Higher Lung Function Research Articles

Undiagnosed Obstructive Lung Disease in the United States. Associated Factors and Long-term Mortality.

Understanding factors associated with undiagnosed obstructive lung disease and its impact on mortality could inform the ongoing discussions about benefits and risks of screening and case finding. To define factors associated with undiagnosed obstructive lung disease and its long-term mortality. Cross-sectional analysis of participants, aged 20 to 79 years, in two National Health and Nutritional Examination Surveys (NHANES), NHANES III (1988-1994) and NHANES 2007-2012, with longitudinal follow-up of NHANES III participants. We classified participants with spirometry-confirmed obstructive disease, based on the fixed ratio definition (FEV1/FVC < 0.7), as "diagnosed" (physician diagnosis of either asthma or chronic obstructive pulmonary disease), and "undiagnosed" (no recorded physician diagnosis). For the longitudinal analysis of NHANES III participants, mortality was the outcome of interest. We tested the contribution of self-reported health status and comorbidity burden (exposure) to the odds of being undiagnosed using logistic models adjusted for demographics, smoking status, and lung function. We estimated hazard ratios (HRs) for all-cause mortality for diagnosed and undiagnosed subjects participating in NHANES III who had spirometry using Cox- proportional regression analysis. Among those with spirometry-defined obstruction, 71.2% (SE, 1.8) in NHANES III and 72.0% (SE, 1.9) in NHANES 2007-2012 were undiagnosed. In multivariate models, undiagnosed obstructive disease was consistently associated in both surveys with self-reported good/excellent health status, lower comorbidity burden, higher lung function, and being of racial/ethnic minority. Among NHANES III participants (median follow up, 14.5 yr), both undiagnosed (HR, 1.23; 95% confidence interval, 1.08-1.40) and correctly diagnosed participants (HR, 1.74; 95% confidence interval, 1.45-2.09) had higher risk for all-cause mortality than participants without obstruction. Undiagnosed obstructive lung disease is common among American adults and remained unchanged over 2 decades. Although undiagnosed subjects appear healthier than those with a diagnosis, their risk of death was increased compared with subjects without obstruction. These findings need to be considered when judging the implications of case-finding programs for obstructive lung disease.

Socioeconomic Status and Longitudinal Lung Function of Healthy Mexican Children.

IntroductionOur aim was to estimate the longitudinal effect of Socioeconomic status (SES) on lung function growth of Mexican children and adolescents.Materials and MethodsA cohort of Mexican children in third grade of primary school was followed with spirometry twice a year for 6 years through secondary school. Multilevel mixed-effects lineal models were fitted for the spirometric variables of 2,641 respiratory-healthy Mexican children. Monthly family income (in 2002 U.S. dollars [USD]) and parents’ years completed at school were used as proxies of SES.ResultsIndividuals with higher SES tended to have greater height for age, and smaller sitting height/standing height and crude lung function. For each 1-year increase of parents’ schooling, Forced expiratory volume in 1 sec (FEV1) and Forced vital capacity (FVC) increased 8.5 (0.4%) and 10.6 mL (0.4%), respectively (p <0.05) when models were adjusted for gender. Impact of education on lung function was reduced drastically or abolished on adjusting by anthropometric variables and ozone.ConclusionsHigher parental schooling and higher monthly family income were associated with higher lung function in healthy Mexican children, with the majority of the effect likely due to the increase in height-for-age.

