Vital Capacity Research Articles

Effect of electronic fibrobronchoscope alveolar lavage combined with local administration of budesonide on the efficacy of Mycoplasma pneumoniae pneumonia in children.

This study investigates the effect of electronic fibrobronchoscope alveolar lavage combined with local administration of budesonide on the efficacy of treating Mycoplasma pneumoniae pneumonia (MPP) in children. A retrospective analysis was conducted on the clinical data of 100 children with MPP treated at our hospital from April 2022 to April 2024. The patients were divided into an experimental group (50 cases) and a control group (50 cases) based to the treatment method. Both groups received routine treatment, however, the control group was treated with electronic fibrobronchoscope alveolar lavage alone, while the experimental group received electronic fibrobronchoscope alveolar lavage combined with local administration of budesonide. The efficacy of the two treatments was compared. The experimental group showed a significantly higher overall effective rate than the control group (p<0.05). After treatment, the time for cough relief, lung rales resolution, fever reduction, and hospital stay were significantly shorter in the experimental group compared to the control group (p<0.05). One week after treatment, the levels of tidal volume, vital capacity, and peak expiratory flow in the experimental group were higher than those in the control group (p<0.05). Post-treatment levels of WBC and CRP were lower in the experimental group than in the control group (p<0.05). Additionally, the incidence of complications in the experimental group was lower than in the control group (p<0.05). Electronic fibrobronchoscope alveolar lavage combined with local administration of budesonide improves the efficacy of treatment for children with MPP, enhances clinical indicators, reduces inflammation levels, and has high safety, making it worthy of clinical promotion.

Brief Report: Alternative Pulmonary Function Measures of Emphysema in People With HIV.

People with HIV (PWH) have nearly twice the risk of emphysema than people without HIV. This risk, which has been associated with HIV-mediated changes in the lung immune environment and more extensive radiographic emphysema, may result in different patterns of airflow limitation on pulmonary function testing (PFT) than those traditionally used in people without HIV. In this prospective cohort of PWH in Atlanta, Georgia, we analyzed PFT and chest computed tomography data from July 2013 through June 2018. After comparing the prevalence of PFT measures of airflow limitation for those with and without radiographic emphysema, we used binary recursive partitioning to identify PFT measures that differentiated between PWH with and without radiographic emphysema. Among 167 PWH who had both PFT and computed tomography data during the study period, 89 (53%) had radiographic emphysema. Those with radiographic emphysema were more likely to have airflow limitations on PFTs. Recursive partitioning identified partitions at a forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC) of 0.78 and a residual volume of 116% predicted. These partitions enabled the identification of 84 (94%) PWH with radiographic emphysema, in contrast to the traditional diagnostic criteria of an FEV1/FVC ratio of 0.7, which only identified 49 (55%) of those with radiographic emphysema. Emphysema in PWH may have different patterns of airflow limitation on PFTs that are not adequately captured by traditional diagnostic criteria. Future studies can seek to validate these findings and determine optimal thresholds for diagnosing HIV-associated emphysema.

Expression of NLRP3 in serum and induced sputum of children with asthma and their relationship with disease severity

ObjectivesThe aim of this cross-sectional study is to investigate the levels of NLRP3 in the serum and induced sputum of children with asthma and their potential association with lung function and disease severity.MethodsThis cross-sectional study included 83 children with bronchial asthma who sought medical care at our hospital from May 2023 to February 2024. Portable spirometry was used to monitor lung function parameters, including forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow. The expression of C-reactive protein (CRP), interleukin (IL)-6, IL-1β, TNF-α, and Nod-like receptor family pyrin domain-containing 3 (NLRP3) in the serum and induced sputum were measured by enzyme-linked immunosorbent assay. Data analysis was performed using SPSS 25.0 and differences with P < 0.05 were considered statistically significant.ResultsChildren with asthma exhibited significantly elevated levels of serum NLRP3, CRP, IL-6, IL-1β, and TNF-α compared to healthy controls. In addition, children with moderate–severe asthma had significantly higher levels of serum and induced sputum NLRP3 and IL-1β compared to children with mild asthma. Spearman’s correlation analysis revealed a positive correlation between induced sputum NLRP3 and IL-6. Moreover, induced sputum NLRP3 was negatively correlated with lung function parameters. The results of receiver operating characteristic curves showed that induced sputum NLRP3 could be used for diagnosing children with moderate–severe asthma, with an AUC was 0.758, cutoff value of 3.33 ng/mL, sensitivity of 66.1%, and specificity of 70.8%. Furthermore, the logistic regression analysis revealed that serum and induced sputum NLRP3, induced sputum IL-6 and IL-1β were risk factors for children with moderate–severe asthma.ConclusionsIn this cross-sectional study, we found a significant increase in NLRP3 levels in induced sputum of children with asthma, which further increased in those with moderate–severe disease. The levels of NLRP3 in induced sputum could serve as potential biomarkers for assessing disease severity.

