Forced Expiratory Volume In 1 Research Articles

Twenty four-month follow-up after bullectomy, unilateral and bilateral lung volume reduction surgery: a single-center retrospective analysis of consecutive cases

PurposeWhile pharmacologic therapy remains the cornerstone of lung emphysema treatment, surgery is an additional therapeutic option in selected patient groups with advanced emphysema. The aim of lung volume reduction surgery (LVRS) is to improve lung function, exercise capacity, quality of life and survival. We sought to determine the therapeutic value of surgical resection in specific patients with lung emphysema.Patients and methodsA retrospective study was performed consisting of 58 patients with lung emphysema who underwent surgical intervention over a 10-year period and were followed for 2 years postoperatively. The clinical characteristics recorded were FEV1 (forced expiratory volume in 1 s), the 6-min walk test (6-MWT), the Modified Medical Research Council (mMRC), body mass index (BMI) and quality of life prior to and 6, 12 and 24 months after surgical intervention. Moreover, all peri- and post-operative complications were noted.ResultsOut of 58 emphysema patients (72% male, FEV1 (L) 2.21 ± 0.17, RV (L) 3.39 ± 0.55), 19 underwent surgical bullectomy, 31 unilateral LVRS and 8 sequential bilateral LVRS. Six months after surgery, there was a statistically significant improvement in FEV1, RV, TLC, 6-MWT and mMRC. Over a period of 12 to 24 months postoperatively, clinical benefit gradually declines most likely due to COPD progression but patients still experienced a significant improvement in FEV1. The most common postoperative complications were persistent air leakage (> 7 days), arrhythmia and subcutaneous emphysema in 60%, 51.6% and 22.4%, respectively. No deaths were observed after surgical intervention.ConclusionIn a selected patient population, surgery led to significant improvement of lung function parameters, exercise capacity and quality of life. Over a period of 12 to 24 months postoperatively, clinical benefit gradually decreased most likely due to COPD progression.

A meta-analysis investigating the efficacy and safety of allergen-specific immunotherapy in the management of respiratory allergies

Background This meta-analysis aimed to evaluate the effectiveness and adverse effects of specific immunotherapy (SIT) in the management of respiratory allergens, including allergic asthma, rhinitis, and related disorders, based on a review of current literature up to November 8, 2022. Methods We conducted a search of databases, including PubMed, Embase, Cochrane, and Web of Science, to identify relevant randomized controlled trials (RCTs) assessing respiratory allergy-specific immunotherapy. We employed the Consolidated Standards of Reporting Trials (CONSORT) Statement to select RCTs that adhered to rigorous reporting standards. Specifically, we focused on double-blind placebo-controlled (DBPC) trials and open studies involving both adults and children, considering factors such as dosage, inclusion criteria, allergens, and primary outcome measurements. Results A total of 25 meta-analyses were included in this study. Among them, 14 evaluated sublingual-specific allergen immunotherapy (SLIT), 4 assessed subcutaneous allergen immunotherapy (SCIT), 4 explored both sublingual and subcutaneous immunotherapy, and 3 investigated intralymphatic immunotherapy. The outcomes of these meta-analyses indicated a reduction in medication scores in 20 cases and a decrease in symptom scores in 23 cases. Additionally, six studies reported on changes in IgE levels, seven studies focused on IgG4, four studies examined FEV1 (forced expiratory volume in 1 s), and eight studies reported on symptom and medication scores. Furthermore, 11 studies reported on differences in adverse reactions. Conclusion The results of our meta-analysis suggest that specific immunotherapy, while associated with some adverse effects, effectively reduces the symptoms of asthma and rhinitis. Therefore, we recommend its use in the treatment of respiratory allergies.