57 Does Pandoraea cause clinical deterioration in healthy CF children?

Objective and Methods Clinical significance of Pandoraea, a multi drug resistant Gram-negative bacteria, is unknown. A clinical review of 6 CF children who grew Pandoraea in a 2 year period from October 2012 to September 2014 was conducted to answer following questions: (1) Does Pandoraea cause clinical deterioration (as measured by change in FEV1 and BMI) in CF children? (2) To identify most sensitive intravenous antibiotic against Pandoraea . Pt no.Age at first isolationMonths since first growthFEV1 at first growthChange in FEV1 since first growthBMI at first growthChange in BMI since first growthFrequency (Pandoraea/total samples)1736/572946102+ 4%18.88+5.9626/653123878−21%15.91+3.8138/61416997+3%17.18+1.541/265142564−3%16.95+2.0911/266108186+1%17.58+3.002/32 Results See the table. 4 out of 6 children grew Pandoraea frequently. 1 child had the first growth recently, but since the first growth, grew Pandoraea in all samples. 4 out of 5 children had stable or higher lung function 3 years after the first growth. Only child who had a drop in lung function of 21% since first isolation of Pandoraea had poor compliance to treatment and was colonised with Pseudomonas aeruginosa (PA), while others were either PA free or grew PA intermittently. BMI increased by a mean of 19% in 3 years since first growth. Imipenem was the most sensitive Intra Venous antibiotic, followed by Tazocin. Ciprofloxacin was found to be intermittently sensitive. Conclusion In 4 out of 5 children, Pandoraea was not found to cause clinical deterioration, as measured by change in lung function and BMI. Imipenem was the most sensitive antibiotic against Pandoraea .

A cross-sectional study of the association between ventilation of gas stoves and chronic respiratory illness in U.S. children enrolled in NHANESIII

BackgroundGas stoves emit pollutants that are respiratory irritants. U.S. children under age 6 who live in homes where gas stoves are used for cooking or heating have an increased risk of asthma, wheeze and reduced lung function. Yet few studies have examined whether using ventilation when operating gas stoves is associated with a decrease in the prevalence of respiratory illnesses in this population.MethodsThe Third National Health and Nutrition Examination Survey was used to identify U.S. children aged 2–16 years with information on respiratory outcomes (asthma, wheeze, and bronchitis) who lived in homes where gas stoves were used in the previous 12 months and whose parents provided information on ventilation. Logistic regression models evaluated the association between prevalent respiratory outcomes and ventilation in homes that used gas stoves for cooking and/or heating. Linear regression models assessed the association between spirometry measurements and ventilation use in children aged 8–16 years.ResultsThe adjusted odds of asthma (Odds Ratio [OR] = 0.64; 95% confidence intervals [CI]: 0.43, 0.97), wheeze (OR = 0.60, 95% CI: 0.42, 0.86), and bronchitis (OR = 0.60, 95% CI: 0.37, 0.95) were lower among children whose parents reported using ventilation compared to children whose parents reported not using ventilation when operating gas stoves. One-second forced expiratory volume (FEV1) and FEV1/FVC ratio was also higher in girls who lived in households that used gas stoves with ventilation compared to households that used gas stoves without ventilation.ConclusionsIn homes that used gas stoves, children whose parents reported using ventilation when operating their stove had higher lung function and lower odds of asthma, wheeze, and bronchitis compared to homes that never used ventilation or did not have ventilation available after adjusting for other risk factors. Additional research on the efficacy of ventilation as an intervention for ameliorating respiratory symptoms in children with asthma is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-069X-13-71) contains supplementary material, which is available to authorized users.

Healthy Eating Index 2005 and selected macronutrients are correlated with improved lung function in humans

