Mean Values Of FEV1 Research Articles

Pulmonary Function Changes in Chronic Obstructive Pulmonary Disease Patients According to Smoking Status.

The aim of our study was to examine pulmonary functions of patients from all stages of chronic obstructive pulmonary disease (COPD) according to their smoking status. A retrospective case-control study was carried out. Total of 148 patients were enrolled and divided into two groups in regards to their smoking status (quitters, n=68; non-quitters, n=80). Pulmonary function parameters, COPD assessment test score, Fagerström Nicotine Addiction Questionnaire score, smoking history and status were obtained from the electronic hospital data system. Patients' admission and 12-month data were recorded. In non-quitters, the mean FEV1 values decreased from 2.32±1.14 to 2.24±1.12 (p<0.001). Particularly, in Stage-0, in the early high-risk group of COPD, the reduction in FEV1 was 90 mL, while the reduction was 70, 60, 40, and 40 mL in Stage-I, -II, -III, and -IV, respectively. In quitters, the mean FEV1 levels increased from 2.10±1.19 to 2.19±1.20 (p<0.001). For COPD patients overall, an average increase in FEV1 of 80-110 mL was observed. At the end of the 12 months follow-up, 17 (27.5%) of the non-quitters showed deterioration, and five (7.3%) of the quitters showed improvement in COPD stage. FEV1 decline was accelerated in COPD patients who continued to smoke, whereas this decline was not prevented by inhaler treatments. The Global Initiative for Chronic Obstructive Lung Disease Stage-0 group, which is not included in the current guidelines, needs to be redefined. This group appears to be the most important group for implementing the smoking cessation and prevention strategy.

The relationship between forced expiratory volume 1 (FEV 1) with 25(OH) vitamin D level and hs-CRP in COPD in H. Adam Malik General Hospital Medan

Background: The number of people with COPD according to WHO was increasing to 400 million people by 2020 and half of these occur in Indonesia. The incidence of COPD in Indonesia ranks 5th highest in the world at 7.8 million. COPD was a non-communicable disease that is thought to be closely related to the increasing number of smokers, especially in young age groups. This study aims to determine between FEV1 with 25 (OH) vitamin D level and hs-CRP in COPD patients.Methods: This study was a cross-sectional method conducted in H. Adam Malik General Hospital Medan, from January to June 2018 on 51 COPD patients who were treated at Pulmonology Outpatient Clinic. Spirometry examination, 25 (OH) levels of vitamin D, and hs-CRP was examined. Data were analyzed statistically using SPSS version 16 for windows.Results: Total 51 patients who participated in the study were all male. Based on Pearson Correlation Test, FEV1 value of COPD patients did not show a significant correlation with levels of 25 (OH) vitamin D. While the Spearman Rank Correlation Test shown significant correlation with hs-CRP levels. Anova test results and Kruskal Wallis test on levels of 25 (OH) vitamin D, hs-CRP and Leukocyte counts shown no significant differences with GOLD criteria. Conclusion: The mean FEV1 value of COPD patients, 25 (OH) levels of vitamin D and the number of Leukocytes shown no significant statistical difference, whereas the higher the FEV1value, the lower the hs-CRP.

Factors Associated With Mortality and Response to Extracorporeal Photopheresis in Lung Allograft Recipients With Bronchiolitis Obliterans Syndrome.

This study was designed to identify factors associated with clinical response to extracorporeal photopheresis (ECP) and mortality after ECP in lung allograft recipients with bronchiolitis obliterans. Forced expiratory volume in 1 second (FEV1) values obtained 6 months before (baseline) and 6 months after initiation of ECP were used to plot the linear relationship between FEV1 versus time before and after ECP. Response to ECP was assigned when a positive integer was derived after subtracting the baseline rate of decline from the rate of decline 6 months after ECP. Univariate and multivariate logistic regression analyses were used to identify demographic, treatment-related factors or spirometric parameters that may be associated with response to ECP or mortality at either 6 or 16 months after initiation of ECP. Forced expiratory volume in 1 second just before ECP was associated with mortality (P = 0.007) at 16 months after ECP initiation. An FEV1 of 1.50 L or less had a sensitivity of 87% and specificity of 60% to identify patients who died within 16 months after ECP initiation. Patients whose FEV1 decline exceeded 40 mL/month were 12 times more likely to have a response to ECP (P = 0.0001). Patients whose decline in FEV1 before ECP was statistically significant (P < 0.05) were nearly 10 times (P = 0.008) more likely to respond to ECP. Forced expiratory volume in 1 second is an important predictor of mortality, and the response to ECP is influenced by both the extent (>40 mL/mo) and statistical significance of the relationship between FEV1 versus time before ECP initiation. Therefore, earlier bronchiolitis obliterans detection and more timely implementation of ECP (ie, when FEV1 values >1.5 L) should be considered especially in patients with a more aggressive rate of decline of lung function.

