Mean Values Of FEV1 Research Articles

Pulmonary functions test in asymptomatic rheumatoid lung disease patients: a hospital-based study

BackgroundAs a common extra-articular symptom of rheumatoid arthritis (RA), pulmonary involvement affects 20–67% of patients and accounts for 10–20% of RA-related deaths. This study aimed to assess the impact of RA on pulmonary function tests (PFTs) in Sudanese RA patients attending the rheumatology clinics of the Omdurman Military Hospital.MethodsThis was an analytical, cross-sectional, hospital-based study of 32 RA patients who met the 2010 Rheumatoid Arthritis Classification Criteria of the American College of Rheumatology (RA ACR/EULAR) and who were nonsmokers and free of known respiratory or chronic diseases. Pulmonary function parameters (PFTs), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the FEV1/FVC ratio, and the peak expiratory flow rate (PEFR), were measured for each participant using a digital spirometer. A control group of Sudanese subjects of similar age, sex, and height was matched, and the results were compared with normal reference values.ResultsA high prevalence of lung function abnormalities (93.8%) was observed in RA patients, and 6.2% of them had normal PFT parameters. Restrictive lung disease was recorded in 78.1% of the patients, and obstructive lung disease was observed in 15.7% of the patients. All measured PFT parameters in the RA patients were significantly lower than the published reference normal values for Sudanese subjects, except for the FEV1/FVC ratio. The mean values of FEV1, FVC, the FEV1/FVC ratio, and the PRFR in RA patients were 1.8 ± 0.3 L/min, 2.1 ± 0.4 L/min, 87.1 ± 12.2%, and 223.6 ± 86.2 L/min, respectively, compared to 2.4 ± 0.1 L/min, 2.7 ± 0.1 L/min, 90.81 ± 2.6%, and 345.4 ± 16.2 L/min, respectively, in the control group (P values of 0.001, 0.001, 0.299, and 0.001, respectively). There was no statistically significant correlation between PFT results and disease duration, age, or BMI.ConclusionsRegardless of the duration of RA, restrictive lung abnormalities are frequent in asymptomatic RA patients. The PFT can serve as an indicator of RA. Spirometry has been advised as a baseline examination and for follow-up and to promote the early detection and management of pulmonary involvement in RA patients.

Cystic fibrosis in Europe: improved lung function and longevity - reasons for cautious optimism, but challenges remain.

Prognosis and disease severity in cystic fibrosis (CF) are linked to declining lung function. To characterise lung function by the number of adults in countries with different levels of Gross National Income (GNI), data from the European Cystic Fibrosis Society Patient Registry were utilised. Annual data including age, forced expiratory volume in 1 s (FEV1), anthropometry, genotype, respiratory cultures and CF-related diabetes (CFRD) were retrieved between 2011 and 2021. All countries were stratified into GNI per capita to reflect differences within Europe. A consistent improvement in FEV1 % pred and survival was observed among the 47 621 people with CF (pwCF), including subjects with chronic Pseudomonas aeruginosa infection, CFRD and/or undernutrition. Mean values of FEV1 % pred changed from 85% to 94.2% for children and from 63.6% to 74.7% for adults. FEV1 % pred further increased among those carrying the F508del mutation in 2021, when elexacaftor/tezacaftor/ivacaftor was available. The number of adult pwCF increased from 13 312 in 2011 to 21 168 in 2021, showing a 60% increase. PwCF living in European lower income countries did not demonstrate a significant annual increase in FEV1 % pred or in the number of adults. This pan-European analysis demonstrates a consistent improvement in FEV1 % pred, number of adult pwCF and survival over the last decade only in European higher and middle income countries. Urgent action is needed in the lower income countries where such improvement was not observed. The notable improvement observed in pwCF carrying the F508del mutation emphasises the need to develop treatments for all CF mutations.

Evaluation of diaphragm functions with diaphragm ultrasound and pulmonary function tests in individuals with Friedreich's ataxia.

