FVC Percent Research Articles

Clinical phenotypes of sarcoidosis using cluster analysis: a Spanish population-based cohort study.

Sarcoidosis is a clinically heterogenous disease. The objective of this study is the identification of clinical phenotypes using cluster analysis. A model-based clustering relaying on 19 clinical variables was performed in a retrospective cohort of 342 sarcoidosis patients, diagnosed and followed-up from 1999 to 2019 in a tertiary hospital at Northern Spain. Chi-square test and ANOVA were used to compare categorical and continuous variables among groups. Two-sample t-tests and the partition of Pearson's chi-square statistic were used in pairwise comparisons. The Wasfi severity score was calculated and compared among clusters. Cluster analysis identified five groups: C1 (16.1%), C2 (14.3%), C3 (24.3%), C4 (5.0%), and C5 (40.4%). Lung involvement was predominant, ranging from 55.1% (C2) to 100% (C1 and C4). Extrapulmonary involvement was significantly higher in C2 (96.4%) and C3 (98.0%). A significant lower FEV1 percent predicted was detected in C5 (90.5±21.8) versus C1 (102.0±22.9), C3 (102.3±17.6) and C4 (105.8±20.8). The cluster 5 had a lower FVC percent predicted (96.6±18.9) than others, ranging from 108.1±18.0 (C3) to 111.5±21.7 (C4). The prescription of systemic glucocorticoids and non-corticosteroid immunosuppressants was higher in the clusters 1, 3 and 5. Chronicity rates were higher in C3 (31.3%) and C5 (32.6%) compared to C1 (9.1%) and C4 (0%), as well as the Wasfi severity score values. Five phenotypes with different clinical and prognostic characteristics are proposed in our study. Cluster analysis can be a useful tool for identifying clinical patterns in a disease as heterogeneous as sarcoidosis and optimising its management.

Impact of pulmonary rehabilitation on exercise capacity, health-related quality of life, and cardiopulmonary function in lung surgery patients: a retrospective propensity score-matched analysis.

Pulmonary rehabilitation is considered beneficial for patients undergoing lung surgery, yet its specific impacts on exercise capacity, health-related quality of life (HRQL), and cardiopulmonary function require further elucidation. This study aimed to evaluate the effect of PR on these outcomes in patients undergoing lung surgery using a retrospective propensity score-matched analysis. We retrospectively analyzed 420 patients with non-small cell lung cancer (NSCLC) who underwent lung surgery from January 2022 to May 2024. Among these, 84 patients received PR while 336 did not (control group). Propensity score matching (PSM) at a 1:1 ratio yielded 46 patients in each group. Baseline characteristics, spirometry, cardiopulmonary exercise testing, respiratory muscle strength, HRQL, and muscle measurements were assessed pre-and post-surgery. Before PSM, significant differences existed between groups, with the PR group being older and having different pulmonary function baselines. After PSM, groups were well-balanced. Postoperatively, the PR group showed significant improvements in FEV1/FVC (64.17% vs. 50.87%, p < 0.001), FEV1 (2.31 L/min vs. 1.75 L/min, p < 0.001), and predicted FVC percentage (88.75% vs. 68.30%, p < 0.001). Cardiovascular responses showed a lower CI during exercise in the PR group post-PSM (6.24 L/min/m2 vs. 7.87 L/min/m2, p < 0.001). In terms of exercise capacity, the PR group had higher maximal WR percentage (104.76% vs. 90.00%, p = 0.017) and peak VO2 (1150.70 mL/min vs. 1004.74 mL/min, p = 0.009). PR also resulted in less leg soreness and lower total CAT scores postoperatively. Muscle measurements indicated significantly smaller reductions in ΔHUESMCSA and percentage change in the PR group. Pulmonary rehabilitation significantly enhances exercise capacity, HRQL, and cardiopulmonary function in patients undergoing lung surgery. It also mitigates postoperative muscle loss, underscoring its importance in the postoperative management of lung surgery patients.

A Descriptive Study of Pulmonary Function Comparison Between Spot Welding and Assembly Line Workers in a Large Automotive Factory in Iran

Background: This study seeks to define the pulmonary function of a considerably large group in one of the largest automotive companies in Iran. The aim of this study was to compare the two groups of spot-welding (exposed) and assembly line (unexposed) workers in terms of pulmonary function and conclude the probable impacts of metal fumes on pulmonary function in the two groups. Methods: A total of 1,798 spot-welding personnel and 2,160 assembly line personnel were compared in terms of pulmonary function. Moreover, 120 breathing zone samples were collected from the welders’ metal fumes and were analyzed. The parameters of age, anthropometric indices, smoking, and pulmonary symptoms were also compared with across the two groups. Results: Results revealed the FEV1 mean of the total population to be 3.9 ± 0.5 liters and FVC to have been 4.9 ± 0.7 liters. Besides, predicted FEV1 and FVC percentages across the whole population were close to 100%, suggesting the better condition of the studied population compared with normal individuals in the society. All the parameters of age, weight, height, and smoking status were similar in the two groups, and no statistically significant difference was observed between the two groups in terms of pulmonary functions. Conclusion: Implementation of professional health and health improvement programs, running screening programs, and hiring personnel with no history of mild pulmonary disorders, and healthy workers effect at the recruitment stage could be the reasons behind the lack of significant difference between the two exposed and unexposed groups to metal fumes in the automotive industry in terms of pulmonary function.

