Normal Spirometry Research Articles

Relationship between diabetes-related clinical characteristics and preserved ratio impaired spirometry (PRISm): findings from NHANES 2007–2012

IntroductionTo analyse the relationship between diabetes, its severity (including blood glucose levels, disease duration, antidiabetic drug use and number of comorbidities) and preserved ratio impaired spirometry (PRISm) using data from...

Contrasting the clinical and biological characteristics of young and old COPD patients

Background.The ECLIPSE study was a large, international, prospective, controlled, observational study that included COPD patients (GOLD grades 2–4), as well as smoking and non-smoking participants with normal spirometry, aged 40–75 yrs., who were followed-up regularly for 3 years. Here we sought to contrast the clinical and biological characteristics of young COPDversuscontrols of similar age and older COPD patients included in ECLIPSE.Methods.We compared 106 young (<50 years) and 488 old (>70 years) COPD patients, as well as 119 young smokers and 92 non-smoker controls (<50 years) with normal spirometry.Results.Young COPD patients:(1)were more symptomatic than young controls, often reported a family history of chronic bronchitis, emphysema and asthma, as well as a personal history of asthma and bronchitis, and suffer from a similar disease burden than older patients;(2)were at higher risk of substantial FEV1decline over time; and(3)had reduced serum levels of CC16 (a lung-derived anti-inflammatory protein that relates to lung damage) and, at the same time, reduced pro-inflammatory markers than older COPD patients.Conclusions.Young COPD patients suffer from significant disease burden, display an altered biomarker and disease progression profile reflected by an accelerated risk of lung function decline highlighting the need for early life diagnosis, prevention approaches and treatment.

Effectiveness of paediatric asthma hubs: a clinical pilot study

BackgroundChildren and young people (CYP) with asthma in the UK are at higher risk of poor outcomes compared with other high-income European countries due to factors including poor access to high-quality asthma reviews, diagnostic testing and inconsistent postattack reviews. The Leicester Integrated Care Board funded the first UK pilot asthma hub for CYP, to investigate the feasibility and effectiveness of hubs, in providing postattack reviews along with providing asthma education, the opportunity to carry out diagnostic lung function tests and optimise treatment.MethodsClinical pilot study including CYP aged 4–17 years referred to the hub with uncontrolled asthma or postattack from November 2021 to April 2022. CYP received a structured clinical assessment including National Institute for Health and Care Excellence (NICE) first-line diagnostic investigations for asthma including spirometry, bronchodilator reversibility (BDR) and fraction of exhaled nitric oxide (FeNO).ResultsOf 312 CYP referred (mean age 8.6±3.2 years; 42% women), 266 (85.3%) attended their appointment. Median time from referral to review was 2 days (IQR 1–3). Three CYP (1.1%) were severely unwell at review and required further hospital treatment. In the 231 CYP who completed first-line tests, asthma was confirmed for 73 (31.6%) based on NICE diagnostic criteria for CYP. Twenty-two per cent of children with normal baseline spirometry had ≥12% BDR.ConclusionPaediatric asthma hubs are a feasible model of care to deliver CYP postasthma attack reviews and identify high-risk patients requiring further treatment. Spirometry, BDR and FeNO testing allowed diagnostic confirmation in a significant proportion of CYP.

The association between preserved ratio impaired spirometry (PRISm) and cognitive function among American older adults: the mediating role of systolic blood pressure

BackgroundRecent studies have drawn attention to the association between preserved ratio impaired spirometry (PRISm) and cognitive function decline. High systolic blood pressure (SBP) is a known risk factor for both PRISm and dementia. This study aimed to investigate whether elevated SBP may mediate the relationship between PRISm and cognitive function in older adults.MethodsThis study analyzed 732 participants aged ≥ 60 years who had completed spirometry and cognitive function tests in the National Health and Nutrition Examination Survey (NHANES) 2011–2012. Multivariable linear regression was employed to assess the relationship between PRISm and cognitive function, as measured through the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word Learning sub-test, the Animal Fluency test (AFT), the Digit Symbol Substitution test (DSST), and global cognition tests. All cognitive tests were modeled as z-scores, and global cognition was calculated as the sum of the z-scores of the CERAD, AFT, and DSST. Mediation analyses were conducted to test the mediating effect of SBP on the association between PRISm and cognitive function.ResultsParticipants with PRISm had lower AFT (β = -0.300; 95% confidence interval [CI] = -0.479 to -0.122; p = 0.001), DSST (β = -0.157; 95% CI = -0.309 to -0.004; p = 0.044), and global cognition scores (β = -0.211; 95% CI = -0.369 to -0.053; p = 0.009) than those with normal spirometry, after adjusting for all potential confounders. SBP was considerably associated with AFT (β = -0.084; 95% CI = -0.162 to -0.005; p = 0.038) and DSST (β = -0.132; 95% CI = -0.207 to -0.057; p < 0.001), mediating 7.9% and 18.0% of the association of PRISm with cognitive function, respectively. Furthermore, SBP mediated 17.1% of the association of PRISm with global cognition.ConclusionsThe findings suggested the potential role of SBP as a mediator of associations between PRISm and cognitive decline in older adults.

