Lung Function Pattern Research Articles

Fibrosis, biomarkers and liver biopsy in AAT deficiency and relation to liver Z protein polymer accumulation.

The course of adults with ZZ alpha-1-antitrypsin deficiency (AATD) liver disease is unpredictable. The utility of markers, including liver biopsy, is undefined. A prospective cohort, including protocol liver biopsies, was enrolled to address these questions. We enrolled 96 homozygous ZZ AATD adults prospectively at three US sites with standardized clinical evaluations, and protocol liver biopsies. Fibrosis was scored using Ishak (stages 0-6). Also, 51% of the 96 subjects had Ishak score >1 fibrosis (49% Ishak 0-1, 36% Ishak 2-3 and 15% ≥4). Elevated aspartate aminotransferase (AST) more than alanine aminotransferase (ALT), high body mass index (BMI), obesity, AST platelet ratio index and elevated serum Z alpha 1 antitrypsin (AAT) polymer levels were associated with increased fibrosis. Steatosis did not correlate to fibrosis. Increased fibrosis was associated with increased mutant Z polymer globular inclusions (p = .002) and increased diffuse cytoplasmic Z polymer on biopsy (p = .0029) in a direct relationship. Increased globule Z polymer was associated with increased serum AST (p = .007) and increased periportal inflammation on histopathology (p = .004), but there was no relationship of Z polymer hepatocellular accumulation with ALT, gamma glutamine transferase, inflammation in other parts of the lobule, necrosis or steatosis. Serum Z polymer levels were directly correlated to hepatic Z protein polymer content. Lung function, smoking and alcohol consumption patterns were not associated with fibrosis. In AATD high BMI, obesity and elevated AST are associated with increased fibrosis. Liver biopsy features are correlated to some serum tests. Serum Z AAT polymer levels could be a future biomarker to detect fibrosis early and is directly correlated to liver Z content.

Prevalence, patterns, and factors associated with abnormal lung function among children with sickle cell disease in Uganda: a cross-sectional study

BackgroundPulmonary complications are common among children with sickle cell disease (SCD). However, there is little literature on associated lung function abnormalities in Uganda. We aimed to determine the prevalence, patterns, and factors associated with abnormal lung function among children with SCD in a tertiary care hospital in Uganda.MethodA cross-sectional study was conducted among children aged 6 to 18 years at the SCD clinic (SCC) of Mulago National Super-Specialized Hospital between January 2020 and April 2021. Data on sociodemographic and clinical characteristics was collected using a standardized questionnaire. Laboratory investigations, including a complete blood count and serum lactate dehydrogenase (LDH), were done. Spirometry was performed following the ATS/ERS standards. Multivariable modified Poisson regression analysis was performed to determine factors associated with abnormal lung function.ResultsA total of 332 participants were enrolled. The mean age was 11.7 ± 3.4 years, and 184 (55.4%) were female. Overall, 126 (37.9%) participants had abnormal lung function: 67/126 (53.2%) restrictive, 57/126 (45.2%) obstructive, and 2/126 (1.6%) mixed-ventilatory patterns. Factors associated with abnormal lung function were; serum LDH level > 600UL (aIRR: 1.89 95% CI: 1.2 — 7.4, p = 0.049), a history of acute chest syndrome (aIRR: 1.55, 95% CI: 1.06–2.25, p = 0.024), wasting (aIRR: 1.33, 95%CI: 1.02 — 1.72, p = 0.032), and use of charcoal for household cooking (aIRR: 1.49, 95% CI: 1.03–2.15, p = 0.035).ConclusionMore than one-third of children with SCD in Uganda have lung function abnormalities. Strategies to improve nutrition, reduce exposure to charcoal smoke, and monitoring serum LDH levels may be important in preventing or managing abnormal lung function in this population. The identification of reversible and irreversible airway obstruction in children with sickle cell disease also highlights the need for targeted interventions to address these specific patterns of abnormal lung function.

