Increase In FEV1 Research Articles

Real-world biologics response and super-response in the International Severe Asthma Registry cohort.

Biologic asthma therapies reduce exacerbations and long-term oral corticosteroids (LTOCS) use in randomized controlled trials (RCTs); however, there are limited data on outcomes among patients ineligible for RCTs. Hence, we investigated responsiveness to biologics in a real-world population of adults with severe asthma. Adults in the International Severe Asthma Registry (ISAR) with ≥24 weeks of follow-up were grouped into those who did, or did not, initiate biologics (anti-IgE, anti-IL5/IL5R, anti-IL4/13). Treatment responses were examined across four domains: forced expiratory volume in 1 second (FEV1) increase by ≥100 mL, improved asthma control, annualized exacerbation rate (AER) reduction ≥50%, and any LTOCS dose reduction. Super-response criteria were: FEV1 increase by ≥500 mL, new well-controlled asthma, no exacerbations, and LTOCS cessation or tapering to ≤5 mg/day. 5.3% of ISAR patients met basic RCT inclusion criteria; 2116/8451 started biologics. Biologic initiators had worse baseline impairment than non-initiators, despite having similar biomarker levels. Half or more of initiators had treatment responses: 59% AER reduction, 54% FEV1 increase, 49% improved control, 49% reduced LTOCS, of which 32%, 19%, 30%, and 39%, respectively, were super-responses. Responses/super-responses were more frequent in biologic initiators than in non-initiators; nevertheless, ~40-50% of initiators did not meet response criteria. Most patients with severe asthma are ineligible for RCTs of biologic therapies. Biologics are initiated in patients who have worse baseline impairments than non-initiators despite similar biomarker levels. Although biologic initiators exhibited clinical responses and super-responses in all outcome domains, 40-50% did not meet the response criteria.

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.

LAMA improves tissue oxygenation more than LABA in patients with COPD.

The effect of bronchodilators is mainly assessed with forced expiratory volume in 1 s (FEV1) in chronic obstructive pulmonary disease (COPD). Their impact on oxygenation and lung periphery is less known. Our objective was to compare the action of long-acting β2-agonists (LABA-olodaterol) and muscarinic antagonists (LAMA-tiotropium) on tissue oxygenation in COPD, considering their impact on proximal and peripheral ventilation as well as lung perfusion. FEV1, Helium slope (SHe) from a single-breath washout test (SHe decreases reflecting a peripheral ventilation improvement), frequency dependence of resistance (R5-R19), area under reactance (AX), lung capillary blood volume (Vc) from double diffusion (DLNO/DLCO), and transcutaneous oxygenation (TcO2) were measured before and 2 h post-LABA (day 1) and LAMA (day 3) in 30 patients with COPD (FEV1 54 ± 18% pred; GOLD A 31%/B 48%/E 21%) after 5-7 days of washout, respectively. We found that TcO2 increased more (P = 0.03) after LAMA (11 ± 12% from baseline, P < 001) compared with LABA (4 ± 11%, P = 0.06) despite a lower FEV1 increase (P = 0.03) and similar SHe (P = 0.98), AX (P = 0.63), and R5-R19 decreases (P = 0.37). TcO2 and SHe changes were negatively correlated (r = -0.47, P = 0.01) after LABA, not after LAMA (r = 0.10, P = 0.65). DLNO/DLCO decreased and Vc increased after LAMA (P = 0.04; P = 0.01, respectively) but not after LABA (P = 0.53; P = 0.24). In conclusion, LAMA significantly improved tissue oxygenation in patients with COPD, while only a trend was observed with LABA. The mechanisms involved may differ between both drugs: LABA increased peripheral ventilation, whereas LAMA increased lung capillary blood volume. Should oxygenation differences persist over time, LAMA could arguably become the first therapeutic choice in COPD.NEW & NOTEWORTHY Long-acting muscarinic antagonists (LAMAs) significantly improved tissue oxygenation in patients with COPD, while only a trend was observed with β2-agonists (LABAs). The mechanisms involved may differ between drugs: increased peripheral ventilation for LABA and likely lung capillary blood volume for LAMA. This could argue for LAMA as the first therapeutic choice in COPD.

Association between pre-biologic T2-biomarker combinations and response to biologics in patients with severe asthma.

