Diffusing Capacity Of Lung Research Articles

Залежність рівня ендотеліну-1 у осіб, що перенесли негоспітальну пневмонію на тлі коронавірусної хвороби (COVID-19), від особливостей перебігу гострого й постгострого періодів

Abstract. The impairment of endothelial function is one of the mechanisms contributing to the increased risk of cardiovascular and cerebrovascular events in patients who have experienced community-acquired pneumonia associated with COVID-19. The aim of the study was to establish the connection between the level of endothelin-1 in peripheral blood of individuals who have experienced community-acquired pneumonia associated with COVID-19, with clinical-anamnestic, demographic, laboratory, and functional indicators in both the acute and post-acute periods. Materials and methods. 39 patients (age — 57.0 (48.5; 64.0) years, male — 18 (46.2 %), female — 21 (53.8 %)) survived COVID-19-associated community-acquired pneumonia were investigated. They were investigated on the 45.0 (40.0; 60.0) day from the onset of COVID-19 and had the dyspnea at the moment of the investigation. The examination included analyzing complaints, medical history and documentation, physical examination, pulse oximetry (SpO2 ), a 6-minute walk test (6MWT), measurement of lung diffusion capacity (DLco), laboratory methods (C-reactive protein (CRP), D-dimer, platelet count, endothelin-1 measurements). Results. Since it was found that patients, on one hand, had varying degrees of respiratory failure, different laboratory parameters during the acute period of COVID-19, and varying severity of dyspnea in the post-acute period of the disease, and on the other hand, exhibited wide fluctuations in endothelin-1 levels, a cluster analysis was conducted. Two clusters of patients were identified. Cluster 1 comprised 15 individuals with higher body mass index, lower SpO2 levels at the time of examination, and poorer results in the 6MWT and DLco compared to Cluster 2, which included 24 individuals. The level of endothelin-1 in Cluster 1 was significantly higher than that in Cluster 2. Clusters 1 and 2 were comparable in terms of age and gender but differed in terms of treatment conditions (outpatient or inpatient), duration of hospitalization, minimum SpO2 levels, CRP, and D-dimer levels in the acute period, and severity of the acute phase of COVID-19. Conclusion. A high level of endothelin-1 in patients who have experienced severe or critical COVID-19, accompanied by elevated levels of CRP and D-dimer, overweight or obesity, significant dyspnea, low tolerance to physical exertion, and poor DLco in post-acute period of COVID-19, indicates the necessity of careful monitoring of these individuals to prevent the development of adverse events in post-acute period of COVID-19.

Syndromes of gas exchange disorders in patients with pulmonary tuberculosis

Introduction. Measurement of diffusion in the lung is important in the diagnosis and management of most pulmonary diseases. The analysis of diffusion lung capac-ity (DLCO) in combination with body plethysmography is useful for the interpretation of the causes of pulmo-nary gas exchange disorders. The aim: to determine the leading syndromes of pulmonary gas exchange disorders in patients with pulmonary tuberculosis (PT). Materials and methods. 608 patients (244/364 M/W) with veri-fied PT with smoking history of less than 10 pack/years were examined. Spirometry, body plethysmography, and DLCO were performed by the single-breath breath-hold-ing method. Results. DLCO decrease was detected in the majority of patients with PT (76%): in 94% of patients with massive fibrous-cavernous PT, 79.4% with disseminated PT and more than 60% of patients with infiltrative foci, local cavities, tuberculomas. In patients without ventilation dis-orders (58.4%), DLCO decrease was caused by damage to the alveolar capillary membrane, less often by air trapping (35.1%), other cases were rare. In the obstructive variant, mixed disorders of gas exchange (38.2%) and air trapping (34.1%) were most typical. In the restrictive variant, gas exchange surface reduction (62.5%) and mixed disorders (30%) prevailed. In mixed ventilation disorders, the mixed pulmonary gas exchange disorders were most often de-tected (63.8%) and the gas exchange surface reduction was quite common (36.2%) also. Conclusion. Alveolar cap-illary membrane damage (35.1%) and air trapping (28.1%) were most common in patients with PT. The mixed variant and gas exchange surface reduction were detected less frequently (24.7 and 12.1%, respectively), but these syn-dromes led to the most significant DLCO decrease.