Race-Neutral Equations and Pulmonary Function Test Interpretation in Two Pediatric Cohorts

ObjectivesTo investigate the changes in predicted lung function measurements when using race-neutral equations in children, based upon the new Global Lung Initiative (GLI) reference equations utilizing a race-neutral approach in interpreting spirometry results compared with the 2012 race-specific GLI equations. Study designWe analyzed data from two multicenter prospective cohorts comprised of healthy children and children with history of severe (requiring hospitalization) bronchiolitis. Spirometry testing was done at the 6-year physical exam and 677 tests were analyzed using new GLI Global and 2012 GLI equations. We used multivariable logistic regression, adjusted for age, height, and sex, to examine the association of race with the development of new impairment or increased severity (FEV1 z-score≤-1.645) as per 2022 ATS guidelines. ResultsCompared with the race-specific GLI, the race-neutral equation yielded increases in the median FEV1 and FVC percent predicted in White children but decreases in these two measures in Black children. The prevalence of obstruction increased in White children by 21% and the prevalence of possible restriction increased in Black children by 222%. Compared with White race, Black race was associated with increased prevalence of new impairments (aOR 7.59; 95%CI, 3.00-19.67; p<0.001) and increased severity (aOR 35.40; 95%CI, 4.70-266.40; p=0.001). Results were similar across both cohorts. ConclusionsAs there are no biological justifications for the inclusion of race in spirometry interpretation, use of race-neutral spirometry reference equations led to an increase in both the prevalence and severity of respiratory impairments among Black children.

Pulmonary Function in People Living With Human Immunodeficiency Virus: A Meta-Analysis

BackgroundHIV can infect bronchial epithelial cells rendering individuals susceptible to lung damage. Our objective was to determine the effects of human immunodeficiency virus (HIV) infection on pulmonary function tests. MethodsWe performed a meta-analysis after conducting a literature search in PubMed, Embase, Cochrane Library and Virtual Health Library databases from inception to December 31st, 2022. We employed the inverse variance method with a random effects model to calculate the effect estimate as the mean difference (MD) and 95% confidence interval (CI). We calculated the heterogeneity with the I2 statistic and performed a meta-regression analysis by age, sex, smoking, CD4 T-cells count and antiretroviral therapy. We also conducted a sensitivity analysis according to the studies’ publication date, and excluding the study with the greatest weight in the effect. The PROSPERO registry number was CRD42023401105. ResultsThe meta-analysis included 20 studies, with 7621 living with HIV and 7410 control participants. The pooled MD (95%CI) for the predicted percentage of FEV1, FVC and DLCO were −3.12 (−5.17, −1.06); p=0.003, −1.51 (−3.04, 0.02); p=0.05, and −5.26 (−6.64, −3.87); p<0.001, respectively. The pooled MD for FEV1/FVC was −0.01 (−0.02, −0.01); p=0.002. In all cases, there was a considerable heterogeneity. The meta-regression analysis showed that among studies heterogeneity was not explained by patient age, smoking, CD4 T-cells count or antiretroviral therapy. ConclusionPulmonary function tests are impaired in people living with HIV, independently of age, smoking, CD4 T-cells count, and geographical region.

Clinical Associations of Mucus Plugging in Moderate to Severe Asthma

Mucus plugging is recognized as a contributory factor to airway obstruction and symptoms in persistent asthma. We aimed to determine phenotypic associations of mucus plugging in patients with moderate to severe asthma in a real-life clinic setting. Mucus plugs (MPs) were identified by a thoracic radiologist upon high-resolution computed tomography imaging. A MP score was subsequently calculated and analyzed along with type 2 biomarkers, spirometry, severe exacerbations, and asthma control for 126 patients with moderate to severe asthma before biologic therapy. Asthma patients with MP had significantly worse FEV1%, forced expiratory flow at 25% to 75% of FVC percent, and FEV1/FVC as well as higher levels of peripheral blood eosinophils, FeNO, total IgE, and Aspergillus fumigatus IgE titers, and had previously experienced more frequent severe exacerbations. FEV1/FVC, more than two exacerbations per year, blood eosinophils, total IgE, and A fumigatus IgE titers were associated with MPs after adjusting for confounders. Poorly controlled asthma patients with MPs exhibited significantly worse airflow obstruction and greater type 2 inflammation associated with more frequent severe exacerbations. Impaired spirometry, more frequent exacerbations, raised blood eosinophils, total IgE, and A fumigatus IgE increased the likelihood of MPs.

