1-sec Forced Expiratory Volume Research Articles

Effect of Inspiratory Muscle Training on Outcomes After Cardiac Surgery: A Comprehensive Meta-Analysis of Randomized Controlled Trials.

Inspiratory muscle training (IMT) has emerged as a potential intervention to improve respiratory outcomes for patients undergoing cardiac surgery. However, the extent of the IMT effects on preoperative and postoperative respiratory metrics remains uncertain. Hence, we designed this study to determine the effects of IMT on various outcomes of patients undergoing cardiac surgery. We conducted a comprehensive meta-analysis of studies evaluating the impact of preoperative and postoperative IMT on various respiratory variables and postsurgical outcomes. We synthesized data from multiple studies, encompassing diverse patient populations and IMT protocols. The key outcomes included the maximal inspiratory pressure (MIP), forced expiratory volume in 1sec (FEV1), forced vital capacity (FVC), and others. Our meta-analysis results showed that preoperative IMT significantly improved the MIP values with a pooled standard mean difference (SMD) of 0.62. The hospital stay length was also reduced with a SMD of-0.4. Other variables such as FEV1 and FVC also improved significantly. Postoperative IMT improved the MIP and peak flow rate values, but the evidence was less robust than with preoperative interventions. We observed high heterogeneity across studies for several outcomes and found evidence of publication bias for some postoperative measures. Both preoperative and postoperative IMT offer benefits for patients undergoing operations, especially by enhancing respiratory muscle strength and potentially reducing hospital stays. However, the presence of heterogeneity and publication bias underscores the need for further standardized research to consolidate these findings and standardize IMT protocols for optimal patient outcomes.

Efficacy and safety of total lymphoid irradiation in different chronic lung allograft dysfunction phenotypes.

Total lymphoid irradiation (TLI) is an alternative treatment for chronic lung allograft dysfunction (CLAD). However, data regarding its efficacy and tolerance are scarce. This study included patients with CLAD treated with TLI at our center between 2011 and 2018. Clinical characteristics before and after TLI and related complications were analyzed. Forty patients with CLAD (twenty-nine bronchiolitis obliterans syndrome [BOS], nine restrictive allograft syndrome [RAS], and two mixed) were included. Significant attenuation of the forced expiratory volume in 1-sec (FEV1 ) decline slope was observed in all phenotypes, in both the BOS and RAS. The median FEV1 12, 6, and 3 months pre-TLI were as follows: 1980 (IQR 1720-2560), 1665 (IQR 1300-2340) and 1300 (IQR 1040-1740) ml (p<.001), while the median FEV1 at 3, 6, and 12 months post-TLI was 1110 (IQR 810-1440), 1130 (IQR 860-1470), and 1115 (IQR 865-1490) ml (p=.769). No dropouts due to radiation toxicity were observed. The mean survival according to the Karnofsky Performance Status Scale (KPS) >70 or ≤70 at baseline was 1837 (IQR 259-2522) versus 298 (IQR 128-554) days (p<.0001), respectively. In conclusion, TLI may stop FEV1 decline in both BOS and RAS. Moreover, a good KPS score may be an important prognostic factor.

Effect of new reflexology maneuver on lung function and functional ability of chronic obstructive pulmonary disease patients in pulmonary rehabilitation program: A randomized control trial

Introduction. Chronic obstructive pulmonary disease (COPD) is a complex disease that requires multidisciplinary interventions provided by a team work of care providers working closely. Pulmonary rehabilitation should be considered a part of integrated patient management. Aim. The main goal of this study was to search for the effectiveness of introducing new reflexology maneuver as main component in pulmonary rehabilitation program (PRP). Material and Methods. Randomized control trial was done on 35 COPD patients of both genders their ages ranged from 50-70 with different degrees of functional severity. Patients were grouped into two groups; Reflexology Group (20 patients) including patients underwent classic PRP with addition of the new reflexology maneuver&amp; control group(15 patients) who underwent classic PRP without reflexology maneuver.Outcomes were mentioned as refinement of pulmonary function,exercise tolerance and capacity measured by 6-min walk test,dyspnea score measured by the Modified British Medical Research Council (mMRC) Questionnaire, health status assigned by Combined Assessment test (CAT) score and parameters of blood gases. Results. Comparison between different variables in both groups before PRP and reflexology revealed statistically significant differences as regards the mean values of forced vital capacity (FVC) only, although the same comparison after full course of PRP and reflexology assigned statistically significant differences as regards the mean values of partial pressure of O2 (PO2), partial pressure of CO2 (PCO2), oxygen saturation (SaO2),forced expiratory volume in 1sec (FEV1), dyspnea &amp;CAT score considering (p &lt; 0.05). Conclusion. With addition of reflexology to PRP the comprehensive PR program outcomes in COPD patients resulted in significant improvement in dyspnea, blood gases, FEV1 and CAT score.

