Forced Expiratory Volume Research Articles

Associations between blood nickel and lung function in young Chinese: An observational study combining epidemiology and metabolomics

Prior research has explored the relationship between occupational exposure to nickel and lung function. Nonetheless, there is limited research examining the correlation between blood nickel levels and lung function among young adults in the general population. The metabolomic changes associated with nickel exposure have not been well elucidated. On August 23, 2019, we enrolled 257 undergraduate participants from the Chinese Undergraduates Cohort to undergo measurements of blood nickel levels and lung function. The follow-up study was conducted in May 2021. A linear mixed-effects model was employed to assess the relationship between blood nickel levels and lung function. We also conducted stratified analyses by home address. In addition, in order to explore the biological mechanism of lung function damage caused by nickel exposure, we performed metabolomic analyses of baseline serum samples (N = 251). Both analysis of variance and mixed linear effect models were utilized to assess the impact of blood nickel exposure on metabolism. Our findings from cross-sectional and cohort analyses revealed a significant association between blood nickel levels and decreased forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) among young adults in the general population. Furthermore, we found stronger associations in urban areas. In metabolomics analysis, a total of nine metabolites were significantly changed under blood nickel exposure. The changed metabolites were mainly enriched in six pathways including carbohydrate, amino acid, and cofactor vitamin metabolism. These metabolic pathways involve inflammation and oxidative stress, indicating that high concentrations of nickel exposure can cause inflammation and oxidative stress by disrupting the above metabolism of the body.

Effectiveness and safety of acupuncture as an adjunctive therapy for chronic obstructive pulmonary disease: a randomised controlled trial

BackgroundThe effectiveness and safety of acupuncture therapy to delay lung function decline in chronic obstructive pulmonary disease (COPD) remain unclear. This study aimed to determine whether acupuncture, as an adjunctive therapy to COPD-guided medication, could prevent lung function decline.MethodsThis randomised, two-centre study was conducted between February 2022 and July 2023. Men and women aged 40–80 years with COPD were recruited. Participants received active or sham acupuncture three times a week (36 sessions total). The primary outcome was the change in the percentage of forced expiratory volume for 1 s to the predicted value (FEV1%) between the baseline and after the intervention.ResultsOverall, 238 participants were screened, and 74 (58 men [78.4%]; mean [standard deviation] age, 69.6 [7.2] years) were randomised into the acupuncture and sham acupuncture groups (37 per group). After the intervention, the change in FEV1% was 1.35 (95% confidence interval [CI]: -0.47 to 3.17) and -2.44 (95% CI: -4.56 to -0.33) in the acupuncture and sham acupuncture groups, respectively. The difference was -3.97 (95% CI: -6.2 to -1.74), and the adjusted difference was -3.46 (95% CI: -5.69 to -1.24, P = 0.003) between the groups. A significantly less decline was found in forced expiratory volume for 1 s in the acupuncture group. All treatment-related adverse events (acupuncture = 11, sham = 2) were mild.ConclusionsCompared with sham acupuncture, acupuncture plus medication may delay lung function decline. However, further studies with a larger sample size and longer-term follow-up are needed to clarify the effects.

Lung function at 1-year follow-up in patients with persistent dyspnea after mild COVID-19 – comparisons with moderate and critical COVID-19

Aim: To assess lung function in patients with persistent dyspnea 1 year after mild coronavirus disease 2019 (COVID-19) and compare with those hospitalized with moderate or critical COVID-19. Methods: Adults with confirmed severe acute respiratory syndrome coronavirus-2 infection with mild COVID-19 and persistent dyspnea (n = 18) or with moderate (n = 34) or critical COVID-19 (n = 19) were followed up 11–13 months after initial infection. Inclusion criteria were age < 65 years, no smoking history, and no preexisting respiratory diseases. Sociodemographic and clinical data were collected, and patients underwent spirometry and measurement of diffusing capacity for carbon monoxide (DLCO). Results: The non-hospitalized patients were significantly younger and more often female compared with those in the moderate and critical groups (P = 0.002 and P < 0.001, respectively). No significant differences in comorbidities or body mass index (BMI) were noted between severity groups. An obstructive spirometry pattern (ratio of forced expiratory volume during the first exhalation second to forced vital capacity under the lower limit of normal (LLN)) was found in 5.6, 5.9, and 5.3% of patients in the mild, moderate, and critical groups, respectively (P = 0.995). Abnormal DLCO (< LLN) rates were seen in 5.6, 16.7, and 47.4% in the mild, moderate, and critical groups, respectively (P = 0.018). DLCO, expressed as a z-score, was significantly lower in the critical group compared with the mild group after adjustment for age, sex, and BMI. Conclusion: Only a few subjects with mild COVID-19 and persistent dyspnea had abnormal lung function 1 year after initial infection, assessed based on spirometry and DLCO measurements. An obstructive spirometry pattern at 1-year follow-up was uncommon even in patients with moderate or critical COVID-19. Impaired DLCO was more common in patients with critical COVID-19.

