Forced Expiratory Volume In 1 Second/forced Vital Capacity Research Articles

The challenges of recruiting never-smokers with chronic obstructive pulmonary disease from the large population-based Swedish CArdiopulmonary bioImage study (SCAPIS) cohort

ABSTRACT Background A substantial proportion of individuals with COPD have never smoked, and it is implied to be more common than previously anticipated but poorly studied. Aim To describe the process of recruitment of never-smokers with COPD from a population-based cohort (n = 30 154). Methods We recruited never-smokers with COPD, aged 50–75 years, from six University Hospitals, based on: 1) post broncho-dilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) < 0.70 and 2) FEV1 50–100% of predicted value and 3) being never-smokers (self-reported). In total 862 SCAPIS participants were identified, of which 652 were reachable and agreed to a first screening by telephone. Altogether 128 (20%) were excluded due to previous smoking or declined participation. We also applied a lower limit of normal (LLN) of FEV1/FVC (z-score<-1.64) according to the Global Lung Initiative to ensure a stricter definition of airflow obstruction. Results Data on respiratory symptoms, health status, and medical history were collected from 492 individuals, since 32 were excluded at a second data review (declined or previous smoking), prior to the first visit. Due to not matching the required lung function criteria at a second spirometry, an additional 334 (68%) were excluded. These exclusions were by reason of: FEV1/FVC ≥0.7 (49%), FEV1 > 100% of predicted (26%) or z-score ≥ −1,64 (24%). Finally, 154 never-smokers with COPD were included: 56 (36%) women, (mean) age 60 years, FEV1 84% of predicted, FEV1/FVC: 0.6, z-score: −2.2, Oxygen saturation: 97% and BMI: 26.8 kg/m2. Conclusions The challenges of a recruitment process of never-smokers with COPD were shown, including the importance of correct spirometry testing and strict inclusion criteria. Our findings highlight the importance of repeated spirometry assessments for improved accuracy in diagnosing COPD.

Effect of fluticasone propionate/formoterol and fluticasone furoate/vilanterol on adolescents with chronic bronchial obstruction

BackgroundThe combination of inhaled corticosteroid and long-acting beta-agonist (ICS/LABA) has shown superiority in improving lung function (FEV1) compared with ICS. The clinical effect of ICS/LABA depends on the fine-particle fraction (FPF) and the pulmonary deposition. ObjectiveWe sought to compare the efficacy of two combinations of an inhaled corticosteroid (ICS) and a long-acting beta agonist (LABA), fluticasone propionate/formoterol and fluticasone furoate/vilanterol, in asthmatic adolescents with chronic bronchial obstruction. MethodsFluticasone propionate/formoterol (FP/FORM) (125/5 μg 2 doses twice daily via the k-haler®) and fluticasone furoate/vilanterol (FF/VI) (92/22 μg once daily via the Ellipta®) were administered to adolescents aged 12 to 17 years who required regular anti-asthmatic medication and had a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio below -1.65 SD in a 2-sequence, 16-week crossover trial. The primary efficacy end point was change in FEV1 compared to baseline. Secondary end points were FEV1/FVC, maximal expiratory flow at 50% of the forced vital capacity (MEF50), impulse oscillometry indices respiratory resistance at 5 Hz (R5), difference of R5 and R20 (R5−20), area of reactance (AX), and Asthma Control Test. ResultsBoth ICS/LABA combinations resulted in a significant improvement in FEV1 and MEF50 Z-scores without any significant difference between FP/FORM and FF/VI. Forty percent of patients achieved a normal prebronchodilator FEV1/FVC Z-score with either treatment. AX or R5−20 did not improve significantly with either treatment. ConclusionBoth ICS/LABA combinations demonstrated significant improvements in FEV1 Z-score. Over one-third of the asthmatic adolescents with prolonged bronchial obstruction achieved a normal prebronchodilator FEV1/FVC level.

Effects of breathing exercises on chronic low back pain: A systematic review and meta-analysis of randomized controlled trials.