To date, studies investigating the association between pre-biologic biomarker levels and post-biologic outcomes have been limited to single biomarkers and assessment of biologic efficacy from structured clinical trials. To elucidate the associations of pre-biologic individual biomarker levels or their combinations with pre-to-post biologic changes in asthma outcomes in real-life. This was a registry-based, cohort study using data from 23 countries, which shared data with the International Severe Asthma Registry (May 2017-February 2023). The investigated biomarkers (highest pre-biologic levels) were immunoglobulin E (IgE), blood eosinophil count (BEC) and fractional exhaled nitric oxide (FeNO). Pre- to approximately 12-month post-biologic change for each of three asthma outcome domains (i.e. exacerbation rate, symptom control and lung function), and the association of this change with pre-biologic biomarkers was investigated for individual and combined biomarkers. Overall, 3751 patients initiated biologics and were included in the analysis. No association was found between pre-biologic BEC and pre-to-post biologic change in exacerbation rate for any biologic class. However, higher pre-biologic BEC and FeNO were both associated with greater post-biologic improvement in FEV1 for both anti-IgE and anti-IL5/5R, with a trend for anti-IL4Rα. Mean FEV1 improved by 27-178 mL post-anti-IgE as pre-biologic BEC increased (250 to 1000 cells/µL), and by 43-216 mL and 129-250 mL post-anti-IL5/5R and -anti-IL4Rα, respectively along the same BEC gradient. Corresponding improvements along a FeNO gradient (25-100 ppb) were 41-274 mL, 69-207 mL and 148-224 mL for anti-IgE, anti-IL5/5R, and anti-IL4Rα, respectively. Higher baseline BEC was also associated with lower probability of uncontrolled asthma (OR 0.392; p=0.001) post-biologic for anti-IL5/5R. Pre-biologic IgE was a poor predictor of subsequent pre-to-post-biologic change for all outcomes assessed for all biologics. The combination of BEC + FeNO marginally improved the prediction of post-biologic FEV1 increase (adjusted R2: 0.751), compared to BEC (adjusted R2: 0.747) or FeNO alone (adjusted R2: 0.743) (p=0.005 and <0.001, respectively); however, this prediction was not improved by the addition of IgE. The ability of higher baseline BEC, FeNO and their combination to predict biologic-associated lung function improvement may encourage earlier intervention in patients with impaired lung function or at risk of accelerated lung function decline.

The Effect of Priming new Plastic Spacers with 20 Puffs Salbutamol on Bronchodilator Response in Asthmatic Children.

The static charge on the plastic body of spacers attracts drug aerosols, reducing the drug available for inhalation from plastic spacers. Some instructions exist to decrease the electric charge on plastic spacers, such as priming them with salbutamol (20 puffs) before use. This study investigates whether priming plastic spacer devices with this method can improve the bronchodilator test result. This study included children with stable mild to moderate asthma. All subjects underwent two pulmonary function tests to evaluate their bronchodilator response on separate days at 24-48 hours intervals. On each day, spirometry was performed at the baseline and 15 min after inhalation of four puffs of salbutamol (100 μg/puff) through either a primed or a new spacer. The change in forced expiratory volumein the first second (FEV1) after inhaling salbutamol was the primary outcome measure. When the patients used a new spacer, the mean baseline FEV1 (% predicted) and FEV1/FVC (forced vital capacity) were 89.56±11.95 and 86.17±6.87, respectively. However, the mean increase in FEV1 from the baseline was 10.87±8.99 in this group. On the other hand, with the primed spacer, the respective mean baseline FEV1 and FEV1/FVC values were 89.41±12.14 and 85.49±6.76, while it increased by 12.1±11.01 after salbutamol inhalation. There were no significant differences between the techniques regarding the variation in FEV1 before and after bronchodilator use via a new spacer or primed spacer. Priming new plastic spacers with 20 puffs of salbutamol did not cause additional bronchodilation in asthmatic children, suggesting this practice is inefficient in clinics.

Impulse oscillometry bronchodilator response in preschool children.

