Improvement In Forced Vital Capacity Research Articles

Nebulization versus metered-dose inhaler and spacer in bronchodilator responsiveness testing: a retrospective study

Background: The recommended delivery mode for bronchodilators in bronchodilator responsiveness (BDR) testing remains controversial. Objective: To compare the efficacy of salbutamol administration using a nebulizer versus a metered-dose inhaler (MDI) with spacer in BDR testing. Design: A retrospective study. Methods: This study examined the data of patients with chronic obstructive pulmonary disease who completed BDR testing between 1 December 2021 and 30 June 2022, at Xiangya Hospital, Central South University. After administering 400 μg of salbutamol through an MDI with spacer or 2.5 mg using a nebulizer, the changes in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were analyzed in patients with moderate-to-very severe spirometric abnormalities [pre-bronchodilator FEV1 percentage predicted values (FEV1%pred) ⩽59%]. Significant responsiveness was assessed as >12% and >200 mL improvement in FEV1 and/or FVC or >10% increase in FEV1%pred or FVC percentage predicted values (FVC%pred) from pre- to post-bronchodilator administration. Results: Of the enrolled 894 patients, 83.2% were male (median age, 63 years). After propensity score matching, 240 pairs of patients were selected. The increment in FEV1 and increased FEV1 relative to the predicted value (ΔFEV1%pred) were significantly higher in patients <65 years and those with severe spirometric abnormalities in the nebulization group than patients in the MDI group (all p < 0.05). Compared with MDI with spacer, patients who used nebulization had a 30 mL greater increase in ΔFEV1 (95% CI: 0.01–0.05, p = 0.004) and a 1.09% greater increase in ΔFEV1%pred (95% CI: 0.303–1.896, p = 0.007) from baseline. According to the > 12% and >200 mL increase criterion, the significant BDR rate with nebulization was 1.67 times higher than that with an MDI with spacer (OR = 1.67, 95% CI: 1.13–2.47, p = 0.009). Conclusion: Salbutamol delivered using a nebulizer may be preferable to an MDI with spacer in certain circumstances. Nebulization has the potential to increase responsiveness to salbutamol in BDR testing.

Effects on Respiratory Pressures, Spirometry Biomarkers, and Sports Performance after Inspiratory Muscle Training in a Physically Active Population by Powerbreath®: A Systematic Review and Meta-Analysis.

Sports performance in athletes can be limited by respiratory factors, so it is understandable to propose that inspiratory muscle training (IMT) can improve respiratory function and exercise performance. Power-Breathe® (PwB) is a sectorized respiratory muscle training tool that uses a resistive load to train IMT. There is currently a growing interest in respiratory muscle training, so we set out to systematically assess the effects of IMT with PwB on respiratory parameters and athletic performance in physically active, healthy adults. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, the Cochrane and PEDro scales to assess methodological quality, effect size using the Rosenthal formula, and the Cochrane tool for estimation of risk of bias, studies searchable in Medline, Web of Science, and Cochrane. In addition, for the performance of the meta-analysis, the documentation and quantification of the heterogeneity in each meta-analysis were directed through the Cochran's Q test and the I2 statistic; in addition, a publication bias analysis was performed using funnel plots. Of the total of 241 studies identified in the search, 11 studies for the systematic review and nine for the meta-analysis met the exclusion and/or inclusion criteria. IMT, with PwB, showed significant improvements in maximal inspiratory pressure (MIP) and substantial improvements in forced vital capacity (FVC) in the meta-analysis results. Also, sports performance was significantly increased by IMT with PwB. In conclusion, the use of PwB is an IMT tool that improves respiratory and sports performance.

Effect of Sequential Intravenous Pulse Cyclophosphamide-Azathioprine in Systemic Sclerosis-Interstitial Lung Disease: An Open-Label Study

