Evaluation Of Lung Function Research Articles

A prospective evaluation of lung function at three and six months in patients with previous SARS-COV-2 pneumonia

ObjectiveThis study investigated the consequences of Coronavirus Disease 2019 (COVID-19) pneumonia on lung function in the first 6 months after hospital discharge. MethodsA prospective lung function assessment in SARS-CoV2 patients with COVID-19 pneumonia, hospitalized between March and April 2020, was conducted with spirometry measurements including lung volumes, mainly total lung capacity (TLC), lung diffusion capacity for carbon monoxide (DLCO) collected at 3 months after hospital discharge. Patients with restrictive ventilatory defect or impaired DLCO or both were re-evaluated at 6 months with global spirometry and chest HRCT scan. ResultsAmong 40 consecutive patients, 19 (48%) had normal pulmonary functional tests (group A), and 21 (52%) showed residual lung function abnormalities at 3 months after hospital discharge (group B). In group B, 4 patients (19%) had only loss of lung volume as shown by TLC reduction (group 1), 13 patients (62%) had decreased both TLC and DLCO (group 2), and 4 patients (19%) had isolated reduction in DLCO (group 3). At 6-month follow-up in group 1, although all patients improved, only one normalized total lung capacity (TLC). In group 2, TLC and DLCO increased significantly (p < 0.01), but only 3 patients reached normal values. In group 3, DLCO improved for most patients, normalizing in 50% of them. At 6-months significant correlations between an internal-built chest HRCT scan severity score and TLC (r2 = 0.33; p < 0.01) and DLCO (r2 = 0.32; p < 0.01) were found. ConclusionsNearly 50% of patients recovered in the post-critical phase. Most of those with abnormal pulmonary function tests at 3 months improved subsequently, but only another 29% (6 out of 21) reached normal values at 6 months. These results indicate that lung function spontaneous recovery is faster at first and occurs more slowly thereafter, leaving more than one third (15 out of 40) of patients with abnormal lung function tests at 6 months.

Association between eye-level greenness and lung function in urban Chinese children

BackgroundHealth effects of greenness perceived by residents at eye level has received increasing attention. However, the associations between eye-level greenness and respiratory health are unknown. The aim of the study was to investigate the associations between exposure to eye-level greenness and lung function in children. MethodsFrom 2012 to 2013, a total of 6740 school children in seven cities in northeast China were recruited into this cross-sectional study. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEF), and maximum mid expiratory flow rate (MMEF) were measured to evaluate lung function and to define lung impairment. Eye-level greenness was extracted from segmented Tencent Map street view images, and a corresponding green view index (GVI) was calculated. Higher GVIs mean more greenness coverage. Mixed-effects logistic regressions were used to estimate the health effects on lung impairment per interquartile range (IQR) increase in GVI. Linear regressions were used to estimate the associations between GVI and lung function. The health effects of ambient air pollutants were also assessed, including particulate matter with an aerodynamic diameter <1.0 μm (PM1), <2.5 μm (PM2.5), <10 μm (PM10) as well as nitrogen dioxide (NO2). ResultsAn increase of GVI800m was associated with lung impairment in FEV1, FVC, PEF and MMEF, with ORs ranging from 0.68 (95% CI: 0.59, 0.79) to 0.83 (95% CI: 0.74, 0.93). The associations between an IQR increase of GVI800m and FEV1 (48.15 ml, 95% CI: 30.33–65.97 ml), FVC (50.57 ml, 95% CI: 30.65–70.48 ml), PEF (149.59 ml/s, 95% CI: 109.79–189.38 ml/s), and MMEF (61.18 ml/s, 95% CI: 31.07–91.29 ml/s) were significant, and PM1, PM2.5, and PM10 were found to be mediators of this relationship. ConclusionMore eye-level greenness was associated with better lung function and reduced impairment. However, eye-level greenness associations with lung function became non-significant once lower particulate matter air pollution exposures were considered.