A range of studies concerning the effects of breathing exercises on chronic low back pain (CLBP) have been proven inconclusive. The study aimed to evaluate the effectiveness of breathing exercises for the treatment of CLBP. We considered randomized controlled trials in English or Chinese that used breathing exercises for the treatment of CLBP. An electronic search was performed in the MEDLINE, EMBASE, Web of Science, Cochrane Library, CNKI, Wan Fang, and CBM databases for articles published up to November 2022. Two reviewers independently screened the articles, assessed the risk of bias using the Cochrane risk of bias tool, and extracted the data. The outcomes included pain, lumbar function and pulmonary function post-intervention. A total of thirteen studies (n= 677) satisfied the inclusion criteria. The meta-analysis results demonstrated a significant effect of breathing exercises on the Visual Analog Scale (VAS) score (SMD =-0.84, 95% CI: -1.24 to -0.45, P< 0.0001), the Oswestry Disability Index (ODI) score (SMD =-0.74, 95% CI: -0.95 to -0.54, P< 0.00001), Forced Vital Capacity (FVC) score (MD = 0.24, 95% CI: 0.10 to 0.37, P= 0.0006), Forced Expiratory Volume in 1 second /Forced Vital Capacity (FEV1/FVC) (MD = 1.90, 95% CI: 0.73 to 3.07, P= 0.001), although there was no significant difference between the breathing exercises and control interventions for Forced Expiratory Volume in the first second (FEV1) score (MD = 0.22, 95% CI = [0.00, 0.43], P= 0.05), and Maximal Voluntary Ventilation (MVV) score (MD = 8.22, 95% CI = [-4.02, 20.45], P= 0.19). Breathing exercises can reduce pain, assist people with lumbar disabilities, and improve pulmonary function, and could be considered as a potential alternative treatment for CLBP.

Association of GAB1 gene with asthma susceptibility and the efficacy of inhaled corticosteroids in children

Asthma is a polygenic disease that may onset during childhood. Inhaled corticosteroids (ICS) are the main therapy in asthma, although their efficacy varies among individuals. Nuclear factor κB (NF-κB) is an important target of ICS treatment of asthma. Recent research has reported that GRB2 associated binding protein 1 (GAB1) gene may participate in the pathogenesis of asthma by regulating the NF-κB pathway. Therefore, we used the technique of an improved multiplex ligation detection reaction to sequence GAB1 gene and investigated the involvement of Single-nucleotide variants (SNVs) in GAB1 gene in asthma and ICS efficacy in asthmatic children. We found no differences between asthma cases and controls in allele or genotype frequencies of GAB1. Haplotype analysis showed an increased tendency for AGGAGC frequency in asthma patients compared with controls (OR = 2.69, p = 0.018). The percentage of EOS and genotype distribution of rs1397527 were associated (p = 0.007). The EOS percentage was higher in GT genotype when compared to the GG genotype (5.50 vs 3.00, Bonferroni adjusted p = 0.005). After 12-weeks ICS treatment, GAB1 rs1397527 TT and GT genotype carriers had a smaller change in forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) than GG carriers (p = 0.009), and rs3805236 GG and AG genotype carriers also had a smaller change in FEV1/FVC than AA carriers (p = 0.025). For ICS response, the frequency of GG genotype of rs1397527 was significantly higher in good responders (p = 0.038). The generalized multifactor dimensionality reduction (GMDR) analysis showed a best significant four-order model (rs1397527, allergen exposure, environmental tobacco smoke exposure, and pet exposure) involving gene-environment interactions (p = 0.001). In summary, we found that GAB1 SNVs were not associated with asthma susceptibility. Haplotype AGGAGC was a risk factor for asthma. GAB1 variants were associated with eosinophils and ICS response in asthmatics. Furthermore, gene-environment interaction was observed.

Identification and Validation of CDKN1A and HDAC1 as Senescence-Related Hub Genes in Chronic Obstructive Pulmonary Disease.

PurposeCellular senescence participates in the occurrence and development of chronic obstructive pulmonary disease (COPD). This study aimed to identify senescence-related hub genes and explore effective diagnostic markers and therapeutic targets for COPD.MethodsThe microarray data from the GSE38974 dataset was downloaded from the Gene Expression Omnibus (GEO) database. The overlapping genes between genes from the GSE38974 dataset and CellAge database were considered differentially expressed senescence-related genes (DESRGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using R software. Protein-protein interaction (PPI), miRNA-mRNA network, and competitive endogenous RNA (ceRNA) network were constructed and visualized by Cytoscape software. GSE100281 and GSE103174 datasets were employed to validate the expression and diagnostic value of hub genes. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to measure the mRNA levels of hub genes in peripheral blood mononuclear cells (PBMCs) from COPD and control samples.ResultsA total of 23 DESRGs were identified between COPD samples and healthy controls. Enrichment analysis revealed that DESRGs were mainly related to apoptosis and senescence. Moreover, four hub genes and two key clusters were acquired by Cytohubba and MCODE plugin, respectively. CDKN1A and HDAC1 were verified as final hub genes based on GSE100281 and GSE103174 datasets validation. The mRNA expression level of CDKN1A was negatively related to forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), and HDAC1 expression had the opposite correlation. Finally, an HDAC1-based ceRNA network, including 6 miRNAs and 11 lncRNAs, was constructed.ConclusionWe identified two senescence-related hub genes, CDKN1A and HDAC1, which may be effective biomarkers for COPD diagnosis and treatment. An HDAC1-related ceRNA network was constructed to clarify the role of senescence in COPD pathogenesis.