In preschoolers, performing an acceptable spirometry and measuring bronchodilator response (BDR) is challenging; in this context, impulse oscillometry (IOS) represents a valid alternative. However, more studies on the standardization of BDR for IOS in young children are required. The objective of the study was to identify optimal thresholds to define a positive BDR test with IOS in preschoolers with suspected asthma. Children aged 3-6 years with suspected asthma and their lung function investigated with both IOS and spirometry pre- and post-BDR were retrospectively analyzed. The spirometric BDR was defined as positive when the change of FEV1 was ≥12% or ≥200 mL. The oscillometric BDR was defined as positive in case of change of at least -40% in R5, +50% in X5, and -80% in AX. Among 72 patients, 36 (age 5.2 ± 1 years; 64% boys) were selected for the subsequent analysis according to ATS/ERS quality criteria of measurements; specifically, 19 patients did not meet IOS and 36 did not meet spirometry criteria. The spirometric BDR was found positive in seven subjects (19.4%); conversely, a positive oscillometric BDR was identified in four patients (11.1%). No patient presented a positive BDR response with both methods. In IOS, the mean decrease in R5 and AX was 19.9% ± 10% and 44% ± 22.1%, and the mean increase in X5 was 23.3% ± 17.8%, respectively. A decrease in R5 of 25.7% (AUC 0.77, p = .03) and an increase in X5 of 25.7% (AUC 0.75, p = .04) showed the best combination of sensitivity and specificity to detect an increase of FEV1 ≥ 12% and/or ≥200 mL. The IOS represents a valid alternative to spirometry to measure BDR in preschool children and should be the gold standard in this age group. We are considering a decrease of 26% in R5 and an increase of 26% in X5 as diagnostic threshold for BDR.

Individual approach in the treatment of occupational chronic obstructive pulmonary disease

Introduction. Occupational COPD (PCODD) is characterized by partially irreversible airflow limitation, the phenomenon of "air traps" and the formation of emphysema, has a steadily progressive character. In the work of a practitioner, an individual approach to the patient with targeted pharmacotherapy using new combinations in the treatment of occupational COPD is important, taking into account the evaluation of the effectiveness of previous therapy.&#x0D; The study aims to evaluate the effectiveness of therapy with combined bronchodilators in PCOPD with an analysis of the dynamics of functional parameters, exercise tolerance, using additional criteria for differential diagnosis.&#x0D; Material and methods. The effectiveness of bronchodilator therapy was analyzed in 45 men, diagnosed with occupational COPD (PCODD). Additional differential diagnostics included the following informative indicators: instantaneous volumetric velocity after exhalation 75 FVC (MOS75); cough intensity according to the CAT questionnaire (1 point); ratio of forced vital capacity to forced expiratory volume in 1 minute (FVC/FEV1); 6MWT data, % predicted; 6MWT, m; overall score on the mMRС questionnaire; the severity of shortness of breath according to the CAT questionnaire (point 4); instantaneous volumetric velocity after exhalation 25 FVC (MOS25). The discriminant equation is represented by the formula: F=–9,76+0,75×a1–2,00×a2–0,19×a3+0,27×a4–0,11×a5+1,22×a6+3,62×a7+2,22×a8.&#x0D; Results. Two clinical trials were retrospectively analyzed using combined bronchodilator therapy with long-acting muscarinic receptor antagonists (LAA) and β2-agonists (LAA) in patients with PCOD. A group of patients was identified where a statistically significant improvement in clinical and functional parameters was not achieved against the background of the therapy. When to the group of occupational bronchial asthma (OBA). When conducting an individual analysis of indicators, it was found that for patients with PCOD during bronchodilator therapy, an improvement in spirometric parameters is characteristic, in particular, an increase in FEV1 and FVC; Significant reduction in symptoms of shortness of breath, cough, sputum. Whereas, the PBA group was characterized only by an improvement in the distance traveled in 6MWT.&#x0D; Conclusion. Our earlier clinical studies on the effectiveness of treatment of patients with PCOD with combined bronchodilator therapy showed the effectiveness of this therapy in 70–75% of the patients examined. An individual analysis of the clinical and functional parameters of the examined patients made it possible to identify the features of the course of occupational bronchopulmonary pathology, with the identification of individuals who need the use of a triple combination of LABA, LAAA with the addition of topical glucocorticosteroids. In this regard, all patients, as part of diagnostic measures, in addition to the standard examination, it is necessary to include 6MWT, BPG, questionnaires using mMRС and CAT questionnaires. Calculation of discriminant equations using data from spirometry, questionnaires, 6MWT and BPG will allow at the first stage of differential diagnosis to identify a group of patients for whom "triple" therapy is the means of choice.&#x0D; Ethics. The study was carried out in accordance with the ethical principles of the Declaration of Helsinki. The Clinical Study Protocol was reviewed at a meeting of the local Ethics Committee East-Siberian Institute of Medical and Ecological Research.

Cystic fibrosis in Europe: improved lung function and longevity - reasons for cautious optimism, but challenges remain.