Longitudinal change in lung function and subsequent risks of cardiovascular events: evidence from four prospective cohort studies

BackgroundLung function is constantly changing over the life course. Although the relation of cross-sectional lung function measure and adverse outcomes has been reported, data on longitudinal change and subsequent cardiovascular (CV) events risks are scarce. Therefore, this study is to determine the association of longitudinal change in lung function and subsequent cardiovascular risks.MethodsThis study analyzed the data from four prospective cohorts. Subjects with at least two lung function tests were included. We calculated the rate of forced respiratory volume in 1 s (FEV1) and forced vital capacity (FVC) decline for each subject and categorized them into quartiles. The primary outcome was CV events, defined as a composite of coronary heart disease (CHD), chronic heart failure (CHF), stroke, and any CV death. Cox proportional hazards regression and restricted cubic spline models were applied.ResultsThe final sample comprised 12,899 participants (mean age 48.58 years; 43.61% male). Following an average of 14.79 (10.69) years, 3950 CV events occurred. Compared with the highest FEV1 quartile (Q4), the multivariable HRs for the lowest (Q1), 2nd (Q2), and 3rd quartiles (Q3) were 1.33 (95%CI 1.19, 1.49), 1.30 (1.16, 1.46), and 1.07 (0.95, 1.21), respectively. Likewise, compared with the reference quartile (Q4), the group that experienced a faster decline in FVC had higher HRs for CV events (1.06 [95%CI 0.94–1.20] for Q3, 1.15 [1.02–1.30] for Q2, and 1.28 [1.14–1.44] for Q1). The association remained robust across a series of sensitivity analyses and nearly all subgroups but was more evident in subjects < 60 years.ConclusionsWe observed a monotonic increase in risks of CV events with a faster decline in FEV1 and FVC. These findings emphasize the value of periodic evaluation of lung function and open new opportunities for disease prevention.

Dual Bronchodilator Therapy as First-Line Treatment in Maintenance-Naïve Patients with Symptomatic COPD: A Pre-Specified Analysis of the EMAX Trial.

IntroductionLimited prospective evidence is available to guide selection of first-line maintenance therapy in patients with COPD. This pre-specified analysis of the EMAX trial explored the efficacy and safety of dual- versus mono-bronchodilator therapy in maintenance-naïve and maintenance-treated patients.MethodsThe 24-week EMAX trial evaluated lung function, symptoms (including rescue medication use), exacerbations, and safety with umeclidinium/vilanterol, umeclidinium, and salmeterol in symptomatic patients at low exacerbation risk who were not receiving inhaled corticosteroids. Maintenance-naïve and maintenance-treated subgroups were defined by maintenance bronchodilator use 30 days before screening.ResultsThe analysis included 749 (31%) maintenance-naïve and 1676 (69%) maintenance-treated patients. For both subgroups, improvements from baseline in trough FEV1 at Week 24 (primary endpoint) were greater with umeclidinium/vilanterol versus umeclidinium (mean difference [95% CI]; maintenance-naïve: 44 mL [1, 87]; maintenance-treated: 77 mL [50, 104]), and salmeterol (maintenance-naïve: 128 mL [85, 171]; maintenance-treated: 145 mL [118, 172]), and in rescue medication inhalations/day over 24 weeks versus umeclidinium (maintenance-naïve: −0.44 [−0.73, −0.16]; maintenance-treated: −0.28 [−0.45, −0.12]) and salmeterol (maintenance-naïve: −0.37 [−0.66, −0.09]; maintenance-treated: −0.25 [−0.41, −0.08]). In maintenance-naïve patients, umeclidinium/vilanterol numerically improved scores at Week 24 for Transition Dyspnea Index versus umeclidinium (0.37 [−0.21, 0.96]) and versus salmeterol (0.47 [−0.10, 1.05]) and Evaluating Respiratory Symptoms–COPD versus umeclidinium (−0.26 [−1.04, 0.53]) and versus salmeterol (−0.58 [−1.36, 0.20]), with similar improvements seen in maintenance-treated patients. All treatments were well tolerated across both subgroups.ConclusionSimilar to maintenance-treated patients, maintenance-naïve patients receiving umeclidinium/vilanterol showed greater improvements in lung function and symptoms compared with patients receiving umeclidinium or salmeterol. These findings provide support for the consideration of dual bronchodilator treatment in symptomatic maintenance-naïve patients with COPD.

