Expiratory Volume Research Articles

The first Japanese case of autosomal dominant cutis laxa with a frameshift mutation in exon 30 of the elastin gene complicated by small airway disease with 8 years of follow-up

BackgroundCutis laxa constitutes a diverse group of connective tissue diseases, both inherited and acquired, characterized by loose skin and varying systemic involvement, including pulmonary lesions. While cutis laxa has been linked to conditions like emphysema, asthma, and bronchiectasis, the specific pathological and radiological characteristics underlying pulmonary complications related to cutis laxa remain unclear.Case presentationA 36-year-old woman, diagnosed with cutis laxa at birth, presented to our outpatient clinic with severe obstructive ventilatory impairment, evident in pulmonary function tests (expiratory volume in one second (FEV1)/forced vital capacity (FVC): 34.85%; %residual volume [RV]: 186.5%; %total lung capacity [TLC]: 129.2%). Pulmonary function tests also indicated small airway disease (%FEF50%, 7.9%; %FEF75%, 5.7%; and %FEF25–75%, 6.8%). Computed tomography (CT) revealed the lack of normal increase in lung attenuation on expiratory CT scan, with no discernible emphysematous changes. Exome sequencing was performed to confirm the association between the pulmonary lesions and cutis laxa, revealing a frameshift variant in exon 30 of the elastin gene (ELN). Further analysis employing a parametric response map revealed a longitudinal increase in the percentage of functional small airway disease (fSAD) from 37.84% to 46.61% over the 8-year follow-up, despite the absence of overt changes in CT findings, specifically the lack of normal increase in lung attenuation on expiratory CT scan. Over the same follow-up interval, there was a modest reduction of 25.6 mL/year in FEV1 coupled with a significant increase in %RV. Pulmonary function test metrics, reflective of small airway disease, exhibited a continual decline; specifically, %FEF50%, %FEF75%, and %FEF25–75% diminished from 7.9% to 7.0%, 5.7% to 4.6%, and 6.8% to 5.4%, respectively.ConclusionsThis case highlighted an instance of autosomal dominant cutis laxa arising from a frameshift variant in exon 30 of ELN, accompanied by small airway disease. Comprehensive investigation, utilizing quantitative CT analysis, revealed a longitudinal increase in fSAD percentage with a mild reduction in FEV1. These findings indicate that elastin deficiency may not only diminish elastic fibers in the skin but also be implicated in small airway disease by impacting components of the extracellular matrix in the lungs.

The role of pulmonary rehabilitation in improving lung functions in patients with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial and peripheral entheseal inflammation and new bone production(1). The development of syndesmophytes, enthesophytes, and spinal fusion along the course of the disease is linked to chronic pain, functional impairment, and disability(2). Fibrosis of the upper lobes of the lungs (interstitial lung disease) and chest wall abnormalities are two of the emerging forms of pulmonary involvement in AS. (3). Pulmonary rehabilitation is a multifaceted program of education, counselling, breathing exercises, and other modalities that can increase the patient’s independence and ease of functioning(4). Aim To estimate the role of pulmonary rehabilitation in enhancing lung function in AS individuals in relation to disease activity, clinical, and functional parameters. Patients and methods This study was an interventional study: single-arm group (prospective randomized clinical study). Thirty people (30) participated in that study from those presented to Physical Medicine, Rheumatology and Rehabilitation inpatient and outpatient clinic at Ain Shams University hospitals, diagnosed as radiographic axial spondyloarthropathy (SPA) from 02/2022 to 12/2022. All patients underwent pulmonary rehabilitation program and were exposed to a detailed history, clinical, and pulmonary function testing. Disease activity was evaluated by Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), Valuation of function by using Bath Ankylosing Spondylitis Functional index (BASFI), 6-Minute walk test (6MWT), the Modified Borg Dyspnoea Scale (MBS), and Timed Up and Go (TUG) test. All function and clinical scores were done at baseline and repeated after completing pulmonary rehabilitation program. Result The mean age of patients was 36.57 ± 7.83 years (23–45 years), with a median disease duration of (5 (3–9) years). In total, there were 19 out of the studied patients with restrictive pattern. With comparison between pre- and postintervention of pulmonary rehabilitation, there was a significant statistical difference in all, disease activity (ASDAS and BASFI) and functional (MBS, TUG, and 6MWT) parameters (P <0.001), except for occiput to the wall. Regarding pulmonary function tests, including forced vital capacity (FVC), expiratory volume in one second (FEV1), and peaked expiratory flow (PEF), there was a statistically significant change at baseline and at the end of exercise (P <0.001). Conclusion Improved respiratory function and disease activity and overall functional activity are possible outcomes of pulmonary rehabilitation programs in combination with other rehabilitation interventions.