Choice of therapy for patients who do not achieve control over bronchial asthma on basic therapy with medium doses of inhaled glucocorticosteroids/long-acting β2-agonists. Resolution of the Expert Council

Recently, new drugs for the treatment of bronchial asthma (BA) have been registered in the Russian Federation: fixed triple combinations, which include inhaled corticosteroids (ICS), long-acting β2-agonists (LABA) and anticholinergics, high-dose combinations of beclomethasone dipropionate (BDP) and formoterol (FORM) in the form of an extrafine metered-dose aerosol, which allows prescribing 800 mcg of extrafine BDP and 24 mcg of FORM per day.The aim of publishing the resolution of the Expert Council “Choice of therapy for patients who do not achieve control over bronchial asthma on basic therapy with medium doses of inhaled corticosteroids/long-acting β2-agonists” was to compare possible ways of therapy optimization and propose criteria for choosing therapeutic alternatives based on the individual clinical and phenotypic characteristics.Conclusion. If a patient does not achieve asthma control (or had asthma exacerbations over the past year) with alternative therapy at step 4, it is advisable to switch to a maintenance and relief therapy (MART) regimen with fixed combination of inhaled corticosteroids/formoterol and with medium doses of ICS in the maintenance part of the regimen. In patients with poor control on alternative therapy with a medium dose of ICS, it is advisable to consider increasing the dose of ICS as part of an ICS/LABA combination or as part of a triple combination instead of switching to MART. Switching to a medium- or high-dose triple combination is especially useful for patients with fixed obstruction and when bronchial asthma is combined with chronic obstructive pulmonary disease. In patients who require high-dose therapy, it is advisable to consider prescribing high doses of ICS using an extrafine combination of BDP/FORM (400/12 mcg in the morning and evening). If MART with a medium dose of ICS does not prevent exacerbations, provide normal spirometry results and/or good control of symptoms, MART in combination with an anticholinergic drug should be used at step 5. If triple therapy or high doses of ICS/LABA are insufficiently effective, biological therapy should be considered.

Pulmonary Vascular Structure and Function Are Related to Exercise Capacity in Health and COPD

Although it is generally accepted that aerobic exercise training does not change lung structure or function, some work suggests that greater pulmonary vascular structure and function is associated with higher exercise capacity (VO2peak). Is there a cross-sectional association between the pulmonary vasculature and VO2peak? We hypothesized that those with higher computed tomography (CT) blood vessel volumes, and pulmonary diffusing capacity for carbon monoxide (DLCO) would have higher VO2peak, independent of airflow limitation. Participants from the CanCOLD study were categorized as: never-smokers with normal spirometry (n=263); ever-smokers with normal spirometry (n=407); and chronic obstructive pulmonary disease (COPD): individuals with spirometric airflow obstruction (n=334). Total vessel volume (TVV), the volume for all vessels with a cross-sectional area ≤5 mm2 (BV5), and between 5-10 mm2 (BV5-10) were generated from CT scans and used as indices of pulmonary vascular structure. DLCO was used as an index of pulmonary microvascular function. VO2peak was evaluated via incremental cardiopulmonary exercise testing. General linear regression models revealed that even after controlling for FEV1, emphysema severity and body morphology, DLCO, TVV, BV5 and BV5-10, were independently associated with VO2peak. Interaction effects were observed between COPD and TVV, BV5, and BV5-10 indicating a weaker association between pulmonary vascular volumes and VO2peak in COPD. Our results suggest that pulmonary vascular structure and DLCO is independently associated with VO2peak, regardless of severity of airflow limitation and emphysema, suggesting that these associations are not limited to COPD.

