to see if there was a difference in pulmonary function tests [Vital Capacity (VC), Forced Expiratory Volume in One Second (FEV1), and Maximum Voluntary Ventilation (MVV)] and handgrip muscular strength between athletes and sedentary controls. Material and Methods – The study included 100 volunteers between the ages of 18 and 25, 50 of whom were athletes who had participated in sports such as cricket, badminton, football, volleyball, and others for at least 3-5 years, and 50 of whom were sedentary control subjects. Pulmonary function tests (VC, FEV1, and MVV) and handgrip muscle strength were performed on both groups. Sportsmen and control group comparison was analyzed by applying an unpaired “t” test. Significant P-value was less than 0.05 (P &lt; 0.05). In our study, it was observed that pulmonary function tests (VC, FEV1, and MVV) and handgrip muscle strength were significantly higher in sportsmen as compared to the control group.

Speckle tracking echocardiography as a promising tool for the prognostic assessment of patients with sarcoidosis

Abstract Background Sarcoidosis is a chronic granulomatous disease characterized by multiorgan inflammatory involvement and recurrent relapses with significant impact on morbidity and mortality. The prognostic assessment of these patients is still challenging. Although the international guidelines didn't recommend basic transthoracic echocardiography (TTE) for diagnostic and prognostic assessment of sarcoidosis, speckle tracking echocardiography (STE) has emerged as more sensitive for the early detection of cardiac sarcoidosis and outcome. Purpose This prospective study aimed to assess the potential value of STE parameters for the prediction of major adverse cardiac events (MACE) and sarcoidosis relapse. Methods Consecutive patients with confirmed diagnosis of sarcoidosis who underwent transthoracic echocardiography (TTE) and subsequent pulmonary function tests (PFTs) were enrolled. Patients with acute events or treatment escalation between TTE and PFTs and previous cardiac surgery were excluded. All patients were followed for sarcoidosis relapse requiring increase in step-up therapy and MACE (cardiovascular death, cardiovascular hospitalizations, arrhythmias). Results 172 patients were included (111 females, 57.4±12.6 years); 56 patients showed extrapulmonary localizations of sarcoidosis; at baseline, 99 patients were on steroid and/or immunosuppressive therapy. During a median follow up of 2217 days, 8 deaths (3 cardiovascular deaths), 23 MACE and 36 sarcoidosis relapses were reported. Patients with MACE were older (p=0.0022), but didn't show significant differences in PFTs and sarcoidosis phenotype. LV global longitudinal strain (GLS) was the only echocardiographic index to show significant differences (lower values) in patients with MACE (p=0.025). LV GLS ≤17.13% (absolute value) was identified as a fair predictor of MACE both with ROC curves (AUC=0.64) and Kaplan Meier analysis (Fig. 1). No significant differences of demographic, clinical, functional, and therapeutic data were observed between patients with/without sarcoidosis relapse. TTE revealed a significant reduction of LV ejection fraction (p=0.0432), tricuspid annular plane systolic excursion (TAPSE, p=0.0272) and global peak atrial longitudinal strain (PALS, p=0.0012) in patients with relapse. Among these 3 parameters, PALS ≤28.5% showed to be the best predictor of sarcoidosis relapse with ROC (AUC=0.7155) and Kaplan Meier curves (Fig. 2). Conclusions Our results highlight a potential role of LV GLS and PALS as prognostic markers in sarcoidosis, suggesting the use of STE in the clinical management of these patients, regardless the evidence or the suspect of cardiac localizations of the disease. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

The 18-cm Thoracic-Height Threshold and Pulmonary Function in Non-Neuromuscular Early-Onset Scoliosis