Joint association of sedentary behavior and physical activity with pulmonary function

BackgroundSedentary behavior may influence the respiratory health, but the joint effects of sedentary behavior and physical activity on pulmonary function remains poorly elucidated. We aimed to estimate the association between sedentary behavior and physical activity with pulmonary function.MethodsA total of 12,343 participants aged 12–79 years were analyzed from the U.S. NHANES 2007–2012. Participants were categorized into 16 groups according to the cross-tabulation of sedentary behavior time (0–4.0, 4.1–8.0, 8.1–12.0, and > 12.0 h/day) and moderate or vigorous physical activity (MVPA) (0, 1–149, 150–299, and ≥ 300 min/week). Generalized linear models were used to test the association of sedentary behavior and MVPA with pulmonary function.ResultsParticipants with sedentary behavior > 4.0 h/day were negatively related to FEV1 (forced expiratory volume in 1 s) (β ranging from -0.015 to -0.009, p < 0.05). Compared with the reference group (0 min of MVPA and > 12.0 h/day of sedentary behavior), the negative association of sedentary behavior ≤ 8.0 h/day with FEV1 may be reduced through appropriate MVPA (β ranging from 0.019 to 0.030, p < 0.05). For sedentary behavior > 8.0 h/day, even MVPA ≥ 300 min/week may not decrease the negative relationships. Similar results were also observed in FVC (forced vital capacity) (β ranging from 0.018 to 0.030, p < 0.05). In participants aged ≥ 45 years, the associations were more notable.ConclusionThis study indicated the sedentary behavior ≤ 4.0 h/day was a relatively healthy lifestyle for pulmonary function. Only below 8.0 h/day of sedentary behavior, the negative association with pulmonary function may be reduced through appropriate MVPA.

3D-Quantitated Single Photon Emission Computed Tomography/Computed Tomography: Impact on intended Management Compared to Lung Perfusion Scan in Marginal Candidates for Pulmonary Resection

ObjectivesBased on previous studies, single-photon emission computed tomography/computed tomography (SPECT/CT) has been proven more accurate and reproducible than planar lung perfusion scintigraphy to assess lobar perfusion. However, the impact of 3D-quantitated SPECT/CT on intended management in functionally marginal candidates for pulmonary resection is unknown. The evaluation of this impact was the main aim of this study. MethodsConsecutive candidates for lung resection underwent preoperative evaluation according to ERS/ESTS Algorithm and underwent preoperative lung perfusion imaging. The lobar contribution to the total lung perfusion was estimated using established planar scintigraphic methods and 3-dimensional quantitative SPECT/CT method (CT Pulmo3D and xSPECT-Quant, Siemens). The difference in estimated lobar perfusion with resulting changes in predicted postoperative (ppo) lung function and extent of lung resection were analyzed to reveal possible changes in operability. In-hospital outcome was assessed. ResultsOne hundred twenty patients (46 females) were enrolled. The mean age (±SD) of patients was 68 ± 9 years, target lesions were in upper lobes in 57.7% and in lower lobes in 33.5%. The median FEV1 (forced expiratory volume in 1 second) was 70.5% (IQR 52-84) and median DLCO (diffusion capacity of lung for carbon monoxide) was 56.6% [47.1-67.4]. The planar posterior oblique method, compared to 3D-quantitated SPECT/CT, underestimated the perfusion of upper lobes by a median difference of 5% (right [2-9], left [2.5-8]; P = <.0001), while it overestimated the perfusion of lower lobes (left by 4% [2-7], right by 6% [2-9]; P = <.0001). In contrast to planar scintigraphy-based evaluation, 4 patients (3.3%), all with upper lobe lesions, were classified as inoperable when 3D-quantitated SPECT/CT was used for calculation of the ppo lung function. ConclusionsIn selected patients with upper lobe lesions, 3D-quantitated SPECT/CT would have changed the treatment strategy from operable to inoperable. Importantly, postoperative mortality in this particular subgroup was disproportionally high. 3D-quantitated SPECT/CT shall be further evaluated as it might improve preoperative risk stratification in functionally marginal candidates.

Evaluation of medical adherence, adverse drug reactions, and quality of life in post tubercular obstructive airway disease.