Dynamic changes in quality of life in older patients with chronic obstructive pulmonary disease: a 7-year follow up

Purposes: Chronic obstructive pulmonary disease (COPD) is a major cause of the rapid decline of health-related quality of life (HRQoL), associated with accelerated frailty in older populations. This study aimed to analyse the long-term dynamic changes of HRQoL and the predictive factors for the rapid decline of HRQoL in older patients with COPD.MethodsOverall 244 patients with COPD, aged ≧ 65 years from one medical centre were enrolled between March 2012 and July 2020. Further, we prospectively assessed HRQoL scores with utility values, using EuroQol Five-Dimension (EQ-5D) questionnaires. Additionally, long-term dynamic changes in HRQoL were analysed using the Kernel smoothing method and examined the factors contributing to the deterioration of HRQoL using a linear mixed effects model.ResultsOlder patients with COPD with forced expiration volume (FEV1) < 50% of prediction entered the phase of rapid and continuous decline of HRQoL ~ 2 years after enrolment, but patients with FEV1 ≥ 50% of prediction without rapidly declined HRQoL during 7 years follow up. Therefore, FEV1 < 50% of prediction is a novel predictor for the rapid decline of HRQoL. The course of rapidly declining HRQoL occurred, initially in the usual activities and pain/discomfort domains, followed by the morbidity, self-care, and depression/anxiety domains ~ 2 and 4 years after enrolment, respectively. The mixed effects model indicated that both FEV1 < 50% of prediction and a history of severe acute exacerbation (SAE) requiring hospitalisation were contributing factors for deterioration in HRQoL .ConclusionsBoth FEV1 < 50% of prediction and exacerbations requiring hospitalisation were contributing factors for the deterioration of HRQoL in long-term follow up. Additionally, FEV1 < 50% of prediction was a novel predictor for patients entering the phase of rapid decline of HRQoL.

Effect modification of glycemic control on association of lung function with all-cause and cardiovascular mortality in persons with type 2 diabetes – A retrospective cohort study

BackgroundPoor glucose control might deteriorate the impaired pulmonary function, which can ultimately lead to mortality. However, few studies have examined the effect modification of glucose control on the association between pulmonary function and mortality. This study aimed to examine the association of pulmonary function with mortality and determine the effect modification of glycemic level on the association of pulmonary function with mortality in persons with type 2 diabetes (T2DM). MethodsA retrospective cohort study included 3846 persons with T2DM with pulmonary function testing in Taiwan during 2002–2020. Expiratory volume in 1 s (FEV1) was measured as pulmonary function. Cox proportional hazards models were used and the effect modification of pulmonary function parameters and glucose control was assessed by their product terms. ResultsThere were 733 deaths during an average follow-up of 7.83 years. Significant associations of FEV1 and mortality were found (hazards ratio [HR] for FEV1 Z-scores of <0 to −1, <-1 to −2 and <−2: 1.47 [1.20, 1.80], 2.48 [1.95, 3.14] and 3.07 [1.74, 5.44] compared with participants with Z-score ≥0, respectively. All p for trend<0.001). Significant effect modifications were found and the association between FEV1 and mortality was stronger in persons with good glycemic control compared with poor glycemic control (FEV1–FPG effect modification, P = 0.01; FEV1–HbA1c effect modification, P = 0.03). ConclusionPulmonary function, measured by FEV1, is significantly associated with mortality in persons with T2DM. Significant effect modification of glucose control on the association between pulmonary function parameters and mortality was found.