CHANGES IN THE DIFFUSION CAPACITY OF THE LUNGS AND THE TRANSFER COEFFICIENT IN PATIENTS WITH PULMONARY TUBERCULOSIS

Introduction. The study of the diffusion lung capacity (DLCO) shows the conditions of oxygen transport from the alveolar air into the blood of the pulmonary capillaries. The features of changes in the parameters of pulmonary gas exchange in patients with pulmonary tuberculosis (PT) have not been sufficiently studied. Materials and methods. 374 patients with verified PT underwent a study of the pulmonary function including DLCO and the transfer coefficient of carbon monoxide DLCO/VA, computed tomography and perfusion scintigraphy of the lungs. Results. The pulmonary gas exchange depends on the duration of PT, the volume of a specific lesion, the severity of disorders of pulmonary perfusion, including in the lung without foci of tuberculous lesions. In 23% of patients, a decrease in the transfer coefficient was observed at normal DLCO values, which indicates significant alveolar-capillary damage. Conclusion. When assessing pulmonary gas exchange in patients with pulmonary tuberculosis, it is necessary to estimate not only DLCO, but also on the transfer coefficient of carbon monoxide - DLCO/VA.

Интерстициальные заболевания легких — опыт применения телепатронажа

INTRODUCTION: Interstitial lung diseases (ILD) are a group of diseases, the only or the main manifestation of which is a pathological process in the pulmonary interstitium. One of factors of the unfavorable course of chronic forms of ILD is progressing fibrosis of the lung tissue. While idiopathic pulmonary fibrosis is a classic fibrosing ILD with the poorest prognosis, diffuse pulmonary fibrosis can also occur in other ILDs. The progression of the disease leads to restrictive alterations of breathing and to impairment of the diffusion capacity of lungs, which results in respiratory failure, reduced tolerance to physical exercise and disability of the patient. This impedes routing of such patients and limits access to specialized medical care. Restrictive measures introduced in 2020–2021 in connection with a new coronavirus infection, and for elderly people with chronic diseases as well, produced an additional negative impact on the possibility of patients to receive qualified medical care of specialists. In these conditions, the relevance of standard telemedicine healthcare services increased, and there appeared an urgent need for developments of a digital nursing system for chronic patients providing a possibility of active remote communication of a doctor and a patient. This review presents the experience in use of a digital nursing program for monitoring and self-monitoring of chronic non-infectious patients, including those with respiratory diseases. The article presents a clinical case of joint management of a comorbid patient with a severe damage to pulmonary interstitium and the underlying rheumatoid arthritis by pulmonologists and rheumatologists through telenursing. Positive aspects of the remote monitoring are discussed. CONCLUSION: Use of telenursing technology in patients with chronic respiratory diseases may improve clinical effectiveness of treatment of this group of patients as well as reduce the load on the primary healthcare doctors and frequency of untargeted hospitalizations, which, in turn, will reduce the treatment costs.

Effect of incentive spirometry on pulmonary function test in post COVID-19 pneumonia patients

Background. COVID-19 caused by SARS-CoV-2 virus was assigned as a pandemic by WHO. Fever, breathlessness, cough and expectoration indicates lung involvement in the form of pneumonia and its most common complications are pulmonary fibrosis, chronic respiratory failure and reduced quality of life. Incentive spirometry is the relevant therapy to enhance the normal lung function and improve quality of life. Aim. To find the effect of incentive spirometry on pulmonary function test in post COVID-19 pneumonia patients. Methodology. An experimental study with simple random sampling (lottery method) of 24 patients in age group (18-68 years). The participants were randomly divided into 2 groups. Group A received pharmacotherapy and incentive spirometry and Group B received only pharmacotherapy. Computerized spirometry and Diffusion lung capacity for carbon monoxide (DLCO) was used as diagnostic tool to measure pre & post test values for both groups. Intervention was given for 4 weeks and after 4 weeks, to analyze the spirometry values post-test was taken for both groups. Outcome measures. Forced expiratory volume in the first second (FEV1), Forced vital capacity (FVC), FEV1/FVC &DLCO. Results. Statistical analysis shows significant improvement (p < 0.05) between pretest and post test values on Pulmonary Function Tests (PFT) in both Group A&B whereas there was increase in the improvement in intervention group than control group. Conclusion. Incentive spirometry improved the lung volume and capacities on PFT in post COVID-19 pneumonia patients and also these patients have mainly restrictive lung pattern by the use of DLCO.