Development of Feed Forward and Conditional Models Based on Rodent Imaging Data to Predict Effects of Nitrogen Mustard on Pulmonary Function

Nitrogen mustard (NM; (bis(2-chloroethyl)methylamine) is a cytotoxic vesicant known to cause pulmonary damage. In these studies, we developed mathematical models that allow prediction of NM-induced functional deficits in the lung based on structural alterations identified by magnetic resonance imaging (MRI) and computed tomography (CT). Male Wistar rats were exposed to PBS (CTL) or NM (0.125 mg/kg) via i.t. instillation. CT and MRI scans were performed prior to exposure and 28 d post exposure. Pulmonary function was assessed using a SCIREQ flexiVent at a positive end expiratory pressure (PEEP) of 3 cm H2O. Because of accuracy and minimal artifacts, MRI data was used to calculate total lung volume (W). As CT is capable of differentiating between regions of air and water within the lung, it was used as a direct measure of fluid density within the tissue. Relative lung volumes calculated from CT data were used to summarize hyperinflation (I), normal lung, and consolidated lung tissue (B) using voxel density. Using these elements, a feed forward model was constructed to predict respiratory impedance (Z), a measure of airflow, with the equation: z = (A(η-j))/ωα where A = B/(I+W). Calculated values of A from imaging data confirmed alterations in lung structure following NM exposure (1.38 ± 0.08, n=4, CTL vs. 0.99 ± 0.16, n=3, NM) as a result of hyperinflation (I). The predicted Z spectra derived from imaging data was compared to the measured Z spectra obtained from the flexiVent data. A strong correlation was observed between predicted and measured Z spectra at 28 d post NM (R2=0.997 ± 0.01, n=7). Predicted and measured Z spectra were consistent with previous findings that NM caused a loss of ventilatory function at high frequencies. To further evaluate lung function, components of the Z spectra were used to conditionally model resistance, RL = (a+bf)/(c+f) and elastance, EL = E0 + ΔE(1 – е-βf). This model allowed us to differentiate functional contributions of tissue and airway components at low and high frequencies in imaging and flexiVent data sets. Together, our results demonstrate that structural imaging data can be used to assess lung function as a toxicological endpoint following exposure to mustard vesicants. The use of this model will aid in the rapid evaluation of potential countermeasures to mitigate lung toxicity.

Literature Review: Health Impact of Coal Combustion Emissions in Power Plant on Adult Respiratory Systems

Introduction: Coal-fired power plants contribute to air pollution emissions of nearly one-third of global SO2 , 14 % of NOx , and 5 % of PM2.5. This condition could worsen adults’ respiratory health who live close to power plants; WHO estimates that COPD and LRTI cause around 18% of premature deaths related to outdoor air pollution. This literature review aims to conduct a systematic review of the health impacts of coal-fired power plant emissions on adults’ respiratory systems and explore what risk factors lead to decreased lung status. Also, to answer how risk factors influence decreased lung function in adults’ respiratory system from coal-fired power plants’ emissions. Discussion: This study used a literature study method using an online database to of various research data sources with the same topic. The searching of articles was performed based on the inclusion criteria. From an initial collection of 468 articles, after screening and considering its feasibility, four articles were obtained to serve as material for the final systematic review. The literature review showed that there had been a change in lung function of respiratory system of adults due to long-term exposure to emissions from coal-fired power plants. Factors that influence decreased lung function in adults were NOx and SO2 exposure levels, residence distance, wind direction, age, and smoking status. Conclusion: Future research should focus on improving models for assessing exposure to NOx , SO2 , PM10 and PM2.5, considering age and smoking habits in evaluating lung function.

Longitudinal Relationship Between Growth Differentiation Factor 11 and Physical Activity in Chronic Obstructive Pulmonary Disease.