A Longitudinal Study of Adherence among Cystic Fibrosis Patients: Associations with Gratitude Over the Course of One Year.

Daily airway clearance therapy (ACT) is a critical aspect of treatment in cystic fibrosis (CF), but poor adherence is a prominent concern. Identifying factors that might enhance or diminish adherence is a priority for treatment centers. Gratitude, a generalized tendency to notice and appreciate positive facets of experience, is a psychosocial resource that has commanded growing research interest. This longitudinal study examined whether gratitude at baseline was associated with ongoing or persistent ACT adherence over the course of a year. Trait gratitude was evaluated at baseline using a validated measure, among adults receiving care at a regional CF treatment center. Self-reported adherence to ACT was assessed at baseline, 6months, and 12months using the Cystic Fibrosis Treatment Questionnaire. Average age of participants was 27.2years, 45.5% were women, and 19.7% had severe disease. In multivariable logistic regression models that accounted for disease severity (Forced Expiratory Volume1% predicted) and other clinical and demographic variables, individuals with higher baseline gratitude were significantly more likely to demonstrate persistent adherence over the course of the year. Gratitude remained predictive after additionally adjusting for other well-known psychosocial resource variables (social support and emotional well-being). This is among the first demonstrations that gratitude is associated with persistent self-reported adherence to treatment over time. Findings suggest that gratitude may be important psychosocial resource for adults with CF, as they contend with complex, highly burdensome treatment regimens. Further research is warranted to examine these relationships and their impact on downstream health outcomes.

Subjective and objective comparative analysis of nasal ventilation function before and after nasal septoplasty

Objective:To investigate the changes of nasal ventilation before and after septoplasty by using NOSE scoring scale and nasal function examination, and to explore the correlation between subjective nasal obstruction and nasal function examination and its clinical application value. Methods:A total of 129 cases of nasal septum deviation from December 2021 to April 2023 in our hospital were selected for study. All patients underwent septoplasty. Nasal obstruction symptom evaluation（NOSE） was performed in all patients before surgery and 3 months after surgery. nasal minimal cross-sectional area（MCA） and nasal cavity volume（NCV） were recorded by nasal acoustic reflex, nasal resistance meter and nasal respiration apparatus, nasal resistance（NR）, distance between the nostril to minimum cross-sectional area,（the distance between the nostril to minimum cross-sectional area, MD）, nasal inspiratory volume（IV）, nasal expiratory volume（EV）, the nasal partitioning ratio, NPR includes objective indicators such as inspiratory volume difference ratio（NPRi） and expiratory volume difference ratio（NPRe）. Paired test was used to compare and analyze the changes of various indicators before and after surgery, and the difference（P<0.05） was statistically significant, and Pearson correlation linear analysis was used to analyze the correlation between subjective and objective indicators. Results:There were statistically significant differences in NOSE score, NCV, NR, MD, EV, IV, NPRe and NPRi of 129 patients before and after surgery（P<0.05）, while there was no statistically significant difference between MCA before and after surgery（P>0.05）. Preoperative NOSE score was correlated with NR, NCV, EV, IV, NPRe and NPRi（P<0.05）, but not with MD and MCA（P>0.05）. There was correlation between NOSE score and NR, MCA, NCV, EV, IV, NPRe and NPRi（P<0.05）, but no correlation between nose score and MD（P>0.05）. Conclusion:The subjective NOSE scale combined with nasal function test has certain clinical reference value in evaluating the surgical effect of patients with deviated nasal septum.

Probable Respiratory Sarcopenia Decreases Activities of Daily Living in Older Patients Hospitalized with Respiratory Diseases: A Cross-sectional Study.