Lung diffusion capacity correlates with pre-implant pulmonary hypertension and predicts outcome after LVAD implantation.

Diffusing capacity of the lung for carbon monoxide (DLCO ) reduction is common in heart failure (HF) and is associated with a worse prognosis. Correlations between DLCO and pulmonary hypertension (PH) are unclear, and published data are conflicting; it has been shown that DLCO impairment may persist or even worsen after normalization of pulmonary pressures following left ventricle assist device (LVAD) implantation, maybe reflecting persistent pulmonary damage. We aimed to investigate the impact of pre-implant DLCO and central haemodynamics on outcome in patients with advanced HF implanted with a LVAD. We retrospectively analysed pre-implant and post-implant data from 42 patients implanted with a LVAD at our institution. Out of 42 patients, 35 had post-capillary PH before implantation, including 17 with combined post- and pre-capillary PH (Cpc-PH). Median DLCO was 59% (IQR 47-68%), and it inversely correlated with pulmonary vascular resistance (PVR) (P 0.037) and diastolic pulmonary gradient (DPG) (P 0.042). Compared with baseline, LVAD resulted in improvement in LV diameter (LVDd, P<0.001), mitral regurgitation (P 0.022), and PH (mPAP 24 vs. 36mmHg, P<0.001; PAWP 12 vs. 23mmHg, P 0.001; pulmonary artery compliance, CPA 3.1 vs. 1.9mL/mmHg, P 0.021). Lower DLCO and Cpc-PH at baseline were associated with a better LV reverse remodelling post-implantation (P 0.027 for LVDd) but also with a smaller gain in CPA (P 0.049). Before LVAD implantation, DLCO impairment is associated with higher PVR and DPG, suggesting that it might be an expression of persistent pulmonary damage occurring in Cpc-PH. After LVAD implantation, both LV dimension and haemodynamics improve. Lower pre-implant DLCO is associated with better LV reverse remodelling.

STUDY OF CLINICAL PROFILE, SPIROMETRIC FUNCTION TEST, DIFFUSING CAPACITY OF CARBON MONOXIDE, 6 MINUTE WALK TEST AND CHEST X-RAY FINDINGS IN TEXTILE DYE-PRINTING WORKERS IN SURAT CITY

INTRODUCTION The textile industry consists of several processes including dyeing, printing etc. and due to the exposures to various chemicals at work, these workers frequently complain of respiratory symptoms. Spirometry allows us to measure FEV1,FVC, FEV1/FVC ratio,FEF25- 75%.Diffusion Capacity of Lung for Carbon Monoxide(DLCO) test indicates the diffusion of Carbon Monoxide gas across the alveolar membrane. In 6 Minute walk Test ,Pulse rate and SpO2 is measure at the start and at the end of the test. (At 0 min and at 6 min) and then fall or rise in Pulse or SpO2 is observed. METHODOLOGY This study included all the subjects according to the inclusion criteria(40) coming to Respiratory Medicine OPD during the study period (15 months). Data was collected and analyzed .RESULTS Majority of the patients were male, (50%) and smokers. Dry cough seen in – 29 patients (72.5%) &amp; Dyspnoea on exertion in 15(37.5%) patients. Chest X-Ray was normal in – 21patients (52.5%), followed by Prominent Broncho-Vascular markings (BVM) was seen in 10(25%) patients. On Spirometry Findings, 24 (60%) patients were normal, 8 (20%) patients showed Restrictive Pattern, 6 (15%) showed Obstructive Pattern and 2 (5%) patients showed Mixed Pattern. In DLCO ndings, 27 patients showed normal (67.5%) and 13 (32.5%) patients showed Decreased Pattern. CONCLUSION Duration of exposure to dye and smoking were signicantly associated with Clinical features, reduced 6 Minute Walk distance, Abnormal Spirometry and DLCO ndings. FEF25-75% was signicantly decreased in most of the dye-workers in present study. As the Dyeing-workers are working in hazardous environment, there should protocols be formed for routine medical check-up at frequent interval in textile industry to detect occupation related diseases at early stage and to intervene the problem timely.