Increasing incidence of tuberculosis is intensifying the posttubercular obstructive airway disease (PTOAD) in developing countries. Currently, there are no standard treatment guidelines for the management of PTOAD patients. The present study aims to evaluate the prescribing pattern, adherence, adverse drug reactions (ADRs), and quality of life (QoL) in PTOAD patients. A prospective observational study was conducted to evaluate the prescriptions of PTOAD patients, estimating the medical adherence using Morisky 8-Item Medication Adherence Questionnaire, assessing ADRs using Hartwig's Severity Assessment Scale and assessing QoL using St. George's respiratory Questionnaire. Chi-square test, analysis of variance, paired t-test were used to compare the data. The significance of change in adherence status was assessed by Wilcoxon signed-rank test. A total of 94 prescriptions of PTOAD were analyzed. Inhaled long-acting muscarinic antagonist was prescribed to 31.9% of patients. The most common inhaled fixed dose combination was long-acting beta-2 agonist with corticosteroid, prescribed to 52.1% of patients. At final follow-up, maximum percentage of patients were found to be highly adherent, i.e. 56.4%. Overall, 34% of patients have complained about mild category of ADRs. A significant improvement in QoL was observed. At baseline, mean forced expiratory volume in 1 (FEV1) was 64.66% ±23.61%, which increased significantly to 73.34% ±21.60% on final follow-up (P < 0.001). Bronchodilators are the mainstay of treatment of PTOAD patients, since both the QoL and FEV1 were improved with treatments. However, to have good treatment outcome, strict adherence along with safety of the medications must be assured.

Evaluation of Pulmonary Functions by Spirometry after Stereotactic Body Radiotherapy in Lung Tumors

Introduction: To evaluate changes in pulmonary function by spirometry after stereotactic body radiotherapy (SBRT). Methods: A single-center, retrospective study was performed which analyzed lung function after SBRT from January 1, 2015 to January 31, 2020. Eligible patients were ≥18 years of age, with early-stage lung cancer or lung metastases ≤5 cm and Karnofsky performance status (KPS) &gt;70. Patients were excluded if they had a history of non-infectious pneumonitis or interstitial lung disease. Clinical cases were discussed in a multidisciplinary tumor board, and the patients were classified as surgically resectable but medically inoperable. Mixed-effects models were used to evaluate changes in forced expiratory volume in 1 (FEV1), forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO) at 3, 6, 12, and 24 months after SBRT. Results: Fifty-two patients underwent SBRT. Median follow-up spirometry post-SBRT was 12 months (range, 12-24). No significant differences were observed during the first year in both liters and the percentage of predicted FEV1 evolution. A gain of 5.9% [95% CI, 2.3; 9.6 percent (p=0.0014)] was beheld after 24 months post-SBRT. Although, no significant difference has been viewed when we analyze it in liters with an FEV1 value 24 months post-SBRT of 1.57 liters [95% CI, 1.56; 1.59 liters (p=0.848)]. There are no differences when we analyze FVC evolution according to liters during the first two years post treatment. Finally, no differences were observed when analyzing DLCO evolution according to percentage or as ml/min/kPa. Conclusions: SBRT in primary lung tumors or pulmonary metastases does not negatively influence pulmonary function assessed by spirometry at least in the first two years after treatment.

Incidence of frailty and construction of prediction model in elderly male patients with chronic obstructive pulmonary disease

The incidence of frailty was studied and prediction model was constructed for the elderly male patients with chronic obstructive pulmonary disease (COPD). Total of 266 elderly males having COPD were selected, and Fried Frailty Phenotype was employed to investigate their frailty status. According to the clinical experience, literature and reports; age, BMI (Body Mass Index), course and condition of COPD, laboratory findings, lung function, life quality, nutritional status and disease acceptance were designated as independent variables; and the incidence of frailty was taken as dependent variable. A binary logistic regression model was applied to analyze the factors affecting incidence of frailty, and a prediction model was constructed for the clinical screening of elderly male COPD patients at high frailty risk. The scores of 266 elderly male COPD patients investigated by frailty phenotype (FP) phenotype ranged from 0 to 5, and mean score was 1.83 ± 0.43. Total of 103 patients scored more than 3 among these patients. The frailty detection rate was 38.72%. Multi-factors logistic regression analysis suggested that age, hospitalization for acute exacerbation of COPD within a year, and interleukin 6 (IL-6) levels were the risk factors for incidence of frailty in elderly male COPD patients, while FEV1 (Forced Expiratory Volume in 1 second) and MNA-SF (Mini Nutritional Assessment Short-Form) levels were the protective factors. COPD frailty was higher in elderly men. Age, inflammatory response, lung function, disease control and nutritional status were the independent factors affecting incidence of frailty. Strengthening the screening for frailty in elderly patients and monitoring their inflammatory response, lung function, and nutritional status were significant in reducing incidence and improving prognosis.

Response to Omalizumab as an Add-On Therapy in the Treatment of Allergic Asthma in Adult Chinese Patients-A Retrospective Study.