The Impact of Chest Binding on Pulmonary Functions of Trans and Gender Diverse Youth

PurposeThere is a scarcity of information regarding the health consequences of chest binding and its effects on pulmonary functions (PFs). This study aimed to evaluate binding practices, physical outcomes, and effects on PFs of trans or gender diverse (TGD) youth who bind. MethodsThe TGD and control groups underwent pulmonary function tests (PFTs), with the TGD group undergoing testing both with their binder and after removal. We additionally evaluated binding practices and its physical outcomes. Results33 TGD participants with a mean age of 20.15 ± 2.76 and 31 controls with a mean age of 20.74 ± 2.95 years were included. A large majority reported physical side effects, back pain being the most common. The comparison of PFTs of the TGD group with and without binder showed that vital capacity , forced vital capacity, and forced expiratory volume in 1 second values were significantly lower in the presence of a binder (both % predicted and L) (p < .005). Binding duration (both lifetime and weekly) did not correlate with PFTs, however, the ratio of change in forced expiratory volume -1/ forced vital capacity induced by binding correlated with weekly binding duration. When we separately compared the PFTs of the TGD group with and without binder to the control group, we found no significant difference. DiscussionDespite the abundance of physical side effects, comparison with the control group does not support long-lasting effects of binding on PF; however, it indicates acute restrictive impairment without a significant effect on airflow obstruction in youth who bind. These findings hold significance in facilitating well-informed decision-making processes pertaining to binding practices.

Low smoking exposure and development and prognosis of COPD over four decades: a population-based cohort study.

A diagnosis of COPD is mainly considered in individuals with >10 pack-years of smoking. We tested the hypothesis that low smoking exposure, below the critical threshold of 10 pack-years, increases risk of COPD and leads to poor prognosis. We followed non-obstructed adult smokers from the Copenhagen City Heart Study for COPD, defined as a forced expiratory volume in 1 s (FEV1)/forced vital capacity <0.70 and FEV1 <80% predicted, and for related clinical outcomes. First, we followed individuals for 5 years according to baseline smoking for risk of developing COPD, and thereafter for up to four decades for severe exacerbations and death. In 6098 non-obstructed smokers, 1781 (29%) developed COPD after 5 years of follow-up: 23% of individuals with <10 pack-years of smoking at baseline, 26% of those with 10-19.9 pack-years, 30% of those with 20-39.9 pack-years and 39% of those with ≥40 pack-years. During four decades of follow-up, we recorded 620 exacerbations and 5573 deaths. Compared to individuals without COPD with <10 pack‑years of smoking, multivariable adjusted hazard ratios (HRs) for exacerbations were 1.94 (95% CI 1.36-2.76) in those without COPD and ≥10 pack-years, 2.83 (95% CI 1.72-4.66) in those with COPD and <10 pack-years, 4.34 (95% CI 2.93-6.43) in those with COPD and 10-19.9 pack-years, 4.39 (95% CI 2.98-6.46) in those with COPD and 20-39.9 pack-years and 4.98 (95% CI 3.11-7.97) in those with COPD and ≥40 pack-years. Corresponding HRs for all-cause mortality were 1.20 (95% CI 1.10-1.32), 1.31 (95% CI 1.13-1.53), 1.59 (95% CI 1.40-1.79), 1.81 (95% CI 1.62-2.03) and 1.81 (95% CI 1.55-2.10). Low smoking exposure below the critical threshold of 10 pack-years increases risk of COPD in middle-aged adults within 5 years, and these individuals have increased risk of severe exacerbation and early death over four decades.