BackgroundDaily physical activity is reduced in patients with chronic obstructive pulmonary disease (COPD) and a reduced level of physical activity has been shown to be an important predictor for the prognosis, such as increased risk of exacerbation and mortality. However, there has not yet been a useful biomarker of the physical activity. In our previous cross-sectional study, we showed that the level of one of the possible myokines, which is an anti-aging factor, growth differentiation factor 11 (GDF11), was decreased in the plasma from patients with COPD and correlated with the physical activity. To clarify this relationship, we conducted a longitudinal evaluation of such factors.Patients and MethodsTwenty-four COPD patients were enrolled and prospectively followed. We measured the levels of plasma GDF11 and systemic inflammatory markers with immunoblotting or ELISA, respectively. We also evaluated lung function and daily physical activity using a triaxial accelerometer and the incidence of exacerbation.ResultsThe change in the plasma level of GDF11, but not systemic inflammatory markers, was positively correlated with the change in the physical activity in an intensity-dependent manner (between the change in the number of steps and GDF11; r = 0.41, p = 0.047). In the multiple regression analysis, the relationship was confirmed (β = 0.93, p < 0.001). In addition, patients who maintained their plasma level of GDF11 showed a significantly lower incidence in exacerbations of COPD than those with decreased levels of GDF11 (p = 0.041).ConclusionThe longitudinal change in the plasma level of GDF11 was positively correlated with the change in the daily physical activity in COPD. GDF11 could be a useful humoral factor that reflects the physical activity in COPD.

Aspirin desensitization in NSAID-exacerbated respiratory disease and its outcomes in the clinical course of asthma: A systematic review of the literature and meta-analysis

Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD) might benefit from aspirin desensitization (AD) as an alternative treatment to standard care. However, there is conflicting evidence regarding its role in bronchial symptoms and asthma exacerbations. To analyze the clinical effects of AD in terms of lung function, systemic and inhaled steroid use, the frequency of acute asthma exacerbations, and adverse effects in patients with NERD and asthma. We identified randomized clinical trials (RCTs) from PubMed, EMBASE, SCOPUS, and EBSCO. We also searched the RCT references for additional studies. Studies comparing AD to placebo in patients with a previous history of pulmonary symptoms triggered by ASA or other NSAIDs or with a positive provocation test to ASA were included. Five studies with 210 participants with NERD were included in this review. The study duration ranged from 3 to 6 months. Overall, the risk of bias across the included RCTs was low. We identified 3 studies evaluating lung function, 2 of which reported a significant improvement in FEV1 in the AD group after 6 months, while the other reported no difference among the treatments. Due to high heterogeneity, we did not pool the results. The remaining primary outcomes were reported only in a single study each, hindering their interpretation. Secondary outcomes revealed reduced symptom and medication scores in patients with AD. Due to the small number of studies included in this systematic review, conclusions should be made with caution. AD shows a trend towards improving lung function (FEV1) following 6 months of treatment, although no conclusions can be made regarding the use of corticosteroids or the frequency of acute exacerbations. AD appears to reduce both symptom and medication scores. Additional RCTs are needed to fully assess the efficacy of AD in reducing bronchial symptoms in patients with NERD.

Pulmonary Function Testing in Work-Related Asthma: An Overview from Spirometry to Specific Inhalation Challenge.

Work-related asthma (WRA) is a very frequent condition in the occupational setting, and refers either to asthma induced (occupational asthma, OA) or worsened (work-exacerbated asthma, WEA) by exposure to allergens (or other sensitizing agents) or to irritant agents at work. Diagnosis of WRA is frequently missed and should take into account clinical features and objective evaluation of lung function. The aim of this overview on pulmonary function testing in the field of WRA is to summarize the different available tests that should be considered in order to accurately diagnose WRA. When WRA is suspected, initial assessment should be carried out with spirometry and bronchodilator responsiveness testing coupled with first-step bronchial provocation testing to assess non-specific bronchial hyper-responsiveness (NSBHR). Further investigations should then refer to specialists with specific functional respiratory tests aiming to consolidate WRA diagnosis and helping to differentiate OA from WEA. Serial peak expiratory flow (PEF) with calculation of the occupation asthma system (OASYS) score as well as serial NSBHR challenge during the working period compared to the off work period are highly informative in the management of WRA. Finally, specific inhalation challenge (SIC) is considered as the reference standard and represents the best way to confirm the specific cause of WRA. Overall, clinicians should be aware that all pulmonary function tests should be standardized in accordance with current guidelines.