Comparison of Homozygous for Delta F508 Mutation Nutritional Status, Lung Function Outcomes, Bacterial Growth, Antibiotic Treatments and Therapeutic Outcomes between the Amish and Non-Amish in a Single Pediatric Cystic Fibrosis Centre: A Retrospective Case-Controlled Study

There exists evident differences in the health and the care received of the Amish people in comparison to the general population. Amish patients were 100% homozygous for delta F508 mutation versus 12% in the non-Amish population (P=0.057). The Amish community was prescribed dietary supplements at a rate of 89% versus 50% for non-Amish (P=0.087). BMI > 75th percentile was 51.25% in Amish patients and 61.25% in non-Amish patients (P=0.31). Mean FEV1 value was 83.6% versus 100% while mean FEF 25-75 value was 58% versus 86% for Amish and nonAmish people respectively. There was substantial variance in the number of episodes of the same infection per patient between Amish and non-Amish population (1 IQR 0–1 versus 0 IQR 0–1; p=0.012). The rate of antibiotic prescribing per patient in the Amish group was 7.9 perceptions versus 2.2 prescriptions. The study aims to create the best possible treatment and the highest quality of life for patients with cystic fibrosis. Our manuscript creates a paradigm for future studies on the delta F508 mutation, nutrition supplements, body mass index (BMI), forced expiratory volume in 1 second (FEV1), forced expiratory flow (FEF 25-75), airway microbial organisms and changes in antibiotic treatments in Amish compared to the non-Amish group, as well as developing a platform for an Amish community health program.

Lung functions abnormalities among auto mechanics in Ogbomoso, Nigeria: Clinical correlates and determinants

Background: Auto mechanics are exposed to various organic, inorganic and particulate matters as a result of their occupation. Determining the association between environmental pollutant and risk of lung function abnormalities among auto mechanics is important to prevent long-termCem&gt;Objective: To describe lung function abnormalities and their determinants among auto mechanics in Ogbomoso, Nigeria. Methods: One hundred and three auto mechanics were randomly selected from Ogbomoso, Nigeria. Their clinical and demographic data were obtained using a data form. Spirometry was performed using the CONTEC handheld Spirometer. The personal best values of three measurements FEV1, FVC and PEFR were determined. Lung function abnormalities were described according to standardized criteria. Results: The mean (SD) age of the participants was 38.5 (11.9) years. The mean systolic blood pressure, mean diastolic pressure and mean duration of the job as auto mechanics were 128.7 (17.9) mmHg, 81.2 (11.4) mmHg and 20.2 (12.5) years respectively. Restrictive, obstructive and mixed lung function abnormalities were demonstrated among 53%, 10% and 2% respectively. The mean values of FEV1 and FVC reduced significantly with increasing job duration. Conclusion: Lung function abnormalities occurred frequently among auto mechanics in Ogbomoso, Nigeria. There seemed to be a progressive decline in lung functions with age and duration of exposure to organic and inorganic pollutants by auto mechanics. Strict environmental and occupational safety measures may limit the hazards associated with poor air quality and other chemical/physical hazards among auto mechanics in Nigeria.

‘Real-life’ experience in asthmatic children treated with omalizumab up to six-years follow-up

Introduction and objectivesOmalizumab is present in international guidelines for the control of severe asthma, but data on the long-term effects in children are limited. Our objective was to perform a ‘real-life’ long-term trial of omalizumab in children with allergic asthma. Materials and methodsAn observational single center ‘real-life’ study was performed. Data for treatment, lung function, side effect, asthma exacerbations and hospitalizations were recorded at six months and annually. ResultsForty-eight patients <18 years of age were enrolled. Median treatment period was 2.9 (0.5–6). Fluticasone dose for the maintenance treatment decreases significantly at six months (452mcg/day to 329.89mcg/day, respectively). This difference was maintained throughout the follow-up. Nobody used oral corticosteroid after six months. The rate of hospital admissions and visits to the emergency department for asthma exacerbations decreased significantly in the third years and fourth years follow-up, respectively. There was an improvement in lung function. Mean values of FEV1 and FEF25–75% before treatment were 79.88 and 62.94, respectively; after six months of treatment a statistically significant change was seen with a mean FEV1 of 92.29 and FEF25–75% of 76.31 (p=0.0001). Lung function values were above normal throughout the six years of treatment. No side effects were reported. ConclusionsOverall in ‘real life’ omalizumab in children reduces asthma exacerbations and hospitalizations, improves lung function, and decreases the maintenance therapy. It is shown to be safe for up to six years of treatment in children.