Association of Preserved Ratio Impaired Spirometry with Arterial Stiffness.

Rationale: Preserved ratio impaired spirometry (PRISm) is a recently recognized spirometric pattern defined by a ratio of forced expiratory volume in 1 second to forced vital capacity of at least 0.70 and a forced expiratory volume in 1 second <80% of reference. For unclear reasons, PRISm is associated with increased cardiovascular (CV) morbidity and mortality. Arterial stiffness is a major mechanism of CV disease, which can be measured by carotid-femoral pulse-wave velocity (cfPWV). Objectives: We explored the hypothesis that cfPWV would be increased in individuals with PRISm and airflow limitation (AL). Methods: We measured forced spirometry, lung volumes by body plethysmography, and cfPWV in 9,466 subjects recruited from the general population in the Austrian cross-sectional LEAD (Lung, Heart, Social, Body) study and tested the association of arterial stiffness with PRISm and AL by multivariable linear regression analysis. Individuals younger than 18 years were excluded from the study. Results: Individuals with PRISm (n = 431; 4.6%) were of similar age to those with normal spirometry (n = 8,136; 85.9%) and significantly younger than those with AL (n = 899; 9.5%). Arterial hypertension, diabetes mellitus, coronary artery disease, heart failure, and peripheral arterial occlusive disease were significantly more common in individuals with PRISm than in those with normal lung function and similar to those with AL. There was a significant association between PRISm and arterial stiffness on bivariate linear regression analysis (crude model, β = 0.038; 95% confidence interval [CI], 0.016-0.058), which persisted after robust adjustment for clinical confounders upon multivariable analysis (final model, β = 0.017; 95% CI, 0.001-0.032). cfPWV was significantly higher in individuals with PRISm irrespective of the presence of established CV disease or pulmonary restriction. AL also showed a significant association with arterial stiffness on multivariable linear regression analysis (final model, β = 0.025; 95% CI, 0.009-0.042). Conclusions: Arterial stiffness measured by cfPWV is increased in individuals with PRISm independent of CV disease and risk factors. The pathobiological mechanisms underlying this association deserve further research.

Assessing the prevalence and impact of preserved ratio impaired spirometry in low-income and middle-income countries: a post-hoc cross-sectional analysis

More than 90% of the morbidity and mortality from chronic respiratory disease occurs in low-income and middle-income countries (LMICs), with substantial economic impact. Preserved ratio impaired spirometry (PRISm) is a prevalent lung function abnormality associated with increased mortality in high-income countries. We aimed to conduct a post-hoc analysis of a cross-sectional study to assess the prevalence of, the risk factors for, and the impact of PRISm in three diverse LMIC settings. We recruited a random, age-stratified and sex-stratified sample of the population in semi-urban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda. Quality-assured post-bronchodilator spirometry was performed to American Thoracic Society standards and PRISm was defined as a forced expiratory volume in one second (FEV1) of less than 80% predicted with a FEV1/forced vital capacity ratio of 0·70 or more. We used t tests and χ2 analyses to assess the relationships between demographic, biometric, and comorbidity variables with PRISm. Multivariable logistic models with random intercept by site were used to estimate odds ratios (ORs) with 95% CIs. 10 664 participants were included in the analysis, with a mean (SD) age of 56·3 (11·7) years and an equal distribution by sex. The prevalence of PRISm was 2·5% in Peru, 9·1% in Nepal, and 16·0% in Uganda. In multivariable analysis, younger age (OR for each decile of age 0·87, 95% CI 0·82-0·92) and being female (1·37, 1·18-1·58) were associated with increased odds of having PRISm. Biomass exposure was not consistently associated with PRISm across sites. Individuals with PRISm had impairment in respiratory-related quality of life as measured by the St George's Respiratory Questionnaire (OR by decile 1·18, 95% CI 1·10-1·25). The prevalence of PRISm is heterogeneous across LMIC settings and associated with age, female sex, and biomass exposure, a common exposure in LMICs. A diagnosis of PRISm was associated with worse health status when compared with those with normal lung function. Health systems in LMICs should focus on all spirometric abnormalities as opposed to obstruction alone, given the disease burden, reduced quality of life, and size of the undiagnosed population at risk. Medical Research Council.