(a) Background: Omalizumab is an anti-IgE humanized monoclonal antibody marketed in China for the conventional treatment of poorly controlled moderate-to-severe allergic asthma. Numerous clinical trials have demonstrated the effectiveness of omalizumab, but the data from studies in actual clinical treatment are still relatively limited. (b) Methods: Thirty-two patients with moderate-to-severe allergic asthma treated with omalizumab on the basis of ICS-LABA (inhaled corticosteroids/long-acting beta2-agonist) were selected. Clinical characteristics before and after treatment were collected to analyze the relationship between changes in serum total IgE levels and peripheral blood EOS (eosinophil) levels, FEV1 (forced expiratory volume in 1 second), PEF (peak expiratory flow), OCS (oral glucocorticoid) dosage, ATC (asthma control test) score, and the number of acute exacerbations and the treatment response, in order to observe the efficacy of omalizumab in addition to primary therapy, and to investigate whether baseline clinical characteristics such as serum total IgE and EOS levels could predict a treatment response. (c) Results: Using the ACT score as an evaluation, 68.75% of patients benefited from omalizumab treatment at the end of 16 weeks. The response group has a reduction in OCS dosage (p-values of 0.026 and 0.039), a significant reduction in ACT scores (both p &lt; 0.001), and a reduction in the number of acute exacerbations (p = 0.034 and 0.025, respectively) after omalizumab treatment. The binary logistics analysis of factors affecting the effectiveness of omalizumab in the treatment of allergic asthma were total serum IgE and the presence of comorbidities (p-values of 0.039 and 0.046, respectively). (d) Conclusions: Combining omalizumab with ICS-LABA for 16 weeks significantly improves asthma symptoms in Chinese adults and can be used as an add-on treatment. In addition, high serum IgE levels and the presence of comorbidities were predictors of its therapeutic efficacy.

Pulmonary function changes after sublobar resection in patients with peripheral non-subpleural nodules

BackgroundIn the treatment of peripheral early-staged lung cancer and benign lesions, segmentectomy and wedge resection are both reliable treatment methods. It is debatable that how much pulmonary function will be lost after different sublobar resection in the treatment of early-staged deep-located peripheral NSCLC (non-small cell lung cancer). The purpose of this study was to explore postoperative pulmonary function changes of sublobar resection in enrolled patients with non-subpleural peripheral nodules.MethodsWe collected clinical data of patients undergoing VATS (video-assisted thoracoscopic surgery) segmentectomy or wedge resection for single nodule. These nodules were confirmed as peripheral non-subpleural nodules by preoperative 3D imaging. Patients were divided into two groups according to the operation procedure. Demographic characteristics, pulmonary function, postoperative outcomes, and others were collected. All data was gathered at the First Affiliated Hospital of Soochow University. Outcomes after wedge resection were compared with those after segmentectomy resection.ResultsA total of 88 patients were included in this study, including 46 patients with VATS wedge resection and 42 patients with VATS segmentectomy. No difference was detected when comparing FEV1 (forced expiratory volume in 1 s) loss between these two groups (17.6 ± 2.1%, wedge resection vs. 19.4 ± 5.4%, segmentectomy, P = 0.176). FVC (forced vital capacity) loss (8.7 ± 2.3%, wedge resection vs. 17.1 ± 2.2%, segmentectomy, P < 0.001) and MVV (maximum ventilatory volume) loss (11.5 ± 3.1%, wedge resection vs. 20.6 ± 7.8%, segmentectomy, P < 0.001) in segmentectomy group was significantly higher than those in wedge resection group. Discrepancies were investigated when comparing duration of surgery (70 ± 22 min, wedge resection vs. 111 ± 52 min, segmentectomy, P = 0.0002), postoperative drainage (85 ± 45 mL, wedge resection vs. 287 ± 672 mL, segmentectomy, P = 0.0123), and treatment hospitalization expenses [35148 ± 889CNY, wedge resection vs. 52,502 (38,276–57,772) CNY, segmentectomy, P < 0.0002]. No significant difference was found between air leak time (1.7 ± 0.7 days, wedge resection vs. 2.5 ± 1.7 days, segmentectomy, P = 0.062) and hospitalization time (2.7 ± 0.7 days, wedge resection vs. 3.5 ± 1.7 days, segmentectomy, P = 0.051).ConclusionsFor patients with peripheral non-subpleural nodules, we observed that patients who underwent wedge resection had less lung function loss than those who underwent segmentectomy when their lung function was reviewed at the 6th month after surgery. Patients undergoing wedge resection had partial advantages over patients with segmental resection in terms of hospitalization cost, operation time and postoperative drainage, etc. Wedge resection, as a treatment for peripheral non-subpleural pulmonary nodules, seemed to have more advantages in preserving patients’ pulmonary function.