CD19-targeting CAR T-cell therapy in patients with diffuse systemic sclerosis: a case series

CD19-targeting chimeric antigen receptor (CAR) T-cell therapy has shown remarkable outcomes in patients with systemic lupus erythematosus. The effects of CD19-targeting CAR T cells on organ manifestations in patients with systemic sclerosis have yet to be characterised. B cells have a central role in the pathogenesis of systemic sclerosis. We present a detailed analysis of the effects of CD19-targeting CAR T-cell therapy in patients with systemic sclerosis. Six patients with severe diffuse systemic sclerosis with an insufficient response to at least two treatments were consecutively recruited at the Department of Internal Medicine 3, University Hospital Erlangen (Erlangen, Germany) to receive CD19-targeting CAR T-cell treatment (1 × 106 CAR T cells per kg bodyweight). Events were predefined by progression of interstitial lung disease, onset of congestive heart failure, onset of renal failure, onset of arterial hypertension, or initiation of new immunosuppressive or antifibrotic therapy. Event-free time or treatment intensification after study entry was the primary outcome. Key secondary outcomes included changes in the modified Rodnan Skin Score (mRSS), imaging (a component of the assessment of lung fibrosis), laboratory assessments, patient-reported outcomes, and a modified version of the American College of Rheumatology Composite Response Index in Systemic Sclerosis (ACR-CRISS), assessed at baseline, 3 months, 6 months, 9 months, and 12 months. Between April 20, 2022, and Nov 8, 2023, six patients with severe diffuse systemic sclerosis (median age 42 years [IQR 36-53]; four men and two women; all White European) were recruited and received CD19-targeted CAR T-cell therapy. The median follow-up time was 487 days (IQR 342-585). No events occurred within the observational period. Probability of improvement in the ACR-CRISS score increased to a median of 100% (IQR 100-100) at 6 months. Median mRSS decreased by 31% (IQR 29-38), corresponding to a median of 8 points (IQR 7-13) within 100 days. The extent of disease on CT scan decreased by a median of 4% (IQR 3-4) due to reduction of ground-glass opacities while the reticular pattern remained stable. Forced vital capacity improved by a median of 195 mL (IQR 18-275) at the latest observational timepoint. We provide the first evidence that CD19-targeting CAR T-cell therapy might intercept with the progression of fibrotic organ manifestations in patients with systemic sclerosis. Deutsche Forschungsgemeinschaft, Deutsche Krebshilfe, ELAN-Foundation Erlangen, IZKF Erlangen, and Bundesministerium für Bildung und Forschung.

Safety, tolerability, and efficacy of fasudil in amyotrophic lateral sclerosis (ROCK-ALS): a phase 2, randomised, double-blind, placebo-controlled trial

Fasudil is a small molecule inhibitor of Rho-associated kinase (ROCK) and is approved for the treatment of subarachnoid haemorrhage. In preclinical studies, fasudil has been shown to attenuate neurodegeneration, modulate neuroinflammation, and foster axonal regeneration. We aimed to investigate the safety, tolerability, and efficacy of fasudil in patients with amyotrophic lateral sclerosis. ROCK-ALS was a phase 2, randomised, double-blind, placebo-controlled trial conducted at 19 amyotrophic lateral sclerosis centres in Germany, France, and Switzerland. Individuals (aged 18-80 years) with at least probable amyotrophic lateral sclerosis (as per the revised El Escorial criteria), a disease duration of 6-24 months, and a slow vital capacity greater than 65% of predicted normal were eligible for inclusion. Patients were randomly assigned (1:1:1) to receive 30 mg (15 mg twice daily) or 60 mg (30 mg twice daily) fasudil or matched placebo intravenously for 20 days over a 4-week period. Follow-up assessments were performed at 45, 90, and 180 days after treatment initiation. The co-primary endpoints were safety until day 180 (defined as the proportion without drug-related serious adverse events) and tolerability during the treatment period (defined as the proportion who did not discontinue treatment due to suspected drug-related adverse events). The primary analyses were carried out in the intention-to-treat population, which included all participants who entered the treatment phase. This trial is registered at ClinicalTrials.gov (NCT03792490) and Eudra-CT (2017-003676-31) and is now completed. Between Feb 20, 2019, and April 20, 2022, 120 participants were enrolled and randomised; two individuals assigned fasudil 30 mg withdrew consent before the baseline visit. Thus, the intention-to-treat population comprised 35 in the fasudil 30 mg group, 39 in the fasudil 60 mg group, and 44 in the placebo group. The estimated proportion without a drug-related serious adverse event was 1·00 (95% CI 0·91 to 1·00) with placebo, 1·00 (0·89 to 1·00) with fasudil 30 mg, and 1·00 (0·90 to 1·00) with fasudil 60 mg; the difference in proportions was 0·00 (95% CI -0·11 to 0·10; p>0·99) for fasudil 30 mg versus placebo and 0·00 (-0·10 to 0·10; p>0·99) for fasudil 60 mg versus placebo. Treatment tolerability (the estimated proportion who did not discontinue) was 0·93 (95% CI 0·81 to 0·99) with placebo, 1·00 (0·90 to 1·00) with fasudil 30 mg, and 0·90 (0·76 to 0·97) with fasudil 60 mg; the difference in proportions was 0·07 (95% CI -0·05 to 0·20; p=0·25) for fasudil 30 mg versus placebo, and -0·03 (-0·18 to 0·10; p=0·70) for fasudil 60 mg versus placebo. Eight deaths occurred: two in the placebo group, four in the fasudil 30 mg group, and two in the fasudil 60 mg group. The most common serious adverse events were respiratory failure (seven events), gastrostomy (five events), pneumonia (four events), and dysphagia (four events). No serious adverse events or deaths were attributed to study treatment. Adverse events, which were mainly related to disease progression, occurred in 139 participants in the placebo group, 108 in the fasudil 30 mg group, and 105 in the fasudil 60 mg group. Fasudil was well tolerated and safe in people with amyotrophic lateral sclerosis. The effect of fasudil on efficacy outcomes should be explored in larger clinical trials with a longer treatment duration, oral administration, and potentially higher dose of the trial drug. Framework of the E-Rare Joint Transnational Call 2016 "Clinical research for new therapeutic uses of already existing molecules (repurposing) in rare diseases".

