Lower Pulmonary Function Research Articles

Lung Function and Heart Disease in American Indian Adults With High Frequency of Metabolic Abnormalities (from the Strong Heart Study)

The associations of pulmonary function with cardiovascular disease (CVD) independent of diabetes mellitus (DM) and metabolic syndrome have not been examined in a population-based setting. We examined prevalence and incidence CVD in relation to lower pulmonary function in the Strong Heart Study second examination (1993 to 1995) in 352 CVD and 2,873 non-CVD adults free of overt lung disease (mean age 60 years). Lung function was assessed by standard spirometry. Participants with metabolic syndrome or DM with or without CVD had lower pulmonary function than participants without these conditions after adjustment for hypertension, age, gender, abdominal obesity, smoking, physical activity index, and study field center. CVD participants with DM had significantly lower forced vital capacity than participants with CVD alone. Significant associations were observed between reduced pulmonary function, preclinical CVD, and prevalent CVD after adjustment for multiple CVD risk factors. During follow-up (median 13.3 years), pulmonary function did not predict CVD incidence, it predicted CVD mortality. Among 3,225 participants, 412 (298 without baseline CVD) died from CVD by the end of 2008. In models adjusted for multiple CVD risk factors, DM, metabolic syndrome, and baseline CVD, compared with highest quartile of lung function, lower lung function predicted CVD mortality (relative risk up to 1.5, 95% confidence interval 1.1 to 2.0, p<0.05). In conclusion, a population with a high prevalence of DM and metabolic syndrome and lower lung function was independently associated with prevalent clinical and preclinical CVD, and its impairment predicted CVD mortality. Additional research is needed to identify mechanisms linking metabolic abnormalities, low lung function, and CVD.

Stigma and optimism in adolescents and young adults with cystic fibrosis

BackgroundDespite increased life expectancy among patients with cystic fibrosis (CF), few studies have examined coping among adolescents and young adults with CF. Previous research suggests that stigma associated with chronic disease is related to worse physical and psychological health, but optimism may be protective. This study examined stigma and optimism among patients with CF. MethodsSeventy-two patients with CF (ages 14 to 25) completed a self-report questionnaire assessing stigma, distress, CF-specific quality of life (QoL), and optimism. Objective health data were recorded from patient medical records. ResultsGreater stigma was associated with lower pulmonary function, QoL, and optimism. Stigma was positively correlated with distress. Optimism moderated the relationship between stigma and anxiety (p<0.001), and between stigma and emotional functioning (p<0.01). ConclusionsStigma is related to worse lung function and psychological health in patients with CF, but higher levels of optimism may act as a protective factor.

Vascular Dysfunction and Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is characterized by low pulmonary function, inflammation, free radical production, vascular dysfunction, and subsequently a greater incidence of cardiovascular disease. By administering an acute oral antioxidant cocktail to patients with COPD (n=30) and controls (n=30), we sought to determine the role of redox balance in the vascular dysfunction of these patients. Using a double-blind, randomized, placebo-controlled, crossover design, patients with COPD and controls were ingested placebo or the antioxidant cocktail (vitamin C, vitamin E, α-lipoic acid) after which brachial artery flow-mediated dilation and carotid-radial pulse wave velocity were assessed using ultrasound Doppler. The patients exhibited lower baseline antioxidant levels (vitamin C and superoxide dismutase activity) and higher levels of oxidative stress (thiobarbituic acid reactive species) in comparison with controls. The patients also displayed lower basal flow-mediated dilation ( P &lt;0.05), which was significantly improved with antioxidant cocktail (3.1±0.5 versus 4.7±0.6%; P &lt;0.05; placebo versus antioxidant cocktail), but not controls (6.7±0.6 versus 6.9±0.7%; P &gt;0.05; placebo versus antioxidant cocktail). The antioxidant cocktail also improved pulse wave velocity in patients with COPD (14±1 versus 11±1 m·s −1 ; P &lt;0.05; placebo versus antioxidant cocktail) while not affecting controls (11±2 versus 10±1 m·s −1 ; P &gt;0.05; placebo versus antioxidant). Patients with COPD exhibit vascular dysfunction, likely mediated by an altered redox balance, which can be acutely mitigated by an oral antioxidant. Therefore, free radically mediated vascular dysfunction may be an important mechanism contributing to this population’s greater risk and incidence of cardiovascular disease.