Physical Activity Behaviors Are Similar Among Preserved Ratio Impaired Spirometry (PRISm), Normal Spirometry And Moderate COPD

Physical Activity Behaviors Are Similar Among Preserved Ratio Impaired Spirometry (PRISm), Normal Spirometry And Moderate COPD

Impaired diffusing capacity and COPD incidence in adults with symptoms and normal spirometry

Impaired diffusing capacity of the lung (DLCO) in the absence of post-bronchodilator (BD) airflow obstruction has been proposed as a marker of 'Pre-COPD'. However, the relationship between impaired DLCO and subsequent lung function decline and COPD incidence has not been examined in-depth. We conducted an observational study of adults aged between 40 and 70 years who were evaluated at a multi-centre lung function laboratory in Australia between 2014 and 2024. Adults referred with respiratory symptoms or a clinical suspicion of obstructive airways disease with follow-up spirometry obtained ≥12 months after the initial assessment were included. The relationship between impaired DLCO and subsequent lung function decline and COPD incidence was assessed among those with normal spirometry at baseline. A total of 266 patients with a mean age of 53.2 (SD 12.8) years were evaluated after a median follow-up of 2.3 [IQR 1.5 to 3.3] years. We found no evidence of an association between impaired DLCO (below the lower limit of normal) and annualised rate of decline in post-BD FEV1 (MD -0.1% predicted per-year, 95%CI -1.3 to 1.2), FVC (-0.4% predicted, 95%CI -1.6 to 0.8) or FEV1/FVC (-0.1% per-year, 95%CI -0.1 to 0.1). The sensitivity of impaired DLCO for COPD incidence was 40%, and specificity 82%. Findings were similar in sub-samples limited to current and former smokers, and when impaired DLCO was defined as < 80% predicted. Impaired DLCO was not an effective discriminator of lung function decline or COPD incidence in this real-world cohort.

Prevalence of Bronchodilator Responsiveness: A Comparison of Old Versus New Criteria.

In 2021, the European Respiratory Society (ERS)/American Thoracic Society (ATS) guidelines issued a new definition of bronchodilator responsiveness, which is now defined as an increase in FEV1 or FVC by ≥ 10% of the predicted FEV1 or FVC. The impact of this revised definition on bronchodilator responsiveness prevalence has been relatively understudied. We retrospectively analyzed data from 2,696 subjects who performed pulmonary function testing at the University of Iowa from 1997 to 2018. We compared the prevalence of bronchodilator responsiveness by using the 2005 (FEV1 or FVC increase ≥ 12% baseline value and ≥ 200 mL) and 2021 (FEV1 or FVC increase ≥ 200 mL and ≥ 12% of baseline value) ERS/ATS definitions, across several different respiratory diagnosis categories. We compared the prevalence of bronchodilator responsiveness using the 2 definitions by applying the McNemar test and assessed concordance of bronchodilator responsiveness by calculating kappa coefficients for the whole study population and within each diagnosis category. The prevalence of bronchodilator responsiveness increased from 9% when using the 2005 ERS/ATS definition to 16% when using the 2021 definition within the entire cohort and also within each respiratory diagnosis category. In the subjects with normal pre-bronchodilator spirometry, there was a low prevalence of bronchodilator responsiveness (3%) when using the 2005 definition, and the prevalence increased (8%) when using the 2021 definition. In the subjects with normal pre-bronchodilator spirometry and FEV1 Z score ≥ 0, 2% had bronchodilator responsivness according to the 2005 guidelines, whereas 7% had bronchodilator responsiveness according to the 2021 guidelines. The prevalence of bronchodilator responsiveness increased when using the new 2021 ERS/ATS definition compared with the 2005 definition. In the subjects with normal pre-bronchodilator spirometry, the prevalence of bronchodilator responsiveness increased when using the 2021 definition, in particular, among those with an FEV1 Z score ≥ 0, which raises concerns for overdiagnosis. Future investigations should examine the correlation of bronchodilator responsiveness with clinical outcomes in this group of subjects.

