Diffusing Capacity Of Lung Research Articles

Relationship between smoking and indicators of systemic inflammation in patients with coronary heart disease

To estimate the severity of systemic inflammation in subjects with coronary artery disease (CAD) without bronchopulmonary system comorbidity depending on smoking factor. The subjects were divided into groups depending on smoking factor. We estimated the following laboratory markers of nonspecific inflammation: interleukine (IL)-12, -1β, tumour necrosis factor-α, matrix metalloproteinase-9, C-reactive protein. The examination of lungs respiratory function included spirometry, body plethysmography and assessment of diffusing lung capacity. 29.9% of the subjects with CAD smoked, 40% reported discontinuation of smoking in their histories. Smoking in CAD subjects without the history of bronchopulmonary system comorbidity was associated with a higher level of inflammatory markers (IL-12, IL-1β, TNF-α, ММР-9 and CRP) than in subjects who ceased to smoke and those who have never smoked. No differences in the levels of inflammatory markers were revealed in subjects who had smoked before and never smoked. Smoking is widespread among CAD subjects. It is associated with a higher level of markers of nonspecific inflammation as compared to subjects who have never smoked before or ceased smoking.

Impairment of pulmonary diffusion correlates with hypoxemic burden in central sleep apnea heart failure patients

PurposeCentral sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) are highly prevalent in heart failure (HF) and are linked to increased mortality. Impaired pulmonary diffusion capacity [DLCO] and [KCO]) have been suggested to play a key role in CSA-CSR pathophysiology. This study investigated the relationship between HF, CSR, DLCO and KCO in well-characterized HF patients. MethodsThis prospective study included HF patients with CSR, all patients underwent full overnight polysomnography (PSG) and lung function testing. ResultsA total of 100 patients were included (age 70.7±9.7years, 95% male, body mass index 28.9±5.3kg/m2, left ventricular ejection fraction 33.5±7.7%, New York Heart Association class III 65%. DLCO and oxygenation were significantly correlated with hypoxemic burden (p<0.05). Mean oxygen saturation, oxygen desaturation, C-reactive protein level and pH were significantly associated with CSA-CSR severity (p<0.05). ConclusionThe finding that lung diffusion capacity is significantly associated with hypoxemic burden in HF patients with CSA-CSR highlights the important of lung function in HF patients.

Evaluation of the questionnaires\u2019 validity in assessing the severity of idiopathic pulmonary fibrosis in correlation with high-resolution computed tomography, lung diffusion, and cardiopulmonary exercise tests

IntroductionHealth-related quality-of-life questionnaires need to be incorporated into the evaluations of idiopathic pulmonary fibrosis (IPF) patients to assess their influence.AimThe aim of the study was to evaluate the validity of generic and specific questionnaires in assessing the severity of IPF in correlation with high-resolution computed tomography (HRCT), diffusion lung capacity for carbon monoxide (DLCO), and cardiopulmonary exercise testing (CPET).Patients and methodsForty stable IPF patients were prospectively recruited and categorized on the basis of spirometry, DLCO, HRCT, and CPET. The results were correlated with a generic International Physical Activity Questionnaire (IPAQ) and a Specific Saint George Respiratory Questionnaire (SGRQ).ResultsIPF patients showed restrictive pattern with impairment of diffusion capacity (forced vital capacity (FVC)= 56±14.8% and DLCO=48.5±20% of predicted value) with a total semiquantitative scoring of HRCT 16.6±8. The mean total score of the SGRQ questionnaire for all studied cases was 56.5+21 and categorical scoring of IPAQ showed that 45, 42.5, and 12.5% of patients were in moderate, severe, and mild categories, respectively. There was a negative correlation between the total score of SGRQ and VO2max (ml/kg/min) (maximum oxygen consumption) (r=−0.35) and VE’ (l/min) (minute ventilation) (r=−0.39) on CPET, as well as with DLCO (r=−0.53), and a positive correlation with HRCT score (r=0.63). There was a highly significant correlation between IPAQ and VO2max (χ2=28), VE’ (χ2=14.8) and desaturation percentage variables of CPET, DLCO (r=0.61), and HRCT score (r=−0.68).ConclusionCorrelations between physiological parameters including DLCO and CPET, radiological parameters in the form of HRCT, and health-related quality-of-life assessment using SGRQ and IPAQ were strong and it was possible to distinguish IPF patients with severely impaired lung functions.