Assessment of Metabolic Syndrome in Patients with Chronic Obstructive Pulmonary Disease: A 6-Month Follow-Up Study.

The association between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) is a common one, with long-term therapeutic and prognostic impact. In view of the high pulmonary and cardiovascular morbidity and mortality, self-management contributes to decreasing the risk of an acute cardiac event or pulmonary decompensation. We conducted a prospective cohort study on 100 patients admitted to Iasi Clinical Rehabilitation Hospital who were divided into two groups according to the presence (67 patients) or absence (33 patients) of MetS. All patients benefited from multidisciplinary counseling sessions on their active role in improving modifiable cardiovascular risk factors and thus increasing quality of life. The aim of this study was to examine the impact of metabolic syndrome on lung function and the role of self-management in a 6-month follow-up period. The demographic, anthropometric, cardiovascular risk factors, and respiratory function were analyzed at baseline and at 6 months. The presence of MetS was associated with higher fasting blood glucose (p = 0.004) and triglycerides (p = 0.003) but not with higher levels of interleukins or TNF-alpha. At the 6-month follow-up, abdominal circumference, forced expiratory volume in one second (FEV1), dyspnea severity, and blood pressure values improved in male patients with COPD. Systolic and diastolic blood pressure decreased in the COPD group as a whole, but especially in male patients with and without associated MetS. BMI was positively correlated with FEV1 (r = 0.389, p = 0.001) and the FEV1/forced vital capacity (FVC) ratio (r = 0.508, p < 0.001) in all COPD patients and in the MetS subgroup. In the COPD group as a whole. the six-minute walk test (6MWT) results (m) were positively correlated with FEV1 and FVC. The correlation remained significant for FVC in COPD patients with and without MetS. An increase in BMI by one unit led to an increase in TG values by 3.358 mg/dL, and the presence of metabolic syndrome led to an increase in TG values by 17.433 mg/dL. In our study, MetS is a common comorbidity in patients with COPD and is associated with higher BMI, fasting glucose, and triglycerides but not with the inflammatory parameters. A mixed pulmonary-cardiovascular rehabilitation intervention leads to improvement in various parameters in both female and male COPD patients.

The Functional Capacity of the Upper Airway in Older Adults with Chronic Stroke

(1) Background: Older adults with chronic stroke may experience compromised upper airway functions due to stroke-related changes and aging. This study aimed to evaluate the functional capacity of the upper airway in older adults with chronic stroke. (2) Methods: A total of 44 patients (22 in each group) were included in the study. The respiratory assessment involved measuring forced vital capacity, forced expiratory volume in one second, maximum voluntary ventilation, and peak cough flow. The voice assessment recorded intensity, frequency, shimmer, and the harmonics-to-noise ratio during a monologue task. Additionally, the maximum phonation time of /a/ and /s/ was recorded. The swallowing assessment included the Eating Assessment Tool—10 and the Swallowing Quality of Life questionnaire. (3) Results: Significant differences were found in the experimental group compared to the control group in maximum voluntary ventilation (44.59 ± 15.61 vs. 58.50 ± 28.08, p = 0.049) and peak cough flow (173.64 ± 101.09 vs. 291.59 ± 176.58, p = 0.009). Additionally, the experimental group showed poorer results than the control group in monologue intensity (66.60 ± 3.72 vs. 114.72 ± 63.09, p = 0.001), the harmonics-to-noise ratio (9.08 ± 2.06 vs. 10.26 ± 1.59, p = 0.042), and the maximum phonation time of /s/ (4.36 ± 1.67 vs. 8.09 ± 4.07, p &lt; 0.001). Patients with stroke also had significantly lower values for swallowing efficiency and safety compared to the control group (7.05 ± 8.44 vs. 2.23 ± 4.14, p = 0.021) and reported poorer quality of life related to swallowing difficulties (185.50 ± 23.66 vs. 200.32 ± 19.60, p = 0.029). (4) Conclusions: Older adults with chronic stroke exhibited significantly reduced cough strength, voice intensity, maximum phonation time, and swallowing function compared to controls.

