Mean Lung Function Research Articles

Demographic factors associated with within-individual variability of lung function for adults with cystic fibrosis: A UK registry study

Background: Lung function is a key outcome used in the evaluation of disease progression in cystic fibrosis. The variability of individual lung function measurements over time (within-individual variability) has been shown to predict subsequent lung function changes. Nevertheless, the association between within-individual lung function variability and demographic and genetic covariates has not been quantified.Methods: We performed a longitudinal analysis of data from a cohort of 7099 adults with cystic fibrosis (between 18 and 49 years old) from the UK cystic fibrosis registry, containing annual review data between 1996 and 2020. A mixed-effects location-scale model is used to quantify mean FEV1 (forced expiratory volume in 1 s) trajectories and FEV1 within-individual variability as a function of sex, age at annual review, diagnosis after first year of life, homozygous F508 genotype and birth cohort.Results: Mean FEV1 decreased with age and lung function variability showed a near-quadratic trend by age. Males showed higher FEV1 mean and variability than females across the whole age range. Earlier diagnosis and homozygous F508 genotype were also associated with higher FEV1 mean and variability. Individuals who died during follow-up showed on average higher lung function variability than those who survived.Conclusions: Key variables known to be linked with mean lung function in cystic fibrosis are also associated with an individual’s lung function variability. This work opens new avenues to understand the role played by lung function variability in disease progression and its utility in predicting key outcomes such as mortality.

Efficacy and safety of LAU-7b in a Phase 2 trial in adults with cystic fibrosis

BackgroundLung inflammation is associated with tissue damage in cystic fibrosis (CF). LAU-7b, a novel oral drug candidate, was shown to control inflammation and stabilize CFTR protein in the epithelial membrane during inflammatory stress in preclinical models of CF. MethodsA double-blind, randomized, placebo-controlled Phase 2 study was conducted to evaluate efficacy and safety of LAU-7b in adults with CF. LAU-7b or placebo was administered over 24 weeks as six 21-day treatment cycles each separated by 7 days. The primary efficacy endpoint was the absolute change from baseline in percent predicted forced expiratory volume in 1 second (ppFEV1) at 24 weeks. ResultsA total of 166 subjects received at least one dose of study drug (Intent-To-Treat population, ITT), of which 122 received ≥5 treatment cycles (Per-Protocol population, PP). Both treatment arms showed a mean lung function loss at 24 weeks of 1.18 ppFEV1 points with LAU-7b and 1.95 ppFEV1 with placebo, a 0.77 ppFEV1 (40 s) difference, p=0.345, and a 0.95 ppFEV1 (49 %) difference in the same direction in PP population, p=0.263. Primary analysis of mean ppFEV1 through 24 weeks showed differences of 1.01 and 1.23 ppFEV1, in the ITT (65 % less loss, p=0.067) and PP populations (78 % less loss, reaching statistical significance p=0.049), respectively. LAU-7b had an acceptable safety profile. ConclusionAlthough the study did not meet its primary efficacy endpoint in the ITT population, LAU-7b was generally well tolerated and showed evidence of preservation of lung function to support further development.

Pulmonary function tests and their associated factors in people living with HIV at Jimma medical center; Ethiopia: a comparative cross-sectional study.