Outcome of patients with interstitial lung diseases admitted to the Respiratory Intensive Care Unit

IntroductionClinicians may face unique challenges while managing critically ill patients with interstitial lung diseases (ILD) admitted to respiratory intensive care units (RICUs).ObjectivesThe aim of the present study was to determine the outcome of ILD patients admitted to RICU as regards mortality rate and risk factors associated with mortality.Patients and methodsNinety-one patients with ILD admitted to RICU were prospectively recruited. We analyzed demographic data, pulmonary function test results, arterial blood gas values, therapeutic strategies, mechanical ventilation (MV) use, RICU and hospital duration, and mortality rates.ResultsThe RICU morality rate was 9.9%. Presence of hemophilia, renal impairment, low-diffusion lung capacity for carbon monoxide, and low arterial oxygen saturation were significantly more frequent among nonsurvivor compared with survivor patients. All nonsurvivor patients had pulmonary hypertension compared with 69% of the survivors, but without a significant difference. Fifteen percent of our patients received invasive MV. There were no significant differences between nonsurvivors and survivors as regards need for MV and duration of MV. Whereas patients with a positive history of previous MV had a significant survival time that was less than those with a negative history of previous MV. The duration of hospital and RICU stay were significantly longer in the survivors group compared with the nonsurvivors group (12.65±9.06 vs. 5.55±4.12 and 10.51±7.51 vs. 4.88±2.31, respectively).ConclusionOur study population showed very low RICU morality rate when compared with previous studies. Nonsurvivors had a shorter hospital and RICU stay, positive history of previous MV, lower diffusion lung capacity for carbon monoxide, and lower arterial oxygen saturation.

Riskfactors for acute exacerbation of idiopathic pulmonary fibrosis: A systematic review and meta-analysis.

Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive fibrotic disease limited to the lungs. The course of disease varies widely, with some patients experiencing acute respiratory deterioration, a condition called acute exacerbations of IPF (AE-IPF). The risk factors contributing to AE-IPF are unclear. This systematic review and meta-analysis investigated the risk factors for AE-IPF. Studies of risk factors for AE-IPF were identified in Medline, EMBASE and Cochrane databases. Fixed effects models were used to calculate pooled relative risks and weighted mean differences (WMD).The meta-analysis included seven articles involving 14 risk factors for AE-IPF. Risk factors for AE included reductions in vital capacity (VC; WMD - 10.58, 95% confidence interval (CI) -17.17 to - 3.99), forced vital capacity (FVC; WMD -6.02, 95%CI - 8.58 to - 3.47), total lung capacity (TLC; WMD -4.88, 95%CI -7.59 to - 2.17), and PaO2 (WMD -4.19, 95%CI -7.66 to -0.71) and a higher alveolar-arterial oxygen difference (AaDO2 ; WMD 4.4, 95%CI 0.24 to 8.57). Mechanical procedures, higher serum KL-6 concentration and secondary pulmonary hypertension, might be risk factors for AE-IPF. In contrast, age, sex, body mass index (BMI), differences in diffusing lung capacity for carbon monoxide (DLCO), exposure to seasonal variations and air pollution, and virus infection might be unrelated to AE-IPF. Poor pulmonary function, mechanical procedures, higher serum KL-6 and secondary pulmonary hypertension were associated with increased risks of AE-IPF.

Resting Physiological Correlates of Reduced Exercise Capacity in Smokers with Mild Airway Obstruction