Extending the horizon in cardiovascular risk prediction: A synergy of conventional predictors and spirometry data

Aim. To assess a correlation between conventional cardiovascular risk factors and unprovoked pulmonary volumes and flows.Material and methods. The subjects (n = 153, median age 43 [32; 51] years) were divided into two groups depending on age. Questionnaires, anthropometry, biochemical blood analysis, spirometry without bronchodilation test, calculation of the lower limit of normal (LLN – low limit of normal) were carried out. Using the Mann – Whitney U-test, the two groups were compared quantitatively. When analyzing four-field conjugacy tables, a comparison was performed using the Pearson criterion χ2. The direction and closeness of the correlation were estimated using Spearman’s rank correlation coefficient. A predictive model was developed using the linear regression method. The differences were considered statistically significant at p &lt; 0.05.Results. In group I (median age 29 [26; 33] years), reliable connections were established between the volume of forced expiratory volume in one second and high-sensitivity C-reactive protein (hsCRP); modified Tiffno index (m-TI) and total cholesterol, lowdensity lipoproteins, glucose. When analyzing the LLN data, reliable associations between m-IT and glucose (p = 0.004), hsCRP (p = 0.011) were obtained. In persons over 40 years of age with a smoking index of more than 10 packs/year, a relationship was found between a decrease in LLN m-TI and LLN of forced expiratory flow between 25 and 75% of forced vital capacity and an increase in creatinine (p &lt; 0.001) and lipoprotein (a) (p = 0.03), respectively. Conclusion. There are differences in the relationship between the function of external respiration and laboratory indicators of cardiovascular risk in people before and after 40 years of age, which makes it possible to individualize the prediction of chronic non-communicable diseases.

The Correlation Of Waist Circumference And Waist Hip Circumference Ratio With Vital Lung Capacity in Collage Students

Final college students tend to lack physical activity accompanied by unhealthy lifestyles, this habit can disrupt body metabolism and potentially cause obesity. Obesity is a risk factor for various conditions including cardiorespiratory disorders. This is related to the accumulation of fat in the abdomen affecting the limitation of respiratory muscle performance. This study aims to determine the correlation between waist circumference and waist-hip ratio (WHR) with lung vital capacity in students. This observational study used a cross-sectional study with the proportionate stratified random sampling method on final-year students of Physiotherapy S1, University of Muhammadiyah Malang. Data collection was done using anthropometric measurements of waist circumference and waist-hip ratio using Medline and lung vital capacity using a spirometer. Data analysis used univariate and bivariate with the Spearmen's Rho test. The study's results obtained 127 students, consisting of 37 men and 90 women. Waist circumference of 58,3% of normal subjects, waist-hip ratio of 77,2% normal, and lung vital capacity value of 79,8% of normal subjects. The results of the hypothesis test of this study showed no significant relationship between waist circumference and waist-hip ratio with lung vital capacity with a value of p&gt; 0,05 (p = 0,091 and p = 0,341). The correlation test of waist circumference was negatively correlated but not significant (r = -0,151 &amp; r = 0,085). As the negative correlation value states, the higher the waist circumference, the lower the lung vital capacity. In contrast, the waist-hip ratio did not correlate significantly with lung vital capacity. This study concludes that there is no relationship between waist circumference and waist-hip ratio with lung vital capacity.

Impact of the scapular dyskinesia on balance and pulmonary health in young adults: Cross-sectional observational study

Purpose. To evaluate balance abilities and respiratory system health in undergraduate students (young adults) with scapular dyskinesia. Methods. 141 sedentary students [65 men (46.1%): 76 women (53.9%)] voluntarily participated in this cross-sectional, observational study that included participants with scapular dyskinesia (group-I; n = 76), and normal control, age-matched subjects (group-II; n = 65). The evaluated variables included scapular dyskinesia (including the dyskinesis side and type) evaluated by the Lateral scapular slide test (LSST), balance (including the overall limits of stability, the limit of stability at the right and the limit of stability at the left) evaluated by the Biodex Balance System, and the pulmonary health variables (including the forced vital capacity “FVC”, the forced expiratory volume in one second “FEV1”, the FEV1/FVC% ratio, the maximum voluntary ventilation “MVV”, peak expiratory flow rate “PEFr” and the estimated “lung age”) using portable spirometer. Results. Among the seventy-six participants with scapular dyskinesia, there were 31 (40.8%) participants with right-side dyskinesia, 21 (27.6%) participants with left-side dyskinesia, 24 (31.6) participants with bilateral dyskinesia. Results showed that there were significant differences between groups I and II in the overall limits of stability (P = 116-3), Limits of Stability “Rt side” (P = 4-2), “Limits of Stability (Lt side)” (P = 2-2), the FVC (P = 1-3), the FEV1 (P = 8-3), and the lung age (P = 1-3). Conclusion. The balance abilities and the pulmonary health variables are significantly deteriorated in young adults with scapular dyskinesis.