Spirometry findings of chronic lung disease in high-altitude residents of Ladakh (>11000 feet above sea level)

Ladakh is a hilly Himalayan dry desert, situated at an altitude of >11000 feet. Studies have demonstrated that the spirometric values of high-altitude residents are significantly higher than those of low-landers. This is a retrospective observational study that analyzes the spirometry pattern in chronic lung diseases among people from Ladakh. Enrolled subjects were clinic-radiologically diagnosed and had at least one spirometry report. The spirometric parameters were analyzed for normal and abnormal patterns of lung function. The abnormal patterns were further classified into types of ventilator defects and their severity. A total of 122 cases were included, with 67 (55%) men. The mean age was 52.2±15.4 years. The most common diseases were chronic obstructive pulmonary disease (COPD) in 51 cases (41%), and asthma in 41 (33%). The median predicted percentage of forced vital capacity (FVC) was 116% (63-179%) with >100% in 105 (85%) patients. The median predicted percentage of the forced expiratory volume in the 1st second (FEV1) was 113% (99-175%) with >100% in 90 (74%) patients. FVC was reduced in 9 (7%) cases, normal in 62 (51%), and more than normal in 49 (42%), with 11 (9%) cases having >150% of the predicted percentage. FEV1 was reduced in 9 (8%) cases, normal in 67 (55%), and more than normal in 46 (37%) cases, with >150% predicted seen in 10 (8%) cases. Similarly, overall, the predicted percentages of both FVC and FEV1 were >100% in all obstructive airway diseases as well as in the separate COPD and asthma subgroups. FVC and FEV1 amongst chronic lung disease patients from Ladakh were more than normal in the majority. These higher values of spirometry led to incorrect disease severity classifications and disease patterns. We propose that studies should be done to devise local reference equations for spirometry for Himalayan high-altitude residents of India.

Individual and mixture analyses of the associations of phenols and phthalates with lung function among US adults

ABSTRACT The effects of endocrine disruptors including phenols and phthalates on adult lung function remain unclear. In the present study, data from 2007–2012 National Health and Nutrition Examination Survey (NHANES) were extracted, and 4338 participants were included in the final analyses. The associations of three phenols and four phthalate metabolites with six lung function parameters were investigated. In generalized linear regression models (GLM) and restricted cubic spline (RCS) analyses, bisphenol A (BPA) was associated with decreased forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC), and 2,5-dichlorophenol (DCP) was associated with reduced FEV1, FVC and peak expiratory flow rate (PEF), and increased prevalence of restrictive lung function (RLF) in adults. Furthermore, weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) models demonstrated that mixed exposures to phenols and phthalates were linked to reduced FEV1, FVC and PEF and increased prevalence of RLF, and these associations were mainly driven by BPA and 2,5-DCP. In conclusion, mixed exposure to phenols and phthalates was linked to compromised and a restrictive pattern of lung function. The mechanisms of the effects of phenol and phthalate exposures on lung function and respiratory diseases need to be further investigated.

A Community-Based Cross-Sectional Study on Respiratory Health and Spirometry-Assessed Pulmonary Function Among Textile Workers in Tamil Nadu, India.

Introduction The textile industry is one of the largest economic activities. Still, the laborers involved in it are exposed to various health-damaging air pollutants, putting them at risk of health issues including morbidities of the respiratory system. Therefore, this study aimed to assess the pulmonary function parameters of the workers involved in textile manufacturing-related jobs. Methodology A cross-sectional study was carried out among adult individuals who had been working in textile manufacturing-related jobs as their main work. The details such as sociodemographic, clinical, workplace conditions, and smoking habits were collected, as well as chest auscultation and lung spirometry using a hand-held spirometer. The participants who had normal and abnormal lung function patterns were statistically analyzed for potential influencing factors. Results The findings of the study conducted from 95 eligible participants identified that the pulmonary function parameters assessed by spirometry were in the abnormal range among 84 (88%) participants. Around 72 (82%) of them had a restrictive pattern, and six (6%) had both restrictive and obstructive (mixed) patterns of lung disease. Smokers and those who lacked cross-ventilation and/or fresh source of air in the workplace were more likely to have abnormal lung function. Participants who had their workplace and residence as same had significantly 6.44 (95% CI: 1.24, 33.36) times higher odds of having abnormal lung function in spirometry. Conclusion As workers involved in household-run textile manufacturing jobs are found to be at a higher risk of developing abnormal lung function, using personal protective equipment, following occupational safety measures, and improving the working environment to acceptable standards are essential to safeguard the respiratory health of laborers in such unorganized sectors.

