European Community For Steel And Coal Research Articles

Assessment of hyperinflation: comparison of Global Lung Function Initiative and European Community for Steel and Coal lung volume reference equations

BackgroundAssessment of static hyperinflation severity is crucial to identify COPD patients eligible for lung volume reduction. The current recommendation of residual volume ≥175% predicted may need to be reconsidered owing to potential differences between the Global Lung Function Initiative (GLI) and the European Community for Steel and Coal (ECSC) reference equations for residual volume and concerns about using percentage of predicted.MethodsWe compared the residual volume reference values derived from the GLI and ECSC equations using mathematically simulated data and used a receiver operating characteristic curve to establish a new GLI-derived z-score cut-off for residual volume using body plethysmography data from patients with severe COPD.ResultsThe GLI reference equation for residual volume consistently yields a lower predicted residual volume for individuals with an average or below-average height (females ≤163 cm and males ≤177 cm). Our clinical cohort consisted of 1011 patients with COPD (graded using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as 38% GOLD 3 and 59% GOLD 4). In this cohort, a GLI-derived residual volume z-score of ≥2.9 could accurately replace the ECSC-derived 175% predicted cut-off and a z-score of ≥3.5 was established for the 200% predicted cut-off.ConclusionThere are substantial differences in predicted residual volume values between the GLI and ECSC equations, with the GLI generally yielding a lower predicted residual volume in the majority of individuals. A GLI-derived residual volume z-score of ≥2.9 could be used to replace the currently used cut-off of ≥175% predicted to identify potential lung volume reduction candidates.

Functional disorders of the respiratory system in patients with penetrating lung wounds: study prospective design

Background. Lung function tests should be performed to patients with penetrating wounds of the lungs to identify lung function disorders, and the data obtained should be taken into account when correcting medical treatment and prescribing individual medical rehabilitation programs.
 The aim was to study the impact of penetrating lung wounds on the lung function in the early recovery period.
 Materials and methods. 13 patients were enrolled in the study, 100% male, median age 26 [21; 31] years. Spirometry, body plethysmography, and a diffusion test were performed on an average of 14 days from the injury.
 Results. A prospective cross-sectional study was performed. A moderate decrease in the vital capacity (VC), the forced vital capacity (FVC), the volume of forced exhalation in the first second (FEV1) was revealed while the total lung capacity (TLCpl) and the FEV1/FVC ratio were within normal values. However, in 2 (15.4%) and 3 (23%) patients, a restrictive ventilation disorders (TLC lower limit of normal) was detected when using Global Lung Function Initiative (GLI) and European Community for Steel and Coal (ECSC) 1993 predicted value system, respectively. The residual lung (RV) and RV/TLCpl were increased. Functional residual capacity (FRC), FRCpl/TLCpl, airway resistance remained within normal values. The diffusion lung capacity impairment was detected in 92.3% and 61.5% cases according to the ECSC 1993 and the GLI system, respectively.
 Conclusion. In the early period of recovery after penetrating lung wounds, a nonspecific pattern of ventilation disorders was the most often abnormality namely a decrease in VC while TLC and FEV1/FVC were within normal values. Less frequently, the classic restrictive pattern of ventilation disorders was diagnosed. Besides, the diffusion lung capacity impairment was detected. The system of predicted values has a significant impact on the frequency of detection of the lung function disorders. The revealed functional disorders should be taken into account for adjusting medical and rehabilitation interventions.

Airway obstruction can be better predicted using Global Lung Function Initiative spirometry reference equations in Marfan syndrome.

Marfan syndrome is a genetic disorder of the connective tissue, including involvement of the lungs.Pulmonary function test was performed in 32 asymptomatic adult Marfan patients using European Community for Coal and Steel (ECCS) and Global Lung Function Initiative (GLI) reference values.Using GLI equations for reference, significantly lower lung function values were noted for forced vital capacity (FVC) (87.0 ± 16.6% vs. 97.1 ± 16.9%; P < 0.01) and forced expiratory volume in the first second (FEV1) (79.6 ± 18.9% vs. 88.0 ± 19.1%; P < 0.01) predicted compared to ECCS. Obstructive ventilatory pattern was present in 25% of the cases when calculating with GLI lower limit of normal (LLN), and it was significantly more common in men as compared to women (n = 6, 50% vs. n = 2, 10%; P = 0.03).GLI is more suitable to detect early ventilatory changes including airway obstruction in young patients with special anatomic features, and should be used as a standard way of evaluation in asymptomatic Marfan population.