People living with HIV (PLHIV) have a greater risk of developing respiratory disorders. The problems are linked to poor socio-economic status, high viral load, low CD4 counts, and antiretroviral therapy. Despite the high prevalence of respiratory disorders, the association between HIV infection and pulmonary function status, as well as the associated factors, is not well established in resource-limited countries. A comparative cross-sectional study was conducted from September 24 to October 15 2020 at Jimma Medical Center among people living with HIV who were arranged into an age-sex-matched comparison group. Data were collected using a pretested structured questionnaire administered via face-to-face interviews. The collected data included socio-demographic, respiratory, HIV infection, and substance use variables. Pulmonary function tests were conducted using an SP10 spirometer. The collected data were entered and analyzed using SPSS version 26. Independent t-test and multiple linear regressions were carried out to identify factors associated with the pulmonary function status of the study participants. A total of 96 PLHIV and 96 matched control individuals participated in the study. The mean of pulmonary function test parameters among the PLHIV respondents was FVC (l) (67.35 ± 19.12, p0.003), FEV1s (l) (61.76 ± 16.04, p0.001), and PEFR (50.14 ± 23.32, p0.001), with a significant lowering in the study group. Female sex, respiratory symptoms, duration of HIV, duration of treatment, and khat chewing were associated with lowered FEV1s (l) (p < 0.05) in HIV-positive respondents. PLHIV had significantly lower mean lung function parameters than HIV-uninfected participants. As a result, health providers should screen HIV-positive patients with respiratory symptoms, prolonged duration of HIV infection, prolonged treatment, and khat chewing for non-infectious lung disorders while treating them.

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.

Asthma exacerbations are associated with a decline in lung function: a longitudinal population-based study

RationaleProgressive lung function (LF) decline in patients with asthma contributes to worse outcomes. Asthma exacerbations are thought to contribute to this decline; however, evidence is limited with mixed results.MethodsThis historical...

Antipseudomonal treatment decisions during CF exacerbation management

BackgroundCystic fibrosis (CF) pulmonary exacerbation (PEx) treatment guidelines suggest that Pseudomonas aeruginosa (Pa) airway infection be treated with two antipseudomonal agents. MethodsWe retrospectively studied treatment responses for STOP2 PEx treatment trial (NCT02781610) participants with a history of Pa infection. Mean lung function and symptom changes from intravenous (IV) antimicrobial treatment start to Visit 2 (7 to 10 days later) were compared between those receiving one, two, and three+ antipseudomonal classes before Visit 2 by ANCOVA. Odds of PEx retreatment with IV antimicrobials within 30 days and future IV-treated PEx hazard were modeled by logistic and Cox proportional hazards regression, respectively. Sensitivity analyses limited to the most common one-, two-, and three-class regimens, to only IV/oral antipseudomonal treatments, and with more stringent Pa infection definitions were conducted. ResultsAmong 751 participants, 50 (6.7%) were treated with one antipseudomonal class before Visit 2, while 552 (73.5%) and 149 (19.8%) were treated with two and with three+ classes, respectively. Females and participants with a negative Pa culture in the prior month were more likely to be treated with a single class. The most common single, double, and triple class regimens were beta-lactam (BL; n = 42), BL/aminoglycoside (AG; n = 459), and BL/AG/fluoroquinolone (FQ; n = 73). No lung function or symptom response, odds of retreatment, or future PEx hazard differences were observed by number of antipseudomonal classes administered in primary or sensitivity analyses. ConclusionsWe were unable to identify additional benefit when multiple antipseudomonal classes are used to treat PEx in people with CF and Pa.

Association of site of treatment with clinical outcomes following intravenous antimicrobial treatment of a pulmonary exacerbation

BackgroundIn the STOP2 (Standardized Treatment of Pulmonary Exacerbations-2) study, intravenous (IV) antimicrobial treatment duration for adults with cystic fibrosis (CF) experiencing pulmonary exacerbations (PEx) was determined based on initial treatment response. The impact of home vs hospital care remains an important clinical question in CF. Our hypothesis was that STOP2 participants treated at home would have less improvement in lung function compared to those treated in the hospital. MethodsTreating clinicians determined PEx treatment location, which was a stratification factor for STOP2 randomization. Lung function, weight, and symptom recovery were evaluated by treatment location. Propensity scores and inverse probability treatment weighting were used to test for differences in clinical response by treatment location. ResultsIn all, 33% of STOP2 participants received IV antimicrobials in the hospital only, 46% both in the hospital and at home, and 21% at home only. Mean (95% CI) ppFEV1 improvement was significantly (p < 0.05) lower for those treated at home only, 5.0 (3.5, 6.5), compared with at home and in the hospital, 7.0 (5.9, 8.1), and in the hospital only, 8.0 (6.7, 9.4). Mean weight (p < 0.001) and symptom (p < 0.05) changes were significantly smaller for those treated at home only compared to those treated in the hospital only. ConclusionsCompared to PEx treatment at home only, treatment in the hospital was associated with greater mean lung function, respiratory symptom, and weight improvements. The limitations of home IV therapy should be addressed in order to optimize outcomes for adults with CF treated at home.