Correlation Of Serum YKL-40 With Anthropometric Measurements And Spirometric Indices Between Healthy Individuals And Asthamatics In A Tertiary Care Hospital

Objective: To correlate serum levels of YKL-40 with anthropometric measurements and spirometric indices between normal individuals and asthmatics. Methodology: The case control study was conducted in Department of Chest Medicine, JPMC, Karachi from the month of August 2015 till March 2016. The study recruited sixty participants after satisfying the inclusion and exclusion criteria; among those 30 were normal healthy individuals (PEF &gt; 80% and pulse rate of 60 – 80 beats per minutes); while equal were cases of mild to moderate asthma (PEF more than 50% and pulse rate of 100 – 120 beats per minutes) matched for age and gender. Vitallograph compacta and peak flow meter was used for spirometric indices. Moreover, anthropometric measurements were age, gender, weight (kg), height (m) and body mass index (kg/m2). Ykl-40 Elisa kit was used for serum YKL 40 levels. The data was entered and analysed using SPSS version 21 (IBM, Chicago, IL). Result: In comparison of Spirometric Evaluation (FEV1, FVC, FEV1/FVC% and PEFR) between control and patients with mild to moderate asthma. significant difference was found in the mean values of FEV1, FVC, FEV1/FVC and PEFR between cases and controls. Significant inverse correlation was found between YKL-40 with FEV1, FVC, FEVI/FVC% and PEFR among Controls. YKL-40 was found to be significantly correlated with only FEV1/ FVC (%) among cases with correlation co-efficient as – 0.510 (p-value &lt; 0.004). Conclusion: There is an inverse correlation between serum YKL-40 levels and spirometric evaluation thus as the inflammation in asthma increases, YKL-40 level upsurges and causes decrease in lung function tests.

Cardiovascular risk assessment, cardiovascular disease risk factors, and lung function parameters.

Decreased lung function is related to higher cardiovascular disease (CVD) incidence and mortality. However, little is known about the relationship between the risk factors of CVD and pulmonary function. The aim of the study was to assess the relationship between the prevalence of cardiovascular risk factors, the total CVD risk, and pulmonary function. The analysis included 4104 men and women aged 45 to 69 years, participants of the Polish part of the Health, Alcohol, and Psychosocial factors In Eastern Europe (HAPIEE) Project, who provided valid measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) using a Micro-Medical Microplus spirometer. The prevalence of CVD risk factors was defined as follows: hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or taking hypertension medication), diabetes (glucose ≥ 7.1 mmol/L or self-reported diabetes), and hypercholesterolaemia (total cholesterol ≥ 5 mmol/L or low-density lipoprotein-cholesterol ≥ 3 mmol/L or taking lipid lowering medication). Categories of total CVD risk were defined according to the 2016 European Guidelines on CVD prevention in clinical practice. The analysis of covariance was used to compare the lung function in the CVD risk factors and the total CVD risk categories. Mean values of FEV1 and FVC, adjusted for age and height, were significantly higher in men than in women (3.02 L; 95% confidence interval [CI] 2.96-3.08 L vs. 2.52 L; 95% CI 2.45-2.63 L for FEV1 and 3.62 L; 95% CI 3.56-3.69 L vs. 3.05 L; 95% CI 2.98-3.12 L for FVC). Obesity was significantly associated with FVC in men and women; it was associated with FEV1 only in men. Compared with participants with normal body mass index, obese men and women had 280 mL and 112 mL lower mean FVC, respectively. Men without hypertension had almost 100 mL higher mean FVC than those with hypertension. The difference in FVC in women was approximately 80 mL. Diabetes was associated with lower values of FVC in both sexes and with FEV1 in women. A significant negative trend was observed in the mean FVC and FEV1 by the considered CVD risk categories. Impaired lung function was associated with higher CVD risk, which could be explained partly by an adverse association between lung function and prevalence of obesity, hypertension, and diabetes.