ФУНКЦИОНАЛЬНЫЕ НАРУШЕНИЯ СИСТЕМЫ ДЫХАНИЯ У БОЛЬНЫХ АНКИЛОЗИРУЮЩИМ СПОНДИЛИТОМ И ИХ ДИНАМИКА ПОСЛЕ ПЕРЕНЕСЕННОЙ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

Abstract. Introduction. Lung function disorders in patients with ankylosing spondylitis can be caused both by the disease itself and the side effect of the treatment. Aim. The aim was to investigate the lung function in patients with ankylosing spondylitis and analyze its dynamics after COVID-19 on the example of clinical case. Material and methods. 29 patients were enrolled in the study. Spirometry, body plethysmography, diffusion test was performed. In 1 patient the dynamics of parameters was analysed after COVID-19. Statistical analyses were performed using SPSS 23.0. Quantitative data with a normal distribution were presented as the mean and standard deviation (m±σ). The data with different type of distribution were presented as the median and interquartile range (Me [Q1 ; Q3 ]). The differences between quantitative parameters were assessed by student’s t-test for data with normal distribution and by the Wilcoxon test for data with different distribution. To assess the differences between qualitative parameters the Fisher’s exact test was used. A value of p&lt;0,05 was considered to be statistically significant. Results and discussion. A retrospective cross-sectional study was performed. The predicted values of the European Community for Steel and Coal 1993 and the Global Lung function Initiative were used in the analysis. On average, no ventilation disorders were detected in the group. However, 7 (24%) patients had airway obstruction. Restriction and impaired lung diffusion capacity were detected in 3 (10%) and 12 (41%) patients using European Community for Steel and Coal 1993 predicted values system and in 2 (7%) and 6 (21%) patients using the Global Lung function Initiative predicted values system respectively. The differences were statistically significant. In clinical case, the previously established lung function disorders became more pronounced after COVID-19: ventilation capacity, total lung capacity, diffusion lung capacity decreased by 50%, 35%, 38% respectively. Conclusion. Lung function tests should be included in the examination plan of patients with ankylosing spondylitis. Patients with ankylosing spondylitis may have a more severe course of COVID-19. The system of the predicted values used should be presented in the medical report.

Repeated cardiopulmonary performance measurements in young competitive handball players with and without SARS-CoV-2 infection

BackgroundThe SARS-CoV-2 virus and its long-term consequences in adolescents have a global impact on upcoming medical issues. The aim of this study was to investigate the effects of a SARS-CoV-2 infection on cardiorespiratory parameters in young athletes.MethodsIn a cohort study involving repeated measurements during a six-month period, cardiorespiratory parameters were assessed in infected (SCoV) and non-infected (noSCoV) athletes. We evaluated handball players (17.2 ± 1.0 years) via performance diagnostics and a specific examination after a SARS-CoV-2 infection or without.ResultsWe observed no significant differences between the two groups at the first visit. But between the first and second visit, the SCoV group’s maximum power output was significantly lower than the noSCoV group’s (− 48.3 ± 12.5; p ≤ 0.01 vs. − 15.0 ± 26.0 W; p = 0.09). At the second visit, lung diffusion capacity (DLCO/VA, %predicted) did not differ between groups (111.6 ± 11.5 vs. 116.1 ± 11.8%; p = 0.45). HR during comparative stress showed no group differences. The SCoV group’s mean oxygen uptake during incremental exercise was lower (Two-way-ANOVA: 1912 vs. 2106 ml; p ≤ 0.01; mean difference: − 194 ml; 95% CI − 317 to − 71); we also noted a significantly lower stroke volume course during exercise (Two-way-ANAOVA: 147.5 vs. 169.5 ml; mean difference: − 22 ml; p ≤ 0.01; 95% CI − 34.2 to − 9.9). The probability of premature ventricular complexes after a SARS-CoV-2 infection yielded an odds ratio of 1.6 (95% CI 0.24–10.81).ConclusionsThe physical performance of young athletes infected with SARS-CoV-2 was impaired. This decreased performance is probably due to cardiac and/or peripheral deconditioning. Studies with larger cohorts are needed to make more profound conclusions.

