FEV1 Levels Research Articles

Effect of heart failure and atrial fibrillation on cardiorespiratory fitness in hemodialysis patients.

Heart failure (HF) and atrial fibrillation (AF) are highly prevalent in hemodialysis. They are well-known significant modifiers of the disease associations with cardiovascular outcomes, but there is a lack of evidence regarding the effects of HF and AF on cardiorespiratory fitness. This study is the first to examine the possible association of the presence of HF and AF with exercise intolerance in patients undergoing hemodialysis. This analysis included 40 sex- and age-matched participants [10 hemodialysis patients with HF or AF, 10 hemodialysis patients without HF or AF, 10 patients with HF or AF without chronic kidney disease (CKD) and 10 healthy controls] that underwent CPET and spirometry examinations. The total of patients with HF had preserved ejection fraction. VO2peak(ml/kg/min) showed a graded increase between hemodialysis patients with HF or AF, hemodialysis patients without HF or AF, non-CKD patients with HF or AF and controls (13.17 ± 2.45 vs 15.26 ± 3.29 vs 19.64 ± 5.84 vs 25.11 ± 6.94ml/kg/min, p < 0.001); VO2peak(ml/min) followed the same pattern (1172 ± 197 vs 1269 ± 314 vs 1817 ± 583 vs 1952 ± 592ml/min respectively, p = 0.001). VO2peak(%predicted), VO2AT(ml/kg/min), VO2AT(ml/min) and maximal work load significantly differed between the study groups, with a tendency for higher values from hemodialysis patients to non-CKD patients with HF or AF and to healthy controls. FEV1 and FVC levels were similar between the study groups. In the whole population, VO2peak(ml/kg/min) showed a positive correlation with hemoglobin (r = 0.663, p < 0.001) and negative correlations with high-sensitivity cardiac troponin I (r = -0.493, p = 0.001) and BNP (r = -0.479, p = 0.002). Hemodialysis patients have low exercise tolerance, and the presence of HF or AF is associated with further decreased values of VO2peak, the most important determinant of cardiorespiratory fitness.

The role of periostin as an inflammatory marker in bronchial asthma in children

Introduction. The extracellular matrix protein periostin, expressed in a number of body tissues, is considered as a marker of type 2 T cell inflammation and of asthma control.Objective. To study the relationship the serum periostin concentration in blood serum depending on the severity of asthma and indicators of respiratory function in children.Materials and methods. The cross-sectional (simultaneous) study included 80 children aged 6 to 17 years (average age 12±3.2), who were divided into 2 groups: 1st — children with asthma (n=40); 2nd — comparison group (n=40). The concentration of periostin in the blood serum was determined by the ELISA method. The spirographic study was performed on a computer spirometer Spirolab 1, MIR (Italy).Results. The Me of periostin in group 1 was within the normal range (730.2 ng/ml), but statistically significantly exceeded the indicator of group 2 (539.7 ng/ml, p&lt;0.05) and did not depend on the age, duration and severity of asthma, anthropometric parameters of the examined. The level of periostin in the blood serum significantly correlated with the frequency of exacerbations of the disease during the year (r=0.74, p=0.000), with the status of asthma control (r=0.32, p=0.04). A moderate correlation was found between the level of periostin and FEV1 (r=−0.34; p=0.03).Conclusions. In children with asthma, the median periostin in the blood serum increased in proportion to the severity of asthma, disease control and the frequency of exacerbation of the disease.