A number of dietary components have been associated with lung function. However, a comprehensive measure of a healthy diet has not been compared with lung function. Herein, we test the hypothesis that a healthy overall diet, as assessed by the Healthy Eating Index 2005 (HEI-2005), will be associated with increased lung function. This is an investigation using the Atherosclerosis Risk in Communities Research Materials obtained from the National Heart Lung Blood Institute. The study surveyed dietary habits of 15 567 American subjects from 4 communities in 1987 to 1990. Spirometric measures of lung function were also taken at entry to the study and a second time 3 years later. Based on food and nutritional data collected by food frequency questionnaire, an HEI-2005 score was calculated for each subject. This total score, together with its 12 components scores and associated macronutrient, was compared with lung function results by linear regression. Models were controlled for smoking behavior, demographics, and other important covariates. The HEI-2005 total scores were positively associated with forced expiratory volume in 1 second per forced vital capacity (FEV(1)/FVC) at visit 1 (β = .101 per increase in 1 quintile of HEI-2005) and visit 2 (β = .140), and FEV(1) as percentage of the predicted FEV(1) at visit 2 (β = .215) (P < .05). In addition, HEI-2005 component scores that represented high intakes of whole grains (β = .127 and .096); saturated fats (β = −.091); and solid fats, alcohol, and added sugar (β = −.109 and −.131) were significantly associated with FEV(1)/FVC at either visit 1 or visit 2. Intakes of total calories (β =−.082 at visit 1) and saturated fatty acids (β = −.085 at visit 2) were negatively associated with FEV(1)/FVC. Dietary polyunsaturated fatty acids (β = .085 and .116) and long-chain omega-3 fatty acids (β = .109 and .103), animal protein (β = .132 and .093), and dietary fiber (β = .129) were positively associated with lung health. An overall healthy diet is associated with higher lung function.

Joint effects of smoking and sedentary lifestyle on lung function in African Americans: the Jackson Heart Study cohort.

This study examined: (a) differences in lung function between current and non current smokers who had sedentary lifestyles and non sedentary lifestyles and (b) the mediating effect of sedentary lifestyle on the association between smoking and lung function in African Americans. Sedentary lifestyle was defined as the lowest quartile of the total physical activity score. The results of linear and logistic regression analyses revealed that non smokers with non sedentary lifestyles had the highest level of lung function, and smokers with sedentary lifestyles had the lowest level. The female non-smokers with sedentary lifestyles had a significantly higher FEV1% predicted and FVC% predicted than smokers with non sedentary lifestyles (93.3% vs. 88.6%; p = 0.0102 and 92.1% vs. 86.9%; p = 0.0055 respectively). FEV1/FVC ratio for men was higher in non smokers with sedentary lifestyles than in smokers with non sedentary lifestyles (80.9 vs. 78.1; p = 0.0048). Though smoking is inversely associated with lung function, it seems to have a more deleterious effect than sedentary lifestyle on lung function. Physically active smokers had higher lung function than their non physically active counterparts.

The Impact of Reduced Dust Exposure on Respiratory Health Among Cement Workers

To compare total dust exposure, prevalence of chronic respiratory symptoms, lung function, and chronic obstructive pulmonary disease (COPD) among Tanzanian cement workers before (2002) and after (2010-2011) establishment of dust-control measures. Personal total dust-exposure measurements, questionnaire assessment for chronic respiratory symptoms, and spirometry were conducted in both examination periods. Total dust exposure was lower in 2010-2011 than in 2002. The prevalence of most chronic respiratory symptoms and COPD was lower in 2010 than in 2002. Forced expiratory volume in 1 second (FEV1), percentage predicted FEV1, and percentage predicted forced vital capacity were higher among cement workers in 2010 than in 2002. There was reduced total dust exposure level, lower prevalence of chronic respiratory symptoms and COPD, and higher lung function among cement workers in 2010 than in 2002.