Changes in lung function in European adults born between 1884 and 1996 and implications for the diagnosis of lung disease: a cross-sectional analysis of ten population-based studies

During the past century, socioeconomic and scientific advances have resulted in changes in the health and physique of European populations. Accompanying improvements in lung function, if unrecognised, could result in the misclassification of lung function measurements and misdiagnosis of lung diseases. We therefore investigated changes in population lung function with birth year across the past century, accounting for increasing population height, and examined how such changes might influence the interpretation of lung function measurements. In our analyses of cross-sectional data from ten European population-based studies, we included individuals aged 20-94 years who were born between 1884 and 1996, regardless of previous respiratory diagnoses or symptoms. FEV1, forced vital capacity (FVC), height, weight, and smoking behaviour were measured between 1965 and 2016. We used meta-regression to investigate how FEV1 and FVC (adjusting for age, study, height, sex, smoking status, smoking pack-years, and weight) and the FEV1/FVC ratio (adjusting for age, study, sex, and smoking status) changed with birth year. Using estimates from these models, we graphically explored how mean lung function values would be expected to progressively deviate from predicted values. To substantiate our findings, we used linear regression to investigate how the FEV1 and FVC values predicted by 32 reference equations published between 1961 and 2015 changed with estimated birth year. Across the ten included studies, we included 243 465 European participants (mean age 51·4 years, 95% CI 51·4-51·5) in our analysis, of whom 136 275 (56·0%) were female and 107 190 (44·0%) were male. After full adjustment, FEV1 increased by 4·8 mL/birth year (95% CI 2·6-7·0; p<0·0001) and FVC increased by 8·8 mL/birth year (5·7-12·0; p<0·0001). Birth year-related increases in the FEV1 and FVC values predicted by published reference equations corroborated these findings. This height-independent increase in FEV1 and FVC across the last century will have caused mean population values to progressively exceed previously predicted values. However, the population mean adjusted FEV1/FVC ratio decreased by 0·11 per 100 birth years (95% CI 0·09-0·14; p<0·0001). If current diagnostic criteria remain unchanged, the identified shifts in European values will allow the easier fulfilment of diagnostic criteria for lung diseases such as chronic obstructive pulmonary disease, but the systematic underestimation of lung disease severity. The European Respiratory Society, AstraZeneca, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, and Sanofi-Genzyme.

Comparison Between The Effect of Clove, Filter and Biomass Cigarette Smoke to The Lung Function of COPD Patients at Harum Melati Pringsewu Clinic Lampung Province, Period January 2013-January 2020

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common disease characterized by respiratory symptoms and limited air flow associated with the airways and/or alveolar abnormalities triggered by a significant effect on substances or gases. COPD is the leading of death cause in the world. COPD can be caused by cigarette smoke and biomass. Method: This research is aquantitative method with descriptive analytic and retrospective approach. The samples were 203 COPD patients taken from medical records January 2013-January 2020 at Harum Melati Pringsewu Clinic Lampung Province with statistical test use Analysis Varians (ANOVA) technique. Results: From the characteristics based on type of COPD smoke exposure were clove smokers 127 people (62.6%), filter smokers 3 people (1.5%) and biomass users 73 people (36.0%). The mean lung function COPD patients based on type of smoke exposure were 127 people with clove smokers with average lung function value 55.03%, the lowest value 12.20% and the highest 121.50%. Filter smokers of 3 people with average lung function value 75.07%, the lowest value was 67.00% and the highest 81.41%. Biomass users 73 people with average lung function value 56.91%, the lowest value 19.50% and the highest 149.13%. Comparison the effect clove cigarettes smoke, filter cigarettes and biomass on the pulmonary function of COPD patients obtained P=0.319. Conclusion: There is a decrease lung function in clove smokers, filter smokers and biomass users in COPD patients but not statistically significant difference.