Preserved peak exercise capacity in Andean highlanders with excessive erythrocytosis both before and after isovolumic hemodilution.

In chronic mountain sickness (CMS), increased blood oxygen (O2)-carrying capacity due to excessive erythrocytosis (EE, [Hb] ≥ 21 g/dL) could be offset, especially during exercise by both impaired cardiac output (Q̇t) and O2 diffusion limitation in lungs and muscle. We hypothesized that EE results in reduced peak V̇o2 despite increased blood O2-carrying capacity, and that isovolumic hemodilution (IVHD) improves exercise capacity. In 14 male residents of Cerro de Pasco, Peru (4,340 m), six with and eight without EE, we measured peak cycle-exercise capacity, V̇o2, Q̇t, arterial blood gas parameters, and (resting) blood volume. This was repeated for participants with EE after IVHD, reducing hematocrit by 20% (from 67% to 53%). From these data, we quantified the major O2 transport pathway components (ventilation, pulmonary alveolar-capillary diffusion, Q̇t, and blood-muscle mitochondria diffusion). Participants with EE had similar peak V̇o2, systemic O2 delivery, and O2 extraction as non-EE controls, however, with lower Q̇t and higher arterial [O2]. After IVHD, peak V̇o2 was preserved (but not enhanced), with lower O2 delivery (despite higher Q̇t) balanced by greater O2 extraction. The considerable variance in exercise capacity across the 14 individuals was explained essentially completely by differences in both pulmonary and muscle O2 diffusional conductances and not by any differences in ventilation, [Hb], nor Q̇t. In conclusion, EE does not result in lower peak V̇o2 in Andean males, and IVHD maintains, but does not enhance, exercise capacity.NEW & NOTEWORTHY Male Andean highlanders with and without excessive erythrocytosis (EE) have similar peak V̇o2 at 4,340 m, with higher arterial [O2] in EE and lower cardiac output (Q̇t), thus maintaining similar O2 delivery. Peak V̇o2 in participants with EE was unaffected by isovolumic hemodilution (hematocrit reduced from 67% to 53%), with lower O2 delivery balanced by slightly increased Q̇t and greater O2 extraction. Differences in lung and muscle diffusing capacity, and not hematocrit variation, accounted for essentially all interindividual variance in peak V̇o2.

Abstract 14741: Sudden Desaturation in the Presence of Severe Hypertensive Blood Pressure Response to Exercise, What Next?

62 year old male was referred for evaluation of exertional breathlessness, predominantly when commuting to work by bicycle. There was no associated chest pain, palpitations, syncope or family history of cardiovascular disease. He had untreated hypertension, a remote history of hairy cell leukemia treated with cladribine in remission and polycythemia rubra vera treated with venesection and pegylated-interferon therapy. Trans-thoracic echocardiogram demonstrated normal biventricular size and systolic function with normal valvular function. There was insufficient tricuspid regurgitation to estimate pulmonary pressure. A stress echocardiogram was negative for ischemia at submaximal exercise capacity due to the protocol used. Previous spirometry testing demonstrated preserved lung volumes, forced expiratory volumes and vital capacity. DLCO (lung diffusion capacity for carbon monoxide) was at the lower limit of normal. A ventilation-perfusion scan excluded pulmonary emboli. Cardiopulmonary exercise testing demonstrated good exercise capacity (peak VO2 40.8 ml/kg/min). An abrupt desaturation was seen at the respiratory compensation point, (Figure 1 - left) with an oxygen saturation nadir of 75% (measured in two peripheral locations), which resolved rapidly in early recovery. This coincided with a profound hypertensive response peaking at systolic blood pressure 252mmHg (Figure 1 - right). The test was ceased due to dyspnea and generalized fatigue. This case demonstrates that while maximal oxygen consumption is a prognostic marker, an above average exercise capacity does not exclude underlying pathology. Pulmonary capillary stress failure resulting in transient pulmonary edema and early pulmonary hypertension cannot be excluded. However, with normal exercise capacity, justification of invasive diagnosis is difficult and there are currently no guidelines regarding an optimal surveillance plan.