Soluble ACE2 and TMPRSS2 Levels in the Serum of Asthmatic Patients.

BackgroundAngiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine subtype 2 (TMPRSS2) are key proteins mediating viral entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although gene expressions of ACE2 and TMPRSS2 have been analyzed in various organs and diseases, their soluble forms have been less studied, particularly in asthma. Therefore, we aimed to measure circulating ACE2 and TMPRSS2 in the serum of asthmatics and examine their relationship with clinical characteristics.MethodsClinical data and serum samples of 400 participants were obtained from an asthma cohort. The soluble ACE2 (sACE2) and soluble TMPRSS2 (sTMPRSS2) level was measured by enzyme-linked immunosorbent assay, and the values underwent a natural log transformation. Associations between sACE2 and TMPRSS2 levels and various clinical variables were analyzed.ResultsThe patients younger than 70 years old, those with eosinophilic asthma (eosinophils ≥ 200 cells/µL), and inhaled corticosteroids (ICS) non-users were associated with higher levels of sACE2. Blood eosinophils and fractionated exhaled nitric oxide levels were positively correlated with serum ACE2. In contrast, lower levels of sTMPRSS2 were noted in patients below 70 years and those with eosinophilic asthma, while no association was noted between ICS use and sTMPRSS2. The level of sTMPRSS2 also differed according to sex, smoking history, coexisting hypertension, and forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio. The proportion of sputum neutrophils was positively correlated with sTMPRSS2, while the FEV1/FVC ratio reported a negative correlation with sTMPRSS2.ConclusionThe levels of ACE2 and TMPRSS2 were differently expressed according to age, ICS use, and several inflammatory markers. These findings suggest variable susceptibility and prognosis of SARS-CoV-2 infection among asthmatic patients.

Effect of Buyang Huanwu Decoction Foot Bath on Pulmonary Rehabilitation of Patients with Chronic Obstructive Pulmonary Disease at Stable Phase

<bold>Objective:</bold> To observe the effect of Buyang Huanwu decoction foot bath on pulmonary function and quality of life of patients with chronic obstructive pulmonary disease (COPD) at stable phase, improving the clinical treatment plan for COPD patients and providing clinical evidence to promote pulmonary rehabilitation. <sec><title>Methods</title> A retrospective analysis of 60 patients with COPD at stable phase who were admitted to the Affiliated Peoples Hospital of Fujian University of Traditional Chinese Medicine from June 2020 to February 2021 and met the inclusion criteria of this study were divided into treatment group and control group using the SPSS 26.0, with thirty cases in each group. The control group was given routine drug treatment, nursing therapy, guided exercise, and health education. The treatment group received the Buyang Huanwu decoction foot bath in addition to the treatment of the control group. To be specific, the prepared Buyang Huanwu decoction was immersed in 5,000 mL water for twenty minutes. After boiling, the decoction was changed to simmer for ten minutes. After discarding the residue, the decoction was placed in a bucket, and foot bath was conducted when the temperature dropped to about 40 ℃. Foot bath required the water surface to be 10 cm above the ankle joint, twenty minutes per time, and once per day before going to bed, seven times per week, continuous treatment for two weeks. At both the before treatment and after treatment for two weeks, the percentage of forced expiratory volume in 1 second to predicted value (FEV1%pred) and forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) were used to evaluate the changes of pulmonary function in COPD patients at stable phase; the change of locomotor ability was observed by 6-minute walk distance (6MWD); the changes in the degree of dyspnea were assessed using the dyspnea scale of modified British Medical Research Council (mMRC); the chronic obstructive pulmonary disease assessment test (CAT) was used to observe the changes of patients quality of life; the anxiety inventory for respiratory disease (AIR) was used to evaluate the change of anxiety. To evaluate the safety of the Buyang Huanwu decoction foot bath in treating COPD patients at stable phase, the vital signs were recorded before and after the intervention, and recording the adverse reactions during the intervention, such as palpitations, and breathing difficulties. </sec><sec><title>Results</title> 1) Before treatment, there was no significant difference in FEV1%pred, FEV1/FVC value, 6MWD, mMRC score, CAT score, and AIR score between the two groups (<italic>P</italic>>0.05). 2) Compared with the situation before treatment, the FEV1%pred, FEV1/FVC value, and 6MWD of the two groups all increased (<italic>P</italic><0.05), but the mMRC score, CAT score, and AIR score all decreased (<italic>P</italic><0.05). After 2 weeks of treatment, the FEV1%pred, FEV1/FVC value, and 6MWD of the treatment group were all higher than those of the control group (<italic>P</italic><0.05); the mMRC score, CAT score, and AIR score of the treatment group were all lower than those of the control group (<italic>P</italic><0.05). 3) Safety results showed that no adverse events occurred during the clinical treatment, suggesting that the Buyang Huanwu decoction foot bath was safe and reliable. </sec><sec><title>Conclusion</title> The Buyang Huanwu decoction foot bath could improve pulmonary function, athletic ability, dyspnea, anxiety level, and quality of life of COPD patients at stable phase. The clinical effect is good and can be promoted clinically. </sec>