Systemic sclerosis (SSc) is a rare connective tissue disorder of unknown aetiology. Pulmonary involvement contributes substantially to its morbidity and mortality. Treatment of pulmonary disease due to SSc remains unsatisfactory. We examined the effect of sequential six-month intravenous pulse therapy with cyclophosphamide (CYC) followed by azathioprine and low-dose corticosteroids on SSc associated interstitial lung disease (SSc-ILD). In a single-centre, prospective, observational, open-labelled study; nine patients (eight females, one male) with SSc-ILD were treated with intravenous pulse CYC (600mg/m(2) body surface area) at monthly interval for six cycles with oral prednisolone 10mg daily. Subsequently, azathioprine (2-3mg/Kg) was administered while continuing with the same dose of prednisolone. Primary end-points were forced vital capacity (FVC) and high resolution computed tomography (HRCT) scan of thorax score. Secondary end-points were quality of life measured by health assessment questionnaire-disability index (HAQ-DI) and six-minute walk distance (6WMD) test. After one year of observation, the FVC showed significant improvement (p=0.003). The 6WMD also improved significantly (p=0.0028). However, change in HRCT scan scoring and HAQ-DI score was not significant. Intravenous, pulse CYC followed by azathioprine along with low-dose corticosteroids produces significant improvement in FVC and 6WMD at 12-month follow-up without significant change in radiological manifestations and health status.

Forced vital capacity trajectories in patients with idiopathic pulmonary fibrosis: a secondary analysis of a multicentre, prospective, observational cohort

Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease with a variable clinical trajectory. Decline in forced vital capacity (FVC) is the main indicator of progression; however, missingness prevents long-term analysis of patterns in lung function. We aimed to identify distinct clusters of lung function trajectory among patients with idiopathic pulmonary fibrosis using machine learning techniques. We did a secondary analysis of longitudinal data on FVC collected from a cohort of patients with idiopathic pulmonary fibrosis from the PROFILE study; a multicentre, prospective, observational cohort study. We evaluated the imputation performance of conventional and machine learning techniques to impute missing data and then analysed the fully imputed dataset by unsupervised clustering using self-organising maps. We compared anthropometric features, genomic associations, serum biomarkers, and clinical outcomes between clusters. We also performed a replication of the analysis on data from a cohort of patients with idiopathic pulmonary fibrosis from an independent dataset, obtained from the Chicago Consortium. 415 (71%) of 581 participants recruited into the PROFILE study were eligible for further analysis. An unsupervised machine learning algorithm had the lowest imputation error among tested methods, and self-organising maps identified four distinct clusters (1-4), which was confirmed by sensitivity analysis. Cluster 1 comprised 140 (34%) participants and was associated with a disease trajectory showing a linear decline in FVC over 3 years. Cluster 2 comprised 100 (24%) participants and was associated with a trajectory showing an initial improvement in FVC before subsequently decreasing. Cluster 3 comprised 113 (27%) participants and was associated with a trajectory showing an initial decline in FVC before subsequent stabilisation. Cluster 4 comprised 62 (15%) participants and was associated with a trajectory showing stable lung function. Median survival was shortest in cluster 1 (2·87 years [IQR 2·29-3·40]) and cluster 3 (2·23 years [1·75-3·84]), followed by cluster 2 (4·74 years [3·96-5·73]), and was longest in cluster 4 (5·56 years [5·18-6·62]). Baseline FEV1 to FVC ratio and concentrations of the biomarker SP-D were significantly higher in clusters 1 and 3. Similar lung function clusters with some shared anthropometric features were identified in the replication cohort. Using a data-driven unsupervised approach, we identified four clusters of lung function trajectory with distinct clinical and biochemical features. Enriching or stratifying longitudinal spirometric data into clusters might optimise evaluation of intervention efficacy during clinical trials and patient management. National Institute for Health and Care Research, Medical Research Council, and GlaxoSmithKline.

Freedive Training Gives Additional Physiological Effect Compared to Pulmonary Rehabilitation in COPD.