Retrospective cohort study of video-assisted thoracoscopic precise positioning reduction and internal fixation and thoracotomy reduction and internal fixation in treating multiple rib fractures.

This study aimed to assess the clinical effect of video-assisted thoracoscopic precise positioning reduction and internal fixation and thoracotomy reduction and internal fixation in the therapy of multiple rib fractures. A total of 80 patients with multiple rib fractures in First People's Hospital of Jingzhou from January 2021 to December 2022 were separated into control group (CG, 40 cases) and research group (RG, 40 cases) by random number table method. Patients in the CG received thoracotomy reduction and internal fixation. Patients in the RG received video-assisted thoracoscopic precise positioning reduction and internal fixation. Surgery-related indexes, serum interleukin, visual analogue scale (VAS) was used to evaluate postoperative pain, arterial oxygen saturation (SaO2) and oxygenation index (PaO2/FiO2), and pulmonary function indexes were measured in the two groups. After surgery, Visual analog scale (VAS) scores at 24 hour after surgery were reduced compared to six hour and 12 hour after surgery (P<0.05). VAS score at 12 hour after surgery was increased relative to 6 h after surgery (P<0.05), and VAS score at six hour, 12 hour as well as 24 hour after surgery in the RG was lessened in comparison with the CG (P<0.05). One day after surgery, SaO2 and PaO2/FiO2 in two groups were elevated compared to before surgery, and those in RG was increased in contrast to the CG (P<0.05). forced expiratory volume (FEV1), forced vital capacity (FVC), peak expiratory flow velocity (PEF) along with FEV1/FVC levels in two groups were increased (P<0.05). Compared with thoracotomy reduction and internal fixation, video-assisted thoracoscopic accurate positioning and internal fixation in treating patients with multiple rib fractures had a short treatment time, obvious advantages, and strong feasibility.

Impact of Cystic Fibrosis Transmembrane Conductance Regulator Modulators on Maternal Outcomes During and After Pregnancy

Cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulators are available to the majority of people with CF in the United States; little is known about pregnancy outcomes with modulator use. The aim of this retrospective study was to determine the impact of CFTR modulators on maternal outcomes. Does pregnancy differentially affect outcomes in female subjects with CF with and without CFTR modulator exposure? Data on pregnancies from 2010 to 2021 were collected from 11 US adult CF centers. Multivariable longitudinal regression analysis was performed to assess whether changes in percent predicted FEV1 (ppFEV1), BMI, pulmonary exacerbations (PEx), and Pseudomonas aeruginosa prevalence differed from prior to, during, and following pregnancy according to CFTR modulator use while adjusting for confounders. Infant outcomes are also described based on maternal modulator use. Among 307 pregnancies, mean age at conception was 28.5 years (range, 17-42 years), prepregnancy ppFEV1 was 74.2, and BMI was 22.3kg/m2. A total of 114 pregnancies (37.1%) had CFTR modulator exposure during pregnancy (77 with highly effective modulator therapy [HEMT] and 37 with other modulators). The adjusted mean change in ppFEV1 from prepregnancy to during pregnancy was -2.36 (95%CI, -3.56 to -1.16) in the unexposed group and 2.60 (95%CI, 0.23 to 4.97) in the HEMT group, with no significant change from during pregnancy to 1 year postpregnancy. There was an overall decline in ppFEV1 from prepregnancy to postpregnancy in the no modulator group (-2.56; 95%CI, -3.62 to -1.49) that was not observed in the HEMT group (1.10; 95%CI, -1.13 to 3.34). PEx decreased from prepregnancy to postpregnancy in the HEMT group, and BMI increased from prepregnancy to during pregnancy in all groups but with no significant change postpregnancy. Missing infant outcomes data precluded firm conclusions. We observed superior pregnancy and postpregnancy pulmonary outcomes in individuals who used HEMT, including a preservation of ppFEV1, compared with those unexposed to HEMT.

Cross-sectional association between posttraumatic stress and cognition is moderated by pulmonary functioning in world trade center responders.