Low-grade systemic inflammation and peripheral airway function

BackgroundLow-grade systemic inflammation is linked to abnormal spirometry. Impulse oscillometry (IOS) is sensitive in detecting peripheral airway dysfunction, but inflammation in relation to IOS is poorly studied.ObjectivesTo analyse associations between C-reactive protein (CRP), blood eosinophils (B-Eos), blood neutrophils (B-Neu), blood lymphocytes (B-Lym), blood leukocytes (B-Leu), blood monocytes (B-Mono) and IOS.MethodsBlood biomarkers and IOS were assessed in 10 602 adults (aged 50–65 years) within the Swedish CardioPulmonary bioImage Study (SCAPIS). Upper tertiles for CRP (&gt;1.80 mg·L−1), B-Eos (&gt;0.20 109·L−1), B-Neu (&gt;3.40 109·L−1), B-Lym (&gt;2.00 109·L−1), B-Leu (&gt;6.10 109·L−1) and B-Mono (&gt;0.50 109·L−1) were analysed in relation to the following abnormal IOS indices: resistance at 5 Hz, resistance at 20 Hz, area of reactance, resonant frequency (&gt;95th percentile) and reactance at 5 Hz (&lt;5th percentile), based on healthy, never-smoking SCAPIS participants.ResultsAbnormal IOS was observed in 1715 (16.2%), of which 580 (33.8%) also had abnormal spirometry. Having several blood biomarkers in the upper tertile (1, 2–3 or 4–6versus0) was overall associated with abnormal IOS; adjusted odds ratios (OR) and 95% confidence intervals (CI) ranging from 1.19 (1.02, 1.38) to 2.27 (1.79, 2.89). Furthermore, having 2–3 or more blood biomarkersversus0 in the upper tertile was overall linked to abnormal IOS in participants with normal spirometry; adjusted OR (95% CI) ranging from 1.43 (1.17, 1.75) to 1.75 (1.29, 2.38).ConclusionsLow-grade systemic inflammation was related to abnormal IOS, and appeared consistent even when participants had normal spirometry.

Association of Preserved Ratio Impaired Spirometry with Arterial Stiffness.

Rationale: Preserved ratio impaired spirometry (PRISm) is a recently recognized spirometric pattern defined by a ratio of forced expiratory volume in 1 second to forced vital capacity of at least 0.70 and a forced expiratory volume in 1 second <80% of reference. For unclear reasons, PRISm is associated with increased cardiovascular (CV) morbidity and mortality. Arterial stiffness is a major mechanism of CV disease, which can be measured by carotid-femoral pulse-wave velocity (cfPWV). Objectives: We explored the hypothesis that cfPWV would be increased in individuals with PRISm and airflow limitation (AL). Methods: We measured forced spirometry, lung volumes by body plethysmography, and cfPWV in 9,466 subjects recruited from the general population in the Austrian cross-sectional LEAD (Lung, Heart, Social, Body) study and tested the association of arterial stiffness with PRISm and AL by multivariable linear regression analysis. Individuals younger than 18 years were excluded from the study. Results: Individuals with PRISm (n = 431; 4.6%) were of similar age to those with normal spirometry (n = 8,136; 85.9%) and significantly younger than those with AL (n = 899; 9.5%). Arterial hypertension, diabetes mellitus, coronary artery disease, heart failure, and peripheral arterial occlusive disease were significantly more common in individuals with PRISm than in those with normal lung function and similar to those with AL. There was a significant association between PRISm and arterial stiffness on bivariate linear regression analysis (crude model, β = 0.038; 95% confidence interval [CI], 0.016-0.058), which persisted after robust adjustment for clinical confounders upon multivariable analysis (final model, β = 0.017; 95% CI, 0.001-0.032). cfPWV was significantly higher in individuals with PRISm irrespective of the presence of established CV disease or pulmonary restriction. AL also showed a significant association with arterial stiffness on multivariable linear regression analysis (final model, β = 0.025; 95% CI, 0.009-0.042). Conclusions: Arterial stiffness measured by cfPWV is increased in individuals with PRISm independent of CV disease and risk factors. The pathobiological mechanisms underlying this association deserve further research.

Identification of factors directly linked to incident chronic obstructive pulmonary disease: A causal graph modeling study.