Respiratory Diseases Associated With Organic Dust Exposure

Organic dusts are complex bioaerosol mixtures comprised of dust and par ticulate matter of organic origin. These include components from bacteria, fungi, pollen, and viruses to fragments of animals and plants commonplace to several environmental/occupational settings encompassing agriculture/farming, grain processing, waste/recycling, textile, cotton, woodworking, bird breeding, and more. Organic dust exposures are linked to development of chronic bronchitis, chronic obstructive pulmonary disease, asthma, asthma-like syndrome, byssinosis, hypersensitivity pneumonitis, and idiopathic pulmonary fibrosis. Risk factors of disease development include cumulative dust exposure, smoking, atopy, timing/duration, and nutritional factors. The immunopathogenesis predominantly involves Toll-like receptor signaling cascade, T-helper 1/T-helper 17 lymphocyte responses, neutrophil influx, and potentiation of manifestations associated with allergy. The true prevalence of airway disease directly attributed to organic dust, especially in a workplace setting, remains challenging. Diagnostic confirmation can be difficult and complicated by hesitancy from workers to seek medical care, driven by fears of potential labor-related consequence. Clinical respiratory and systemic presentations coupled with allergy testing, lung function patterns of obstructive versus restrictive disease, and radiological characteristics are typically utilized to delineate these various organic dust-associated respiratory diseases. Prevention, risk reduction, and management primarily focus on reducing exposure to the offending dust, managing symptoms, and preventing disease progression.

Real-world therapeutic performance of pirfenidone for connective tissue disease-associated interstitial lung diseases.

Pirfenidone (PFD) is commonly applied for antifibrotic treatment in patients with idiopathic pulmonary fibrosis but has rarely been studied in cases with connective tissue disease-associated interstitial lung diseases (CTD-ILDs). We aimed to examine the efficacy of PFD in patients with CTD-ILD based on real-world data. A retrospective cohort study. This study assessed the clinical features of CTD-ILD patients with or without a 6-month PFD treatment. A linear mixed effects model was employed to evaluate the effectiveness of PFD in alleviating lung function changes. Differences in response to PFD were analyzed based on CTD subtype, imaging classification, and pattern of pulmonary function at baseline. A total of 289 patients with CTD-ILD were included, with 155 (53.6%) receiving PFD treatment and the remaining constituting the control group. Patients with the usual interstitial pneumonia (UIP) pattern were more likely to receive PFD treatment, and a relatively lower proportion of cases in the PFD group received immunosuppressive therapies compared to the control group (p < 0.05). At the 6-month follow-up, patients in the PFD group demonstrated a more significant improvement in forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) (ΔFVC%: 2.9% vs 0.45%, p = 0.009; ΔDLCO%: 1.9% vs -1.1%, p = 0.004). In the linear mixed model analysis, there was a statistically significant group-time interaction between FVC% and DLCO% changes over time (FVC%: β = 4.52, p < 0.001; DLCO%: β = 4.13, p = 0.003). Furthermore, subgroup analysis indicated that pirfenidone may have superior therapeutic effects in patients with systemic sclerosis (SSc)-associated ILD, non-UIP pattern, and restrictive pattern of lung function at baseline. This study provided real-world data demonstrating the effectiveness of PFD in terms of lung function improvement in patients with CTD-ILD.

Obstructive and restrictive spirometry from school age to adulthood: three birth cohort studies

Spirometric obstruction and restriction are two patterns of impaired lung function which are predictive of poor health. We investigated the development of these phenotypes and their transitions through childhood to early adulthood. In this study, we analysed pooled data from three UK population-based birth cohorts established between 1989 and 1995. We applied descriptive statistics, regression modelling and data-driven modelling to data from three population-based birth cohorts with at least three spirometry measures from childhood to adulthood (mid-school: 8-10 years, n=8404; adolescence: 15-18, n=5764; and early adulthood: 20-26, n=4680). Participants were assigned to normal, restrictive, and obstructive spirometry based on adjusted regression residuals. We considered two transitions: from 8-10 to 15-18 and from 15-18 to 20-26 years. Obstructive phenotype was observed in ∼10%, and restrictive in ∼9%. A substantial proportion of children with impaired lung function in school age (between one third in obstructive and a half in restricted phenotype) improved and achieved normal and stable lung function to early adulthood. Of those with normal lung function in school-age, <5% declined to adulthood. Underweight restrictive and obese obstructive participants were less likely to transit to normal. Maternal smoking during pregnancy and current asthma diagnosis increased the risk of persistent obstruction and worsening. Significant associate of worsening in restrictive phenotypes was lower BMI at the first lung function assessment. Data-driven methodologies identified similar risk factors for obstructive and restrictive clusters. The worsening and improvement in obstructive and restrictive spirometry were observed at all ages. Maintaining optimal weight during childhood and reducing maternal smoking during pregnancy may reduce spirometry obstruction and restriction and improve lung function. MRC Grant MR/S025340/1.