Research and Healthcare Priorities of Individuals Living with COPD

This study describes the research and healthcare priorities of individuals living with COPD. On an online survey, individuals living with COPD assigned a percentage of funding to 22 research priorities and a percentage of time spent communicating with a healthcare provider to 24 healthcare priorities, indicating which topics were most important. For each research and healthcare priority, we examined the selection frequency of the priority and used chi-square analyses to examine differences in priority selection by quartiles of airflow obstruction (percent predicted forced expiratory volume in 1-sec (FEV1%predicted)) and breathlessness burden and exacerbation risk. Based on participants’ responses (N = 148, 47% women; Mean ± Standard Deviation age = 68 ± 9 yrs) relief of breathlessness was the most often selected research (76% of respondents) and healthcare priority (61% of respondents). It was selected most often, regardless of disease severity or breathlessness burden and exacerbation risk. We found differences for disease severity and breathlessness burden and exacerbation risk in some research priorities (e.g., to improve the maximal amount of exercise of adults living with COPD in and out of the home (χ2 (3) = 9.97, Cramer’s V =.28) and healthcare priorities (e.g., increase your ability to exercise (χ2 (3) = 9.72, Cramer’s V =.27)). This study provides empirical evidence that relief of breathlessness is a top research and healthcare priority for individuals living with COPD. Future healthcare and research activities should align with the priorities of individuals with COPD to improve their care by minimizing disease/symptom burden and optimizing health-related quality of life.

Respiratory functional and motor control deficits in children with spinal cord injury

Children with spinal cord injury (SCI) are at high risk for developing complications due to respiratory motor control deficits. However, underlying mechanisms of these abnormalities with respect to age, development, and injury characteristics are unclear. To evaluate the effect of SCI and age on respiratory motor control in children with SCI, we compared pulmonary function and respiratory motor control outcome measures in healthy typically developing (TD) children to age-matched children with chronic SCI. We hypothesized that the deficits in respiratory functional performance in children with SCI are due to the abnormal and age-dependent respiratory muscle activation patterns. Fourteen TD (age 7±2 yrs., Mean±SD) and twelve children with SCI (age 6±1 yrs.) were evaluated by assessing Forced Vital Capacity (FVC); Forced Expiratory Volume in 1sec (FEV1); and respiratory electromyographic activity during maximum inspiratory and maximum expiratory airway pressure measurements (PImax and PEmax). The results indicate a significant reduction (p<.01) of FVC, FEV1 and PEmax values in children with SCI compared to TD controls. During PEmax assessment, children with SCI produced significantly decreased (p<.01) activation of respiratory muscles below the neurological level of injury (rectus abdominous and external oblique muscles). In addition, children with SCI had significantly increased (p<.05) compensatory muscle activation above the level of injury (upper trapezius muscle). In the TD group, age, height, and weight significantly (p<.05) contributed towards increase in FVC and FEV1. In children with SCI, only age was significantly (p<.05) correlated with FVC and FEV1 values. These findings indicate the degree of SCI-induced respiratory functional and motor control deficits in children are age-dependent.

Consumption of fruit and vegetables might mitigate the adverse effects of ambient PM2.5 on lung function among adults

BackgroundEvidence on the effects of ambient PM2.5 on lung function is limited among adults and the effect modification by dietary fruit and vegetables remains largely unknown. MethodsWe interviewed 29,032 participants aged 50 years and older from the WHO Study on global AGEing and adult health. Annual average PM2.5 levels were estimated for each community using satellite data. We applied multi-level linear regressions to examine the association between ambient PM2.5 and lung function (forced vital capacity (FVC), forced expiratory volume in 1-sec (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), and forced expiratory flow between 25th and 75th percentiles of FVC (FEF25–75)). ResultsWe found that ambient PM2.5 was associated with lower lung functions. Each 10μg/m3 increase in PM2.5 corresponded to reductions of 123.58ml in FVC (95% CI: −185.21, −61.95), 126.64ml in FEV1 (95% CI: −186.04, −67.23) and 178.93ml/s FEV25–75 (95% CI: −249.20, −108.66). Lower effect estimates were observed among those with higher consumption of fruit and vegetables. ConclusionOur study suggests that exposure to ambient PM2.5 might be one risk factor of reduced lung function in adults and that higher consumption of fruit and vegetables may mitigate this effect.

