Lung Function Profiles Research Articles

Impacts of zinc enriched spirulina as an adjunct to conventional treatment of patients with Chronic Obstructive Pulmonary Disease: Study protocol for a North African randomized controlled trial (SPIRICOPD).

Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition strongly related to oxidative stress. Recent studies have explored the potential benefits of nutritional supplementation in managing several conditions. To investigate the effects of zinc-enriched Spirulina Supplementation (ZSS) on patients with COPD. This study is a monocentric randomized controlled clinical trial. COPD-eligible adult male patients under 65 years of age, receiving regular medical treatment, will be included. They will continue their conventional medical treatment following the GOLD 2023 guidelines for COPD. Ninety subjects will be randomly assigned to either the experimental group (G1) or the control group (G2) in a 1:1 ratio. G1 will receive ZSS (1 g/day) for 2 months, while G2 will continue only basic medical treatment. The study will assess oxidant-antioxidant balance, lung function through pulmonary function tests, functional capacity via the 6-minute walking test, lipid profile, dyspnea, and health-related quality of life. All outcomes will be measured at baseline and two months later after supplementation completion. After the 8-week treatment, patients will be followed up for an additional 4 weeks. Ethics approval was obtained from the faculty of medicine of Sousse ethics committee. It is expected that ZSS can positively impact the oxidant/antioxidant balance in patients with COPD after two months of supplementation. The authors anticipate that ZSS may improve various physiological parameters, such as lung function, exercise capacity, endothelial function, and metabolic profile, leading to an overall improvement in the quality of life of patients with COPD.

Combined Exercise and Diet Induce Airway Hyperreactivity While Reducing Liver Steatosis in Mice with Diet-Induced Obesity.

Obesity is a multi-organ system disease, which is associated with, e.g., a higher prevalence of non-alcoholic fatty liver disease (NAFLD) and asthma. Little is known regarding the effect of obesity-related parameters (including liver integrity) and the respiratory phenotype after a combination of physical activity and diet. Thirty-two C57BL/6 mice were, after 27 weeks of a high fat diet (HFD), randomly assigned to two dietary interventions for three weeks: a HFD or a normal chow diet (NCD). In both dietary groups, half of the animals were subjected to a sub-maximal exercise protocol. Lung function, lung inflammation, liver histology, and metabolic profile were determined. Mice with obesity did not show airway hyperreactivity after methacholine provocation. Sub-maximal exercise with diet (NCD/E) induced a significant reduction in forced expiratory volume in 0.1 s after methacholine provocation. NCD/E had significantly more neutrophils and inflammation (IFN-γ, TNF-α, IL-4, and IL-17F) in bronchoalveolar lavage compared to non-exercising mice on a HFD (HFD/NE). However, more epithelial injury (serum surfactant protein D and IL-33) was seen in HFD/NE. Additionally, hepatic steatosis and fibrosis were reduced by combined diet and sub-maximal exercise. Combining sub-maximal exercise with diet induced airway hyperreactivity and pulmonary inflammation, while body weight, hepatic steatosis, and fibrosis improved.

Non-cystic fibrosis bronchiectasis: a retrospective review of clinical, radiological, microbiological and lung function profile at a tertiary care center of a low-middle-income country.

Non-cystic fibrosis (non-CF) bronchiectasis has emerged as a significant respiratory disease in developing countries. Given the variation in causes and clinical characteristics across different regions, it is necessary to conduct studies in regions with limited data, such as low-middle-income countries (LMIC). The aim of the study was to investigate the underlying causes, clinical presentation, etiology, lung function, and imaging in patients with bronchiectasis who sought treatment at a tertiary care hospital in an LMIC. We conducted a retrospective observational study at the Aga Khan University, Pakistan. Adult patients diagnosed with non-CF bronchiectasis on high-resolution computed tomography (HRCT) scan between 2000 and 2020 were included. We evaluated the etiology, clinical characteristics, microbiology, radiology, and spirometric patterns of these patients. A total of 340 patients were included, with 56.5% being female and 44.7% aged over 60 years. Among them, 157 (46.2%) had experienced symptoms for 1-5 years. The most common spirometric pattern observed was obstructive impairment (58.1%). Previous tuberculosis (TB) (52.94%) was the most common etiology, followed by allergic bronchopulmonary aspergillosis (7.64%). Bilateral lung involvement on HRCT scan was found in 63.2% of patients. Pseudomonas aeruginosa was the most frequently identified organism (38.75%) among 240 patients with available specimens. Patients with P. aeruginosa infections had a significantly higher number of exacerbations (p=0.016). There was a significant difference (p<0.001) in P. aeruginosa growth among different etiologies. In conclusion, post-TB bronchiectasis was the most common cause of non-CF bronchiectasis in our study population. P. aeruginosa was the predominant organism, and 63.2% of the patients exhibited bilateral lung involvement. Since P. aeruginosa growth and extensive lung involvement have been associated with poor prognosis and increased mortality risk, we recommend close follow-ups of these patients to improve quality of life and survival in developing countries like Pakistan.