ABSTRACTSmokers with minor spirometric abnormalities can experience persistent activity-related dyspnea and exercise intolerance. Additional resting tests can expose heterogeneous physiological abnormalities, but their relevance and association with clinical outcomes remain uncertain. Subjects included sixty-two smokers (≥20 pack-years), with cough and/or dyspnea and minor airway obstruction [forced expiratory volume in one-second (FEV1) ≥80% predicted and >5th percentile lower limit of normal (LLN) (i.e., z-score >−1.64) using the 2012-Global Lung Function Initiative equations]. They underwent spirometry, plethysmography, oscillometry, single-breath nitrogen washout, and symptom-limited incremental cycle exercise tests. Thirty-two age-matched nonsmoking controls were also studied. Thirty-three (53%) of smokers had chronic obstructive pulmonary disease by LLN criteria. In smokers [n = 62; age 65 ± 11 years; smoking history 43 ± 19 pack-years; post-bronchodilator FEV1 z-score −0.60 ± 0.72 and FEV1/FVC z-score −1.56 ± 0.87 (mean ± SD)] versus controls, peak oxygen uptake (̇VO2) was 21 ± 7 vs. 32 ± 9 ml/kg/min, and dyspnea/̇VO2 slopes were elevated (both p < 0.0001). Smokers had evidence of peripheral airway dysfunction and maldistribution of ventilation when compared to controls. In smokers versus controls: lung diffusing capacity for carbon monoxide (DLCO) was 85 ± 22 vs. 105 ± 17% predicted, and residual volume (RV)/total lung capacity (TLC) was 36 ± 8 vs. 31 ± 6% (both p < 0.01). The strongest correlates of peak ̇VO2 were DLCO% predicted (r = 0.487, p < 0.0005) and RV/TLC% (r = −0.389, p = 0.002). DLCO% predicted was also the strongest correlate of dyspnea/̇VO2 slope (r = −0.352, p = 0.005). In smokers with mild airway obstruction, associations between resting tests of mechanics and pulmonary gas exchange and exercise performance parameters were weak, albeit consistent. Among these, DLCO showed the strongest association with important outcomes such as dyspnea and exercise intolerance measured during standardized incremental exercise tests.

Lower-limb muscle function is a determinant of exercise tolerance after lung resection surgery in patients with lung cancer.

This study aims to investigate the association between exercise tolerance, pulmonary function and lower-limb muscle function in patients with lung cancer who underwent lung resection surgery in the previous year. Sixty-four patients (age: 67 ± 11 years, 66% males) performed a symptom-limited incremental cycle test to define peak oxygen consumption (VO2 peak) and peak workload (Wpeak). The best of two 6-min walking distance (6MWD) tests was also included. Isometric quadriceps strength and isokinetic quadriceps endurance were measured. Post-bronchodilator spirometry, lung volumes and diffusing capacity of the lung for carbon monoxide (DLCO ) measurements were assessed. Univariate correlation analysis and multiple regression analyses were performed. VO2 peak, W peak and 6MWD showed moderate to strong correlations with quadriceps strength/endurance and DLCO while weak to moderate correlations were found with forced expiratory volume in 1 s (FEV1) , functional residual capacity (FRC) and body weight. Multiple regression showed that peak isometric quadriceps strength (P < 0.001) and DLCO (P < 0.001) were significant predictors of VO2 peak (explained variance R2 = 0.67), while quadriceps endurance (P = 0.0015) and DLCO (P < 0.0001) were significant predictors of W peak (R2 = 0.61). Quadriceps endurance capacity (P = 0.013), but not DLCO , significantly contributed to the 6MWD model (R2 = 0.29). We identified a strong significant relationship between peak aerobic capacity and quadriceps muscle function and lung diffusing capacity. 6MWD was significantly related to quadriceps muscle function but not to pulmonary function. These findings suggest that accurate assessment of lower-limb muscle strength has a role in the accurate interpretation of exercise tests and in selecting optimal candidates for resistance training interventions targeting the lower-limb muscles after resection surgery.

Chronic obstructive pulmonary disease as a predictor of poor outcome of surgery for chronic thromboembolic pulmonary hypertension

Aim. The aim of this study was to investigate an influence of pulmonary ventilation and diffusion disorders on outcome of pulmonary endarterectomy.Methods. The study involved patients with chronic thromboembolic pulmonary hypertension (CTEPH) with (n = 43) or without (n = 88) chronic obstructive pulmonary disease (COPD). Body plethysmography and lung diffusing capacity measurement were performed in all patients before pulmonary endarterectomy. We analyzed perioperative clinical characteristics, complications and inhospital mortality.Results. COPD was diagnosed twice more often in patients with CTEPH. Patients with CTEPH and COPD had more severe lung function disorders including more significant reduction in lung diffusing capacity. Comorbidity of COPD and CTEPH significantly increased a risk of respiratory failure in early postoperative period (OR = 2.1 (1.25 – 4.76), p = 0.020), length of hospitalization (p = 0.02), and a risk of inhospital mortality (OR = 4.4 (1.21 – 16.19), p = 0.023). Lung diffusion capacity had an independent predictive value to predict the development of the respiratory failure in early postoperative period (OR = 1.8 (1.08 – 3.57), p = 0.050).Conclusion. Diagnosis of COPD in patients with CTEPH significantly increased risk of poor outcome of the pulmonary endarterectomy

Determinants of exercise capacity in school-aged esophageal atresia patients.