Ventilatory Responses at Peak Exercise in Endurance-Trained Obese Adults

Alterations in respiratory mechanics predispose healthy obese individuals to low lung volume breathing, which places them at risk of developing expiratory flow limitation (EFL). The high ventilatory demand in endurance-trained obese adults further increases their risk of developing EFL and increases their work of breathing. The objective of this study was to investigate the prevalence and magnitude of EFL in fit obese (FO) adults via measurements of breathing mechanics and ventilatory dynamics during exercise. Ten (seven women and three men) FO (mean ± SD, 38 ± 5 years, 38% ± 5% body fat) and 10 (seven women and three men) control obese (CO) (38 ± 5 years, 39% ± 5% body fat) subjects underwent hydrostatic weighing, pulmonary function testing, cycle exercise testing, and the determination of the oxygen cost of breathing during eucapnic voluntary hyperpnea. There were no differences in functional residual capacity (43% ± 6% vs 40% ± 9% total lung capacity [TLC]), residual volume (21% ± 4% vs 21% ± 4% TLC), or FVC (111% ± 13% vs 104% ± 15% predicted) between FO and CO subjects, respectively. FO subjects had higher FEV1 (111% ± 13% vs 99% ± 11% predicted), TLC (106% ± 14% vs 94% ± 7% predicted), peak expiratory flow (123% ± 14% vs 106% ± 13% predicted), and maximal voluntary ventilation (128% ± 15% vs 106% ± 13% predicted) than did CO subjects. Peak oxygen uptake (129% ± 16% vs 86% ± 15% predicted), minute ventilation (128 ± 35 L/min vs 92 ± 25 L/min), and work rate (229 ± 54 W vs 166 ± 55 W) were higher in FO subjects. Mean inspiratory (4.65 ± 1.09 L/s vs 3.06 ± 1.21 L/s) and expiratory (4.15 ± 0.95 L/s vs 2.98 ± 0.76 L/s) flows were greater in FO subjects, which yielded a greater breathing frequency (51 ± 8 breaths/min vs 41 ± 10 breaths/min) at peak exercise in FO subjects. Mechanical ventilatory constraints in FO subjects were similar to those in CO subjects despite the greater ventilatory demand in FO subjects. FO individuals achieve high ventilations by increasing breathing frequency, matching the elevated metabolic demand associated with high fitness. They do this without developing meaningful ventilatory constraints. Therefore, endurance-trained obese individuals with higher lung function are not limited by breathing mechanics during peak exercise, which may allow healthy obese adults to participate in vigorous exercise training.

A longitudinal study of the impact of social deprivation and disease severity on employment status in the UK cystic fibrosis population.

BackgroundPeople with Cystic Fibrosis (CF) in the UK and elsewhere are increasingly surviving into adulthood, yet there is little research on the employment consequences of having CF. We investigated, for the first time in a UK-wide cohort, longitudinal employment status, and its association with deprivation, disease severity, and time in hospital.MethodsWe did a longitudinal registry study of adults with CF in the UK aged 20 to 40 (3458 people with 15,572 observations between 1996 and 2010), using mixed effects models.ResultsAround 50% of adults with CF were in employment. Male sex, higher lung function and body mass index, and less time in hospital were associated with improved employment chances. All other things being equal, being in the most deprived quintile was associated with a reduction of employment prevalence of 17.6 percentage points compared to the prevalence in the least deprived quintile. Having poor lung function was associated with a reduced employment prevalence of 7.2 percentage points compared to the prevalence for people with relatively good lung function. Acting synergistically, deprivation modifies the effect of lung function on employment chances – poor lung function in the least deprived group was associated with a 3 percentage point reduction in employment chances, while poor lung function in the most deprived quintile was associated with a 7.7 point reduction in employment chances.ConclusionsGreater deprivation, disease severity, and time in hospital are all associated with employment chances in adults with CF. Furthermore, our analysis suggests that deprivation amplifies the harmful association of disease severity on employment. Future studies should focus on understanding and mitigating the barriers to employment faced by people with CF.

Does allergic rhinitis make a difference to the respiratory resistance and reactance of asthma?

