Lower FEV1 Research Articles

The CRTh2 polymorphism rs533116 G > A associates with asthma severity in older females.

BackgroundCRTh2 is G protein coupled receptor for prostaglandin D2 (PGD)2 expressed by immune cells that drive type 2 inflammation such as CD4+ T cells (Th2), eosinophils and group 2 innate lymphoid cells (ILC2) as well as structural cells including smooth muscle and epithelium. CRTh2-expressing cells are increased in the blood and airways of asthmatics and severe asthma is characterized by increased activity of the PGD2-CRTh2 pathway. The CRTh2 single nucleotide polymorphism (SNP) rs533116 G > A is associated with development of asthma and increased Th2 cell differentiation.ObjectiveTo examine whether CRTh2 rs533116G > A associates with asthma severity. Since severe asthma is more common in females than males, we performed a sex-stratified analysis.MethodsClinical data from asthmatics (n = 170) were obtained from clinic visits and chart review. Asthma severity was assessed according to ERS/ATS guidelines. Peripheral blood cells were characterized by flow cytometry and qRT-PCR. Genotyping was performed by TaqMan assay.ResultsOlder females (≥45 years) homozygous for minor A allele of rs533116 were more likely to have severe asthma, lower FEV1, a higher prescribed dose of inhaled corticosteroid and more type 2 inflammation than females carrying GA or GG genotypes. Comparing females and males with the AA genotype also revealed that women had more type 2 inflammation.Conclusions and significanceThe polymorphism CRTh2 rs533116 G > A associates with severe asthma and type 2 inflammation in older females. This study reveals a gene-sex-aging interaction influencing the effect of CRTh2 on asthma severity.

The Relationship Between BMI and Lung Function in Populations with Different Characteristics: A Cross-Sectional Study Based on the Enjoying Breathing Program in China.

PurposeTo analyze the relationship between body mass index (BMI) and lung function, which may help optimize the screening and management process for chronic obstructive pulmonary disease (COPD) in the early stages.Patients and MethodsIn this cross-sectional study using data from the Enjoying Breathing Program in China, participants were divided into two groups according to COPD Screening Questionnaire (COPD-SQ) scores (at risk and not at risk of COPD) and three groups based on lung function (normal lung function, preserved ratio impaired spirometry [PRISm], and obstructive lung function).ResultsA total of 32,033 subjects were enrolled in the current analysis. First, in people at risk of COPD, overweight and obese participants had better forced expiratory volume in one second (FEV1; overweight: 0.33 liters (l), 95% confidence interval [CI]: 0.27 to 0.38; obesity: 0.31 L, 95% CI: 0.22 to 0.39) values than the normal BMI group. Second, among people with PRISm, underweight participants had a lower FEV1 (−0.56 L, 95% CI: −0.86 to −0.26) and forced vital capacity (FVC; −0.33 L, 95% CI: −0.55 to −0.11) than participants with a normal weight, and obese participants had a higher FEV1 (0.22 L, 95% CI: 0.02 to 0.42) and FVC (0.16 L, 95% CI: 0.02 to 0.30) than participants with a normal weight. Taking normal BMI as the reference group, lower FEV1 (−0.80 L, 95% CI: −0.97 to −0.63) and FVC (−0.53 L, 95% CI: −0.64 to −0.42) were found in underweight participants with obstructive spirometry, and better FEV1 (obesity: 0.26 L, 95% CI: 0.12 to 0.40) was found in obese participants with obstructive spirometry.ConclusionBeing underweight and severely obese are associated with reduced lung function. Slight obesity was shown to be a protective factor for lung function in people at risk of COPD and those with PRISm.