Apnea-related sleep fragmentation and poor vigilance in children with well-controlled asthma.

It has been reported that sleep problems and neurocognitive deficit in asthmatic children is prevalent. However, systematic studies on these problems in stable asthma using polysomnography have rarely been performed. We therefore investigated sleep and neurocognitive functioning in children with well-controlled asthma. Forty-three children with well-controlled, stable asthma and 31 controls (age range: 6-9years) were enrolled in the study. Subjects were questioned for daytime sleepiness using the Paediatric Daytime Sleepiness Scale. Complete overnight polysomnography and neurocognitive function tests were performed on all subjects. Children with stable asthma had lower pulmonary function in comparison to their age-matched controls. Asthmatic children had a higher apnea-hypopnea index (P<0.001) and apnea-hypopnea-related arousal index (P<0.001) as compared with non-asthmatics. Deep sleep was decreased in asthmatics (P=0.001). In the vigilance test, the mean number of correct answers was lower (P=0.005) and the mean reaction time was slower (P=0.002) in asthmatic children. A hierarchical multiple linear regression showed that deep sleep and apnea-hypopnea-related arousal index were significant predictors of vigilance. The data suggest that the prevalence of paediatric sleep-disordered breathing and sleep fragmentation could be very high among children with well-controlled asthma. Moreover, vigilance, the ability to maintain attention and alertness, was worse in stable asthmatic children when compared with healthy controls. Sleep-disordered breathing should be checked even in stable asthmatic children as they are at risk for developing neurobehavioural deterioration associated with frequent arousals during sleep. Furthermore, early treatment for asthma may be required in order to prevent airway remodelling that could cause sleep problems.

Low pulmonary function in individuals with impaired fasting glucose: the 2007-2009 Korea national health and nutrition examination survey.

ObjectiveTo investigate the association between fasting plasma glucose level and pulmonary function.Research Design and MethodsNutritional information, pulmonary function data, and laboratory test data from 9,223 subjects from the fourth Korea National Health and Nutrition Examination Survey were examined. The participants were divided into five groups according to fasting plasma glucose (FPG) level: normal fasting glucose (NFG)1, FPG <90 mg/dl; NFG2, FPG 90-99 mg/dl; impaired fasting glucose (IFG)1: FPG 100-109 mg/dl; IFG2, FPG 110-125 mg/dl; and diabetes, FPG ≥126 mg/dl and/or current anti-diabetes medications.ResultsAfter adjustment for several variables, the percentage of predicted forced vital capacity(FVC%) decreased with increasing fasting plasma glucose level in both sexes[men: (mean ± SEM) 92.0±0.3 in NFG1; 91.9±0.3 in NFG2; 92.0±0.4 in IFG1; 90.2±0.7 in IFG2; and 89.9±0.5 in diabetes, P = 0.004; women: 93.7±0.3 in NFG1; 93.7±0.3 in NFG2; 93.1±0.5 in IFG1; 91.1±0.9 in IFG2; and 90.7±0.6 in diabetes, P<0.001]. A logistic regression analysis found that IFG2 and diabetes were independently associated with the lowest quintile of predicted FVC% (IFG2: odds ratio [95%CI], 1.50 [1.18-1.89], P = 0.001; diabetes: 1.56 [1.30-1.88], P<0.001) using NFG1 as a control.ConclusionsThe current data suggest that forced vital capacity may begin to decrease in the higher range of IFG.