Posttraumatic stress disorder (PTSD) symptomatology and poorer pulmonary function are highly prevalent psychiatric and medical conditions. In the present study, we tested for the individual, additive, and modifying associations of PTSD symptomatology and pulmonary function with cognitive performance. In this cross-sectional study, a total of 1,401 World Trade Center (WTC) responders (mean age = 53, SD = 8 years, 92% males) participated in the study. Cogstate assessment measured cognitive performance. PTSD symptomatology was measured using the trauma-specific version of the posttraumatic stress disorder checklist (PCL-17) adapted for the WTC attacks. The 1-second forced expiratory volume and forced vital capacity (FEV1/FVC) ratio was used to measure pulmonary function. Linear regressions with cognitive performance as the outcome were conducted to assess individual, additive, and moderating associations of PTSD symptomatology and pulmonary function. Higher PTSD symptomatology and poorer pulmonary function were negatively associated with cognitive performance. A 10% increase on the FEV1/FVC ratio moderated the association between PTSD symptomatology and cognition, whereby its association with cognition was stronger when PTSD symptomatology was higher (est. = 0.01, 95%CI = 0.004, 0.01, p < 0.001). When stratified by responder type, these associations persisted in trained (est. = 0.01, 95%CI = 0.01, 0.02, p < 0.001), but not in non-trained (est. = 0.004, 95% C.I. = -0.01, 0.02, p = 0.39) responders. In the presence of higher PTSD, better pulmonary functioning is associated with better cognitive performance. Early intervention efforts to mitigate preventable cognitive decline in high-risk populations should be studied, especially since intervention in one modality may have an impact on others.

Long-Term Clinical Efficacy of Elexacaftor-Tezacaftor-Ivacaftor in People With Cystic Fibrosis and Preexisting Advanced Lung Disease at Treatment Initiation

BackgroundElexacaftor-tezacaftor-ivacaftor (ETI) is associated with increased forced expiratory volume in the first second (FEV1), decreased exacerbation frequency, and increased body mass index (BMI) in people with Cystic Fibrosis (pwCF) [1, 2]. Landmark clinical trials excluded patients with advanced lung disease (ALD) as defined by FEV1<40%. We have previously reported an improvement in ppFEV1 of 7.9% after 3 months of ETI in people with CF and ALD (ACFLD)[3]. The long-term effects of ETI on this cohort are unknown. This study reports the efficacy of ETI following 24 months of treatment in people with ACFLD. Study DesignWe conducted a retrospective cohort study of adult patients with FEV1<40% and/or other high-risk features defined by the 2019 CFF lung transplant guidelines who were started on ETI between September 2019 and February 2020. Response to therapy was assessed with repeat spirometry measured at 12 and 24 months. All measurements were taken outside of an acute exacerbation. Demographics and clinical data including BMI and pulmonary exacerbation frequency were extracted from the medical record. Results57 of 64 people with ACFLD showed improved lung function with a mean change in ppFEV1 of 6.74% (p = <0.001, 95% CI 4.25 – 9.23%) between baseline and 24 months of treatment. BMI increased by a mean change of 1.55 kg/m2 (p = <0.001, 95% CI 0.93 – 2.18 kg/m2) during this interval. The annual exacerbation rate between the year before ETI and 24 months on ETI declined with a median of 1 fewer per year (p = 0.0007). InterpretationPeople with ACFLD experienced a significant increase in lung function at 24 months on ETI, although less than those with higher baseline lung function compared to prior studies [1, 2]. They also had an increase in BMI and a decline in the rate of annual pulmonary exacerbations.

Long-term effect of corticosteroid treatment during acute COVID-19 infection on pulmonary function test results.