LACK OF PULMONARY HYPERTENSION REGRESSION IN PATIENTS WITH SEVERE AORTIC STENOSIS ASSOCIATED WITH CHRONIC LUNG DISEASE AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT

LACK OF PULMONARY HYPERTENSION REGRESSION IN PATIENTS WITH SEVERE AORTIC STENOSIS ASSOCIATED WITH CHRONIC LUNG DISEASE AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT

EFFICACY OF TEZEPELUMAB IN PATIENTS WITH UNCONTROLLED ASTHMA DESPITE RECEIVING TREATMENT FOR MODERATE OR SEVERE DISEASE: POOLED ANALYSIS OF PATHWAY AND NAVIGATOR STUDIES

EFFICACY OF TEZEPELUMAB IN PATIENTS WITH UNCONTROLLED ASTHMA DESPITE RECEIVING TREATMENT FOR MODERATE OR SEVERE DISEASE: POOLED ANALYSIS OF PATHWAY AND NAVIGATOR STUDIES

OUTCOMES OF COVID-19 IN LUNG TRANSPLANT RECIPIENTS: A SINGLE CENTER REVIEW

SESSION TITLE: Lung Transplantation: New Issues in 2022SESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/19/2022 11:15 am - 12:15 pmPURPOSE: Currently the sequelae of COVID pneumonia in lung transplant recipients (LTR) is poorly described and the long-term effects are largely unknown. LTRs encompass a unique patient population with anatomic and immunological changes that pose a huge challenge in the management of COVID pneumonia compared to the general population. This project looks to further delineate risk factors, prognostication, and long-term sequelae of COVID pneumonia in LTRs.METHODS: A retrospective analysis was performed in a single large lung transplant center in Chicago from January 2020 to June 2021. Impact of COVID-19 based on patient demographics, management strategies, level of care, mortality, and pre- and post-COVID spirometry changes were analyzed based on follow-up visits after infection in survivors.RESULTS: There was an overall mortality of 21% with 68% requiring hospital admission. Of the patients admitted, there was a 62% mortality risk associated with ICU admission. Pre-existing chronic lung allograft dysfunction (CLAD) was present in 10 patients of which 50% were admitted to the ICU. Baseline FEV1 was 1.95 L with an average post covid FEV1 of 1.89 L (3.7% decline) for survivors. Pre-existing CLAD, lower baseline FEV1, and increased time since transplant were predictors of ICU admission.CONCLUSIONS: COVID-19 continues to remain a dangerous, life-threatening disease, particularly for LTRs. While there were no patients that developed CLAD post infection, there was an overall decrease in lung function. The long term trajectory of graft function post-covid remains unclear, however pre-existing allograft dysfunction appears to provide prognostic value.CLINICAL IMPLICATIONS: Further study needs to be done on COVID-19 and the long-term implications of allograft function in the LTR population.DISCLOSURES: Speaker/Speaker's Bureau relationship with boehringer ingelheim Please note: $5001 - $20000 by Brad Bemiss, value=Travel and payment for lectureNo relevant relationships by Timothy O'ConnorNo relevant relationships by Love Patel SESSION TITLE: Lung Transplantation: New Issues in 2022 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Currently the sequelae of COVID pneumonia in lung transplant recipients (LTR) is poorly described and the long-term effects are largely unknown. LTRs encompass a unique patient population with anatomic and immunological changes that pose a huge challenge in the management of COVID pneumonia compared to the general population. This project looks to further delineate risk factors, prognostication, and long-term sequelae of COVID pneumonia in LTRs. METHODS: A retrospective analysis was performed in a single large lung transplant center in Chicago from January 2020 to June 2021. Impact of COVID-19 based on patient demographics, management strategies, level of care, mortality, and pre- and post-COVID spirometry changes were analyzed based on follow-up visits after infection in survivors. RESULTS: There was an overall mortality of 21% with 68% requiring hospital admission. Of the patients admitted, there was a 62% mortality risk associated with ICU admission. Pre-existing chronic lung allograft dysfunction (CLAD) was present in 10 patients of which 50% were admitted to the ICU. Baseline FEV1 was 1.95 L with an average post covid FEV1 of 1.89 L (3.7% decline) for survivors. Pre-existing CLAD, lower baseline FEV1, and increased time since transplant were predictors of ICU admission. CONCLUSIONS: COVID-19 continues to remain a dangerous, life-threatening disease, particularly for LTRs. While there were no patients that developed CLAD post infection, there was an overall decrease in lung function. The long term trajectory of graft function post-covid remains unclear, however pre-existing allograft dysfunction appears to provide prognostic value. CLINICAL IMPLICATIONS: Further study needs to be done on COVID-19 and the long-term implications of allograft function in the LTR population. DISCLOSURES: Speaker/Speaker's Bureau relationship with boehringer ingelheim Please note: $5001 - $20000 by Brad Bemiss, value=Travel and payment for lecture No relevant relationships by Timothy O'Connor No relevant relationships by Love Patel