Clustering-based COPD subtypes have distinct longitudinal outcomes and multi-omics biomarkers

IntroductionChronic obstructive pulmonary disease (COPD) can progress across several domains, complicating the identification of the determinants of disease progression. In our previous work, we applied k-means clustering to spirometric and...

Evaluation of the Global Lung Function Initiative 2012 reference values for spirometry in an Iranian population

Spirometry is an important measurement in detecting and monitoring of chronic obstructive pulmonary disease. The validity of the multi-ethnic Global Lung Function Initiative 2012 (GLI-2012) spirometric norms have been debated in some countries. The aim of the present study was to evaluate the applicability of the GLI reference norms in the Iranian population. A cross-sectional study was performed on 622 healthy non-smoker population (204 males and 418 females, age range: 4 ± 82 years) between July 16 and August 27, 2019 in Iran. Z-scores for spirometric data [FEV1 (forced expiratory volume in 1 s), FVC (forced vital capacity) FEV1/FVC, and FEF25–75% (forced expiratory flow averaged over the middle portion of FVC)] were calculated. According to the agreement approved, a mean Z-score outside the range of ± 0.5 was considered clinically significant. The mean (SD) Z-score values of FEV1, FVC, FEV1/FVC and FEF25–75% were 0.44 (1.21), 0.49 (1.14), 0.11 (1.03), and − 1.13 (0.99) in males and 0.61 (1.14), 0.89 (1.26), 0.17 (0.88) and − 0.49 (0.96) in females, respectively. The Z-score of FEV1/FVC was below the lower limit of normal (LLN) in 3.43% of men and 2.01% of women (in ≥ 21 years), while these values were significantly higher in people under 21 years old (46.2% in boys and 40.0% in girls). The GLI reference values are not perfect for the Iranian population, especially in children below 10 years old. The use of the GLI reference values was appropriate in population above 21 years; however, they would overestimate the prevalence of airway obstruction in individuals below 21 years.

Comparison of the Impact of Conventional and Web-Based Pulmonary Rehabilitation on Physical Activity in Patients With Chronic Obstructive Pulmonary Disease: Exploratory Feasibility Study.

BackgroundPulmonary Rehabilitation (PR) increases exercise capacity, with less clear evidence regarding physical activity (PA). The World Health Organization recommends at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic PA per week to reduce the risks of chronic disease.ObjectiveThe objective of this study was to assess the effectiveness of conventional PR versus web-based PR with respect to changes in PA.MethodsPatients with COPD were randomized to either conventional PR classes (n=51) or a web-based PR program (n=52) for 7 weeks in a feasibility study. Accelerometers (Sensewear) were worn before and after the intervention, and PA was measured as steps per day and mean bouts of moderate activity for ≥2, ≥5, ≥10, and ≥20 minutes. Measures were derived for patients with ≥8 hours of data per day for ≥4 days, using the R package for statistical analysis. Variables were explored to examine their relationships with bouts of activity.ResultsBaseline characteristics did not differ significantly between groups. Complete PA data were available for the groups receiving web-based (n=20) and conventional (n=34) PR interventions. The web-based PR group demonstrated a nonsignificant increase in the number of steps per day, which mainly comprised short bouts of moderate to vigorous intensity PA when compared to the conventional PR group (P=.20). The conventional PR group demonstrated increased 20-minute bouts of PA by 49.1%, although this was not significant (P=.07). At baseline, age (r=–0.21, P=.04), BMI (r=–0.311, P=.004), and FEV1 (forced expiratory volume in 1 second; % predicted; r=–0.248, P=.048) were significantly correlated with 10-minute bouts of PA; however, this was not observed post intervention.ConclusionsThe analysis revealed a nonsignificant difference in the pattern of PA between groups receiving conventional vs web-based PR—the former being associated with an increase in 20-minute bouts, while the latter having demonstrated an increase in the number of steps per day. There appears to be a differing response emerging between the two interventions.Trial RegistrationInternational Clinical Trials Registry ISRCTN03142263; https://tinyurl.com/y4dmfyrb

Is the unrealistic expectation of getting cured related to poor treatment adherence among Indian Asthma patients? A hospital based mixed methods study from central India.