Radiological appearance and lung function six months after invasive ventilation in ICU for COVID-19 pneumonia: An observational follow-up study.

Respiratory functional sequelae in COVID-19 patients admitted to the intensive care unit for invasive ventilation are sparsely reported. The aim of this study was to investigate the radiological lung appearance, lung function and their association at 6 months after hospital discharge. It was hypothesized that the degree of pathological morphology on CT scans would correlate with lung function at the time of follow-up. In this single-centre prospective observational study, 86 from 154 patients admitted to ICU due to COVID-19 between March 2020 and May 2021 were followed up at 6 months post discharge with computed tomography (CT) of the chest and pulmonary function tests (PFTs). The PFT results were expressed as z-scores calculated as the difference between the measured and predicted values divided by the standard deviation obtained from a reference population. Correlations were evaluated by Spearman's rho including the 95% confidence interval. Pathological changes on CT were found in 78/85 participants with fibrous parenchymal bands being the most prevalent finding (91%) followed by traction bronchiectasis (64%) and ground glass opacities (41%). Sixty-five participants performed PFTs, and a restrictive pattern was the most prevalent abnormality (34%). Diffusing capacity of the lung for carbon monoxide (DLCO) was reduced in 66% of participants. The CT severity score weakly correlated with forced vital capacity (FVC) z-score (0.295, p = 0.006), DLCO z-score (-0.231, p = 0.032) and alveolar volume (VA) z-score (0.253, p = 0.019). Most patients showed persistent radiological abnormalities on CT and reduced lung volumes, impaired diffusion capacity and patterns of restrictive lung function at 6 months post discharge from the ICU. The correlations between abnormalities on CT and lung function tests were weak. Further, studies with a long-term follow-up of lung function in this group of patients are needed.

Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns.

Frailty associates with increased vulnerability to adverse health outcomes and reduced tolerance to medical interventions. Its impact on patients with chronic respiratory diseases, particularly beyond chronic obstructive pulmonary disease (COPD), remains poorly understood. To evaluate the association between frailty index and 5-year mortality across different "spirometric" patterns and the variation in their occurring frailty determinants. This study analyzed data from the SARA study, which enrolled 1968 older adults, to evaluate the association between frailty and 5-year mortality across different spirometric patterns. Frailty was assessed using the frailty index (FI), and spirometry was performed to determine lung function patterns. Hazard ratios (HRs) were calculated using Cox regression models, adjusting for age and sex. Among the study participants, 16% were classified as frail. Frailty was associated with a significantly increased risk of mortality across all spirometric patterns. The 5-year mortality rates were 34.3% in subjects with normal spirometry, 45.1% in those with obstructive defects, 55% in those with restrictive defects, and 42.6% in those with mixed airflow defects. The unadjusted HRs for mortality were 2.64 (95% CI 2.10-3.32) for the overall cohort, 2.24 (95% CI 1.48-3.40) for obstructive defects, 2.45 (95% CI 1.12-5.36) for restrictive defects, and 2.79 (95% CI 1.41-3.17) for mixed airflow defects. After adjusting for age and sex, the HRs remained statistically significant: 2.25 (95% CI 1.37-2.84) for the overall cohort, 2.08 (95% CI 1.37-3.18) for obstructive defects, 2.27 (95% CI 1.04-1.17) for restrictive defects, and 2.21 (95% CI 1.20-3.08) for mixed airflow defects. Frailty is a common syndrome and is associated with a significantly increased risk of mortality. The FI provides valuable information for risk profiling and personalized interventions beyond age and lung function parameters. Including frailty assessment in clinical evaluations can aid in resource allocation and improve patient care in respiratory diseases.