A Study on Cardiopulmonary Function Tests in Thalassemia Major Patients (6-14 Years) and its Correlation to Serum Ferritin

Background: Patients with thalassemia major require regular blood transfusions which causes iron overload which untreated leads to respiratory, cardiac, hepatic and endocrine dysfunction. Objectives: This study was undertaken to assess cardiopulmonary functions in thalassemia major patients and its correlation to serum ferritin. Methods: A hospital based observational study was conducted over a period of 11 months, between November 2015 and September 2016. 47 thalassemia major patients were included along with 20 age and sex matched controls were taken as controls. Results: Mean age in our study population was 9.44 ± 2.030 years. The mean Sr. ferritin level was 3217+1351.853 ng/dl. 18 (38%) patients had low FEV1 and FVC; suggesting restrictive pattern along with small airway obstruction suggested by reduced FEF25% to 75%. We observed that as the serum ferritin level increased, mean value of FEV1, FVC, FEV1/FVC, FEF (25% to 75%) decreased and it was statistically significant in cases with ferritin >3000 ng/ml (p value 3000 ng/dl and 5 patients out of 17 (31%) had dilated cardiomypathy in ferritin levels of 2000 to 3000 ng/dl. So the cardiovascular complications were found to be higher in the high-ferritin group (serum ferritin>3000 ng/dl) than in low-ferritin group (serum ferritin 1000-2000). In our study among 47 Thalassemic patients, 15 (40%) were found to have both cardiac pathology as well as pulmonary dysfunction. This finding was statistically significant. Conclusion: At the end of our study on thalassemic patients, we concluded that all the PFT parameters were decreased with increasing Sr. ferritin level. Most of the echocardiographic parameters were found to be significantly deranged with reference to increase in Sr. ferritin levels. Nearly half of the patients were found to have both pulmonary and cardiac involvement.

Spirometric Assessment of Impact of Complete Dentures on Respiratory Performance: An in vitro Study

Edentulism is one of the debilitating states affecting a significant portion of the geriatric population. It is often considered as the ultimate marker for predicting the pressure and burden on oral health. Respiration is also a routine vital function running continuously through the human body and most commonly assessed by a spirometer. Hence, we planned the present study to assess the impact of complete dentures on the functioning of the respiratory system. In the present study, a spirometric assessment of the effect of complete dentures on respiratory performance was done. A total of 100 subjects were included, and diagnostic spirometer was used for carrying out the spiro-metric test at different stages of each subject. The spirometric test was carried out at four different stages: In the absence of both the denture (AODs), with both the dentures (maxillary and mandibular) inserted in the patient's mouth (BDs), with only maxillary denture inserted in the oral cavity (UDs), and finally, by inserting only the mandibular dentures in the oral cavity (LDs). Forced vital capacity (FVC), peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), and forced expiratory flow between 25 and 75% (FEF25-75) were evaluated. All the results were compiled and assessed using Statistical Package for the Social Sciences (SPSS) software. Of the total 100 subjects included in the study, 42 were males and 58 were females. The mean FVC values of AOD, BD, LD, and UD group were 3.10, 3.02, 2.90, and 2.93 respectively. The mean PEF values of AOD, BD, LD, and UD group were 5.79, 5.60, 5.40, and 5.48 respectively; 2.39, 2.35, 2.33, and 2.32 were the mean FEV1 values observed in AOD, BD, LD, and UD group respectively. Statistically significant results were obtained while comparing AOD-FVC and BD-FVC and other oral conditions. Spirometric values of respiratory functional tests in edentulous patients might be unfavorably affected by wearing complete dentures. Since subjects without complete dentures exhibited a maximum value of respiratory functional test, respiratory exercise protocols should also be carried in denture-wearing edentulous patients for increasing the performance of the respiratory system.

The Correlation Between Airway Obstruction Severity and Low Attenuation Volume With Bronchiectasis in COPD