Clinical features of pulmonary hypertension in lymphangioleiomyomatosis

Objective: To describe the prevalence of lymphangioleiomyomatosis-pulmonary hypertension (LAM-PH), to explore the clinical features of patients with LAM-PH, and to evaluate the role of pulmonary artery optical coherence tomography (OCT) in the diagnosis of LAM-PH. Methods: Among 234 patients diagnosed with LAM in our center from June 2017 to August 2023, echocardiography was performed in 167 patients, 15 patients with PH indicated by echocardiography were selected as the LAM-PH group. From the remaining 152 patients, 32 patients were randomly selected as the control group. We compared the demographic data, clinical manifestations, pulmonary function, blood gas analysis, and serum vascular endothelial growth factor D (VEGF-D) levels between the two groups. We also evaluated the data from right heart catheterization in five patients and the images from optical coherence tomography of pulmonary arteries in two patients. Results: Echocardiography showed pulmonary hypertension in 15 patients (8.98%). Compared with the control group, LAM-PH group had a higher proportion of patients receiving oxygen therapy. Patients with PH had lower FEV1, FVC, FEV1/FVC, DLCO and higher serum VEGF-D levels compared with those without PH. Right heart catheterization was performed in five patients. Five patients had a pre-capillary pattern and three of these patients had severe pulmonary hypertension. Optical coherence tomography showed that there were no obvious abnormalities in the intima and lumen of the blood vessels in the two patients. Conclusions: The prevalence of PH in LAM is low. Patients in the LAM-PH group had more severe hypoxemia, worse lung function and higher serum VEGF-D levels than those in the control group. PH in LAM is mainly pre-capillary. Optical coherence tomography can evaluate the pulmonary artery vascular condition and help to identify the cause of pulmonary hypertension in LAM patients.

Factors related with lung functions among Orang Asli in Tasik Chini, Malaysia: a cross-sectional study

BackgroundOrang Asli lifestyle and household setting may influence their health status especially respiratory system and lung functions. This cross-sectional study was carried out to investigate the status of lung functions of Orang Asli community and the associated factors.MethodsData collection was carried out from November 2017 until May 2018 among 211 Orang Asli respondents aged 18 years old and above, who lived in five villages in Tasik Chini, Pahang. All respondents who fulfilled the inclusion criteria were recruited in this study. Interview-guided questionnaire was administered, and spirometry test that include Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), and Peak Expiratory Flow Rate (PEFR) was carried out. Data were analyzed using SPSS software version 23.0. In the first stage, descriptive analysis was done to describe the characteristics of the respondents. In the second stage, bivariable analysis was carried out to compare proportions. Finally, multiple logistic regression was performed to assess the effects of various independent predictors on spirometry parameters.ResultsThe respondents’ age ranged from 18 to 71 years old in which 50.2% of them were female. The majority ethnicity in Tasik Chini was Jakun tribe (94.3%). More than half of the respondents (52.1%) were current smoker, 5.2% were ex-smoker and 41.7% were non-smoker. More than half of them (62.1%) used woodstove for cooking, compared to only 37.9% used cleaner fuel like Liquefied Petroleum Gas (LPG) as a fuel for everyday cooking activity. The lung function parameters (FEV1 and FVC) were lower than the predictive value, whereas the ratio of Forced Expiratory Volume in one second and Forced Vital Capacity (FEV1/FVC) (%) and PEFR were within the predictive value. The FEV1 levels were significantly associated with age group (18–39 years old) (p = 0.002) and presence of woodstove in the house (p = 0.004). FVC levels were significantly associated with presence of woodstove in the house (p = 0.004), whereas there were no significant associations between all factors and FEV1/FVC levels.ConclusionsFEV1 levels were significantly associated with age group 18–39 years old, whereas FVC levels were significantly associated with the presence of woodstove in the house. Thus, environmental interventions such as replacing the use of woodstove with LPG, need to be carried out to prevent further worsening of respiratory health among Orang Asli who lived far from health facilities. Moreover, closer health monitoring is crucial especially among the younger and productive age group.

Therapeutic Effect of Avishan-e-Shirazi (Zataria Multiflora Boiss) Root Extract on Oxidative Stress Markers in Moderate Asthmatic Patients