Data on long-term outcome of exercise capacity in school-aged children with esophageal atresia (EA) are scarce. We evaluated maximal exercise capacity and its relation to lung function. Moreover, we studied other possible determinants of exercise capacity and lung function. Exercise capacity of 63 children with EA born 1999-2007 was evaluated at the age of 8 years with the Bruce-protocol. Dynamic and static lung volumes, bronchodilator response and diffusion capacity were measured. Furthermore, perinatal characteristics, hospital admissions for lower respiratory tract infections (RTIs), RTIs treated with antibiotics in the past year, symptoms of gastroesophageal reflux, weight-for-height, and sports participation were evaluated as other potential determinants. Exercise capacity was significantly below normal: mean (SD) SDS -0.91 (0.97); P < 0.001. All spirometric parameters were significantly below normal with significant reversibility of airflow obstruction in 13.5% of patients. Static lung volumes were significantly decreased (mean (SD) SDS TLChe -1.06 (1.29); P < 0.001). Diffusion capacity corrected for alveolar volume was normal (mean (SD) SDS KCO -0.12 (1.04)). Exercise capacity was positively associated with total lung capacity and negatively with SDS weight-for-height. Spirometric parameters were negatively associated with congenital cardiac malformation, duration of ventilation, and persistent respiratory morbidity. Eight-year-old children with EA had reduced exercise capacity which was only associated with the reduction in TLChe and higher SDS weight-for-height. We speculate that diminished physical activity with recurrent respiratory tract infections may also play a role in reduced exercise capacity. This should be subject to further research to optimize appropriate intervention.

No effect of baseline diffusing capacity of lung for carbon monoxide on benefit of nintedanib

No effect of baseline diffusing capacity of lung for carbon monoxide on benefit of nintedanib

Long-term outcomes after salvage radiotherapy for postoperative locoregionally recurrent non-small-cell lung cancer.

PurposeThe outcomes and toxicities of locoregionally recurrent non-small-cell lung cancer (NSCLC) patients treated with curative radiotherapy were evaluated in the modern era.Materials and MethodsFifty-seven patients receiving radical radiotherapy for locoregionally recurrent NSCLC without distant metastasis after surgery from 2004 to 2014 were reviewed. Forty-two patients were treated with concurrent chemoradiotherapy (CCRT), and 15 patients with radiotherapy alone. The median radiation dose was 66 Gy (range, 45 to 70 Gy). Lung function change after radiotherapy was evaluated by comparing pulmonary function tests before and at 1, 6, and 12 months after radiotherapy.ResultsMedian follow-up was 53.6 months (range, 12.0 to 107.5 months) among the survivors. The median overall survival (OS) and progression-free survival (PFS) were 54.8 months (range, 3.0 to 116.9 months) and 12.2 months (range, 0.8 to 100.2 months), respectively. Multivariate analyses revealed that single locoregional recurrence focus and use of concurrent chemotherapy were significant prognostic factors for OS (p = 0.048 and p = 0.001, respectively) and PFS (p = 0.002 and p = 0.026, respectively). There was no significant change in predicted forced expiratory volume in one second after radiotherapy. Although diffusing lung capacity for carbon monoxide decreased significantly at 1 month after radiotherapy (p < 0.001), it recovered to pretreatment levels within 12 months. Acute grade 3 radiation pneumonitis and esophagitis were observed in 3 and 2 patients, respectively. There was no chronic complication observed in all patients.ConclusionSalvage radiotherapy showed good survival outcomes without severe complications in postoperative locoregionally recurrent NSCLC patients. A single locoregional recurrent focus and the use of CCRT chemotherapy were associated with improved survival. CCRT should be considered as a salvage treatment in patients with good prognostic factors.