Relationships between respiratory parameters, exercise capacity and psychosocial factors in people with chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) affects respiratory functioning and psychosocial factors. However, little is known about perceived ability of people with COPD to engage in a regular exercise program. This study assessed respiratory parameters, exercise capacity, psychosocial factors and their relations in people with COPD. MethodsThis cross-sectional study involved patients with COPD recruited from a Nigerian university teaching hospital. Respiratory parameters including forced expiratory volume in 1sec (FEV1) and forced vital capacity (FVC) were assessed by using a spirometer and FEV1/FVC ratio was calculated. Participants were sitting upright in a comfortable chair and wearing a nose clip for measurements. The procedure was performed in accordance with the American Thoracic Society criteria. Exercise capacity was assessed by the 6-min walk test (6MWT). Gait speed was assessed by the distance covered in 6min. Perceived exercise self-efficacy (PESE) and rating of perceived exertion (RPE) were assessed by exercise self-efficacy and Borg scales, respectively. Data were analysed using descriptive and inferential statistics. Alpha level was set at P<0.05. ResultsThe mean age of the 125 participants was 62.0±7.1years (60% male). The mean values for FEV1, FVC and FEV1/FVC were 1.8±0.6L, 2.4±0.5L and 58.0±8.8%, respectively, and the mean 6MWT and PESE values were 291.1±41.6m 63.1±11.2%. Exercise capacity was correlated with mean values for the respiratory parameters FEV1 (r=0.29; P=0.035), FVC (r=0.32; P=0.045) and FEV1/FVC ratio (r=0.37; P=0.007), and both exercise capacity and PESE were correlated with gait speed (r=0.96, P=0.001 and r=0.57; P=0.042) and RPE (r=0.42, P=0.050 and r=−0.44; P=0.032), but PESE was not correlated with respiratory parameter values (P>0.05). ConclusionParticipants with COPD demonstrated reduced respiratory parameter values and low exercise capacity but moderate PESE. We found significant correlations between exercise capacity and respiratory parameter values, but PESE was correlated with only gait speed and RPE. The study has implications for respiratory health promotion and exercise adherence.

Personal exposure to fine particulate matter, lung function and serum club cell secretory protein (Clara)

BackgroundThe underlying mechanisms about the association between ambient fine particulate matter (PM2.5) and lung function were unclear. Few epidemiological studies have evaluated the potential mediating effects of serum club cell secretory protein (Clara) (CC16), a biomarker of pulmonary epithelium integrity. ObjectivesTo evaluate the short-term effect of personal PM2.5 exposure on lung function and to explore the potential mediating role of CC16 in this effect. MethodsWe enrolled 36 healthy, nonsmoking college students for a panel study in Shanghai, China from December 17, 2014 to July 11, 2015. We measured personal and real-time exposure to PM2.5 for 72 h preceding each of four rounds of health examinations, including lung function test and serum CC16 measurement. We used linear mixed-effect models to examine the effects of PM2.5 on lung function and CC16 over various lag times. Furthermore, we analyzed the mediating effect of CC16 in the association between PM2.5 and lung function. ResultsAverage PM2.5 exposure ranged from 36 to 52 μg/m3 across different lag periods. PM2.5 exposure was negatively associated with lung function and positively associated with serum CC16 concentration. The effect of PM2.5 on CC16 occurred earlier than that on lung function. For instance, an interquartile range (IQR) increase in 0–2 h average exposure to PM2.5 was significantly associated with a 4.84% increase in serum CC16; and an IQR increase in 3–6 h average exposure to PM2.5 was significantly associated with a 1.08% decrease in 1-sec forced expiratory volume. These effects lasted up to 24 h after exposure. Increased serum CC16 contributed 3.9%–36.3% of the association between PM2.5 and impaired lung function. ConclusionsAcute exposure to PM2.5 might induce an immediate decrease in lung function by virtue of the loss of pulmonary epithelium integrity.