Prognosis and disease severity in cystic fibrosis (CF) are linked to declining lung function. To characterise lung function by the number of adults in countries with different levels of Gross National Income (GNI), data from the European Cystic Fibrosis Society Patient Registry were utilised. Annual data including age, forced expiratory volume in 1 s (FEV1), anthropometry, genotype, respiratory cultures and CF-related diabetes (CFRD) were retrieved between 2011 and 2021. All countries were stratified into GNI per capita to reflect differences within Europe. A consistent improvement in FEV1 % pred and survival was observed among the 47 621 people with CF (pwCF), including subjects with chronic Pseudomonas aeruginosa infection, CFRD and/or undernutrition. Mean values of FEV1 % pred changed from 85% to 94.2% for children and from 63.6% to 74.7% for adults. FEV1 % pred further increased among those carrying the F508del mutation in 2021, when elexacaftor/tezacaftor/ivacaftor was available. The number of adult pwCF increased from 13 312 in 2011 to 21 168 in 2021, showing a 60% increase. PwCF living in European lower income countries did not demonstrate a significant annual increase in FEV1 % pred or in the number of adults. This pan-European analysis demonstrates a consistent improvement in FEV1 % pred, number of adult pwCF and survival over the last decade only in European higher and middle income countries. Urgent action is needed in the lower income countries where such improvement was not observed. The notable improvement observed in pwCF carrying the F508del mutation emphasises the need to develop treatments for all CF mutations.

Feasibility of a home-designed respiratory rehabilitation program for chronic obstructive pulmonary disease.

According to international guidelines, respiratory rehabilitation (RR) for patients with chronic obstructive pulmonary disease (COPD) is a cornerstone of standard non-pharmacological treatment. To evaluate feasibility of a home-designed RR program and analyze its medium-term impact on respiratory parameters and quality of life. This was a prospective study involving 74 COPD patients enrolled in January 2019 and put on inhaled bronchodilator treatment associated with RR at home following a written protocol, for 16 weeks. The comparative statistical analysis highlights the difference before and after RR in terms of clinical and functional respiratory parameters as well as in terms of quality of life (assessed on the short form 36 (SF-36) questionnaire). The comparison involves RR-adherent patients versus non-adherent patients. Mean age was 66.7±8.3 years with a median of 67 years. All patients were smokers, out of which 42 patients (57%) did not quit yet. Forty-one percent of patients were frequent exacerbators. The average COPD assessment test (CAT) score in our patients was 23. The average 6-minutes walk distance (MWD) was 304m. The BODE index in our patients was 4.11 on average. The RR program was followed by 36 patients (48%). Thirty patients (40%) applied it at least twice a week. RR-adherent patients had an average CAT score decreasing from 23 to 14.5 (P = 0.011). Their average 6-MWD was 444.6 m by the end of the study, which would be 64.2% of the calculated theoretical value. The average FEV1 increase after RR was 283mL. The majority (69%) of RR-adherent patients were ranked as quartile 1; BODE index ≤2. The average scores of physical, psycho-social, and general dimensions assessed on the SF-36 questionnaire improved in RR-adherent patients. RR is a key non-pharmacological treatment for COPD. Its interest originates from its multidisciplinary nature, hence its effectiveness in several respiratory parameters. Our study reflects the feasibility of home-designed protocols in the absence of contraindications. We highlight also the positive impact on quality of life after RR at home.

Effects of Qingjin Huatan decoction on pulmonary function and inflammatory mediators in acute exacerbations of chronic obstructive pulmonary disease: a systematic review and meta-analysis.

The inflammatory response is the main pathophysiological basis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and is a key factor leading to frequent exacerbations and disease progression. Suppressing the inflammatory response can improve pulmonary function, prognosis, and quality of life in AECOPD patients. To evaluate the effect of Qingjin Huatan decoction (QHD) on pulmonary function and inflammatory mediators in AECOPD patients. Randomized controlled trials (RCTs) on the treatment of AECOPD with QHD were retrieved from eight Chinese and English electronic databases up to 31 May 2024. The quality of the studies was assessed using the Cochrane Risk of Bias Tool and the modified Jadad scale. Statistical analysis, sensitivity analysis, and publication bias assessment were performed using Stata 17.0 software. A total of 40 RCTs involving 3,475 AECOPD patients were included. Compared to conventional treatment, QHD significantly improved pulmonary function, with increases in FEV1 (MD = 0.30, 95% CI: 0.26 to 0.34, p = 0.000), FVC (MD = 0.34, 95% CI: 0.27 to 0.41, p = 0.000), FEV1/FVC (MD = 6.07, 95% CI: 5.55 to 6.58, p = 0.000), and PaO2 (MD = 7.20, 95% CI: 4.94 to 9.47, p = 0.000), and a decrease in PaCO2 (MD = -5.37, 95% CI: 7.99 to -2.74, p = 0.000). QHD also significantly suppressed the expression of inflammatory mediators, including TNF-α (MD = -10.87, 95% CI: 12.51 to -9.23, p = 0.000), IL-1β (MD = -13.63, 95% CI: -16.31 to -10.95, p = 0.000), IL-6 (MD = -7.58, 95% CI: -10.10 to -5.06, p = 0.000), IL-8 (MD = -9.45, 95% CI: -12.05 to -6.85, p = 0.000), CRP (MD = -5.62, 95% CI: -6.60 to -4.65, p = 0.000), and PCT (MD = -0.84, 95% CI: -1.07 to -0.62, p = 0.000). Additionally, QHD improved clinical efficacy (RR = 4.16, 95% CI: 3.26 to 5.30, p = 0.000) without increasing the incidence of adverse reactions (RR = 1.04, 95% CI: 0.68 to 1.61, p = 0.000). Existing evidence suggests that QHD can significantly improve pulmonary function, suppress the expression of inflammatory mediators, and enhance clinical efficacy in AECOPD patients, with a good safety profile. Given the limitations of this study, more high-quality studies are needed to provide reliable evidence. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=559436, identifier CRD42024559436.