Prevalence and Characteristics of Individuals with Preserved Ratio Impaired Spirometry (PRISm) and/or Impaired Lung Function in Japan: The OCEAN Study.

PurposeMany individuals with obstructive airway disease (OAD), including chronic obstructive pulmonary disease (COPD) and asthma, remain undiagnosed, despite the potential for reducing disease burden through early detection and treatment. OCEAN aimed to determine the prevalence of, and characteristics associated with, impaired lung function in a Japanese population, with the goal of improving strategies for early OAD detection.MethodsOCEAN was an observational, cross-sectional study in sequentially recruited Japanese individuals ≥40 years of age undergoing routine health examinations. Participants completed screening questionnaires and spirometry testing. Airflow limitation was defined as forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.7 by pre-bronchodilator spirometry. Preserved ratio impaired spirometry (PRISm) was defined as FEV1/FVC ≥0.7 and FEV1 <80% predicted. The primary endpoint was prevalence of spirometry-based airflow limitation and PRISm. The characteristics of study participants were reported as secondary endpoints.ResultsOverall, 2518 individuals were included; 79% were <60 years of age (mean 52.0 years). Airflow limitation and PRISm were observed in 52 (2.1%) and 420 (16.7%) participants, respectively. FEV1 in the PRISm group was between that in the no airflow limitation/PRISm and airflow limitation groups, FVC was similar in the PRISm and airflow limitation groups. The PRISm group had higher mean body mass index and a higher proportion of comorbid metabolic disease compared with the airflow limitation group. The prevalence of airflow limitation and PRISm was highest among current smokers (3.9% and 21.3%, respectively) versus former or never smokers.ConclusionA significant proportion of Japanese individuals <60 years of age attending their annual health examination had impaired lung function (airflow limitation and PRISm); prevalence was highest among current smokers. These findings support screening of current or former smokers ≥40 years of age using patient-reported questionnaires to inform the need for spirometry to confirm an OAD diagnosis.

Predictors of impaired pulmonary function in people living with HIV in an urban African setting.

BackgroundStudies have associated HIV with an increased risk of obstructive lung disease (OLD).ObjectivesWe aimed to identify the predictive factors for impaired lung function in an urban, African, HIV-positive population.MethodA cross-sectional study was performed in Johannesburg, South Africa, from July 2016 to November 2017. A questionnaire was administered and pre- and post-bronchodilator spirometry conducted. The predictors investigated included age, sex, antiretroviral treatment (ART) duration, body mass index, history of tuberculosis (TB) or pneumonia, occupational exposure, environmental exposure, smoking and symptoms of OLD (cough, wheeze, mucus and dyspnoea). Impaired lung function was defined as a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of < 0.70, or below the 20th percentile of normal.ResultsThe 98 ART-naïve participants (mean age = 34.0, standard deviation [s.d.] = 8.2), 85 participants on first-line ART (mean age = 36.9, s.d. = 6.6) and 189 participants on second-line ART (mean age = 43.5, s.d. = 7.9) were predominantly female (65.6%). Of the participants, 64 (17.2%) had impaired lung function and 308 had normal lung function. Linear regression identified age (β = –0.003, P < 0.01), male sex (β = –0.016, P = 0.03) and history of TB or pneumonia (β = –0.024, P < 0.01) as independent predictors of a lower FEV1/FVC ratio. Following logistic regression, only a history of TB or pneumonia (odds ratio = 2.58, 95% confidence interval = 1.47–4.52) was significantly related to impaired lung function (area under the receiver operating characteristic curve = 0.64).ConclusionOur data show that a history of TB or pneumonia predicts impaired lung function. In order to improve timely access to spirometry, clinicians should be alert to the possibility of impaired lung function in people with a history of TB or pneumonia.

