Forced Expiratory Volume In 1s Research Articles

Rapid effect of benralizumab for severe asthma with chronic rhinosinusitis with nasal polyps

BackgroundThe anti-interleukin (IL)-5 agent benralizumab has recently become available for treatment of severe asthma with promising results; however, it appears effective only in specific subgroups of asthma patients. Severe asthma with chronic rhinosinusitis/nasal polyps (CRSwNP or eosinophilic chronic rhinosinusitis, ECRS) is a severe eosinophilic asthma phenotype that necessitates individualized treatment. ObjectiveTo assess differences in response to benralizumab between severely eosinophilic asthma patients with and without CRSwNP. MethodsSeventeen outpatients with severe eosinophilic asthma treated with benralizumab for 1 year were evaluated at the Osaka Habikino Medical Center. Blood eosinophil count, Asthma Control Questionnaire 5 (ACQ5), Asthma Quality of Life Questionnaire (AQLQ), fractional exhaled nitric oxide (FeNO), and spirometry were recorded at weeks 0, 4, 16, 24, and 50. ResultsACQ5 and AQLQ in CRSwNP(+) groups improved significantly after 4, 16, 24, and 50 weeks (p = 0.0195, 0.0156, 0.0117, and 0.0078 and p = 0.0098, 0.0098, 0.0029, and 0.0098, respectively) of benralizumab treatment. ACQ5 in CRSwNP(−) groups did not improve significantly after benralizumab treatment, but AQLQ improved significantly after 24 (p = 0.0313) and 50 weeks (p = 0.0313). Forced expiratory volume in 1s (FEV1) predicted in CRSwNP(+) groups were improved significantly after 4 weeks (p = 0.0137), 16 weeks (p = 0.0127), 24 weeks (p = 0.0098) and 50 weeks (p = 0.0420) of benralizumab treatment. %FEV1 in CRSwNP(−) groups were improved significantly after 24 weeks (p = 0.0313) and 50 weeks (p = 0.0313) of benralizumab treatment (Fig. 3). Forced vital capacity (FVC) predicted in CRSwNP(+) groups were improved significantly after 24 weeks (p = 0.0195) and %FVC in CRSwNP(−) groups improved significantly after 50 weeks (p = 0.0313) of benralizumab treatment. Maximum mid-expiratory flow rate predicted in CRSwNP(+) groups were improved significantly after 16 (p = 0.0137 and 50 weeks (p = 0.0371) of benralizumab treatment. ConclusionsBenralizumab can exert a very rapid therapeutic action, detectable 4 weeks after treatment initiation in patients with severe eosinophilic asthma with CRSwNP. However, severe eosinophilic asthma without CRSwNP takes longer to respond to benralizumab treatment.

Airway inflammation and lung function recovery after lobectomy in patients with primary lung cancer.

Fractional exhaled nitric oxide (FeNO), which represents airway inflammation, is an indicator of postoperative complication after lung surgery. However, its effects in the late postoperative period are unknown. The aim of this prospective study was to clarify the impact of FeNO on postoperative lung function in patients with lung cancer. We measured preoperative FeNO using NIOX VERO® in patients with primary lung cancer. Patients were divided into two groups according to their potential airway inflammatory status: preoperative FeNO levels below 25ppb (N group) and above 25ppb (H group). They were evaluated by spirometry at 3 and 6months after surgery during follow-up. The relationship between postoperative lung function and preoperative FeNO was evaluated. Between September 2017 and March 2019, 61 participants were enrolled. All of them underwent lobectomy as a curative surgery. There were no significant background variables between the two groups. Postoperative vital capacity (VC) and forced expiratory volume in 1s (FEV1) in the H group achieved less predictive values than those in the N group, which were not significant. The postoperative VC and FEV1 from 3 to 6months in the H group were significantly increased as compared to those in the N group (p<0.001). Preoperative FeNO is a predictor of delayed lung function recovery 3months after lobectomy in lung cancer patients. The impact had extended to VC and FEV1. Although this impact is temporary, early postoperative intervention is expected to reduce the adverse effect.

Efficacy of Tiotropium/Olodaterol Compared with Tiotropium as a First-Line Maintenance Treatment in Patients with COPD Who Are Naïve to LAMA, LABA and ICS: Pooled Analysis of Four Clinical Trials.