Avalglucosidase Alfa (Nexviazyme)

&#x0D; CADTH recommends that Nexviazyme be reimbursed by public drug plans for the long-term treatment of patients with late-onset Pompe disease (LOPD) if certain conditions are met.&#x0D; Nexviazyme should only be covered to treat patients who have a confirmed diagnosis of LOPD, are able to walk, and have never received Myozyme before or were unable to tolerate Myozyme during the first year of treatment. Nexviazyme should not be covered to treat patients who have known Pompe-specific enlargement of the heart muscle, have severe disease, or are unable to perform repeated forced vital capacity (FVC percent predicted) measurements between 30% and 85%.&#x0D; Nexviazyme should only be reimbursed if prescribed by a clinician experienced in treating lysosomal storage diseases or other types of neuromuscular diseases and the price is less costly than Myozyme for the treatment of patients with LOPD.&#x0D;

CORRELATION OF PERCEIVED DYSPNEA WITH 6 MINUTE WALK TEST AND SPIROMETRIC FINDINGS IN DIFFUSE PARENCHYMAL LUNG DISEASE PATIENTS IN A TERTIARY CARE HOSPITAL.

DYSPNEA12score is a reliable method of grading patient perceived dyspnea.The distance covered by 6min walk test is used to grade performance capacity.FVC percentage by spirometryisused to assess disease severity in DPLD patient. After taking detailed history and clinical examination 6minute walk test,spirometry,HRCT thorax carried out in all patients with DPLD.Dyspnea score calculated in all patients.Correlation of dyspnea 12 score is made with 6minute walk testndings,spirometric analysis.mild,20% had moderate and24% had severe on dyspnea12score. Study conducted among 50 patients showed 56% patients had mild,20% had moderate and24% had severe on dyspnea12score. By 6MWT 28% patients had normal distance covered(&gt;350m),38% patients had mildly reduced distance(250-349m)covered,12%patients had Moderately reduced distance(150-249m)covered and22%patients Had severely reduced(&lt;149m)distance covered. spirometry analysis showed 28%patients had mild restriction,26%patients had moderate restriction,8%patients had normal spirometry interpretation and 38%patients had severe restriction. Dyspnea12score has positive correlation with 6minute walking distance covered and FVC percentage(by spirometry). Dyspnea12score has positive correlation with 6minute walking distance covered and FVC percentage(by spirometry).

Relationships Between Pulmonary Function and Composite Indices of Femoral Neck Strength in Korean Men (KNHANES IV).

BackgroundDespite the close relationship between osteoporosis and chronic pulmonary diseases, few studies have evaluated relationships between pulmonary functions and bone quality. We investigated associations between pulmonary function test results and femoral neck strength indices (SIs) in Korean men.MethodsThis population-based, cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey IV on 936 men aged ≥ 19 years. Pulmonary functions (forced vital capacity [FVC] and forced expiratory volume in one second [FEV1]) were measured using a dry rolling seal spirometer. Femoral neck SIs, relative to load, were calculated by hip dual-energy X-ray absorptiometry for compression strength index (CSI), bending strength index (BSI), and impact strength index (ISI).ResultsThe 443 (47.3%) of the 936 men were current smokers. FVC, FVC percentage with respect to the expected normal value, FEV1, and FEV1 percentage with respect to the expected normal value (FEV1p) were positively associated with CSI and BSI after adjusting for confounders, including smoking history (β = 0.003–0.223, P = 0.005–0.036). FEV1 and FEV1p were positively associated with ISI (β = 0.000–0.014, P = 0.010–0.025). Of components of femoral neck SIs, bone mineral density was correlated with FEV1 and FEV1p (β = 0.001–0.037, P = 0.017–0.019). After adjusting for all confounders, all femoral neck SIs increased with FVC quintiles (P for trends = 0.001–0.012), and CSI and BSI increased with FEV1 quintiles (P for trends = 0.034–0.043).ConclusionReduced pulmonary function was correlated with reduced femoral neck strength, even after adjusting for smoking history in Korean men. Femoral neck SIs might be useful tools for evaluating bone health in men with reduced pulmonary function.

Association between socioeconomic status and chronic obstructive pulmonary disease in Jiangsu province, China: a population-based study.

Background:Chronic obstructive pulmonary disease (COPD) is a common public health problem worldwide. Recent studies have reported that socioeconomic status (SES) is related to the incidence of COPD. This study aimed to investigate the association between SES and COPD among adults in Jiangsu province, China, and to determine the possible direct and indirect effects of SES on the morbidity of COPD.Methods:A cross-sectional study was conducted among adults aged 40 years and above between May and December of 2015 in Jiangsu province, China. Participants were selected using a multistage sampling approach. COPD, the outcome variable, was diagnosed by physicians based on spirometry, respiratory symptoms, and risk factors. Education, occupation, and monthly family average income (FAI) were used to separately indicate SES as the explanatory variable. Mixed-effects logistic regression models were introduced to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for examining the SES-COPD relationship. A pathway analysis was conducted to further explore the pulmonary function impairment of patients with different SES.Results:The mean age of the 2421 participants was 56.63 ± 9.62 years. The prevalence of COPD was 11.8% (95% CI: 10.5%–13.1%) among the overall sample population. After adjustment for age, gender, residence, outdoor and indoor air pollution, body weight status, cigarette smoking, and potential study area-level clustering effects, educational attainment was negatively associated with COPD prevalence in men; white collars were at lower risk (OR: 0.60, 95% CI: 0.43–0.83) of experiencing COPD than blue collars; compared with those within the lower FAI subgroup, participants in the upper (OR: 0.68, 95% CI: 0.49–0.97) tertiles were less likely to experience COPD. Such negative associations between all these three SES indicators and COPD were significant among men only. Education, FAI, and occupation had direct or indirect effects on pulmonary function including post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), FEV1, FVC, and FEV1 percentage of predicted. Education, FAI, and occupation had indirect effects on pulmonary function indices of all participants mainly through smoking status, indoor air pollution, and outdoor air pollution. We also found that occupation could affect post-bronchodilator FEV1/FVC through body mass index.Conclusions:Education, occupation, and FAI had an adverse relationship with COPD prevalence in Jiangsu province, China. SES has both direct and indirect associations with pulmonary function impairment. SES is of great significance for COPD morbidity. It is important that population-based COPD prevention strategies should be tailored for people with different SES.