The outbreak of the novel coronavirus 19 has led to unprecedented clinical challenges globally. Various therapeutic and pharmacologic interventions have been proposed, yet evidence of their long-term efficacy remains limited. Corticosteroids (CS) have shown efficacy in the sub-acute phase of the pandemic. This study aims to evaluate the long-term effects on pulmonary function tests (PFTs) in patients treated with CS during acute coronavirus disease 2019 (COVID-19) infection. A retrospective study was conducted from February 2020 to March 2021. Clinical and demographic data were extracted from electronic medical records of patients attending the post-COVID outpatient clinic at the Pulmonary Institute of Soroka University Medical Center. A multivariate linear mixed effects model was employed to obtain adjusted estimates for the impact over time. The study included 405 patients, of whom 155 (38.3%) received CS treatment. Approximately 60% completed two or more follow-up visits. PFTs [forced expiratory volume in the first second (FEV1), forced vital capacity (FVC)] returned to baseline more rapidly (0.9% and 0.85% per month, respectively) in patients treated with CS. This accelerated recovery was observed across all patients, including those with a body mass index (BMI) above 30 kg/m2 and those with known chronic lung disease. Systemic CS treatment during acute COVID-19 infection was associated with a faster recovery of PFTs during long-term follow-up, even among subgroups at higher risk of long-term pulmonary damage.

The role of FEV1/FVC in the prediction of acute exacerbation of COPD

BackgroundWhether the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) can be used as a biomarker to predict the risk of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is unclear. MethodsTo investigate the predictive role of FEV1/FVC for AECOPD, we analyzed data from an observational and multicenter cohort study of 2043 patients with COPD in KOREA. Exposures were post-bronchodilator FEV1/FVC and/or percentage predicted FEV1 (FEV1%pred). The outcome was the development of AECOPD during the first year of follow-up. ResultsDuring the first year of follow-up, the proportion of patients who developed AECOPD increased as FEV1/FVC decreased (P < 0.01). FEV1/FVC and FEV1%pred had similar predictive power for AECOPD, with optimal predictive cut-offs of approximately 0.5 for FEV1/FVC and 50 % for FEV1%pred. When the participants were classified into groups based on these cut-offs, compared with a high both-lung function group (FEV1/FVC≥0.5 and FEV1%pred≥50 %), the low-FEV1 group (FEV1/FVC≥0.5 and FEV1%pred<50) had a modestly increased risk of severe AECOPD (adjusted odds ratio[aOR] = 3.12; 95 % confidence interval[CI] = 1.59–6.16), while the risk of severe AECOPD was the highest in the low both-lung function group (FEV1%pred<50 % and FEV1/FVC<0.5) (aOR = 5.16; 95 % CI = 3.34–7.97). ConclusionsFEV1/FVC is a spirometric biomarker predictive of AECOPD. In countries where FEV1%pred is not available for their population, FEV1/FVC could be used as a biomarker for assessing the risk of AECOPD. In countries where accurate FEV1%pred is available, both FEV1%pred and FEV1/FVC could be used to provide additional information to assess the risk of AECOPD. Key messageThis study showed that FEV1/FVC had similar predictive power for AECOPD compared with percentage predicted FEV1. Furthermore, the use of both FEV1 and FEV1/FVC provides additional information for the risk assessment of AECOPD.

Glucagon-like-peptide-1 agonist therapy in adults with cystic fibrosis

Glucagon-like-peptide-1 (GLP-1) agonists are commonly used to improve glycemic control and promote weight loss in individuals with type 2 diabetes mellitus (T2DM) and/or obesity. However, there is a paucity of evidence regarding GLP-1 agonist use in people with cystic fibrosis (pwCF). We present 11 people with CF (males: 3, females: 7; age range 24–47; BMI range 25.7–43.7) treated with GLP-1 agonists (semaglutide: 9,tirzepatide: 2) for variable duration (1–50 months). All experienced weight loss on GLP- 1 agonist therapy (median change in weight = -7.2 kg; change in BMI [kg/m2] = -0.9 to -8.1). Eight pwCF showed improvement in percent predicted forced expiratory volume in 1 second (ppFEV1) [change = -5 to + 18] and nine pwCF showed improvement in percent predicted forced vital capacity (ppFVC) [change= +1 to + 26]. Of the 7 pwCF with CFRD, all reduced their insulin quantity (mean, 31.5 % decrease in total daily insulin dose), and glucose time in range improved for most (mean, +11 % increase from baseline). Four pwCF stopped using GLP-1 agonists: 2 due to severe nausea/vomiting, 1 due to lack of perceived benefit, and 1 due to change in insurance coverage. This report is the largest published series to date of pwCF treated with GLP-1 agonist therapy. With the addition of GLP-1 agonists, all individuals experienced weight loss and a reduction in daily insulin dose, and most had improvement in pulmonary function. Future multi-center studies are needed to corroborate the efficacy and safety of these agents in the CF population.