Comparison of five major airflow limitation criteria to identify high-risk individuals with COPD: a contemporary population-based cohort

BackgroundDifferent airflow limitation criteria are often used to diagnose COPD. We investigated head-to-head whether Global Initiative for Chronic Obstructive Lung Disease (GOLD) (FEV1/FVC <0.70) and four lower limit of normal...

Global Lung Function Initiative 2012 reference equations for spirometry in the Norwegian population.

We studied the fit of the Global Lung Function Initiative (GLI) all-age reference values to Norwegians, compared them with currently used references (European Community for Steel and Coal (ECSC) and Zapletal) and estimated the prevalence of obstructive lung disease.Spirometry data collected in 30 239 subjects (51.7% females) aged 12-90 years in three population-based studies were converted to z-scores.We studied healthy non-smokers comprising 2438 adults (57.4% females) aged 20-90 years and 8725 (47.7% female) adolescents aged 12-19 years. The GLI-2012 prediction equations fitted the Norwegian data satisfactorily. Median±sd z-scores were respectively 0.02±1.03, 0.01±1.04 and -0.04±0.91 for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC in males, and -0.01±1.02, 0.07±0.97 and -0.21±0.82 in females. The ECSC and Zapletal references significantly underestimated FEV1 and FVC. Stricter criteria of obstruction (FEV1/FVC <GLI-2012 lower limit of normal (LLN)) carried a substantially higher risk of obstructive characteristics than FEV1/FVC <0.7 and >GLI-2012 LLN. Corresponding comparison regarding myocardial infarction showed a four-fold higher risk for women.The GLI-2012 reference values fit the Norwegian data satisfactorily and are recommended for use in Norway. Correspondingly, the FEV1/FVC GLI-2012 LLN identifies higher risk of obstructive characteristics than FEV1/FVC <0.7.

Assessment of the respiratory health in young smokers using an acoustic analysis

The aim of this comparative study was a comprehensive analysis of respiratory health in young smokers. Methods. An acoustic analysis of respiratory sounds, spirometry, the Fagerstrom Test for Nicotine Dependence, and the Questionnaire of the European Community for Coal and Steel (ECCS) on respiratory symptoms were used in this study. Results. The study involved 158 young subjects aged 18 to 19 years (mean age, 18.4 ± 1.1 years; 91 males). A significant difference in spirometric parameters, prevalence of symptoms of chronic bronchitis and the acoustic work of breathing (AWB) was found between smokers and non-smokers. Nicotine dependence was evaluated as weak with lower to moderate exhaled CO levels. However, motivation to continue smoking was moderate or higher; spirometric and AWB parameters were significantly lower in smokers compared to non-smokers. Conclusion. The acoustic analysis of respiratory sounds could be used for clinical and functional evaluation of respiratory status, predicting COPD development and smoking control along with spirometry, specific questionnaires and smoking status assessment.

Adopting universal lung function reference equations

Since the dawn of spirometry and testing lung function [1, 2], clinicians have been aware that the values obtained from testing an individual's lung function can reflect the effects of lung diseases, and that this can be helpful with regard to all aspects of disease prevention and management. It was also recognised that the values obtained were also a reflection of the subject's sex, age and height; so to maximise the clinically relevant signal from the tests these aspects first needed to be taken into account. Studies were then undertaken to record lung function in subjects free from disease and free from the effects of tobacco smoke in order to have reference ranges of lung function. Clinicians have had to decide which of the many available prediction equations to use for their patients, realising that the different equations might lead to different judgements about the results obtained, because predicted values might vary by as much as 1 L for forced expiratory volume in 1 s (FEV1) [3]. Guidance in this choice has been based on the reference population being appropriate for the patients and the equipment used for recording the lung function being equivalent. Other considerations include the age span of the reference population and the statistical approach used to derive the various predicted equations. Many European centres used the equations derived for the European Community for Steel and Coal (ECSC) [4]. However, it was still …

Prediction equations for spirometry in South Africa

The South African Guideline for Office Spirometry was recently published. Its aim was to provide an updated guideline for office spirometry in South Africa (SA), thereby improving the quality, standardisation and usefulness of spirometry. The need for local prediction equations based on large, all-inclusive studies of the SA population was highlighted in this guideline. It was suggested that the European Community for Steel and Coal (ECSC) prediction equations, derived from the study of Europeans, should be used as a norm, and that the use of a correction factor for adjusting predicted values that was sometimes applied in the past be discouraged.