Viral infections in asthma and COPD

Airway viral infections are associated with the pathogenesis of asthma and COPD. It has been argued that respiratory syncytial virus (RSV) infection in infancy is a probable causal factor in the development of pediatric asthma. RSV infections tend to induce Th2-biased immune responses in the host airways. RSV infection, atopy, and low pulmonary function in neonates may work synergistically toward the development of pediatric asthma. Human rhinovirus (HRV) is a representative virus associated with the exacerbation of asthma in both children and adults. Viral infections trigger innate immune responses including granulocytic inflammation and worsen the underlying inflammation due to asthma and COPD. The innate immune responses involve type-I and -III interferon (IFN) production, which plays an important role in anti-viral responses, and the airway epithelia of asthmatics reportedly exhibit defects in the virus-induced IFN responses, which renders these individuals more susceptible to viral infection. A similarly impaired IFN response is seen in COPD, and several investigators propose that latent adenoviral infection may be involved in COPD development. Persistent RSV infections were detected in a sub-population of patients with COPD and were associated with the accelerated decline of lung function. The virus-induced upregulation of co-inhibitory molecules in the airway epithelium partly accounts for the persistent infections. Experimental animal models for virus-asthma/COPD interactions have shed light on the underlying immune mechanisms and are expected to help develop novel approaches to treat respiratory diseases.

Assessment of respiratory symptoms and pulmonary function in relation to mold and dampness in South India: Preliminary results from the SICAPHE study

Background: Few efforts have been undertaken to objectively assess respiratory symptoms and pulmonary function in relation to mold and dampness assessments especially in studies from developing countries. We report preliminary results from respiratory assessments in the newly established South Indian Cohort for Air Pollution and Health Effects (SICAPHE) study aimed at generating exposure-response relationships for air pollution, select birth/early childhood outcomes and adult respiratory outcomes. Aim: Assessment of respiratory symptoms and pulmonary function in relation to mold and dampness assessments a rural –urban adult mother cohort in south India. Methodology: We administered a standardised validated questionnaire based on the International Union Against Tuberculosis and Lung Disease’s 1984 questionnaire to assess prevalence of respiratory symptoms and performed pulmonary function assessments following protocols developed by the American Thoracic Society for a sub-set adult subjects enrolled in the SICAPHE study (n=444 out of total cohort enrollment of 1200). We performed dampness assessments using questionnaires developed by WHO and characterized 4 types of mold species including Aspergillus, Cladosporium, Penicillium, Alternaria. Results: Initial analyses indicate a prevalence of 28.8 % for mold and 31.6% for dampness. 13.3% of the subjects reported symptoms of wheeze, allergic cough and allergic rhinitis. Pulmonary function decline was significantly associated with higher concentrations of PM 2.5 and presence of mold or dampness. Rural households had a higher prevalence of mold, dampness and higher concentrations of PM 2.5. Rural subjects reported a greater prevalence of respiratory symptoms and lower pulmonary function as compared to urban subjects. Conclusion: The on-going analyses is expected to generate exposure –response relationships for respiratory symptoms and pulmonary function in relation to dampness, mold and air pollution exposure for the SICAPHE study.

Perception of Pulmonary Function and Asthma Control: The Differential Role of Child Versus Caregiver Anxiety and Depression*

To examine child and caregiver anxiety and depression as predictors of children's perception of pulmonary function, quick-relief medication use, and pulmonary function. 97 children with asthma, ages 7 to 11 years old, reported their anxiety and depressive symptoms and completed spirometry. Caregivers completed a psychiatric interview. Children's predictions of their peak expiratory flow were compared with actual values across 6 weeks. Quick-relief medication use was assessed by Dosers. Children's anxiety symptoms were associated with over-perception of respiratory compromise and greater quick-relief medication use. Children's depressive symptoms were associated with greater quick-relief medication use, but not perception of pulmonary function. Children of caregivers with an anxiety or depressive disorder had lower pulmonary function than children of caregivers without anxiety or depression. Child anxiety was associated with a subjective pattern of over-perception. Caregiver anxiety and depression were risk factors for lower lung function assessed by objective measurement.

Treatment of Intractable Pneumothorax with Emphysema Using Endobronchial Watanabe Spigots

Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.