Combined assessment of bronchial asthma control using forced expiratory volume in first second and exhaled nitric oxide

Introduction The principal goal of bronchial asthma (BA) management is to control and reduce the risk of exacerbations. Poor assessment of asthma control is a major cause of poor asthma management. This study aimed to detect the level of asthma control using spirometry and exhaled nitric oxide (FeNO). Patients and methods This study investigated 210 patients with a diagnosis of BA. Asthma control in included patients was classified according to the Global Initiative for Asthma symptom-based assessment of asthma control, into controlled, partly controlled, or uncontrolled. Spirometry and FeNO results were recorded. Results Most of the studied patients had partly controlled BA (43.3%), while uncontrolled BA was found in 29% of them. There was a significant association between both prebronchodilator forced expiratory volume in 1 s (FEV1) and the presence of reversibility with levels of BA control. There was no significant difference in the FeNO value between the levels of BA control (P=0.5). Combined assessment of BA using low FEV1 with high FeNO showed a significant difference between BA control groups. Conclusion A combination of FeNO and FEV1 provides a better method in detecting the level of BA control. It may be very important for patients with higher airway reversibility to consistently monitor disease control and then to modify therapeutic strategy.

Small airway function measured using forced expiratory flow between 25% and 75% of vital capacity and its relationship to airflow limitation in symptomatic ever-smokers: a cross-sectional study

BackgroundChronic obstructive pulmonary disease (COPD) is diagnosed and its severity graded by traditional spirometric parameters (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and FEV1, respectively) but these...

Determinants of Severe Asthma - A Long-Term Cohort Study in Northern Sweden.

BackgroundRisk factors for severe asthma are not well described. The aim was to identify clinical characteristics and risk factors at study entry that are associated with severe asthma at follow-up in a long-term prospective population-based cohort study of adults with asthma.MethodsBetween 1986 and 2001, 2055 adults with asthma were identified by clinical examinations of population-based samples in northern Sweden. During 2012–2014, n = 1006 (71% of invited) were still alive, residing in the study area and participated in a follow-up, of which 40 were identified as having severe asthma according to ERS/ATS, 131 according to GINA, while 875 had other asthma. The mean follow-up time was 18.7 years.ResultsObesity at study entry and adult-onset asthma were associated with severe asthma at follow-up. While severe asthma was more common in those with adult-onset asthma in both men and women, the association with obesity was observed in women only. Sensitization to mites and moulds, but not to other allergens, as well as NSAID-related respiratory symptoms was more common in severe asthma than in other asthma. Participants with severe asthma at follow-up had lower FEV1, more pronounced FEV1 reversibility, and more wheeze, dyspnea and nighttime awakenings already at study entry than those with other asthma.ConclusionAdult-onset asthma is an important risk factor for development of severe asthma in adults, and obesity increased the risk among women. The high burden of respiratory symptoms already at study entry also indicate long-term associations with development of severe asthma.