It is known that the correlation of pulmonary function tests (PFT) with muscle dysfunction is insufficient. Here, we aimed to evaluate the diaphragm functions in individuals with Friedreich's ataxia (FRDA) and to examine its relationship with respiratory parameters and disease severity. This prospective study, conducted between November and December 2022, at Erciyes University, included 14 individuals with genetically confirmed FRDA and an age- and gender-matched healthy control group of eight individuals. We examined pulmonary functions with spirometric methods and evaluated diaphragm excursion, and diaphragm thickness-expiratory (Tde) and - end of inspiration (Tdi) with ultrasonography during calm breathing. Thickening fraction (TF) calculated. Also, we examined PaCO2 at rest. The neurological status of individuals was assessed using the Scale for the Assessment and Rating of Ataxia (SARA). The mean values of FEV1(lt), FEV1(%), FVC (lt), and FVC (%) were higher in the control group (p; <0.001, 0.013, <0.001, and 0.009, respectively). Also, mean Tdi, Tde, excursion and TF were lower in the FRDA group compared to the control group (p = 0.005, 0.294,0.005, and 0.019, respectively). The mean excursion value was 1.13 ± 0.54cm in the FRDA group and 1.71 ± 0.49cm in the control group. There is a strong, negative, and statistically significant correlation between SARA total score with excursion and TF (r = -0.7432, p = 0.002; r = -0.697, p = 0.008). There is no statistically significant relationship between excursion and BMI, standing-to-supine decrease in FVC, FEV1, and PaCO2. Also, the relationship between maximal inspiratory pressure (PImax) and excursion was moderate. Diaphragm ultrasound may reveal respiratory dysfunction better than PFT. Diaphragm excursion and TF are associated with disease scores in individuals with FDRA. Further studies are needed regarding the detection of alveolar hypoventilation.

EFFECT OF BODY MASS INDEX ON PULMONARY FUNCTION OF ELDERLY PEOPLE OF NORTH INDIA

Background: Obesity significantly affects lung function which has been reported among children, adolescents and adult age groups. However, there is limited research on effect of obesity on pulmonary function among elderly age group.Methods:In this study 600 elderly people aged 65 years and above were selected from rural areas of Haryana in whom lung function parameters including force expiratory volume in first second (FEV1),force vital capacity (FVC) and FEV1/FVC were measured. Body mass index (BMI) was estimated and categorised into underweight, normal, overweight and obese categories as per BMI classification of Asian Indians. Mean and standard deviations were calculated and association between lung function parameters and body mass index was determined by one way ANOVA test. Results: Mean age of subjects was 68 ± 5.2 years. Among all the three parameters, highest mean values were observed among subjects with normal body mass index, whereas lowest mean FVC and FEV1/FVC values were observed in underweight category and lowest mean FEV1 values in obese individuals. A statistically significant difference in the mean FEV1 and FEV1/FVC values were observed between various body mass index categories. Conclusion: Body mass index has significant impact on lung function of elderly people depicted by reduction in FEV1 and FEV1/FVC values in obese individuals

Effect of Soft Tissue Manual Technique and Breathing Exercises on Pulmonary Function, Chest Expansion and Functional Status in Post COVID-19 Survivors: A Quasi-experimental Study