269 Nutritional assessment and dietary intake in children and teenagers with cystic fibrosis

Introduction: Cystic Fibrosis (CF) is characterized by respiratory infections and malabsorption. The hypercatabolism inherent to CF, affects the nutritional requirements and, consequently, the nutritional status. Objectives: Assess the nutritional status of patients with CF and compare the dietary intake with the nutritional state and requirements. Methods: Cross-sectional observational study, 40 patients followed in a specialized CF center in Lisbon were included. A questionnaire was applied to the patient/care taker, which included a 48 h recall. Clinical and anthropometric parameters were recorded. The sample was divided in 5 groups: G1:7−12M; G2 1−3Y; G3: 4−8Y; G4: 9−13Y: G5: 14−18Y. Statistic analysis by SPSS v.20.0. Results: 40 patients were evaluated; 51.2%female; average age of 9.4±5.0 Y. The diagnosis, was made in 25% between 6W and 6M and 25% between 1 and 5Y. No correlation was found between the age of diagnosis and the BMI z-score. A positive correlation was found in G1 and G2 between the energetic intake and BMI (r = 1, p = 0.00; r = 0.835, p = 0.039, respectively). The average pulmonary function (FEV1) was 88.9±22.9%; it was also found a positive correlation with BMI (p = 0.00). It was observed that 42.5% of the patients did supplementation and that the protein free powder was the most prescribed. It was also observed that the patients with supplementation had lower pulmonary function and BMI (p = 0.018 e p = 0.034, respectively). Conclusion: In conclusion the nutritional state, according to the z-score of BMI, is better on G3(4−8Y) and G5(14−18Y). However, only a small part of the sample reached the requirements in which G4(9−13Y) had the higher fulfillment percentage.

270 Body mass index percentiles in children with cystic fibrosis

Introduction: Cystic Fibrosis (CF) is characterized by respiratory infections and malabsorption. The hypercatabolism inherent to CF, affects the nutritional requirements and, consequently, the nutritional status. Objectives: Assess the nutritional status of patients with CF and compare the dietary intake with the nutritional state and requirements. Methods: Cross-sectional observational study, 40 patients followed in a specialized CF center in Lisbon were included. A questionnaire was applied to the patient/care taker, which included a 48 h recall. Clinical and anthropometric parameters were recorded. The sample was divided in 5 groups: G1:7−12M; G2 1−3Y; G3: 4−8Y; G4: 9−13Y: G5: 14−18Y. Statistic analysis by SPSS v.20.0. Results: 40 patients were evaluated; 51.2%female; average age of 9.4±5.0 Y. The diagnosis, was made in 25% between 6W and 6M and 25% between 1 and 5Y. No correlation was found between the age of diagnosis and the BMI z-score. A positive correlation was found in G1 and G2 between the energetic intake and BMI (r = 1, p = 0.00; r = 0.835, p = 0.039, respectively). The average pulmonary function (FEV1) was 88.9±22.9%; it was also found a positive correlation with BMI (p = 0.00). It was observed that 42.5% of the patients did supplementation and that the protein free powder was the most prescribed. It was also observed that the patients with supplementation had lower pulmonary function and BMI (p = 0.018 e p = 0.034, respectively). Conclusion: In conclusion the nutritional state, according to the z-score of BMI, is better on G3(4−8Y) and G5(14−18Y). However, only a small part of the sample reached the requirements in which G4(9−13Y) had the higher fulfillment percentage.