Background:Thoracic spine height is cited as a crucial outcome measure in the treatment of early-onset scoliosis (EOS) because of its reported relationship to pulmonary function tests (PFTs). An 18-cm threshold has been proposed, although this single parameter might be overly simplistic for cases of different etiologies and deformity magnitude. We aimed to reevaluate pulmonary function in patients undergoing corrective surgery, assessing the role of residual scoliosis as well as spine elongationMethods:Patients undergoing EOS correction with a minimum of 5 years of follow-up since initial treatment were evaluated. Standard spirometry (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1]) was correlated to deformity magnitude and T1-T12 height. Patients were compared by age at first surgery (<5 or ≥5 years), final thoracic height (≤18 or >18 cm), and percentage of predicted pulmonary function (<60% or ≥60%).Results:Twenty-nine patients (15 congenital, 11 syndromic, and 3 idiopathic cases) were tested at a mean of 8.5 years following initial surgery. Twenty-two patients (mean initial age, 4.8 years) had growth-sparing instrumentation, and 7 patients (age, 5.1 years) had definitive fusion performed. Age at initial surgery was not associated with a difference in PFT results at the time of follow-up, and both age groups had ominously low percentages of predicted pulmonary-function volumes (50% to 55%). Only 18 of the 29 patients achieved a T1-T12 height of >18 cm. Those with a thoracic height of ≤18 cm had similar percentage-of-predicted spirometry results at the time of follow-up as those with greater thoracic height, possibly because of increased deformity correction. Only 14 of 29 patients had spirometry of ≥60% of predicted volume at the time of follow-up. These 14 had slightly smaller curves and slightly greater T1-T12 heights but significantly better spirometry results than the 15 subjects with <60% of predicted volume. For those with a T1-T12 height of ≤18 cm, the residual Cobb angle negatively correlated with spirometry results. In those with a final T1-T12 height of >18 cm, spirometry did correlate with thoracic height, especially when residual deformity was ≥60°.Conclusions:Regardless of thoracic height of ≤18 or >18 cm, with residual curves of >50o, pulmonary function was ominously low in fully half of the patients, raising doubt about the value of this threshold as an EOS outcome parameter.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Inflammatory Biomarkers in the Pathogenesis of Respiratory Dysfunction in People Living with HIV

Although the association between HIV infection and airways obstruction is well known, its etiopathogenesis is not clear. Our aim was to analyze the association between biomarkers of systemic inflammation and bacterial translocation and pulmonary function tests in HIV infected patients and compare it between smokers and non-smokers. Cross-sectional, observational study. Inclusion criteria: people living with HIV with undetectable plasma viral load. Exclusion criteria: other comorbidities associated with systemic inflammation. Outcome variables: spirometry and diffusing capacity for carbon monoxide; explanatory variables: inflammatory biomarkers (interleukin-6, tumor necrosis factor-alpha), bacterial translocation (soluble CD14 [sCD14] and bacterial 16S rDNA), and variables related to HIV infection. Associations were tested using the Pearson/Spearman correlation tests, the student t test, and multivariable linear regression. We included 71 patients (54.9% smokers). We did not observe significant differences in pulmonary function tests according to biomarkers of inflammation or bacterial translocation. In non-smokers (n=32), sCD14 was negatively correlated with forced expiratory volume in 1 second (R = -0.35, P = 0.048) and forced vital capacity (R= -0.40, P=0.023). Age, time since HIV diagnosis and CD4+ nadir were associated with alterations in PFTs. In smokers, the only association observed was between the pack-years and pulmonary obstruction. In non-smokers HIV patients, lung dysfunction can be, at least partially, related to bacterial translocation (sCD14), CD4+ nadir and time since HIV diagnosis.

Assessment of respiratory health profile in cooks of roadside Dhaba’s (diner) around the national highway of Nashik district

Introduction: The health hazards in the unorganized sector, especially in Dhaba’s kitchen workers, could be more attributing to both indoor pollution like fuel, methods of cooking with improper ventilation. Outdoor air pollution due to the highway also makes the working condition even more difficult for these workers. So present study was planned to assess the respiratory health profile of Dhaba’s cooks & other workers. Aim: To assess respiratory function in the cooks & non cooks workers of the Dhaba’s and comparing their lung function test. Materials and Methods: the present cross-sectional study included 105 Dhaba workers from 18 Dhabas on national highway 3 with 38 being kitchen workers & 67 being a non-kitchen worker. Interview technique for respiratory health profile questionnaire followed by pulmonary function test by spirometry was used for data collection. Results: Difference in pulmonary function test was found statistically insignificant in both the groups. Stratified analysis in smokers & non-smokers groups, it was statistically higher in smoker control group compared to smoker study group (p Conclusion: None of the parameters from pulmonary function test came significant which could be due to the duration of the exposure that would be not significant to pose any health problems. But it will not rule out the fact that the indoor air pollution irrespective of tandoor cooking or normal gas/stove cooking, all have ascertain inclination for causing respiratory alteration. Keywords: Dhaba’s, cooks, Kitchen, Air pollution, Occupational health.