Literature review: Early-onset Scoliosis and the Space Available for Lung (SAL) post-surgery

Background: Early-onset scoliosis (EOS) poses significant risks to thoracic development and pulmonary function in children due to the deformities’ impact on the space available for lung (SAL). Various surgical techniques, including growth-sparing methods like growing rods, vertical expandable prosthetic titanium ribs (VEPTR), and the Shilla system, aim to correct spinal deformities while allowing for thoracic growth. This literature review explores the efficacy of these interventions in improving SAL and lung function, as measured by forced vital capacity (FVC) and other pulmonary outcomes. Studies indicate that growth-friendly techniques are associated with substantial improvements in SAL, with growing rods showing an average 30% increase in thoracic volume and a corresponding improvement in pulmonary function. VEPTR has been similarly effective in increasing thoracic volume by 25% in patients with thoracic insufficiency syndrome. The Shilla system offers advantages in maintaining spinal correction while promoting growth but has been noted for potential complications like metal debris. Conclusion: Despite these advances, complications such as hardware failure and the need for revision surgeries remain concerns. This review underscores the importance of early surgical intervention to maximize thoracic volume and prevent long-term pulmonary impairment. However, further research is needed to assess the long-term outcomes of these surgical techniques, particularly in adulthood.

Enhancing respiratory function through Yoga and Pilates in women aged 45-50

Background and Study Aim. Respiratory function in women aged 45-50 often declines due to natural physiological changes associated with aging. These changes include reduced lung elasticity, decreased diaphragm efficiency, and a general reduction in physical activity. The purpose of this study was to assess the impact of a combined yoga and Pilates program on respiratory function in women aged 45-50. Material and Methods. The study involved 38 women with an average age of 47.7 ± 2.5 years. A pedagogical experiment was conducted over six months. The experimental group (n=19) participated in a training regimen focused on improving respiratory function through a combination of yoga and Pilates. The control group (n=19) followed a yoga-based training program. Both groups completed an equal number of sessions—72 in total. The external respiratory function of the participants was assessed using spirometry at two key points: at the beginning of the study and after six months. Results. The comparison of respiratory function indicators between the experimental and control groups after 6 months of training revealed significant differences across most parameters. The actual value of Vital Capacity was significantly greater in the experimental group compared to the control group by 0.17 L (p &lt; 0.01), forced vital capacity by 0.30 L (p &lt; 0.01), forced expiratory volume by 0.19 L (p &lt; 0.01), peak expiratory flow by 0.23 L/sec (p &lt; 0.01), maximum expiratory flow at 25% of Forced Vital Capacity by 0.96 L/sec (p &lt; 0.001), maximum expiratory flow at 50% of Forced Vital Capacity by 0.59 L/sec (p &lt; 0.001), expiratory reserve volume by 0.47 L (p &lt; 0.001), and maximal voluntary ventilation by 17.00 L/min (p &lt; 0.001). Conclusions. The combined Yoga and Pilates training regimen was more effective in improving external respiratory function than Yoga alone. This result highlights the benefits of an integrated approach to respiratory health for women aged 45-50. The study demonstrates the potential advantages of combining different types of exercise to counteract age-related declines in respiratory function. Such programs could play a significant role in promoting overall well-being in this age group.

Characterization of patients with Duchenne muscular dystrophy across previously developed health states.

Project HERCULES has developed a natural history model (NHM) of disease progression in Duchenne muscular dystrophy (DMD) that comprises eight ordered health states (two ambulatory states, one transfer state indicating increased caregiver burden in which patients cannot walk/run 10m or rise from floor but can still support their own weight, and five non-ambulatory states). The current study used data from nine sources (clinical trial placebo arms, one real-world dataset, and three natural history datasets) to further characterize patients with DMD according to these health states. The study included 1,173 patients across 5,306‬ visits. Patients were on average older and exhibited worse ambulatory, pulmonary, upper limb, and cardiac functions with each successive health state. Mean±SE ages increased monotonically across health states, starting with 8.47±0.07 for early ambulatory, 10.86±0.13 for late ambulatory, 11.65±0.35 for transfer state, and ranging from 13.17±0.32 to 16.84±0.37 for the non-ambulatory states. North Star Ambulatory Assessment (NSAA) total score, which measures motor function and ranges from 34 (best) to 0 (worst), was 23.7 (interquartile range [IQR]: 20-30) for early ambulatory patients, 12.7 (IQR: 9-16) for late ambulatory patients, and 3.9 (IQR: 2-5) for transfer patients. Pulmonary function as measured by mean±SE of forced vital capacity percent predicted (FVC%p) was 94.5±0.8 for early ambulatory, 89.1±1.4 for late ambulatory, and 80.2±2.8 for transfer states, and decreased from 77.2±1.7 to 20.6±1.6 across the five non-ambulatory health states. In summary, these findings further characterize health states and their interpretation in economic modeling and decision-making in DMD management.