Introduction: Pulmonary rehabilitation (PR) is beneficial for lung mechanics, chest kinematics, metabolism, and inspiratory and peripheral muscle function. Freediving training (FD) can be effective in sportsmen and can improve breath-holding time. Aims: We sought to determine the effectiveness of freediving training in the pulmonary rehabilitation of COPD patients. Patients and methods: Twenty-three COPD patients (15 men and 8 women; median age 63 years; FEV1: 41% pred; BMI: 28 kg/m2) participated in the FD + PR group (3 weeks PR and 3 weeks FD + PR) and 46 patients with COPD (25 men and 21 women; median age 66 years; FEV1: 43% pred; BMI: 27 kg/m2) participated in an inpatient PR program (6 weeks). Patients performed comfort zone breath holding for 30 min/day. Patients increased their breath-holding time within their comfort zone for 30 min. We detected lung function, chest expansion (CWE), inspiratory muscle pressure (MIP), peripheral muscle function (GS), and exercise capacity (6MWD), and we included breath-holding time (BHT), quality of life score (COPD Assessment Test (CAT)), modified Medical Research Dyspnea Scale (mMRC) score, and the severity of the disease assessed by the BODE index (FEV1, BMI, 6MWD, and mMRC) and an alternative scale (FEV1, BMI, 6MWD, and CAT). Result: There were significant differences in the characteristics of the two groups. Significant improvement was detected in all functional and quality of life parameters except lung function in both groups. Significantly higher improvement was detected in CWE, GS, 6MWD, BHT, CAT, mMRC, alternative scale, and MIP. The improvement in forced vital capacity (FVC) was not significant. There were no side effects of FD training. Conclusion: The FD method can potentiate the effect of PR, improving not only BHT but also other parameters. Trial registration: ISRCTN ISRCTN13019180. Registered 19 December 2017.

Study design and rationale for the TETON phase 3, randomised, controlled clinical trials of inhaled treprostinil in the treatment of idiopathic pulmonary fibrosis

IntroductionIdiopathic pulmonary fibrosis (IPF) greatly impacts quality of life and eventually leads to premature death from respiratory failure. Inhaled treprostinil was associated with improvements in forced vital capacity (FVC) and...

Combination of Prednisolone and Calcineurin Inhibitors Prevents Lung Function Decline in Patients with Anti-aminoacyl-tRNA Synthetase Antibody-Positive Polymyositis/Dermatomyositis.

Anti-aminoacyl-tRNA synthetase antibody-positive polymyositis/dermatomyositis-associ ated interstitial lung disease (ARS-ILD) has a good prognosis, with few cases progressing to respiratory failure. This study aimed to determine factors predictive of lung function changes in patients with ARS-ILD. We retrospectively studied 49 patients with ARS-ILD treated at Kurume University Hospital Hospital between 2000 and 2018. We followed 30 patients for more than 2 years after prednisolone (PSL) therapy, with or without calcineurin inhibitors (CNIs), evaluating clinical, physiological, computed tomography, pulmonary func tion, and serological data. After treatment for 24 months, no significant differences were noted between clinical parameters and improvement in forced vital capacity (FVC), %FVC, % carbon monoxide diffusing capacity/alveolar volume (%DLCO), and %DLCO/alveolar volume. Conversely, the annual change of %FVC significantly correlated with the Medical Research Council dyspnea scale grade and %FVC at the first visit and treatment. Furthermore, the annual change of %DLCO/VA significantly correlated with the duration from the first visit to treatment initiation. Compared with PSL monotherapy, combining PSL and CNI showed greater mitigation of %FVC decline. The time from onset of ARS-ILD to the first visit is critical for preventing a decline in lung function, and as such, patients should be monitored carefully.

POS0859 C-REACTIVE PROTEIN AND INTERLEUKIN-6: POTENTIAL BIOMARKERS OF DISEASE ACTIVITY AND TREATMENT RESPONSE IN SYSTEMIC SCLEROSIS-INTERSTITIAL LUNG DISEASE