Effects of arm ergometry exercise on the pulmonary function in young obese women

Background: Pulmonary function in young obese women is reduced than when compared to non-obese indi-viduals. This study was aimed to evaluate the effectiveness of arm ergometry combined with breathing exercise on the pulmonary function for young obese women. Materials and Methods: 30 subjects based on inclusion and exclusion criteria: Participants in both groups per-formed Diaphragmatic breathing exercise. Participants in intervention group performed arm ergometer in ad-dition. Outcome measures: FEV1/FVC %. The intervention was given for 8 weeks, 30 min/day for 5days/week. Results: A comparison between the mean values of arm ergometer plus breathing exercise group and breathing exercise alone group showed that there was a statistically significant difference in pulmonary function test(p&lt;0.0001) Conclusion: Arm ergometer may be combined with breathing exercise in improving the pulmonary function for young obese women. Keywords: Aerobic Exercise, Obesity, Gender

Routine versus selective plasma exchange before thymectomy in myasthenia gravis

Background: Prethymectomy plasma exchange may improve the outcome of surgery; however, the technique is associated with an increased risk of complications. Therefore, the objective of this study was to compare selective versus routine plasma exchange before thymectomy in patients with myasthenia gravis.&#x0D; Method: We conducted a prospective multi-center cohort study to compare two protocols for plasma exchange before thymectomy. We compared the routine plasma exchange in all patients undergoing thymectomy for myasthenia gravis (group I; n= 30) versus selective exchange (Group II; n= 30). Endpoints were the duration of postoperative mechanical ventilation, plasma exchange, and operative complications.&#x0D; Results: There was no difference in age between both groups (30± 10.1 vs. 29± 9.2 years in Group I and II, respectively; p= 0.69). There were 17 females in Group I (56.67%) vs. 16 in group II (53.33%) (p= 0.8). Comorbidities are comparable between groups. All patients preoperative pyridostigmine, and 27 patients (90%) in Group I and 26 patients (87%) in Group II received glucocorticoids. There was no difference in pulmonary function tests between groups. Plasma exchange related complications were not different between groups. Immediate extubation was achieved in 29 patients (97%) in Group II, and after 6 hours in one patient (3.33%). In Group I, 28 patients (93%) extubated immediately, and two patients were ventilated for 7-12 hours. The mean ICU stay was 1.5 days in Group I and 1.4 days in group II (p= 0.615). The mean hospital stay was 8.5 days in Group I and 9.2 days in group II (p= 0.118). There was no significant difference in pathology between groups (p= 0.137).&#x0D; Conclusion: Selective plasma exchange is feasible before thymectomy for myasthenia gravis. Selective plasma exchange may decrease exchange related complications without affecting the operative outcomes.

Effects of Donor Smoking History on Early Post-Transplant Lung Function Measured by Oscillometry

Oscillometry (Osc) is a non-invasive test of respiratory impedance that is sensitive to small airways, a region of lung that is not well characterized by conventional pulmonary function tests (PFT) and has been shown to detect chronic obstructive lung disease (COPD) prior to changes in PFT. We posit that Osc could identify small airway obstruction post-lung transplant (LTx) and discriminate between lungs from smoking vs non-smoking donors. All double LTx recipients who consented to the study were prospectively tested with Osc prior to PFT during post-LTx clinic follow-up. Osc was conducted according to ERS criteria. Mann-Whitney U test was used to compare Osc and PFT parameters of recipients of non-smoking vs. smoking donor lungs. From December 2017 to July 2019, 179 patients were enrolled, of whom 102 received lungs from donors with a smoking history (27 had ≥20 pack years) and 68 received lungs from non-smokers. We excluded 33 patients with insufficient data on donor smoking history. No differences were observed between smoking and non-smoking donor groups overall. However, in patients who received donor lungs with ≥20 pack years, Osc identified small airway obstruction 8 weeks post LTx. The main Osc parameters of small airway obstruction, Ax (area of reactance) and X5 (reactance at 5 Hz) were significantly different between the 2 groups. The R5-19 (difference between resistance at 5 and 19 Hz), a measure of small airway obstruction, was increased in smokers, but the difference was not significant. Differences in PFT were not significant (Table 1). Recipients of lungs from donors with a significant smoking history had evidence of small airway obstruction as detected by Osc. Differences in Osc measurements were not detected for donors with a <20 pack year smoking history, suggesting that a moderate smoking history is unlikely to affect post-LTx lung function. Longer follow-up is needed to determine whether the observed differences persist over time and lead to graft dysfunction.