Implications of adopting the Global Lungs Initiative 2012 all-age reference equations for spirometry

The aim of this study was to determine the diagnostic and interpretative consequences of adopting the Global Lungs Initiative (GLI) 2012 spirometric prediction equations. We assessed spirometric records from 17 572 subjects (49.5% females), aged 18-85 years, from hospitals in Australia and Poland. We calculated predicted forced expiratory volume in 1 s (FEV1), forced expiratory volume (FVC), FEV1/FVC and lower limits of normal (LLN) using European Community for Steel and Coal (ECSC), National Health and Nutrition Examination Survey (NHANES) III and GLI 2012 equations. Obstruction was defined as FEV1/FVC<LLN and a restrictive pattern as FEV1/FVC>LLN and FVC<LLN. Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 and higher was defined as FEV1/FVC<0.70 and FEV1 <80% pred. GLI 2012 equations produce similar predicted values for FEV1 and FVC compared with NHANES, but produce larger values than ECSC. Differences in the LLN lead to an important increase in the prevalence rate of a low FVC compared to ECSC, and a significant decrease compared to NHANES prediction equations. Adopting GLI 2012 equations has small effects on the prevalence rate of airway obstruction. GOLD stages 2-4 lead to >20% underdiagnosis of airway obstruction up to the age of 55 years and to 16-23% overdiagnosis in older subjects. GLI 2012 equations increase the prevalence of a "restrictive spirometric pattern" compared to ECSC but decrease it compared to NHANES.

Prof. Paul Sadoul, 1918–2011

We learned with infinite sadness that Professor Paul Sadoul passed away on September 6, 2011, at the age of 93 years. Paul Sadoul was a prominent figure in the Nancy Teaching Hospital for 35 years from 1949. After a 1-year stay with Wallace Fenn and Hermann Rahn's group, and Andre Cournand's laboratory in the USA, he applied new technologies for evaluating patients with chronic respiratory failure, such as right heart catheterisation at rest and during exercise. He developed a great interest in pneumoconiosis in iron and coal miners in Lorraine [1]. The respiratory function tests and epidemiological studies that he conducted with his team, using research programmes funded by the European Community for Steel and Coal (ECSC), led to the official recognition of silicosis as an occupational disease. In 1949, Paul Sadoul established one of the earliest lung function laboratories in France; he then developed a clinical unit specialising in a condition later known as chronic obstructive lung disease. He was promoted to associate professor in 1955 and full professor and head of the Medical Department of Respiratory Insufficiency at the Maringer Hospital in Nancy in 1960. During that period, patient care benefited from the clinical research carried out in the lung function laboratory. The importance of this research was acknowledged by the establishment of the INSERM research unit number 14. Co-operation between clinical and basic investigators continued. Optimisation of mechanical ventilation benefited from Rene Peslin's basic research on lung mechanics and ventilators [2]. Acid–base management of lung failure benefited from Claude Saunier's work in the laboratory [3]. Paul Sadoul is also considered one of the pioneers of respiratory intensive care in France [4, 5]. He substituted instrumental invasive ventilation with a noninvasive mask technique. He also developed long-term home oxygen …

Effects of changing reference values and definition of the normal range on interpretation of spirometry

Recent spirometry reference studies are arguably the most valid ever performed and the ATS/ERS now recommend the National Health and Nutrition Assessment Survey (NHANES) equations for North America. It is timely to consider adopting these reference values in Australasia; however, an evaluation of the consequences of such a change is required. We analysed data from 1108 patients tested in two pulmonary function laboratories in public hospitals. Lower limits of normal (LLN) were calculated using European Community for Steel and Coal (ECSC) (1993), Knudson (1983), NHANES (1999) and Health Survey of England (HSE) (2004) equations and used to define restriction (FVC < LLN) and obstruction (FEV(1)/FVC < LLN). This interpretative strategy was also compared with the GOLD definition of obstruction (FEV(1)/FVC < 70%). Average age for all patients (50% female) was 60 years (range: 20-91). The mean predicted FVC from NHANES and HSE were similar and consistently higher than those from ECSC and Knudson (average 270 mLs). This translates into a 76% increase in the incidence of 'restrictive' interpretations using NHANES data compared with ECSC and Knudson, and a smaller increase of 40% for HSE. Using FEV(1)/FVC < 70% to diagnose obstruction in those over 65 years would result in false positive rates of approximately 28%. Using the same definition in a younger group (<50 years old) results in a false negative rate of approximately 14%. Changing to either NHANES or HSE predicted values will significantly increase the rate of 'restrictive' interpretation, and alter the rate of obstructive findings. The NHANES and HSE data confirm that using FEV(1)/FVC < 70% to define obstruction causes misdiagnosis in elderly and younger subjects.