Respiratory sarcopenia is characterized by low respiratory muscle mass and respiratory muscle strength, but its impact on activities of daily living (ADL) remains unknown. We aimed to investigate the association between respiratory sarcopenia and decreased ADL. This retrospective cross-sectional study included older inpatients (≥65 years old) with respiratory diseases who underwent rehabilitation. Because the evaluation of respiratory muscle mass is challenging, probable respiratory sarcopenia was defined according to low appendicular skeletal muscle index (<7 kg/m2 for men, <5.7 kg/m2 for women) and peak expiratory flow rate (<4.4 L/s for men, <3.21 L/s for women). ADL was assessed on the first day of rehabilitation using the baseline Barthel Index (BI). Of 111 inpatients (median age 75 years; 57 women), 13 (11.7%) had probable respiratory sarcopenia. Forty-five patients (40.5%) had sarcopenia and 12 of these had probable respiratory sarcopenia. Pulmonary functions (Forced Vital Capacity and expiratory volume in 1 s) were significantly lower in patients with probable respiratory sarcopenia than those without. Spearman's rank coefficient analysis showed probable respiratory sarcopenia did not significantly correlate with age, phase angle, Charlson Comorbidity Index (CCI), or hemoglobin (Hb). Multivariate linear regression analysis with baseline BI revealed probable respiratory sarcopenia (β -0.279 and P=0.004) was the significant factor after adjusting for age, sex, body mass index, chronic obstructive pulmonary disease, CCI, and Hb. Probable respiratory sarcopenia was independently associated with decreased ADL in patients aged 65 years and older who were hospitalized with respiratory diseases.

A prospective research on depression among chronic obstructive pulmonary disease patients in a tertiary care hospital

Background: Chronic obstructive pulmonary disease (COPD) indicates chronic lung disorders presented by a gradually progressive irrevocable bronchial obstruction (progressive restriction of the enforced expiratory capacity in 1 s forced expiratory volume-1) and manifestation compound of recurring bronchial cough and breathlessness. The patient’s life enters into a vicious cycle due to the complications of concurrent depressive disorder. Aims and Objectives: This research was conducted to evaluate the occurrence of despair among COPD patients in an advanced care hospital using a patient health questionnaire (PHQ-9) scale. Materials and Methods: This research was led subsequently receiving authorization from Institutional Ethical Board and inscribed well-versed agreement from the patients in the department of respiratory medicine. The PHQ-9 scale was employed for screening and assessment of despair yielding relevant details. No intervention was administered for the research. The analysis was based on the information obtained from the investigation reports. Results: Reddy et al. suggested the arbitrary classification of PHQ-9 scores: 0–4 indicates negligible misery, 5–9 minor misery, 10 and higher than indicates reasonable to acute misery. In our research, 39 patients scored PHQ-9 score between 0 and 4, 46 patients scored PHQ-9 score between 5 and 9, and 15 patients scored PHQ-9 score 10 and above. Conclusion: The occurrence of depression among COPD patients is significantly excessive so validated screening tool for depression is required in COPD management.

Predicting the Aerobic Capacity in Chronic Obstructive Pulmonary Disease Patients with Infection: A Study Protocol

Introduction: Chronic Obstructive Pulmonary Disease (COPD), a prevalent respiratory condition, can be prevented and treated. Among various triggers, infections are a leading cause of COPD exacerbations. Assessing aerobic capacity is essential in COPD management, as it serves as a fundamental indicator of both quality of life and mortality. However, determining this target value necessitates the estimation of a gender-specific predictive aerobic capacity value for each individual. Need of the study: The newly developed gender-based reference equation for aerobic capacity may have the potential to accurately calculate predicted values that assess the individual patient and aerobic capacity. Aim: To develop a gender-based prediction equation to assess aerobic capacity in COPD patients with infection. Materials and Methods: A cross-sectional study will be conducted at a tertiary care super specialty hospital, analysing various parameters including anthropometric data and pulmonary function tests to identify factors related to aerobic capacity. The Forced Expiration Volume in 1 second/Forced Vital Capacity (FEV1/FVC) ratio will be documented using the post-bronchodilator Pulmonary Function Test (PFT) report, while aerobic capacity will be evaluated through the Six-Minute Walk Test (6MWT). The sample size will be calculated with G*Power 3.1.9.7 software. Data will be analysed using IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Demographics and outcomes will be checked for normality using the Shapiro–Wilk test. Depending on data type, Chi-square, Spearman’s or Pearson’s tests will be used to assess the correlations between FEV1/FVC and 6MWT. Multivariate linear regression with a step-wise approach will create a predictive equation for aerobic capacity. Subsequently, a standardised equation for aerobic capacity will be derived.