Voice Assessment in Patients with Amyotrophic Lateral Sclerosis: An Exploratory Study on Associations with Bulbar and Respiratory Function

Background: Speech production is a possible way to monitor bulbar and respiratory functions in patients with amyotrophic lateral sclerosis (ALS). Moreover, the emergence of smartphone-based data collection offers a promising approach to reduce frequent hospital visits and enhance patient outcomes. Here, we studied the relationship between bulbar and respiratory functions with voice characteristics of ALS patients, alongside a speech therapist’s evaluation, at the convenience of using a simple smartphone. Methods: For voice assessment, we considered a speech therapist’s standardized tool—consensus auditory-perceptual evaluation of voice (CAPE-V); and an acoustic analysis toolbox. The bulbar sub-score of the revised ALS functional rating scale (ALSFRS-R) was used, and pulmonary function measurements included forced vital capacity (FVC%), maximum expiratory pressure (MEP%), and maximum inspiratory pressure (MIP%). Correlation coefficients and both linear and logistic regression models were applied. Results: A total of 27 ALS patients (12 males; 61 years mean age; 28 months median disease duration) were included. Patients with significant bulbar dysfunction revealed greater CAPE-V scores in overall severity, roughness, strain, pitch, and loudness. They also presented slower speaking rates, longer pauses, and higher jitter values in acoustic analysis (all p &lt; 0.05). The CAPE-V’s overall severity and sub-scores for pitch and loudness demonstrated significant correlations with MIP% and MEP% (all p &lt; 0.05). In contrast, acoustic metrics (speaking rate, absolute energy, shimmer, and harmonic-to-noise ratio) significantly correlated with FVC% (all p &lt; 0.05). Conclusions: The results provide supporting evidence for the use of smartphone-based recordings in ALS patients for CAPE-V and acoustic analysis as reliable correlates of bulbar and respiratory function.

Usefulness of monitoring mycophenolic acid exposure in systemic sclerosis-related interstitial lung disease: a retrospective cohort study

BackgroundSystemic sclerosis-related interstitial lung disease (SSc-ILD) represents a significant cause of morbidity and mortality in Systemic Sclerosis (SSc). Mycophenolate mofetil (MMF) is currently the first line treatment for SSc-ILD. There is no recommendation on the dosage of mycophenolic acid (MPA) blood concentrations, so we aimed to study the correlation between MPA exposure and respiratory outcomes in this population.MethodsWe conducted a retrospective cohort study of SSc-ILD patients treated with MMF in our center. According to our policy, a complete patient evaluation was performed approximately one year after MMF initiation, during which the mycophenolic acid (MPA) residual rate (RR) was measured. We analyzed the association between RR and changes in forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) over time.ResultsForty-three SSc-ILD patients were included. Patients with higher RR levels (≥ 1.5 mg/L) had a significantly better FVC evolution with a higher proportion of stabilization and lower proportion of FVC decrease (p = 0.024). RR above 1.5 mg/L was a predictive factor of reduced FVC decline compared with lower RR levels adjusting for MMF dose and duration of MMF exposure (p = 0.008). There was no difference regarding DLCO outcome.ConclusionOur study suggests that optimal MPA exposure, as indicated by RR levels, may better protect against FVC decline in SSc-ILD patients treated with MMF. Routine monitoring of MPA exposure could be beneficial in optimizing treatment outcomes. Prospective, multicenter studies are needed to further explore the relationship between MPA exposure and clinical outcomes in SSc-ILD.

Impact of temperature and humidity on airway obstruction in a cohort of elderly women