Diagnosis and treatment of Combined Pulmonary Fibrosis and Emphysema (CPFE)

Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome of combination pulmonary fibrosis and emphysema which is now widely found. Clinical characteristics of the CPFE are current or former heavy smoker, predominantly male, and symptom of shortness of breath on exertion. The standard diagnosis of CPFE is based on high resolution computed tomography (HRCT) with emphysema in the upper lung zone and fibrosis in the lower lung zone. The lung function profile in CPFE is different from patients with emphysema or pulmonary fibrosis alone. The lung volumes in CPFE is preserved, but there is significant reduction in lung diffusion capacity. CPFE has a poor prognosis. The presence of pulmonary hypertension in CPFE is a poor prognostic factor. Because there is no current standard treatment of CPFE, the focus of management is supportive therapy, management of complications, and management of exacerbation CPFE.

Effects of Inspiratory Muscles Trainer in Pulmonary Rehabilitation Program among COPD Patients

Background: Chronic obstructive pulmonary disease (COPD) is associated with prolonged respiratory problems and compromised airflow. Eventually, routine activities become troublesome. Pulmonary rehabilitation program and specific training of inspiratory muscles can do management of such patients. Aim: To find out the effects of Inspiratory Muscle Trainer on dyspnea in moderate COPD patients during Pulmonary Rehabilitation in terms of improvement of pulmonary lung function and Multidimensional Dyspnea profile. Study Design: Randomized controlled trial. Methodology: Two groups were designed; in one group Pulmonary Rehabilitation Program was applied in other group both PRP and IMT was given. Patients were recruited into two groups by simple random technique. Pre-treatment measurements were taken and then Sessions of 4 weeks with 5 days per week were given and post treatment assessment was done. Data was evaluated by using SPSS version 24. Independent sample t-test was applied to determine any significant difference between Pre-treatment and Post-treatment Functional pulmonary assessment between two groups. Results: Findings revealed that differences between two groups were statistically significant (p &lt;0.05) and also statistically significant difference were observed within group analysis (p&lt; 0.05) with respect to dyspnea , fatigue , quality of life. Practical Implication: This study considered moderate COPD patients for Inspiratory Muscle training (IMT) along with Multi-Disciplinary Approach in slowing down the worsening of disease and in this way prevented the future complications. Conclusion: It was concluded that inspiratory muscle trainer group was more effective as compare to standard rehabilitation in improving pulmonary function testing and reducing dyspnea among COPD patients. Keywords: Dyspnea, Inspiratory Muscle Training and Pulmonary Rehabilitation Programme.

Pulmonary Arterial Pressure Changes Under Dobutamine Stress Echocardiography in Non-Anemic Iron Deficient COPD Subjects.

PurposeNon-anemic iron deficiency (NAID) is common in COPD, and could induce functional/structural changes in the pulmonary vascular bed. Thus, we aimed to study, during resting and ambient oxygen conditions, the systolic pulmonary arterial pressure (sPAP) changes during dobutamine stress echocardiography (DSE) for NAID+ compared to NAID- subjects with COPD.Patients and MethodsWe analyzed 24 patients with COPD and evaluated their clinical parameters, including lung function and serum iron profile, followed by the changes in the sPAP under DSE.ResultsTen subjects with NAID+ were compared with fourteen NAID- subjects for sPAP measurement. At baseline, only left atrial volume was significantly different between groups (30±4 vs 23±5 mL*m2), respectively (p-value=0.002). For the right side, tricuspid annular plane systolic excursion (TAPSE) was similar between-groups (22±2 vs 20±4, p-value >0.05), at baseline. The sPAP (mmHg) changes were also not significantly different between groups (pre 32±14 vs peak 48±14 for NAID+ and pre 29±7 vs peak 43±10 for NAID-, Group p-value=0.400, Time p-value <0.0001, and Interaction p-value=0.606).ConclusionCOPD subjects with NAID do not show increased sPAP responses during DSE, compared with iron-replete subjects.