The efficacy of tiotropium/olodaterol compared with tiotropium in patients with chronic obstructive pulmonary disease (COPD) has been demonstrated in a large clinical programme. Currently, randomised controlled trial (RCT) data on dual bronchodilation as first-line maintenance therapy are limited. In this post hoc analysis of pooled data from four RCTs, we compared the efficacy of tiotropium/olodaterol versus tiotropium as maintenance therapy in patients with COPD who were not receiving maintenance treatment with long-acting muscarinic antagonists (LAMAs), long-acting β2-agonists (LABAs) or inhaled corticosteroids (ICS) ("maintenance naïve") at study entry. TONADO®1/2 (52weeks) and OTEMTO®1/2 (12weeks) were phaseIII RCTs in patients with COPD. TONADO1/2 and OTEMTO1/2 enrolled patients with post-bronchodilator forced expiratory volume in 1s (FEV1) < 80% predicted (lower limit FEV1 ≥ 30% in OTEMTO1/2 only). We examined the effect of tiotropium/olodaterol5/5µg versus tiotropium 5µg on trough FEV1 response, St. George's Respiratory Questionnaire (SGRQ) total score and Transition Dyspnoea Index (TDI) focal score at 12weeks in four pooled studies. The pooled analysis included 1078 maintenance-naïve patients. There were significant improvements with tiotropium/olodaterol versus tiotropium in trough FEV1 [0.056L; 95% confidence interval (CI) 0.033, 0.079; P < 0.0001], SGRQ score (-1.780; 95% CI -3.126 to -0.434; P = 0.0096) and TDI score (0.409; 95% CI 0.077, 0.741; P = 0.0158) at week12. For patients receiving tiotropium/olodaterol, the odds of achieving a minimal clinically important difference from baseline in any of the analysed outcomes (FEV1 ≥ 0.1 L, SGRQ ≥ 4.0 points or TDI ≥ 1.0 point) were higher versus tiotropium. In patients who were maintenance naïve at baseline, treatment initiation with tiotropium/olodaterol resulted in greater improvements in lung function, health status and dyspnoea severity compared with tiotropium alone, without compromising patient safety. These results support the use of dual bronchodilation with tiotropium/olodaterol as first-line maintenance treatment in patients with COPD. ClinicalTrials.gov: TONADO® 1 and 2 (NCT01431274 and NCT01431287, registered 8 September 2011) and OTEMTO® 1 and 2 (NCT01964352 and NCT02006732, registered 14 October 2013).

Target Workload For Exercise Challenge Tests Exceeds Achievable Workload In Children With Mild Asthma

PURPOSE: Exercise challenge tests are bronchoprovocation tests used to diagnose exercise induced bronchoconstriction. The American Thoracic Society (ATS) recommends calculating the target workload for exercise challenge tests using predicted forced expiratory volume in 1s (FEV1). The goal is for patients to achieve a minute ventilation between 40 to 60% of predicted maximum voluntary ventilation (PMVV) during the exercise challenge test. The purpose of this study was to compare predicted workload with actual workload achieved during an exercise challenge test in 8 to 12-year-old children with mild asthma. METHODS: Eleven children (3 girls, 10.3 ± 0.9 yr, 142.6 ± 8.1 cm, 40.7 ± 9.6 kg) completed pulmonary function testing and also completed maximal exercise tests and exercise challenge tests on a stationary bike. PMVV was calculated as 35 x measured FEV1. The test was completed at a target workload calculated using measured FEV1 (53.76 x measured FEV1 - 11.07). Our goal was to increase workload every minute as follows: 60%, 75%, 90%, and 100% target. However, if the child was unable to maintain cadence or expressed inability to complete 6 minutes of cycling, the workload was maintained or reduced to an achievable workload. RESULTS: 27% of children were below 40% PMVV, 36% were between 40 - 60% of PMVV, and 36% exceeded 60% of PMVV during the fifth minute of the exercise challenge test. After excluding the 3 children who did not achieve minute ventilation of at least 40% of PMVV, measured workload during the exercise challenge test (64 ± 18W; 66 ± 9%, Range: 49 - 78% of predicted target workload) was significantly lower than predicted target workload (96 ± 18W; P<0.001). Workload during the exercise challenge test was 67 ± 8% (Range: 60 - 80%) of maximum workload from the maximal exercise test. In the current project, we used measured FEV1 to calculate target workload for exercise challenge tests. However, even when predicted FEV1 was used to calculate target workload, measured workload during the exercise challenge test was below target and ranged from 43 - 112% (66 ± 22%) of target workload. CONCLUSIONS: The predicted workload for exercise challenge tests based on ATS guidelines may be difficult to achieve for children with mild asthma. However, target ventilation can be achieved at a workload that is between 60 - 80% of maximum workload.

Outcomes and predictive factors for successful smoking cessation therapy in COPD patients with nicotine dependence.

The data on smoking cessation treatment outcomes for smokers with chronic obstructive pulmonary disease (COPD)are limited. The present study assessed the effectiveness of smoking cessation interventions at our clinic. Data from a prospective registry of a 3-month smoking cessation program were evaluated. The primary outcome, smoking cessation, was defined as the complete abstinence from smoking between the 8-week and 12-week clinic visits. Pulmonary function and health-related quality of life using St. George's Respiratory Questionnaire (SGRQ) were assessed at baseline and at the end of the program. Out of the 155 COPD patients with nicotine dependence (female/male=39/116; mean age, 67.2±9.8 years; mean forced expiratory volume in 1s (FEV1), 59.7±21.1% predicted), 107 participants completed the program. Among the completers, 74 achieved smoking cessation. In the multivariate analysis, mental disorders (odds ratio [OR] 3.678, 95% confidence interval [CI]: 1.182, 11.445), higher exhaled carbon monoxide (CO) level (OR 1.080, 95% CI: 1.013, 1.151) and lower FEV1/forced vital capacity (FVC) (OR 0.958, 95% CI: 0.923, 0.995) were negatively associated with successful smoking termination. Significant changes in pulmonary function were found in quitters but not in continuous smokers (increases in FEV1 by 0.09L/s [95% CI: 0.03, 0.15] and peak expiratory flow by 0.23L/s [95% CI: 0.01, 0.44]). SGRQ total scores improved significantly in both quitters (-5.4 [95% CI: -8.4, -2.5]) and continuous smokers (-7.0 [95% CI: -11.6, -2.5]). In the program completers, the exhaled CO levels, FEV1/FVCratio, and presence of mental disorders were significantly associated with program success or failure in COPD patients with nicotine dependence.