Lung function is associated with tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) levels in school-aged children

BackgroundTumour necrosis factor-related apoptosis-inducing ligand (TRAIL) is a cytokine with inflammatory and apoptotic properties. A complex relationship exists between TRAIL and the lung where both elevated TRAIL and TRAIL deficiency are associated with lung impairment. In neonatal mice, TRAIL is thought to translate respiratory infections into chronic lung disease but the association between TRAIL and lung function in childhood has not been assessed. AimTo assess the cross-sectional relationship between TRAIL levels and lung function in school-aged children. MethodsThe study cohort consisted of 170 school-aged children attending four schools in Malmö, Sweden. Lung volumes, impulse oscillometry (IOS) and serum TRAIL were measured for all children. Linear regression was used to assess changes in lung function per 1-SD increase in TRAIL. General linear models were used to assess mean lung function by tertiles (T) of TRAIL. ResultsMean age was 9.9 years (±0.6). A 1-SD increase in TRAIL was associated with lower values of FEV1 and FEV1/VC (change in FEV1 (L) and FEV1/VC ratio: −0.047, p-value 0.002, and −0.011, p-value 0.020, respectively) and higher values of lung resistance (change in R5 and R20 (kPa/(L/s)): 0.035, p-value <0.001 and 0.027, p-value 0.004, respectively). These associations remained significant after excluding children with pre-existing lung disease. Higher TRAIL levels were associated with more negative values for X5 in general linear models (Mean X5 (kPa/(L/s)) in T1 (low TRAIL): −0.193 vs T3 (high TRAIL): −0.216, p-value 0.026). ConclusionsHigh TRAIL levels are significantly associated with markers of pulmonary airflow obstruction in school-aged children.

Real-life experience with benralizumab during 6 months

BackgroundBenralizumab is a monoclonal antibody that binds to the human interleukin-5 (IL-5) receptor (IL-5R), thereby preventing IL-5 from binding to its receptor and inhibiting differentiation and maturation of eosinophils in the bone marrow. Because of its recent marketing approval, sufficient real-life evidence is lacking to confirm the efficacy and safety data from clinical trials. The purpose of this study was to evaluate the efficacy and safety of benralizumab for the treatment of severe refractory eosinophilic asthma in a real-world cohort of patients.MethodsThis was a cross-sectional multicentre study of consecutive patients with severe refractory eosinophilic asthma who received treatment with benralizumab during at least 6 months. Patient follow-up was performed in specialised severe asthma units.ResultsA total of 42 patients were enrolled and treated with benralizumab. Asthma control, as measured by the asthma control test (ACT), improved in all patients both at 3 months of treatment compared with baseline (13.9 ± 4 vs 20.1 ± 3.7, p < 0.001) and at 6 months of treatment compared with the results obtained at 3 months (20.1 ± 3.7 vs 21 ± 2.7, p = 0.037). Similarly, the number of emergency department visits decreased both at 3 months compared with baseline (1 [IR:0.7] vs 0 [IR:0.75], p < 0.001) and at 6 months compared with the results at 3 months (0 [IR:0.75] vs 0 [IR:0], p = 0.012). Reductions in the number of oral corticosteroid cycles, percentage of corticosteroid-dependent patients, and mean daily dose of oral or inhaled corticosteroid were also evidenced. Finally, mean lung function improvement was 291 mL (p < 0.001), and FEV1% improved both at 3 months compared with baseline (64.4 ± 9.3 vs 73.1 ± 9.1, p < 0.001) and at 6 months compared to 3 months (73.1 ± 9.1 vs 76.1 ± 12, p = 0.002). Side effects were mild and did not lead to treatment discontinuation.ConclusionsThis study confirms the efficacy and safety of benralizumab in a real-life setting with improved asthma control and lung function, and a reduced oral and inhaled corticosteroid use as well as fewer emergency department visits. In addition to a rapid initial improvement, it appears that patients continue to improve during the first 6 months of treatment.