POS0564 THE EFFECT OF ARTHRITIS TREATMENT ON THE COURSE OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE FOCUSING ON BIOLOGIC DMARDS: FROM A PROSPECTIVE COHORT STUDY (PART 5)

Background:Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). However, the effect of RA treatment on the course of ILD is not yet known.Objectives:To assess the effect of RA treatment on the course of lung physiology of RA-focusing on biologic DMARDs treatment.Methods:The Korean Rheumatoid Arthritis ILd (KORAIL) cohort is the prospective observational cohort and aims to investigate the natural course of RAILD. Based on either 1987 or 2020 ACR criteria, patients diagnosed with RA and ILD based on CT scan were recruited from six tertiary medical hospitals in Korea since January 2015. RA disease activity was assessed using disease activity (DAS)28-ESR and CRP, annually. Pulmonary function tests (PFT), including FVC and DLCO were conducted annually. In the current study, we analyzed patients who completed a 2-years follow-up or had died during those terms till October 2020. They classified patients into three groups: patients treated with abatacept ≥24 weeks ever (Group 1), those with other bDAMRDs ≥24 weeks ever (Group 2), and those without any bDMARDs or with bDMARDs &lt;24 weeks (Group 3).Results:Of a total of 125 patients who completed 2-year follow-up, 21 patients were classified as Group 1, 26 for Group 2, and 78 for Group 3. The mean age or the number of patients with ≥ 65-year-old was comparable between groups(Table 1). The mean duration since RA diagnosis was shorter in Group 3, but that since ILD diagnosis was comparable. DAS28-ESR score was comparable between Group 1 and 2 at enrollment, so was in 1-year-follow-up (p=0.75) and 2-year-follow-up (p=1.00). FVC and % of the predicted value in FVC, FEV1, and DLco were also comparable among the three groups at enrollment. The numbers of patients with ≥10-point decline in % of FVC predicted was 2 (10.0%) for Group 1, 1 (3.8%) for Group 2, 3 (3.9%) for Group3 during the first 1-year follow-up, and 3 (15.8%), 3 (11.5%), 10 (14.1%) during the last 1-year follow up. The percent of FVC predicted was 81.6 ± 17.5 %, 87.4 ± 17.9 %, 85.2 ± 17.7 % for Group 1,2 and 3, respectively, at 1-year-follow-up, and 79.5 ± 18.8 %, 89.0 ± 16.8 %, 83.5 ± 17.3 % at 2-year-follow-up. (Figure 1A). The percent of DLco predicted was 75.5 ± 23.4 %, 66.7 ± 18.1 %, 67.5 ± 16.7 % for Group 1,2 and 3, respectively, at 1-year-follow-up, and 74.0 ± 23.7 %, 69.1 ± 18.9 %, 67.0 ± 18.5 % at 1-year-follow-up (Figure 1B).Conclusion:Treatment of bDMARDs did not exacerbate FVC than without bDMARDs treatment and mitigated the decline of DLCO compared to without bDMARDs treatment during 2-year-follow-up.Table 1.Clinical characteristics at enrollment (V1)TotalGroup 1.Group 2.Group 3.PN125212678Age at enrollment65.9±8.266.0±8.863.9±8.066.6±8.10.3465, n (%)72 (57.6)13 (61.9)11 (42.3)48 (61.5)0.21Female, n (%)89 (71.2)16 (76.2)17 (65.4)56 (71.8)0.71RA duration, years8.0±8.49.6±6.69.2±9.07.2±8.60.05ILD duration, years3.0±3.33.8±3.73.8±3.52.5±3.10.10BMI, kg/m224.1±3.123.8±3.724.8±2.923.9±3.00.39Ever-smoker1855180.57RF positive, n (%)111 (88.8)19 (90.5)22 (84.6)70 (89.7)0.72Anti-CCP positive, n (%)119 (95.2)20 (95.2)25 (96.2)74 (94.9)1.00Arthritis activityDAS28-ESR4.0 ± 1.44.1 ± 1.14.3 ± 1.83.8 ± 1.40.60*DAS28-CRP3.1 ± 1.43.2 ± 1.23.4 ± 1.63.0 ± 1.40.76*HAQ-DI0.70 ± 0.760.64 ± 0.490.82 ± 0.820.67 ± 0.800.28*Pulmonary function testFVC, ml2522.5 ± 765.42406.2 ± 772.62617.3 ± 965.22522.2 ± 692.30.65FVC, % of pred.84.6 ± 16.980.9 ± 17.786.12 ± 17.8285.08 ± 16.50.53FEV1, % of pred.92.4 ± 21.492.0 ± 24.890.6 ± 22.193.0 ± 20.40.88DLco, % of pred.71.5 ± 19.772.3 ± 26.769.1 ± 16.472.0 ± 18.70.80Figure 1.Acknowledgements:This research was supported by Bristol Myers Squibb Inc.Disclosure of Interests:Sung Hae Chang: None declared, Ji Sung Lee: None declared, Jeong Seok Lee: None declared, Chan Ho Park: None declared, Min Uk Kim: None declared, You-Jung Ha: None declared, Eun Ha Kang: None declared, Yeon Ah Lee: None declared, Yongbeom Park: None declared, Jung-Yoon Choe: None declared, Eun Young Lee Grant/research support from: Bristol Myers Squibb Inc.