Characterization Of Chronic Lung Allograft Dysfunction With Oscillometry

Chronic lung allograft dysfunction (CLAD) affects up to 70% of lung transplant (LTx) recipients and is the major impediment to long-term survival. CLAD is a retrospective diagnosis of exclusion when other causes for sustained drop of ≥20% of forced expiratory volume in 1s or forced vital capacity have been ruled out. No effective treatments exist, likely due to irreversible lung damage at diagnosis. Oscillometry (Osc) is a promising pulmonary function test that is particularly sensitive to changes in small airways, the site of CLAD onset. Our aim is to characterize Osc in patients with early CLAD. In a prospective study that began in December 2017, all new double LTx recipients are enrolled for Osc prior to routine spirometry. CLAD will be diagnosed according to ISHLT guidelines. By March 2020 we anticipate enrolment of 300 patients and 30 to have CLAD. We will compare Osc in CLAD patients with those who remain CLAD free after ≥6 mths follow-up. Univariate and mixed models will be used to examine spirometry vs Osc parameters of small airway disease: namely, X5 (reactance at 5Hz), Ax (area of reactance) and R5-19 (difference of resistance at 5 and 19 Hz). Receiver operating characteristic area under the curve (AUC) will be used to assess the predictive power of each. In interim analysis of patients enrolled by 31 July 2019, 13/197 had CLAD [all with bronchiolitis obliterans syndrome (BOS)], with median time of diagnosis at 24 wks post-LTx (range 10-59). Osc was abnormal and significantly different in CLAD vs. 87 CLAD-free recipients who had follow-up of ≥ 6 mths (median 40 wks). The mean Osc measurements at time of CLAD diagnosis vs last follow-up of CLAD-free patients are: X5 = -3.7 vs -2.1 cmH20.s/L, Ax = 31.6 vs 15.9 cmH20/L and R5-19 = 1.5 vs 0.8 cmH20.s/L (p < 0.05 for all). Using X5 to predict BOS, the AUC was 84%; a cut-off of X5 < -2.4 cmH20.s/L had sensitivity 73% and specificity 92%. Early analysis suggests Osc has excellent predictive capacity for BOS. Future work will test whether Osc can predict CLAD onset while spirometry is normal.

Quantitative CT analysis for bronchiolitis obliterans in perinatally HIV-infected adolescents-comparison with controls and lung function data.

To compare quantitative chest CT parameters in perinatally HIV-infected adolescents with and without bronchiolitis obliterans compared with HIV-uninfected controls and their association with lung function measurements. Seventy-eight (41 girls) HIV-infected adolescents with a mean age of 13.8 ± 1.65years and abnormal pulmonary function tests in the prospective Cape Town Adolescent Antiretroviral Cohort underwent contrast-enhanced chest CT on inspiration and expiration. Sixteen age-, sex-, and height-matched non-infected controls were identified retrospectively. Fifty-one HIV-infected adolescents (28 girls) displayed mosaic attenuation on expiration suggesting bronchiolitis obliterans. Pulmonary function tests were collected. The following parameters were obtained: low- and high-attenuation areas, mean lung density, kurtosis, skewness, ventilation heterogeneity, lung mass, and volume. HIV-infected adolescents showed a significantly higher mean lung density, ventilation heterogeneity, mass, and high- and low-attenuation areas compared with non-infected individuals. Kurtosis and skewness were significantly lower as well. HIV-infected adolescents with bronchiolitis obliterans had a significantly lower kurtosis and skewness compared with those without bronchiolitis obliterans. Lung mass and volume showed the strongest correlations with forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), and alveolar volume. Low-attenuation areas below -950HU and ventilation heterogeneity showed the strongest correlation with FEV1/FVC (range, - 0.51 to - 0.34) and forced expiratory flow between 25 and 75% of FVC (range, - 0.50 to - 0.35). Quantitative chest CT on inspiration is a feasible technique to differentiate perinatally HIV-infected adolescents with and without bronchiolitis obliterans. Quantitative CT parameters correlate with spirometric measurements of small-airway disease. • Perinatally HIV-infected adolescents showed a more heterogeneous attenuation of the lung parenchyma with a higher percentage of low- and high-attenuation areas compared with non-infected patients. • Kurtosis and skewness are able to differentiate between HIV-infected adolescents with and without bronchiolitis obliterans using an inspiratory chest CT. • Quantitative CT parameters of the chest correlate significantly with pulmonary function test. Low-attenuation areas and ventilation heterogeneity are particularly associated with spirometric parameters related to airway obstruction.