Lung function and respiratory outcomes in teenage boys and girls born very prematurely.

Male sex in prematurely born infants has been associated with worse respiratory outcomes in early childhood. Respiratory outcomes at 11 to 14 years of age in children born very prematurely and routinely exposed to antenatal corticosteroids and postnatal surfactant would differ according to sex. Analysis of follow-up data. Three hundred and nineteen children born before 29 weeks of gestational age from the United Kingdom Oscillation Study. Spirometry was used to assess forced expiratory flow at 75%, 50%, and 25% of expired vital capacity (FEF75 , FEF50 , and FEF25 ), forced expiratory volume in 1 second (FEV1 ), peak expiratory flow (PEF), and forced vital capacity (FVC). Lung volumes were measured using a helium dilution technique (FRCHe ) and by plethysmography (FRCpleth ). Total lung capacity (TLC) and residual volume (RV) were calculated. Mean lung function measurements were compared using linear mixed models and reported as unadjusted and adjusted for neonatal and age 11 to 14 years factors. The participants also completed health questionnaires and provided a urine sample for assessment of passive or active smoking. Three (FEF25 , FEF25-75 , FEV1 ) lung function measures showed significant differences in favor of females after adjustment. The percentage of children with abnormal lung function (below 5th centile for normal) had adjusted differences between 10 and 30 percentage points, for example, for FEF25 15% females compared with 26% males. Among extremely prematurely born school children airway function was significantly worse in males.

Effects of Particulate Respirator Use on Cardiopulmonary Function in Elderly Women: a Quasi-Experimental Study.

BackgroundIndividual particulate respirator use may offer protection against exposure to particulate matter < 2.5 µm in diameter (PM2.5). Among elderly Korean women, we explored individual particulate respirator use and cardiopulmonary function.MethodsRecruited in Seoul, Korea, 21 elderly, non-smoking women wore particulate respirators for six consecutive days (exlcuding time spent eating, sleeping, and bathing). We measured resting blood pressure before, during, and after respirator use and recorded systolic and diastolic blood pressure, mean arterial blood pressure, pulse pressure, and lung function. We also measured 12-hour ambulatory blood pressure at the end of the 6-day long experiment and control periods. Additionally, we examined physiological stress (heart rate variability and urinary 8-hydroxy-2′-deoxyguanosine) while wearing the particulate respirators. Person- and exposure-level covariates were also considered in the model.ResultsAfter the 6-day period of respirator use, resting blood pressure was reduced by 5.3 mmHg for systolic blood pressure (P = 0.013), 2.9 mmHg for mean arterial blood pressure (P = 0.079), and 3.6 mmHg for pulse pressure (P = 0.024). However, particulate respirator use was associated with changes in physiological stress markers. A parasympathetic activity marker (high frequency) significantly decreased by 24.0% (P = 0.029), whereas a sympathetic activity marker (ratio of low-to-high frequency) increased by 50.3% (P = 0.045). An oxidative stress marker, 8-hydroxy-2′-deoxyguanosine, increased by 3.4 ng/mg creatinine (P = 0.021) during the experimental period compared with that during the control period. Lung function indices indicated that wearing particulate respirators was protective; however, statistical significance was not confirmed.ConclusionIndividual particulate respirator use may prevent PM2.5-induced blood-pressure elevation among elderly Korean women. However, the effects of particulate respirator use, including physiological stress marker elevation, should also be considered.Trial RegistrationClinical Research Information Service Identifier: KCT0003526

Correlation between Physical Activity and Lung Function in Dusty Areas: Results from the Chronic Obstructive Pulmonary Disease in Dusty Areas (CODA) Cohort.