The role of the Aerobic Interval Exercise Training on the Lung Function Profile in Adolescent Girls With Different Body Composition Index

Background and Objectives Obesity and a sedentary lifestyle factors related to pulmonary function and cardiorespiratory requirements (CRF). This study was to determine the effect of regular aerobic training on cardiac and respiratory function in adolescent girls with different body mass index. Methods In the present quasi-experiments (QEs) study, which was conducted with pre-test and post-test design, 45 female students in the age range of 13 to 18 years old were selected and added to 3 groups of 15 people with normal, overweight and obese body mass index. The training protocol included 10 weeks of aerobic training, 3 sessions per week and each exercise session for 20-45 minutes of. Pulmonary function was measured by spirogram and Maximal oxygen uptake (VO2max) by modified treadmill bulk test. Results There were significant differences in Forced Vital Capacity (FVC), Forced Expiration Volume in one Second (FEV1), Peak Expiratory Flow (PEF), FEV1/FVC and VO2max in groups with normal body mass index, overweight and obese (P&lt;0.001). After the training period, a significant improvement was observed in spirometry indices (FVC, FEV1, PEF, FEV1/VC) and VO2max compared to the pre-test (P &lt;0.001), but still significantly lower than the post-test values in the was normal group. Also significant decreased was observed in Body Mass Index (BMI) in obese and overweight groups (P&lt;0.001). Conclusion The results of the present study showed that obesity is one of the effective factors in reducing pulmonary function and aerobic exercise improves pulmonary function and cardiorespiratory endurance in adolescent girls with different body mass index.

Development of a nomogram for predicting the presence of combined pulmonary fibrosis and emphysema

BackgroundIn the clinical management of patients with combined pulmonary fibrosis and emphysema (CPFE), early recognition and appropriate treatment is essential. This study was designed to develop an accurate prognostic nomogram model to predict the presence of CPFE.MethodsWe retrospectively enrolled 85 patients with CPFE and 128 patients with idiopathic pulmonary fibrosis (IPF) between January 2015 and January 2020. Clinical characteristics were compared between groups. A multivariable logistic regression analysis was performed to identify risk factors for CPFE. Then, and a nomogram to predict the presence of CPFE was constructed for clinical use. Concordance index (C-index), area under the receiver operating characteristic curve (AUC), and calibration plot was used to evaluate the efficiency of the nomogram.ResultsCompared to the IPF group, the proportion of patients with male, smoking and allergies were significantly higher in the CPFE group. In terms of pulmonary function tests, patients with CPFE had lower FEV1/FVC%, DLCO/VA% pred, and higher RV, RV%pred, VC, VC%pred, TLC%pred, VA, TLC, TLC%pred, FVC, FVC%pred and FEV1 with significant difference than the other group. Positive correlation was found between DLCO and VA%, RV%, TLC% in patients with IPF but not in patients with CPFE. By multivariate analysis, male, smoking, allergies, FEV1/FVC% and DLCO/VA%pred were identified as independent predictors of the presence of CPFE. The nomogram was then developed using these five variables. After 1000 internal validations of bootstrap resampling, the C-index of the nomogram was 0.863 (95% CI 0.795–0.931) and the AUC was 0.839 (95% CI 0.764–0.913). Moreover, the calibration plot showed good concordance of incidence of CPFE between nomogram prediction and actual observation (Hosmer–Lemeshow test: P = 0.307).ConclusionsPatients of CPFE have a characteristic lung function profile including relatively preserved lung volumes and ventilating function, contrasting with a disproportionate reduction of carbon monoxide transfer. By incorporating clinical risk factors, we created a nomogram to predict the presence of CPFE, which may serve as a potential tool to guide personalized treatment.

Non-occupational exposure to pesticides and health markers in general population in Northern Finland: Differences between sexes.