Background: Concomitant allergic rhinitis (AR) in asthmatic patients can contribute to increased asthma exacerbations and poorer symptom control. A recent study indicated that impulse oscillometry is a more sensitive measure of change in airway function than spirometry, but this has not been used to compare asthmatic patients with or without AR. Objective: We used impulse oscillometry (Mostgraph-01) to examine the impact of AR on asthma. Methods: Impulse oscillometry and spirometry were assessed in 50 patients with asthma only and 95 patients with asthma and AR. Results: Mean age in the asthma only group was significantly higher than in the asthma with AR group. Therefore, analysis of covariance adjusted for age was used to compare between these two groups. Percentage of mean forced expiratory volume in 1 s (FEV1), respiratory resistance at 5 Hz (R5) minus respiratory resistance at 20 Hz (R20), and resonant frequency (Fres) in the asthma with AR group were significantly less severe than in the asthma only group. Parameters of resistance and reactance were correlated with age and body mass index only in the asthma with AR group but not in the asthma only group. Correlations were observed between rate of change of maximum mid-expiratory flow and impulse oscillometry values of R5 and Fres in the asthma only group, but not between the rate of change of FEV1 and impulse oscillometry values. Conclusion: Asthma with AR was associated with higher lung function and better values of resistance and reactance than asthma only.

Probability of Treatment Following Acute Decline in Lung Function in Children with Cystic Fibrosis is Related to Baseline Pulmonary Function

To determine whether the association between high forced expiratory volume in 1 second (FEV1) and increased rate of decline in FEV1 in children with cystic fibrosis could be due to less frequent intervention after acute declines (sudden decline events) in FEV1. Patients with cystic fibrosis aged 6-17 years enrolled in the Epidemiologic Study of Cystic Fibrosis were assessed for a sudden decline event, defined as a 10% relative decline in FEV1% predicted from an average of 3 consecutive stable baseline spirometries. The likelihood of therapeutic intervention within 14 days before and 56 days after this event was then related to their baseline FEV1% predicted age-specific decile using a logistic regression adjusting for age group (6-12 years, 13-17 years) and presence of Pseudomonas aeruginosa on respiratory culture. A total of 10 888 patients had at least 1 sudden decline event in FEV1. Patients in the highest FEV1 decile were significantly less likely than those in the lowest decile to receive intravenous antibiotics (OR, 0.14; 95% CI, 0.11-0.18; P < .001) or be hospitalized (OR, 0.18; 95% CI, 0.14-0.23; P < .001) following decline. Children and adolescents with high baseline lung function are less likely to receive a therapeutic intervention following an acute decline in FEV1, which may explain their greater rate of FEV1 decline.

High Serum Retinol and Lung Function in Young Patients With Cystic Fibrosis

The aim of the present study was to explore the relation between lung function and serum retinol (SR) in cystic fibrosis (CF) patients. This was a cross-sectional study conducted in a group of 98 young patients with CF (6.8-22.3 years), after the exclusion of those with pulmonary exacerbation, vitamin A deficiency, or other risks, from an initial group of 124 cases. Data of forced expiratory volume in 1 second (FEV₁) were widely scattered (87.7% ± 16.9%). These were similar in the 78 pancreatic insufficient and 11 pancreatic sufficient patients. SR (56.6 ± 18.4 μg/dL) was >2.5th percentile of healthy people in the whole group, although 31 patients were situated above the 97.5th percentile (higher value: 110 μg/dL). The FEV₁ was noticeably higher in these than in those within the normal range (93.6 ± 14.0 vs 85.0 ± 17.6 μg/dL; P < 0.05). The z score of SR correlated positively with FEV₁ (r = 0.364; P = 0.000), after adjusting data for sex, age, body mass index, and pancreatic function. The odds ratio for a FEV₁ >80% is 3.78 in patients with SR above the 97.5th percentile, versus only 0.26 in those within the normal range. There were no cases with retinol toxicity. FEV₁ of young patients with CF correlates positively with SR, regardless of age, pancreatic function, or nutritional condition. Those with a moderately high retinol (up to 110 μg/dL) maintain the best respiratory function (FEV₁ ≥80% in >90% of them) without any signs of toxicity.