들숨근 훈련과 테이핑 동시적용이 호흡의 근력, 지구력, 폐기능 향상에 미치는 영향

Purpose: The purpose of this study was to identify the effect of a kinesio tape on inspiratory muscle training(IMT) to improve muscle strength, endurance and pulmonary function. Methods: Healthy 20 males were divided into IMT group (control group) and IMT with tape group (experimental group). The same IMT program was applied to both groups using the Respifit S for four weeks, three times a week, a total 12 times. To exprimental group, kinesio tape was applied on the inspiratory agonist diaphragm and the accessory inspiratory muscle scalene, sternocleidomastoid, pectoralis minor. The inspiratory pulmonary muscle strength was measured by the maximal inspiratory pressure (PI max) and minute volume (MV) using the Respifit S and the pulmonary function were measured peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in 1sec (FEV1), FEV1/FVC using the Spirometer and compared before and after. Results: Results showed that the PI max in the two groups increased significantly and experimental group increased more effectively than that of control group. However, only MV showed a significant increase in experimental group but was not significantly different between the two groups. PEF and FEV1/FVC are significantly increased in both groups, but they did not make much difference between two groups, and the FVC for the two groups did not increase significantly. FEV1 increased significantly only with control group, but did not make a difference with experimental group. Conclusion: These result show that the PI max value for experimental group increased significantly than that of control group. Therefore kinesio tape maximizes inspiratory muscle exercise effect on muscle strength improvement. However, because of the short experimental period and difficulty in subject control, increase values of the others did not show a significant difference. In other words, kinesio tape did not show maximizing the inspiratory muscle exercise effect to improve endurance and pulmonary function.

Adults face increased asthma risk after infant RSV bronchiolitis and reduced respiratory health-related quality of life after RSV pneumonia.

To evaluate the association between hospitalisation for respiratory syncytial virus lower respiratory tract infection (RSV LRTI) in infancy and asthma, respiratory health-related quality of life and lung function at 28-31years of age. In 2010, we carried out a 30-year follow-up on 43 adults admitted to Kuopio University Hospital, Finland, for RSV LRTI, 27 for bronchiolitis and 16 for pneumonia, between 1981 and 1982. Together with 86 population-based controls, they completed the Saint George's Respiratory Questionnaire and underwent prebronchodilator (pre-BD) and post-BD spirometry tests to measure percentage of predicted forced vital capacity (FVC%), percentage of predicted forced expiratory volume in 1sec (FEV1%) and percentage of predicted FEV1/FVC (FEV1/FVC%). Both the pre-BD and post-BD FEV1% and FEV1/FVC% were significantly lower in former RSV LRTI patients than in the controls. The bronchiolitis patients had more asthma in adulthood than the controls and pneumonia in infancy was associated with lower St George's Respiratory Questionnaire (SGRQ) scores. Respiratory tract infection LRTI hospitalisation in infancy was associated with an increased risk of permanent obstructive lung function reduction in adulthood. The asthma risk was higher after hospitalisation for bronchiolitis, than in the controls, and respiratory health-related quality of life was lower after hospitalisation for pneumonia.

The Effect of Combining Fish Oil and Vitamin C on Airway Inflammation and Hyperpnea-Induced Bronchoconstriction in Asthma

Purpose: To compare the effects of two mono-therapies (fish oil and vitamin C) alone and in combination, on airway inflammation and the bronchoconstrictor response to eucapnic voluntary hyperpnea (EVH) in asthmatics. Methods: Sixteen asthmatic subjects with hyperpnea-induced bronchoconstriction (HIB) entered the study on their usual diet (pre-treatment, n=16) and then randomly assigned to receive either active vitamin C tablets (1.5 g) and placebo fish oil capsules (n=8) or active fish oil capsules (3.2 g EPA/2.0 g DHA) and placebo vitamin C tablets (n=8) taken for 3 weeks. Thereafter, all subjects (combination treatment; n=16) underwent a further 3-week treatment period consisting of active vitamin C tablets and active fish oil capsules taken daily (NT01057615). Results: HIB was significantly inhibited (p<0.017) by fish oil, vitamin C and combination treatment compared to pre-treatment (usual diet); percent fall in post-EVH forced expiratory volume in 1-sec was 18.8 + 5.7%, 9.7 + 5.4%, 10.5 ± 10.2% and 10.7 ± 9.3% on the usual diet, fish oil, vitamin C and combination treatment respectively. All three treatments, compared to the usual diet, were associated with a significant reduction (p<0.017) in the fraction of exhaled nitric oxide and bronchodilator use, and improvement in asthma symptom scores and exhaled breath condensate pH. There was no significant difference between treatment groups for any dependent variables. Conclusion: While fish oil and vitamin C supplementation are both effective in attenuating airway inflammation and HIB, combining these two nutrients does not confer a greater anti-inflammatory effect or suppression of HIB than either intervention alone.