Effects of Blatta orientalis on Treatment of Bronchial Asthma: A Prospective, Non-Randomised, Open-Label, Observational Study

Abstract Background Bronchial asthma is a globally significant non-communicable disease with major public health consequences for both children and adults, including high morbidity, and relatively low mortality compared with other chronic diseases. It is a chronic disorder that compels the patient to take lifelong medications including bronchodilators. Aim This study was undertaken to ascertain the effects of Blatta orientalis in centesimal potency on the treatment of bronchial asthma assessed by spirometry and Asthma Control Questionnaire (ACQ) Score. Method A prospective, non-randomised, open-label, observational study was conducted at Dr. MPK Homoeopathic Medical College, Hospital &amp; Research Centre, Jaipur, Rajasthan, from 2015 to 2016. Patients between 5 and 80 years of age suffering from dyspnoea, cough with expectoration and wheezing were screened. The convenience sampling technique was used to enrol 120 patients, after fulfilling the inclusion and exclusion criteria of the study. The patients of Bronchial asthma were treated with potentized Blatta orientalis for 6 months. Patients were diagnosed and assessed on the basis of the ACQ Score by Elizabeth Junipers and spirometry findings. Blatta orientalis was prescribed to all patients in increasing potency from 30C. The paired t-test was applied to calculate the statistical significance of the study. Result Out of 120 patients, 100 had completed the study with follow-up of 6 months. A significant difference was found in pre- and post-treatment spirometry—that is, forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio—from baseline to 6 months (mean ± standard deviation [SD]: –10.27 ± 4.95; 95% confidence interval [CI]: –11.25 to –9.28; p = 0.00001). Also, significant difference was seen in the ACQ Score from baseline to 6 months (mean ± SD: 19.44 ± 8.69; 95% CI: 17.71–21.16; p = 0.00001). Conclusion The study findings are encouraging enough to prescribe Blatta orientalis in potency in cases of bronchial asthma. Further systematic replication is required. Conducted as randomised controlled trials with long-term follow-ups for definite conclusions.

The effect of qigong for pulmonary function and quality of life in patients with covid-19: A protocol for systematic review and meta-analysis.

Background:Qigong is a traditional Chinese exercise method for health care, keeping fit and getting rid of diseases. It has the advantages of simple operation and few side effects. Corona Virus Disease 2019 (COVID-19) is an acute respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2(SARS-COV-2). Its clinical manifestations mainly include fever, fatigue, and dry cough. Clinical practice showed that Qigong had some therapeutic effects on pulmonary dysfunction caused by novel Coronavirus, but there was lacking in evidence of evidence-based medicine. The purpose of this protocol is to systematically evaluate the effects of Qigong on lung function and quality of life in COVID-19 patients, and to add evidence to evidence-based medicine for the clinical application of Qigong therapy.Methods:Use computer to retrieve English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (China Knowledge Network (CNKI), Wanfang Database, VIP Information Chinese Journal Service Platform (VIP), Chinese Biomedical Database). In addition, we manually retrieve randomized controlled clinical research from Baidu academic and Google academic from its establishment to July 2020. Two researchers independently extracted and evaluated the quality of the data included in the study, using RevMan5.3 to do meta-analyses of articles included, without language restrictions.Results:This research evaluated the effectiveness and safety of Qigongs influence on patients pulmonary function and life quality by index such as 6-minute walk distance (6MWD), Forced expiratory volume in 1 second (FEV1), Forced vital capacity (FVC), Forced expiratory volume in 1 second/Forced vital capacity (FEV1/FVC), Forced expiratory volume in 1 second/prediction (FEV1/PRE), Self-rating anxiety scale (SAS), etc.Conclusions:This study will provide reliable evidence-based evidence for the clinical application of Qigong in the treatment of COVID-19.PROSPERO Registration number:CRD42020191877.

Biomarkers of aging and lung function in the normative aging study.