Positive airway pressure therapy in heart failure patients: Long-term effects on lung function

PurposeThe prevalence of sleep-disordered breathing (SDB) in patients with heart failure (HF) is high. Positive airway pressure (PAP) is first-choice therapy, but recent data indicates that PAP therapy may increase mortality in HF patients with reduced ejection fraction (HF-REF) and predominant central sleep apnea (CSA). This study investigated long-term effects of PAP therapy on pulmonary function, including respiratory muscle strength. All patients underwent multichannel cardiorespiratory polysomnography (PSG) and comprehensive lung function testing at baseline and follow-up (mean 588±43days). Results350 patients (mean age 68±10.7years, 88% male) were included, inspiratory vital capacity, 3.3±0.9 vs 3.2±0.8L; forced expiratory volume in 1s, 2.5±0.7 vs 2.4±0.7L; lung diffusion capacity, 6.2±1.9 vs 5.9±1.8mmol/min/kPa; correction for hemoglobin, 1.1±0.02 vs 1.1±0.3mmol/min/kPa/L; and mouth occlusion pressure, 0.42±0.11 vs 0.4±0.12kPa. ConclusionsPAP therapy had no negative nor positive impact on lung function, including respiratory muscle strength, in stable HF-REF patients with SDB, and is therefore safe from a respiratory perspective.

Effects on respiratory system due to exposure to wheat flour

BackgroundThere is growing consensus on the deleterious effects of organic dust on respiratory symptoms and function of industrial workers. Flour dust is widely incriminated to cause impairment of lung function. Exposure to flour dust occurs across a range of food industries including grain mills, flour mills and bakeries. Aim of workTo assess the effects of exposure to flour dust on respiratory symptoms and lung function of bakery workers at a number of bakeries in Cairo. Subjects and methodsThe study was conducted on 30 bakery workers working at bakeries in Cairo state, the cases matched for age, sex, and height. All bakery workers participated in this study were subjected to following: Full medical history taking, Thorough clinical examination, Routine laboratory investigation, BMI was calculated, Chest X-ray, Spirometric lung function test, Diffusion capacity for carbon monoxide (DLCO), Further proper radiological assessment using CT scan for cases that show abnormalities in their chest X-ray or DLCOSB. ResultsAll workers included in the study were males. The age of the flour milling workers ranged between 14 and 56years. They worked at least for 10h per day for 6days per week for total working years ranged between 2 and 30years. This study reported that there was an increase in respiratory symptoms among bakery workers due to exposure to wheat flour. Also, 16.6% of the studied population had abnormal spirometry compared to the reference value, 30% had abnormal diffusion capacity of lung to carbon mono-oxide compared to reference value. Nine participants underwent HRCT chest as their DLCOSB has shown diffusion defect, 5 (55.6%) of them have normal HRCT chest and 4 (44.4%) of them have interstitial changes. ConclusionsExposure to wheat flour increases the risk of developing respiratory symptoms; it also causes reduction in the pulmonary function parameters, as regards spirometry and DLCOSB. Exposure to wheat flour causes interstitial lung disease as detected by HRCT chest. Smoking augments the wheat flour induced lung disease.

Lung diffusing capacity in sub-Saharan Africans versus European Caucasians

Single breath measurements of lung diffusing capacity (DL) for carbon monoxide (CO) and nitric oxide (NO) were performed in age-, sex-, weight- and height-matched 32 sub-Saharan Africans (13 women) and 32 Caucasian Europeans, and repeated in 14 of each group at 80% of maximum exercise capacity. In Africans versus Caucasians respectively, DLNO was 153±31 vs 176±38ml/mmHg/min at rest (P<0.001) and 210±48 vs 241±52ml/mmHg/min at exercise (P<0.01) while hemoglobin-adjusted DLCO was 29±6 vs 34±6ml/mmHg/min at rest (P<0.001), and 46±11 vs 51±13ml/mmHg/min at exercise (P<0.01). However there were no differences in DLCO/alveolar volume(VA) (KCO) and DLNO/VA(KNO). The sitting-to-standing height ratio was lower in the Africans. Differences in lung volume with respect to body height explain lower DLNO and DLCO in sub-Saharan Africans as compared to Caucasian Europeans.