Mechanical correlates of dyspnea in bronchial asthma.

We hypothesized that dyspnea and its descriptors, that is, chest tightness, inspiratory effort, unrewarded inspiration, and expiratory difficulty in asthma reflect different mechanisms of airflow obstruction and their perception varies with the severity of bronchoconstriction. Eighty‐three asthmatics were studied before and after inhalation of methacholine doses decreasing the 1‐sec forced expiratory volume by ~15% (mild bronchoconstriction) and ~25% (moderate bronchoconstriction). Symptoms were examined as a function of changes in lung mechanics. Dyspnea increased with the severity of obstruction, mostly because of inspiratory effort and chest tightness. At mild bronchoconstriction, multivariate analysis showed that dyspnea was related to the increase in inspiratory resistance at 5 Hz (R5) (r2 = 0.10, P = 0.004), chest tightness to the decrease in maximal flow at 40% of control forced vital capacity, and the increase in R5 at full lung inflation (r2 = 0.15, P = 0.006), inspiratory effort to the temporal variability in R5‐19 (r2 = 0.13, P = 0.003), and unrewarded inspiration to the recovery of R5 after deep breath (r2 = 0.07, P = 0.01). At moderate bronchoconstriction, multivariate analysis showed that dyspnea and inspiratory effort were related to the increase in temporal variability in inspiratory reactance at 5 Hz (X5) (r2 = 0.12, P = 0.04 and r2 = 0.18, P < 0.001, respectively), and unrewarded inspiration to the decrease in X5 at maximum lung inflation (r2 = 0.07, P = 0.04). We conclude that symptom perception is partly explained by indexes of airway narrowing and loss of bronchodilatation with deep breath at low levels of bronchoconstriction, but by markers of ventilation heterogeneity and lung volume recruitment when bronchoconstriction becomes more severe.

Pulmonary function tests in type 2 diabetics and non-diabetic people -a comparative study.

The complications which are associated with type 2 Diabetes mellitus are mostly caused by macro vascular and micro vascular damages. The pulmonary complications of diabetes mellitus have been poorly characterised. The present study has focused on the mechanical aspects of lung dysfunction which are attributable to type 2 Diabetes Mellitus; maximal forced Spiro metric Pulmonary Function Tests (PFTs) like Forced vital capacity (FVC), Forced Expiratory Volume in 1sec (FEV1),. FEV1/FVC % and Peak expiratory flow rate (PEFR), to be specific. 1. To do a comparative analysis of the PFTs in type 2 diabetics and non-diabetics by using computerised spirometry. 2. To assess the effects of chronic hyperglycaemia on lung functions and functional limitations of activities of daily living which are ascribable to pulmonary complications, in patients with type 2 diabetes. Spirometry was performed by using a computerised electronic spirometer, (RMS Helios 401, version 3-1-59, transducer number 4-16-1669) on 40 type 2 diabetics who were between 40-65 years of age and on 40 controls (who were matched for age, sex and BMI). Any person with a H/O smoking or any condition which affected the lung functions, was excluded from the study. The study was a cross sectional and a retrospective study. Data was analyzed and processed with the help of EPI INFO statistical software by using unpaired Student's 't'-test (two-tailed). The level of significance was taken as a p-value of <0.025. This study clearly showed a statistically significant reduction in FVC, FEV1, PEFR in type 2 diabetics as compared to those in the controls. FEV1/FVC% was increased in type 2 diabetics as compared to that in controls and the increase was statistically significant. This study concluded that type 2 diabetes adversely affects the mechanical functions of the lung, the pattern of disease being primarily restrictive in nature.

Six minute walking test and carbon monoxide diffusing capacity for non-small cell lung cancer: easy performed tests in every day practice.

Several studies have demonstrated that reduced lung function is a significant risk factor for lung cancer and increased surgical risk in patients with operable stages of lung cancer. The aim of the study was to perform pulmonary function tests and investigate which is a favorable respiratory function test for overall survival between lung cancer stages. Lung function tests were performed to lung cancer patients with non-small cell lung cancer of stage I, II, III and IV (241 patients in total). They had the last follow-up consecutively between December 2006 and July 2008. The staging was decided according to the sixth edition of TNM classification of NSCLC. The Forced Expiratory Volume in 1sec (FEV1), Forced Vital Capacity (FVC) and Carbon Monoxide Diffusing Capacity (DLCO) were measured according to American Thoracic Society/European Respiratory Society guidelines. The 6 Minute Walking Test (6MWT) was measured according to the American Thoracic Society. There was a significant association of the DLCO upon diagnosis and overall survival for stage II (P<0.007) and IV (P<0.003). Furthermore, there was a significant association between 6MWT and overall survival for stage III (P<0.001) and stage IV (P<0.010). The significance for each lung function test is different among the stages of NSCLC. DLCO and 6MWT upon admission are the most valuable prognostic factors for overall survival of NSCLC.