Introduction: It is known that around one third of Coronavirus Disease-2019 (COVID-19) patients develop severe pulmonary complications and acute respiratory distress syndrome, leading to long-term impairments in Pulmonary Function Test (PFT) and physical performance. Due to deteriorating health status of the COVID-19 survivors after their recovery, rehabilitation is must. Aim: To evaluate the effect of soft tissue manual technique and breathing exercises on PFT, chest expansion and functional status in Post COVID-19 Survivors. Materials and Methods: This quasi-experimental study was carried out in the Department of Cardiorespiratory Physiotherapy, MGM hospital, Aurangabad, Maharashtra, India, from November 2021 to July 2022. Total 54 subjects diagnosed with COVID-19 who required oxygen therapy and had persistent respiratory symptoms for three weeks to six months after the infection, were included. All the subjects received one week of soft tissue manual techniques which included proprioceptive neuromuscular function, muscle energy technique for recruitment of diaphragm, muscles of respiration and the ribcage. Breathing exercises were inculcated at the end of the session to ensure relaxation of the subjects. Subjects were assessed for PFT, chest expansion and post COVID-19 Functional Status Scale (PCFS) pre and post-treatment. Data were analysed through Wilcoxon signed-rank Test. Results: Amongst total 54 subjects included, 10 (18.6%) males and 44 (81.4%) females with mean age of 29.92±11.94. After one week of intervention p-value was 0.0001 for Forced Expiratory Volume (FEV1), FEV1/Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF) with mean values for FEV1 at baseline was 1.91±0.51 and post-treatment was 2.45±0.34, FVC was 2.25±0.50 before the treatment whereas it was 2.73±0.36 post-treatment with p-value of 0.002, FEV1/FVC and PEF was 83.99±12.03 and 4.36±1.78 at baseline whereas, post-treatment it was 87.76±7.29 and 5.88±0.95 respectively. The p-value of 0.0001 was also similar for chest expansion. No statistically significant difference was found in post COVID-19 functional status (p-value=0.013). Conclusion: Positive changes in the ribcage’s activation and integration with its muscles were seen in all of the study variables. Therefore, it is concluded that soft tissue manipulation techniques and breathing exercise improves functional status, thoracic expansion, in post COVID-19 survivors.

Analysis of lung function and respiratory symptoms in brass/metal industrial workers of Moradabad, Uttar Pradesh, India.

The job demands of some of the industries have been reported to be hazardous to the health and safety of workers. Workplace environmental hazards or occupational hazards are a globally major cause of disability and mortality among the working population. The present study was done to analyze the effect of exposure to metal dust on pulmonary function and respiratory symptoms. The study population selected as cases were 200 male mill workers working for at least 1-year duration (direct exposure) in the age group of 20-50 years, and controls were 200 age- and gender-matched male participants without any history of occupational or environmental exposure. A complete history was taken. Spirometry was done. Spirometric parameters studied were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), ratio of FEV1 and FVC, and peak expiratory flow rate (PEFR). The spirometry data and baseline characteristics of the participants were compared using unpaired t-test. The mean age of the participants of the study group and the control group was 42.3 years and 44.1 years, respectively. The majority of the study population belonged to the age group of 41-50 years. The mean FEV1 value among participants of the study group and control group was 2.69 and 2.13, respectively. The mean FVC value among participants of the study group and control group was 3.18 and 3.63, respectively. The mean FEV1/FVC value among participants of the study group and control group was 84.59% and 86.22%, respectively. The mean PEFR value among the study group and control group was 7.78 and 8.67, respectively. While analyzing statistically, mean lung functional tests were significantly lowered among the study group. About 69.5% of the participants of the study group thought it to be essential for making safety measures a necessity. The present study concluded that mean lung functional tests were significantly lowered among the study group. Despite the use of face mask, lung function abnormality was present in mill workers.

The Effect of Cement Dust Exposure on Lung Function among Cement Factory Workers

Background: Previous studies reported equivocal results about effects of cement dust on the lung. The objective of the present study was to assess the impact of cement dust on the respiratory health of exposed workers. Methods: A cross-sectional study was conducted on 300 cement exposed production workers from the crusher and packing sections, and 303 controls not exposed to any noxious materials that could affect their chest. All subjects were asked personal, occupational and BMRC questionnaire on respiratory symptoms and smoking habits. Forced spirometry and anthropometry were conducted on each subject. Multiple linear regression as well as other statistical tests were used. The level of significance for the present study was considered 0.05. Results: Chronic cough was significantly more encountered among the cement exposed workers (22.7%), compared to the unexposed workers (13.9%) where p-value was &lt; 0.005. Chronic bronchitis was, also, significantly more encountered among the cement exposed workers compared to the unexposed workers (19.0% and 9.9% respectively) where p-value was &lt;0.001. Multiple linear regression analysis revealed that, after allowing for the age, height, weight and the smoking habit, the mean values of FVC, and FEV1 were significantly lower in the cement exposed workers compared to the unexposed group; and the mean value of FEV1% was higher in the cement exposed workers compared to the unexposed group. The mean values for FEF25%-75%, PEFR, FEF75, FEF50, and FEF25 were significantly lower among the cement exposed workers compared to the unexposed group. These effects in the exposed group were found duration of exposure related. Conclusion: It is suggested that workplace exposure to cement dust may lead to increased occurrence of chronic bronchitis and impairment of lung function. It is recommended that more effort should be implemented to protect respiratory systems of workers in cement factories.