BackgroundClinically feasible and valid biomarkers of systemic sclerosis-interstitial lung disease (SSc-ILD) are needed. While promising candidate biomarkers are under investigation (e.g., KL-6, CCL-8), clinical assays for these proteins are not currently available. C-reactive protein (CRP) measurements are feasible, cost-effective, and have been shown to predict mortality in SSc.1 Measuring interleukin (IL)-6, a proinflammatory cytokine implicated in SSc-ILD pathogenesis, is also feasible in most clinical settings.Objectives(1) To investigate whether CRP and IL-6 levels change in response to treatment with immunosuppression in SSc-ILD; (2) To explore whether the change in CRP and IL-6 predict the future course of forced vital capacity (FVC).MethodsCRP and IL-6 levels were measured in serum at baseline and after 12 months in participants of Scleroderma Lung Study (SLS) II (patients with active SSc-ILD receiving 24 months of mycophenolate or 12 months cyclophosphamide followed by 12 months of placebo2). Measured values were log-transformed to remove skewness. The FVC%-predicted was measured every 3 months over the course of 24 months. Spearman’s correlations evaluated the relationship between baseline CRP or IL-6 measurements and other patient parameters. Paired t-tests were used to compare the change in individual CRP and IL-6 measurements from baseline to 12 months. Linear mixed effects models were used to examine the relationship between the change in CRP and IL-6 (baseline to 12 months) and the subsequent course of the FVC (12 to 24 months). All analysis were performed for the entire cohort and separately by treatment arm.ResultsOf the 142 participants of SLS II, 101 had CRP and IL-6 measurements at baseline and 12 months. Baseline CRP and IL-6 levels correlated significantly with higher modified Rodnan skin score (CRP: r=0.3, P=0.005; IL-6: r=0.2, P=0.01) and shorter disease duration (CRP: r=-0.3, P=0.005; IL-6: r=-0.2, P=0.01) and were higher in patients with diffuse SSc (CRP: P=0.007; IL-6: P=0.01). Relationships to baseline FVC and DLCO were not observed. CRP decreased significantly from baseline to 12 months in the whole group (P=0.01), but the decrease was slightly greater in patients randomized to mycophenolate versus cyclophosphamide (-0.47 vs. -0.33 ug/mL). IL-6 also decreased from baseline to 12 months in the whole group with a trend towards significance (P=0.10) (Figure 1). The mean decrease in IL-6 was again slightly greater in patients randomized to mycophenolate versus cyclophosphamide (-0.31 vs. -0.10 pg/mL). After controlling for baseline FVC and treatment arm in the mixed effects model, there was a relationship between the decrease in CRP from baseline to 12 months and an improved course of FVC 12 to 24 months (Estimate -0.64), but this did not reach significance (P=0.14). However, after controlling for baseline FVC and treatment arm, a greater decrease in IL-6 from baseline to 12 months was significantly associated with a greater improvement in FVC from 12 to 24 months (Estimate -1.28; P=0.01).Figure 1.Change in CRP (A) and IL-6 (B) from baseline to 12 months by treatment arm in SLS II. CYC=cyclophosphamide (Blue), MMF=mycophenolate (red)ConclusionPatients with active SSc-ILD receiving one year of immunosuppressive therapy in the SLS II study experienced reductions in their CRP and IL-6 levels over this interval. The magnitude of the decrease in CRP and IL-6 over the first year also correlated with the course of FVC over the ensuing 12 months. These findings suggest a dynamic relationship between CRP and IL-6 measurements and the course of SSc-ILD in patients on immunosuppressive therapy. Further investigation of these findings is warranted.

Effect of Twin-block Appliance on Pharyngeal Airway, Sleep Patterns, and Lung Volume in Children with Class II Malocclusion

In this study, we sought to evaluate the effect of the twin-block appliance on pharyngeal airway dimensions, sleep patterns, and lung volumes in growing children with class II malocclusion with a retrognathic mandible. Twenty children aged 9-12 years with class II malocclusion with a retrognathic mandible participated in the study. A validated sleep questionnaire assessed the sleep patterns and the sleep problems of the children. The pre-treatment cephalometric variables and the pharyngeal airway passage (PAP) dimensions were analyzed. Spirometry tests were performed to evaluate lung volumes. A custom-made twin-block appliance was fabricated, and children were instructed to wear it for a minimum of 10 months. All variables including sleep problems, cephalometric variables, and pharyngeal airway measurements were evaluated post-treatment. Spirometry tests were re-evaluated at the end of the twin-block treatment. All data were statistically analyzed. Post-twin-block appliance treatment, there was a definite decrease in snoring, noisy breathing, and sleeping with mouth open. The sella-nasion to B point angle (SNB), mandibular length, the depths of oropharynx, nasopharynx, and hypopharynx as well as the height of nasopharynx (HNP) were significantly increased post-treatment (p <0.001). The length and thickness of soft palate (SPI) increased significantly (p <0.001), while its inclination decreased significantly (p <0.001). We found improvements in forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1); however, the changes were statistically not significant (p = 0.88 and p = 0.78). Twin-block appliance significantly increased the pharyngeal airway dimensions and improved the length and thickness of the soft palate in children with class II malocclusion. Post-twin-block treatment showed a considerable reduction in the sleep problems of the children. The lung volume measurements showed improvement; however, it was not statistically significant. Twin block may be used not only to correct the facial disharmony of children with a retrognathic mandible but also to improve the airway dimensions and lung volume as well as to reduce the sleep-disordered symptoms.