Spirometric Response to Bronchodilator and Eucapnic Voluntary Hyperpnea in Adults With Asthma.

The spirometric response to fast-acting bronchodilator is used clinically to diagnose asthma and in clinical research to verify its presence. However, bronchodilator responsiveness does not correlate with airway hyper-responsiveness measured with the direct-acting stimulus of methacholine, demonstrating that bronchodilator responsiveness is a problematic method for diagnosing asthma. The relationship between bronchodilator responsiveness and airway hyper-responsiveness assessed with indirect-acting stimuli is not known. Retrospectively, the spirometric responses to inhaled bronchodilator and a eucapnic voluntary hyperpnea challenge (EVH) were compared in 39 non-smoking adult subjects with asthma (26 male, 13 female; mean ± SD age 26.9 ± 7.8 y; mean ± SD body mass index 26.3 ± 4.7 kg/m2). All subjects met one or both of 2 criteria: ≥ 12% and 200 mL increase in FEV1 after inhaled bronchodilator, and ≥ 10% decrease in FEV1 after an EVH challenge. Overall, FEV1 increased by 9.9 ± 7.9% after bronchodilator (3.93 ± 0.97 to 4.28 ± 0.91 L, P < .001) and decreased by 23.9 ± 15.0% after the EVH challenge (3.89 ± 0.89 to 2.96 ± 0.88 L, P < .001). However, the change in FEV1 after bronchodilator did not correlate with the change after EVH challenge (r = 0.062, P = .71). Significant bronchodilator responsiveness predicted a positive response to EVH challenge in 9 of 33 subjects (sensitivity 27%). Following EVH, the change in FEV1 strongly correlated with the change in FVC (FEV1 percent change vs FVC percent change, r = 0.831, P < .001; FEV1 ΔL vs FVC ΔL, r = 0.799, P < .001). These results extend previous findings that demonstrate a lack of association between bronchodilator responsiveness and methacholine responsiveness. Given the poor concordance between the spirometric response to fast-acting bronchodilator and the EVH challenge, these findings suggest that the airway response to inhaled β2-agonist must be interpreted with caution and in the context of its determinants and limitations.

P157 Potential benefit of intravenous immunoglobulin in connective tissue disease associated interstitial lung diseases