653. DOES MIE REDUCE PULMONARY COMPLICATIONS IN A REAL-WORLD SCENARIO?

Abstract Pulmonary complications are a common cause of morbidity, and occurs in upto 30% after esophagectomy. Randomised trials have shown significant decrease in pulmonary complications after minimally invasive esophagectomy (MIE). We conducted a study to evaluate whether this was true in a real-world scenario. We performed a retrospective analysis of a prospectively maintained database of patients undergoing esophagectomy. Data of consecutive patients undergoing MIE or open Mc-keown transthoracic esophagectomy (OE) between 2013 and 2021 were included. Categorical variables were compared by Pearson’s Χ2 test or Fisher’s exact test. Multivariate logistic regression analysis was performed to analyse the relation between pulmonary complications and potential related factors to identify independent predictors of pulmonary complications. A total of 1046 patients underwent MIE or OE between 01/01/2013 and 31/12/2021. The mean age was 54.2+/-9.9 y; 413 (39.5%) were smokers; 862 (82.4%) patients underwent neo-adjuvant chemotherapy; 411 patients(41.1%) underwent MIE( 309- VATS, 102- Robotic) while the remaining 635 underwent OE. Overall, 354(33.8%) patients had pulmonary complications, of which 234(22.4%) were CD 3a and above. Pulmonary complications were reduced by 11.6% (171/635, 26.9% with OE vs 63/411, 15.3% with MIE; p=0.001)(). On multivariate analysis, age > 60y, open surgery, FEV1,3-field lymphadenectomy and ASA grade(II and III) were found to be significant predictors of pulmonary complications (table 1) Adoption of MIE results in fewer pulmonary complications in the real world; however, the large differences seen in randomised trials may not be replicable in a real-world scenario. Elderly patients, those with low FEV1 values, a higher ASA grade and those who have undergone a 3-field lymphadenectomy may develop significant pulmonary complications in spite of undergoing MIE.

Street-View Greenspace Exposure and Childhood Asthma-Related Outcomes: Analyses in Project Viva

Background and Aim: While higher levels of greenspace can mitigate air pollution, reduce stress, and increase physical activity, its role in childhood asthma is unclear. The aim of this study is to examine the associations of neighborhood greenspace based on Google street view (GS) images with asthma-related measures among children in Project Viva, a cohort in eastern Massachusetts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium. Methods: We leveraged GSV images from 2007 to 2011 within 250m of participants’ home addresses at mid-childhood and applied deep learning algorithms to derive unique metrics of ground-level greenspace exposure. We calculated total greenspace exposure, which combined %grass, %trees, %plants, %fields, and %flowers within each image. Mothers reported the child’s asthma status in mid-childhood (median 7.7 yr) and early adolescence (median 12.7 yr). Trained research assistants performed lung function tests (FEV1 and FVC) using spirometry and collected blood for total serum IgE measurement. We constructed linear and logistic regression models to examine associations of neighborhood greenspace with these asthma-related outcomes adjusting for child’s sex, race/ethnicity, age at outcome, maternal and paternal education, marital status and household income (at enrollment), and census tract level household income and urbanicity (at delivery). Results: In adjusted cross-sectional analyses (N=486), each interquartile range increase in total greenspace was associated with lower FEV1 (-44.7 mL [95% CI: -82.7, -6.64]) and higher total IgE (56.4 kU/L [95% CI: 0.86, 112]). Similar associations were observed for %tree but not for %grass. Greenspace was not associated with asthma status cross-sectionally in mid-childhood. There were no longitudinal associations between any greenspace measures in mid-childhood and any asthma-related outcomes in early adolescence (N=414). Conclusions: We observed cross-sectional but not longitudinal associations between GSV-based greenspace with FEV1 and total serum IgE in adverse directions and found no association between greenspace and asthma status.

Subclinical Risk Factors for Heart Failure With Preserved and Reduced Ejection Fraction Among Black Adults