LPA1 antagonist BMS-986020 changes collagen dynamics and exerts antifibrotic effects in vitro and in patients with idiopathic pulmonary fibrosis

BackgroundIdiopathic pulmonary fibrosis (IPF) is a debilitating lung disease with limited treatment options. A phase 2 trial (NCT01766817) showed that twice-daily treatment with BMS-986020, a lysophosphatidic acid receptor 1 (LPA1) antagonist, significantly decreased the slope of forced vital capacity (FVC) decline over 26 weeks compared with placebo in patients with IPF. This analysis aimed to better understand the impact of LPA1 antagonism on extracellular matrix (ECM)-neoepitope biomarkers and lung function through a post hoc analysis of the phase 2 study, along with an in vitro fibrogenesis model.MethodsSerum levels of nine ECM-neoepitope biomarkers were measured in patients with IPF. The association of biomarkers with baseline and change from baseline FVC and quantitative lung fibrosis as measured with high-resolution computed tomography, and differences between treatment arms using linear mixed models, were assessed. The Scar-in-a-Jar in vitro fibrogenesis model was used to further elucidate the antifibrotic mechanism of BMS-986020.ResultsIn 140 patients with IPF, baseline ECM-neoepitope biomarker levels did not predict FVC progression but was significantly correlated with baseline FVC and lung fibrosis measurements. Most serum ECM-neoepitope biomarker levels were significantly reduced following BMS-986020 treatment compared with placebo, and several of the reductions correlated with FVC and/or lung fibrosis improvement. In the Scar-in-a-Jar in vitro model, BMS-986020 potently inhibited LPA1-induced fibrogenesis.ConclusionsBMS-986020 reduced serum ECM-neoepitope biomarkers, which were previously associated with IPF prognosis. In vitro, LPA promoted fibrogenesis, which was LPA1 dependent and inhibited by BMS-986020. Together these data elucidate a novel antifibrotic mechanism of action for pharmacological LPA1 blockade.Trial registration ClinicalTrials.gov identifier: NCT01766817; First posted: January 11, 2013; https://clinicaltrials.gov/ct2/show/NCT01766817.

Hyperbaric oxygen treatment for long coronavirus disease-19: a\xa0case report

BackgroundThe coronavirus disease 2019 pandemic has resulted in a growing population of individuals who experience a wide range of persistent symptoms referred to as “long COVID.” Symptoms include neurocognitive impairment and fatigue. Two potential mechanisms could be responsible for these long-term unremitting symptoms: hypercoagulability, which increases the risk of blood vessel occlusion, and an uncontrolled continuous inflammatory response. Currently, no known treatment is available for long COVID. One of the options to reverse hypoxia, reduce neuroinflammation, and induce neuroplasticity is hyperbaric oxygen therapy. In this article, we present the first case report of a previously healthy athletic individual who suffered from long COVID syndrome treated successfully with hyperbaric oxygen therapy.Case presentationA previously healthy 55-year-old Caucasian man presented 3 months after severe coronavirus disease 2019 infection with long COVID syndrome. His symptoms included a decline in memory, multitasking abilities, energy, breathing, and physical fitness. After evaluation that included brain perfusion magnetic resonance imaging, diffusion tensor imaging, computerized cognitive tests, and cardiopulmonary test, he was treated with hyperbaric oxygen therapy. Each session included exposure to 90 minutes of 100% oxygen at 2 atmosphere absolute pressure with 5-minute air breaks every 20 minutes for 60 sessions, 5 days per week. Evaluation after completing the treatment showed significant improvements in brain perfusion and microstructure by magnetic resonance imaging and significant improvement in memory with the most dominant effect being on nonverbal memory, executive functions, attention, information procession speed, cognitive flexibility, and multitasking. The improved cognitive functions correlated with the increased cerebral blood flow in brain regions as measured by perfusion magnetic resonance imaging. With regard to physical capacity, there was a 34% increase in the maximum rate of oxygen consumed during exercise and a 44% improvement in forced vital capacity. The improved physical measurements correlated with the regain of his pre-COVID physical capacity.ConclusionsWe report the first case of successfully treated long COVID symptoms with hyperbaric oxygen therapy with improvements in cognition and cardiopulmonary function. The beneficial effects of hyperbaric oxygen shed additional light on the pathophysiology of long COVID. As this is a single case report, further prospective randomized control studies are needed.