Preserved Ratio Impaired Spirometry and COPD Accelerate Frailty Progression: Evidence From a Prospective Cohort Study

Chronic obstructive pulmonary disease (COPD) was found to associate with frailty. However, there is inadequate longitudinal evidence for associations of COPD with frailty progression. Furthermore, recent studies revealed a new phenotype of lung function impairment: preserved ratio impaired spirometry (PRISm). Associations of PRISm and its transitions with frailty progression are unclear. What are the associations of PRISm, transitions of PRISm, and COPD with frailty progression? To analyze the associations of PRISm and COPD with frailty progression, 5,901 subjects were included from the English Longitudinal Study of Ageing. Subjects were classified into three lung function patterns of normal spirometry, PRISm, and COPD. Frailty progression was assessed by repeated measurements of the frailty index (FI) during follow-up. Among these 5,901 subjects, 3,765 subjects were included to analyze the associations of PRISm transitions with frailty progression. PRISm transitions were assessed based on the changes of lung function patterns after a four-year interval. Linear mixed-effect models were used for statistical analyses. The median follow-up periods were 9.5 years for the analyses of PRISm and COPD with frailty progression and 5.8 years for PRISm transitions with frailty progression. When compared with normal spirometry, subjects with PRISm and COPD presented accelerated FI progression with additional annual increases of 0.301(95%CI: 0.211 to 0.392, P<0.001) and 0.172(95%CI: 0.102 to 0.242, P<0.001), respectively. Subjects who transitioned from normal spirometry to PRISm also presented accelerated FI progression when compared with stable normal spirometry (β=0.242, 95%CI: 0.008 to 0.476, P=0.042). However, no accelerated FI progression was found in PRISm subjects who transitioned to normal spirometry (β=0.119, 95%CI: -0.181 to 0.418, P=0.438). Our findings indicate that PRISm and COPD are associated with accelerated frailty progression. Further studies are needed to elucidate the causality of PRISm and COPD with frailty.

Asthma with recurrent middle lobe syndrome in children: Clinical features and lung function patterns.

Middle lobe syndrome (MLS) is a complication of childhood asthma. This study aimed to compare the clinical features and lung function between asthmatic children with recurrent MLS and transient right middle lobe (RML) and/or lingula atelectasis. This study retrospectively analyzed asthmatic children with RML and/or lingula atelectasis between 2010 and 2020 using data from the pediatric pulmonary department. According to the episodes of atelectasis, children were divided into recurrent (≥2 episodes) and non-recurrent (only 1 episode) MLS groups, to compare clinical features and lung function. Spirometry during acute asthma exacerbation and stable stages were recorded, and variations were calculated. A total of 35 children with asthma and RML and/or lingula atelectasis were included, 15 of whom had recurrent MLS. The recurrent MLS group had a higher proportion of girls, infections, family allergy history, severe asthma, severe exacerbation, and higher levels of total IgE than the non-recurrent MLS group (P < 0.05). The recurrent MLS group had a significantly higher % predicted and z-scores for forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), a greater proportion of high FEV1 and higher variations in FEV1 and FVC than that in the non-recurrent group (P < 0.05). After excluding children with mild to moderate asthma in the recurrent MLS group, the differences in clinical features disappeared, but the results regarding lung function remained similar, when compared to severe asthma patients without RML and/or lingula atelectasis. Childhood asthma with recurrent MLS has more frequent severe asthma and exacerbation but high lung function and variations.

Asthma-related lung function and physical activity patterns among children living in urban neighborhoods

Objective Black and Latino American children residing in urban environments are at increased risk for comorbid asthma and obesity. Physical activity (PA) is a modifiable behavior known to contribute to the asthma-obesity phenotype. While research has indicated links between optimal asthma status and high PA among children, little is documented about whether this group may display other asthma and PA patterns that warrant clinical attention and tailored interventions. Methods Children with persistent asthma (N = 97) ages 7–9 and their caregivers from urban neighborhoods completed daily measures of asthma status and moderate-to-vigorous physical activity (MVPA) and questionnaires about health and sociodemographic characteristics. Clinical asthma guidelines (e.g. FEV1 ≥ 80%) and sample means were used to categorize children into high or low lung function and MVPA patterns. Individual, family, and contextual differences across lung function and MVPA patterns were investigated. Results Twenty-nine percent of participants displayed optimal lung function and high MVPA. The remainder of the sample exhibited various less optimal patterns (e.g. poorer lung function and high MVPA). Caregivers of children displaying poorer lung function and high MVPA levels were more likely to report asthma related fears than caregivers of children with low MVPA levels regardless of lung function status. Conclusions Asthma and PA interventions can be tailored to better address each child’s unique clinical and behavioral patterns. An enhanced understanding of risk factors for suboptimal patterns of asthma status and PA may aid in multicomponent intervention efforts.