Characteristics and clinical significance of pulmonary function test and KL-6 in ASSD-ILD and IPF

Objective: To study the characteristics and clinical significance of pulmonary function test and kerbs von den lungen 6 (KL-6) in anti-synthetase syndrome related interstitial lung disease (ASSD-ILD) and idiopathic pulmonary fibrosis (IPF). Methods: The clinical data of 43 patients with ASSD-ILD (ASSD-ILD group) from May 2015 to May 2017 were collected retrospectively, including 12 males and 31 females, and 34 patients with IPF (IPF group) treated in the First Affiliated Hospital of Zhengzhou University during the same period, including 28 males and 6 females, were also included. The basic information, and the value of pulmonary function test [pulmonary function parameters included the forced vital capacity expressed as percent predicted (FVC%pred), the forced expiratory volume in 1 second expressed as percent predicted (FEV(1)%pred), the ratio of FVC to FEV(1) (FVC/FEV(1)), the peak expiratory flow expressed as percent predicted (PEF%pred), the forced expiratory flow at 25%, 50%, 75% of FVC as percent predicted (FEF(25)%pred, FEF(50)%pred, and FEF(75)%pred), the maximum mid-expiratory flow as percent predicted (MMEF% pred), and the diffusing capacity for carbon monoxide as percent predicted (DLCO% pred)], and serum KL-6 level in ASSD-ILD and IPF were compared. Results: The FEV(1)%pred, FEF(50)%pred, FEF(75)%pred, and MMEF%pred values in ASSD-ILD group were significantly lower than those in IPF group (all P<0.05), while the FVC% pred, FVC/FEV(1), PEF% pred, FEF(25)%pred, and DLCO% pred values in ASSD-ILD group had no significant difference compared with IPF group (all P>0.05). There was no significant difference in serum KL-6 level between ASSD-ILD group and IPF group [(1 169±911) vs (1 210±908) U/ml, t=0.62, P=0.463]. Follow-up analysis showed that the serum KL-6 level of ASSD-ILD patients who died within two years was significantly higher than that of survivors [(2 060±1 168) vs (1 042±858) U/ml, t=2.93, P=0.041]. The serum KL-6 level of patients who died within two years of IPF patients was also significantly higher than that of patients who survived [(1 767±865) vs (1 089±894) U/ml, t=2.53, P=0.026]. The serum KL-6 level in ASSD-ILD group was negatively correlated with FVC%pred (r=-0.43, P=0.004), FEV(1)%pred (r=-0.39, P=0.010) and DLCO% pred (r=-0.41, P=0.006). There was no correlation between serum KL-6 level and pulmonary function test indexes in IPF group (all P>0.05). Conclusions: There is difference in pulmonary function test between ASSD-ILD patients and IPF patients. High serum KL-6 level will be predictive of poor prognosis.

A study of plasma copeptin level as a predictor of severity during acute exacerbation of bronchial asthma

BackgroundAn exacerbation of asthma is an episode, characterized by a progressive increase in one or more typical asthma symptoms (shortness of breath, wheezing, cough, and chest tightness).Copeptin is a 39-amino acid glycopeptide that is derived from the c-terminal part of the pre–pro-hormone of arginine vasopressin.AimThe aim of our study was to evaluate the role of copeptin in asthmatic patients and its relationship to disease severity.Patients and methodsThis was a prospective observational study carried out on 45 patients during acute exacerbation of bronchial asthma (15 mild, 15 moderate, and 15 severe cases) and 15 healthy participants.ResultsOur study showed no significant difference in age, sex, and BMI between case and control groups. There was a statistical highly significant differences in pulmonary function tests, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, and oxygen saturation among mild, moderate, and severe cases, and significant increase in total leukocytic count and hospital stay in severe cases than mild and moderate cases. There was a highly significant increase of plasma copeptin in moderate and severe cases than mild cases and control groups. There were nonsignificant correlations between copeptin and pulmonary function tests in mild cases; a significant negative correlation between copeptin and forced expiratory volume in 1 s (FEV1) actual in moderate cases; significant negative correlations between copeptin, FEV1 actual, FEV1% predicted, forced vital capacity% predicted, and peak expiratory flow% predicted in severe cases; and highly significant negative correlations between copeptin and partial pressure of oxygen in arterial blood and oxygen saturation in all cases (P<0.001). Partial pressure of carbon dioxide in arterial blood exhibited a nonsignificant positive correlation with copeptin (P<0.05).ConclusionCopeptin is proven to be a novel biomarker and is increased in patients with asthma as compared with healthy controls.