Lung function abnormalities in different respiratory diseases

The most common lung function abnormalities in patients with respiratory diseases have been reviewed in the article. Ventilation disorders with change in the lung volumes, bronchial obstruction and hypoxemia are typical for patients with pneumonia. Lung compliance reduction, inconsistency of ventilation, and ventilation perfusion mismatch could be found in chronic non-obstructive bronchitis. Chronic obstructive pulmonary disease is associated with bronchial obstruction which is defined as decreased forced expiratory volume for 1 sec (FEV 1 ) and forced expiratory flows at different levels of forced vital capacity (FVC) and increased airway resistance. Asthma is associated with reversible change in expiratory flows, such as FEV1 and peak expiratory flow, due to bronchial hyperresponsiveness. Residual volume (RV) could increase in patients with acute asthma attack. Emphysema is characterized by changes in lung volumes, primarily due to increased RV; lung diffusing capacity (DL CO ) could decrease and the lung perfusion could change. Mixed (obstructive and restrictive) lung ventilation disorders could be diagnosed in patients with chronic purulent lung diseases. Patients with disseminated lung lesions could demonstrate decreased lung compliance, reduced lung volumes, decreased DLCO and hypoxemia without hypercapnia.

Relationship of pectoralis muscle area and skeletal muscle strength with exercise tolerance and dyspnea in interstitial lung disease.

Background: Pectoralis muscle area (PMA) is an easily derived computed tomography-based assessment that can provide insight into clinical features of other skeletal muscles. Respiratory and locomotor muscle dysfunction has been increasingly recognized in patients with interstitial lung disease (ILD). Its contribution to exercise performance has been controversial. Objective: We aimed to investigate if PMA is related with respiratory and locomotor skeletal muscle strength in ILD patients, and if skeletal muscle function is compromised and independently related with exercise capacity and dyspnea. Methods: Cross-sectional study where subjects performed incremental cycling cardiopulmonary exercise testing with maximal inspiratory (MIP) and expiratory (MEP) pressure measurements, and quadriceps maximal voluntary contraction (MVC) before and after exercise. Results: Thirty ILD patients (forced vital capacity [FVC] and lung diffusing capacity [DLCO] of 60±15% and 38±10% of predicted, respectively) and 15 healthy control subjects were studied. Patients presented significantly lower MIP and qMVC compared to controls. PMA was significantly associated with qMVC only (r=0.506; p<0.01). Only expiratory muscles showed a significant strength decline after exercise, both in patients and controls. In multivariate regression analysis, only FVC remained as independent predictor of peak aerobic capacity and MEP post exercise remained as independent predictor of peak exercise dyspnea even adjusting for FVC. Conclusion: ILD patients exhibited reduced inspiratory and quadriceps strength, but PMA was associated with the later only. Muscle strength was not associated with exercise capacity while expiratory muscle fatigue might underlie exertional dyspnea. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 200-208)

Diffusion Capacity of the Lung and Maladaptive Post-Infarction Remodeling of the Heart

To assess the association of the lowering of diffusion capacity of the lung and maladaptive remodeling of the heart in a year after myocardial infarction (MI). We included into this study 107 patients with ST elevation MI (STEMI). Examination of all patients on 7-12 th days included echocardiography (echoCG), spirography, body plethysmography, and determination of lung diffusion capacity. After one year of observation in 87 patients (81.3%) we performed echocardiogram in dynamics. After 1 year signs of maladaptive remodeling were detected in 25 patients (28.7%). The group of patients with remodeling had clinically significantly lowered parameters of lung diffusion function: diffusion capacity corrected for hemoglobin (DLCOcor) by 30% (p=0.001) and diffusing capacity for carbon monoxide/alveolar volume (DL/VA) by 21% (p=0.001). A mathematical model for prediction of maladaptive cardiac remodeling was obtained by the method of multivariate discriminant analysis. Univariate analysis showed that the reduction of DLCOcor was associated with 3.5-fold elevation of the risk of maladaptive remodeling in one year after STEMI. After adjustment for risk factors this risk rose up to 13.7-fold. Reduction of lung diffusion capacity below 80% of the predicted value on the 12-th day of STEMI was associated with 13.7-fold increase of the risk of detection of maladaptive remodeling of the heart after one year. Independent predictors of cardiac maladaptive remodeling were the number of diseased coronary arteries, reduced DLCO and the presence of myocardial remodeling during acute phases of myocardial infarction.