Occupational exposure to pesticides has been reported among general population worldwide. However, little is known about the associations between non-occupational exposure to pesticides, and biological markers of health and their response by sex. We aimed to assess the associations between non-occupational overall pesticide exposure, length of exposure and specific pesticides reported with 35 biological markers of health representing cardiometabolic, haematological, lung function, sex hormones, liver and kidney function profiles, and vitamin D in Finnish cohort. 31-year cross-sectional examination of the Northern Finland Birth Cohort 1966 provided blood samples for biomarker measurements in 1997-1998. Number of subjects varied between 2361 and 5037 for given exposures and certain outcome associations. Multivariable regression analyses were performed to examine associations between overall pesticide exposure (OPE), length of pesticide exposure in months (PEM), in years (PEY), and specific pesticides use (PEU) or not with cardiometabolic [SBP, DBP, TC, LDL, HDL, triglycerides, fasting glucose, insulin, HOMA-IR, HOMA-B, HOMA-S, hs-CRP], hematological [WBC, RBC, Hb, HCT, MCV, MCH, MCHC, platelets], lung function (FVC, FEV1), sex hormones [luteinizing hormone (LH), testosterone (TT), sex-hormone binding globulin (SHBG)], liver and kidney function profiles [total protein, albumin, globulin, ALP, ALT, GGT, urea, creatinine], and vitamin D adjusting for sex, BMI, socioeconomic position (SEP) and season of pesticide use. This cohort study on up to 5037 adults with non-occupational OPE, PEM, PEY and PEU differed by sex and SEP. In regression analyses, all the exposures were positively associated with total cholesterol and low-density lipoprotein cholesterol, and PEU was negatively associated with high-density lipoprotein cholesterol in females. OPE and PEM were positively associated with haematocrit in females and PEU with platelets in males. PEU was negatively associated with mean corpuscular haemoglobin. OPE and PEM were positively associated with LH in males. OPE was negatively associated with total protein and albumin in males. In Finnish young adults, non-occupational overall pesticide exposure, length of exposure and specific pesticides were associated with multiple biological markers of health. The biological markers seem to be indicative of adverse effects of pesticides and warrant for further studies to replicate the findings and determine the underlying mechanisms.

Dose-Response Relationship between Environmental Exposure to Nickel and Pulmonary Function in the Korean General Population Aged 40 or Older.

Nickel is a well-known skin allergen; however, few studies to date have investigated the association between nickel exposure and lung function impairment. The present study, therefore, evaluated the relationship between blood nickel concentrations and lung function profiles in the Korean general population (n = 1098). Dose–response relationships between blood nickel quartiles and pulmonary function were assessed by sex in multivariate models, after adjustment for potentially confounding factors such as age, height, and smoking status. Quartiles of blood nickel concentrations were significantly associated with markers of pulmonary function in Korean men, such as forced expiratory volume in 1 second (FEV1) and forced expiratory flow 25–75% (FEF25–75%). Relative to the first quartile, the estimated coefficients (standard error (SE)) of blood nickel levels for FEV1 in the third and fourth quartiles of Korean men were −126.6 mL (59.1) and −138.5 mL (59.8), respectively (p < 0.05). Relative to the first quartile, the estimated coefficients (SE) of blood nickel levels for FEF25–75% in the second and fourth quartiles were −244.9 mL (109.5) and −266.8 mL (111.5), respectively (p < 0.05). Dose–response relationships were observed between quartiles of blood nickel concentrations and the pulmonary function markers FEV1 and FEF25–75% in Korean men aged 40 or older.

The contribution of patients' lung function to the inspiratory airflow rate achievable through a DPIs' simulator reproducing different intrinsic resistance rates.