Abstract Background Temperature and relative humidity (RH) impact human health. However, little is known about the combined association between temperature and RH on respiratory health in the elderly. In this study, we evaluated the interactive associations of temperature and RH on airway obstruction in elderly German women. Methods Using data from the second follow-up (2007-2010) of the German SALIA cohort study, we assessed the short-term (Lag0-8) combined association between maximum and minimum temperature (Tmax, Tmin) and RH on airway obstruction. Airway obstruction was defined as the ratio of first second of forced expiration (FEV1) / forced vital capacity (FVC) &amp;lt; 0.70. Multivariable logistic regression with a distributed lag non-linear model (DLNM) was constructed for the interaction between temperature and RH and adjusted for a single pollutant, location, socioeconomic status and smoking status. Results 735 elderly women with an average (±SD) age of 73.46 (±3.09) years were included. Around 16.73% of them had airway obstruction. For non-linear antagonistic Tmax and RH interaction models, we found a U-shaped relationship from Lag 0-8, with an immediate adverse association from Lag0-1 and a significant delayed adverse association from Lag7-8. For non-linear antagonistic Tmin and RH interaction models, the relationship was U-shaped and showed an immediate adverse association from Lag0-1, while there was also a significant delayed association from Lag6-8. Conclusions Climate change increases the likelihood of exposure to adverse temperatures and weather conditions. Vulnerable populations like the elderly are more susceptible to the adverse associations of climate change. In this epidemiological study, we found that exposure to Tmax/Tmin and RH had immediate and delayed adverse associations by increasing respiratory obstruction in elderly women. Increasing public awareness of the danger of interactions between non-optimum temperature and RH on respiratory health is crucial. Key messages • Elderly women’s respiratory health is impacted by temperature and humidity interactions, requiring awareness and proactive measures. • Climate change heightens risk for vulnerable groups, emphasising the need to address environmental impacts on health.

E-selectin and asymmetric dimethylarginine plasma levels in adult cyanotic congenital heart disease patients: relation to biochemical parameters, vascular function, and clinical status.

Abstract Background and Aim Patients with cyanosis secondary to congenital heart disease (CHD) are characterized by erythrocytosis and increased blood viscosity, which contributes to endothelial dysfunction, increased arterial stiffness, and impaired vascular function, which may affect the final clinical presentation. Asymmetric dimethylarginine (ADMA) and e-selectin (e-sel) are valuable biomarkers for prognosis of endocardial dysfunction and vascular damage. Their concentration levels in blood serum have the potential to be a rapid and easily accessible tool that reflects the severity of the disease. We aimed to assess e-sel and ADMA levels, their relationship with clinical status, as well as endothelial and vascular function. Methods A cross-sectional study including 36 adult CHD cyanotic patients [(17 males)(42.3 +/- 16.3 years)] with arterial blood oxygen saturation less than 92% and 20 healthy controls [(10 males)( 38.2 +/- 8.5 years)] was performed. All patients underwent clinical examination, blood testing, and cardiopulmonary tests. Endothelial function was assessed using intima-media thickness and flow-mediated dilatation (FMD). Vascular function using applanation tonometry methods was completed while considering aortic systolic pressure, aortic pulse pressure (AoPP), augmentation pressure (AP), augmentation index (AI), pulse pressure amplification (PPampl), and pulse wave velocity (PWV). Results Concentrations of e-sel and ADMA were significantly higher in patients with CHD than in controls (56.3 ± 13.6 ng/mL vs. 15.5 +/- 8.6 ng/mL, p&amp;lt;0.001) and (1.48 ± 0.48 ng/mL vs. 0.46 ± 0.1 ng/mL, p&amp;lt;0.001) respectively. E-sel levels correlated with gender, blood oxygen saturation, red blood cell, hemoglobin concentration, hematocrit, augmentation pressure, forced expiratory one second volume, forced vital capacity, and oxygen uptake. ADMA levels were found to correlate with age only. Conclusions E-sel level, unlike ADMA concentration, reflects the degree of severity of erythrocytosis and hypoxia and, thus, the physical status of patients with cyanotic CHD. E-selectin predicts increased augmentation pressure.Figure 1.A) ROC analysis for e-selectin

Cardiopulmonary long-term effects 6, 18 and 30 months after severe COVID-19 infection

Abstract Background SARS-CoV-2 infection affects the cardiopulmonary system in both the acute and long-term phase. This study aimed to comprehensively assess symptoms and potential longterm impairments 6, 18 and 30 months in patients previously hospitalized for severe Covid-19 infection. Methods This prospective registry included patients hospitalized for PCR-confirmed Covid-19 infection. Approximately 6 months post-discharge, follow-up examination included patient history, clinical examination, echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a comprehensive laboratory panel. Patients with pathologic findings during the first visit underwent a second (at 18 months) and third (at 30 months) follow-up examination. Those without pathologic findings or who refused further medical examinations were contacted via phone to inquire about symptoms. Results Between July 2020 and April 2022, 200 patients (91% general ward, 9% intensive care unit) were recruited. Due to dropouts, the second visit was conducted in 170 patients and the third visit in 139 (74 in person, 65 via telephone). Long Covid criteria were fulfilled by 73% at 6 months, 52% at 18 months and 49% at 30 months post-discharge, with fatigue being the most common symptom (Figure 1). Echocardiography at 6 months showed impaired left ventricular function in 15 patients, with normalization in 80% at 18 months and further 66% at 30 months (Figure 2). cMRI revealed pericardial effusions in 28 patients at 6 months, which resolved in 47% at 18 months and in further 60% at 30 months. Signs of peri- or myocarditis were present in 7 patients at 6 months and were resolved in all 4 patients who attended control studies at 18 months. PFT at 6 months detected reduced vital capacity in 17 patients, of whom 10% returned to normal at 18 months and a further 66% showed normalization at 30 months. Chest CT scans at 6 months identified post-infectious residues in 41 patients, with full recovery in 20% at 18 months without further normalization after 30 months. The length of in-hospital stay was identified as a significant predictor for persisting Long Covid 6 months after discharge (95% CI: 1.005 - 1.12, p=0.03). No predictors have been found for Long Covid at 18 and 30 months. Conclusion While the prevalence of Long Covid decreased over time, a significant symptom burden persisted at 6, 18 and even 30 months after severe Covid-19 infection. Structural and functional abnormalities were less frequent compared to reported symptoms, posing a challenge in substantiating the causes of these symptoms.