BackgroundAlthough physical activity is known to be beneficial to lung function, few studies have been conducted to investigate the correlation between physical activity and lung function in dusty areas. Therefore, the purpose of this study is to investigate the correlation between physical activity and lung function in a Korean cohort including normal and COPD-diagnosed participants.MethodsData obtained from the COPD in dusty areas (CODA) cohort was analyzed for the following factors: lung function, symptoms, and information about physical activity. Information on physical activity was valuated using questionnaires, and participants were categorized into two groups: active and inactive. The evaluation of the mean lung function, modified Medical Research Council dyspnea grade scores, and COPD assessment test scores was done based on the participant physical activity using a general linear model after adjusting for age, sex, smoking status, pack-years, height, and weight. In addition, a stratification analysis was performed based on the smoking status and COPD.ResultsPhysical activity had a correlation with high forced expiratory volume in 1 second (FEV1) among CODA cohort (p=0.03). While the active group exhibited significantly higher FEV1 compared to one exhibited by the inactive group among past smokers (p=0.02), no such correlation existed among current smokers. There was no significant difference observed in lung function after it was stratified by COPD.ConclusionThis study established a positive correlation between regular physical activity in dusty areas and lung function in participants.

Broadening the Perspective of Cost-Effectiveness Modeling in Chronic Obstructive Pulmonary Disease: A New Patient-Level Simulation Model Suitable to Evaluate Stratified Medicine

ObjectivesTo develop a health economic model that included a great diversity of patient characteristics and outcomes for chronic obstructive pulmonary disease (COPD), which can be used to inform decisions about stratified medicine in COPD. MethodsThe choice of patient characteristics and outcomes to include in the model was based on 3 literature reviews on multidimensional prognostic COPD indices, COPD phenotypes, and treatment effects in subgroups. A conceptual model was constructed including 14 patient characteristics, 7 intermediate outcomes (lung function, physical activity, exercise capacity, symptoms, disease-specific quality of life, exacerbations, and pneumonias), and 3 final outcomes (mortality, quality-adjusted life-years [QALYs], and costs). Regression equations describing the statistical associations between the patient characteristics and intermediate and final outcomes were estimated using the longitudinal data of 5 large COPD trials (19,378 patients). A patient-level simulation model was developed in which individual patients from the baseline population of the 5 trials are sampled and their outcomes over lifetime are predicted based on the regression equations. ResultsThe base-case analysis (single-arm simulation representing treatment with tiotropium) showed that patients had a mean lung function decline of 43 mL/year, 0.62 exacerbations/year, a worsening of their physical activity and quality of life with 1.48 and 1.10 points/year, a life expectancy of 11.2 years, 7.25 QALYs, and total lifetime costs of £24,891. Results for a selection of treatment scenarios and subgroups were shown to demonstrate the potential of the model. ConclusionsWe developed a unique patient-level simulation model that can be used to evaluate COPD treatment options for a variety of subgroups.