Change in Pulmonary Function Following Decortication for Chronic Pleural Empyema.

Chronic empyema is the final stage of the triphasic pathogenesis of empyema that is characterized by fibrin deposits in both pleural surfaces, leading to the formation of a thickened pleural peel. This restricts the lung movements, giving rise to a trapped lung and impairment of pulmonary function. The aim of this study was to determine the change in pulmonary function following decortication for chronic empyema. A total of 35 patients with chronic pleural empyema who underwent decortication via a posterolateral thoracotomy between July 2016 and July 2017 were reviewed and followed-up for 6±3 months after surgery. All patients underwent a pulmonary function test using spirometry before and after surgery. Pre-operation spirometry values [mean forced expiratory volume in 1s (FEV1) and mean forced vital capacity (FVC)] were compared with the post-operation data obtained during follow-up and the change was quantified by statistical analysis. FEV1 was 70.51% before surgery vs. 83.43% after surgery (p<0.001). FVC was 69.74% before surgery vs. 85.40% after surgery (p<0.001). There was no influence of bacteriology, side of occurrence of the lesion, smoking habit, or diabetes mellitus present before the operation on the patients' lung function (p>0.01). Decortication and pleurectomy via a posterolateral thoracotomy resulted in significant clinico-functional improvement in patients with chronic empyema, regardless of the bacteriology, side of occurrence of the lesion, smoking habit, or diabetic status of the patient.

Children with uncontrolled asthma and significant reversibility might show hypoxaemia.

Asthmatic children free of exacerbation with airway obstruction may have low partial pressure of oxygen (PaO2) which can be a marker for future risk, but PaO2 is scarcely measured during pulmonary function testing. We prospectively included asthmatic children with airway obstruction referred for pulmonary function testing, including blood gas analysis (n = 51). Hypoxaemia, defined as a value lower than - 2 z-score, was present in 15 (29%) children, and 37 (72%) children had a significant reversibility after bronchodilator administration. The multivariable model showed a positive influence of baseline forced expiratory volume in 1s (FEV1) on PaO2 (β coefficient 0.69, [95% CI: 0.07; 1.30]; P = 0.03), whereas uncontrolled asthma and FEV1 reversibility negatively influenced it (β coefficient - 1.59 [95% CI: - 2.74; - 0.44]; P = 0.01; and - 0.07 [95% CI: - 0.13; - 0.02]; P = 0.01, respectively). As a consequence, children with uncontrolled symptoms of asthma and FEV1 reversibility ≥ 12% were significantly more at risk of having hypoxaemia compared to children with well/partly controlled asthma or no significant reversibility of FEV1.Conclusion: Among obstructive asthmatic children without current exacerbation, hypoxaemia is more likely to be seen in children with uncontrolled asthma and a significant post-bronchodilator FEV1 reversibility, in favour of different pathophysiology and treatment requirements of their airway obstruction.What is Known:• Recommendations are to treat asthmatic children in order to control respiratory symptom and maintain normal pulmonary function.• Asthmatic children free of exacerbation may have different pathophysiology for airway obstruction (central, peripheral, inflammatory, spasticity, remodelling) and should be treated according the pathophysiology of their airway disease.What is New:• In obstructive asthmatic children free of current exacerbation, the presence of hypoxaemia (ventilation-perfusion mismatch) is influenced by asthma control and post-bronchodilator reversibility, independently of the level of baseline airway obstruction.• The presence of hypoxaemia in obstructive asthmatic children free of current exacerbation can be highly suspected by the composite index "uncontrolled asthma + FEV1reversibility ≥ 12%" which may guide treatment.

The time window of pet ownership exposure modifies the relationship of Environmental Tobacco Smoke with lung function: A large population-based cohort study

There is a large body of evidence linking Environmental Tobacco Smoke (ETS) exposure with impaired lung function. However, it is not known whether exposure to pets modifies this relationship. To investigate if pet ownership changes the association between ETS exposure and lung function, a population-based sample of 7326 children, 7-14 years old, were randomly recruited from 24 districts in northeast China. Lung function including forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF) was measured by spirometry, while pet ownership time periods and ETS exposure were collected by questionnaire. Two-level regression analysis was done, with covariates controlled for. The results showed pet exposure in certain early lifetime windows modified the associations of ETS exposure on decreased lung function in children. Among children exposed to current ETS, those exposed to pets in utero had greater reductions in lung function (for instance: OR for reduced FVC (<85% predicted)=10.86; 95% CI: 3.80-30.97) than those not exposed to pets in utero (OR=2.32; 95% CI: 1.76-3.05) (pinteraction=0.005). While, children exposed to current pet ownership reduced the lung function impairment induced by ETS exposure during the first 2 years of life and/or ETS exposure during pregnancy, especially for FVC impairment. For instance, OR (95%CI) for reduced FVC (<85% predicted) was 0.81 (0.56, 1.18) and 1.42 (1.15, 1.74), respectively, for children with or without current pet ownership exposed to ETS during the first 2 years of life (pinteraction=0.010). Furthermore, pet type or number of pets did not significantly modify associations between ETS exposure and lung function. In conclusion, the timing of pet ownership modified associations between ETS exposure and lung function, pet ownership in utero and during the first 2 years of life significantly worsened the adverse impacts of passive smoking on lung function.