Sparse data exist regarding the contributions of subclinical impairments in cardiovascular and noncardiovascular function to incident heart failure (HF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) among Black US residents, limiting understanding of the etiology of HF subtypes. To identify subclinical cardiovascular and noncardiovascular risk factors associated with HFrEF and HFpEF in Black US residents. This cohort study used cross-sectional and time-to-event analysis with data from the community-based Jackson Heart Study (JHS), a longitudinal cohort study with baseline data collected from 2000 to 2004 (visit 1) and 10-year follow-up for incident HF. Black US residents from the Jackson, Mississippi, metropolitan area enrolled in JHS; those with prevalent HF, with moderate or greater aortic or mitral valve diseases on visit 1, who died before 2005, and who had missing HF status on follow-up were excluded. The analysis included 4361 participants and was performed between June 2020 to August 2021. Quantitative measures of cardiovascular (left ventricular mass index [LVMI], left ventricular ejection fraction [LVEF], left atrial [LA] diameter, and pulse pressure) and noncardiovascular (percent predicted forced expiration volume in 1 second [FEV1 (percent predicted)], estimated glomerular filtration rate (eGFR), waist circumference, and hemoglobin A1c [HbA1c] level) organ function. Incident HF, HFrEF, and HFpEF over 10-year follow-up. The 4361 participants had a mean (SD) age of 54 (13); 2776 (64%) were women; and there were 163 HFpEF and 146 HFrEF events. In multivariable models incorporating measures reflecting each organ system, factors associated with incident HFpEF included greater LA diameter (hazard ratio [HR], 1.23; 95% CI, 1.03-1.47; P = .02), higher pulse pressure (HR, 1.23; 95% CI, 1.05-1.44; P = .009), lower FEV1 (percent predicted) (HR, 1.22; 95% CI, 1.04-1.43; P = .02), lower eGFR (HR, 1.43; 95% CI, 1.19-1.72; P < .001), higher HbA1c level (HR, 1.25; 95% CI, 1.07-1.45; P = .005), and higher waist circumference (HR, 1.41; 95% CI, 1.18-1.69; P < .001). Factors associated with incident HFrEF included greater LVMI (HR, 1.25; 1.07-1.46; P = .005), lower LVEF (HR, 1.65; 95% CI, 1.42-1.91; P < .001), lower FEV1 (percent predicted) (HR, 1.19; 95% CI, 1.00-1.42; P = .047), and lower eGFR (HR, 1.27; 95% CI, 1.04-1.55; P = .02). In this community-based cohort study of Black US residents, subclinical impairments in cardiovascular and noncardiovascular organ function were differentially associated with risk of incident HFpEF and HFrEF.

Association of lung function with the risk of cardiovascular diseases and all-cause mortality in patients with diabetes: Results from NHANES III 1988-1994.

ObjectiveThe potential effects of pulmonary dysfunction on cardiovascular diseases (CVD) and all-cause mortality are receiving attention. The current study aimed to explore whether reduced lung function predicts CVD and all-cause mortality in people with diabetes.MethodsA total of 1,723 adults with diabetes (mean age 60.2 years) were included in the National Health and Nutrition Examination Survey (NHANES III). Death outcomes were ascertained by linkage to the database records through 31 December 2015. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for coronary heart disease (CHD), CVD, and all-cause mortalities. We conducted stratified analyses based on age, body mass index (BMI), history of hypertension, and dyslipidemia.ResultsDuring a mean follow-up of 14.62 years (25,184 person-year), a total of 1,221 deaths were documented, of which 327 were CHD, 406 were CVD, and 197 were cancer. After multi-factor adjustment, participants with lower FEV1 and FVC had a higher risk of CHD, CVD, and all-cause mortality. This association was also found in lower FVC and a higher risk of cancer mortality [HR: 3.85 (1.31–11.32); P for trend = 0.040], but the association of FEV1 was attenuated after adjustment for covariates [HR:2.23 (0.54–9.17); P for trend = 0.247]. In subgroup analysis, we found that the adverse associations of FEV1 and FVC with CVD mortality were observed in subgroups of age, BMI, and history of hypertension and dyslipidemia.ConclusionDeclined lung function was associated with a higher risk of CVD and all-cause mortality in people with diabetes. Lung function tests, especially FEV1 and FVC, should be encouraged to provide prognostic and predictive information for the management of CVD and all-cause mortality in patients with diabetes.

Spirometric Evaluation of Effect of Air Pollution on Pulmonary Functions of Traffic Police in Kathmandu Valley