Lung function in athletes and non-athletes aged 13-15 years

Background Regular sports or physical training contributes in increasing the body’s pulmonary function. The increase of pulmonary function is determined by the strength of respiratory muscle, thoracic compliance, upper respiratory system resistance, and pulmonary elasticity.&#x0D; Objective To compare pulmonary function between athletes and non-athletes aged 13-15 years.&#x0D; Methods This is a cross-sectional analytical study conducted onnior high school students aged 13-15 years throughout June to August 2017. Participants are classified as athletes from particular sports and non-athletes. Assessment of pulmonary function was done using a spirometry test, in which each subject was asked to inhale and exhale in a particular method. Parameters assessed include vital capacity (VC), forced vital capacity (FVC), expiratory volume in 1 second (FEV1), forced expiratory flow (FEF) and FEV1/FVC. Differences in lung function between athletes and non-athletes were analyzed using independent T-test.&#x0D; Results There were 60 athletes and 60 non-athletes included in this study. The mean age of athletes and non-athletes were 13.38 (SD 0.99) years old and 13.70 (SD 0.76) years old, respectively. The statistically significant differences in mean lung function parameters between athletes and non-athletes were as follows: VC: 85.03% vs. 79.41%, respectively (P=0.035); FVC: 95.66% vs. 88.43%, respectively (P=0.016); FEV1: 102.10% vs. 94.28%, respectively (P=0.016); and FEV1/FVC: 105.95% vs. 102.69%, respectively (P=0.011). However, there were no statistically significant differences in the means of FEF 25-75% between the two groups (P&gt;0.05).&#x0D; Conclusions Parameters of lung function in athletes are in general significantly higher than in non-athletes.

Effect of dexamethasone exposure on the neonatal unit on the school age lung function of children born very prematurely.

The objective of this study was to determine the impact of postnatal dexamethasone treatment on the neonatal unit on the school age lung function of very prematurely born children. Children born prior to 29 weeks of gestational age had been entered into a randomised trial of two methods of neonatal ventilation (United Kingdom Oscillation Study). They had comprehensive lung function measurements at 11 to 14 years of age. One hundred and seventy-nine children born at a mean gestational age of 26.9 (range 23–28) weeks were assessed at 11 to 14 years; 50 had received postnatal dexamethasone. Forced expiratory flow at 75% (FEF75), 50%, 25% and 25–75% of the expired vital capacity, forced expiratory volume in one second, peak expiratory flow and forced vital capacity and lung volumes including total lung capacity and residual volume were assessed. Lung function outcomes were compared between children who had and had not been exposed to dexamethasone after adjustment for neonatal factors using linear mixed effects regression. After adjustment for confounders all the mean spirometry results were between 0.38 and 0.87 standard deviations lower in those exposed to dexamethasone compared to the unexposed. For example, the mean FEF75 z-score was 0.53 lower (95% CI 0.21 to 0.85). The mean lung function was lower as the number of courses of dexamethasone increased. In conclusion, postnatal dexamethasone exposure was associated with lower mean lung function at school age in children born extremely prematurely. Our results suggest the larger the cumulative dose the greater the adverse effect on lung function at follow-up.

Challenges in Collating Spirometry Reference Data for South-Asian Children: An Observational Study.

Availability of sophisticated statistical modelling for developing robust reference equations has improved interpretation of lung function results. In 2012, the Global Lung function Initiative(GLI) published the first global all-age, multi-ethnic reference equations for spirometry but these lacked equations for those originating from the Indian subcontinent (South-Asians). The aims of this study were to assess the extent to which existing GLI-ethnic adjustments might fit South-Asian paediatric spirometry data, assess any similarities and discrepancies between South-Asian datasets and explore the feasibility of deriving a suitable South-Asian GLI-adjustment.MethodsSpirometry datasets from South-Asian children were collated from four centres in India and five within the UK. Records with transcription errors, missing values for height or spirometry, and implausible values were excluded(n = 110).ResultsFollowing exclusions, cross-sectional data were available from 8,124 children (56.3% male; 5–17 years). When compared with GLI-predicted values from White Europeans, forced expired volume in 1s (FEV1) and forced vital capacity (FVC) in South-Asian children were on average 15% lower, ranging from 4–19% between centres. By contrast, proportional reductions in FEV1 and FVC within all but two datasets meant that the FEV1/FVC ratio remained independent of ethnicity. The ‘GLI-Other’ equation fitted data from North India reasonably well while ‘GLI-Black’ equations provided a better approximation for South-Asian data than the ‘GLI-White’ equation. However, marked discrepancies in the mean lung function z-scores between centres especially when examined according to socio-economic conditions precluded derivation of a single South-Asian GLI-adjustment.ConclusionUntil improved and more robust prediction equations can be derived, we recommend the use of ‘GLI-Black’ equations for interpreting most South-Asian data, although ‘GLI-Other’ may be more appropriate for North Indian data. Prospective data collection using standardised protocols to explore potential sources of variation due to socio-economic circumstances, secular changes in growth/predictors of lung function and ethnicities within the South-Asian classification are urgently required.