BackgroundThe performance of DPIs depends on several physiological (patient-dependent) and technological (device-dependent) factors. The inspiratory airflow rate is the only active force generated and operating in the system for inducing the required pressure drop and eliciting the resistance-induced turbulence needed to disaggregate the powder through the device. The present study aimed to investigate in the most prevalent respiratory disorders whether and at what extent the inspiratory airflow rate achievable when inhaling through a DPIs’ simulator reproducing different intrinsic resistance regimens (low, mid, and high resistance) is affected by peculiar changes in lung function and/or can be predicted by any specific lung function parameter.MethodsThe inspiratory airflow rate was assessed in randomized order by the In-Check DIAL G16 at low, mid, and high resistance regimens in a sample of consecutive subjects at recruitment. Independent predictors of the probability to achieve the expected inhalation airflow rate were investigated by means of a multivariate logistic regression model, specific to the disease.ResultsA total of 114 subjects were recruited (asthmatics n=30; COPD n=50, restrictive patients n=16, and normal subjects n=18). The mean values of the expected inspiratory airflow rate achieved proved significantly different within the groups (p<0.0001), independently of sex and age. In asthmatics and in COPD patients, the mid-resistance regimen proved highly associated with the highest mean values of airflow rates obtained. Low- and high-resistance regimens were significantly less likely to consent to achieve the expected level of inspiratory airflow rate (OR<1 in all comparisons). Restrictive patients performed the lowest airflow rates at the low-resistance regimen (p<0.01). Unlike FEV1, RV in asthmatics (OR=1.008); RV and IRaw in COPD (OR=0.587 and OR=0.901, respectively), and FIF and TLC in restrictive patients (OR=1.041, and OR=0.962, respectively) proved the only sensitive predictors of the inspiratory airflow rate achievable at the different resistive regimens.ConclusionsThe intrinsic resistive regimen of DPIs can play a critical role. The patients’ lung function profile also affects the extent of their inhalation airflow rate. Some specific lung function parameters (such as: FIF; RV; IRaw; TLC, but not FEV1) may be regarded as specific predictors in real-life. In order to optimize the DPI choice, further to the device’s technology, also the current patients’ lung function should be properly investigated and carefully assessed.

Trajectories of asthma and allergies from 7 years to 53 years and associations with lung function and extrapulmonary comorbidity profiles: a prospective cohort study

Longitudinal trajectories of asthma and allergies from childhood to adulthood might be differentially associated with lung function and chronic obstructive pulmonary disease (COPD), but associations with extrapulmonary comorbidities have not been well investigated. We aimed to assess these trajectories and examine their associations with lung function outcomes and profiles of comorbidities. In this prospective cohort study, data for asthma and related allergic conditions (ie, eczema, hay fever, and food allergy) were prospectively collected from the Tasmanian Longitudinal Health Study for participants aged 7-53 years originally recruited in Tasmania, Australia. All surviving individuals in the database with contact details were invited in the most recent follow-up (mean age 53 years). There were no exclusion criteria. With use of latent class analysis, we identified longitudinal trajectories of asthma and allergic conditions from 7-53 years, and profiles of self-reported extrapulmonary conditions recorded at 53 years. The associations between asthma and allergy trajectories and morbidity profiles and lung function at 53 years were investigated with regression models. Between Sept 3, 2012, and Nov 8, 2016, of 6128 individuals invited, 3609 (58·9%) individuals were enrolled. We identified five asthma and allergy trajectories: minimal and least asthma and allergies (n= 1767 [49·0%]); late-onset hay fever, no asthma (n=1065 [29·5%]); early-onset remitted asthma and allergies (n=236 [6·5%]); late-onset asthma and allergies (n=317 [8·8%]); and early-onset persistent asthma and allergies (n=224 [6·2%]); and four profiles of extrapulmonary morbidities: minimal or least disease (n=2206 [61·1%]); dominant mental health disorders (n=861 [23·9%]); dominant cardiovascular diseases or risks (n=424 [11·7%]); and multiple disorders (n=117 [3·2%]). The late-onset asthma and allergies trajectory was predominantly associated with the multiple disorders profile (relative risk ratio 3·3 [95% CI 1·9-5·9]), whereas the other asthma and allergy trajectories were associated only with the dominant mental health disorders profile. Both spirometrically defined and clinical COPD were most strongly associated with the early-onset persistent asthma and allergies trajectory (odds ratio [OR] 5·3 [95% CI 3·2-8·6]) and also with the late-onset asthma and allergies trajectory (OR 3·8 [2·4-6·1]). Distinct longitudinal trajectories of asthma and allergic disease from childhood to 53 years are associated with different profiles of extrapulmonary comorbidities and varying risk of COPD. These findings can inform a personalised approach in clinical guidelines and management focusing on treatable traits. Comorbidity profiles are a new target for early identification and intervention. National Health and Medical Research Council of Australia, EU's Horizon 2020, The University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, The Victorian, Queensland & Tasmanian Asthma Foundations, The Royal Hobart Hospital, Helen MacPherson Smith Trust, and GlaxoSmithKline.

Real-World Study Analysing Progression and Survival of Patients with Idiopathic Pulmonary Fibrosis with Preserved Lung Function on Antifibrotic Treatment.