Effect of experimental exposures to 3-D printer emissions on nasal allergen responses and lung diffusing capacity for inhaled carbon monoxide/nitric oxide in subjects with seasonal allergic rhinitis.

3-D printers are widely used. Based on previous findings, we hypothesized that their emissions could enhance allergen responsiveness and reduce lung diffusing capacity. Using a cross-over design, 28 young subjects with seasonal allergic rhinitis were exposed to 3-D printer emissions, either from polylactic acid (PLA) or from acrylonitrile butadiene styrene copolymer (ABS), for 2 h each. Ninety minutes later, nasal allergen challenges were performed, with secretions sampled after 1.5h. Besides nasal functional and inflammatory responses, assessments included diffusing capacity. There was also an inclusion day without exposure. The exposures elicited slight reductions in lung diffusing capacity for inhaled nitric oxide (DLNO ) that were similar for PLA and ABS. Rhinomanometry showed the same allergen responses after both exposures. In nasal secretions, concentrations of interleukin 6 and tumor necrosis factor were slightly reduced after ABS exposure versus inclusion day, while that of interleukin 5 was slightly increased after PLA exposure versus inclusion.

Features of determining the diffusion capacity of the lungs by carbon monoxide in cystic fibrosis children

The article presents current literature data from English-language (search made in PubMed) and Russian-language (search made in eLibrary) sources about the method for measurement of the lung diffusing capacity for carbon monoxide in children with cystic fibrosis (CF). This review presents the general characteristics of this test in children and adults with various diseases, and also describes the conflicting results of studies using this method in CF patients of various ages and disease severity. The expediency, the informativeness, and difficulties of evaluation and interpretation of the test’s results, depending on the age and course of the disease of patients, are discussed. The author concludes that further research of interpretation of indicators determined during the test of the lung diffusing capacity for carbon monoxide, such as the transfer factor, alveolar volume, and their ratio in CF children is necessary.

GRECO-1: Phase 1/2 Study of Stereotactic Body Radiation Therapy (SBRT) with or without Rucosopasem (GC4711) for Early Stage, Peripheral or Centrally Located Non-Small Cell Lung Cancer (NSCLC)

<h3>Purpose/Objective(s)</h3> The number of patients diagnosed with early-stage non-small cell lung cancer (NSCLC) has been increasing with screening programs and more frequent thoracic imaging. SBRT is an alternative for patients who are not candidates for surgery. SBRT for larger and/or centrally located tumors may have reduced efficacy and lead to higher-grade toxicity (Timmerman 2006; Dunlap 2010). Rucosopasem (GC4711) is one of a class of investigational selective dismutase mimetics that rapidly and specifically produces hydrogen peroxide from superoxide (Riley 2006). In preclinical models including NSCLC, the addition of a dismutase mimetic to SBRT regimens demonstrated mechanism-related anticancer synergy with SBRT while protecting normal tissues from radiation damage (Sishc 2021). The purpose of this trial is to test the hypothesis that rucosopasem may improve tumor control without increasing pulmonary toxicity after SBRT. <h3>Materials/Methods</h3> This phase 1/2 trial is designed to test the safety of rucosopasem and its potential to improve tumor control and reduce lung injury due to SBRT for cT1c-3N0M0 peripheral or centrally located (within 2 cm of the proximal bronchial tree) NSCLC. An open-label, phase 1 run-in cohort of 5 patients received rucosopasem 100 mg as a 15-minute IV infusion within a 180-minute window prior to each of 5 SBRT fractions of 10–12 Gy delivered on sequential weekdays. A placebo-controlled phase 2 cohort of approximately 66 patients randomized to either rucosopasem or placebo concurrent with SBRT follows and is ongoing. The primary endpoint for phase 1 is dose-limiting toxicities during treatment or within 30 days post-SBRT, and for phase 2, in-field tumor response. Reduction from baseline in diffusion capacity of lung for carbon monoxide (DLCO) at 6 months (Stone 2015) is a secondary endpoint for phase 2. Progression-free and overall survival, locoregional control, and distant metastasis rate will be followed over 24 months. Additional secondary endpoints include clinical (CTCAE 5.0) and radiological pneumonitis, measured at the same timepoints as quarterly lung function tests, and other adverse events. Trial-in-progress NCT04476797 is currently enrolling. This study is funded by Galera Therapeutics, Inc. <h3>Results</h3> TBD <h3>Conclusion</h3> TBD

Benefits of Cardio-Pulmonary Rehabilitation in Moderate to Severe Forms of COVID-19 Infection.