Short term seasonal effects of airborne fungal spores on lung function in a panel study of schoolchildren residing in informal settlements of the Western Cape of South Africa

BackgroundThe individual effects of biological constituents of particulate matter (PM) such as fungal spores, on lung function in children are not well known. This study investigated the seasonal short-term effect of daily variation in Alternaria and Cladosporium fungal spores on lung function in schoolchildren. MethodsThis panel study evaluated 313 schoolchildren in informal settlements of the Western Cape of South Africa, exposed to spores of two commonly encountered fungi, Alternaria and Cladosporium species. The children provided forced-expiratory volume in 1-s (FEV1) and peak-expiratory flow (PEF) measurements thrice daily for two consecutive school-weeks in summer and winter. Daily PM10 levels, from a stationary ambient air quality monitor and fungal spore levels using spore traps were measured in each study area throughout the year. The effects of Alternaria and Cladosporium spores, on lung function were analysed for lag periods up to five-days, adjusting-for PM10, other pollen exposures, study area, and other host and meteorological factors. Same-day exposure-response curves were computed for both fungal species. ResultsThere was more variability in Alternaria spores level with noticeable peaks in summer. There were consistent lag-effects for Alternaria on PEF compared to Cladosporium, with the largest PEF deficit observed in winter (mean deficit: 13.78 L/min, 95%CI: 24.34 to −3.23 L/min) per 10spores/m3 increase in Alternaria spores on lag day-2. Although there were no observable lag-effects for Alternaria and Cladosporium on FEV1, same-day effects of Cladosporium spores on FEV1 was present across both seasons. Threshold effects of Alternaria on both PEF and FEV1 deficits were apparent at levels of 100 spores/m3, but could not be explored for Cladosporium beyond the levels observed during the study. ConclusionThe study provides evidence for the independent effects of daily exposure to ambient fungal spores of Alternaria and Cladosporium on lung function deficits, more especially in winter for PEF.

Determinants of the diminished exercise capacity in patients with chronic obstructive pulmonary disease: looking beyond the lungs.

Peak oxygen uptake, a primary determinant of prognosis, mortality and quality of life, is diminished in patients with chronic obstructive pulmonary disease (COPD), with mounting evidence supporting an important role for peripheral dysfunction, particularly within skeletal muscle. In patients with severe COPD and activity-matched controls, muscle oxygen transport and utilization were assessed at peak effort during single-leg knee-extensor exercise (KE), where ventilation is assumed to be submaximal. This strategy removes ventilation as the major constraint to exercise capacity in COPD, allowing maximal muscle function to be attained and evaluated. During maximal KE, both convective arterial oxygen delivery to the skeletal muscle microvasculature and subsequent diffusive oxygen delivery to the mitochondria were diminished in patients with COPD compared to control subjects. These findings emphasize the importance of factors, beyond the lungs, that influence exercise capacity in this patient population and may, ultimately, influence the prognosis, mortality and quality of life for patients with COPD. Peak oxygen uptake ( ), a primary determinant of prognosis, mortality and quality of life, is diminished in patients with chronic obstructive pulmonary disease (COPD). Mounting evidence supports an important role of the periphery, particularly skeletal muscle, in the diminished with COPD. However, the peripheral determinants of have not been comprehensively assessed in this cohort. Thus, the hypothesis was tested that both muscle convective and diffusive oxygen (O2 ) transport, and therefore skeletal muscle peak O2 uptake ( ), are diminished in patients with COPD compared to matched healthy controls, even when ventilatory limitations (i.e. attainment of maximal ventilation) are minimized by using small muscle mass exercise. Muscle O2 transport and utilization were assessed at peak exercise from femoral arterial and venous blood samples and leg blood flow (by thermodilution) in eight patients with severe COPD (forced expiratory volume in 1s (FEV1 )±SEM=0.9±0.1l, 30% of predicted) and eight controls during single-leg knee-extensor exercise. Both muscle convective O2 delivery (0.44±0.06vs. 0.69±0.07lmin-1 , P<0.05) and muscle diffusive O2 conductance (6.6±0.8vs. 10.4±0.9mlmin-1 mmHg-1 , P<0.05) were ∼1/3 lower in patients with COPD than controls, resulting in an attenuated in the patients (0.27±0.04vs. 0.42±0.05lmin-1 , P<0.05). When cardiopulmonary limitations to exercise are minimized, the convective and diffusive determinants of , at the level of the skeletal muscle, are greatly attenuated in patients with COPD. These findings emphasize the importance of factors, beyond the lungs, that may ultimately influence this population's prognosis, mortality and quality of life.