Background and objectives: Traffic police personnel are exposed to ambient air pollution which leads to important health hazards like impairment of lung functions. The objectives of this study were to measure and compare the pulmonary function parameters of traffic police and general duty police and also aimed to evaluate the effect of job duration on those parameters in Kathmandu valley. Materials and methods: A cross-sectional comparative study was done in a total of 133 healthy, non-smoker, male policemen working in Kathmandu valley for a minimum of one year. Out of them, 70 were from traffic police and 63 were from general duty police. MIR Spirolab II was used for pulmonary function test (PFT) measurement. Statistical analysis was done using SPSS version 20. The results were presented as mean ±SD and Independent sample t-test: was used. The p-value &lt;0.05 was considered statistically significant. Pulmonary functions of the two groups were compared. Results: There was a statistically significant decrease in FEV1, FEV1/FVC and FEF25%=75% among policemen working in Kathmandu valley for seven years or more as compared to those working for less than seven years. Although the traffic police had lower FVC, FEV1, FEV1/FVC and PEF in comparison to the general duty police, these differences were not statistically significant. Conclusion: The findings of this study demonstrated that pulmonary functions of both the traffic and the general duty police decrease with increase in duration of job in Kathmandu valley. The pulmonary functions of the traffic police were lower than their predicted values although they were not significantly lower than those of the general duty police. Keywords: Lung function, Spirometry, Traffic policemen, FVC, FEV1, PEF, FEF25%-75%

Determinants of lung function across childhood in the Severe Asthma Research Program (SARP) 3

Children with asthma are at risk for low lung function extending into adulthood, but understanding of clinical predictors is incomplete. We sought to determine phenotypic factors associated with FEV1 throughout childhood in the Severe Asthma Research Program 3 pediatric cohort. Lung function was measured at baseline and annually. Multivariate linear mixed-effects models were constructed to assess the effect of baseline and time-varying predictors of prebronchodilator FEV1 at each assessment for up to 6 years. All models were adjusted for age, predicted FEV1 by Global Lung Function Initiative reference equations, race, sex, and height. Secondary outcomes included postbronchodilator FEV1 and prebronchodilator FEV1/forced vital capacity. A total of 862 spirometry assessments were performed for 188 participants. Factors associated with FEV1 include baseline Feno (B, -49 mL/log2 PPB; 95% CI, -92 to -6), response to a characterizing dose of triamcinolone acetonide (B, -8.4 mL/1% change FEV1 posttriamcinolone; 95% CI, -12.3 to -4.5), and maximal bronchodilator reversibility (B, -27 mL/1% change postbronchodilator FEV1; 95% CI, -37 to -16). Annually assessed time-varying factors of age, obesity, and exacerbation frequency predicted FEV1 over time. Notably, there was a significant age and sex interaction. Among girls, there was no exacerbation effect. For boys, however, moderate (1-2) exacerbation frequency in the previous 12 months was associated with -20 mL (95% CI, -39 to -2) FEV1 at each successive year. High exacerbation frequency (≥3) 12 to 24 months before assessment was associated with -34 mL (95% CI, -61 to -7) FEV1 at each successive year. In children with severe and nonsevere asthma, several clinically relevant factors predict FEV1 over time. Boys with recurrent exacerbations are at high risk of lower FEV1 through childhood.

Chronic Bronchitis Affects Outcomes in Smokers without Chronic Obstructive Pulmonary Disease (COPD).

Background. Chronic bronchitis (CB) importantly affects outcomes in smokers with COPD, but the effects on smokers without COPD are less well known and less emphasized. The aim of our study was to investigate the possible effects of CB on clinical outcomes in smokers without COPD (noCOPD) and compare them with the effects in smokers with COPD (COPD). Methods. For that purpose, we studied 511 smokers, 302 with and 209 without COPD, followed for 10 years in an academic COPD ambulatory setting. Chronic bronchitis was defined as the presence of cough and sputum production for at least 3 months in each of two consecutive years. All subjects underwent clinical and functional examination with spirometry, diffusion capacity (DLco), 6-min walking test (6MWT), mMRC Dyspnoea Scale, COPD Assessment Test (CAT), and recording of annual frequency of exacerbations. All-cause mortality during follow-up was recorded. Results. 27% of noCOPD and 45% of COPD had CB. noCOPD with CB had lower FEV1 and DLco, worse 6MWT, more dyspnoea, a higher number of exacerbations and lower survival than noCOPD without CB. CB did not affect FEV1 decline in noCOPD but it significantly did in COPD. Conclusions. The presence of chronic bronchitis in smokers without COPD will significantly affect symptoms, quality of life, and survival, underlining the importance of recognizing the condition and managing it accordingly.

Body mass index increase: a risk factor for forced expiratory volume in 1 s decline for overweight and obese adults with asthma.