Effect of Positive Expiratory Pressure Therapy on Lung Volumes and Health Outcomes in Adults With Chest Trauma: A Systematic Review and Meta-Analysis.

The purposes of this study were to evaluate the effect of positive expiratory pressure (PEP) therapy on lung volumes and health outcomes in adults with chest trauma and to investigate any adverse effects and optimal dosages leading to the greatest positive impact on lung volumes and recovery. Data sources were MEDLINE/PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database, CINAHL, Open Access Thesis/Dissertations, EBSCO Open Dissertations, and OpenSIGLE/Open Grey. Randomized controlled trials investigating PEP therapy compared with usual care or other physical therapist interventions were included. Participants were >18years old and who were admitted to the hospital with any form of chest trauma, including lung or cardiac surgery, blunt chest trauma, and rib fractures. Methodological quality was assessed using the Physiotherapy Evidence Database Scale, and the level of evidence was downgraded using the Grading of Recommendations Assessment, Development and Evaluation approach. Eleven studies involving 661 participants met inclusion eligibility. There was very low-level evidence that PEP improved forced vital capacity (standardized mean difference = -0.50; 95% CI = -0.79 to -0.21), forced expiratory volume in 1second (standardized mean difference = -0.38; 95% CI = -0.62 to -0.13), and reduced the incidence of pneumonia (relative risk = 0.16; 95% CI = 0.03 to 0.85). Respiratory muscle strength also significantly improved in all 3 studies reporting this outcome. There was very low-level evidence that PEP did not improve other lung function measures, arterial blood gases, atelectasis, or hospital length of stay. Both PEP devices and dosages varied among the studies, and no adverse events were reported. PEP therapy is a safe intervention with very low-level evidence showing improvements in forced vital capacity, forced expiratory volume in 1second, respiratory muscle strength, and incidence of pneumonia. It does not improve arterial blood gases, atelectasis, or hospital length of stay. Because the evidence is very low level, more rigorous physiological and dose-response studies are required to understand the true impact of PEP on the lungs after chest trauma. There is currently no strong evidence for physical therapists to routinely use PEP devices following chest trauma. However, there is no evidence of adverse events; therefore, in specific clinical situations, PEP therapy may be considered.

The Feasibility and Efficiency of Remote Spirometry System on the Pulmonary Function for Multiple Ribs Fracture Patients.

Background: Multiple rib fractures is a common chest trauma with a significant and sustained impact on pulmonary function and quality of life. Continuous monitoring of the pulmonary function parameter was necessary to adjust the therapeutic goals in these patients. We developed an internet-based remote system for lung function monitoring with a remote spirometry and smart device application to follow up these patients consecutively. Method: From Jan 2021 to April 2021, we conducted a prospective study that applied an intelligent spirometry system for patients with multiple rib fractures. With informed consent, we collected clinical data from them and introduced the remote spirometry system. We followed up with these patients for 12 weeks after trauma and compared the recovery of pulmonary function parameters and clinical outcomes. Result: A total of 21 patients were enrolled in our study. We divided them into two groups by the compliance to this remote spirometry system. The improvement of forced vital capacity was better in the good compliance group than the poor compliance group (110% versus 21%, p value 0.049). Moreover, the complication rate was also lower in the good compliance group than the poor compliance group (10% versus 66.7% p value 0.017). Conclusions: Remote spirometry system is a novel system that can help in lung rehabilitation in patients with multiple rib fractures. Patients that cooperate well with this system presented superior lung function improvement and inferior complication rate.

Cord medialisation in unilateral vocal fold paralysis improves forced vital capacity.