Pulmonary function in children and young adults with ataxia telangiectasia

Pulmonary disease contributes to significant morbidity and mortality in people with ataxia telangiectasia (A-T). To determine the association between age and lung function in children and young adults with A-T and to identify factors associated with decreased lung function, pulmonary function tests were performed in 100 consecutive people with A-T. Children and adults ranging from 6 to 29 years of age and with the diagnosis of A-T were recruited, and underwent pulmonary function tests. The mean forced vital capacity % predicted (FVC %) in the population was 56.6 ± 20.0. Males and females between 6 and 10 years of age had similar pulmonary function. Older females were found to have significantly lower FVCs % than both older males (P < 0.02) and younger females (P < 0.001). The use of supplemental gamma globulin was associated with significantly lower FVC %. A modest correlation was found between higher radiation-induced chromosomal breakage and lower FVC % in males. No significant change in FVC % was found in a subset of subjects (n = 25) who underwent pulmonary function testing on two or more occasions over an average of 2 years. In children and young adults with A-T, older females and people who required supplemental gamma globulin had significantly lower lung function by cross-sectional analysis. Stable lung function is possible over a 2-year period. Recognition of groups who are at higher risk for lower pulmonary function may help direct care and improve clinical outcomes in people with A-T.

Pulmonary Function Impairment May Be an Early Risk Factor for Late‐Life Cognitive Impairment

To determine the association between change in pulmonary function (PF) and mid- and late-life cognitive function. Prospective population-based cohort study that included measures of pulmonary function in midlife and brain magnetic resonance imaging data acquired in late life. The Age, Gene/Environment Susceptibility-Reykjavik Study. Three thousand six hundred sixty-five subjects who had at least one measure of forced expiratory volume in 1 second (FEV(1)) and were cognitively tested on average 23 years later. A subset of 1,281 subjects had two or three measures of FEV(1) acquired over a 7.8-year period. Pulmonary function was estimated as FEV(1)/height(2). Rate of PF decline was estimated as the slope of decline over time. Cognitive status was measured with continuous scores of memory, speed of processing, and executive function and as the outcome of mild cognitive impairment (MCI) and dementia. Lower PF measured in midlife predicted poorer memory, slower speed of processing, poorer executive function, and greater likelihood of MCI and dementia 23 years later. Decrease in PF over a 7.8-year period in midlife was not associated with MCI or dementia. Low PF measured in midlife may be an early marker of later cognitive problems. Additional studies characterizing early and late PF changes are needed.

Differences of the Truncal Expansion and Respiratory Function between Children with Spastic Diplegic and Hemiplegic Cerebral Palsy

[Purpose] We attempted to determine whether differences of respiratory function could be found in terms of truncal expansion, respiratory muscle strength, and pulmonary function test (PFT) between children with spastic diplegic and hemiplegic cerebral palsy. [Subjects and Methods] We recruited 19 children with spastic diplegic CP (diplegic-CP group) and 10 children with spastic hemiplegic CP (hemiplegic-CP group). For all the children, clinical factors associated with respiratory functions were assessed in terms of truncal expansion (chest and waist expansion), respiratory muscle strength (maximal inspiration and expiration pressures: MIP and MEP), and pulmonary function test (FVC, FEV1, and FEV1/FVC). [Results] Overall, the diplegic-CP group showed lower truncal circumference, respiratory muscle strength, and pulmonary function values than the hemiplegic-CP group. However, in the comparison of the two groups significant differences were only found in waist expansion, MIP, MEP, FVC, and FEV1. [Conclusion] The results of this study indicate that children with diplegic CP have much poorer waist expansion, weaker respiratory muscle, and lower pulmonary function values. These findings will provide valuable information for use in the clinical assessment and treatment of children with spastic CP.

Genetic Variation of SCNN1A Influences Lung Diffusing Capacity in Cystic Fibrosis