BackgroundWith increasing prevalence of overweight and obesity, it is important to study how body mass index (BMI) change may affect lung function among subjects with asthma. There are few prospective studies on this topic, especially with separate analyses of those with normal and high BMI. The aim of the present study was to prospectively study the association between annual BMI change and annual lung function decline, separately among those with normal initial BMI and overweight/obesity, in an adult asthma cohort.MethodsA population-based adult asthma cohort was examined at study entry between 1986 and 2001 and at follow-up between 2012 and 2014 (n=945). Annual BMI change was analysed in association with annual decline in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC separately in those with normal weight (BMI 18.5–24.9) and overweight/obese subjects (BMI ≥25) at study entry. Regression models were used to adjust for sex, age, smoking, inhaled corticosteroids use and occupational exposure to gas, dust or fumes.ResultsOverweight/obese subjects had lower FEV1 and FVC but slower annual FEV1 and FVC decline compared to those with normal weight. After adjustment through regression modelling, the association between BMI change with FEV1 and FVC decline remained significant for both BMI groups, but with stronger associations among the overweight/obese (FEV1 B[Overweight/obese]=−25 mL versus B[normal weight]=−15 mL). However, when including only those with BMI increase during follow-up, the associations remained significant among those with overweight/obesity, but not in the normal-weight group. No associations were seen for FEV1/FVC.ConclusionsBMI increase is associated with faster FEV1 and FVC decline among overweight and obese adults with asthma in comparison with their normal-weight counterparts.

Small airway dysfunction in Chinese patients with idiopathic pulmonary fibrosis

BackgroundRecent years, idiopathic pulmonary fibrosis (IPF) is thought to be a disease of alveoli as well as small airways. This study aimed to demonstrate the clinical feature, predictor, and prognosis of small airway dysfunction (SAD) in Chinese patients with IPF.MethodsWe enrolled 416 patients with IPF who hospitalized in Beijing Chao-Yang Hospital from 2000 to 2014 in this study, and the follow-up ended at December 2016. We collected demographic information, clinical examination results, spirometry results, HRCT results, and blood gas results during the study. Logistic regression analysis was used to identify the predictor for SAD. The COX proportional hazard model was used to analysis the prognosis effect of SAD.ResultsAmong all the participants, 165 (39.66%) patients had SAD. FEV1 (% predicted) and FEV3/FVC were significantly associated with SAD in patients with IPF. IPF patients with lower FEV1 (% predicted, OR 30.04, 95% CI 9.61–93.90) and FEV3/FVC (OR 77.76, 95% CI 15.44–391.63) had increased risk for SAD. Patients with SAD were associated with significantly increased risk of mortality in patients with IPF (HR 1.73, 95% CI 1.02–2.92), as well as in IPF patients without other pulmonary comorbidities (COPD, emphysema, and asthma).ConclusionsSpirometry-defined SAD was like 40% in patients with IPF. Lower FEV1 (% predicted) and FEV3/FVC were main predictors for SAD. IPF patients with SAD showed poorer prognosis.

Gestational phthalate exposure and lung function during childhood: A prospective population-based study

The potential effect of gestational exposure to phthalates on the lung function levels during childhood is unclear. Therefore, we examined this association at different ages (from 4 to 11 years) and over the whole childhood. Specifically, we measured 9 phthalate metabolites (MEP, MiBP, MnBP, MCMHP, MBzP, MEHHP, MEOHP, MECPP, MEHP) in the urine of 641 gestating women from the INMA study (Spain) and the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and FEV1/FVC in their offspring at ages 4, 7, 9 and 11. We used linear regression and mixed linear regression with a random intercept for subject to assess the association between phthalates and lung function at each study visit and for the overall childhood, respectively. We also assessed the phthalate metabolites mixture effect on lung function using a Weighted Quantile Sum (WQS) regression. We observed that the phthalate metabolites gestational levels were consistently associated with lower FVC and FEV1 at all ages, both when assessed individually and jointly as a mixture, although most associations were not statistically significant. Of note, a 10% increase in MiBP was related to lower FVC (−0.02 (−0.04, 0)) and FEV1 z-scores (−0.02 (−0.04, −0.01) at age 4. Similar significant reductions in FVC were observed at ages 4 and 7 associated with an increase in MEP and MnBP, respectively, and for FEV1 at age 4 associated with an increase in MBzP. WQS regression consistently identified MBzP as an important contributor to the phthalate mixture effect. We can conclude that the gestational exposure to phthalates was associated with children's lower FVC and FEV1, especially in early childhood, and in a statistically significant manner for MEP, MiBP, MBzP and MnBP. Given the ubiquity of phthalate exposure and its established endocrine disrupting effects in children, our findings support current regulations that limit phthalate exposure.