Formoterol by Pressurized Metered-Dose Aerosol or Dry Powder on Airway Obstruction and Lung Hyperinflation in Partially Reversible COPD

We compared the efficacy and safety of formoterol given by a pressurized metered-dose inhaler (pMDI) (Atimos®, Chiesi Farmaceutici, Italy), using a chlorine-free hydrofluoroalkane (HFA-134a) propellant developed to provide stable and uniform dose delivery (Modulite™, Chiesi Farmaceutici, Italy), with formoterol by dry powder inhaler (DPI) (Foradil® Aerolizer®, Novartis Pharmaceuticals) and placebo, in reducing airflow obstruction and lung hyperinflation, in moderate-to-severe, partially reversible chronic obstructive pulmonary disease (COPD). Forty-eight patients were randomized to a 1-week, double-blind, double-dummy, three-period crossover study with 12 μg b.i.d. of formoterol given by pMDI or DPI, or placebo. Spirometry, specific airway conductance, and lung volumes were measured at the beginning and at the end of each treatment period from predose to 4 h postdose. A 6-min walking test was carried out 4 h after the first and the last dose, with dyspnea assessed by Borg scale. Safety was assessed through adverse events monitoring electrocardiography and vital signs. The two formulations of formoterol were significantly superior to placebo but not different from each other in increasing 1-sec forced expiratory volume, specific airway conductance, inspiratory capacity, and inspiratory-to-total lung capacity ratio. The two active treatments were also equivalent and superior to placebo in reducing dyspnea at rest and on exertion. No differences in terms of safety between the two active forms and placebo were detected. Formoterol given with chlorine-free pMDI was equivalent to DPI in reducing airway obstruction and lung hyperinflation in COPD patients. Both formoterol formulations confirmed the good safety profile similar to placebo.

Randomized Controlled Trial of Fish Oil and Montelukast and Their Combination on Airway Inflammation and Hyperpnea-Induced Bronchoconstriction

BackgroundBoth fish oil and montelukast have been shown to reduce the severity of exercise-induced bronchoconstriction (EIB). The purpose of this study was to compare the effects of fish oil and montelukast, alone and in combination, on airway inflammation and bronchoconstriction induced by eucapnic voluntary hyperpnea (EVH) in asthmatics.MethodsIn this model of EIB, twenty asthmatic subjects with documented hyperpnea-induced bronchoconstriction (HIB) entered a randomized double-blind trial. All subjects entered on their usual diet (pre-treatment, n = 20) and then were randomly assigned to receive either one active 10 mg montelukast tablet and 10 placebo fish oil capsules (n = 10) or one placebo montelukast tablet and 10 active fish oil capsules totaling 3.2 g EPA and 2.0 g DHA (n = 10) taken daily for 3-wk. Thereafter, all subjects (combination treatment; n = 20) underwent another 3-wk treatment period consisting of a 10 mg active montelukast tablet or 10 active fish oil capsules taken daily.ResultsWhile HIB was significantly inhibited (p<0.05) by montelukast, fish oil and combination treatment compared to pre-treatment, there was no significant difference (p>0.017) between treatment groups; percent fall in forced expiratory volume in 1-sec was −18.4±2.1%, −9.3±2.8%, −11.6±2.8% and −10.8±1.7% on usual diet (pre-treatment), fish oil, montelukast and combination treatment respectively. All three treatments were associated with a significant reduction (p<0.05) in FENO, exhaled breathe condensate pH and cysteinyl-leukotrienes, while the fish oil and combination treatment significantly reduced (p<0.05) urinary 9α, 11β-prostaglandin F2 after EVH compared to the usual diet; however, there was no significant difference (p>0.017) in these biomarkers between treatments.ConclusionWhile fish oil and montelukast are both effective in attenuating airway inflammation and HIB, combining fish oil with montelukast did not confer a greater protective effect than either intervention alone. Fish oil supplementation should be considered as an alternative treatment for EIB.Trial RegistrationClinicalTrials.gov NCT00676468

Chronic obstructive pulmonary disease in older persons: A comparison of two spirometric definitions