Feasibility and acceptability of home monitoring with portable spirometry in young adults with asthma

Objective Self-monitoring asthma control is a key component of asthma management. Few studies have reported usability and acceptability of portable spirometry among young adults with asthma. Portable spirometry offers a practical solution to monitoring airway narrowing at home. The purpose of this paper was to determine if self-administered spirometry is feasible and acceptable in young adults with asthma and whether regular monitoring resulted in improved airway function as measured by forced expiratory volume in one second (FEV1). Methods Sixty-seven young adults (18–26 years) with self-reported asthma participated in a clinical trial during wildfire season which measured FEV1 as an outcome measure. Data was collected at baseline, week 4, and week 8 using a portable spirometer linked to a smartphone application. A subset of intervention participants completed spirometry twice daily. Acceptability of self-administered spirometry was evaluated after the trial among participants that volunteered to submit a survey and be interviewed. Results At baseline, all 67 participants (100.0%) completed their scheduled spirometry readings which declined to 94.0% (n = 63) at week 4 and 86.6% (n = 58) at week 8. Daily readings were completed 83.2% of the time in the mornings and 84.3% of the time in the evenings. Mean FEV1 values were lower than predicted values, but above the lower limit of expected. FEV1 remained steady throughout the study period. Over two-thirds of participants used the notes feature in the application and described symptoms, asthma triggers, mitigating actions and test-taking issues. Conclusions Young adults in our sample were highly compliant with regular, self-administered spirometry.

Respiratory symptoms, spirometric, and radiological status of stone-cutting workers in Bangladesh: A cross-sectional study.

Background and AimsInhalation of respirable silica dust during several stone processing methods can result in several respiratory diseases. However, data are scarce regarding the respiratory health of stone‐cutting workers in Bangladesh. We aimed to determine the point prevalence of respiratory symptoms, lung function status and radiological abnormalities among the stone‐cutting workers.MethodsThis cross‐sectional study was conducted among 200 stone‐cutting workers. Adult workers having a job experience of at least 3 years participated in this study. Then inquiry was made regarding respiratory symptoms with the help of a preformed questionnaire. All the participants underwent chest X‐ray and spirometry. A respiratory dust sampler was used to measure the dust concentration of the stone‐cutting factories.ResultsAmong the 200 stone‐cutting workers, 89% (178) showed at least one chronic respiratory symptom while they had chest tightness (75.5%), chronic cough (74.5%), and shortness of breath (66.5%) as the most prominent ones. Spirometry findings revealed that the mean forced expiratory volume in 1 s (FEV1) value was 1.42± 0.65 L in the obstructive pattern, 1.43 ± 0.73 L in the restrictive pattern. The mean forced vital capacity (FVC) value was 2.53 ± 1.12 L in the obstructive pattern, 1.53 ± 0.75 L in the restrictive pattern. 42.69% of stone‐cutting workers who complained of at least one respiratory symptom had abnormal chest X‐ray findings. Those with progressive massive fibrosis had the lowest mean FEV1 value (0.75 ± 0.50 L). While measuring workplace dust concentration, we found high particulate matter (PM) 2.5 (979.78 µg/m3) and PM 10 (1298.35 µg/m3) values.ConclusionsMost of the stone‐cutting workers in our study exhibited different respiratory symptoms. These symptoms were associated with abnormal lung function and radiology. Further longitudinal studies are recommended to determine the actual dimension of this problem.