Air Trapping Is Associated with Heterozygosity for Alpha-1 Antitrypsin Mutations in Patients with Asthma

Background: Alpha-1 antitrypsin deficiency (AATD) is a hereditary disorder involving lungs, characterized by low serum concentration of the protein alpha-1 antitrypsin (AAT) also called proteinase inhibitor (PI). Asthma is common in AATD patients, but there are only few data on respiratory function in asthmatic patients with AATD. Objectives: The aim of the study was to evaluate lung function in asthmatic outpatients with mutation in the SERPINA1 gene coding for AAT versus asthmatic subjects without mutation. Methods: We performed the quantitative analysis of the serum concentration of AAT in 600 outpatients affected by mild to moderate asthma from the University Hospital of Parma, Italy. Fifty-seven of them underwent the genetic analysis subsequently; they were subdivided into mutated and non-mutated subjects. All the mutated patients had a heterozygous genotype, except 1 (PI*SS). We assessed the lung function through a flow-sensing spirometer and the small airway parameters through an impulse oscillometry system. Results: The values of forced vital capacity (% predicted) and those of the residual volume to total lung capacity ratio (%) were, respectively, lower and higher in patients mutated versus patients without mutation, showing a significantly greater air trapping (p = 0.014 and p = 0.017, respectively). Moreover, patients with mutation in comparison to patients without mutation showed lower forced expiratory volume in 3 s (% predicted) and forced expiratory volume in 6 s (L) spirometric values, reflecting a smaller airways contribution. Conclusions: In asthmatic patients, heterozygosity for AAT with PI*MZ and PI*MS genotypes was associated with small airway dysfunction and with lung air trapping.

Preoperative evaluation for lung resection in patients with bronchiectasis: should we rely on standard lung function evaluation?

The scant data about non-cystic fibrosis bronchiectasis, including tuberculosis sequelae and impairment of lung function, can bias the preoperative physiological assessment. Our goal was to evaluate the changes in lung function and exercise capacity following pulmonary resection in these patients; we also looked for outcome predictors. We performed a non-randomized prospective study evaluating lung function changes in patients with non-cystic fibrosis bronchiectasis treated with pulmonary resection. Patients performed lung function tests and cardiopulmonary exercise tests preoperatively and 3 and 9 months after the operation. Demographic data, comorbidities, surgical data and complications were collected. Forty-four patients were evaluated for lung function. After resection, the patients had slightly lower values for spirometry: forced expiratory volume in 1 s preoperatively: 2.21 l ± 0.8; at 3 months: 1.9 l ± 0.8 and at 9 months: 2.0 l ± 0.8, but the relationship between the forced expiratory volume in 1 s and the forced vital capacity remained. The gas diffusion measured by diffusing capacity for carbon monoxide did not change: preoperative value: 23.2 ml/min/mmHg ± 7.4; at 3 months: 21.5 ml/min/mmHg ± 5.6; and at 9 months: 21.7 ml/min/mmHg ± 8.2. The performance of general exercise did not change; peak oxygen consumption preoperatively was 20.9 ml/kg/min ± 7.4; at 3 months: 19.3 ml/kg/min ± 6.4; and at 9 months: 20.2 ml/kg/min ± 8.0. Forty-six patients were included for analysis of complications. We had 13 complications with 2 deaths. To test the capacity of the predicted postoperative (PPO) values to forecast complications, we performed several multivariate and univariate analyses; none of them was a significant predictor of complications. When we analysed other variables, only bronchoalveolar lavage with positive culture was significant for postoperative complications (P = 0.0023). Patients who had a pneumonectomy had a longer stay in the intensive care unit (P = 0.0348). The calculated PPO forced expiratory volume in 1 s had an excellent correlation with the measurements at 3 and 9 months; but the calculated PPO capacity for carbon monoxide and the PPO peak oxygen consumption slightly underestimated the 3- and 9-month values. However, none of them was a predictor for complications. Better tools to predict postoperative complications for patients with bronchiectasis who are candidates for lung resection are needed. Clinicaltrials.gov: NCT01268475.