Epithelial Na channels (ENaCs) play a crucial role in ion and fluid regulation in the lung. In cystic fibrosis (CF), Na hyperabsorption results from ENaC overactivity, leading to airway dehydration. Previous work has demonstrated functional genetic variation of SCNN1A (the gene encoding the ENaC α-subunit), manifesting as an alanine (A) to threonine (T) substitution at amino acid 663, with the αT663 variant resulting in a more active channel. We assessed the influence of genetic variation of SCNN1A on the diffusing capacity of the lungs for carbon monoxide (DLCO) and nitric oxide (DLNO), together with alveolar-capillary membrane conductance (DM), pulmonary capillary blood volume, and alveolar volume (VA) at rest and during peak exercise in 18 patients with CF (10 homozygous for αA663 (AA group) and 8 with at least one T663 allele (AT/TT group)). Because of the more active channel, we hypothesized that the AT/TT group would show a greater increase in DLCO, DLNO, and DM with exercise because of exercise-mediated ENaC inhibition and subsequent attenuation of Na hyperabsorption. The AT/TT group had significantly lower pulmonary function, weight, and body mass index than the AA group. Both groups had similar peak workloads, relative peak oxygen consumptions, and cardiopulmonary responses to exercise. The AT/TT group demonstrated a greater increase in DLNO, DLNO/VA, and DM in response to exercise (% increases: DLNO = 18 ± 11 vs 41 ± 38; DLNO/VA = 14 ± 21 vs 40 ± 37; DM = 15 ± 11 vs 41 ± 38, AA vs AT/TT, respectively). There were no differences between groups in absolute diffusing capacity measures at peak exercise. These results suggest that genetic variation of the α-subunit of ENaC differentially affects the diffusing capacity response to exercise in patients with CF.

Occupational Exposure to Petroleum Products and Respiratory Health

To investigate the possible impact of long-term occupational exposure to hydrocarbons on respiratory health. Respiratory health was assessed by questionnaires, spirometry, and exhaled nitric oxide in 250 male workers from a company handling and distributing refined petroleum products (exposed) and 250 electricians (controls). Exposure to hydrocarbons was assessed by personal air monitoring. Aerial exposure to hydrocarbons was low. Respiratory and nasal symptoms were significantly more frequent among exposed subjects than among controls. Although forced vital capacity and forced expiratory volume in 1 second did not differ, ratio of forced expiratory volume in 1 second to forced vital capacity and maximal expiratory flows were significantly lower in exposed than in control subjects, adjusting for smoking. Exhaled nitric oxide was significantly higher among exposed subjects (30.1 ppb) than among controls (21.6 ppb), adjusting for age and smoking. Even low exposure to petroleum-derived hydrocarbons is associated with more respiratory and nasal symptoms, lower pulmonary function, and airway inflammation.

Is There a Dose Response Relationship for Pulmonary Function Changes After Stereotactic Body Radiation Therapy for Early-stage Non-small Cell Lung Cancer?

Is There a Dose Response Relationship for Pulmonary Function Changes After Stereotactic Body Radiation Therapy for Early-stage Non-small Cell Lung Cancer?

Low Lung Function and Risk of Type 2 Diabetes in Japanese Men: The Toranomon Hospital Health Management Center Study 9 (TOPICS 9)

ObjectiveTo evaluate the effect of elevated fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) concentrations on lung dysfunction and to prospectively investigate whether reduced lung function would be independently predictive of diabetes. Participants and MethodsFrom January 6, 1997, through December 22, 2008, we observed 5346 men with no history of diabetes or lung dysfunction. Hazard ratios (HRs) for incident diabetes (FPG ≥126 mg/dL, HbA1c ≥6.5%, or self-reported clinician-diagnosed diabetes) were estimated for spirometry indices as continuous and categorical variables. ResultsElevated HbA1c concentrations within the normal range were significantly and more strongly associated with reduced forced vital capacity and forced expiratory volume in the first second after expiration (FEV1) than were FPG concentrations. During a 4.0-year follow-up, diabetes developed in 214 individuals. A 10-point decrease in percentage of FEV1 predicted value was associated with an increased HR of 1.21 (95% confidence interval [CI], 1.09-1.34; P=.001) for diabetes after adjustment for demographic factors and body mass index. This association remained significant even after adjustment for metabolic factors, smoking status, and FPG or HbA1c concentrations but was attenuated substantially after adjustment for baseline HbA1c values (HR, 1.13; 95% CI, 1.01-1.26; P=.03). Lower quartile (Q) categories of percentage of FEV1 predicted value were associated with increased risk of diabetes independently of known predictors including HbA1c (HR, 1.73; 95% CI, 1.14-2.62 for Q1; and HR, 1.76; 95% CI, 1.15-2.69 for Q2). ConclusionReduced lung function was significantly related to chronic glycemic exposure within a normal range. Relatively low pulmonary function was an independent risk factor for diabetes in apparently healthy Japanese men.