SESSION TITLE: Medical Imaging: New Approaches to Old Technologies SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: To determine the correlations of emphysema measured by automated lung parenchyma analysis software (%LAV) and pulmonary function tests with bronchiectasis measured by Bhalla score in COPD patients. METHODS: It is a retrospective study of 108 COPD exacerbation patients admitted to hospital during 2014 - 2016. Emphysema quantification (%LAV) of total lungs, left, right lung and according to pulmonary fields, was measured by syngo InSpace Lung Parenchyma software in 128 detectors HRCT Siemens somatom during full inspiration. Respiratory function test FVC, FEV1 and FEV1/FVC have been measured and interpreted according to ERS/ATS guideline.Bronchiectasis was quantified with Bhalla score (B). For analysis of data SPS20, Pearson correlation (R), Anova were used. RESULTS: There is a good correlation between B and FEV1 with R=0.21 , P<0.009. There is a significant statistical changes between mean scores of two groups of bronchiectasis 0-15 and 16 - 25 points according to mean FEV1 values of 30.7 and 44 respectively with a P< 0.02 There is a significant statistical changes between mean scores of bronchiectasis 20.4; 19.9; 16 according to the %LAV classified in 3 categories <23.5;23.6-40;>40 respectively with P<0.035 CONCLUSIONS: There is an important correlation between airway obstruction and %LAV severity with bronchiectasis score. This correlation show that bronchiectasis is a finding of COPD obstruction severity and advanced disease CLINICAL IMPLICATIONS: The presence of bronchiectasis in COPD patients is a finding of obstruction severity which help us to determine the different approach according to the antibiotic, bronchodilatator choices and follow up DISCLOSURE: The following authors have nothing to disclose: Eritjan Tashi, Sofiela Telo, Eugerta Dilka, Esmeralda Nushi, Alma Teferici, Dafina Todri, Oltion Sina, Jetmira Shehu, Serxho Golgota, Eliana Avllai, Perlat Kapisyzi No Product/Research Disclosure Information

Respiratory Abnormalities among Occupationally Exposed, Non-Smoking Brick Kiln Workers from Punjab, India.

Background: Brick manufacturing industry is one of the oldest and fast-growing industries in India that employs a large section of people. Brick kiln workers are occupationally exposed to air pollutants. Nonetheless, only a few studies have so far been conducted on their respiratory health. Objective: To investigate the extent of respiratory impairment in brick kiln workers and to correlate it with the duration of exposure. Methods: A cross-sectional study was conducted. Spirometric parameters of 110 non-smoking male brick kiln workers aged 18–35 years in Patiala district, Punjab, India, were compared with an age-matched comparison group of 90 unexposed individuals. Results: Brick kiln workers showed a significant (p<0.05) decline in forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced mid-expiratory flow rate (FEF25-75%) and peak expiratory flow rate (PEFR) compared with those of the comparison group. The extent of deterioration in lung function of brick kiln workers was associated with the duration of exposure. In workers with >8 years of exposure, the mean values of FEV1 (1.92 L), FVC (2.01 L), FEF25-75% (2.19 L/s) and PEFR (4.81 L/s) were significantly (p<0.05) lower than those recorded in workers with <8 years of exposure in whom the values were 2.01 L, 2.68 L, 2.71 L/s, and 5.76 L/s, respectively. Conclusion: There is a significant association between exposure to workplace pollutants and lung function deterioration among brick kiln workers.

Immediate salbutamol responsiveness does not predict long-term benefits of indacaterol in patients with chronic obstructive pulmonary disease

BackgroundThe purpose of this study was to evaluate the correlation between immediate responsiveness with the short-acting β2-agonist salbutamol and effects of treatment with the ultra-long-acting β2-agonist indacaterol in patients with chronic obstructive pulmonary disease (COPD).MethodsThe REVERBREZ study was a phase IV, multicentre, open-label study in which patients with moderate-to-severe COPD received indacaterol 150 μg once-daily for 5 months. The primary endpoint was the correlation between immediate response of forced expiratory volume in 1 s (FEV1) post-inhalation of salbutamol (400 μg) at study entry and the change from baseline in trough FEV1 after 1 month of indacaterol. Secondary endpoints included dyspnoea measured by the modified Medical Research Council (mMRC) grade and health-related quality of life measured by the clinical COPD questionnaire (CCQ).ResultsOf the 602 patients enrolled from 177 centres in France, 543 patients received at least one indacaterol dose, 512 patients completed 1 month of indacaterol treatment (primary endpoint), and 400 patients completed 5 months of treatment. At study entry, mean FEV1 values before and after salbutamol inhalation were 1.54 ± 0.50 L and 1.65 ± 0.53 L, respectively. Based on the magnitude of an immediate response of FEV1 after salbutamol inhalation at study entry, patients were classified into reversible (Rv, ≥12% and ≥200 mL from pre-salbutamol value; n = 106) and non-reversible (NRv, <12% or <200 mL from pre-salbutamol value; n = 431) groups. After 1 month of indacaterol treatment, mean absolute and relative difference in trough FEV1 were 100 mL and 9%, respectively. No significant correlation was found between the immediate FEV1 response to salbutamol at study entry and change from baseline in trough FEV1 after 1 month of indacaterol treatment (correlation coefficient = 0.056 [95% CI;−0.032, 0.144] for absolute response and 0.028 [95% CI;−0.06, 0.116] for relative response). At all subsequent visits, mMRC and CCQ scores, and FEV1 improved from baseline with no significant difference between the Rv and NRv groups.ConclusionsImmediate FEV1 response to salbutamol did not predict the long-term benefits observed with indacaterol treatment in patients with COPD. Patients considered reversible or non-reversible to salbutamol showed comparable improvements in lung function, dyspnoea and health-related quality of life.Trial registrationClinicalTrials.gov: NCT01272362. Date: January 5, 2011