Combination of Perioperative Comprehensive Nursing and Early Postoperative Nutritional Intervention Promotes Recovery and Immune Function of Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer

This study aimed to explore the effects of perioperative comprehensive nursing combined with early postoperative nutritional intervention on the postoperative recovery and immune function of patients undergoing thoracoscopic radical resection of lung cancer. The study included 116 patients at the People’s Hospital of Danyang from March 2020 to March 2023. Patients in the control group received routine nursing + routine intravenous nutrition, while those in the study group received perioperative comprehensive nursing + early enteral nutrition. The study group presented a shorter time for getting out of bed, anal exhaust, first feeding, and hospitalization than the control group. In the study group, the levels of forced vital capacity and expiratory volume in one second exceeded than those in the control group; the Hamilton Anxiety Scale and Hamilton Depression Scale scores were lower; the total protein, prealbumin, and albumin levels were higher; and the CD3+, CD4+, and CD4+/CD8+ levels were higher, while CD8+ levels were lower. The study group presented a lower incidence of complications than the control group, and the SF-36 scores were higher. Overall, perioperative comprehensive nursing combined with early postoperative nutritional intervention can accelerate postoperative recovery and promote the immune function of patients undergoing thoracoscopic radical resection of lung cancer.

Longitudinal assessment of lung function in Swiss childhood cancer survivors-A multicenter cohort study.

Childhood cancer survivors are at risk for pulmonary morbidity due to exposure to lung-toxic treatments, including specific chemotherapeutics, radiotherapy, and surgery. Longitudinal data on lung function and its change over time are scarce. We investigated lung function trajectories in survivors over time and the association with lung-toxic treatments. This retrospective, multicenter cohort study included Swiss survivors diagnosed between 1990 and 2013 and exposed to lung-toxic chemotherapeutics or thoracic radiotherapy. Pulmonary function tests (PFTs), including forced expiration volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity, and diffusion capacity of the lung for carbon monoxide, were obtained from hospital charts. We calculated z-scores and percentage predicted, described lung function over time, and determined risk factors for change in FEV1 and FVC using multivariable linear regression. We included 790 PFTs from 183 survivors, with a median age of 12 years at diagnosis and 5.5 years of follow-up. Most common diagnosis was lymphoma (55%). Half (49%) of survivors had at least one abnormal pulmonary function parameter, mainly restrictive (22%). Trajectories of FEV1 and FVC started at z-scores of -1.5 at diagnosis and remained low throughout follow-up. Survivors treated with thoracic surgery started particularly low, with an FEV1 of -1.08 z-scores (-2.02 to -0.15) and an FVC of -1.42 z-scores (-2.27 to -0.57) compared to those without surgery. Reduced pulmonary function was frequent but mainly of mild to moderate severity. Nevertheless, more research and long-term surveillance of this vulnerable population is needed.

Inhalation of smoke from cooking activities in Katanga, a health burden among women users of charcoal and firewood

This study focused on the Inhalation of smoke from culinary activities in Katanga. It was carried out over a period of approximately 4 years. The study population consisted of women whose average age was 37.8 (16) years. On the one hand, 119 rural women (permanent users of coal in the Futuka village and 121 urban women (FU) in the Vallée urban district of the city of Lubumbashi were approached and selected. The fundamental question was whether prolonged or sporadic exposure to smoke from cooking activities could be an exposure factor to the risk of respiratory infections. Following the investigations made and the multiple functional explorations, we arrived at the confirmation of this hypothesis . In view of the results obtained, we found that the frequency of use of these biomasses oscillated respectively between 63.6% in town and 75% in rural areas. In the two female categories considered, the rates of cough and morning and usual sputum were, in almost all cases, higher among women from Futuka than among those from the Vallée district. Concerning the crisis of breathlessness and difficulty breathing, we noticed that for the three parameters observed (morning awakening with difficulty breathing, shortness of breath at rest during the day and shortness of breath after intense effort), the women users of the Vallée district were the more affected. For the values, apart from the Tiffnaud ratio (FEV1/FVC%), the functional exploration using the spirometer showed overall that almost all the spirometric parameters led to statistically significant differences between urban women (FU ) of the Vallée district and rural (FR) of the Futuka village. These are the forced vital capacity (FVC% pred with a p=0.034), the peak expiratory flow (PEF with a p value of 0.000) and the expiratory volume at the first second (FEV1% pred with a p value of 0.000).