J11 A pilot study on respiratory function in people with huntington's disease

BackgroundHuntington's disease (HD) is a neurodegenerative condition resulting in motor, cognitive and behavioural dysfunction. Physiotherapists are involved in the management of respiratory problems during the later stages of the disease1...

In memoriam Rene Peslin

Rene Peslin, director of Unite 14 INSERM in Vandoeuvre-les-Nancy, France, from 1985 to 1999, passed away on October 6, 2009. As a young MD in the 1960s, he had been recruited as a researcher by Paul Sadoul, the founder of one of the very first INSERM units. At that time there was great concern about the deadly exposure of mine workers to coal and silica, and the European Community for Steel and Coal (ECSC) funded research programmes to study lung function in coal miners. Rene took part in a number of such studies, which included examining subjects on site in the northernmost area of Lorraine (France), after travelling for hours in an old van that would sometimes fall apart. Rene was actively involved with, and soon became an Associate Editor of, the Bulletin …

Using the lower limit of normal for the FEV1/FVC ratio reduces the misclassification of airway obstruction

Aim:The prevalence of airway obstruction varies widely with the definition used.Objectives:To study differences in the prevalence of airway obstruction when applying four international guidelines to three population samples using four...

FEV 1/FVC and FEV 1 for the assessment of chronic airflow obstruction in prevalence studies: Do prediction equations need revision?

Little is known on the long-term validity of reference equations used in the calculation of FEV(1) and FEV(1)/FVC predicted values. This survey assessed the prevalence of chronic airflow obstruction in a population-based sample and how it is influenced by: (i) the definition of airflow obstruction; and (ii) equations used to calculate predicted values. Subjects aged 45 or more were recruited in health prevention centers, performed spirometry and fulfilled a standardized ECRHS-derived questionnaire. Previously diagnosed cases and risk factors were identified. Prevalence of airflow obstruction was calculated using: (i) ATS-GOLD definition (FEV(1)/FVC<0.70); and (ii) ERS definition (FEV(1)/FVC<lower limit of normal) with European Community for Coal and Steel (ECCS) reference equations and with predicted values derived from the presumably normal fraction of the studied population. A total of 5008 subjects (4764 adequate datasets) were studied. Prevalence of airflow obstruction was 8.71% with ATS-GOLD definition and 6.40% with ERS definition and ECCS predicted values. The ERS definition with predicted values derived from the studied population provided a 7.96% prevalence. Severity distribution of airflow obstruction was also influenced by the equation used to calculate predicted values of FEV(1). Prevalence and severity of chronic airflow obstruction are influenced not only by the definition used but also by equations used to calculate predicted FEV(1)/FVC and FEV(1) values. These equations likely need to be periodically revised.

RECENT INVESTIGATIONS INTO COMPOSITE SWAY FRAMES

A modern design code for composite construction such as Eurocode 4 limits its scope to “non‐sway buildings” with efficient bracing systems. Therefore it gives mainly rules to analyse and to check structural elements like beams, columns, slabs and joints. However, in the last years, the construction of taller buildings and larger industrial halls without wind bracing systems is susceptible to make global instability a relevant failure mode, what is not yet covered by Eurocode 4. For three years, in the framework of a European research project funded by the European Community for Steel and Coal (ECSC), in which Liège University was deeply involved, intensive experimental, numerical and theoretical investigations have been carried out. The latter aimed at improving the knowledge in the field of sway composite frames and at developing appropriate design rules. The rotational behaviour of the beam‐to‐column composite joints is one of the key aspects of the problem to which a special attention has been paid. This paper presents numerical and analytical studies carried out at Liège University, as part of the above European project, with the objective to investigate the behaviour of 2D composite sway frames under static loading. Particular phenomena put into sight through different analyses are illustrated herein.