Fractional Exhaled Nitric Oxide Has a Good Correlation with Asthma Control and Lung Function in Latino Children with Asthma

Background. Although the measurement of fractional exhaled nitric oxide (FENO) has been recommended for observational studies and clinical trials of asthma, FENO has not been examined in studies of childhood asthma in Latin America, Objective. To examine the relationship between FENO and indicators of disease control or severity [asthma control test/childhood asthma control test (ACT/C-ACT), lung function, and exercise challenge test (ECT)] in Mexican children with persistent asthma, Methods. Children (6–18 years of age) with persistent asthma were consecutively recruited in a tertiary asthma clinic and divided into two groups, e.g. FENO < 20 parts per billion (ppb) and ≥20 ppb.Adequate FENO measurements were obtained in 134 (83.2%) of 161 eligible children, Results. Children with FENO<20 ppb had significantly higher scores on the ACT/C-ACT than those with FENO ≥ 20 ppb (median [interquartile range] :23 [20.8–25] vs. 21 [18–24], p = .002, respectively). Compared to children with FENO ≥20 ppb, those with FENO <20 ppb had a higher baseline predicted forced expiratory volume (FEV1) [94% (92.5%–99.4%) vs. 83% (81%–89.9%), p = .001] and a lower probability of having a positive ECT (42.7% vs. 71.2%, p = .001). In addition, FENO was significantly inversely correlated with the participants’ ACT/C-ACT score and predicted FEV1, and directly correlated with positive ECT, Conclusion. Among Mexican children with persistent asthma, low levels of FENO ( <20 ppb) are associated with better asthma control, and higher lung function.

Lung Function Among 9- to 10-Year-Old Tibetan and Han Chinese Schoolchildren Living at Different Altitudes in Tibet

Tibetans have lived at high altitude longer than any other high-altitude population. Still little is known about their lung function and especially among children. This study compared lung function values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and forced expiratory flow at 50% of FVC (FEF50) in children living at various altitudes in Tibet and with different ancestries. A cross-sectional study of lung function was performed among 9-10-year-old native Tibetan and Han Chinese children living at 3700 meters above sea level, and among native Tibetan children living at 4300 meters above sea level. The adjusted FVC and FEV1 were significantly higher in Tibetan children living at 4300 m above sea level as compared to Tibetans living at 3700 m. Tibetans living at 3700 m had higher FVC and FEV1 than Han Chinese living at the same altitude. All Tibetan children had on average higher FEF50 than Han Chinese. Tibetan children living at an altitude of 4300 m had relatively higher lung function than those living at 3700 m, and there were differences in lung function between Tibetans and Han Chinese who live at the same altitude. It seems likely that genetic factors involved in long-term adaptation to high altitude and cultural attributes could have contributed to the study findings.

Smoking cessation and COPD.

The mainstay in smoking cessation is counselling in combination with varenicline, nicotine replacement therapy (NRT) or bupropion SR. Varenicline and combination of two NRTs is equally effective, while varenicline alone is more effective than either NRT or bupropion SR. NRT is extremely safe but cardiovascular and psychiatric adverse events with varenicline have been reported. These treatments have also been shown to be effective in patients with chronic obstructive pulmonary disease (COPD). A model study is the Lung Health Study from the USA. Findings from this study of 5,587 patients with mild COPD showed that repeated smoking cessation for a period of 5 yrs resulted in a quit rate of 37%. After 14.5 yrs the quitters had a higher lung function and a higher survival rate. A study with a new nicotine formulation, a mouth spray, showed high relative efficacy. As 5-10% of quitters use long-term NRT, we report the results of a study where varenicline compared with placebo increased the quit rate in long-term users of NRT. Smoking cessation is the most effective intervention in stopping the progression of COPD, as well as increasing survival and reducing morbidity. This is why smoking cessation should be the top priority in the treatment of COPD.