Peak risk of SARS-CoV-2 infection within 5 s of face-to-face encounters: an observational/retrospective study

The link between aerosol dynamics and viral exposure risk is not fully understood, particularly during movement and face-to-face interactions. To investigate this, we employed Particle Trace Velocimetry with a laser sheet and a high-speed camera to measure microparticles from a human mannequin’s mouth. The average peak time in the non-ventilated condition (expiratory volume, 30 L; passing speed, 5 km/h) was 1.33 s (standard deviation = 0.32 s), while that in the ventilated condition was 1.38 s (standard deviation = 0.35 s). Our results showed that the peak of viral exposure risk was within 5 s during face-to-face encounters under both ventilated and non-ventilated conditions. Moreover, the risk of viral exposure greatly decreased in ventilated conditions compared to non-ventilated conditions. Based on these findings, considering a risk mitigation strategy for the duration of 5 s during face-to-face encounters is expected to significantly reduce the risk of virus exposure in airborne transmission.

Effect of Individualized Nursing Intervention on Patients with Tuberculosis Latent Infection and Active Tuberculosis

Objective: This paper aims to explore the effect of individualized nursing intervention on patients with activetuberculosis (ATB) and latent tuberculosis infection (LTBI). Methods: The nursing study started in January 2020 and ended in January 2023. A total of 60 patients with ATB and LTBI were included, and they were divided into two groups according to the intervention schemes selected for control testing, each with 30 cases. The intervention program selected for group A was routine care, and for group B was individualized nursing. The proportion of adverse reactions, changes in the level of lung items, self-management outcomes and satisfaction were evaluated and compared. Results: After evaluating the proportion of adverse reactions, the total proportion of ATB and LTBI in group B was lower than that in group A (P &lt; 0.05). Based on the evaluation and testing of the expiratory flow (EF), expiratory volume (EV), and vital capacity (VC) after the intervention, these levels in group B showed higher outcomes than those in group A (P &lt; 0.05). The scores in terms of living habits, sleep, diet, and compliance in group B were higher than those in group A (P &lt; 0.05). The total proportionof the satisfaction of ATB and LTBI patients in group B was higher than that in group A (P &lt; 0.05). Conclusion: After the intervention of individualized nursing measures in patients with ATB and LTBI, it was found that it can not only play a positive role in the prevention and control of adverse reactions, but also improve their lung function, and promote their self-management, with good satisfaction level, thus it has high research and clinical application values.

The effect of abdominal bracing on respiration during a lifting task: a cross-sectional study

BackgroundAbdominal bracing is a maneuver widely used by rehabilitation specialists and sports trainers to improve spinal stability. This study aimed to investigate how lifting tasks with and without abdominal bracing affect the respiratory function of the diaphragm.MethodsM-mode ultrasonographic assessment of diaphragmatic motion combined with spirometry was performed on 31 healthy adults. Participants were asked to breathe continuously whilst lifting a load with spontaneous abdominal muscle contraction (natural loaded breathing) and abdominal bracing (AB loaded breathing).ResultsPearson’s correlations revealed strong correlations between ultrasonography and spirometry measures (p < 0.001) for all types of breathing: tidal breathing (r = 0.709, r2 = 0.503), natural loaded breathing (r = 0.731, r2 = 0.534) and AB loaded breathing (r = 0.795, r2 = 0.632). Using paired-samples t-tests, the natural loaded breathing ultrasonography revealed more caudal diaphragm positions during inspiration (p < 0.001) but not during expiration (p = .101). Spirometry demonstrated lower lung volumes (L) at the end of inspiration and expiration (p < 0.001), with no changes in total lung volume (p = 0.06). The AB loaded breathing ultrasonography revealed more caudal diaphragm positions during inspiration (p = 0.002) but not during expiration (p = 0.05). Spirometry demonstrated lower lung volumes at the end of inspiration (p < 0.001), expiration (p = 0.002), and total lung volumes (p = 0.019).ConclusionThis study demonstrated that abdominal bracing performed during a lifting task reduces lung volume despite an increase in diaphragmatic motion. Diaphragm excursions strongly correlate with lung volumes even under postural loading.Trial registrationThe study was prospectively registered on 8 April 2021 at ClinicalTrials.gov with identification number NCT04841109.