Once-daily fluticasone furoate/vilanterol combination versus twice-daily budesonide/formoterol combination in the treatment of controlled stable asthma: a randomized crossover trial.

IntroductionFluticasone furoate (FF)/vilanterol (VI) dry powder inhaler (DPI) is the only once-daily maintenance inhaled corticosteroid (ICS)/long-acting β2 adrenergic agonist (LABA) combination for asthma. We aimed to compare the clinical effects of once-daily FF/VI and twice-daily budesonide (BUD)/formoterol (FM) DPI in patients with controlled stable asthma.MethodsWe performed a randomized crossover trial in which stable asthmatic patients controlled on ICS/LABA received 8 weeks of FF/VI (100/25 μg 1 puff once-daily) or BUD/FM (160/4.5 μg 2 puffs twice-daily) DPI treatment. After a 4–8-week washout period, patients received another crossover treatment for 8 weeks. We assessed pulmonary function, the 5-item version asthma control questionnaire (ACQ5), the asthma control test (ACT), and fractional exhaled nitric oxide (FeNO) at baseline and after 8 weeks of treatment (week 8). As the primary outcome was change in force expiratory volume in 1 s (FEV1) between baseline and week 8, we evaluated the incidence of asthma exacerbation and adherence barrier questionnaire (Ask-12) at week 8.ResultsTwenty-three patients were initially enrolled in this study; however, one patient had to be excluded. The FF/VI DPI treatment group showed a similar magnitude of change in FEV1 between baseline and week 8 as the BUD/FM DPI treatment group. In addition, there were no significant differences in pulmonary function tests, ACQ5 scores, ACT scores, and FeNO between baseline and week 8 in both groups. Although the incidence of exacerbation did not differ between groups, the Ask-12 score in the FF/VI DPI group was significantly lower than that in the BUD/FM DPI group.ConclusionsThe present study indicates that once-daily FF/VI DPI is not inferior to twice-daily BUD/FM DPI in clinical effect and more likely to improve inconvenience and forgetfulness in inhalation adherence barriers for stable asthma control therapy. Once-daily FF/VI DPI may be an effective alternative for asthma maintenance treatment.

Muscular Strength, Exercise Capacity and Body Composition of Alpha-1 Antitrypsin Deficient COPD Patients

PURPOSE: Alpha-1 antitrypsin deficiency (AATD) is the most common genetic disorder affecting people of European descent. The condition often results in the development of emphysema, leading to chronic obstructive pulmonary disease (COPD) in the third/fourth decade of life. Breathlessness, resultant deconditioning and exercise intolerance are often the most troublesome symptoms reported by patients with COPD and are linked to poor quality of life (QoL). Typically, patients with AATD COPD are assessed by pulmonary function test (PFT). However, exercise capacity (EC) cannot be reliably predicted from PFTs. Deconditioning is associated with reduced EC and QoL. The current study examines differences in PFTs, body composition, muscular strength, EC and QoL between AATD COPD patients (ZZ) and alpha-1 antitrypsin replete COPD patients (MM). METHODS: 29 ZZ patients, (m/f 20/9, age 60±yr8, FEV1/FVC: 0.47±0.12, FEV1%pred. 51±22, DLCO%pred. 73±21) were recruited from the National Centre of Expertise for AATD in Beaumont Hospital, Ireland. Patients performed spirometry and diffusing capacity for carbon monoxide (DLCO) was assessed. Body mass index (BMI) and waist:hip (W:H) ratio were calculated. QoL and symptom perception were examined using the SF-36 questionnaire (SF-36) and St. George’s Respiratory Questionnaire (SGRQ), respectively. EC was assessed via 6 minute walk test (6MWT), upper body strength via handgrip dynamometer (HG) and lower body strength via 30 sec sit to stand test (30STS). 9 MM patients (m/f 2/7, age 65±5yr, FEV1/FVC: 0.47±0.15, FEV1%pred. 58±29, DLCO%pred. 72±17) completed the same protocol. Continuous data are presented as mean ± SD. Mean group differences were compared using an independent t-test. RESULTS: There was a significant group difference for handgrip strength (ZZ 38±10 vs MM 29±7 p=0.009) and SGRQ scores for Symptoms (ZZ 41.2±20.9 vs MM 60.0±13.8 p=0.023), Impacts (ZZ 24.4±17.4 vs MM 43.2±20.8 p=0.014), and Total (ZZ 35.6±18.2 vs MM 54.5±14.5 p=0.011). SF-36 Vitality score was higher in ZZ than MM (58.2±21.5 vs 40.5±19.6 p=0.035). CONCLUSIONS: For the same level of COPD and similar body composition, fitness and upper body strength, ZZ patients present with significantly lower SGRQ scores and significantly higher SF-36 scores than MM patients.