Avishan-e-Shirazi (Zataria Multiflora Boiss) is a plant widely recognised for its medicinal and culinary purposes. Objectives: To evaluate the therapeutic effect of plant’s root extract on pulmonary function tests and oxidative stress markers among moderate Asthma tic patients. Methods: A total participant of 66 patients with pulmonary disease, 30-40 age, were selected for the 2-month research trial. Individuals were enrolled and distributed equally in two groups, 33 each. In the control group, 53.8% of individual were man, and 46.2% were women. In the treatment group, 49.1% of participants were man, and 50.9% were women. The groups G0 was considered as a control group with no root extract, and group G1 where conventional treatment and root extract were advised to participants. The participants were selected from the Jinnah Hospital, Pakistan. The 5mg/kg/day dried root extract supplements 3 times a day were given to the individuals daily for 2 months. Results: The mean age group of Asthma tic patients enrolled in the study was 35 ± 2.98 years in G0, and in G1, it was 34 ± 3.05. The mean BMI was 31.34 and 30.98 kgm-2 in both groups, respectively. There was a significant improvement in FEV1 levels and MDA enzyme levels with a p-value less than 0.05. The NO2 levels were also better. Similarly, the enzymes thiolase and SOD levels also improved with a p-value less than 0.05 in the treatment group. Conclusions: The current study concluded that Avishan-e-Shirazi root extract could improve the pulmonary function and inflammation among Asthma patients.

Investigation of respiratory muscle strength and its influence on exercise capacity and quality of life in patients with idiopathic pulmonary fibrosis.

Adequate respiratory muscle strength is required to meet the increased ventilatory demand during physical activities. However, it is not well known whether respiratory muscle strength is impaired in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to investigate the relationship between respiratory muscle strength and exercise capacity, quality of life, physical activity level, and fatigue in IPF patients. The study comprised 30 individuals with idiopathic pulmonary fibrosis (IPF) and 30 healthy controls. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured to assess respiratory muscle strength. The International Physical Activity Questionnaire-Short Form, 6-minute walk test distance (6MWD), St George Respiratory Questionnaire (SGRQ), and Fatigue Severity Scale (FSS) were employed to evaluate physical activity level, exercise capacity, quality of life, and fatigue severity, respectively. MIP (81±29 vs.73±20 cmH2O) and MEP (93±31 vs. 93±34 cmH2O) did not differ significantly between IPF patients and controls (p>0.05). In patients with IPF, MIP was significantly correlated with 6MWD (r=0.533), SGRQ (r=-0.428), and FSS (r=-0.433). Multivariate models including MIP, MEP, FEV1, FVC, and PA level explained 74% of the variance in the 6MWD (p<0.001), and MIP, FEV1, and PA level were independent predictors of the 6MWD, with FEV1 being the strongest predictor (β=0.659). Multivariate models predicting SGRQ revealed none of MIP, FEV1 or PA level was directly influencing the SGRQ score. This study suggests that patients with IPF do not have respiratory muscle weakness. Inspiratory muscle strength has a direct influence on exercise capacity but an indirect effect on quality of life, probably by influencing exercise capacity.

A comparative study on safety profile and efficacy of salmeterol and tiotropium in COPD Patients

Aim and Objectives: The aim of the study is assess the safety profile and efficacy of salmeterol and Tiotropium in patients with COPD. The objective is to compare to evaluate the safety profile and efficacy of salmeterol and Tiotropium in patients with COPD. Methodology: This was a prospective observational study conducted at secondary care hospital in India. In our study, we have included a total of 50 patients who are divided in to two groups based on their treatment and follow-ups was done for 12 weeks. Results: Patients were divided into 2 equal groups to receive salmeterol and Tiotropium (25 subjects each). The mean FEV1 level at baseline was 63.72±3.0210 for Tiotropium group and 64.96±1.645 for Salmeterol group and the mean FEV1 level after 12 weeks of treatment was 72.12±1.423 for Tiotropium group and 70.68±1.973 for Salmeterol group. Tiotropium treatment were associated with significant decrease in FEV1 level from baseline to 12 weeks. (P*&lt;0.05). Conclusion: In our study, by performing the study, we concluded that tiotropium used once daily, produced superior bronchodilation and reduced dyspnea in patients with COPD when compared with salmeterol. Patients treated with tiotropium also indicated more improvement in their symptoms than those who treated with salmeterol. Because of these advantages, tiotropium should be considered first-line treatment in patients with COPD. While performing the safety parameters for a drug, side effects of tiotropium are less when compared to salmeterol.