The lateralised vocal fold of unilateral vocal fold paralysis (ULVFP) is unphysiological for expiration wherein vocal folds normally adduct to increase expiratory resistance and prevent small airway collapse. ULVFP may therefore impair ventilatory function and ventilatory volume. This study seeks to test whether vocal fold medialisation improves forced vital capacity (FVC). Prospective inception cohort intervention study. Academic Tertiary Care Institution. Twenty-five patients of ULVFP with a phonatory gap ranging from 2 to 6mm. Vocal fold medialisation was undertaken with autologous fat injection. Forced vital capacity (FVC) assessments by spirometry were undertaken pre-treatment and 1-month post-treatment. Improvement in FVC was noted in all patients with the quantum of improvement ranging from 0.1 to 0.6litres. Mean FVC improved from 3.10L pre-injection to 3.45L post-injection. (p<.001). A moderate correlation was noted between the degree of medialisation and improvement in FVC (r=.33, Pearson's correlation coefficient). Objective improvement in FVC is consistently noted in post vocal fold medialisation for ULVFP and is probably mediated by increased glottic expiratory resistance and consequent improvement in intrinsic PEEP.

Integrated therapy for post-COVID complications

People who contract COVID-19, including those with mild infections, suffer from post-COVID complications for months after they recover. These complications include chest pain, breathlessness, pulmonary fibrosis, vision problems, joint pain, loss of smell sensation, fatigue, body pain, headache, mood changes, and memory loss. The present case study is aimed at devising an integrated therapy protocol to assist in regaining overall health during post-COVID-19 recovery phase. A 56-year-old male was enrolled in post-COVID Yoga relaxation program for 13 days with complaints of fatty liver, lung fibrosis, and shortness of breath. During COVID-19, he was on ventilator support and recovered after 15 days of intensive care unit care. He was having generalized weakness and needed walking assistance upon admission. The patient was assessed for Heart Rate Variability (HRV) and pulmonary function at the baseline and after the completion of 13 days of Yoga and Ayurveda therapy. The patient showed significant improvement in forced vital capacity, slow vital capacity, and maximal voluntary ventilation after 13 days of integrated therapy. Further, a significant increase in time domain markers of HRV and a significant reduction in Low Frequency (LF) and ratio of LF to High Frequency (LF/HF) with the simultaneous increase in HF was observed. This implies an autonomic balance shift from the sympathetic to the parasympathetic system. Integrative therapy of Yoga and Ayurveda was found to be effective in mitigating the post-COVID-19 complications in this patient. The patient showed improvement in HRV and pulmonary function after integrative therapy for 13 days. Thus, Yoga and Ayurveda therapy proved to be promising and efficacious treatments in the present case study.

THE IMPACT OF HEMODYNAMIC PARAMETERS ON INHALED TREPROSTINIL TREATMENT RESPONSE: A SUBGROUP ANALYSIS FROM THE INCREASE TRIAL

THE IMPACT OF HEMODYNAMIC PARAMETERS ON INHALED TREPROSTINIL TREATMENT RESPONSE: A SUBGROUP ANALYSIS FROM THE INCREASE TRIAL

VARIABILITY IN CENTRAL AND LOCAL MEASUREMENT OF FVC IN IDIOPATHIC PULMONARY FIBROSIS: AN EXPLORATORY ANALYSIS FROM THE CAPACITY, ASCEND, AND RIFF (COHORT A) TRIALS

VARIABILITY IN CENTRAL AND LOCAL MEASUREMENT OF FVC IN IDIOPATHIC PULMONARY FIBROSIS: AN EXPLORATORY ANALYSIS FROM THE CAPACITY, ASCEND, AND RIFF (COHORT A) TRIALS

Impact of 27Gln\Glu Polymorphisms of β2-Adrenergic Receptor Gene on Pulmonary Function in Asthmatic Children Treated with Nebulized Salbutamol