Treatment Responses in Histologic Versus Molecular Diagnoses of Lung Rejection.

Histologic evaluation of allograft biopsies after lung transplantation has several limitations, suggesting that molecular assessment using tissue transcriptomics could improve biopsy interpretation. This single-center, retrospective cohort study evaluated discrepancies between the histology of transbronchial biopsies (TBBs) with no rejection (NR) and T-cell mediated rejection (TCMR) by molecular diagnosis. The accuracy of diagnosis was assessed based on response to treatment. 54 TBBs from Prague Lung Transplant Program obtained between December 2015 and January 2020 were included. Patients with acute cellular rejection (ACR) grade ≥ 1 by histology received anti-rejection treatment. Response to therapy was defined as an increase in FEV1 of ≥ 10% 4weeks post-biopsy compared to the pre-biopsy value. Among the 54 analyzed TBBs, 25 (46%) were concordant with histology, while 29 (54%) showed discrepancies. ACR grade 0 was found in 12 TBBs (22%) and grade A1 ≥ 1 in 42 TBBs (78%). Treatment response was present in 14% in the NR group and in 50% in the TCMR group (p = 0.024). Our findings suggest that low-grade acute cellular rejection is less likely to be associated with molecular TCMR, which might better identify lung transplant recipients who benefit from therapy.

Study on the effects of short-term yoga practice on body composition, physical fitness, physiological variables, nutritional and mental health status of school children

Background and Aim: Physical inactivity may cause poor physical fitness, obesity, cardio-respiratory and mental illness. The present study was designed to find out the effects of short term yoga practice on body composition, physical fitness, physiological variables, nutrition and mental status of school children of 10 to 12 years. Materials and Methods: For the present study 120 volunteers (60 healthy female and 60 healthy male) within the age group of 10–12 years were screened randomly and were divided into: (a) Yoga Group (n = 60) and (b) Control Group (n = 60). Both these groups were sub-divided into (i) Male (n = 30) and (ii) Female (n = 30) volunteers. The volunteers of yoga group followed a yoga practice schedule of 1hr/day, 6 days/week for 6 weeks, with no yoga practice in control group. Body composition, physical fitness, physiological variables, nutrition and mental status were measured before (0 week) and after (6 weeks) training. Results: A significant increase (p ≤ 0.05) in strength, flexibility, anaerobic power, VO2max, FVC, FEV1, PEFR; and decrease (p ≤ 0.05) in resting heart rate, blood pressure, depression, anxiety and stress scores were observed in both male and female volunteers after six weeks of yoga practice. Conclusion: Regular practice of yogic asana, pranayama, and meditation improves body composition, cardiovascular, respiratory, physical fitness, and reduces stress level.

Is there a synergistic relationship between diaphragm and pelvic floor muscles in pregnant women?