#1555 The effects of different interdialytic intervals on cardiorespiratory fitness assessed with CPET in hemodialysis patients

Abstract Background and Aims Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval. Method A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak (ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated. Results Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak (ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24 ± 4.18 vs 13.64 ± 2.76; p &amp;lt; 0.001); similar were the results for VO2peak (ml/min) (1188 ± 257 vs 1074 ± 224; p &amp;lt; 0.001) and VO2peak (%predicted) (58.9 ± 9.2 vs 52.3 ± 8.6; p &amp;lt; 0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1 ± 23.2 vs 79.3 ± 25.1; p &amp;lt; 0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak (ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak (ml/kg/min). Conclusion The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.

#1767 Effect of heart failure and atrial fibrillation on cardiorespiratory fitness in hemodialysis patients

Abstract Background and Aims Heart failure (HF) and atrial fibrillation (AF) are highly prevalent in hemodialysis. They are well-known significant modifiers of the disease associations with cardiovascular outcomes, but there is a lack of evidence regarding the effects of HF and AF on cardiorespiratory fitness. This study is the first to examine the possible association of the presence of HF and AF with exercise intolerance in patients undergoing hemodialysis. Method This analysis included 40 sex- and age-matched participants [10 hemodialysis patients with HF or AF, 10 hemodialysis patients without HF or AF, 10 patients with HF or AF without chronic kidney disease (CKD) and 10 healthy controls) that underwent CPET and spirometry examinations. Results VO2peak (ml/min/kg) showed a graded increase between hemodialysis patients with HF or AF, hemodialysis patients without HF or AF, non-CKD patients with HF or AF and controls (13.17 ± 2.45 vs 15.26 ± 3.29 vs 19.64 ± 5.84 vs 25.11 ± 6.94 ml/min/kg, p &amp;lt; 0.001); VO2peak (ml/min) followed the same pattern (1172 ± 197 vs 1269 ± 314 vs 1817 ± 583 vs 1952 ± 592 ml/min respectively, p = 0.001). VO2peak (%predicted), VO2AT (ml/kg/min), VO2AT (ml/min) and maximal work load significantly differ between the study groups, with a tendency for higher values from hemodialysis patients to non-CKD patients with HF or AF and to healthy controls. FEV1 and FVC levels were similar between the study groups. In the whole population, VO2peak (ml/kg/min) showed a positive correlation with hemoglobin (r = 0.663, p &amp;lt; 0.001) and negative correlations with high-sensitivity cardiac troponin I (r = −0.493, p = 0.001) and BNP (r = −0.479, p = 0.002). Conclusion Hemodialysis patients have low exercise tolerance, and the presence of HF or AF is associated with further decreased values of VO2peak, the most important determinant of cardiorespiratory fitness.

Reversibility of bronchial obstruction in patients with primary ciliary dyskinesia to justify correction of inhalation therapy

Purpose. To assess the reversibility of bronchial obstruction in patients with primary ciliary dyskinesia in groups with and without concomitant allergic inflammation, with the aim of a differentiated approach to inhalation therapy and the validity of prescribing bronchodilators.Material and methods. Retrospective analysis of the results of FEV1 before and after inhalation of a bronchodilator and study of the dependence of the reversibility of obstruction on the presence of atopy markers.Results. Of 100 patients, 63% (n=63) had atopy markers; 37% (n=37) did not have these markers (p≤0.05). When comparing the FEV1 indicator in children with the presence of allergic burden (n=63) and in the absence of it (n=37), it was found that in patients with markers of atopy, obstructive changes identified during spirometry were 14.2% more common ( p≤0.05). Reversibility of bronchial obstruction was recorded in 24% (n=24), of which 87.5% (n=21) of patients had markers of atopy (p≤0.05). In children with concomitant allergic burden and a decrease in FEV1, reversibility of obstruction was detected in 48.4% (n=15) of cases (p≤0.05). It was revealed that in patients with the presence of atopy markers and a decrease in FEV1≤80%, reversibility of obstruction occurs 42.8% more often compared to the group of patients with a normal level of FEV1 (p≤0.05).Conclusions. The vast majority of patients with primary ciliary dyskinesia (n=63) have markers of atopy, mainly due to an isolated increase in total IgE in the blood serum (p≤0.05). A decrease in FEV1≤80% in children with allergies was detected 14.2% more often compared to the group of children without it (p≤0.05). In the vast majority of patients with an allergic phenotype, reversibility of obstruction was observed after a test with a bronchodilator. Thus, all patients with primary ciliary dyskinesia and the presence of atopy markers are recommended to undergo a test with a bronchodilator, and if reversibility of obstruction is detected, it is advisable to add a bronchodilator drug to therapy.