Waist circumference, BMI, and lung function in 8‐year‐old children: The PIAMA birth cohort study

Body mass index (BMI) and waist circumference (WC) may be associated with lung function in children, as observed in adults. Height, weight, waist circumference, and lung function (FVC and FEV1 ) were measured during a medical examination in 1,058 eight-year-old children participating in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study. After adjusting for height, age and other potential confounders large WC or high BMI (>90th percentile) were not associated with forced expiratory volume in 1 sec (FEV1) or forced vital capacity (FVC). In girls only, large WC was, independently of BMI, associated with 3.5% (95% confidence interval (CI): -6.4, -0.6) lower FEV1 /FVC ratio in the model including WC and BMI. Girls with low BMI (<10th percentile) had 4.6% lower FEV1 (95% CI: -8.4, -0.6) and 5.1% lower FVC (95% CI: -8.8, -1.2) than girls with normal BMI. In boys, we did not observe associations between low or high BMI and lung function independent of WC, or between small or large WC and lung function after adjustment for BMI. At 8 years of age, a high BMI or large WC are not yet associated with FEV1 and FVC, indicating that this association may change over the course of life from childhood to adulthood.

Reference percentiles for FEV1 and BMI in European children and adults with cystic fibrosis

BackgroundThe clinical course of Cystic Fibrosis (CF) is usually measured using the percent predicted FEV1 and BMI Z-score referenced against a healthy population, since achieving normality is the ultimate goal of CF care. Referencing against age and sex matched CF peers may provide valuable information for patients and for comparison between CF centers or populations. Here, we used a large database of European CF patients to compute CF specific reference equations for FEV1 and BMI, derived CF-specific percentile charts and compared these European data to their nearest international equivalents.Methods34859 FEV1 and 40947 BMI observations were used to compute European CF specific percentiles. Quantile regression was applied to raw measurements as a function of sex, age and height. Results were compared with the North American equivalent for FEV1 and with the WHO 2007 normative values for BMI.ResultsFEV1 and BMI percentiles illustrated the large variability between CF patients receiving the best current care. The European CF specific percentiles for FEV1 were significantly different from those in the USA from an earlier era, with higher lung function in Europe. The CF specific percentiles for BMI declined relative to the WHO standard in older children. Lung function and BMI were similar in the two largest contributing European Countries (France and Germany).ConclusionThe CF specific percentile approach applied to FEV1 and BMI allows referencing patients with respect to their peers. These data allow peer to peer and population comparisons in CF patients.

Abstract P270: The Association between Physical Performance Characteristics and Independence in Activities of Daily Living in Middle-aged and Elderly Men

Introduction: The functional status at one moment in time is a strong determinant of future functional status and survival in older persons. Physical functioning is an important component of functional status. Physical deterioration tends to occur early in the disabling process and is therefore suitable to interventions. The aim of this study was to investigate the association of physical performance characteristics (muscle capacity, lung function, physical performance score and physical activity) and functioning independently in middle aged and elderly men. Methods: In a cross-sectional study 400 independently living men aged 40-80 were included. Preservation of function was measured using the Stanford Health Assessment Questionnaire. Physical characteristics were grip strength and leg strength by dynamometer, lung function by peak flow, lower extremity function by Guralniks physical performance score and physical activity by Voorrips questionnaire. Logistic regression analysis was used to estimate the association between potential determinants and the dichotomized HAQ-score, adjusting for confounders. Results: After adjustment for confounders, higher walking speed (OR=2.96, [95% CI 1.31; 6.72]) and shorter time to perform the chair stand test (OR=0.84, [95% CI 0.76; 0.94]) were associated with a higher probability of being independent in activities of daily living (ADL). Borderline significant associations were found for higher lung function and higher leg strength with a higher probability of being independent in ADL. No associations were found for grip strength and physical activity. Discussion and conclusion: The results are in line with previous studies, except for the associations between grip strength and physical activity with ADL independency. Longitudinal studies showed associations between grip strength and the probability of being independent in ADL. These results might indicate that whereas grip strength at a particular moment is not a determinant of ADL independency, change in grip strength over several years is. In addition, grip strength changes little until the 6 th decade but then decreases 1.0% to 1.5% per year from 50 to 70 years. The (relatively young) age of our study population could explain why we did not find an association. The mean total score on the Voorrips questionnaire was much higher compared to previous studies and very low scores of physical activity did not occur, indicating that our study population was relatively active. In the present study, lower body function and peak flow were associated with a higher probability of being independent in ADL. Future research should focus on the relation of physical performance characteristics and living independently using a longitudinal design for better insight in the direction of the associations. It seems that even at a younger age lower extremity function is associated with living independently.