Effect of late preterm birth on lung clearance index and respiratory physiology in school-age children.

We hypothesized that former late preterm (LP) children have abnormal pulmonary physiology parameters, including uneven ventilation distribution, due to premature disruption of normal lung development. A cross-sectional study evaluating former LP children at the age of 6 to 12 years as compared to term controls. Demographics and child's and family history of asthma/atopy/smoking were recorded. The outcome parameters were spirometry, multiple breath washout (MBW) measurement by lung clearance index (LCI), 6-minute walk test (6MWT), symptoms related to asthma and allergy, and Godin Leisure-Time Exercise Questionnaire. Twenty-nine former LP were compared to 30 term-control children (mean age, 8.2 ± 1.7 and 8.8 ± 1.8 years, respectively). LP had reduced forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) compared to term controls (FEV1 1.59 ± 0.48 vs 1.80 ± 0.39 L, P = 0.005 and FVC 1.73 ± 0.45 vs 1.99 ± 0.49 L, P = 0.009). There were no differences between the two groups regarding FEV1/FVC, forced expiratory flow between 25 and 75 (FEF25-75), LCI (7.10 ± 0.79 vs 6.96 ± 0.75, P = 0.50), 6MW distance, and weekly leisure-activity score. Former LP children had more episodes of wheezing and greater use of asthma medication. This pilot study suggests that LP have lower pulmonary function tests (PFTs) but not ventilation inhomogeneity measured by LCI or functional disturbance. It is unclear if the differences in PFTs are due to late prematurity by itself or are the consequence of maternal and neonatal factors associated with LP. Further larger studies are required to assess the long-term respiratory consequences of LP birth.

Pulmonary Oxygen Toxicity in Navy Divers: A Crossover Study Using Exhaled Breath Analysis After a One-Hour Air or Oxygen Dive at Nine Meters of Sea Water.

Introduction: Exposure to hyperbaric hyperoxic conditions can lead to pulmonary oxygen toxicity. Although a decrease in vital capacity has long been the gold standard, newer diagnostic modalities may be more accurate. In pulmonary medicine, much research has focussed on volatile organic compounds (VOCs) associated with inflammation in exhaled breath. In previous small studies after hyperbaric hyperoxic exposure several methyl alkanes were identified. This study aims to identify which VOCs mark the development of pulmonary oxygen toxicity.Methods: In this randomized crossover study, 12 divers of the Royal Netherlands Navy made two dives of one hour to 192.5 kPa (comparable to a depth of 9 msw) either with 100% oxygen or compressed air. At 30 min before the dive, and at 30 min and 1, 2, 3, and 4 h post-dive, exhaled breath was collected and followed by pulmonary function tests (PFT). Exhaled breath samples were analyzed using gas chromatography–mass spectrometry (GC–MS). After univariate tests and correlation of retention times, ion fragments could be identified using a standard reference database [National Institute of Standards and Technology (NIST)]. Using these fragments VOCs could be reconstructed, which were then tested longitudinally with analysis of variance.Results: After GC–MS analysis, seven relevant VOCs (generally methyl alkanes) were identified. Decane and decanal showed a significant increase after an oxygen dive (p = 0.020 and p = 0.013, respectively). The combined intensity of all VOCs showed a significant increase after oxygen diving (p = 0.040), which was at its peak (+35%) 3 h post-dive. Diffusion capacity of nitric oxide and alveolar membrane capacity showed a significant reduction after both dives, whereas no other differences in PFT were significant.Discussion: This study is the largest analysis of exhaled breath after in water oxygen dives to date and the first to longitudinally measure VOCs. The longitudinal setup showed an increase and subsequent decrease of exhaled components. The VOCs identified suggest that exposure to a one-hour dive with a partial pressure of oxygen of 192.5 kPa damages the phosphatidylcholine membrane in the alveoli, while the spirometry and diffusion capacity show little change. This suggests that exhaled breath analysis is a more accurate method to measure pulmonary oxygen toxicity.