Background: The β2-adrenergic receptor gene is a typical candidate for the study of genetic polymorphism. Many patients with asthma do not respond to β2-agonist; in addition, a wide interindividual variability in pharmacological response exists, likely because of the interaction between clinical, environmental, and genetic factors. Methods: A total of 80 children (55 boys and 25 girls) with mild-moderate acute asthma attacks, ages range between 5 and 18 years, attended the Asthma Clinic at Karbala Teaching Hospital for Children were included in this study. Spirometry (Spirolab III) was used for lung function assessment before and after treatment with nebulized salbutamol, and allele-specific polymerase chain reaction was performed to determine single nucleotide polymorphisms (SNP) of β2-adrenergic receptor gene at nucleic acid 79 (27 amino acid position). Results: The effect of treatment with nebulized salbutamol on lung function in asthmatic children having different genotypes of 27Gln\Glu SNP demonstrated that patients having GG and CG genotypes showed significant improvement (P &lt; 0.05) in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and FEV1% predicted after treatment, while patients having CC genotype showed significant improvement (P &lt; 0.05) in FEV1, FVC, and FEV1% predicted after treatment with nebulized salbutamol without significant improvement in FEV1/FVC ratio. Patients having CG genotype of 27Gln\Glu SNP showed highest change (increase) in FEV1 (185.38 ± 174.93 ml) and in FEV1% predicted (14.96 ± 15.45%) after treatment with nebulized salbutamol in comparison with other genotype groups although this change was not statistically significant between groups. Conclusion: Asthmatic children having CG and GG genotypes of β2-adrenergic receptor gene (27Gln\Glu) showed better improvement in lung function after treatment with nebulized salbutamol in comparison with those having CC (27Gln\Glu) genotype during mild-to-moderate acute asthma attacks.

Changes in Physical Fitness and Body Composition Associated with Physical Exercise in Patients with Myasthenia Gravis: A Longitudinal Prospective Study.

There is a lack of guidelines for physical exercise in patients with myasthenia gravis (MG). A few pilot studies have shown that exercise can be safely applied to patients with MG. However, how physical exercise affects body composition, disease function, and disease severity remains unknown. In this prospective study, we enrolled 34 patients with MG with stable condition and evaluated the disease severity, physical fitness parameters, and body composition (measured using whole-body dual-energy X-ray absorptiometry (DXA)), before and after conducting a 24-week physical exercise regimen of aerobic and resistance strength training. The outcomes were measured by DXA, quantitative MG (QMG) score, quality of life score, handgrip strength and walking speed. During the training regimen, participants were free to decide how many exercise sessions per week and regularly reported their weekly exercise time. The physical exercise program was well tolerated by the participants, the parameters of the QMG score and handgrip strength improved, and participants’ body composition did not change significantly. The high exercise group experienced greater deterioration in muscle mass in the arms, but exhibited a greater improvement in forced vital capacity, walking speed, and symptom severity. The group with low QMG scores improved more in terms of physical fitness, including walking speed. These findings indicate that physical exercise is well tolerated by patients with MG, and is accompanied by improved muscular and physical functions. We propose that physical exercise is safe, effective, and appropriate for patients with well-regulated MG.

Determinants and Follow-up of Lung Function Data from a Predominantly First Nations Cohort of Adults Referred to Specialist Respiratory Outreach Clinics in Regional and Remote Queensland.

Northern Territory (NT)-based clinical service data suggest substantial lung function impairment amongst First Nations adults as young as 18-40years. Our objectives were to describe the burden of disease and lung function of adults living in regional-remote Queensland, identify determinants of lung function, and evaluate the impact of a specialist respiratory outreach service on lung function. Retrospective 8-year cohort study (February 2012-March 2020) of 1113 First Nations Australian adults (and 648 non-First Nations adults) referred to respiratory outreach clinics in regional-remote Queensland. In the combined cohort, the forced expiratory volume in 1s (FEV1) was clinically abnormal for 54% of First Nations patients (51% of non-First Nations patients), forced vital capacity (FVC) for 46% (36%), FEV1/FVC% for 30% (36%), and gas diffusing capacity (DLCO) for 44% (37%). A respiratory diagnosis was assigned by a respiratory physician in 78% of First Nations (76% non-First Nations) patients. Smoking, household smoke exposure, underweight BMI, and respiratory disease were associated with reduced lung function. In the 40% of patients (709/1765) followed up, FEV1 and FVC significantly improved (mean change: zFEV1 = 0.15 [95% CI 0.10-0.20]; zFVC = 0.25 [0.20, 0.31]), and FEV1/FVC% significantly reduced (mean = - 0.10 [95%CI - 0.07 to - 0.03]), with no significant change in DLCO. Patients with COPD had lower FEV1 improvement, whilst underweight and obese patients had lower FVC improvement. Regional-remote First Nations adult Queenslanders have higher lung function than previously reported, with no lung function decline observed at follow-up visit, including for those with respiratory disease.