Changes in fractional exhaled nitric oxide, forced expiratory volume in one second, and forced oscillation technique parameters over three years in adults with bronchial asthma managed under Yokohama Seibu Hospital’s coordinated care system

BackgroundIn western Yokohama, our hospital and primary care clinics manage adults with asthma via a coordinated care system. We investigated the changes in the fractional expired nitric oxide (FeNO), forced expiratory volume in 1 second (FEV1), and forced oscillation technique (FOT) parameters over 3 years in a cohort of patients in our collaborative system.MethodsFrom 288 adults with well controlled asthma managed under the Yokohama Seibu Hospital coordinated care system between January 2009 and May 2018, we selected 99 subjects to undergo spirometry, FeNO and FOT testing over 3 years and analyzed the changes in these parameters.ResultsOf the 99 patients enrolled, 17 (17.2%) experienced at least one exacerbation (insufficiently controlled (IC)), whereas, 82 (82.8%) remained in well controlled during the 3-year study period. Of well-controlled patients, 54 patients (54.5%) met the criteria for clinical remission under treatment (CR); the remaining 28 patients did not meet the CR criteria (WC). There were no differences in FeNO, FEV1, or FOT parameters at baseline among the IC, WC, and CR groups. The levels of FEV1 decreased gradually, whereas the levels of FeNO decreased significantly over 3 years. The levels of percent predicted FEV1 (%FEV1) significantly increased. We also observed significant improvement in FOT parameters; reactance at 5 Hz (R5), resonant frequency (Fres), and integral of reactance up to the resonant frequency (AX). The CR group demonstrated significant relationships between the change in FeNO and the change in FEV1 and between the change in FEV1 and the change in FOT parameters. No significant correlations emerged in the IC or WC group.ConclusionThe decrease in FeNO and increase in %FEV1, we observed in all study participants suggest that the coordinated care system model benefits patients with asthma. Although it is difficult to predict at baseline which patients will experience an exacerbation, monitoring changes in FeNO and FEV1 is useful in managing patients with asthma. Furthermore, monitoring changes in R5, Fres, and AX via forced oscillation technique testing is useful for detecting airflow limitation.

THE EFFECTS OF DIFFERENT INTERDIALYTIC INTERVALS ON CARDIORESPIRATORY FITNESS ASSESSED WITH CARDIOPULMONARY EXERCISE TESTING IN HEMODIALYSIS PATIENTS

Objective: Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval. Design and method: A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak(ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated. Results: Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak(ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24±4.18 vs 13.64±2.76;p&lt;0.001); similar were the results for VO2peak(ml/min) (1188±257 vs 1074±224;p&lt;0.001) and VO2peak(%predicted) (58.9±9.2 vs 52.3±8.6;p&lt;0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1±23.2 vs 79.3±25.1;p&lt;0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak(ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak(ml/kg/min). Conclusions: The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.

Impaired lung function and lung cancer risk in 461 183 healthy individuals: a cohort study

BackgroundIt has been known that smoking and various lung diseases including lung cancer can cause lung function impairment. However, the impact of different types of lung function impairments, such as...