Elderly individuals who are never smokers but have the same height and chronological age can have substantial differences in lung function. The underlying biological mechanisms are unclear. To evaluate the associations of different biomarkers of aging (BoA) and lung function, we performed a repeated-measures analysis in the Normative Aging Study using linear mixed-effect models. We generated GrimAgeAccel, PhenoAgeAccel, extrinsic and intrinsic epigenetic age acceleration using a publically available online calculator. We calculated Zhang’s DNAmRiskScore based on 10 CpGs. We measured telomere length (TL) and mitochondrial DNA copy number (mtDNA-CN) using quantitative real-time polymerase chain reaction. A pulmonary function test was performed measuring forced expiratory volume in 1 second / forced vital capacity (FEV1/FVC), FEV1, and maximum mid-expiratory flow (MMEF). Epigenetic-based BoA were associated with lower lung function. For example, a one-year increase in GrimAgeAccel was associated with a 13.64 mL [95% confidence interval (CI), 5.11 to 22.16] decline in FEV1; a 0.2 increase in Zhang’s DNAmRiskScore was associated with a 0.009 L/s (0.005 to 0.013) reduction in MMEF. No association was found between TL/mtDNA-CN and lung function. Overall, this paper shows that epigenetics might be a potential mechanism underlying pulmonary dysfunction in the elderly.

The clinical efficacy of AG NPP709 (Synatura®) in patients with chronic bronchitis type stable chronic obstructive pulmonary disease.

BackgroundAG NPP709 (Synatura®) has been demonstrated to be efficacious in decreasing cough and sputum in patients with acute upper respiratory infection and chronic inflammatory bronchitis. The aim of this study was to evaluate the efficacy of AG NPP709 in patients with chronic bronchitis type chronic obstructive pulmonary disease (COPD).MethodsThis was a prospective, open-label, single-arm clinical trial (NCT03623282). Chronic bronchitis type COPD patients aged >40 years were enrolled. The primary endpoint was improvement on the CAT scores between the baseline visit and week 12. The secondary endpoints were the effect of AG NPP709 on the pulmonary function and systemic inflammation, as indexed by CRP, fibrinogen, IL-6, TNF-α and IL-33 levels.ResultsThirty patients were enrolled. All patients were male, and their mean age was 71.93±7.93 years. The mean post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio was 58.63±11.40, and FEV1 (%) was 75.93±20.42. The mean total CAT score was 14.77±7.14. Of these patients, 26 were followed up after 3 months. A significant improvement was observed in the total CAT score (from 14.38±6.62 to 12.73±6.60, P=0.005). Fibrinogen level decreased significantly (P=0.013). No serious adverse events occurred.ConclusionsAG NPP709 improved the quality of life, as represented by the CAT score, in patients with chronic bronchitis type COPD, and significantly reduced fibrinogen levels. These results suggest that AG NPP709 is efficacious and safe in patients with chronic bronchitis type COPD.

Fractional exhaled nitric oxide and forced expiratory volume in 1 second/forced vital capacity have predictive value of asthma exacerbation in Korean school children.

BackgroundThe incidence of asthma exacerbation (AE) and the predictive value of spirometry and fractional exhaled nitric oxide (FeNO) in school children have not been evaluated.ObjectiveWe sought to evaluate the efficacy of spirometry measurement and FeNO monitoring for predicting AE in school children in the Cheongju area in Korea.MethodsWith parental agreement, we studied 170 students aged 7–12 years. Children were evaluated by an asthma specialist using baseline spirometry, skin prick test, seasonal FeNO measurement, and asthma control test. The study participants underwent a physical examination and their medical history was also evaluated by the specialist. They were assessed for asthma control status during regular doctor visits for 1 year.ResultsIn total, 160 children (94.1%) completed follow-up and FeNO monitoring. Of which, 26 children (16.3%) had AE. AE was associated with male children and children with allergic rhinitis (p < 0.05). While, children with AE tended to have higher FeNO than those without AE, no significant difference was found. The maximum value of FeNO ≥35 ppb was associated with AE (p < 0.05). Children with AE had a significantly decreased baseline forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), %predicted, forced expiratory flow at 25%–75% of FVC (FEF25%–75%). FEV1/FVC < 80% was associated with AE in children regardless of inhalant allergen sensitization (all p < 0.05).ConclusionBaseline spirometry had a predictive value of AE in school children. Sensitive spirometric parameters such as FEV1/FVC and FEF25%–75% can be used as prognostic factors to predict future childhood AE. FeNO value ≥ 35 ppb during monitoring was associated with AE in school children.