IntroductionIdiopathic pulmonary fibrosis (IPF) is a chronic, progressive and irreversible lung disease. Licensed treatment options for IPF are pirfenidone and nintedanib. The aim of this study was to assess the impact of antifibrotic therapy in patients with IPF with preserved lung function based upon a forced vital capacity (FVC) above 80%.MethodThis is a retrospective single-centre cohort study, performed as part of a service evaluation, between January 2007 and September 2018. Patient demographic, treatment and lung function profiles were collected using electronic patient records. A linear mixed model and Kaplan–Meier estimator were utilised to assess changes in FVC and survival over 36 months.ResultsA total of 161 patients were included in this study. Mean age was 72 ± 4. Twenty-four (14.9%) received pirfenidone, 86 (53.4%) received nintedanib and 18 (11.2%) received both antifibrotics provided by a compassionate use program (CUP), as the National Institute of Heath and Clinical excellence (NICE) criteria for antifibrotics in the UK is restricted to an FVC 50–80%. Thirty-three (20.5%) patients did not receive treatment. Patients without antifibrotic therapy had a statistically higher baseline FVC compared to other groups: 3.55 l (100%) vs 2.85 l (89.7%) pirfenidone (p = 0.012), vs 2.99 l (93.5%) nintedanib (p = 0.04) and 3.10 l (92.7%) (p = 0.07) for both antifibrotics. FVC decline over 1 year was similar in groups receiving pirfenidone, nintedanib or no treatment [3.72% (158.1 ml) untreated vs 2.77% (139 ml) pirfenidone vs 2.96% (131 ml) nintedanib]; however, it was significantly greater in patients who received both antifibrotics [6.36% (233 ml), p = 0.01]. Use of antifibrotics was associated with a higher median survival post diagnosis; 3.5, 3 and 3.75 years respectively in pirfenidone, nintedanib and both antifibrotic cohorts, compared to the untreated cohort (2.5 years).ConclusionOne in five untreated patients with an average FVC of 100% die within a median of 2.5 years. Antifibrotic therapy was associated with a higher median survival of 3–3.75 years despite treatment groups having lower baseline lung function.

Dietary Macronutrient Distribution and Nutrition Outcomes in Persons with Cystic Fibrosis: An Evidence Analysis Center Systematic Review

Cystic fibrosis (CF) increases risk for undernutrition and malabsorption. Individuals with CF traditionally have been counseled to consume a high-fat diet. However, a new era of CF care has increased lifespan and decreased symptoms in many individuals with CF, necessitating a re-examination of the high-fat CF legacy diet. A literature search was conducted of Medline (Ovid), Embase, and CINAHL (EBSCO) databases to identify articles published from January 2002 to May 2018 in the English language examining the relationships between dietary macronutrient distribution and nutrition outcomes in individuals with CF. Articles were screened, risk of bias was assessed, data were synthesized narratively, and each outcome was graded for certainty of evidence. The databases search retrieved 2,519 articles, and 7 cross-sectional articles were included in the final narrative analysis. Three studies examined pediatric participants and 4 examined adults. None of the included studies reported on outcomes of mortality or quality of life. Very low certainty evidence described no apparent relationship between dietary macronutrient distribution and lung function, anthropometric measures, or lipid profile in individuals with CF. The current systematic review demonstrates wide ranges in the dietary macronutrient intakes of individuals with CF with little to no demonstrable relationship between macronutrient distribution and nutrition-related outcomes. No evidence is presented to substantiate an outcomes-related benefit to a higher fat-diet except in the context of achieving higher energy intakes in a lesser volume of food.

Chronic Obstructive Pulmonary Disease Prevalence and Associated Factors in a Setting of Well-Controlled HIV, A Cross-Sectional Study

In Sub-Saharan Africa, COPD remains prevalent but its association with HIV is not well characterized especially in rural settings. We assessed for COPD prevalence, associated factors and lung function profile among HIV-infected individuals attending ART clinics in rural Nakaseke district of Uganda. We enrolled HIV-positive participants from four HIV treatment centers in rural Uganda. Participants underwent spirometry testing following standard guidelines. We defined COPD as a post-bronchodilator FEV1/FVC ratio less than the fifth percentile of the NHANES III African-American reference. We assessed for factors associated with COPD and lung function profiles using multivariable logistic and linear regression analyses. We analyzed data from 722 HIV-positive participants (mean age 48.0 years, 59.7% women). Over 90% of participants were on ART for a median duration of 4 years (IQR 2–7 years), with a median viral load of 0 copies/mL (IQR 0–0 copies/mL), current and baseline CD4 + T cell count of 478 cells/mm3 (IQR 346–663 cells/mm3) and 335 cells/mm3 (IQR 187–523 cells/mm3) respectively. The prevalence of COPD was 6.22%. COPD was associated with worse respiratory symptoms and health status. History of pulmonary tuberculosis was strongly associated with COPD (adjusted OR = 4.92, 95% CI 1.71 to 14.15, p = 0.003) and reduced lung function. Use of ART, CD4+T cell count and viral load were not associated with COPD or reduced lung function. In conclusion, we report a COPD prevalence of 6.22% in HIV-infected individuals in rural Uganda. Pulmonary tuberculosis remains the strongest predictor of COPD risk and reduced lung function in well-controlled HIV.