Effects of montelukast sodium plus budesonide on lung function, inflammatory factors, and immune levels in elderly patients with asthma.

Asthma in elderly patients causes excessive suffering and inconvenience. Regimens with better efficacy and less adverse events are still in need of researches. To investigate the effect of montelukast sodium plus budesonide on lung function, inflammatory factors, and immune levels in elderly asthma patients. A total of 180 patients with asthma were assigned into the control group and the observation group. The control group was given aerosol inhalation of budesonide suspension, while the observation group was given budesonide inhalation and oral montelukast sodium. The treatment effect, lung function (forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF)%), inflammatory factors (interleukin (IL)-4, IL-6, and tumor necrosis factor-α (TNF-α)), and immune level (immunoglobulin (Ig) A, and IgE) were analyzed and compared between the two groups. After treatment, the effective rate was significantly higher in the observation group. The lung function and serum inflammatory factors were improved in both groups. The FEV1, FVC, and PEF% in the observation group were better, and the inflammatory factors IL-4, IL-6, and TNF-α were lower. Patients in both groups showed elevated IgA level and reduced IgE level, and the improvements were more significant in the observation group. There was no significant difference between the two groups in terms of adverse reaction. Montelukast sodium plus budesonide has a promising clinical effect on asthma in elderly patients, effectively improves lung function and immunocompetence, and controls inflammatory response, without increasing the adverse reaction.

Abnormal Lung Clearance Index in Cystic Fibrosis Screen Positive, Inconclusive Diagnosis (CFSPID) Children with Otherwise Normal FEV1.

In preschool children with cystic fibrosis (CF), lung clearance index (LCI) is a sensitive test to detect early lung disease. Some children with CF screen positive, inconclusive diagnosis (CFSPID) may in time develop clinical features of CF. LCI has not been studied in CFSPID children. LCI and spirometry were performed in preschool age children with CF, CFSPID, and non-CF healthy controls (HCs) during two visits. Fifty-four preschool age children (HC n = 18, CFSPID n = 17, and CF n = 19) were tested. Mean LCI from the CFSPID group was not statistically different from HC (p = 0.49), but significantly different when compared to CF (p = 0.04). LCI was abnormal in 2 CFSPID children who carried potentially deleterious CFTR variants. Mean forced expiratory volume in 1s (FEV1) was not statistically different between CFSPID and CF (p = 0.26). LCI can potentially detect early lung disease in CFSPID individuals as part of assessing their risk for reclassification to CF diagnosis.

Uniportal thoracoscopic pulmonary lobectomy in the treatment of Lung Cancer.

Objective:To investigate the clinical efficacy of uniportal thoracoscopic pulmonary lobectomy in the treatment of lung cancer.Methods:One hundred and ten patients with lung cancer who were admitted to our hospital from February 2017 to June 2018 were enrolled and they were divided into the control group (55 patients) and observation group (55 patients) according to the random number table method. The patients in the observation group received uniportal thoracoscopic pulmonary lobectomy, and patients in the control group underwent triportal thoracoscopic pulmonary lobectomy. The surgical condition, postoperative pulmonary functions, postoperative complication incidence, and postoperative quality of life were compared between the two groups.Results:The intraoperative blood loss and number of dissected lymph nodes of the observation group were (125.31±12.63) mL and (13.91±2.41) respectively, which were not significantly different with (127.54±13.60) mL and (13.96±2.69) of the control group (P>0.05). The incision length of the observation group was (4.22±0.31) cm, shorter than (6.97±0.42) cm of the control group, the postoperative pain score was (2.87±0.69) points, lower than (4.31±1.09) points of the control group, and the operation time was (195.21±19.42) minutes, longer than (162.68±18.52) min of the control group; the differences were significantly different (P<0.05). The postoperative forced vital capacity (FVC), Maximum Ventilatory Volume (MVV) and Forced Expiratory Volume in 1s (FEV1) in the observation group were (1.90±0.75) L, (54.59±16.03) L/minutes and (1.60±0.53) L respectively, larger than (1.06±0.28) L, (38.41±15.59) L/min and (1.02±0.15) L respectively (P<0.05). The scores of Short Form 36-item Health Survey (SF-36) of patients in the observation group was observed one month after surgery, significantly higher than those in the control group, and the difference was statistically significant (P<0.05). The incidence of complications of the postoperative complication of the observation group was 12.7%, which was not significantly different with 14.5% of the control group (P>0.05).Conclusion:Patients who receive uniportal video-assisted thoracoscopic pulmonary lobectomy have milder trauma, which is beneficial to the lung functions and postoperative recovery. Moreover, the number of dissected lymph nodes in uniportal thoracoscopic pulmonary lobectomy is equivalent with that in triportal thoracoscopic pulmonary lobectomy. Hence it is worth clinical promotion.