Our aim was to evaluate the benefits of cardio-pulmonary rehabilitation on severe to moderate COVID-19 patients. 25 discharged COVID-19 patients underwent a cardio-pulmonary test (CPET), a spirometry test and a measure of carbon monoxide lung diffusion capacity (DLCO) at the beginning of their rehabilitation program and after 23 ± 5 rehabilitation sessions. This rehabilitation program combined interval training exercises on a bike and resistance exercises for major muscle groups. We then compared their progress in rehabilitation to that obtained with cardiac patients. At the beginning of their rehabilitation program, COVID-19 patients presented a reduced physical capacity with a maximal aerobic capacity (VO2 max) at 71% of predicted value, a maximal workload at 70% of predicted value and an exercise hyperventilation measured by a higher VE/VCO2 slope. Exercise was mainly limited by muscle deconditioning. After rehabilitation, the VO2 max and maximal workload increased in COVID 19 patients by 18% and 26%, respectively. In patients with ischemic heart disease the post-rehabilitation gains in VO2 max and maximal workload were 22% and 25%, respectively. Moreover, exercise hyperventilation decreased by 10% in both groups. On the other hand, the intrinsic pulmonary function of COVID 19 patients improved following natural recovery. In conclusion, even if cardio-pulmonary rehabilitation is probably not the only parameter which explains the partial recovery of moderate to severe COVID-19 patients, it certainly helps to improve their physical capacity and reduce exercise hyperventilation.

Functional and quantitative computed tomographic changes in the bronchopulmonary system in patients who have undergone COVID-19

Introduction. COVID-19 is a highly contagious infectious disease caused by the novel coronavirus SARS-CoV-2. After the acute phase and discharge from the hospital, convalescent people continue to have respiratory symptoms, changes in pulmonary function (PF) and indicators of chest computed tomography (CT).Aim. To evaluate changes in PF and quantitative CT data in patients after severe coronavirus pneumonia.Materials and methods. A cross-sectional observational study was conducted: 55 patients (including 28 men, aged 32–78 years) with a diagnosis of “lung interstitial process due to a coronavirus infection” were examined. All patients underwent a study of PF (spirometry, body plethysmography, measurement of the diffusion lung capacity: DLCO) in the interval of 24–305 days after discharge from the hospital. CT scan of the chest was performed simultaneously with the functional examination (±30 days), the parameters were calculated: ground glass areas, functional lung tissue volume (FV), affected tissue volume (AV), CovidQ (AV/FV ratio).Results. A decrease in DLCO was found in 28 patients. Restrictive disorders – in 13 patients, obstructive disorders – in 2 patients. At the time of the CT examination, all patients had residual changes in both lungs of varying severity. Functional parameters (FVC, TLC and DLCO) were statistically significantly correlated with the CT data.Conclusion. During the recovery period in patients after COVID-19, lung structural changes, according to CT scans, persist for at least 3 months. Pulmonary ventilation indicators in most patients normalize during this time, half of the patients retained a decrease in diffusion lung capacity. Acknowledgment. The study was carried out as part of the state task on the topic: “The impact of the new coronavirus infection SARS-CoV-2 on the functional parameters of the respiratory system during the convalescence period” (code: “PostCOVID-functional diagnostics”).