Abstract Background/Aims Intravenous immunoglobulin (IVIg) confers significant benefit in range of connective tissue diseases (CTD) including inflammatory myopathy (IM) of which interstitial lung diseases (ILD) are a major complication. This study aimed to assess the efficacy of IVIg on pulmonary involvement in refractory active CTD including systemic sclerosis (SSc). Methods All patients with CTD-ILD confirmed on HRCT either with IM or SSc overlap myositis who did not achieve satisfactory clinical response to standard immunosuppressive agents and subsequently received regular IVIg infusions for IM were retrospectively identified. Serial lung function tests and immunosuppressive treatment regimen 9-12 months prior and 9-12 months after repeat courses of IVIg were recorded. Progressive ILD was considered when, despite immunosuppressive treatment, a relative FVC decline≥10% and/or relative DLco decline ≥15% were identified during the 9-12 months preceding IVIg treatment. The significance of median DLco and FVC percentage relative change to IVIg treatment was assessed by Wilcoxon signed-rank test. Results 22 patients (mean age 50.5±13.1 years old) with IM-ILD treated with IVIg were identified. ILD occurred in association with IM in 10 patients, overlap SSc myositis in another 11 patients, while one had mixed connective tissue disease with myositis. Lung function results were available for 19/22 (86%). Eight patients (42.1%) were found to have progressive ILD(four with IM and four with overlap SSc-myositis). The median change in FVC% predicted and DLco% predicted in the 9-12 months before and after IVIg treatment is presented in Table 1. There was a significant difference in the DLco% predicted rate of relative change before and after IVIg treatment (p = 0.035) for the overall cohort. However, no differences in lung function were observed in the rate of relative change between patients with IM and patients with SSc myositis overlap. Significant improvement in DLco% predicted values was identified in the subgroup analysis of patients with progressive ILD(p = 0.012). P157 Table 1:The median change in FVC and DLco% predicted values prior and after the IVIg treatmentPatients with myositis related ILD9-12 months before IVIg treatment (relative change)9-12 months after IVIg treatment (relative change)p-valueAll (n = 19)FVC % predicted-3.8 (-54.4 - 14.6)2.1 (-33 - 33.7)0.145DLco % predicted-9.2 (-60.7 - 9.2)-2.3 (-26 - 41.9)0.035PM/DM (n = 10)FVC % predicted-1.8 (-20.2 - 14.6)0.8 (-33 - 30.9)0.401DLco % predicted-9.6 (-60.7 - 9.2)-2.4 (-26 - 41.9)0.093SSc-PM/DM overlap (n = 11)FVC % predicted-6 (-54.4 - 10.6)3.4 (-19.9 - 33.7)0.139DLco % predicted-10.8 (-47.1 - 2.5)4.2 (-22.7 - 16.8)0.173Progressive ILD (n = 8)FVC % predicted-14.5 (-54.4 - 14.6)5.7 (-11.9 - 33.7)0.123DLco % predicted-25.3 (-60.6 - -14.1)12 (-2.3 - 41.9)0.012 Conclusion IVIg may be an effective rescue therapy in the prevention of further lung function decline in refractory myositis and SSc overlap in particular in subgroups with progressive ILD. Future studies to determine its role in CTD-ILD are warranted. Disclosure V. Kouranos: None. L.V. Host: None. C. Campochiaro: None. A. Wells: None. C.P. Denton: None. V.H. Ong: None. E. Renzoni: None.

Prognostic role of KL-6 in SSc-ILD patients with pleuroparenchymal fibroelastosis.

Krebs von den Lungen-6 (KL-6) is a high-molecular-weight (200kDa) glycoprotein proposed as a diagnostic biomarker for differentiating interstitial lung disease (ILD). Systemic sclerosis (SSc) is a rare immune-mediated disorder, and ILD is the leading cause of morbidity and mortality. Pleuroparenchymal fibroelastosis (PPFE) has been described to have a poor prognosis in SSc-ILD patients. This study undertook to compare serial changes in KL-6 in SSc-ILD patients with and without PPFE, to verify its prognostic value as a disease biomarker. Twenty-five SSc-ILD patients (median IQR, 62 (56-58); 20% males) were retrospectively enrolled. 12 SSc-ILD patients (48%) had also a radiological diagnosis of PPFE. Serum KL-6 concentrations were measured by KL-6 reagent assay (Fujirebio Europe, Ghent, Belgium). Serum KL-6 measurements were increased in SSc-ILD patients with and without PPFE compared with healthy controls (P<.0001). Comparative analysis of the rate of variation of KL-6 over the 6years of follow-up was performed by serial two-yearly KL-6 measurements: Δ1(t1-t0), Δ2(t2-t1) and Δ3(t3-t2). In SSc-ILD patients with PPFE pattern, Δ3 was significantly different than those without PPFE pattern (P=.0020). Serum KL-6 levels were significantly different (P=.0455) either at Δ2 and Δ3 in the PPFE group. In SSc-ILD patients with PPFE, at t3 serum KL-6 concentrations were inversely correlated with FEV1 (r=-.76; P=.037) and FVC percentages (r=-.79; P=.028). These results suggest that serial measurements of KL-6 in the follow-up of these patients may help to monitor disease progression. In real life, in SSc-ILD patients PPFE should be always evaluated at CT and when present should suggest a tight follow-up to monitor its evolution.

Serum Concentrations of KL-6 in Patients with IPF and Lung Cancer and Serial Measurements of KL-6 in IPF Patients Treated with Antifibrotic Therapy.

Simple SummaryEvaluation of the prognostic significance of serial measurements of serum concentrations of Krebs von den Lungen-6 (KL-6) showed that an annual increment in KL-6 exceeding a threshold amount was an independent risk factor for progressive disease and poor prognosis. No literature data are available on long-term KL-6 measurements in the follow-up of IPF patients treated with Nintedanib. The aim of this study is to serially analyze KL-6 in idiopathic pulmonary fibrosis (IPF) patients after 24 months of Nintedanib and to investigate its biomarker potential in patients with IPF and lung cancer with respect to fibrotic hypersensitivity pneumonitis patients, pulmonary fibrosis associated with autoimmune diseases group and healthy controls.Background: Krebs von den Lungen-6 (KL-6) was suggested as ILD biomarker including idiopathic pulmonary fibrosis (IPF). Lung cancer is one of the most severe comorbidity of IPF patients. This study aims to serially analyze KL-6 in IPF patients after 24 months of Nintedanib and to first investigate the biomarker behavior in IPF associated with adenocarcinoma. Materials and methods: One hundred and forty-two ILD patients (median (IQR), 69 (63–75) years; 86 males) were retrospectively enrolled. Serial serum samples were collected from IPF patients before starting antifibrotic therapy and after 12 months. Serum KL-6 levels were measured by KL-6 reagent assay (Fujirebio Europe, UK). Results: Increased KL-6 concentrations were identified in IPF-LC patients than IPF, fibrotic hypersensitivity pneumonitis, and pulmonary fibrosis associated with autoimmune disease groups. A cut-off value was calculated to distinguish IPF and IPF-LC patients. IPF patients monitored for 24 months with Nintedanib showed persisted increased levels of KL-6 with a progressive decline of FVC percentages. Conclusion: This preliminary study offers a first demonstration that very high serum concentrations of KL-6 in IPF-LC patients are associated with poor prognosis. Moreover, serial evaluation of serum KL-6 in IPF patients over 24 months of Nintedanib treatment revealed that most patients experienced a stabilization of lung function parameters and of serum concentrations of KL-6.