ObjectiveThe aim of this study is to examine whether there is a synergistic relationship between the diaphragm and pelvic floor muscles (PFM) in pregnant women. Material and MethodsOur study was carried out as a cross-sectional study in primigravid pregnants in the second and third trimesters. Superficial electromyography (EMG), 2D/3D ultrasonography (USG), pulmonary function test (PFT), PERFECT, maximum expiratory pressure (MEP) and inspiratory pressure (MIP) measurements were used to evaluate pelvic floor and diaphragm muscle functions during pregnancy. Mann-Whitney U test was used to show the change in the second and third trimesters, and Spearman correlation was used to determine the relationship. ResultsNo correlation was found between the EMG data of the PFM and diaphragm, or between the USG data of the PFM and diaphragm in all participants, in the second and third trimesters. In the third trimester of the study, diaphragmatic thickness and levator hiatal area (LHA) decreased and both diaphragm and PFM % MVC EMG parameters increased. In the third trimester, FVC, MIP, MEP decreased, and nonsignificant increase in FEV1, FEV1/FVC and peak ekspiratuar flow(PEF) were detected. A significant correlation was found between pelvic floor levator hiatal area USG and FEV1/FVC in both trimesters (r: 0,577p: 0,004). ConclusionThere may be a synergistic relationship between the diaphragm and PFM in pregnant women, the relationship may weaken as pregnancy progresses, and there may be no coactivation relationship between the two muscles. In order to prevent the occurrence of pelvic floor dysfunction during pregnancy and to increase the effect of rehabilitation programs, the relationship between the diaphragm and the PFM should be determined and more studies should be conducted.

Bronchodilator reversibility in the GAN severe asthma cohort.

Positive bronchodilator reversibility (BDR) is a diagnostic criterion for asthma. However, patients with asthma may exhibit negative BDR test.To describe frequency of positive and negative BDR in patients with severe asthma and associations with phenotypic characteristics. Positive BDR was defined as FEV1 increase > 200 ml AND > 12% upon testing with a short-acting beta-agonist (SABA). Out of 2013 patients included in the German Asthma Net (GAN) severe asthma registry, 793 had data on BDR. Hereof, 250 (31.5%) had a positive and 543 (68.5%) had a negative BDR test. Comorbidities significantly associated with negative BDR were gastro-esophageal reflux (GERD) (28.0% vs 40.0%, p<0.01) and EGPA (0.4% vs 3.0%; p<0.05), while smoking history (active: 2.8% vs 2.2%; ex: 40.0% vs 41.7%) and COPD comorbidity (5.2% vs 7.2%) were similar in both groups. Patients with positive BDR had worse asthma control (median ACQ-5 3.4 vs 3.0, p<0.05), reported dyspnea at rest (26.8% vs 16.4%, p<0.001) and chest tightness (36.4% vs 26.2%, p<0.001) more frequently, had more severe airway obstruction at baseline (FEV1% pred: 56 vs 64, p<0.001) and higher FeNO levels (41 vs 33 ppb, p<0.05), while diffusion capacity did not differ (DLCO-SB % pred. 70% vs 71%). Multivariate linear regression analysis identified association of lower baseline FEV1% (p<0.001) and chest tightness (p<0.05) with positive, and GERD (p<0.05) with negative BDR. In this real-life setting the majority of patients with severe asthma exhibited negative BDR. Interestingly, this was not associated with smoking history or COPD, but with lower FeNO and presence of GERD.

Effectiveness of rosuvastatin and pulmonary rehabilitation in patients with concurrent course of asthma, chronic obstructive pulmonary disease and diabetes mellitus type 2

The aim of this study was to assess the effectiveness of rosuvastatin and pulmonary rehabilitation in patients with asthma-COPD overlap (ACO) concurrent with type 2 diabetes (T2D).Material and methods. A total of 26 patients with ACO and T2D were examined, with an average age of 61 [55.6; 67.8]. In addition to standard therapy, patients in the main group were prescribed rosuvastatin and a pulmonary rehabilitation program. Treatment efficacy was assessed using questionnaires (CAT, ACQ, SGRQ), dyspnea severity scale (mMRC), BODE index, pulmonary function, bioimpedance analysis, 6-minute walk test, carbohydrate and lipid metabolism status, levels of 8-isoprostane, sCD14, CRP, stable nitric oxide (NO) metabolites - nitrite and nitrate ions, and endothelin-1 in the blood. Results. In the main group, a significant improvement was observed during the treatment course, including a 40% reduction in the BODE index (p&lt;0.05), a 33.4% decrease in dyspnea on the mMRC scale (p&lt;0.05), a 28.5% reduction in CAT, a 40.8% decrease in ACQ, and a 20.6% decrease in SGRQ. Other notable improvements included a 1.3% decrease in BMI, a 13% reduction in body fat percentage, a 23.5% decrease in visceral fat level, a 16% increase in patients' tolerance to physical activity, a 27.5% increase in FEV1 (p&lt;0.05), an 8.1% decrease in fasting blood glucose (p&lt;0.01), a 20% reduction in triglycerides (p&lt;0.05), a 24.9% decrease in LDL cholesterol, and a 27.2% decrease in total cholesterol (p&lt;0.05). Additionally, there was a 23.8% decrease in CRP levels (p&lt;0.05), a two-fold reduction in blood 8-isoprostane levels (p&lt;0.05), a 58% reduction in serum sCD14 levels, a 59.8% increase in stable nitric oxide metabolites (p&lt;0.05), and a 55% decrease in endothelin-1 levels (p&lt;0.05).Conclusions. The use of rosuvastatin and pulmonary rehabilitation significantly improves the quality of life for patients with the concurrent presentation of COPD, asthma, and T2D. It reduces the severity of dyspnea, enhances tolerance to physical activity, improves pulmonary function, lowers visceral fat levels and body fat percentage, enhances lipid profile, and improves endothelial function, all while concurrently reducing oxidative stress and systemic inflammation without worsening carbohydrate metabolism.