Combined Pulmonary Fibrosis and Emphysema.

Combined pulmonary fibrosis and emphysema (CPFE) is a clinical entity characterized by the combination of upper lobe emphysema and lower lobe fibrosis, the latter owing to various interstitial lung diseases. These patients have a characteristic lung function profile, with relatively preserved dynamic and static lung volumes, contrasting with a significant reduction of carbon monoxide transfer. The pathogenic mechanisms leading to the coexistence of emphysema with fibrosis remain unclear and different theories have been proposed. CPFE is frequently complicated by pulmonary hypertension, acute exacerbations, and lung cancer leading to poor natural history and prognosis. The syndrome of CPFE represents a distinct pulmonary manifestation in the spectrum of lung diseases associated with connective tissue diseases. Currently, there are no established recommendations regarding the management of patients with CPFE. We provide a review on the existing knowledge of CPFE regarding the epidemiology, pathogenesis, clinical manifestations, radiologic appearance, complications, prognosis, and possible treatment options.

Ozone-induced enhancement of airway hyperreactivity in rhesus macaques: Effects of antioxidant treatment

Ozone (O3) inhalation elicits airway inflammation and impairs treatment responsiveness in asthmatic patients. The underlying immune mechanisms have been difficult to study because of the lack of relevant experimental models. Rhesus macaques spontaneously have asthma and have a similar immune system to human subjects. We sought to investigate mucosal immune changes after O3 inhalation in a clinically relevant nonhuman primate asthma model and to study the effects of an antioxidant synthetic lignan (synthetic secoisolariciresinol diglucoside [LGM2605]). A cohort of macaques (n=17) previously characterized with airway hyperreactivity (AHR) to methacholine was assessed (day 1). Macaques were treated (orally) with LGM2605 (25mg/kg) or placebo twice per day for 7days, exposed to 0.3ppm O3 or air for 6hours (on day 7), and studied 12hours later (day 8). Lung function, blood and bronchoalveolar lavage (BAL) fluid immune cell profile, and bronchial brushing and blood cell mRNA expression were assessed. O3 induced significant BAL fluid neutrophilia and eosinophilia and increased AHR and expression of IL6 and IL25 mRNA in the airway epithelium together with increased BAL fluid group 2 innate lymphoid cell (ILC2s), CD1c+ myeloid dendritic cell, and CD4+ T-cell counts and diminished surfactant protein D expression. Although LGM2605 attenuated some of the immune and inflammatory changes, it completely abolished O3-induced AHR. ILC2s, CD1c+ myeloid dendritic cells, and CD4+ Tcells are selectively involved in O3-induced asthma exacerbation. The inflammatory changes were partially prevented by antioxidant pretreatment with LGM2605, which had an unexpectedly disproportionate protective effect on AHR.

Association of Air Pollution and Lung Function of Young Adult Females in New Delhi.