The Efficacy and Safety of Azithromycin for Patients with Cystic Fibrosis: A Systematic Review

Chronic inflammation of the lungs is a major cause of morbidity and mortality in patients with cystic fibrosis. One of the macrolides, azithromycin has antimicrobial, immunomodulatory, and anti-inflammatory effects that are useful in diseases with chronic inflammatory processes such as cystic fibrosis. This systematic review aimed to determine the efficacy and safety of azithromycin administration for cystic fibrosis patients in improving lung function. Pulmonary function was assessed by measuring the value of forced expiratory volume in one second (FEV1) in patients after intervention. The process of searching literature through PUBMED and Cochrane Library uses the keywords "Cystic Fibrosis" and "Azithromycin" with the Boolean operator "AND". There were seven studies selected, with criteria RCT studies, patients of all ages, patients with cystic fibrosis, and compared azithromycin with placebo. After reviewing seven studies, 71.4% of the studies stated that there was a significant increase of mean FEV1 value after being given azithromycin therapy. Other outcomes assessed were FVC values, pro-inflammatory indicators, exacerbations, changes in body weight, and quality of life. Azithromycin administration is considered relatively safe and well-tolerated by patients.

Assessment of pulmonary function tests among patients with hypothyroidism

Background: The respiratory system involvement in hypothyroidism varies from mild dyspnea to a more severe respiratory failure. This has been reported as reduction in expiratory and inspiratory muscle strength, alveolar hypoventilation along with reduction of hypoxic and hypercapnic ventilatory drives and decreased maximal breathing capacity and decreased diffusion capacity among hypothyroid patients. Material &amp; Methods: The present prospective study was conducted at department of respiratory medicine of our tertiary care hospital. In present study, we enrolled 50 study participants from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant Results In the present study, majority of patients showed obstructive pattern i.e. 30% which was followed by mixed pattern among 22% patients and 18% of patients showed restrictive pattern. 30% of patients showed normal respiratory pattern on pulmonary function test. On the basis of the Spirometry examination finding among case group, the mean value of FEV1 (L) was 1.38±0.68, the man value of FVC(L) was 2.24±0.71. on assessment the mean value of FEV1/FVC proportion (postbronchodilator) was 61.6 ±11.3.

The coexistence of bronchial asthma in patients with bronchiectasis: A cross sectional study

To determine the co-existence of bronchial asthma in patients of bronchiectasis, and to compare the clinico-radiological profile between patients having only bronchiectasis and both bronchiectasis and bronchial asthma.: 67 patients who presented as Bronchiectasis (Clinical and radiological) to Respiratory Medicine Department at VIMS &amp; RC, Bangalore from January 2020 to June 2021, were subjected to baseline investigations and spirometry/PEFR after informed consent. Statistical analysis was performed using SPSS 22 version software.The clinical and radiological profile were compared between the group having only bronchiectasis and those with bronchiectasis and asthma.Out of the 67 study patients, 55(82.08%) had only bronchiectasis and 12(17.91%) had bronchiectasis with bronchial asthma. In the bronchiectasis only group, majority of the patients were male 40(72.72%) and in the in bronchiectasis with bronchial asthma group majority of the patients were female 7(58.33%) which was statistically significant (P value &amp;#60;0.05). Patients with bronchiectasis and coexisting asthma had statistically significant increased symptoms of breathlessness, wheeze, running nose, sneezing, itching (P value &amp;#60;0.05). Similarly exposure to dust, fumes, pets was found to be more common in bronchiectasis with bronchial asthma group (P value &amp;#62;0.05). The mean age for onset of symptoms was found to be lower in the bronchiectasis with bronchial asthma group. Patients in the bronchiectasis with bronchial asthma group had a lower mean FEV1 value. Hyperinflation on chest radiograph was found to be 10.90% in bronchiectasis group, and 8.33 % in bronchiectasis with bronchial asthma group. Bilateral bronchiectasis on CT thorax was common in both groups.17.91% of bronchiectasis patients had coexisting bronchial asthma. Hence, a proper diagnosis can reduce the burden of patients suffering from more frequent exacerbations, with better optimized treatment options.