Phase II Trial of SBRT for Stage I NSCLC: Survival, Local Control, and Lung Function at 36 Months

ObjectivesThe long-term impact of stereotactic body radiotherapy (SBRT) on respiratory function in patients with inoperable non–small cell lung cancer (NSCLC) has not been well studied. The aim of this phase II trial was to assess local control, survival, and lung function at 36 months after treatment. MethodsFrom July 2008 to February 2012, 42 patients in whom inoperable NSCLC with peripheral lesions was diagnosed were consecutively enrolled. Lung function testing included measurement of forced expiratory vital capacity, forced expiratory volume in 1 second, and diffusing capacity for carbon monoxide. All lung function parameters were registered at baseline and evaluated prospectively after SBRT every 6 months for 2 years and annually thereafter. ResultsOf the 42 initial patients, four were excluded. At 36 months after SBRT, 22 patients were still evaluable (12 deaths and four patients lost to follow-up). At 36 months, the rate of local control was 94%. At 1, 2, and 3 years, respectively, overall survival rates were 92%, 75%, and 66%. Median overall survival was 57 months. Grade (G) 3 acute toxicity was observed in four patients (10%). Chronic G1 toxicity was observed in all 38 cases (100%), with the most common type being pneumonitis (26 patients [68%]). The mean lung function parameters at baseline and at 36 months after treatment were as follows: forced expiratory vital capacity 83% versus 79%; forced expiratory volume in 1 second 62% versus 57%; and diffusing capacity for carbon monoxide 54% versus 54%. These changes were not significant. ConclusionsIn this trial, local control and survival rates after SBRT were very good. Treatment with SBRT had no significant impact on lung function at 36 months. These findings provide further support for the use of SBRT as a radical treatment for NSCLC. Lung toxicity is minimal, even in patients with poor pulmonary function before treatment.

Serum Interleukin-6 Levels and Pulmonary Function in Ataxia-Telangiectasia

To evaluate the potential link between systemic inflammation and impaired lung function in people with ataxia-telangiectasia (A-T), we hypothesized that serum levels of interleukin (IL)-6, a proinflammatory cytokine, would correlate inversely with lung function in subjects with A-T. Consecutive subjects with A-T were recruited from the Johns Hopkins Outpatient A-T Clinical Center. Serum levels of IL-6 and 8 were measured by enzyme-linked immunosorbent assay. Spirometry was performed in subjects ≥ 6 years of age on the same day that serum was obtained for measurements of cytokines. Approximately 80% of subjects had elevated serum IL-6 levels (> 1.0 pg/mL). No association was found between elevated IL-6 and age. Elevated IL-8 levels were found in 23.6% of subjects, and all subjects with elevated IL-8 levels had elevated IL-6 levels. Subjects with elevated IL-6 levels (mean: 6.14 ± 7.47 pg/mL) had significantly lower mean percent forced vital capacity (FVC%, 50.5% ± 17.8%) compared with subjects with normal serum IL-6 levels (FVC% of 66.2 ± 16.1, P = .018). Greater IL-6 levels were associated with lower FVC% even after adjustment for receiving gamma globulin therapy (P = .024) and supplemental nutrition (P = .055). An association was found between elevated serum IL-6 levels and lower lung function in subjects with A-T. In addition, subjects with both elevated IL-6 and IL-8 had the lowest mean lung function. These findings indicate that markers for systemic inflammation may be useful in identifying individuals with A-T at increased risk for lower lung function and may help in assessing response to therapy.