The Association Between Bronchial Wall CT Attenuation and Spirometry in Patients with Bronchial Asthma

The purpose of this study was to evaluate the correlation between generation-based bronchial wall attenuation on thin-section computed tomography (CT) scans and airflow limitation in patients with bronchial asthma. This study included 28 bronchial asthma patients (13 men, 15 women; age range, 23-89 years) who underwent both chest CT and spirometry. On CT, the mean values of peak wall attenuation, wall area percentage, and luminal area were measured in the segmental, subsegmental, and sub-subsegmental bronchi of the right B1 and B10 bronchi. Correlations of the CT measurements with forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), percent predicted forced expiratory flow at 25%-75% of the FVC (%pred forced expiratory flow25-75), and percent predicted peak flow rate were evaluated with Spearman's rank correlation test. The peak wall attenuation of each generation of segmental bronchi significantly correlated with the forced expiratory volume in 1 second/FVC (B1 segmental, ρ = -0.683, p < 0.0001; B1 subsegmental, ρ = -0.875, p < 0.0001; B1 sub-subsegmental, ρ = -0.926, p < 0.0001; B10 segmental, ρ = -0.811, p < 0.0001; B10 subsegmental, ρ = -0.903, p < 0.0001; B10 sub-subsegmental ρ = -0.950, p < 0.0001). Similar correlations were found between the peak wall attenuation and %pred forced expiratory flow 25-75 or percent predicted peak flow rate. Overall, the correlation coefficients were relatively high in the more peripheral bronchial generations. In all measurements, the coefficients of the peak wall attenuations were higher than those of the wall area percentage and luminal area. Peak attenuation of the bronchial wall, particularly in the peripheral bronchi, measured on CT is a good biomarker for the severity of bronchial asthma.

Association of Elevated Serum GM-CSF, IFN-γ, IL-4, and TNF-α Concentration with Tobacco Smoke Induced Chronic Obstructive Pulmonary Disease in a South Indian Population.

Background Chronic obstructive pulmonary disease (COPD) is a devastating condition with limited pharmacotherapeutic options and exceptionally high public-health burden globally as well as in India. Tobacco smoking is the primary cause for COPD among men in India. Systemic inflammation involving altered regulation of cytokines controlling the host defense mechanism is a hallmark of COPD pathogenesis. However, biomarker discovery studies are limited among Indian COPD patients. Methods We assessed the serum concentrations [median (25th-75th percentile) pg/ml] of interleukin (IL)-2,4,6,8,10, granulocyte macrophage colony stimulating factor (GM-CSF), interferon gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α) using a multiplexed immunoassay. Our study cohort consisted of 30 tobacco smokers with COPD (TS COPD) and 20 tobacco smokers without COPD (TS CONTROL) from South India. The study population was matched for age, sex (male), and tobacco consumption (pack-years). COPD was diagnosed according to the global initiative for chronic obstructive lung disease (GOLD) criteria of persistent airflow obstruction determined by the ratio of postbronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) of <0.7. A validated structured questionnaire-based survey [Burden of Obstructive Lung Disease (BOLD) study] and spirometry were performed during house to house visit of the field study. Statistical analysis included nonparametric (two-tailed) Mann–Whitney U and Spearman rank test, as appropriate (significance: p<0.05). Results Serum GM-CSF [69.64 (46.67, 97.48); 36.78 (30.07, 53.88), p=0.014], IFN-γ [51.06 (17.00, 84.86); 11.70 (3.18, 32.81), p=0.017], IL-4 [9.09 (1.8, 19.9); 1.8 (1.8, 4.46); p=0.024], and TNF-α [20.68 (5.5, 29.26); 3.5 (3.5, 4.5); p<0.001] concentrations (pg/ml) were increased in TS COPD subjects compared to TS CONTROL. A weak correlation between lung function parameters and cytokine concentrations was detected. Conclusion Our pilot study reveals GM-CSF, IFN-γ, IL-4, and TNF-α as plausible COPD susceptibility biomarkers within the investigated South Indian population that needs to be validated in a larger cohort.

Prevalence and features of asthma‐COPD overlap in the United States 2007–2012

Perceived to be distinct, asthma and chronic obstructive pulmonary disease (COPD) can co-exist and potentially have a worse prognosis than the separate diseases. Yet, little is known about the exact prevalence and the characteristics of the Asthma-COPD overlap (ACO) in the US population. To determine ACO prevalence in the United States, identify ACO predictors, examine ACO association with asthma and COPD severity, and describe distinctive spirometry and laboratory features of ACO. Data on adult participants to the National Health and Nutrition Examination Surveys conducted from 2007 to 2012 was analyzed. ACO was defined as current asthma and post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.7. Overall, 7,570 participants representing 98.58 million Americans were included in our study. From 2007 to 2012, the crude and age-standardized ACO prevalence were, respectively, 0.96% (95% CI: 0.65%-1.26%) and 1.05% (0.74%-1.37%). In asthma, ACO predictors included older age, male gender, and smoking. In COPD, ACO predictors were non-Hispanic Black race/ethnicity and obesity. ACO was associated with increased ER visits for asthma (OR = 3.46, 95% CI: 1.48-8.06]) and oxygen therapy in COPD (OR = 11.17, 95% CI: 5.17-24.12]). In spirometry, FEV1 and peak expiratory flow were lower in ACO than in asthma or COPD alone. Age-adjusted prevalence of ACO in the United States was 1.05% in 2007-2012, representing 0.94 (95% CI: 0.62-1.26) million Americans. It is much lower than previously reported. The overlap was associated with higher asthma and COPD severity as well as decreased lung function compared with COPD or asthma alone.