ABSTRACTBackground:Prevention of premature deaths due to asthma requires continued disease control through efforts of both patients and healthcare providers. The expectations of patients have been shown to influence treatment adherence and disease control.Methodology:We conducted a hospital-based sequential exploratory mixed methods study and used definitions of the Global Initiative for Prevention of Asthma (GINA). We recruited 80 asthma patients in a tertiary public health facility of central India. We assessed treatment expectations, health literacy, awareness, behavioural risk factors, self-care, treatment adherence, and disease control. We conducted a thematic analysis of qualitative data through manual inductive coding and used statistical software R version-3.6.1 for quantitative analysis.Results:Sixty-seven (83.75%) patients expected that the current doctor would help them achieve ‘cure’, while 28 (35%) expected to obtain information about asthma. 81.2% and 77.5% of participants had inadequate health literacy and inadequate awareness, respectively. 73.8% were using inhalers and 21.2% were not using any treatment. Forced expiratory volume in 1 (FEV1) and Forced vital capacity (FVC) values were available for only 46.25%, while a meagre 6.25% were using peak-flow meter for self-monitoring. Though 21.2% reported optimal treatment adherence, 27.5% had good control. We found the expectation of cure and poor health literacy being significantly related to sub-optimal treatment adherence. We didn’t find any association between the expectations of patients and their disease control.Conclusion:Asthma patients in our setting mostly expected to get cured. The unrealistic expectation of ‘cure’ is related to poor treatment adherence and possibly poor disease control.

Duration of intravenous antibiotic treatment for acute exacerbations of cystic fibrosis: A systematic review

BackgroundAcute exacerbations of Cystic Fibrosis (AECF) are associated with significant morbidity. Recommendations are to treat for 2-3 weeks despite limited data. Spirometry is a measure of clinical response yet appears to plateau at 7-10 days. While durations <9 days have been associated with poorer outcomes, a duration of 10 days may be as effective as 14 days, potentially conferring advantages in terms of cost and adverse events. A 2019 Cochrane review by Abbott et al. did not identify any randomised controlled trials (RCT) comparing durations of treatment. Utilising data from non-randomised studies (NRS), we report a systematic review of intravenous antibiotic treatment, exploring changes in FEV1 (Forced Expiratory Volume in 1 second), CRP (C-reactive protein) and peripheral WBC (white blood cell) count in studies with different treatment durations. Study design and methodsSystematic review of published literature following a search of MEDLINE, Embase, CINAHL and the Cochrane Clinical Trials register. Guidelines from the Preferred Reporting items for Systematic reviews and Meta-Analysis (PRISMA) and reporting Meta-analysis of Observational studies (MOOSE) statement were followed. ResultsNo randomised controlled trials were identified that specifically examined duration of treatment during AECF. This study included all relevant RCTs and also NRS, grouping according to study characteristics, such as length of treatment, location, year, and also characteristics of the patient population. 52 studies, comprising 79 subgroups, and 1,597 patients, were identified. Mean change (95%CI) in ppFEV1 was 10.13 (9.21-11.05). There was no significant difference in change in ppFEV1 for studies treating for 10-12 days; 8.85 (7.47-10.23), vs 13-15 days; 10.68 (9.53-11.82). Similar changes in CRP and WBC were seen irrespective of treatment duration. ConclusionThis systematic review provides evidence that shorter durations of treatment may be associated with similar changes in FEV1, CRP and WBC compared with longer durations.