EFFECT OF HEART FAILURE AND ATRIAL FIBRILLATION ON CARDIORESPIRATORY FITNESS IN HEMODIALYSIS PATIENTS

Objective: Heart failure (HF) and atrial fibrillation (AF) are highly prevalent in hemodialysis. They are well-known significant modifiers of the disease associations with cardiovascular outcomes, but there is a lack of evidence regarding the effects of HF and AF on cardiorespiratory fitness. This study is the first to examine the possible association of the presence of HF and AF with exercise intolerance in patients undergoing hemodialysis. Design and method: This analysis included 40 sex- and age-matched participants [10 hemodialysis patients with HF or AF, 10 hemodialysis patients without HF or AF, 10 patients with HF or AF without chronic kidney disease (CKD) and 10 healthy controls) that underwent CPET and spirometry examinations. Results: VO2peak (ml/min/kg) showed a graded increase between hemodialysis patients with HF or AF, hemodialysis patients without HF or AF, non-CKD patients with HF or AF and controls (13.17±2.45 vs 15.26±3.29 vs 19.64±5.84 vs 25.11±6.94 ml/min/kg, p&lt;0.001); VO2peak (ml/min) followed the same pattern (1172±197 vs 1269±314 vs 1817±583 vs 1952±592 ml/min respectively, p=0.001). VO2peak (%predicted), VO2AT (ml/kg/min), VO2AT (ml/min) and maximal work load significantly differ between the study groups, with a tendency for higher values from hemodialysis patients to non-CKD patients with HF or AF and to healthy controls. FEV1 and FVC levels were similar between the study groups. In the whole population, VO2peak (ml/kg/min) showed a positive correlation with hemoglobin (r=0.663, p&lt;0.001) and negative correlations with high-sensitivity cardiac troponin I (r=-0.493, p=0.001) and BNP (r=-0.479, p=0.002). Conclusions: Hemodialysis patients have low exercise tolerance, and the presence of HF or AF is associated with further decreased values of VO2peak, the most important determinant of cardiorespiratory fitness.

Prevalence, Medicaid use and mortality risk of low FEV1 in adults aged 20–35 years old in the USA: evidence from a population-based retrospective cohort study

BackgroundThe prevalence, Medicaid use and mortality risk associated with low forced expiratory volume in 1 s (FEV1) among young adults aged 20–35 years are not well understood, despite its potential...

FEV1 and FVC as robust risk factors for cardiovascular disease and mortality: Insights from a large population study

IntroductionData is limited on influence of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) in a large adult population, including individuals with normal spirometry at baseline. MethodsUsing the UK Biobank cohort, a multivariable Cox regression analysis was conducted on 406,424 individuals to examine the association between FEV1 and FVC, categorized into three groups based on their percentage of predicted values (%pred) (≥80, 60–80 and < 60), and overall mortality, cardiovascular mortality, myocardial infarction, stroke, and heart failure over approximately 12.5 years. Moreover, a subgroup analysis was conducted on 295,459 individuals who had normal spirometry. ResultsReduced FEV1 and FVC %pred values were associated with an elevated risk across all studied outcomes. Individuals with the lowest FEV1 and FVC %pred values (<60 %) exhibited HR of 1.83 (95 % CI 1.74–1.93) and 1.98 (95 % CI 1.76–2.22) for overall mortality, and 1.96 (95 % CI 1.83–2.1) and 2.26 (95 % CI 1.94–2.63) for cardiovascular mortality. Moreover, a graded association was observed between lower FEV1 and FVC %pred, even among never smokers and individuals with normal spirometry at baseline. DiscussionReduced FEV1 and FVC represent robust risk factors for cardiovascular disease and mortality. The fact that the increased risk was evident also at FEV1 and FVC levels exceeding 80 %pred challenges the contemporary classification of lung function categories and the notion that the entire FEV1- and FVC-range above 80 % of predicted represents a normal lung function.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE: RATE OF THERAPIOTIC ADHERENCE IN OUTPATIENT PRACTICE