Effects of Yogic Breathing Techniques on Respiratory Function and Breathing Patterns at High Altitude

Background: Practices involving resistive breathing have been shown to enhance endurance and performance in competitive athletes. However, there is still little research on how pranayama or yogic breathing techniques (YBP) might help professional athletes improve their respiratory endurance and performance. Aim: The objective of the current research was to assess how yoga breathing practices affected competitive athletes’ respiratory function. Methodology: A total of 60 (30 male and 30 female) athletes were included and were divided into two groups; control and experimental. 30 individuals were randomly assigned in both the groups. The experimental group received daily instruction in yogic breathing techniques for one hour for six months. The control group received the same daily schedule (normal exercise). Various anthropometric measurements and spirometry measurements such as FVC, FEV1, PEFR, and the FEV1/FVC ratio both before and after yoga intervention in both the groups were measured. Result: The result showed significant increase in FVC level in control (3.51L) and experimental group (3.64L) P&lt;0.05). A significant increase in FEV1 (3.43L) and PEF (534.18L/s) levels were also observed post-test of experimental groups (P&lt;0.05), whereas the increase was non-significant in control group (P&gt;0.05). Non-significant results were also observed in FEV1/FVC ratio in both control and experimental group (P&lt;0.05). Conclusions: At high altitudes, yoga practices may beneficial for athletes in bringing about favorable psychological changes among low landers athletes.

Comparison of the effectiveness of dornase alfa in chronic rhinosinusitis with nasal polyposis using different types of drug delivery

Introduction. When using the drug dornase alfa in children with cystic fibrosis (CF) in the form of inhalations through a compressor inhaler with a pulsating aerosol supply, a high concentration of aerosol is achieved in the nasal cavity and paranasal sinuses, which reduces the severity of rhinological pathology, namely chronic rhinosinusitis, including those with nasal polyposis. There is also a positive effect on the function of external respiration, due to a decrease in the negative impact of rhinological pathology on the respiratory tract, primarily due to descending infection.Aim. To evaluate the effect of intranasal dornase alfa therapy as part of a complex treatment on lung function and indicators of physical development in children with CF.Materials and methods. The study compared the effectiveness of the drug dornase alfa for chronic rhinosinusitis with nasal polyposis using different types of drug delivery in children who did not receive targeted therapy for CF. A group of children who received two inhalations of dornase alfa (n = 43), information about patients in this group was taken from the 2020 register, and a group of children who received inhalation of dornase alfa only in the lower respiratory tract were compared (n = 28), information about patients in this group was taken from the 2016 register.Results. The effect of additional intranasal inhalation of the drug dornase alfa was observed in the form of an increase in FEV and FVC. In addition, there was an improvement in body weight and height in the group of patients receiving intranasal inhalations, but the identified difference did not reach significant values.Conclusion. The results obtained in the form of an increase in FEV1 and FVC allow us to draw a conclusion about the effectiveness of prescribing additional intranasal inhalation of the drug dornase alfa.

Respiratory function rehabilitation in individuals with Covid-19: swimming exercise