Analyzation of the Clinical Effects of Fine Nursing Model Combined with Integrated Medical Care Intervention on Elderly Patients with Chronic Obstructive Pulmonary Disease

Objectives: To study the clinical effects of fine nursing model combined with integrated medical care intervention on elderly patients with chronic obstructive pulmonary disease (COPD), and to further analyze the clinical application value of this nursing model. Methods: A total of 144 elderly patients who were diagnosed with COPD and received treatments in our hospital from April 2018 to April 2019 were selected as research subjects. The patients were divided into a control group and an experimental group by the random number table method, with 72 cases in each group. The control group adopted routine disease nursing program, while the experimental group adopted intervention program that combined fine nursing and integrated medical care together. Both groups’ pulmonary function related indexes were statistically analyzed after nursing intervention: forced expiratory volume in 1 (FEV1)/forced vital capacity (FVC) (%), 6-minute walking distance (6MWD), modified medical research council (mMRC) dyspnea scales, COPD assessment test (CAT), quality of life (QOL) and nursing satisfaction rate. Results: The experimental group’s pulmonary function indexes, 6MWD, mMRC dyspnea scales, and CAT scores one month after intervention and half a year after intervention were all significantly better than those of the control group. There were significant differences between two groups (P&lt;0.05). The QOL (physical activity, mentality and social function) and nursing satisfaction rate of the experimental group were significantly higher than those of the control group as well (P&lt;0.05). Conclusion: The integrated medical care group, which was formed based on the disease development of elderly patients with COPD, was capable of developing customized fine nursing programs according to patients’ individual symptoms. Compared with routine clinical care, this nursing model is more practical. It is good for improving patients’ QOL and their symptoms, raising nursing satisfaction rate, and establishing good doctor-patient relationship. Therefore, it should be widely applied and promoted in clinical practice.

Computed Tomographic Changes in Patients with Cystic Fibrosis Treated by Combination Therapy with Lumacaftor and Ivacaftor.

Background: As Cystic Fibrosis (CF) treatments drastically improved in recent years, tools to assess their efficiency need to be properly evaluated, especially cross-sectional imaging techniques. High-resolution computed tomography (HRCT) scan response to combined lumacaftor- ivacaftor therapy (Orkambi®) in patients with homozygous for F508del CFTR has not yet been assessed. Methods: We conducted a retrospective observational study in two French reference centers in CF in Marseille hospitals, including teenagers (>12 years old) and adults (>18 years) who had received lumacaftor–ivacaftor and for whom we had at disposal at least two CT scans, one at before therapy and one at least six months after therapy start. CT scoring was performed by using the modified version of the Brody score. Results: 34 patients have been included. The mean age was 26 years (12–56 years). There was a significant decrease in the total CT score (65.5 to 60.3, p = 0.049) and mucous plugging subscore (12.3 to 8.7, p = 0.009). Peribronchial wall thickening (PWT) was significantly improved only in the adult group (29.1 to 27.0, p = 0.04). Improvements in total score, peribronchial thickening, and mucous pluggings were significantly correlated with improvement in FEV1 (forced expiratory volume in 1 s). Conclusions: Treatment with lumacaftor–ivacaftor was associated with a significant improvement in the total CT score, which was mainly related to an improvement in mucous pluggings.

Infinitix-BOS Trial: Multi-Center, Randomised, Double-Blind Placebo-Controlled Trial of Nintedanib in Lung Transplant Recipients with Bronchiolitis Obliterans Syndrome (BOS) Grade 0-p and Grade 1-2

Purpose Lung transplantation (TxP) is now a validated treatment of end-stage pulmonary diseases, but long-term survival are still hampered by the development of chronic allograft dysfunction (CLAD) affecting> 50% of patients. Bronchiolitis obliterans syndrome/obliterative bronchiolitis (BOS/OB) is the most common manifestation of CLAD. Survival after onset of BOS is poor ( Methods A phase III clinical randomized trial to assess the efficacy of Nintedanib in LTx recipients with BOS.Inclusion criteria: n=80 LTx recipients with BOS 0p-1-2, with a decline of FEV1> 200ml within the previous year.Primary Objective: to assess Nintedanib efficacy in the reduction of the rate of decline of FEV1 (forced expiratory volume in 1 sec) at a dose of 150 mg twice daily (bid) compared to placebo over 6 months. Secondary Objectives: to assess Nintedanib efficacy and tolerance in the treatment of BOS 0p-1-2, based on the change over 6 months of : 6WT, QOL, BOS grade/graft failure, O2 saturation, KL-6, SPD, VEGF, PDGF parameters, and tolerance. Results The trial was started in December 2019 among 8 french LTx centers (Hopital Foch, Bichat, HEGP/Cochin, Marie-Lannelongue, Marseille, Bordeaux, Strasbourg, and Grenoble), for a total duration of inclusion anticipated at 36 months. On October 15th 2020, 14 patients were already included. Conclusion Infinitix-BOS is the first therapeutic randomized trial testing the efficacy of nintedanib in LTx recipients with BOS. In case of demonstrated effectiveness of Nintedanib, the benefit for LTx patients with BOS seems high in terms of stabilization of lung function and enhancement of survival.