Effect of lung protective ventilation on perioperative pulmonary infection in elderly patients with mild to moderate COPD under general anesthesia

ObjectiveThe research aims to explore the effects of different ventilation time on postoperative pulmonary infection in elderly patients with the mild and moderate chronic pulmonary obstructive disease (COPD), so as to provide evidence for reducing postoperative pulmonary infection complications in patients with COPD. Methods120 elderly patients with mild and moderate COPD were selected as the research objects. First, the general information of patients with COPD before surgery and the difference between healthy population and lung forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), FEV1/FVC and maximum midexpiratory flow (MMEF) functional indexes were analyzed and detected. Patients with COPD were operated on with single lung ventilation and general anesthesia. Patients with mild and moderate COPD were divided into two groups according to lung ventilation time (ventilation time 1.0–2.0h group, ventilation time >2.0h group). The inflammatory factors of IL-6, IL-21, TNF-α, and CXCL13 as well as inflammatory indicators of polycaprolactam (PCT), C-reactive protein (CRP) and white blood cell (WBC) in serum of all patients were detected after the operation. The probability of pulmonary infection after COPD was diagnosed and analyzed. Finally, the regression analysis of postoperative pulmonary infection in COPD patients was analyzed. Results(1) The results showed that the smoking rate of mild and COPD patients was significantly higher than that of healthy people (P<0.05). (2) The lung function indexes of the mild and moderate groups were significantly lower than those of the control group (P<0.01), while the lung function indexes of the moderate group were significantly lower than those of the mild group (P<0.05). (3) All the inflammatory indicators of moderate COPD patients were significantly higher than those of mild COPD patients (P<0.05). (4) All inflammation-related indicators in patients with mild and moderate COPD with ventilation time of >2.0h were significantly higher than those in the 1.0–2.0h group (P<0.05). (5) The probability of postoperative pulmonary infection in moderate patients was significantly higher than that in mild patients (P<0.01). The probability of postoperative pulmonary infection in >2.0h group was significantly higher than that in the 1.0–2.0h group (P<0.01). (6) Multivariate Logistic regression analysis results showed that lung function, duration of lung ventilation and smoking were independent risk factors for postoperative pulmonary infection in COPD patients. ConclusionIt is important to detect pulmonary function before surgery, maintain single lung ventilation protection for no more than 2.0h during surgery, and quit smoking to improve pulmonary infection in patients with COPD after surgery. In addition, the incidence of postoperative pulmonary infection in patients with moderate COPD was higher than that in patients with mild COPD, suggesting that early treatment in patients with COPD was also of great significance in reducing the incidence of postoperative pulmonary infection.

The evaluation of pulmonary function after rib fixation for multiple rib fractures and flail chest: a retrospective study and systematic review of the current evidence.

The primary aim of this retrospective cohort study was to evaluate the pulmonary function after rib fixation for patients with multiple rib fractures and flail chest. Secondary, a systematic review was performed to give an overview of the current literature and to allow comparison with our results. All adult (≥18years) patients who underwent rib fixation for multiple rib fractures or flail chest between 2010 and 2018 and who received a control pulmonary function test during the postoperative follow-up at our level-1 trauma center were retrospectively reviewed. Secondary, the PubMed, EMBASE and Cochrane databases were searched to identify studies reporting on the pulmonary function after rib fixation. The primary outcome parameters were the forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), FEV1/FVC ratio, maximum vital capacity (VCmax), total lung capacity (TLC), residual volume (RV), and RV/TC ratio. Of the 103 patients who underwent rib fixation, a total of 61 (59%) patients underwent a pulmonary function test in our hospital and were ultimately included. In the majority of patients all pulmonary function parameters fell within the normal range of the reference values. Obstructive impairment was predominantly seen in patients with pre-existing chronic obstructive pulmonary disease (COPD). Patients with multiple rib fractures had better recovery compared to those with a flail chest. The systematic review included a total of 15 studies and showed comparable results. The present study demonstrates that rib fixation for multiple rib fractures or flail chest results in adequate recovery of the pulmonary function within 3months after surgery. In addition, based on the current literature, further gradual improvement to maximum pulmonary values appears to occur during the first 12months after rib fixation.

Non-invasive carbon dioxide monitoring in patients with cystic fibrosis during general anesthesia: end-tidal versus transcutaneous techniques.