Effect of passive smoking on lung function tests in women

Pulmonary function tests are non-invasive diagnostic test that provide measurable feedback about the function of lungs. An assessment of lung volumes, capacities and flow rates provide specific information for clinical diagnosis and research purposes. Smoking is an addiction which affects the normal life, body and organ system as whole. Passive Smoking is defined as exposure of non smoker to tobacco smoke in the environment. Second hand tobacco smoke is the precursor of the primary active smoke from the smoker. Second hand tobacco smoke is believed to be more harmful than the primary smoke from the active smoker. The potency and health effects of second hand smoke involved the smell of secondhand smoke being an allergen affecting the respiratory system. The effects of passive smoking on respiratory system and lung function test warrants documentation. To evaluate the effect of passive smoke on lung function test among women exposed for ten years. The study was conducted on fifty females in the age group of 30-60 years who were exposed to passive smoke for ten years. An identical number of age matched females who were not exposed to cigarette smoke at home served as controls. The lung function parameters recorded were FVC, FEV1, FEV1/FVC%, PEFR, MVV and FEF25-75% The study demonstrated decline in mean values of FVC, FEV1/FVC%, MVV and FEF25-75% in female subjects but the difference in the mean values when compared with controls was found to be statistically insignificant. The mean values of FEV1 and PEFR was less in female subjects and the difference in the mean values was statistically significant. The study demonstrated decline in the expiration of FVC in first second and decline in maximum flow rate during forceful expiration that conforms to obstructive pattern of lung changes in females exposed to chronic passive smoke. Any significant decline in lung functions in females being most vulnerable in household, with time merits attention as they indicate likely morbidity in the event of continuing exposure to the offending agent.

Severe asthma: One disease and multiple definitions

IntroductionThere is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. MethodsData collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. ConclusionsThe present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem.

Effect of Endobronchial Coils on Exercise Tolerance and Lung Functions in Patients with Severe Emphysema - A Retrospective Cohort Study of 48 Patients.

BackgroundLung volume reduction with endobronchial coils treatment (ECT), for patients with severe emphysema, has shown modest improvement in exercise capacity and lung functions in clinical trials, yet the benefit of this procedure is still unclear.MethodsWe conducted a multicenter retrospective cohort study including all patients who underwent ECT in Israel and a propensity score matched control group of patients with chronic obstructive pulmonary disease (COPD) that were treated with usual care. The primary outcome was six-minute walk test distance (6MWTD), secondary outcomes were lung function tests and patient survival.ResultsOverall, 46 patients were included in the ECT group. Their mean 6MWTD at baseline and at 6 and at 24 months post procedure was 331.0±101.4, 372.9±76.8 and 338.8±104.8, respectively (overall P=0.04, pairwise comparison: baseline to 6 months (P=0.1), baseline to 24 months (P=1.0)). Mean FEV1 values at baseline and at 6 and at 24 months post procedure were 0.86±0.38, 0.92±0.37 and 0.82±0.36 liters, respectively (overall P=0.003, pairwise comparison: baseline to 6 months (P=0.04), baseline to 24 months (P=0.75)). The median 6MWTD for the ECT and control groups at 24 months were 333.0 (262.5–390) and 280 (210–405), respectively (P=0.16). There was no difference in overall survival (P=0.84). Heterogenous emphysema was a significant predictor of treatment success in univariate analysis (p=0.004).ConclusionLung volume reduction with endobronchial coils may improve the exercise capacity and FEV1 of COPD patients. However, the majority of the effect was diminished after 24 months. The current state of evidence does not support regulatory approval of ECT and warrant its use only after consideration of the benefit-harm ratio in a highly selected patient population.

The Effect of Pulmonary Rehabilitation on Respiratory Functions, and the Quality of Life, following Coronary Artery Bypass Grafting: A Randomised Controlled Study.

Objective Examining the effects of a pulmonary rehabilitation (PR) program applied to patients undergoing coronary artery bypass grafting (CABG) surgery with open heart technique on respiratory functions, functional capacity, and quality of life (QoL). Design This randomised controlled study applied the Consolidated Standards of Reporting Trials statement. Methods The study was conducted with two groups: the intervention group (n = 25) and the control group (n = 25). The control group received standard care after coronary artery bypass grafting. On the contrary, the experimental group participated in a PR program created by the researchers in addition to standard care. After coronary artery bypass grafting, the respiratory functions (on the 4th day of clinical care) and QoL (at the 6th week) of both groups were evaluated. The primary outcome measure was the respiratory function (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC). The secondary outcome measure of this study was the QoL. Results When the average pulmonary function test values of the patients were examined, the mean FVC and FEV1 values of the patients in the intervention group on the 4th day of clinical care were significantly higher with a medium level size effect than the control group (p = 0.027; effect size (d) = 0.643; p < 0.024; effect size (d) = 0.658, respectively). At the postoperative 6th week measurement of QoL, a decrease was observed in all subdimensions of the scale, albeit less in the intervention group (p < 0.05). There was a decrease in both the mental and physical component summary of QoL (p < 0.05). Conclusion The results of this study revealed that pulmonary rehabilitation applied to patients who have undergone coronary artery bypass graft recover their functional capacity faster.