Comparison of pulmonary function tests in patients with sickle cell anemia and sickle beta-thalassemia referring to the hematology clinic of Bandar Abbas Shahid Mohammadi Hospital with the control group in 2019-2020

Aim: Due to the high prevalence of sickle cell anemia and beta-shaped sickle cell thalassemia in this region, we decided to conduct this study with the aim of investigating the status of pulmonary function in these patients in Bandar Abbas.&#x0D; Method: The statistical population in this study included all patients with sickle cell anemia and sickle cell beta-thalassemia who had referred to the hematology clinic from 2019-2020, which was equal to 60 people. Also, the workers who had referred to the specialized lung clinic for periodic health tests entered the study by observing the criteria for leaving the review as a control group. Participants were subjected to spirometry and pulmonary volumes were measured.&#x0D; Result: The patients in the case group, 39 (65%) were from sickle cell anemia, and 21 (35%) were from the sickle cell beta-thalassemia. In this study, all the studied parameters had a significant difference between the study group and the control, except for the mean age (p=0.906). In the control group, the values of FEV1 (Forced expiratory volume in 1 second), FVC (Forced vital capacity), and FEF25-75% (Forced expiratory flow 25-75%) are higher than these values in the case group, and this difference is significant (P &lt;0.001).&#x0D; Conclusion: The results of the present study showed that the levels of FEV1, FVC and FEF 25-75% in the control group are higher than these values in the patient group and this difference is significant.

Ayurvedic Management of Interstitial Lung Disease : A Case Report

Interstitial Lung Diseases(ILD) are a group of diffuse parenchymal lung disorders, most of which cause progressive scarring of lung tissue associated with substantial morbidity and mortality as the scarring in ILD eventually affects the ability to breathe and get enough oxygen into the blood- stream. Prolonged ILD may result in pulmonary fibrosis. As there is no definite treatment for the disease, it has remained a great problem for the patients. Several conventional treatment modalities are in existence but not much comprehensive. Though the permanent cure for the disease is not available but Ayurveda can provide cost-effective and conveniently the better treatment which relieves the symptoms to a good extent and improves the quality of life of the diseased. In this article, a case study presented on a case of ILD. A 63 years old female, diagnosed case of ILD, attended Kayachikita OPD , with chief complaint of breathlessness since 2018 but severe from 1 month. Patient got admitted in IPD and treated on the Ayurvedic principles. At the time of discharge, symptomatic relief was found in breathlessness, effectiveness in FEV1( Forced Expiratory Volume in 1 sec)and also maitained saturation , but no significant changes in X-Ray Chest was observed after treatment.

The Effects of Horse-riding Simulator Training with Dual-task on Pulmonary Function and Flexibility in Healthy Adults

Purpose: The purpose of the present study was to investigate the effects of a simultaneous dual-task and horse-riding simulator (HRS) training regime on pulmonary function and flexibility. Methods: Sixteen subjects were recruited and randomly allocated to two groups: a dual-task (DT) (n=8) or a single-task (ST) (n=8) training group. Flexibility and pulmonary function were assessed before and after HRS training. Both groups underwent HRS training for 4 weeks, 3 times/week in 15-minute training sessions. The ST group underwent HRS training and the DT group underwent dual-task HRS training, which consisted of throwing and catching a ball and ring catching while HRS training. Results: Training significantly increased flexibility and FVC (forced vital capacity) and FEV1 (forced expiratory volume in 1 second) in both groups (p 0.05). After the training, flexibility and FVC in the DT group were significantly greater than in the ST group (p 0.05). Conclusion: Simultaneous dual-task and HRS motor training improved flexibility, FVC, and FEV1, and our comparative analysis suggests that dual-task HRS training improved flexibility and FVC more than single-task training.