Association between biomass exposure and COPD occurrence in Fez, Morocco: results from the BOLD study

ObjectiveTo investigate the association between biomass exposure and chronic obstructive pulmonary disease (COPD) in a representative sample of adults from the Moroccan populationMethodsA cross-sectional study was conducted in Fez as...

Study the Relation of Serum Level of IL-33 with Severity of COPD Disease

Background: Cytokines are important in many pathobiological processes of chronic obstructive pulmonary disease (COPD). This study aimed to determine the relationship between serum levels of interleukin-33 (IL-33) and the severity of COPD disease. Method: In this cross-sectional research, the study population consisted of all COPD patients referring to the pulmonary clinic of Imam-Ali Hospital of Zahedan city in 2014. Sixty patients were selected using the available sampling method. Serum IL-33 levels were measured by the quantitative ELISA method. Results: Of 60 patients, 23 (38.3%) and 37 (61.7%) subjects were male and female, respectively. Analysis shows a significant difference between serum IL-33 of the two groups with regard to the severity of COPD disease. There was a statistically significant negative relationship between the serum level of IL-33 and the severity (decrease of forced expiratory volume in one second (FEV1)) of COPD disease. Conclusion: : Our results indicate a systemic release of IL-33 correlated with the severity of COPD.

Prognostic impact of pulmonary dysfunction in older gastric cancer patients

The influence of pulmonary dysfunction on postoperative outcomes in older patients with gastric cancer was assessed. In this retrospective study, 352 older patients (age ≥ 75 years) with gastric cancer who underwent preoperative spirometry and curative gastrectomy were enrolled. Of these patients, 200 underwent laparoscopic gastrectomy. Restrictive and obstructive pulmonary dysfunction were defined as percentage of vital capacity (%VC) < 80% and percent of forced expiratory volume in one second (FEV1.0%) < 70%, respectively. Twenty-six (7.3%) and 123 (34.9%) exhibited restrictive and obstructive pulmonary dysfunction, respectively. The low-%VC group showed a higher incidence of postoperative pneumonia (p = 0.018) while the low-FEV1.0% group did not (p = 0.677). Multivariate analysis identified a decreased %VC as a significant risk factor for postoperative pneumonia. However, this association was not observed in patients who underwent laparoscopic gastrectomy. Concerning the long-term outcomes, restrictive dysfunction was a significant prognostic factor in older patients with gastric cancer who underwent either laparotomy or laparoscopy, whereas obstructive dysfunction did not. Restrictive pulmonary dysfunction increased the risk of postoperative pneumonia and had a negative prognostic effect in older patients with gastric cancer, whereas obstructive pulmonary dysfunction did not.

Associations between respiratory pathogens and lung function in primary ciliary dyskinesia: cross-sectional analysis from the PROVALF-PCD cohort.

Respiratory pathogens are frequently isolated from airway samples in primary ciliary dyskinesia (PCD) patients. Few studies have investigated associations between these pathogens and lung function, with current management based on evidence from cystic fibrosis. We investigated the association between commonly isolated respiratory pathogens and lung function in PCD patients. Using a cross-sectional design, we prospectively collected clinical and concurrent microbiology data from 408 participants with probable or confirmed PCD, aged ≥5 years, from 12 countries. We used Global Lung Function Initiative 2012 references to calculate forced expiratory volume in 1 s (FEV1) z-scores. For 351 patients (86%) with complete data, we assessed the association of the four most frequently isolated pathogens with lung function by fitting multilevel linear models with country as random intercept, adjusted for age at diagnosis, age at lung function, use of antibiotic prophylaxis and body mass index z-scores. Individuals with Pseudomonas aeruginosa growth in culture had significantly lower FEV1 z-scores (β= -0.87, 95% CI -1.40- -0.34), adjusted for presence of Haemophilus influenzae, methicillin-sensitive Staphylococcus aureus and Streptococcus pneumoniae, and for covariates. When stratified by age, associations remained strong for adults but not for children. Results were similar when ciliary defects by transmission electron microscopy were included in the models and when restricting analysis to only confirmed PCD cases. We found that P. aeruginosa was associated with worse lung function in individuals with PCD, particularly adults. These findings suggest that it is prudent to aim for P. aeruginosa eradication in the first instance, and to treat exacerbations promptly in colonised patients.