SC08.01 Impact and Management of Co-Morbidities

SC08.01 Impact and Management of Co-Morbidities

PULMONARY VENTILATION AND GAS EXCHANGE EFFICIENCY IN RISK ASSESSMENT FOR CHRONIC POSTTHROMBOEMBOLIC PULMONARY HYPERTENSION

Aim. To evaluate prognostic significance of diffusion capacity of the lungs and efficacy of pulmonary gas exchange in risk assessment of perioperational and early postoperational complications in patients with chronic post-thromboembolic pulmonary hypertension (CPH). Material and methods. Totally, 131 patient included, with CPH, who had undergone thrombo-endarterectomy from the branches of pulmonary artery. Before the surgery, together with standard investigation, the following methods were applied: body pletismography, lung diffusion capacity assessment, ventilation efficiency assessment. The relation was analyzed, of the parameters of pulmonary functional tests with the results of surgical treatment of CPH patients. Results . CPH patients present with a low level of pulmonary diffusion capacity and ventilation efficiency. Among the parameters of pulmonary functional tests, diffusion ability of the lungs shows the highest prediction significance in surgical risk assessment for CPH treatment. The relation found, for diffusion ability of the lungs and risk of respiratory failure (ОR 0,94 (0,91-0,99), p=0,004), heart failure (ОR 0,93 (0,87-1,00), p=0,023), short term post-operaton mortality (ОR 0,95 (0,89-0,99), p=0,034) and long-term mortality (ОR 0,94 (0,79-0,99), p=0,030). Efficacy of pulmonary ventilation showed significant relation only with the development of respiratory failure (ОR 0,91 (0,82-1,00), p=0,038) Conclusion . Decline of pulmonary diffusion ability to 45% and lower from expected level increases the risk of respiratory and heart failure development in early postoperation period, as the risk of in-hospital death and mortality throughout 1 year follow-up after thrombo-endarterectomy from the branches of pulmonary artery.

P2.05-054 Radiation Pneumonitis; Early Diagnosis and Protein Expression Profile in NSCLC Patients: Topic: Toxicities

Radiotherapy (RT) alone or in combination with chemotherapy (CT) are essential in treatment of non small cell lung cancer (NSCLC). A limitation for those therapies is the radiosensitivity of the lung. The aim of this study was to evaluate the incidence of radiation pneumonitis as well to identify potential markers for its early detection and to determine changes in the BAL protein expression. Fourteen NSCLC patients diagnosed at Multidisciplinary Lung Cancer Unit treated with chemotherapy-radiotherapy (CT-RT) or RT alone were enrolled in this prospective study. The collected variables were anthropometric values, lung function, tumor features and RT dosimetric data. A fiberopticbronchoscopy for bronchoalveolar lavage (BAL) was performed in both lungs before RT and at the third week of treatment. Radiation pneumonitis was scored according to the “Common Terminology Criteria for Adverse Events v4.0”. One patient with grade 1 pneumonitis and one patient with grade 3 pneumonitis were selected to perform the protein analysis using “Human Cytokine Array Panel A” (R&D Systems). The normality was determined with the Kolmogorov-Smirnov test. Student’s t-test was used when variables had a normal distribution. Differences were considered statistically significant when p values were < 0.05. All patients develop radiation pneumonitis, 35.75% of patients developed grade 1 pneumonitis, 20% grade 2, 35.75% grade 3 and 6.66% grade 5. Four patients developed pneumonitis in the lung without tumor. The decrease in lung diffusion capacity for carbon monoxide (DLCO) was the most sensitive parameter for determining the existence of early lung damage (p=0.04). Development of radiation pneumonitis was not associated with baseline lung function neither RT dosimetric data. The BAL protein expression profile was different between the two patients before RT. Expression of PAI-1, IL-1ra, MIF, and CXCL-1 in patient with pneumonitis grade 1 were increased only in the lung with tumor however these proteins were also increased in patient with pneumonitis grade 3 but in both lungs. It was significant that in the 2 cases, RT induced similar changes in BAL protein expression in both lungs. In this prospective study, the incidence of radiation pneumonitis was greater than previously reported in the literature. The DLCO decline was the most sensitive parameter for its early detection. The risk to develop radiation pneumonitis appeared to be independent of dosimetric parameters and might be related with the baseline inflammatory state. According to BAL protein expression analysis, RT produced comparable molecular changes in both lungs. Funded by SEPAR and IDIBELL.