Spirometric evaluation of ventilatory function in adult male cigarette smokers in Sokoto metropolis.

Cigarette smoking is a widespread social habit in Nigeria with extensive deleterious multisystemic effect. Ventilatory dysfunction is one of the cigarette smoking-related illnesses that affect the respiratory system. Spirometry is an investigative method that can be used for the early detection of ventilatory dysfunction even before the onset of the symptoms. A questionnaire adapted from the European Community Respiratory Health Survey was administered to collect demographic, clinical, and cigarette smoking data. Ventilatory function test was conducted using Clement Clarke (One Flow) Spirometer, version 1.3. The highest value of each ventilatory function index was chosen for analysis, and individual(s) with ventilatory dysfunction were subjected to post bronchodilator spirometry. For the purpose of this research, 150 participants who were currently cigarette smokers were enrolled, and 50 apparently healthy, age-matched individuals who were never smokers served as controls in the ratio of 3:1. Eighty percent of participants and 68% of controls were aged 40 years or below. The mean age of participants (34.27 ± 8.91 years) and the controls (35.08 ± 10.35 years) was not significantly different (P = 0.592). Similarly, there were no statistically significant differences between the mean anthropometric indices (weight: P = 0.663, height: P = 0.084, and body mass index: P = 0.099) of both participants and controls. The mean values of FEV1 (forced expiratory flow in one second) and FEV1/FVC (FVC=forced vital capacity) were lower in the participants compared to the controls, and this difference was statistically significant (P < 0.001). There was a weak negative correlation between pack-years of cigarette smoking and FEV1 (r = -0.237 and P = 0.004). Obstructive ventilatory defect was found among six study participants (4%) and two controls (4%). Cigarette smoking is associated with decline in ventilatory function test indices (FEV1 and FEV1/FVC) in adult males. Decline in FEV1 is directly related to pack-years of cigarette smoking.

Association Between Sensitization to Mold and Impaired Pulmonary Function in Children With Asthma.

PurposeRecent data indicate that sensitization to mold contributes to the severity and persistence of asthma. In this study, we investigated the relationships between sensitization to mold and lung function parameters in children with asthma.MethodsWe retrospectively reviewed clinical data from 551 asthmatic subjects. We selected subjects who met clinical diagnostic criteria of asthma. Their spirometry, methacholine challenge tests, and measurements of blood eosinophils, serum IgE, eosinophil cationic protein (ECP) and fractional exhaled nitric oxide (FeNO) results were included. Skin prick testing (SPT) results with 13 common aeroallergens in Korea including house dust mites, animal dander, pollen, cockroach and mold were reviewed. Subjects were divided into 3 groups according to their SPT results. Subjects who showed no positive result to any aeroallergen were designated as group 1 (non-sensitized). Group 2 represented subjects who were sensitized to aeroallergens other than mold (other allergen-sensitized) and group 3 included subjects who were sensitized to mold allergens (mold-sensitized).ResultsAmong the 551 asthmatic subjects, 67 (12.2%) were sensitized to mold and 366 (66.4%) were sensitized to other aeroallergens. The log mean IgE levels were higher in groups 2 (5.96±1.14 IU/mL) and 3 (5.81±0.97 IU/mL) compared to group 1 (3.88±1.68 IU/mL). Blood eosinophils, ECP and FeNO concentrations were significantly higher in groups 2 and 3, but no significant difference was found between the 2 groups. The mean FEV1 value was significantly lower in group 3 (86.9±12.1%pred) than in groups 2 (92.0±14.8%pred) and 1 (93.4±15.4%pred). The log mean methacholine PC20 was significantly lower in group 3 (0.08±1.91 mg/mL) than in groups 2 (1.31±1.69 mg/mL) and 1 (2.29±1.66 mg/mL).ConclusionsWe observed a differential association between mold and other aeroallergen sensitization, and severity of asthma. Sensitization to mold is associated with lower lung function and increased airway hyper-responsiveness in children with asthma. Mold sensitization could be an important factor determining asthma severity particularly airflow limitation in children.