Pulmonary Function and Cognitive Decline in an Older Chinese Population in Singapore

Introduction: Various cognitive deficits associated with reduced pulmonary function are reported in different studies, but the pattern of cognitive deficits across multiple domains and its associated everyday functional disability remain unclear. Methods: We analyzed neuropsychological functioning, cognitive impairment and accompanying disability in instrumental activities of daily living (IADL) associated with reduced pulmonary function in community-living middle-aged and older adults in Singapore. Performance on a comprehensive battery of neuropsychological tests, spirometry and cognitively demanding IADLs were assessed in the population-based Singapore Longitudinal Ageing Studies. Results: Consecutive 10% increase in forced expiratory volume in 1 s (FEV1) as percent of predicted was positively associated with 0.18 points increase in Mini-mental state examination (MMSE) and 0.04 points increase in executive function, independent of age, education and other variables. Subjects with moderate-to-severe airway obstruction showed significantly poorer MMSE score (p for linear trend = 0.001), and information processing speed (p for linear trend < 0.001). FEV1 (per 10% of predicted) was significantly associated with lower risk of cognitive impairment (OR = 0.92, 95% CI: 0.87-0.98, P = 0.005) and cognitive IADL disability (OR = 0.86,95% CI:0.79–0.93, P < 0.001). Pulmonary restriction was associated with greater risk of cognitive impairment (OR = 1.98, 95% CI: 1.26-3.11, P = 0.003) and cognitive IADL disability (OR = 2.43, 95% CI: 1.31-4.53, P = 0.005). Moderate-to-severe airway obstruction (OR = 2.04, 95% CI: 1.11–3.74, P = 0.022) was positively associated with cognitive IADL disability. Conclusion: The findings suggest a measurable but modest cognitive effect of low pulmonary function that was accompanied by corresponding disability in living activities. The effect on executive functioning should be further investigated in longitudinal studies.

Prediction of radiation pneumonitis in lung cancer patients: a systematic review

Factors prediction in the development of radiation pneumonitis (RP) remains unclear. A meta-analysis about this was performed. Articles were searched in February 2012 from PubMed, EMBASE, Cochrane Library and CNKI (Chinese Journal Full-text Database) using the keywords "lung cancer," "radiation pneumonitis" or "radiation lung injury." The outcome was the RP incidence. We pooled the data using RevMan 5.1 software and tested the statistical heterogeneity. We included the following factors: age, gender, weight loss, smoking history, complications, performance status, pre-radiation therapy (RT) pulmonary function, TNM, histological type, tumor location, pre-RT surgery, RT combined with chemotherapy (RCT), RT/RCT combined with amifostine, plasma end/pre-RT TGF-β1 ratio and irradiation volume. The significant risk factors for RP≥grade 2 were patients with chronic lung disease, tumor located in the middle or lower lobe, without pre-RT surgery, RCT, plasma end/pre-RT TGF-β1 ratio ≥1 and gross tumor volume (GTV). Following factors were identified significant for RP, including tumor located not in the upper lobe, smokers, combined with chronic lung diseases or diabetes mellitus, low pre-RT pulmonary function, RCT, RT/RCT without amifostine and plasma end/pre-RT TGF-β1 ratio ≥1. Dose-volume parameters included the average of mean lung dose (MLD) of disease lung, GTV and V (5), V (10) (≥34%), V (20) (≥25%), V (30) (≥18%) of bilateral lung. More attention should be paid to the levels of patients' pulmonary function, plasma TGF-β1 and dose-volume histogram (DVH). Rigorous studies are needed to identify the relationship between the above-mentioned factors and RP ≥grade 1 or 3.