High blood pressure, antihypertensive medication and lung function in a general adult population

BackgroundSeveral studies showed that blood pressure and lung function are associated. Additionally, a potential effect of antihypertensive medication, especially beta-blockers, on lung function has been discussed. However, side effects of beta-blockers have been investigated mainly in patients with already reduced lung function. Thus, aim of this analysis is to determine whether hypertension and antihypertensive medication have an adverse effect on lung function in a general adult population.MethodsWithin the population-based KORA F4 study 1319 adults aged 40-65 years performed lung function tests and blood pressure measurements. Additionally, information on anthropometric measurements, medical history and use of antihypertensive medication was available. Multivariable regression models were applied to study the association between blood pressure, antihypertensive medication and lung function.ResultsHigh blood pressure as well as antihypertensive medication were associated with lower forced expiratory volume in one second (p = 0.02 respectively p = 0.05; R2: 0.65) and forced vital capacity values (p = 0.01 respectively p = 0.05, R2: 0.73). Furthermore, a detailed analysis of antihypertensive medication pointed out that only the use of beta-blockers was associated with reduced lung function, whereas other antihypertensive medication had no effect on lung function. The adverse effect of beta-blockers was significant for forced vital capacity (p = 0.04; R2: 0.65), while the association with forced expiratory volume in one second showed a trend toward significance (p = 0.07; R2: 0.73). In the same model high blood pressure was associated with reduced forced vital capacity (p = 0.01) and forced expiratory volume in one second (p = 0.03) values, too.ConclusionOur analysis indicates that both high blood pressure and the use of beta-blockers, but not the use of other antihypertensive medication, are associated with reduced lung function in a general adult population.

Occupational Lung Disease Risk and Exposure to Butter-Flavoring Chemicals after Implementation of Controls at a Microwave Popcorn Plant

After an outbreak of severe lung disease among workers exposed to butter-flavoring chemicals at a microwave popcorn plant, we determined whether or not lung disease risk declined after implementation of exposure controls. National Institute for Occupational Safety and Health staff performed eight serial cross-sectional medical and industrial hygiene surveys at the plant from November 2000 through August 2003. Medical surveys included standardized questionnaires and spirometry testing. Industrial hygiene surveys measured levels of production-related air contaminants, including butter-flavoring chemicals such as diacetyl. All diacetyl concentrations above detectable limits were corrected for the effects of absolute humidity and days to sample extraction. Ventilation and isolation of the production process resulted in one to three orders of magnitude reductions in diacetyl air concentrations in different areas of the plant. Workers with past high exposures had stable chest symptoms over time; nasal, eye, and skin irritation symptoms declined. New workers had lower symptom prevalences and higher lung function than workers with past high exposures, and they did not worsen over time. In workers who had at least three spirometry tests, those with past high exposures were more likely to experience rapid declines in lung function than new workers. Implemented controls lowered exposures to butter-flavoring chemicals and decreased lung disease risk for much of the plant workforce. Some workers with continuing potential for intermittent, short-term peak and measurable time-weighted exposures remain at risk and should use respiratory protection and have regularly scheduled spirometry to detect rapid lung function declines that may be work-related. Close follow-up of such workers is likely to yield additional information on risks due to peak and time-weighted exposure levels.