Hispanics/Latinos With Type 2 Diabetes Have Functional and Symptomatic Pulmonary Impairment Mirroring Kidney Microangiopathy: Findings From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Type 2 diabetes mellitus (DM) has been associated with lung dysfunction, but this association has not been explored in Hispanics/Latinos. The relation between diabetic nephropathy and lung function and symptoms has not been explored. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a large, multicenter, observational study, recruited 16,415 participants aged 18-74 years (14,455 with complete data on variables of interest), between 2008 and 2011 from four U.S. communities through a two-stage area household probability design. Baseline measurements were used for analyses. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and dyspnea score were compared between individuals with and without DM, overall, and stratified by albuminuria. The analyses were performed separately for those with and without preexisting lung disease (chronic bronchitis, emphysema, asthma). Linear regression with sampling weights was used for all analyses. Among Hispanics/Latinos without lung disease, those with DM had lower mean FEV1 and FVC values and a higher mean dyspnea score than those without DM (mean [95% CI] FEV1 3.00 [2.96-3.04] vs. 3.10 [3.09-3.11] L, P < 0.01; FVC 3.62 [3.59-3.66] vs. 3.81 [3.79-3.83] L, P < 0.001; dyspnea score 0.60 [0.49-0.71] vs. 0.41 [0.34-0.49], P < 0.001). Hispanics/Latinos with DM and macroalbuminuria showed 10% lower FVC (P < 0.001), 6% lower FEV1 (P < 0.001), and 2.5-fold higher dyspnea score (P = 0.04) than those without DM and with normoalbuminuria. Similar findings but with higher impairment in FVC were found in Hispanics/Latinos with lung disease. Hispanics/Latinos with DM have functional and symptomatic pulmonary impairment that mirror kidney microangiopathy. The progression of pulmonary impairment in adults with DM needs to be investigated further.

Respiratory Health in Waste Collection and Disposal Workers.

Waste management, namely, collection, transport, sorting and processing, and disposal, is an issue of social concern owing to its environmental impact and effects on public health. In fact, waste management activities are carried out according to procedures that can have various negative effects on the environment and, potentially, on human health. The aim of our study was to assess the potential effects on respiratory health of this exposure in workers in the waste management and disposal field, as compared with a group of workers with no occupational exposure to outdoor pollutants. The sample consisted of a total of 124 subjects, 63 waste collectors, and 61 office clerks. Informed consent was obtained from all subjects before inclusion in the study. The entire study population underwent pulmonary function assessments with spirometry and completed two validated questionnaires for the diagnosis of rhinitis and chronic bronchitis. Statistical analyses were performed using STATA 13. Spirometry showed a statistically significant reduction in the mean Tiffenau Index values in the exposed workers, as compared with the controls, after adjusting for the confounding factors of age, BMI, and smoking habit. Similarly, the mean FEV1 values were lower in the exposed workers than in the controls, this difference being again statistically significant. The FVC differences measured in the two groups were not found to be statistically significant. We ran a cross-sectional study to investigate the respiratory health of a group of workers in the solid waste collection and disposal field as compared with a group of office workers. In agreement with most of the data in the literature, our findings support the existence of a prevalence of respiratory deficits in waste disposal workers. Our data suggest the importance of adopting preventive measures, such as wearing specific individual protection devices, to protect this particular category of workers from adverse effects on respiratory health.

Effect of low dose versus high dose Ipratropium over Lung functions in chronic obstructive pulmonary disease patients