Association of impaired lung function with dementia, and brain magnetic resonance imaging indices: a large population-based longitudinal study.

to examine the association between different patterns of impaired lung function with the incident risk of dementia and magnetic resonance imaging (MRI)-based brain structural features. in UK Biobank, a total of 308,534 dementia-free participants with valid lung function measures (forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]) were included. Association was assessed using Cox proportional hazards regression model. Furthermore, the association between impaired lung function and brain MRI biomarkers related to cognitive function was analysed among 30,159 participants. during a median follow-up of 12.6years, 3,607 incident all-cause dementia cases were recorded. Restrictive impairment (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.27-1.60) and obstructive impairment (HR, 1.28; 95% CI, 1.15-1.42) were associated with higher risk of all-cause dementia. The restricted cubic splines indicated FEV1% predicted and FVC % predicted had reversed J-shaped associations with dementia. Participants with impaired lung function have higher risks of all-cause dementia across all apolipoprotein E (APOE) risk categories, whereas associations were stronger among those of low APOE risk (P for interaction = 0.034). In addition, restrictive and obstructive impairment were linked to lower total (β: -0.075, SE: 0.021, Pfdr = 0.002; β: -0.033, SE: 0.017, Pfdr = 0.069) and frontoparietal grey matter volumes, higher white matter hyperintensity, poorer white matter integrity, lower hippocampus (β: -0.066, SE: 0.024, Pfdr = 0.017; β: -0.051, SE: 0.019, Pfdr = 0.019) and other subcortical volumes. participants with restrictive and obstructive impairments had a higher risk of dementia. Brain MRI indices further supported adverse effects and provided insight into potential pathophysiology biomarkers.

Assessment of air quality, health status and lung function of workers from selected poultry management systems in Ogun State, Nigeria

Background/ObjectivesThis study assessed the air quality, health status and lung function of workers from intensive poultry production systems in selected areas of Ogun State. MethodsAir samples were monitored monthly between November 2017 and April 2018 from six pens in three selected poultry zones of Ogun State. The air pollutants (CO2, CH4, NO2, NH3, H2S, SO2, PM2.5) and the microclimatic parameters around the poultry pens were determined. Copies of structured questionnaires were administered to assess the impacts of air pollutants on the health status of the poultry workers. Lung function parameters [Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), FEV1/FVC and Peak Expiratory Flow Rate (PEFR)] were measured to assess the pulmonary health of the poultry workers and the control group. ResultsThe levels of NH3, PM2.5, CO2 and CH4 were higher than the permissible standards while NO2, H2S and SO2 were below the permissible limits of the World Health Organization. Regression analysis between pollutants and microclimatic parameters showed that relative humidity and windspeed had negative effects on PM2.5, NO2, H2S and SO2. FEV1/FVC measured for poultry workers was 86.84 ± 18.32% with 10.0% having obstructive lung function, while the control group had 98.82 ± 1.52% with 100% normal lung function pattern. The predicted PEFR for poultry workers was significantly lower at 61.12 ± 27.85% with 13.3% having severe airway restrictions, while the predicted PEFR for the control group was significantly higher at 88.41 ± 21.76% with no severe airway narrowing. ConclusionsThis study established that air quality around the poultry operations affected the workers’ health.

Spirometric Indices of Charcoal Smoke Exposed Food Grillers in Yenagoa South-South, Nigeria