Long-term exposure to PM10 and NO2 in relation to lung function and imaging phenotypes in a COPD cohort

BackgroundAmbient air pollution can contribute to the development and exacerbation of COPD. However, the influence of air pollution on objective COPD phenotypes, especially from imaging, is not well studied. We investigated the influence of long-term exposure to air pollution on lung function and quantitative imaging measurements in a Korean cohort of participants with and without COPD diagnosis.MethodsStudy participants (N = 457 including 296 COPD cases) were obtained from the COPD in Dusty Areas (CODA) cohort. Annual average concentrations of particulate matter less than or equal to 10 μm in diameter (PM10) and nitrogen dioxide (NO2) were estimated at the participants’ residential addresses using a spatial air pollution prediction model. All the participants underwent volumetric computerized tomography (CT) and spirometry measurements and completed survey questionnaires. We examined the associations of PM10 and NO2 with FVC, FEV1, emphysema index, and wall area percent, using linear regression models adjusting for age, gender, education, smoking, height, weight, and COPD medication.ResultsThe age of study participants averaged 71.7 years. An interquartile range difference in annual PM10 exposure of 4.4 μg/m3 was associated with 0.13 L lower FVC (95% confidence interval (CI), − 0.22- -0.05, p = 0.003). Emphysema index (mean = 6.36) was higher by 1.13 (95% CI, 0.25–2.02, p = 0.012) and wall area percent (mean = 68.8) was higher by 1.04 (95% CI, 0.27–1.80, p = 0.008). Associations with imaging phenotypes were not observed with NO2.ConclusionsLong-term exposure to PM10 correlated with both lung function and COPD-relevant imaging phenotypes in a Korean cohort.

The Effects of Pioglitazone on Respiratory Function Test in Patients with Asthma and Type 2 Diabetes Mellitus- A before –after Study

Objective: Pioglitazone is one of the oral medications of type 2 diabetes (T2DM). The purpose of this study was to evaluate the effect of pioglitazone on asthma and diabetes treatment outcomes among patients with concurrent asthma and T2DM. Materials and Methods: We conducted a quasi-experimental study on 11 patients with concurrent asthma and T2DM in Yazd Afshar Hospital and Yazd diabetic research center 2014-2017. The inclusion criteria were patients between 20-60 years old, at least one year with concurrent asthma and T2DM (documented with spirometer, bronchodilator test), ejection fraction more than 50%. Patients who were smoker, on oral corticosteroids, phenobarbital, methotrexate, rifampin, phenytoin and gemfibrozil were excluded. Laboratory tests (FBS, HbA1c, 2hpp, leptin), spirometer test, exhaled nitric oxide were done before and after 10 weeks of pioglitazone medication. All patients were visited every two weeks. The before and after pioglitazone treatment differences were checked by paired t-test and Wilcoxon Rank sum test. Results: The mean (± SD) age of participants was 55.81 (±7.66). The median of differences of leptin (p-value: 0.885), FEV1 to FVC ( P -value: 0.185), FEV1 (p-value: 0.386), NO ( P -value: 0.574), FVC percent ( P -value: 0.477), FEV1 percent ( P -value: 0.515) did not differ before and after pioglitazone treatment. Conclusion: Our finding suggested that pioglitazone may not be effective in the treatment and improvement of respiratory function in T2DM with concurrent asthma.

Comparative Study of Flutter Device and Active Cycle of Breathing Technique in Airway Clearance in Subjects with Chronic Obstructive Pulmonary Disease