The objective is to determine the effect of changing anticholinergic therapy in patients with chronic obstructive pulmonary disease from low dose ipratropium to high dose ipratropium on pulmonary function. This study was conducted to evaluate single metered aerosol doses of 20 mcg, 40 mcg, and 80 mcg of ipratropium bromide; and placebo. 20 adult patients with partially reversible airway obstruction were included in the study. They were all tested for 6 hours with each dose range. Spirometric studies were performed 5, 30, 60, 120, 180, 240, 300 and 360 minutes after the dose was administered. The values for FEV1 and FVC were significantly increased within 5 minutes after all doses of ipratropium. The two lower doses ipratropium had significant effects for 3-4 hours, while the 80 mcg dose significantly increased both the FEV1 and FVC for 5 hours. Baseline mean FEV1 (litres) values for placebo, 20 mcg, 40 mcg, and 80 mcg of ipratropium bromide were 1.068, 1.078, 1.080, 1.089 litres respectively. Compared with placebo, each dose of ipratropium bromide produced a significant increase of the mean FEV1 (P<0.05). When compared to baseline value, the FEV1 was significantly greater with 80 mcg than 40 mcg at 5 hours (p<0.05). We concluded that ipratropium 80 mcg shows greater lung function improvement compared to lower doses in obstructive pulmonary diseases.

Effect of Inhaled Budesonide on Interleukin-4 and Interleukin-6 in Exhaled Breath Condensate of Asthmatic Patients.

Background:Studies of interleukin (IL)-4 and IL-6 in the exhaled breath condensate (EBC) of asthmatic patients are limited. This study was to determine the effect of inhaled corticosteroid (ICS) treatment on IL-4 and IL-6 in the EBC of asthmatic patients.Methods:In a prospective, open-label study, budesonide 200 μg twice daily by dry powder inhaler was administered to 23 adult patients with uncontrolled asthma (mean age 42.7 years) for 12 weeks. Changes in asthma scores, lung function parameters (forced expiratory volume in 1 s [FEV1], peak expiratory flow [PEF], forced expiratory flow at 50% of forced vital capacity [FEF50], forced expiratory flow at 75% of forced vital capacity, maximum mid-expiratory flow rate) and the concentrations of IL-4 and IL-6 in EBC were measured.Results:Both asthma scores and lung function parameters were significantly improved by ICS treatment. The mean IL-4 concentration in the EBC was decreased gradually, from 1.92 ± 0.56 pmol/L before treatment to 1.60 ± 0.36 pmol/L after 8 weeks of treatment (P < 0.05) and 1.54 ± 0.81 pmol/L after 12 weeks of treatment (P < 0.01). However, the IL-6 concentration was not significantly decreased. The change in the IL-4 concentration was correlated with improvements in mean FEV1, PEF and FEF50 values (correlation coefficients −0.468, −0.478, and −0.426, respectively).Conclusions:The concentration of IL-4 in the EBC of asthmatic patients decreased gradually with ICS treatment. Measurement of IL-4 in EBC could be useful to monitor airway inflammation in asthmatics.

Respiratory sleep disturbance in children and adolescents with cystic fibrosis

Sleep disturbance has been described in cystic fibrosis (CF) patients as relevant to clinical and lung function predictive factors helping to improve the diagnosis and early intervention. Related paediatric studies are scarce. ObjectiveTo describe respiratory sleep disturbance (RSD) and its association with spirometric indices in a population of CF children. A second aim was to determine if spirometric indices and wake-time SpO2 are predictors of sleep disturbance. MethodsA cross-sectional study involving 33CF paediatric patients. All participants underwent in-lab polysomnography (PSG), pulse oximetry and spirometry. A standardized sleep questionnaire was completed for each patient. Two subgroups were considered: I – Normal (FEV1>−1.64 z-score); II – Obstructed (FEV1≤−1.64 z-score). ResultsParticipant's median age was 12 (6–18) years, 16 (48.5%) were male. Twenty-nine patients (87.9%) presented sleep complaints. Sleep efficiency was reduced; sleep latency and waking after sleep onset (WASO) increased. N1 increased, N2, N3, REM and awakenings were normal. The apnoea–hypopnoea index was 0.6/h (sd 0.9); respiratory disturbance index (RDI) was 6.6/h (sd 5.2). Mean awaking (97% (sd 1.1)) and sleep SpO2 (95% (sd 2.7)) were normal; mean nocturnal oximetry desaturation index was 2.36/h; minimal nocturnal SpO2 was 89% (sd 4.1).We found associations between mean nocturnal SPO2 and mean values of FEV1 (r=0.528; p=0.002) and FEF25–75 (r=0.426; p=0.013). There were significant differences in nocturnal SpO2 between normal and obstructed patients (p<0.000). PSG data correlated with the questionnaire answers for night awakenings and WASO (p=0.985) and difficult breathing during sleep and RDI (p=0.722).This study points to most CF children having sleep complaints, and highlights the correlation between subjective assessment of sleep and PSG and spirometric results. Awake-time SpO2 and spirometric values are possible risk predictors for nocturnal desaturation.