The adherence of a patient with chronic obstructive pulmonary disease (COPD) to treatment is of utmost importance as it prevents the disease progression and the delayed complication development that determine the quality of life and life span.&#x0D; The purpose of the study is to assess the level of adherence for patients with COPD to drug therapy with respiratory drugs, to identify factors influencing the adherence, and study 5-year survival rate based on adherence level.&#x0D; Materials and Methods. The study enrolled 150 patients with COPD (87 men, and 63 women, mean age 58.3±0.86 years). Pulmonary function (FEV1, FVC, FEV1/FVC), severity of respiratory symptoms (mMRS scale, CAT questionnaire), and disease severity were assessed (GOLD, 2022). Adherence to COPD treatment was determined according to the Morisky-Green test (1986). Five-year survival rate of patients was analyzed.&#x0D; Results. Low adherence to treatment in patients with COPD was revealed: 1 month after the initiation or correction of respiratory therapy, only 32 patients (21.3 %) were assessed as adherent, 56 patients (37.3 %) were insufficiently adherent, and 62 patients (41.3 %) were non-adherent to treatment. Adherence to treatment was associated with age, disease severity, severity of respiratory symptoms, FEV1 and did not depend on gender. In five years, survival rate in the group of non-adherent patients (89.5 %) and insufficiently adherent patients (80.4 %) was significantly higher than in the group of adherent one (61.9 %). It is associated with a more severe status of patients who are adherent to therapy.&#x0D; Conclusion. The authors identified an insufficient adherence level in patients with COPD. Elderly patients with a more severe course of the disease, low FEV1 levels, and severe exacerbations are more adherent to respiratory drug therapy. Worse five-year survival rates were observed in the group of patients who were adherent to therapy. It was associated with more severe clinical status, age and comorbidity.

Clinical implications of airway obstruction with normal or low FEV1 in childhood and adolescence

BackgroundAirway obstruction is defined by spirometry as a low forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio. This impaired ratio may originate from a low...

Cystic Fibrosis in Adults: A Paradigm of Frailty Syndrome? An Observational Study.

This study aimed to assess the main clinical and anamnestic characteristics of adult Cystic Fibrosis (CF) patients and to evaluate the association of frailty with the CF genotyping classification. In an observational cross-sectional study, all ambulatory CF patients over 18 years old who received a diagnosis at the Regional Cystic Fibrosis Center for adults were enrolled and assessed by spirometry for respiratory function, by ADL and IADL for functional status, and by the Study of Osteoporotic Fractures (SOF) Index for frailty. The study population consisted of 139 CF patients (mean age 32.89 ± 10.94 years old, 46% women). Most of the subjects were robust (60.4%). The pre-frail/frail group was more frequently females (p = 0.020), had a lower BMI (p = 0.001), worse respiratory function, a higher number of pulmonary exacerbations/years, cycles of antibiotic therapy, and hospitalization (all p < 0.001) with respect to robust patients. The pre-frail/frail subjects used more drugs and were affected by more CF-related diseases (all p < 0.001). In relation to logistic regression, the best predictor of the pre-frail/frail status was a low FEV1 level. The CF patients show similarities to older pre-frail/frail subjects, suggesting that CF might be considered an early expression of this geriatric syndrome. This finding could help to better define the possible progression of CF, but overall, it could also suggest the usefulness employing of some tools used in the management and therapy of frailty subjects to identify the more severe CF subjects.

Efficacy of noninvasive ventilator treatment in patients with severe chronic obstructive pulmonary disease (COPD) type II respiratory failure.

To investigate the efficacy of noninvasive ventilator usage for type II respiratory failure in patients with severe chronic obstructive pulmonary disease (COPD). A total of 124 patients with COPD complicated with type II respiratory failure were divided into an observation group (n = 63) and a control group (n = 61) according to their intervention protocols. The patients in the observation group received noninvasive ventilator intervention, and the patients in the control group received bronchodilators, cough suppressants, oxygen therapy, anti-infection medications, nutritional support, and correction of electrolyte imbalances. Lung function indexes, arterial blood gas index, and inflammatory indicators were collected to assess the efficacy of noninvasive ventilator treatment in patients with severe COPD and type II respiratory failure. The levels of FEV1, FEV1/FVC and FEV1% of the two groups after treatment were significantly higher than those before treatment (P<0.05), with significantly higher levels in the observation group than the control group (all P<0.05). Post-treatment levels of PaCO2 decreased significantly while the post-treatment levels of PaO2 increased significantly (all P<0.05). Additionally, the levels of WBC, CRP and PCT of the control group was significantly higher than that of the observation group after treatment (all P<0.05). Noninvasive ventilator treatment can improve hypoxemia, improve lung function and reduce inflammatory responses in patients with COPD complicated with type II respiratory failure, suggesting its potential for wider clinical application.