Breathlessness Beliefs and Related Factors in Male Patients with Chronic Obstructive Pulmonary Disease.

Dyspnea may be a debilitating factor for people with pulmonary problems as it may cause fear of movement. The aim of the present study was to determine the related factors with breathlessness beliefs, in other words, dyspnea-related fear of movement, in patients with chronic obstructive pulmonary disease. Male patients with chronic obstructive pulmonary disease were included in the study. Breathlessness beliefs (Breathlessness Belief Questionnaire), perceived dyspnea severity (modified Medical Research Council Dyspnea Scale and modified Borg Scale), pulmonary function tests (forced vital capacity, forced expiration volume in 1 second, and peak expiratory flow), emotional status (Hospital Anxiety and Depression Scale), fatigue (Fatigue Impact Scale and Fatigue Severity Scale), physical activity level (International Physical Activity Questionnaire-Short Form), disease-related quality of life (St. George Respiratory Questionnaire), and generic quality of life (Short-Form 36) were evaluated. A total of 70 patients were included. Significant correlations were detected between breathlessness beliefs and perceived dyspnea severity, pulmonary function tests, emotional status, fatigue, physical activity level, disease-related quality of life, and generic quality of life (P < .001). No correlations were detected between physical characteristics and dyspnea-related fear of movement (P > .05). Dyspnea-related fear of movement was found to be strongly related to perceived dyspnea severity, pulmonary function tests, emotional status, fatigue, physical activity level, and quality of life; thus, including breathlessness beliefs assessment into clinical examination may help clinicians to understand their patients' needs comprehensively.

Efficacy and safety of once-daily single-inhaler triple therapy for mild-to-moderate chronic obstructive pulmonary disease: a study protocol for a randomised and interventional study

IntroductionBronchodilators, including long-acting muscarinic antagonists (LAMA) and long-acting beta 2 agonists (LABA), are the main treatments for chronic obstructive pulmonary disease (COPD). The efficacy of triple therapy (inhaled corticosteroids/LAMA/LABA) has...

ABOLITION OF SAGITTAL T7-T10 DYNAMICS DURING FORCED VENTILATION IN LENKE 1A AIS PATIENTS AS COMPARED WITH HEALTHY SUBJECTS: AN UNDERLYING FACTOR OF RESPIRATORY LIMITATION IN AIS

To analyze the dynamics of the thoracic spine during deep breathing in AIS patients and in healthy matched controls.Case-control cross-sectional study. 20 AIS patients (18 girls, Cobb angle, 54.7±7.9°; Risser 1.35±1.2) and 15 healthy volunteers (11 girls) matched in age (12.5 versus 15.8 yr. mean age) were included. In AIS curves, the apex was located in T8 (14) and T9 (6). Conventional sagittal radiographs of the whole spine were performed at maximal inspiration and expiration. The ROM of each spinal thoracic functional segment (T1-T7, T7-T10, T10-T12), the global T1–T12 ROM were measured. Respiratory function was assess by forced vital capacity (FVC), expiratory volume (FEV1), FEV1/FVC, inspiratory vital capacity (IVC) and peak expiratory flow (PEF).In healthy subjects, the mean T1–T12 ROM during forced breathing was 16.7±3.8. AIS patients showed a T1-T12 ROM of 1.1±1.5 (p&lt;0.05) indicating a sagittal stiffness of thoracic spine. A wide T7–T10 ROM (15.3±3.0) was found in healthy controls (91.6% of the T1–T12 ROM). AIS patients showed only 0.4±1.4 ROM at T7-T10 (36.4% of the T1–T12 ROM) (p&lt;0.001). There was a significant correlation between T7-T10 ROM and IVC.Lenke 1A AIS patients show a restriction of the thoracic spine motion with an almost complete abolition of T7-T10 ROM, a crucial segment participating in the deep breathing. T7-T10 stiffness could explain the ventilatory limitations found in AIS patients.