Lung function tests reflect the underlying physiological condition of the airways and the alveoli. Therefore, they help to evaluate the respiratory health of an individual. Lung functions are compromised far before appearance of the signs and symptoms of chronic respiratory diseases. Air pollution adversely affects lung function. Exposure to sources of pollution differ between men and women due to commuting and smoking habits. The present study was carried out in Delhi to assess the association of exposure to air pollution sources with lung function of young adult females, as this younger age group is expected to have a different exposure profile than older women. The present study was conducted on the campus of a central university in Delhi among 18- to 25-year old females (n=200). A pre-tested, close-ended and interviewer-administered questionnaire was used that consisted of information on sociodemographic details of the participants and self-reported exposure to air pollution sources at the residence of participants, during their commute to and from college, and at school. Both active and passive smoking status were recorded. Lung function was assessed using a digital spirometer. A significant association was observed between percentage of predicted value of forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) and peak expiratory flow (PEF) with the number of years the participant had resided in Delhi (p<0.05). Forced vital capacity and FEV1 of those using closed transport methods such as car, metro, and air-conditioned (A/C) bus were significantly better than those who used open transport methods such as non-A/C bus and scooter (p<0.05). Forced vital capacity and FEV1 were significantly decreased among those who had a smoke-producing factory in the vicinity of their residence (p<0.05). A significant decrease in FVC and FEV1 was observed among active smokers and among those who were exposed to passive smoking by family members in comparison to those who were not exposed (p<0.05). The results of the present study suggest that air pollution exposure plays a role in determining the lung function profile of young adult females. This study provides baseline data on lung function of young adult females which could be used in future longitudinal cohort studies. Obtained. The study was approved by the Institutional Ethics Committee of University College of Medical Sciences. The authors declare no completing financial interests.

Measures of low lung function and the prediction of incident COPD events and acute coronary events.

Although reduced lung function is associated with both COPD and coronary events (CE), the pattern of lung function impairment could be different for the two outcomes. We examined different measures of lung function in relation to incident COPD events and CE in a population-based cohort. Baseline spirometry and lung clearance index (LCI) were assessed in 672 men aged 55 years. Outcomes included incident COPD events and CE (hospitalisation or mortality). Cox regression was used to obtain HRs per 1-standard deviation (SD) decrement in baseline lung function. The Lunn-McNeil competing risks approach was used to assess if differences in risks for incident COPD events and CE were significant. Over 44 years follow-up there were 85 incident COPD events and 266 incident CE. Low FEV1 and FEV1/VC and high LCI showed significantly stronger relationships with COPD events than CE (adjusted HRs per 1SD decrement and p-value for equal associations: FEV1; HRCOPD: 2.11 (1.66-2.68), HRCE: 1.30 (1.13-1.49) p < 0.001, FEV1/VC; HRCOPD 1.95 (1.60-2.36), HRCE 1.11 (0.98-1.26) p < 0.0001, LCI; HRCOPD: 1.58 (1.26-1.98), HRCE: 1.14 (1.00-1.31) p = 0.015. Low VC was significantly associated with both COPD and CE, but HRs were not significantly different between the outcomes (p-value for equal associations = 0.706). Low FEV1 and FEV1/VC and high LCI at baseline show significantly stronger relationships with future COPD events than CE. Low VC at baseline is similarly associated with future COPD events and CE. This indicates differences but also an important similarity in the "lung function profile" for developing incident COPD events or incident CE later in life.

The respiratory physiome: Clustering based on a comprehensive lung function assessment in patients with COPD.

BackgroundWhile spirometry and particularly airflow limitation is still considered as an important tool in therapeutic decision making, it poorly reflects the heterogeneity of respiratory impairment in chronic obstructive pulmonary disease (COPD). The aims of this study were to identify pathophysiological clusters in COPD based on an integrated set of standard lung function attributes and to investigate whether these clusters can predict patient-related outcomes and differ in clinical characteristics.MethodsClinically stable COPD patients referred for pulmonary rehabilitation underwent an integrated assessment including clinical characteristics, dyspnea score, exercise performance, mood and health status, and lung function measurements (post-bronchodilator spirometry, body plethysmography, diffusing capacity, mouth pressures and arterial blood gases). Self-organizing maps were used to generate lung function based clusters.ResultsClustering of lung function attributes of 518 patients with mild to very severe COPD identified seven different lung function clusters. Cluster 1 includes patients with better lung function attributes compared to the other clusters. Airflow limitation is attenuated in clusters 1 to 4 but more pronounced in clusters 5 to 7. Static hyperinflation is more dominant in clusters 5 to 7. A different pattern occurs for carbon monoxide diffusing capacity, mouth pressures and for arterial blood gases. Related to the different lung function profiles, clusters 1 and 4 demonstrate the best functional performance and health status while this is worst for clusters 6 and 7. All clusters show differences in dyspnea score, proportion of men/women, age, number of exacerbations and hospitalizations, proportion of patients using long-term oxygen and number of comorbidities.ConclusionBased on an integrated assessment of lung function variables, seven pathophysiological clusters can be identified in COPD patients. These clusters poorly predict functional performance and health status.