Among older persons, we previously endorsed a two-step spirometric definition of chronic obstructive pulmonary disease (COPD) that requires a ratio of forced expiratory volume in 1sec to forced vital capacity (FEV(1)/FVC) below .70, and an FEV(1) below the 5th or 10th standardized residual percentile ("SR-tile strategy"). To evaluate the clinical validity of an SR-tile strategy, compared to a current definition of COPD, as published by the Global Initiative for Obstructive Lung Disease (GOLD-COPD), in older persons. We assessed national data from 2480 persons aged 65-80 years. In separate analyses, we evaluated the association of an SR-tile strategy with mortality and respiratory symptoms, relative to GOLD-COPD. As per convention, GOLD-COPD was defined solely by an FEV(1)/FVC<.70, with severity staged according to FEV(1) cut-points at 80 and 50 percent predicted (%Pred). Among 831 participants with GOLD-COPD, the risk of death was elevated only in 179 (21.5%) of those who also had an FEV(1)<5th SR-tile; and the odds of having respiratory symptoms were elevated only in 310 (37.4%) of those who also had an FEV(1)<10th SR-tile. In contrast, GOLD-COPD staged at an FEV(1) 50-79%Pred led to misclassification (overestimation) in terms of 209 (66.4%) and 77 (24.6%) participants, respectively, not having an increased risk of death or likelihood of respiratory symptoms. Relative to an SR-tile strategy, the majority of older persons with GOLD-COPD had neither an increased risk of death nor an increased likelihood of respiratory symptoms. These results raise concerns about the clinical validity of GOLD guidelines in older persons.

Impact of hypoxaemia on neuroendocrine function and catecholamine secretion in chronic obstructive pulmonary disease (COPD). Effects of long-term oxygen treatment

The aim of the study was to investigate the effects of chronic hypoxaemia on neuroendocrine function in hypoxaemic chronic obstructive pulmonary disease (COPD). The stress level was assessed by measurement of daytime plasma catecholamine and nocturnal urinary catecholamine levels and endocrine function was assessed by measuring serum gonadotropins, peripheral sex hormones and peripheral thyroid hormones, and by measuring thyroid stimulating hormone (TSH), prolactin and growth hormone before and after thyroid releasing hormone challenge in 12 male, stable, hypoxaemic COPD patients before and after at least 4 months of long-term oxygen treatment (LTOT). Mean pre-treatment P aO2was 7·39±0·78 kPa and mean nocturnal arterial oxygen saturation (MSaO2) was 86·6±3·2%. Plasma norepinephrine (NE) levels were higher than normal, while all other pre-treatment hormone levels were within normal range. Low forced expiratory volume in 1sec (FEV1) was associated with low basal and stimulated TSH (P<0·01). Urinary NE excretion correlated positively to nocturnal time spent with SaO2<85% (P<0·05). In similarity with normal controls, positive correlations were found between sex hormone binding globulin and testosterone both before and after LTOT (P<0·01). No significant hormonal changes were noted following an average of 8 months of LTOT for the entire study group. However, in a subgroup (n=6) with an increase in MSaO2exceeding 7% points following LTOT, nocturnal excretion of NE and epinephrine were reduced by 30% (P<0·05) and S-free thyroxin by 20% (P<0·05).In conclusion, patients with chronic hypoxaemia secondary to COPD exhibit elevated plasma NE levels but otherwise normal endocrine levels, including a normal hypothalamic–pituitary–testicular axis. The severity of airway obstruction is associated with reduced basal and stimulated TSH. The endocrine function is not significantly changed following LTOT except for a subgroup with severe nocturnal hypoxaemia, where elevated nocturnal NE excretion was noted, which was reduced only if whole night oxygenation was normalized during oxygen therapy.

Prevalence and mechanisms of diurnal hypercapnia in a sample of morbidly obese subjects with obstructive sleep apnoea