Study of Electrocardiographic Abnormalities in Patients with Chronic Obstructive Pulmonary Disease and its Correlation With Severity

Introduction: The current study aimed to identify the electrocardiographic (ECG) changes in chronic obstructive pulmonary disease (COPD) patients and their correlation to severity. Methods: A prospective observational study was conducted on 100 patients with COPD with expiratory volume in the first second (FEV1)&lt;0.7. Patients were categorized according to GOLD criteria and underwent Spirometry and ECG. Results: Among the COPD cases, 40% belonged to severe airflow limitation followed by very severe (32%), moderate (22%), and mild (6%) categories. The mean forced FEV1% in mild, moderate, severe, and very severe COPD was 81.3+0.57, 63.9+6.28, 41.15±4.59, and 25.625±2.41, respectively (P&lt;0.05). The higher risk factor for COPD is smoking in 80% with a mean pack of 20.67±6.5 years. The most ECG abnormality in COPD patients was right ventricular hypertrophy (RVH) (52%), followed by right bundle branch block (RBBB) in 40% of patients, right axis deviation (34%), P pulmonale (32%), and atrial fibrillation in 22% of COPD cases, respectively. Furthermore, there was a strong association between ECG abnormalities and COPD severity. COPD patients with a poor FEV1/FVC% ratio had more ECG abnormalities, and the ECG abnormalities were shown to be highly correlated with the severity, duration, and length of symptoms. Conclusion: COPD is a common condition in patients with a smoking history of&gt;20 pack-years, being more common in males in their 5th decade of life. Moreover, low FEV1 values were associated with ECG abnormalities. As the duration/severity of the disease rises, ECG abnormalities become more common. To avoid cardiac mortality and morbidity, all COPD patients should undergo cardiac examination through ECG for the management of co-morbidities.

Itraconazole Improved Bronchial Wall Thickness in Severe Persistent Asthma: A Double-blind Placebo-controlled Randomized Clinical Trial.

The purpose of this study was to evaluate the effect of 8 months of treatment with itraconazole on airway wall thickness in patients with severe persistent asthma. It was a double-blind, randomized, placebo-controlled clinical trial (IRCT20091111002695N9). Seventy-five subjects with severe persistent asthma received itraconazole (100 mg), prednisolone (5 mg), or placebo twice a day for eight months in three treatment groups (n=25 in each group). The primary objective was to improve the right upper lobe apical segmental bronchus (RB1) wall thickness percentage measured by high-resolution computed tomography scan of the lungs. Other morphometric measurements of RB1, asthma control test (ACT) score, presence of wheezing, dyspnea severity, rate of asthma exacerbation, fractional exhaled nitric oxide (FeNO), and expiratory volume in 1 second (FEV1) were set as the secondary outcomes. Wall thickness percentage reduced significantly from 46% to 43.7% from pre- to post-treatment in the itraconazole-treated subjects. Similarly, lumen area and radius increased significantly in both the prednisolone and itraconazole groups. Itraconazole led to a significant improvement in wheezing, dyspnea severity, FEV1, ACT score, and FeNO. Although prednisolone was also effective in improving pulmonary function tests and ACT scores, it was associated with significantly more side effects than itraconazole. Long-term treatment with itraconazole resulted in a significant reduction in bronchial wall thickness and improvements in clinical findings and pulmonary function tests. Thus, itraconazole could be a helpful add-on treatment option for severe persistent asthma patients to achieve better disease control.