Is exposure to biomass smoke really associated with COPD?

Is exposure to biomass smoke really associated with chronic obstructive pulmonary disease? Vandana Das, Vanjare Nitin, Sundeep Salvi, Rahul Kodgule Department of Pulmonary Function Laboratory, Chest Research Foundation, Pune, Maharashtra, IndiaWe read the article by Balcan et al1 with great interest. The authors have reported a case–control study that included 115 females and looked at the association between exposure to biomass smoke and detection of COPD. Although the authors concluded a positive association, we are concerned about the issues related to the conduct of the study and discrepancies in the data reported. COPD cases in this study were defined based on pre-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio

High serum levels of IGF-I and IGFBP3 may increase comorbidity risk for asthmatic patients

Asthma is known as a chronic inflammatory lung disease which has also systemic features. Insulin-like growth factor I (IGF-I) plays a role for asthma pathogenesis. Controversially, IGF-binding protein 3 (IGFBP3) blocks asthma development. That is why IGF-I and IGFBP3 are targeted for future therapeutic treatments of asthma. We aimed to investigate serum level of IGF-I and IGFBP3 in patients with asthma. This study was performed in 27 asthma and 23 healthy individuals. Serum levels of IGF-I and IGFBP3 were measured by human ELISA assay kits. Serum levels of IGF-I and IGFBP3 were significanlty higher in the asthma group than the control group. Significant negative correlation was found between IGF-I and asthma control test (ACT) puan, O2 saturation, Forced Expiratory Volume in 1 second/ Forced Vital Capacity (FEV1/FVC), Forced Expiratory Flow 25 second/75 second (FEF2575) (%). Significant positive correlation was found between IGFBP3 and IGF-I, systolic blood pressure. Significant negative correlation was found between IGF-I and FEV1 (ml). Our results indicate that the serum levels of IGF-I and IGFBP3 are significanlty elevated in the asthma group. We assume that current treatment strategies are not really good enough for asthma. We suppose further strategies which are seeking to balance IGF-I and IGFBP3 should be developed for more effective and curative treatment of asthma (Tab. 2, Fig. 2, Ref. 22).

Current situation of asthma-COPD overlap syndrome (ACOS) in Chinese patients older than 40 years with airflow limitation: rationale and design for a multicenter, cross-sectional trial (study protocol).

Asthma and chronic obstructive pulmonary disease (COPD) are the frequently occurring chronic airway diseases, and the overlapping syndrome observed in the majority of patients has been recently defined as asthma-COPD overlap syndrome (ACOS) by the Global Initiative for Chronic Obstructive Lung (GOLD, 2014) and Global initiative for Asthma (GINA, 2015). The proportion, features, and clinical practice of ACOS still remain elusive in China. We are conducting this multicenter, cross-sectional, observational study (NCT02600221) to investigate the distributions of chronic obstructive diseases in patients >40 years of age with chronic airflow limitation in China along with determination of the main clinical practice and features of these diseases. The study will also explore the factors that may influence the exacerbations and severity of ACOS in Chinese patients (>40 years of age). A total of 2,000 patients (age, ≥40 years; either sex) who are clinically diagnosed as having asthma, COPD/chronic bronchitis/emphysema, or ACOS for at least 12 months with airflow limitation [post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC): <0.7] will be enrolled from approximately 20 sites in China between December 2015 and December 2016. The proportion of ACOS among patients older than 40 years based on GINA 2015 and GOLD 2014 definitions is the primary variable. Following were the secondary variables: the proportions of COPD and asthma among the patients, distributions of the severity of airflow limitation, distribution of groups according to GOLD 2011 group definition (A, B, C, D), and the distribution of medication by drug class in patients with ACOS, asthma, and COPD. Acute exacerbation history, hospitalization, and severity of ACOS as evaluated using COPD Assessment Test, Asthma Control Questionnaire-5, and Modified British Medical Research Council in patients with ACOS were also assessed. This will be the first study to disseminate scientific knowledge on the current situation, main clinical practice, and features of ACOS, asthma, and COPD conditions in Chinese patients. The insights will be helpful in designing optimal management strategies for ACOS and redefining the healthcare development programs.