Consensus of Chinese experts on product principles, quality control and clinical application of portable spirometer

Compared with the traditional laboratory spirometer, the portable spirometer has obvious advantages, e.g., small size, portability, simple operation and low cost. The portable spirometer is a supplementary instrument in the primary health institutions when the laboratory spirometer is unavailable or inapplicable. However, there is still a lack of guidance in documents regarding the application of portable spirometer in China. This consensus elaborated the specific details of portable spirometer, such as the equipment hardware, the equipment quality requirement, the operation protocols, the quality control, the clinical application and the personnel training. The portable spirometer consists of a spirometer and a computer system. Its core component is the flow sensor, which retains the core functions of the traditional spirometer, i.e., regular pulmonary function and bronchodilation test, but does not have the ability to measure the total lung volume, residual volume and diffusion capacity. In addition, the portable spirometer needs to pass the quality inspection of the national and international authorities and needs to meet the standard of ISO26782 of 2009. The quality control for a portable spirometer includes equipment quality control, process quality control and report quality control, and its technical details are consistent with the quality control requirements of the laboratory spirometer. It can be widely used for screening of respiratory diseases, epidemiological investigation and regular physical check-up, clinical trials, management of chronic respiratory diseases, and examination on the disability. The training courses for the portable spirometer contain theory and practice curriculums, mostly for primary and community healthcare workers with various and flexible options. Furthermore, the portable spirometer has integrated many high-tech technologies that surpass the similar functions in the laboratory spirometer such as intelligent data transmission, cloud database, big data management, biosensors, etc. With the development of the high-tech, portable spirometer has become more and more intelligent and diversified, and is able to greatly improve the management model for chronic respiratory diseases in the future.

Acute Moderate-Intensity Aerobic Exercise under High PM2.5 Levels Does Not Influence the Pulmonary Function and Lung Diffusion Capacity in Healthy Young Men

Exposure to fine particulate matter (PM2.5) impairs the respiratory system and increases the morbidity and mortality of respiratory diseases. Even though aerobic exercise is known to improve pulmonary function in diverse populations, it can lead to an increase in the inhalation of PM2.5 in polluted environments. We aimed to investigate the effects of aerobic exercise under high PM2.5 conditions on the pulmonary function in young adults. Nine healthy young men performed indoor treadmill running in both high and low PM2.5 conditions (59.0 ± 2.1 vs. 7.8 ± 1.0 μg/m3) by a crossover study design. Pulmonary function was assessed by spirometry and diffusing capacity for carbon monoxide (DLCO) at pre- and 1-h post-exercise. There was no difference in the response of pulmonary function and lung diffusion capacity to the acute aerobic exercise in high and low PM2.5 conditions (p ≥ 0.09). These findings indicate that aerobic exercise in high PM2.5 conditions may not adversely affect pulmonary function in healthy young adults.

PULMONARY CAPILLARY HEMANGIOMATOSIS: A CONUNDRUM FOR EXPERTS

PULMONARY CAPILLARY HEMANGIOMATOSIS: A CONUNDRUM FOR EXPERTS

Efficacy and safety of abatacept for interstitial lung disease associated with antisynthetase syndrome: a case series.

This study investigated the efficacy and safety of abatacept (ABA) in interstitial lung disease (ILD) associated with antisynthetase syndrome (ASS). Eight patients were identified through retrospective analysis of the medical records of our centre. All patients fulfilled the Solomon criteria and had a disease complicated with ILD. Lung function, imaging, serum markers, clinical evaluation indicators of ILD, peripheral blood cell classification, cytokines, and prednisone doses were analysed. Seven of the eight patients were female. The mean age was 54.4 (standard deviation [SD] 6.0) years. Antibodies against Jo-1, PL-12, and PL-7 were present in three, three, and two patients respectively. At baseline, the mean diffusing lung capacity for carbon monoxide (DLCO) was 53.8% (SD 9.2%), the mean score of King's Brief Interstitial Lung Disease (KBILD) was 40.6 (SD 13.8), the median Krebs Von den Lungen-6 (KL-6) was 1612.5 (interquartile range [IQR] 1180.5-2431.5) U/ml. All patients experienced symptom alleviation after ABA therapy. The mean and median changes in DLCO percentage, KBILD, and KL-6 were 12.3% (p<0.05), 21.4 (p<0.01), and 174.5U/ml (p<0.01), respectively. No obvious adverse events related to ABA were observed during the treatment. Our study offers preliminary, but encouraging, clinical evidence in favour of ABA as a therapy for ASS-ILD. ABA demonstrated favourable effects on ILD and was well-tolerated. Well-designed randomised controlled studies are required to confirm the efficacy and safety of this strategy.