It is well known that obstructive sleep apnoea is especially frequent in the morbidly obese. In these subjects diurnal chronic hypercapnia, whose mechanism is still debated, may be present.Our study was performed to evaluate the prevalence and the mechanism of diurnal hypercapnia in the morbidly obese affected by obstructive sleep apnoea. From a population referred to our centre because of suspicion of sleep related breathing disorders, we selected 285 subjects without cardiopulmonary, neuromuscular or endocrinological diseases: 89 (36 M and 53 F, aged 46±13 years) had body mass index (BMI)≥40 kg m−2(MO group: morbidly obese subjects) and 196 (99 M and 97 F, aged 48±16 years) had BMI<40 kg m−2(NMO group: non-morbidly obese subjects). Then the MO group was divided into three subgroups: normocapnic subjects without obstructive sleep apnoea, normocapnic subjects with obstructive sleep apnoea, hypercapnic subjects with obstructive sleep apnoea; while we found no hypercapnic subject without obstructive sleep apnoea.All subjects underwent anthropometric evaluations and bioelectrical impedance analyses, respiratory function tests and arterial blood gas analysis, a modified version of the Sleep and Healthy Questionnaire and a full night polysomnography.Our results showed that hypercapnia (P aCO2≥45 mmHg) associated with obstructive sleep apnoea [respiratory disturbance index (RDI)≥,10 h−1] was found in 27% of the morbidly obese subjects, but only in 11% of the non-morbidly obese ones (P<0·01)The comparison among the three subgroups, in which we divided the morbidly obese subjects, shows that those with hypercapnia and obstructive sleep apnoea had significantly more important ventilatory restrictive defects [forced vital capacity (FVC)% of pred 73·27±14·81 vs. 82·37±16·93vs. 87·25±18·14 respectively; total lung capacity (TLC)% of pred 63·83±16·35 vs. 79·11±14·15 vs. 87·01±10·5], a significantly higher respiratory disturbance index (RDI 46·34±26·90 vs. 31·79±22·47 vs. 4·98±3·29) a longer total sleep time with oxyhaemo- globin saturation <90% [total sleeptime (TST)SaO2<90%63·40±33·86 vs. 25·95±29·34 vs. 8·22±22·12] and a lower rapid eye movement (REM) stage (9·5±1·2 vs. 14·0±0·9 vs. 17·05±1·2) than normocapnic subjects with obstructive sleep apnoea or subjects without obstructive sleep apnoea.The best model to predict P aCO2resulted from a combination of TSTS aO2<90%(r2=0·22,P <0·001), forced expiratory volume in 1sec (FEV1)% of pred (r2=0·09, P<0·01), FVC % of pred (r2=0·075, P<0·01).In conclusion our study suggests that diurnal hypercapnia is frequently associated with obstructive sleep apnoea in the morbidly obese without chronic obstructive pulmonary disorder (COPD) and that ventilatory restriction and sleep related respiratory disturbances correlate to diurnal hypercapnia.

Bronchial reactivity to cigarette smoke; relation to lung function, respiratory symptoms, serum-immunoglobulin E and blood eosinophil and leukocyte counts

Study objectives: The aim of the study was to investigate the relationship between the immediate bronchial response to inhaled cigarette smoke [cigarette smoke bronchial reactivity (CBR)] and lung function, respiratory symptoms and markers of allergy and inflammation.Design, participants and measurements: This cross-sectional study included 98 smokers. Their lung function and reversibility to inhaled terbutaline was measured. Their clinical history was obtained, an allergological examination was done, and bronchial reactivity to methacholine and inhaled cigarette smoke was measured. Questionnaires about respiratory symptoms, smoking history and drug usage were completed and a blood sample was obtained. Participants were divided into three groups: with asthma, chronic bronchitis and persons without asthma or chronic bronchitis (the respiratory healthy).Results: Forced expiratory volume in 1sec (FEV1) residuals were independently related to the % fall in FEV1after 12 cigarette smoke inhalations (DFEV%) in all participants (P<0·01), in asthmatic smokers (P<0·01) and in smokers with chronic bronchitis (P<0·05). In smokers with asthma and chronic bronchitis FEV1residuals explained 51% and 13% of the variation in DFEV%, respectively, but only 8% (P<0·05) and 1% (N.S.) of the variation in the methacholine bronchial reactivity. In the total population the presence of wheeze (P<0·01), attacks of breathlessness (P<0·05) and daily expectoration (P<0·001) were related to higher DFEV% readings. Serum immunonoglobulin (ES-IgE) was independently related to DFEV% in all participants (P<0·01), in smokers with chronic bronchitis (P<0·01) and in the respiratory healthy (0·05<P<0·1). The eosinophil blood count was, in similar analyses, related to DFEV% in all participants (P<0·05) and in persons with chronic bronchitis (0·05<P<0·1).Conclusion: Cigarette smoke bronchial reactivity was strongly associated to actual FEV1in smokers with asthma and bronchitis, overall to most respiratory symptoms and in smokers without asthma to S-IgE. Cigarette smoke bronchial reactivity might be suitable to test further how cigarette smoke influences the pathophysiology of the bronchial wall, especially in smokers with asthma.