Recent investigations into composite sway frames

A modern design code for composite construction such as Eurocode 4 limits its scope to “non‐sway buildings” with efficient bracing systems. Therefore it gives mainly rules to analyse and to check structural elements like beams, columns, slabs and joints. However, in the last years, the construction of taller buildings and larger industrial halls without wind bracing systems is susceptible to make global instability a relevant failure mode, what is not yet covered by Eurocode 4. For three years, in the framework of a European research project funded by the European Community for Steel and Coal (ECSC), in which Liège University was deeply involved, intensive experimental, numerical and theoretical investigations have been carried out. The latter aimed at improving the knowledge in the field of sway composite frames and at developing appropriate design rules. The rotational behaviour of the beam‐to‐column composite joints is one of the key aspects of the problem to which a special attention has been paid. This paper presents numerical and analytical studies carried out at Liège University, as part of the above European project, with the objective to investigate the behaviour of 2D composite sway frames under static loading. Particular phenomena put into sight through different analyses are illustrated herein. First Published Online: 14 Oct 2010

Present Status and Perspectives of European Research in the Field of Advanced Structural Steels.

The status of steel research in Europe with particular emphasis to multipartner projects sponsored by the European Community for Steel and Coal (ECSC) is reviewed through specific examples in the field of high strength (HS) designed with various metallurgical options and made possible by different production routes. Modern HS sheets for car body and structural parts of the automotive as well as the new generation of very high strength pipes for high pressure gas lines are discussed in the light of their recent developments inside the European Community R&TD circuit. A rapid glance to HS steel wires for suspension bridges is also given with reference to the newly designed Messina Strait Bridge in Italy. Some reference to possibilities offered in properties enhancement by the new casting technologies (Thin Slab & Strip Casting) is rapidly commented.

Alterations in lung function due to mixtures of organic solvents used in floor laying

To determine the short-term and long-term effects of organic solvents on the respiratory tract, 26 male floorlayers exposed to organic solvents were compared with 36 persons unexposed to such substances. The investigation primarily included a detailed history, determination of solvent concentration in the air inhaled by the workers, long-term ECG during the entire shift and lung-function test (vital capacity, forced expiratory volume in one second, flow volume curve) as well as non-specific bronchial inhalation challenge using a 3% acetylcholine aerosol before and after the shift. The floorlayers were primarily subjected to inhalative exposure to adhesives containing mixtures of toluene, petroleum hydrocarbons, ethyl acetate, methanol and acetone or one of these substances alone. This frequently resulted in short-term value limit excesses, especially in the MAK value (standardised threshold concentration in Germany) for toluene, which is a prime component of neoprene glue. Of the 26 floorlayers, 6 complained of breathlessness and coughing, whereas 13 suffered from nasal discharge and blockage--symptoms closely related to work. The smokers in this group showed a decline in lung function during the shift--especially in the forced expiratory volume in 1 s (FEV1)--as compared with the non-smokers in this group and the persons in the control group. This probably due to the combination of noxious substances. A strong correlation between occupational age and changes in lung function was observed: the occupationally youngest workers demonstrated the highest decrease in values during the course of the shift. There was no evidence of either obstructive or restrictive respiratory disorders or of marked deviation from the European Community for Coal and Steel (ECCS) references.(ABSTRACT TRUNCATED AT 250 WORDS)

Accuracy, precision and linearity of the portable flow-volume meter Microspiro HI-298

The accuracy, precision and linearity of a new portable flow-volume meter, the Microspiro HI-298 (Chest Corporation, Tokyo, Japan), was investigated using a Fleisch no. 4 pneumotachograph as a standard. After connection and calibration of the pneumotachograph and the Microspiro, a healthy subject performed 44 forced vital capacity (FVC) manoeuvres at different levels of lung inflation. The FVC of these expirations ranged from 2.5-5.1 l. Linear regression of Microspiro values (dependent variable) on Fleisch pneumotachograph values (independent variable) showed that a good linear relationship existed: Pearson correlation coefficients ranged from 0.938-0.985. Linearity of the Microspiro was good except for the peak expiratory flow rate (PEFR) and the maximal expiratory flow at 25% of the expired volume (MEF75). The random error (measure of precision) of all flow-volume (F-V) indices was lower than 5%. The systematic error (measure of accuracy) was low for the forced expiratory volume in one second (FEV1) and the FVC (1% and 4.6%, respectively) but much higher for the instantaneous expiratory flows (PEFR 11.0%; MEF75 7.0%; MEF50 8.5%; MEF25 11.4%). Only the total error in FEV1 complied with the tolerance of 4% of the European Community for Coal and Steel (ECCS). When the measured values were adjusted according to the regression equations of this study, all F-V indices were accurate and precise within 5%. It was concluded that the portable Microspiro HI-298 is a useful instrument for bedside, work-site spirometry and for use in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)