Background: Pulmonary function is an important marker of the effects of air pollution on the exposed population. Mild to moderate reductions of FEV1/FVC, FEV1, FEV1%, PEF, and FEF25–75 have been associated with the exposure to biomass burning in cross-sectional studies. Some hospital-based case-control studies, confirm that people exposed to biomass smoke have high risk for developing airflow obstruction with significant reduction of FEV1 and FEV1/FVC. However, none of these studies has evaluated lung function parameters among charcoal smoke exposed food grillers. Therefore this index study took a look at spirometric indices among food grillers exposed to charcoal smoke in Yenagoa, South-South Nigeria. Methods: This was a comparative observational cross-sectional study of charcoal smoke exposed spirometric indices of food grillers compared to fruit sellers The Medical Research Council (MRC) Questionnaire was administered to participants and a “one-on-one” interview was conducted by the researcher using the questionnaires.Information obtained included socio-demographic characteristics such as age, gender, marital status and level of education. Spirometry was performed in accordance with the ATS/ERS using standard single reusable turbine spirometer (MIR Spirobank II Basic; manufactured by P &amp; A Medical Limited). Spirograms that met the ATS/ERS criteria for acceptability were used. Information obtained with the spirometer were FEV1, FVC, FEV1/FVC, PEF and FEF25-75. A portable HANA analogue weight machine was used to weigh the study participants and a flexible plastic tape measure was used to measure the heights of participants Results: A total of one hundred and sixty (160) participants made up of eighty (80) food-grillers and fruit-sellers (controls) respectively were recruited for this study. A normal lung function pattern was found in 60 (75.0%) of food-grillers and 72 (90.0%) of controls. This shows that more fruit-sellers had normal lung function pattern, and this was statistically significant (p = 0.013). Obstructive pattern was found in 16 (20.0%) of food-grillers and 6 (7.5%) of controls (p = 0.022). The mean lung function values for food-grillers compared to fruit sellers were: FEV1=2.8±0.5L vs 3.2±0.5 (72.3±5.8% predicted); FVC=3.6±0.6L vs 3.9±0.8 (76.8±6.6% predicted), FEV1/FVC=78.5±4.9 vs 85.3 ±5.3 (77.1±5.4% predicted); PEF=5.7± 1.2L/s vs 6.9 ±2.9 (81.6±7.3% predicted) and FEF25-75=2.8±0.8L/s vs 3.0 (±0.4) (80.5±15.3% predicted). The values were statistically different between food-grillers and controls (p &lt; 0.001). Conclusion: Exposure to charcoal smoke is associated with the development of lung function abnormalities and reduction in lung function parameters. Increasing exposure time to charcoal smoke increase the likelihood of lung function abnormalities.

Assessment of Lung Function of People, Chronically Exposed to Air Pollution in Delhi/NCR, India

Background: Air pollution in India is a serious issue with the major sources being motor vehicle emissions, thermal power stations, cooling towers, biomass burning, fuel adulteration, factory smoke, and stubble burning. Chronic exposure to ambient air pollution has obtunded effects on the development of lung function in children and detrimental effects on lung function of adults. The adverse effects of pollution on lung function increase the development of lung diseases in the future. Aims and Objective: The aim of the study was a comparison of lung function between two groups of population with different occupations, one group with outdoor occupation (high exposure) and second group with indoor occupation (low exposure). Settings and Design: It was a cross-sectional study and the sampling approach was Quota sampling. Quota sampling is a type of non-probabilistic sampling. There are certain groups of people who are particularly vulnerable to ambient air pollution because of their sustained high exposure like traffic police personnel deputed at traffic junctions, auto rickshaw driver/Taxi driver, E-Rickshaw driver plying in this area, and road side vendors this group. Low exposure group chosen were employee of offices and showrooms who are working indoor. Methods and Materials: This study was a two groups of 245 participants in each. First group with outdoor occupation and second group with indoor occupation having different level of exposure to air pollution due to their nature of occupation. Lung function parameters FEV1, FVC, FEV1/FVC, PEFR, and FEF were compared between two groups. Statistical Analysis: SPSS 26 software was used. Independent “T” test for continuous data type for different population, paired “T” test within the group, and Chi-square test for categorical data were applied. Results: Among high exposure group, 62.7% and 9.4% were found to have restrictive and normal lung function pattern, respectively. In comparison, among low exposure group, 31% and 59.5% were found to have restrictive and normal lung function pattern, respectively. Among outdoor group, there was a significant decline of lung function parameters such as FEV1, FVC, FEV1/FVC, PEFR, and FEF in comparison to indoor group. Conclusion: In this study, the lung function parameters were decreased in population working outdoor and chronically exposed to air pollution, in comparison to indoor subjects.