Background and Study Aim. Understanding the impact of swimming exercises on post-Covid-19 respiratory function is crucial for optimizing recovery strategies in affected individuals. The aim of this study is to determine the effect of 8-week swimming exercises on respiratory function parameters in adult individuals who have had Covid-19 disease. Material and Methods. Sixteen male students, aged 19-21, voluntarily participated in the study. Eight participants were assigned to the experimental group (EG), and eight to the control group (CG), all of whom were students of the Faculty of Sports Sciences at the University. The EG underwent an 8-week swimming exercise program conducted at the Bingöl Youth and Sports swimming pool (25 meters), three days a week. The CG was not involved in any exercise regimen. Pulmonary function tests (FVC, FEV1, FEV1/FVC, PEF) were conducted using a Cosmed Pony FXdel 2016 spirometer, one day before and one day after the exercise program for both EG and CG. Data analysis was performed using Independent Samples and Paired Samples T tests in SPSS 25, with a significance level set at p &lt; 0.05. Results. A statistically significant increase in respiratory FVC, FEV1, FEV1/FVC, and PEF function values was observed in the experimental group (EG) after the exercise intervention (p &lt; 0.05). This increase was observed when comparing these values to their pre-exercise measurements. In contrast, there was no statistically significant difference in respiratory function results before and after exercise in the control group (CG) (p &gt; 0.05). Conclusions. The findings of this study highlight the therapeutic potential of an 8-week swimming exercise program in significantly enhancing respiratory function among adult individuals who have previously contracted Covid-19. These results offer valuable insights for the development of post-Covid-19 rehabilitation protocols, emphasizing the importance of regular exercise, such as swimming, in the recovery process.

Achieving clinical outcomes with benralizumab in severe eosinophilic asthma patients in a real-world setting: ORBE II study

BackgroundThe ORBE II study aimed to describe the characteristics and clinical outcomes of adult patients with severe eosinophilic asthma (SEA) treated with benralizumab in a real-world setting in Spain.MethodsORBE II (NCT04648839) was an observational, retrospective cohort study in adult SEA patients who had been prescribed benralizumab. Demographic and clinical data of 204 SEA patients were collected 12 months prior to benralizumab initiation (baseline) and at follow-up. Exacerbation rate, asthma symptoms, maintenance oral corticosteroid (OCS) use and lung function were evaluated, among other variables.ResultsA total of 204 SEA patients were evaluated. Mean (standard deviation, SD) age of the study population was 56.4 (12.4) years, 62.3% were women and mean (SD) duration of asthma was 15.1 (12.7) years. Median (Q1–Q3) follow-up duration was 19.5 (14.2–24.2) months. At baseline, 72.6% of the overall population (OP) presented blood eosinophil counts ≥ 300 cells/µL; 36.8% had comorbid chronic rhinosinusitis with nasal polyps (CRSwNP); 84.8% reported at least one severe exacerbation, and 29.1% were OCS-dependent. At 1 year of follow-up, patients receiving benralizumab treatment had a 85.6% mean reduction in exacerbations from baseline, and 81.4% of patients achieved zero exacerbations. We also found a clinically relevant mean (SD) increase in pre-bronchodilator (BD) FEV1 of 331 (413) mL, with 66.7% of patients achieving a pre-BD FEV1 increase ≥ 100 mL, and 46.3% of patients achieving a pre-BD FEV1 ≥ 80% of predicted. Regarding symptom control, 73.8% of the OP obtained an ACT score ≥ 20 points. After 1 year of follow-up, mean reduction in the daily OCS dose was 70.5%, and complete OCS withdrawal was achieved by 52.8% of the OCS-dependent patients. Almost half (43.7%) of the OP on benralizumab met all four criteria for clinical remission. Patients with concomitant CRSwNP obtained similar or enhanced outcomes.ConclusionsThese data support the real-world benefits of benralizumab in SEA patients, and particularly in those with concomitant CRSwNP.Trial registrationNCT04648839.

Impact of short term training on morphological, physical fitness and physiological variables of middle distance runners

Purpose: The present study was designed to investigate the effects of short term training on morphological, physical fitness and physiological determinants of middle distance runners. Method: Total of 97 male volunteers (age: 18-20 yrs.) (40- sedentary control, and 57- middle distance runners) were included randomly, and 17 middle distance runners were excluded. The rest were divided into (a) Sedentary Control Group (SCG, n = 40) and (b) Middle Distance Runners Group (MDR, n = 40). The volunteers of MDR followed a training schedule of 2 hrs/d, 5days/wk., for 6 wks.; no training was given in SCG. Results: A significant (p &lt; .05) increase in strength (of grip, back, leg, upper body strength, abdominal), anaerobic power, flexibility, VO2max, FEV1, FVC, PEFR; and decrease (p &lt; .05) in body mass, body fat and sprint time, heart rate (during rest, sub-maximal exercise and recovery) among the volunteers of MDR after 6 weeks of training. This study showed positive correlation between standing broad jump and height (r = +0.51, p &lt; .05); and between speed and leg strength (r = +0.52, p &lt; .05). Conclusion: Training have a positive impact on morphological, physical fitness and physiological variables of middle distance runners. Further research would provide conclusive results that can be extrapolated to general population.