Background and Objectives: Chronic obstructive pulmonary disease is a disorder characterized by presence of air flow obstruction that is generally progressive, may be accompanied by airway hyperactivity and maybe partially reversible. COPD comprises major pathological changes. Conventional airway clearance techniques form the main stay of the routine Pulmonary Rehabilitation of subjects with chronic obstructive pulmonary disease. The procedure of Active Cycle of Breathing Technique causes an increase in lung volume which allows air to flow via collateral channels and may assist in mobilizing the secretions which but incorporating newer techniques that are effective, comfortable and can be independently performed by the subject without assistance help motivate the subjects to participate actively in their own health care. A device is proposed to have good efficacy, reliability and provides relief of the symptoms in a better way than the manual therapy in a way by excluding the bias and thus can be used as an alternative to it, so proves efficient to it. This study incorporates a device called ‘THE FLUTTER DEVICE’ which aids in mucus clearance in subjects with COPD effectively. Materials and Methodology: The Study participants were thirty subjects aged 35 to 45yrs with chronic obstructive pulmonary disease. After two weeks of ACBT and Flutter therapy with routine Physiotherapy each patient was told to record their VAS score for breathlessness on Visual Analogue Scale for breathlessness, the patient’s peak expiratory flow rate was then checked with the peak flow meter and FEV1 /FVC percentage was also obtained from the patient’s Pulmonary Function Test reports. Results: Data was analyzed by statistical means, standard deviation and students t- test and the results showed significant changes in terms of the VAS score for breathlessness, PEFR, FEV1 /FVC percentage of PFT. Conclusion: It can be concluded that application of flutter therapy for airway clearance to patients with Chronic obstructive pulmonary disease decreased the breathlessness drastically and increased the peak expiratory flow rate and FEV1 /FVC percentage than the application of ACBT.

Hubungan antara Obesitas dengan Penurunan Fungsi Faal Paru pada Polisi Wanita di Polda Jawa Timur

Background: The prevalence of obesity is increasing in Indonesia, and there is evidence that obesity, in particular abdominal obesity as a marker of insulin resistance, is negatively associated with pulmonary function. The mechanism for this association and the best marker of abdominal adiposity in relation to pulmonary function is not known. Study objectives: We assessed the association between pulmonary function (ie, FEV1 and FVC) [with maneuvers performed in the sitting position] with adiposity markers (ie, body mass index (BMI) and waist circumference (WC), as markers of adiposity and body fat distribution in Policewomen in East Java Police Departement. We used paired student t test to analyze the association of pulmonary function and abdominal adiposity markers. Design: Observational cross sectional analytic study. Setting and participants: A random sample of policewomen (n = 120) from the general population East Java Police Departement, 20 to 45 years of age, who fulfill inclusion criterion of this study. Results: The measures of adiposity (ie. Waist circumference and BMI) were not significantly related to %FEV1 and %FVC after analyzed with correlation Pearson and Spearman test (p &gt; 0.05). Conclusion: BMI categories and waist circumference (WC) were not associated with FEV1 percent predicted and FVC percent predicted, may be the physical activity twice a week can maintain health status.

PULMONARY FUNCTION TEST PARAMETERS IN DIFFUSE AND LIMITED SCLERODERMA

SESSION TITLE: Pulmonary Manifestations of Systemic Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Scleroderma is characterized by varying degrees of organ fibrosis and obliterative vasculopathy. Lung involvement is the leading cause of morbidity in Scleroderma. The spectrum of Pulmonary Function Test (PFT) abnormalities in Scleroderma has been reported to be variable, with a recent study revealing that PFTs have a low sensitivity in detecting Scleroderma-related interstitial lung disease, with false negative cases more common in diffuse Scleroderma. The objectives of this study are to determine the spectrum of PFT abnormalities in Scleroderma and to compare PFTs in limited and diffuse Scleroderma. METHODS: We reviewed the records of 174 Scleroderma patients followed at the rheumatology clinic in our institution. Patient demographics and PFT parameters [FEV1, FVC, FEV1/FVC, TLC and DLCO percent predicted (%)] were noted in patients with limited (Scl-Ltd) and diffuse (Scl-Diffuse) disease. Obstruction was defined as FEV1/FVC < 70%; restriction as TLC < 80% and impaired diffusion as DLCO < 80%. Severity of restriction was defined per ATS criteria. PFT parameters in the two groups were compared by Student’s t-test. p < 0.05 was deemed statistically significant. RESULTS: Mean age: 65 +/- 12.2 years; 91% were females; 76.4% had Scl-Ltd. Mean FEV1 was: 92 +/- 22%; mean FVC: 88.5 +/- 21.3%; mean TLC: 91.5 +/- 18%; mean DLCO:70.5 +/- 23%. Twenty-eight % patients had normal PFTs; 12 % had obstruction, 32% had restriction and 28% patients had isolated reduction in DLCO. Thirty-five % patients with Scl-Ltd and 24.4% patients with Scl-Diffuse had a normal DLCO. In patients with restriction, 40% had mild, 51% moderate and 9% had severe restriction. PFT abnormalities were seen in 37.6% Scl-Ltd, and 56% Scl-Diffuse. PFT parameters in the 2 groups are shown below. PFT parameters in 2 groups (Table) CONCLUSIONS: Majority of Scleroderma-patients have abnormal PFTs. Restriction and impairment in diffusion were the most common abnormalities. Over 1/3rd patients with limited disease had PFT abnormalities. CLINICAL IMPLICATIONS: Whether restriction defined by TLC corelates with fibrosis on imaging need to be studied. DISCLOSURES: No relevant relationships by Debapriya Datta, source=Web Response No relevant relationships by Carol Halasan, source=Web Response No relevant relationships by Sophie Korzan, source=Web Response