The impact of pulmonary fibrosis on cardiac function in chronic obstructive pulmonary disease

Abstract Background Emerging evidence indicates the coexistence pulmonary fibrosis and emphysema in patients with Chronic Obstructive Pulmonary Disease (COPD). The effect of pulmonary fibrosis on cardiac structure and function in COPD patients remains unclear. Purpose This study aimed to examine the association between the degree of pulmonary fibrosis identified on Computed Tomographic (CT) imaging and echocardiographic measures of cardiac structure and function in individuals with COPD. Methods The study included 456 individuals with COPD, participating in a large prospective cohort study. Patients with available CT scans and echocardiograms were included. Local histogram-based assessments of lung density were utilized to determine the percentage of fibrosis. Fibrosis was defined based on the CT attenuation within the range of -600 and -250 Hounsfield units. The association between percent fibrosis and measures of cardiac structure and function were investigated by univariable and multivariable linear regression models. Multivariable adjustments included age, sex, body mass index (BMI), and smoking. In addition, restricted cubic splines were generated to visually present the relationship between the percentage of fibrosis and specific echocardiographic parameters. Results The mean age was 71 (± 8 years), 48% were female, and the median BMI was 27 kg/m2 (IQR: 22; 30kg/m2). The mean forced expiratory volume in 1 second as a percentage of the predicted value (FEV1pp) was 47% (±18%). The mean forced vital capacity of predicted value was 71% (± 19%). The median percentage of fibrosis in the cohort was 4.9% (IQR: 3.9; 6.0%). Patients were stratified into tertiles based upon fibrosis percentage. BMI, frequency of diabetes, and FEV1pp were increasingly positively associated with fibrosis. Furthermore, significant trends for echocardiographic measures found that the patients with the most extensive fibrosis were seen to have impaired left ventricular (LV) ejection fraction (LVEF), lower absolute global longitudinal strain (GLS), increased left atrial (LA) volume index (LAVi), and higher LV mass as compared to those with less significant fibrosis. There were no significant differences between tertiles of fibrosis and age or sex. In univariable linear regression, significant inverse associations between the percentage of fibrosis, LVEF, GLS, and tricuspid annular plane systolic excursion (TAPSE) were seen (Table). For LV mass index and LAVi, significant direct associations were found (Table). After adjusting for potential confounding factors, only GLS and LAVi remained associated with pulmonary fibrosis (Figure). Conclusion This study found that GLS and LA volume were significantly associated with the degree of pulmonary fibrosis, even after adjusting for confounding variables. This may suggest that fibrosis is primarily linked with impaired left-sided measures of cardiac structure and function.Linear Regression ModelsCubic Spline Curves

Respiratory Trajectories and Correlation with Serum Biochemical Indices in Spinal and Bulbar Muscular Atrophy

Background/Objectives: The primary life-threatening complication in spinal–bulbar muscular atrophy (SBMA) is ventilatory failure. The present study analyzes the longitudinal patterns of respiratory function tests over a follow-up of 11 years. Methods: We collected data from 9 genetically confirmed SBMA patients. Spirometric measurements [maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and forced vital capacity (FVC)], serum biochemical indices and SBMA functional rating scale (SBMAFRS) were collected every 6 months for 11 years. An average time curve was utilized to assess the changes in both pulmonary tests and serum biochemical indices of the patients. One-way repeated-measures ANOVA was applied to assess statistical differences. The Spearman’s rank correlation coefficient was utilized to evaluate the correlations between the respiratory function tests and serum biochemical and clinical indices. Results: A progressive decrease was observed in the respiratory function tests; the slope of the linear regression was significantly non-zero (p &lt; 0.0001) for all three time curves. A major decrease was observed for MEP (52%) and MIP (42%), while this was minor for FVC (25%). SBMAFRS score correlated with FVC (r = 0.27), MIP (r = 0.53) and MEP (r = 0.51). MIP and MEP correlated with creatine phosphokinase (r = 0.3, r = 0.25, respectively) and MIP with creatinine levels (r = 0.31). Conclusions: This longitudinal study shows a progressive decline of spirometric data throughout life in SBMA patients. The decline appears to be related to clinical deterioration and muscle denervation. Spirometric measures relative to maximal strength of the respiratory muscles (MIP and MEP) may have a better predictive value for pulmonary and muscular decline than FVC.