Effects of metabolic syndrome on pulmonary function tests

Background: Metabolic syndrome is defined as at least three of the five following medical conditions: central obesity(mandatory), high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL). It has been shown that obesity causes physiological impairment in respiratory system.Methods: In this observational cross sectional study, 60 patients who fulfilled the IDF criteria for metabolic syndrome were included after applying the exclusion criteria and were subjected to spirometry.Results: Most of the patients had a restrictive pattern (43.3%) (n=26). 33.3% (n=20) of the patients had a mixed pattern while 16.7% (n=10) of the patients had a normal picture. Only 6.7% (n=4) of the patients had an obstructive pattern (p&lt;0.001). Mean value of FEV1 had no correlation with increasing number of components of metabolic syndrome whereas mean value of FVC showed a decreasing trend with increasing number of components of metabolic syndrome. Mean FEV1 of the patients was significantly higher in males (1.82±0.71 L) than females (1.24±0.42 L) (p 0.007). Similarly, the mean FVC was significantly higher in males as compared to females. Mean FVC was 2.45 (±0.86) L in males while females had a mean FVC of 1.65 (±0.49) L (p 0.002).Conclusions: In conclusion, Patients with metabolic syndrome have significant impairment of the pulmonary function with restrictive pattern being the most common one.

A randomized trial comparing inspiratory training and positive pressure training in immediate lung recovery after minor pleuro-pulmonary surgery.

BackgroundTwo respiratory physiotherapy modalities were compared in a randomized controlled trial on patients undergoing minor pleuro-pulmonary surgery.MethodsForty-five patients were randomly allocated into positive expiratory pressure (PEP) therapy (n=23) and inspiratory muscle training (IMT) groups (n=22). Individualized group specific physiotherapeutic guidance was administered preoperatively, and once a day postoperatively. Patients also performed independent exercises and kept a logbook. Pain was assessed on a numerical reference scale (NRS). Volumetric pulmonary function values and walking distance were recorded preoperatively, and on first (POD1) and second postoperative days (POD2). Pre- and postoperative values were compared using two-way repeated measures analysis of variance.ResultsPatient characteristics and pleuro-pulmonary interventions were similar between the groups. Thoracotomy was performed in 14/45 and video assisted surgery (VATS) in 31/45 of cases. Preoperative volumetric pulmonary functions were normal or slightly decreased in 29/45, and fell significantly (P<0.001) on the first postoperative day (POD1) and improved but remained significantly lower on the second postoperative day. The recovery of mean FEV1, FIV1 and FIVC values was greater in the IMT than in the PEP group between POD1 and POD2, but without significant difference. The corresponding relative to preoperative values were higher in the IMT group, with a significant difference in FEV1 (P=0.045). Also relative PEF and FIV1 values seemed to be slightly higher in the IMT compared to the PEP group, but not significantly. Average NRS values for pain were lower in the IMT group (P=0.010) but only on POD1. Air leak was noted in 4/45 patients, two in each group, on POD1, and two in PEP groups and one in IMT group on POD2. Mean measured walking distances between groups did not differ. Mean hospital stay was 4 days in the PEP group and 3 days in the IMT group. There was no hospital mortality.ConclusionsPulmonary function values decreased significantly after minor lung resections, supporting rehabilitative respiratory physiotherapy to avoid postoperative pulmonary complications (PPCs). Both PEP and IMT training were well tolerated and equally efficient when comparing spirometry values at three time points. IMT appeared advantageous regarding relative FEV1 recovery and immediate postoperative pain.