The gold standard for measuring the partial pressure of carbon dioxide remains arterial blood gas (ABG) analysis. For patients with cystic fibrosis undergoing general anesthesia or polysomnography studies, continuous non-invasive carbon dioxide monitoring may be required. The current study compares end-tidal (ETCO2), transcutaneous (TCCO2), and capillary blood gas carbon dioxide (Cap-CO2) monitoring with the partial pressure of carbon dioxide (PaCO2) from an ABG in patients with cystic fibrosis. Intraoperatively, a single CO2 value was simultaneously obtained using ABG (PaCO2), capillary (Cap-CO2), TCCO2, and ETCO2 techniques. Tests for correlation (Pearson's coefficient) and agreement (Bland-Altman analysis) were performed. Data were further stratified into two subgroups based on body mass index (BMI) and percent predicted forced expiratory volume in 1s (FEV1%). Additionally, the absolute difference in the TCCO2, ETCO2, and Cap-CO2 values versus PaCO2 was calculated. The mean ± SD differences were compared using a paired t test while the number of times the values were ≤ 3mmHg and ≤ 5mmHg from the PaCO2 were compared using a Fishers' exact test. The study cohort included 47 patients (22 males, 47%) with a mean age of 13.4 ± 7.8years, median (IQR) BMI of 18.7kg/m2 (16.7, 21.4), and mean FEV1% of 87.3 ± 18.3%. Bias (SD) was 4.8 (5.7) mmHg with Cap-CO2 monitoring, 7.3 (9.7) mmHg with TCCO2 monitoring, and 9.7 (7.7) mmHg with ETCO2 monitoring. Although there was no difference between the degree of bias in the population as a whole, when divided based on FEV1% and BMI, there was greater bias with ETCO2 in patients with a lower FEV1% and a higher BMI. The Cap-CO2 vs. PaCO2 difference was 5.2 ± 5.3mmHg (SD), with 16 (48%) ≤ 3mmHg and 20 (61%) ≤ 5mmHg from the ABG value. The TCCO2-PaCO2 difference was 9.1 ± 7.2mmHg (SD), with 11 (27%) ≤ 3mmHg and 15 (37%) ≤ 5mmHg from the ABG value. The ETCO2-PaCO2 mean difference was 11.2 ± 7.9mmHg (SD), with 5 (12%) ≤ 3mmHg and 11 (26%) ≤ 5mmHg from the ABG value. While Cap-CO2 most accurately reflects PaCO2 as measured on ABG, of the non-invasive continuous monitors, TCCO2 was a more accurate and reliable measure of PaCO2 than ETCO2, especially in patients with worsening pulmonary function (FEV1% ≤ 81%) and/or a higher BMI (≥ 18.7kg/m2).

Impact of age on the recovery of six-minute walking distance after lung cancer surgery: a retrospective cohort study.

The aim was to investigate the relationship of age for recovery of six-minute walking distance (6MWD), pulmonary function, and health-related quality of life (HRQOL) after lung cancer surgery. Primary outcome was the 6MWD recovery until 6months after surgery. Secondary outcome was the recoveries of forced expiratory volume in 1s (FEV1) and HRQOL until 6months after surgery. Linear mixed-effects model was used to estimate the association of age to the outcomes. A total of 311 lung cancer patients were included. All the 6MWD, FEV1, and HRQOL decreased after surgery (-32m, -0.39L, and -2 scores, respectively, p = 0.027-p < 0.001). While 6MWD increased every month after surgery (5m/month, 95% confidence interval (CI); 4-7, p < 0.001), the recovery decreased, as the age increased 1 standard deviation (SD) (i.e., 9years) (-2m/month; 95% CI -3 to -1, p < 0.001). While FEV1 increased every month after surgery (0.03L/month; 95% CI 0.02-0.03, p < 0.001), the recovery increased, as the age increased by 1 SD (0.01 L/month; 95% CI 0.00-0.01, p = 0.003), which was opposite to the 6MWD recovery. While the postoperative HRQOL recovered every month (2 score/month; 95% CI 1-2, p < 0.001), there was no significant association between the recovery and age (0 score/month; 95% CI -1 to 0, p = 0.5). The 6MWD recovery delayed in elderly patients, which was not related to their FEV1-and HRQOL recoveries. Postoperative walking training would be important for the elderly lung cancer patients.

Determinants of impaired lung function and lung cancer prediction among never-smokers in the UK Biobank cohort.

BackgroundImpaired lung health represents a significant burden on global health, including chronic obstructive pulmonary disease (COPD) and lung cancer. Given its global health impact, it is important to understand the determinants of impaired lung function and its relation to lung cancer risk independent of smoking. However, to date, no study has evaluated determinants of impaired lung function in a cohort exclusively of never-smokers, who also represent a growing proportion of all lung cancers.MethodsA total of 222,274 never-smokers with reproducible spirograms were identified in the UK Biobank population-based cohort and included in the analysis. Baseline volumetric measures of lung function, including forced expiratory volume in 1-s (FEV1) and forced vital capacity (FVC), were used to define lung function impairment. Determinants of impaired lung function were evaluated using Poisson regression with robust variance estimation. The added value of lung function in lung cancer prediction was evaluated using Fine and Gray regression accounting for the competing risk of all-cause mortality.FindingsLung function impairment was associated with low birthweight, ambient air pollution (PM2·5 μg/mm3), and overweight, after adjustment for other important risk factors. We observed modest improvement in discrimination by adding lung function to our lung cancer prediction model for never-smokers. The highest optimism-corrected AUC at 3 (0·700, 95% CI: 0·654–0·734) and 5 years (0·694, 95% CI: 0·658–0·736) included FEV1 (% of GLI predicted FEV1), while the highest AUC at 7 years was based on the inclusion of FEV1/FVC (0·722, 95% CI: 0·687–0·762).InterpretationWe identified several modifiable risk factors associated with increased risk of lung function impairment among lifetime never-smokers in UKB. We achieved moderate discrimination for lung cancer risk-prediction for never-smokers, and found modest improvement with the inclusion of lung function.FundThis study was supported by a Canada Research Chair to RJH.