Thinness negatively affects lung function among Sri Lankan children.

BackgroundThere have been conflicting findings on the effect of body mass index (BMI) on lung functions in children. Therefore, we studied the relationship between spirometry parameters and BMI among healthy Sri Lankan school children aged 5–7 years.MethodsA cross-sectional study was conducted among 296 school children (5–7-year-old) without apparent lung disease. Recruitment was done with stratified random sampling. Spirometry parameters, FEV1, FVC, PEFR, and FEV1/FVC ratio were determined. The acceptable and reproducible spirometry recordings were included in the analysis. Simple and multivariate linear regression analysis examined possible associations of lung function parameters with BMI, socio‐demographic variables and indoor risk factors. Also, the mediator effect of gender on lung function through BMI was explored.ResultsThe participants’ mean age (SD) was 6.4 (0.65) years. One-third were thin/severely thin (37%). A statistically significant difference in FVC (p = 0.001) and FEV1 (p = 0.001) was observed between BMI groups (obesity/overweight, normal, and thinness). Yet, PEFR or FEV1/FVC did not significantly differ among BMI groups (p = 0.23 and p = 0.84). Multivariate regression analysis showed that FEV1 and FVC were significantly associated with BMI, child’s age, gender, family income, father’s education, having a pet, and exposure to mosquito coil smoke. Interaction between gender and BMI for lung functions was not significant. The thin children had significantly lower FVC (OR: -0.04, 95%CI: -0.077, -0.012, p = 0.008) and FEV1 (OR: -0.04, 95%CI: -0.075, -0.014, p = 0.004) than normal/overweight/obese children. Family income demonstrated the greatest effect on lung functions; FVC and FEV1 were 0.25L and 0.23L smaller in low-income than the high-income families.ConclusionLower lung function parameters (FVC and FEV1) are associated with thinness than normal/overweight/obese dimensions among children without apparent lung disease. It informs that appropriate nutritional intervention may play a role in improving respiratory health.

Residential Wood Burning and Pulmonary Function in the Agricultural Lung Health Study.

Background:In low- and middle-income countries, burning biomass indoors for cooking or heating has been associated with poorer lung function. In high-income countries, wood, a form of biomass, is commonly used for heating in rural areas with increasing prevalence. However, in these settings the potential impact of chronic indoor woodsmoke exposure on pulmonary function is little studied.Objective:We evaluated the association of residential wood burning with pulmonary function in case–control study of asthma nested within a U.S. rural cohort.Methods:Using sample weighted multivariable linear regression, we estimated associations between some and frequent wood burning, both relative to no exposure, in relation to forced expiratory volume in 1 s (), forced vital capacity (FVC), their ratio (), and fractional exhaled nitric oxide (FeNO). We examined effect modification by smoking or asthma status.Results:Among all participants and within smoking groups, wood burning was not appreciably related to pulmonary function. However, in individuals with asthma (), frequent wood burning was significantly associated with lower [: ; 95% confidence interval (CI): , ], FVC (: ; 95% CI: , ), and (: ; 95% CI: , ), whereas no appreciable association was seen in individuals without asthma (). These differences in association by asthma were statistically significant for () and (). Frequent wood burning was also associated with higher FeNO levels in all individuals (; : ; 95% CI: 0.02, 0.2), but associations did not differ by asthma or smoking status.Discussion:Frequent exposure to residential wood burning was associated with a measure of airway inflammation (FeNO) among all individuals and with lower pulmonary function among individuals with asthma. This group may wish to reduce wood burning or consider using air filtration devices. https://doi.org/10.1289/EHP10734