Effectiveness and safety of mycophenolate mofetil in connective tissue disorder associated interstitial lung disease: A real-life experience from India

Aim: To study the effectiveness and safety of mycophenolate mofetil (MMF) in patients with connective tissue disease (CTD) associated interstitial lung disease (ILD). Methods: The retrospective observational study was carried out from Jan 2015 to Feb 2019. Symptomatic CTD-LD patients with (HRCT chest) documented ILD and abnormal pulmonary function test (forced vital capacity, FVC&lt; 70%), who were treated with MMF were included. The treatment response was assessed clinically by pulmonary function test and radiology. Clinical assessment and PFT were done at baseline, 6, 12 and 24 months. HRCT chest was done at baseline and 24 months. Results and analysis: Out of 33 patients, 13 had MCTD, 12 had RA, and remaining 8 belonged to the systemic sclerosis (SSc)-predominant groups (3: diffuse cutaneous SSc, 2: SSc/myositis overlap, and 1 each with Sjogren’s syndrome, SLE/Sjogren’s overlap and interstitial pneumonia with autoimmune features). Increased female predominance was noted (90.9%). The mean FVC at baseline noted in MCTD, RA and SSc-predominant groups were 62±6.17, 64±4.17 and 59±6 respectively. Improvement was reported in 4 patients, each in MCTD and RA groups. Eight patients in the MCTD group and 7 each in RA and SSc- predominant groups had a stable lung disease. One patient each in all the groups reported worsening of the disease. There was a positive trend in FEV1 and FVC with treatment. No significant difference in FEV1 and FVC values with treatment was noted across the three groups. Numerical differences in the mean values of FEV1 and FVC between two groups (NSIP and UIP) were noted, but was not statistically significant. All the subjects completed 24 months of follow-up. They were on 2 g/day of MMF for the first 12 months, followed by a maintenance of 1.5- 2 g/day for the next 12 months. None of the subjects discontinued treatment due to intolerance or adverse effects.

PRS12 Prospective Association between LUNG Function and the Incidence of Diabetes, Asthma, Myocardial Infarction, Hypertension and ALL-Cause Mortality: Competing Risks MODEL

To examine whether lung function is a significant predictor for incident diabetes, asthma, myocardial infarction, hypertension and all-cause mortality, using a competing risks model. The data source used was the National Health and Nutrition Examination Survey (Epidemiological follow-up). For this cohort study, participants were prospectively followed from baseline (1970) until the end of the epidemiological follow-up (1984). We measured incident events based on self-reports or hospital visit codes during the study time conditional on no prior history of the same event. Lung function was measured as forced expiratory volume in 1 second (FEV1). The covariates adjusted for the association were: gender, age, body mass index, smoking status, inactivity, marital status, alcohol consumption, chronic obstructive pulmonary disease (COPD), cancer, and Charslon’s modified comorbidity score. We used the Fine-Gray subdistribution and cause-specific hazard models to quantify the hazard ratios for the association of FEV1 and the primary events of interest. The final cohort included 3,018 participants (mean FEV1 value: 3.00 liter (standard deviation (SD):0.84); mean age: 45.22(SD:13.49)). We found that for one unit increase in FEV1 (liters), the subdistribution hazad ratio was 0.37(0.22,0.61), 0.20(0.10,0.40), 0.81(0.53,1.26), 0.84(0.71,0.99) and 0.86(0.62,1.18) for diabetes, asthma, heart attack, hypertension and all-cause mortality, respectively. The corresponding estimates for the cause-specific hazard ratios were 0.45(0.33,0.60), 0.43(0.31,0.60), 0.56(0.40,0.77), 0.73(0.63,0.86) and 0.66(0.51, 0.85). While the cause-specific hazard model indicates the instantaneous hazard ratios for the primary events of interest amongst all event-free individuals, the subdistribution hazard model provides insight into cumulative incidence function by adding to the denominator people who may have had experienced competing events. Amongst event-free individuals, FEV1 was statistically significantly associated with an increased instantaneous hazard for the primary events. Lower FEV1 values were also showed to increase the incidence of diabetes, asthma, and hypertension. Therefore, modifying lung function can potentially mitigate the risks of subsequent events.