Validation of portable Bluetooth enabled smart spirometer (Alveoair™) for the measurement of various lung functions in healthy subjects

Background: Alveoair™ is a fully indigenously developed turbine operated handheld and portable Bluetooth enabled smart spirometer. Affordable Bluetooth enabled smart spirometers like Alveoair™ have been designed and developed to meet the challenges of patients with lung tissue disorders with aims to provide constant monitoring of the lung conditions and identify the degree of prognosis of the diseases before and after treatment. During the current pandemic of coronavirus disease 2019, lung function is severely affected. Spirometry is one of the most important tools in the investigation and monitoring of the patients with respiratory pathology and helps establish diagnosis for various lung diseases through the evaluation of lung functions and curves. Aims and Objectives: The objective of the present study is validation of Alveoair™ spirometer accuracy with Food and Drug Administration 510K Notified and CE approved spirometer NuvoAir in measuring lung capacity with various parameters limited to forced vital capacity (FVC), forced expiratory volume (FEV)1, peak expiratory flow (PEF), and FEV1/FVC measurement readings. Materials and Methods: The present study was done on 60 healthy subjects without any risk factors affecting pulmonary functions and all the necessary precaution taken during the period of study. Pulmonary function test was performed by both Alveoair™ and NuvoAir devices on each of the subjects for result comparisons. Results: It is evident that measurements parameters FVC, FEV1, PEF, and FEV1/FVC by the Alveoair™ have demonstrated parity with NuvoAir measurement with high Pearson and interclass correlation coefficient >90%, r2 value of FVC, FEV1, and PEF >90% and for FEV1/FVC ratio >80% and P-value for all the parameters

Spirometry Abnormalities and Its Associated Factors Among Primary School Children in a Nigerian City.

Background:There is paucity of data on objectively measured lung function abnormalities in Nigerian children using diagnostic testing methods such as spirometry. Such assessments could prompt early diagnosis and therapeutic interventions.Methods:This was a cross sectional study among children aged 6 to 12 years in South-Eastern Nigeria. We selected participants from one school using a multistage stratified random sampling technique. A structured respiratory questionnaire was administered to obtain necessary data. The lung functions of the children were measured by spirometry. We used Lower Limits of Normal (LLN) based on GLI reference equations for African-American and mixed ethnicities to define abnormal spirometry. We studied the association between the exposures and lung function using logistic regression/chi-squared tests.Results:A total of 145 children performed acceptable and repeatable tests. There were 73 males (50.3%), mean age of 9.13 years (+1.5) and age range 6 to 12 years. Frequency of respiratory symptoms was cough- 64 (44.1%) and wheeze in 19 (13.1%). Using GLI for African-Americans, fifty-five (37.9%) children had abnormal spirometryobstructive pattern in 40 (27.6%) and restrictive pattern in 15 (10.3%). The two references showed significant differences in interpretation of abnormality (χ2 = 72.86; P < .001). Respiratory symptom-wheeze was an independent determinant of abnormal lung function in this population.(OR = 0.31; 95%CI: 0.10–0.94; P = .04)Conclusion:There is a high burden of respiratory symptoms and abnormal spirometry among these children. The need for objective evaluation of lung function especially for children with respiratory symptoms is evident.

Pulmonary Function of 449 Hospitalized COVID-19 Patients Which Including 141 Asymptomatic Carriers and 308 Mild and Moderate Cases

Background: Since the COVID-19 outbreak, there has been a few articles on pulmonary function studies in COVID-19 patients discharged one month later or three month later. However, there is no literature mentioned about the pulmonary function of hospitalized COVID-19 patients so far.Methods: In this study, we firstly performed a retrospective study to identify the pulmonary function changes with 449 COVID-19 inpatients including 141 asymptomatic carriers compared with 228 non-COVID-19 outpatients which accepted pulmonary function test in health examine center.Results: We found that COVID-19 patients included asymptomatic carriers had worse pulmonary function compared to non-COVID-19 patients even when they were hospitalized. In addition, age may be an important factor which contributes to pulmonary dysfunction in COVID-19 patients. Besides, the IL-6 level in the blood may affect the evaluation of lung function results and may be used to predict the pulmonary function of COVID-19 patients.Conclusion: Early rehabilitation training for COVID-19 patients is critical to their recovery.Funding Information: Supported by Novel coronavirus pneumonia emergency treatment and diagnosis technology research project of Heilongjiang provincial science and Technology Department, the National Natural Science Foundation of China (No.81571871, 81770276), Harbin Medical University Cancer Hospital Haiyan Fund (JJMS2021-10), Heilongjiang Postdoctoral Fund (LBH-Z20070).Declaration of Interests: All the authors have no conflict of interest to declare.Ethics Approval Statement: A written informed consent was regularly obtained from all patients upon admission into the 1st affiliated hospital of Harbin Medical University (the intensive care center for severe COVID-19 patients in Harbin, Heilongjiang province). The study was approved by the Ethics Committee of 1st affiliated hospital of Harbin Medical University.

Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective.

Chronic obstructive pulmonary disease (COPD) is highly prevalent among patients with atrial fibrillation (AF), shares common risk factors, and adds to the overall morbidity and mortality in this population. Additionally, it may promote AF and impair treatment efficacy. The prevalence of COPD in AF patients is high and is estimated to be ∼25%. Diagnosis and treatment of COPD in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and pulmonologist. Differential diagnosis may be challenging, especially in elderly and smoking patients complaining of unspecific symptoms such as dyspnoea and fatigue. Routine evaluation of lung function and determination of natriuretic peptides and echocardiography may be reasonable to detect COPD and heart failure as contributing causes of dyspnoea. Acute exacerbation of COPD transiently increases AF risk due to hypoxia-mediated mechanisms, inflammation, increased use of beta-2 agonists, and autonomic changes. Observational data suggest that COPD promotes AF progression, increases AF recurrence after cardioversion, and reduces the efficacy of catheter-based antiarrhythmic therapy. However, it remains unclear whether treatment of COPD improves AF outcomes and which metric should be used to determine COPD severity and guide treatment in AF patients. Data from non-randomized studies suggest that COPD is associated with increased AF recurrence after electrical cardioversion and catheter ablation. Future prospective cohort studies in AF patients are needed to confirm the relationship between COPD and AF, the benefits of treatment of either COPD or AF in this population, and to clarify the need and cost-effectiveness of routine COPD screening.

Dynamic hyperinflation induced by the 6-minute pegboard and ring test in hospitalized patients with exacerbated COPD.

The six-minute pegboard and ring test (6-PBRT) has been used to evaluate functional capacity of the upper limbs in stable chronic obstructive pulmonary disease (COPD) patients. To the best of our knowledge, no studies have evaluated dynamic hyperinflation (DH) during exercise with upper limbs in the hospital setting. The aim of this study was to evaluate physiological responses and DH induced by 6-PBRT in hospitalized patients with acute exacerbation of COPD (AECOPD). A cross-sectional study was conducted in a tertiary hospital enrolling patients who were hospitalized due to AECOPD. All included participants underwent an evaluation of lung function and 6-PBRT when they reached minimum clinical criteria. Ventilatory and hemodynamics parameters were monitored during 6-PBRT and until 6 minutes of rest after the test. Symptoms of dyspnea and upper limb fatigue were also measured. Eighteen patients (71.3±5.1 years) with a mean FEV1 of 43.2±18.3% were included in the study (11 females). Prevalence of DH after 6-PBRT was 50% (considering the drop of 150 ml or 10% of inspiratory capacity, immediately after the end of the test). There was a significant increase in respiratory rate, minute volume, dyspnea, and upper limb fatigue after the end of 6-PBRT (p<0.05). Dyspnea recovered more precociously than the perception of fatigue, being reestablished within four minutes of rest. An increase in heart rate, systolic and diastolic blood pressures was also induced by 6-PBRT (p<0.05), requiring 6 minutes of recovery to return to baseline. No adverse events were observed during 6-PBRT. We concluded that 6-PBRT induces physiological changes during its execution, at safe levels, requiring a maximum of 6 minutes for recovery. Finally, the test proved to be safe and applicable for patients hospitalized due to AECOPD.

Tidal breath in healthy term newborns: An analysis from the 2nd to the 30th days of life.