Increased risk of respiratory events during endobronchial ultrasound examination in patients with reduced forced expiratory volume: a prospective observational study.

The incidence of adverse events during endobronchial ultrasound is low. Nevertheless, it is unclear, whether patients with impaired pulmonary function have an increased risk of respiratory events during the intervention. A monocentric prospective observational study was performed at the Department of Respiratory Medicine, University Hospital Frankfurt/Main, Germany. Adult patients undergoing an endobronchial ultrasound examination with propofol-sedation were included. Pre-interventional screening included pulmonary function testing, laboratory tests and electrocardiogram. The occurrence of hypercapnia >55 mmHg or reduced oxygen saturation <85% was defined as a respiratory event was recorded and compared between patients with normal and impaired pulmonary function tests. In total, 126 patients were included. Pulmonary function testing revealed a median FEV1 of 2.2 l (range 0.4-6.04l) and a predicted FEV1 of 79.5% (range 20-127.8%) respectively. The median FVC was 3.0 l (range 0.87-7.28l), the median predicted FVC was 82% (range 31.4-128.4%). In 72 examinations (60%) pCO2 levels >55 mmHg were measured. Transient oxygen desaturation <85% occurred in 31 cases (25.8%). The Mann Whitney U-test showed a significantly lower FEV1 (% predicted value) in patients with respiratory events (p = 0.007). ROC analysis identified a predicted FEV1 of 78.5% as the optimal cut-off with a sensitivity of 58% and a specificity of 71%. Using Z-score instead of predicted values, there was no significant association between a lower Z- score of FEV or FVC and hypercapnic or hypoxic events. However, both a lower absolute value of FEV1/FVC and a lower Z-score of the FEV1/FVC index were associated with the occurrence of respiratory events. In binary logistic regression analysis, we could not demonstrate any association with other relevant parameters (age, BMI, sedation dosage, sedation duration, or ASA-score). An impaired forced expiratory volume is associated with the frequency of respiratory events during endobronchial ultrasound examination under propofol-sedation.

Effect of physiotherapy intervention (chest physiotherapy) on chronic obstructive pulmonary disease (COPD) in a 72-year-old patient: a case report

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive obstruction of the airflow that is often fatal if not appropriately managed. COPD is prevalent among older adults worldwide, and diagnosis is often missed in comprehensive geriatric assessment. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, the management approach includes pharmacological, non-pharmacological treatment, and surgery in severe cases. This case report determines the effect of physiotherapy intervention (a non-pharmacological approach) on geriatric patients with COPD.Case presentationThis is a case report of a 72-year-old male patient who presented as an outpatient with COPD grade D (GOLD guidelines) with a forced expiratory volume in 1 s (FEV1) value of 52%. The patient had 3 acute episodes of exacerbation but was stabilized. The first episode of shortness of breath was 2 years ago while taking a brisk walk at home. He was immediately rushed to the hospital where he was placed on hospital admission and managed for about 2 weeks and was discharged but to continue physiotherapy on an outpatient basis due to the proximity of his home from the hospital. On physical examination with chronic obstructive pulmonary assessment test (CAT), 6-min walk test (6MWT), and functional assessment with the Barthel Index, the patient was easily fatigued and had challenges in performing basic activities of daily living (BADL). The patient had 72 sessions of physiotherapy interventions for 6 months which consisted of education, purse-lip breathing, active cycle of breathing technique, incentive spirometry exercise, aerobic exercise, and home exercise aimed at improving activity tolerance, encouraging diaphragmatic breathing, enhancing sputum clearance, improving function, and overall quality of life.Improvement was initially gradual and then significant in about the third month of the intervention. Activity tolerance improved with a 6MWT of 2 laps. The patient developed more confidence in performing ADL and leaving his home despite his lung condition as seen in CAT scores.ConclusionsOverall, results from this study showed that COPD is a treatable condition that is amenable to physiotherapy interventions in a multidisciplinary approach.