Reduced decline of lung diffusing capacity in COPD patients with diabetes and metformin treatment

We studied whether in patients with COPD the use of metformin for diabetes treatment was linked to a pattern of lung function decline consistent with the hypothesis of anti-aging effects of metformin. Patients of GOLD grades 1–4 of the COSYCONET cohort with follow-up data of up to 4.5 y were included. The annual decline in lung function (FEV1, FVC) and CO diffusing capacity (KCO, TLCO) in %predicted at baseline was evaluated for associations with age, sex, BMI, pack-years, smoking status, baseline lung function, exacerbation risk, respiratory symptoms, cardiac disease, as well as metformin-containing therapy compared to patients without diabetes and metformin. Among 2741 patients, 1541 (mean age 64.4 y, 601 female) fulfilled the inclusion criteria. In the group with metformin treatment vs. non-diabetes the mean annual decline in KCO and TLCO was significantly lower (0.2 vs 2.3, 0.8 vs. 2.8%predicted, respectively; p < 0.05 each), but not the decline of FEV1 and FVC. These results were confirmed using multiple regression and propensity score analyses. Our findings demonstrate an association between the annual decline of lung diffusing capacity and the intake of metformin in patients with COPD consistent with the hypothesis of anti-aging effects of metformin as reflected in a surrogate marker of emphysema.

Acute Respiratory Deterioration in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Single-Center Study

Interstitial lung disease (ILD) is associated with increased morbidity and mortality in rheumatoid arthritis (RA). Moreover, acute exacerbation (AE) is a devastating complication of RA plus ILD. However, few data on AE in RA-associated ILD are available. What are the incidence, risk factors, and outcomes of AE in patients with RA-associated ILD? The clinical data of 310 patients with RA-associated ILD were analyzed retrospectively. AE was defined as the acute worsening of dyspnea typically within 30days with new bilateral lung infiltration, which was based on a 2016 report by an international working group. The mean age of the participants was 61.9 years, and 56.2%of them were women. During follow-up (median, 47.7months), AE occurred in 87 patients (28.1%). The 1-year, 3-year, and 5-year cumulative incidence rates of AE in patients with RA-associated ILD were 9.2%, 19.8%, and 29.4%, respectively. Ever smoker status, lower FVC, and shorter 6-min walk distance were significant risk factors for the occurrence of AE. In the multivariate Cox analysis adjusted by age, sex, smoking status, lung function, exercise capacity, and high-resolution CT scan pattern, AE was a significant prognostic factor for overall survival (hazard ratio, 2.423; 95%CI, 1.605-3.660; P< .001) in patients with RA-associated ILD. The 30-day and 90-day mortalities after AE were 12.6%and 29.9%, respectively. Our findings suggest that approximately one-third of patients with RA-associated ILD experience AE and that ever smoker status, and lower lung function and exercise capacity predispose patients to AE. AE significantly affects the overall survival of patients with RA-associated ILD.

Study of Pulmonary Function Tests in Multitransfused Children with Thalassaemia: A Case-control Study

Introduction: Lung involvement is one of the known complications of thalassaemia. This study was undertaken to assess the predominant type of pulmonary dysfunction. Most studies show pulmonary function abnormalities but the results are conflicting. Aim: To study Pulmonary Function Tests (PFTs) in multitransfused children with thalassaemia and compare them with normal children. Materials and Methods: This was a case-control study conducted from May 2012 to June 2013 at MS Ramaiah Medical College, Bengaluru, Karnataka, India, which included 35 children in the age group of 3-16 years with β-thalassaemia major and on regular transfusion as cases and 35 age and sex matched healthy children participated as controls. PFTs were done in 35 children with β-thalassaemia major, using Spirobank G and within three days of blood transfusion. Following parameters were recorded: Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Ratio of Forced Expiratory Volume in 1 second to Forced Vital Capacity (FEV1/FVC), Peak Expiratory Flow Rate (PEFR), and Forced Expiratory Flow (FEF25%-75). Student’s’ test was used for statistical analysis. Results: Percentage abnormalities of PFT in thalassaemia children were observed, 20 (57.14%) children had normal PFTs. Among the remaining children 9 (25.71%), 5 (14.29%) and 1 (2.86%) had restrictive, obstructive and mixed pattern of abnormalities respectively. Conclusion: Pulmonary function appeared to be affected in a majority of subjects with thalassaemia. Abnormal patterns of lung function were common in which restrictive type was predominant. No respiratory symptoms was found in any of these children. Studies are needed to establish the precise cause of pulmonary dysfunction.