Few data are available concerning normative lung function parameters measured in unsedated neonates. To evaluate lung function changes in neonates. In this prospective cohort study, tidal breath parameters were measured using the MasterScreen PAED system and standardized protocols. Measurements were performed on 60 (30 male) term, healthy, unsedated neonates on the postnatal 2nd and 30th days. Expiratory time (TE; p < .001; Cohen's d = 0.561), exhaled volume to peak tidal expiratory flow (VPTEF; p < .001; Cohen's d = 0.789), minute ventilation (p < .001; Cohen's d = 0.926), tidal volume (VT; p < .001; Cohen's d = 1.835), expiratory flow when 75%, 50%, and 25% of tidal volume remaining in the lungs (TEF75 [p < .001; Cohen's d = 1.070], TEF50 [p < .001; Cohen's d = 0.824], TEF25 [p < .001; Cohen's d = 0.568]), and inspiratory time (Ti; p < .001; Cohen's d = 0.654) were higher on Day 30 compared to Day 2, while time to reach peak tidal expiratory flow to total expiratory time (TPTEF/TE; p = .006; Cohen's d = 0.371), the volume until peak tidal expiratory flow to total expiratory volume (VPTEF/VE; p = .001; Cohen's d = 0.447), and respiration rate (RR; p = .001; Cohen's d = 0.432) were lower, and Ti/TE was unchanged. Positive correlation was observed between length and VT (r = .347; p = .008) on Day 2 and (r = .338; p = .008) on Day 30. The present study reveals the physiological changes occurring in lung functions in healthy term neonates during the neonatal period.

Quantitative assessment of pulmonary function in lymphangioleiomyomatosis patients using high-resolution computed tomography and pulmonary function tests.

BackgroundTo explore the feasibility of using quantitative high-resolution computed tomography (HRCT) to evaluate pulmonary function in patients with pulmonary lymphangioleiomyomatosis (PLAM).MethodsPulmonary function tests (PFTs) were performed in 30 patients with pathologically confirmed PLAM with the use of HRCT. These results were correlated with quantitative HRCT in 21 patients.ResultsThere were significant correlations between the HRCT parameters for lung function and PFT parameters. Among these parameters, emphysema volume (EV), pulmonary volume with a pixel index less than the trigger threshold (−950 HU) to account for a proportion of total lung volume [PI-950 (%)] and forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC (%)] had the strongest correlations, reaching values between −0.71 and −0.68. HRCT lung function might therefore also be helpful for predicting changes in lung function before and after treatment.ConclusionsHRCT is helpful for the assessment of pulmonary function in PLAM patients and can assist in the clinical evaluation of lung function and treatment response in patients with this disease.

Body image in COPD and its relation with physical activity levels, lung function and body composition: An observational study.

Body image has been previously defined as the mental figure we have of the contours and shape of our body; and the feelings concerning these characteristics. A change in body perception can influence one's feelings of self-worth and compromise functional abilities. Thus, the detection of distortions in body image could be important data for clinical evaluation of subjects with COPD. To assess the body image perception of subjects with COPD. Also, to investigate the association between body image and levels of physical activity in these subjects. 109 subjects were recruited and divided into the COPD group and control subjects without any pulmonary conditions. For this cross-sectional study, we performed an initial evaluation and participants were evaluated regarding physical activity level, body image (silhouette scale) and determination of body mass index (BMI). Finally, we performed the evaluation of lung function (spirometry) and body composition analysis (bioelectrical impedance). BothCOPD and control subjects presented alterations in body image. Both groups desired significantly lower BMI and weight measures, according to the silhouette scale, demonstrating body dissatisfaction (P < .05). No differences in the level body dissatisfaction were found between Control and COPD groups (P > .05). No associations between physical activity levels and body image were observed (P > .05; r = -0.24 to 0.14). In conclusion, patients with COPD present significant body dissatisfaction, similar to control individuals. Furthermore, body image perception in COPD is related to body composition measurements but not to physical activity levels.

Longitudinal Evaluation of Lung Function in Gulf War I Veterans Exposed to Depleted Uranium.

Gulf War I (GWI) Veterans exposed to depleted uranium (DU) have undergone biennial surveillance to assess for DU-related health effects. No DU-specific respiratory effects have been observed cross-sectionally, but longitudinal lung function decline has not been assessed. A dynamic cohort of 71 Veterans underwent spirometry testing between 1999 and 2019. Longitudinal rates of decline of spirometry values were compared among Veterans with high versus low uranium levels using a linear mixed model. There was no significant difference in rate of decline of spirometry values between Veterans with high versus low uranium levels. The overall rate of decline was similar to that of the general population. In 20 years of follow-up, there does not appear to be an accelerated rate of decline of lung function among veterans exposed to depleted uranium.