Beyond exposure to cigarette smoking and aging, the factors that influence lung function decline to incident chronic obstructive pulmonary disease (COPD) remain unclear. Advancements have been made in categorizing COPD into emphysema and airway predominant disease subtypes; however, predicting which healthy individuals will progress to COPD is difficult because they can exhibit profoundly different disease trajectories despite similar initial risk factors. This study aimed to identify clinical, genetic, and radiological features that are directly linked-and subsequently predict-abnormal lung function. We employed graph modeling on 2,643 COPDGene participants (aged 45 to 80 years, 51.25% female, 35.1% African Americans; enrollment 11/2007-4/2011) with smoking history but normal spirometry at study enrollment to identify variables that are directly linked to future lung function abnormalities. We developed logistic regression and random forest predictive models for distinguishing individuals who maintain lung function from those who decline. Of the 131 variables analyzed, 6 were identified as informative to future lung function abnormalities, namely forced expiratory flow in the middle range (FEF25-75%), average lung wall thickness in a 10 mm radius (Pi10), severe emphysema, age, sex, and height. We investigated whether these features predict individuals leaving GOLD 0 status (normal spirometry according to Global Initiative for Obstructive Lung Disease (GOLD) criteria). Linear models, trained with these features, were quite predictive (area under receiver operator characteristic curve or AUROC = 0.75). Random forest predictors performed similarly to logistic regression (AUROC = 0.7), indicating that no significant nonlinear effects were present. The results were externally validated on 150 participants from Specialized Center for Clinically Oriented Research (SCCOR) cohort (aged 45 to 80 years, 52.7% female, 4.7% African Americans; enrollment: 7/2007-12/2012) (AUROC = 0.89). The main limitation of longitudinal studies with 5- and 10-year follow-up is the introduction of mortality bias that disproportionately affects the more severe cases. However, our study focused on spirometrically normal individuals, who have a lower mortality rate. Another limitation is the use of strict criteria to define spirometrically normal individuals, which was unavoidable when studying factors associated with changes in normalized forced expiratory volume in 1 s (FEV1%predicted) or the ratio of FEV1/FVC (forced vital capacity). This study took an agnostic approach to identify which baseline measurements differentiate and predict the early stages of lung function decline in individuals with previous smoking history. Our analysis suggests that emphysema affects obstruction onset, while airway predominant pathology may play a more important role in future FEV1 (%predicted) decline without obstruction, and FEF25-75% may affect both.

Early diagnosis of small airway disease in asymptomatic polishing sector workers of a leather factory

Background: The leather industry stands as one of India’s burgeoning sectors, boasting significant manpower. Workers in the finishing sector, particularly those involved in polishing, face heightened risks due to exposure to formaldehyde, aniline, and resins, which can lead to respiratory complications. Aims and Objectives: The aims and objectives of the study are to determine the small airway obstruction in asymptomatic finishing sector workers of a leather factory. Materials and Methods: The current study was a cross-sectional study conducted in a leather factory located in Chennai, Tamil Nadu. A random sample of 60 workers was drawn from different sectors of a leather factory. Basic demographic details, smoking history, nature of work, exposure to irritants along with duration, and respiratory symptoms were collected. All workers were subjected to spirometry as per ATS guidelines and the results were analyzed. Association between length (years) of exposure, respiratory symptoms, and spirometry impairment among the workers were analysed. Results: Out of 60 samples, 38 were exposed to irritants and 22 were not exposed to irritants. Out of 38, 25 had small airway disease, seven had large airway obstruction, one had a restrictive pattern, and five had normal spirometry. 42.1% of them were asymptomatic. Conclusion: Small airway obstruction is notably prevalent, especially among asymptomatic workers in the polishing sector. Prolonged exposure is associated with the development of large airway obstructive disease. This study underscores the importance of continuous monitoring for airway diseases in occupationally exposed workers, advocating for timely preventive and protective measures to curb disease progression.

Risk Factors, Morbidity, and Mortality in Association With Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern: Clinical Relevance of Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern

BackgroundPreserved Ratio Impaired Spirometry (PRISm) and Restrictive Spirometric Pattern (RSP) are often considered interchangeable in identifying restrictive impairment in spirometry. Research QuestionDo PRISm and RSP have different individual associations with risk factors, morbidity, and mortality? Study Design and MethodsIn a cross-sectional and longitudinal study, including 26,091 30–46-year-old Norwegian general population men, we explored the association of PRISm and RSP with smoking habits, BMI, education, respiratory symptoms, self-reported cardiopulmonary disease, and mortality after 26 years of follow-up. PRISm was defined as FEV1/FVC ≥ lower limit of normal (LLN) & FEV1<LLN, RSP as FEV1/FVC≥LLN & FVC<LLN. We compared the associations of PRISm and RSP to airflow obstruction and normal spirometry, both as mutually (PRISm-alone, RSP-alone) and non-mutually exclusive (PRISm, RSP) categories, adjusting for age, BMI, smoking, education. We also conducted sensitivity analyses using GOLD criteria to define spirometric abnormalities. ResultsThe prevalence of the mutually exclusive spirometric patterns was: normal 82.4%, obstruction 11.0%, PRISm-alone 1.4%, RSP-alone 1.7%, PRISm+RSP 3.5%. PRISm-alone subjects were frequently obese (11.2%), current or former smokers, commonly reporting cough, phlegm, wheeze, asthma, and bronchitis. RSP-alone subjects were both obese (14.6%) and underweight (2.9%), with increased breathlessness, but similar smoking habits to subjects with normal spirometry. The prevalence of heart disease was 4.6% in PRISm-alone, 2.7% in RSP-alone and 1.6% in obstruction. With normal spirometry as a reference, RSP-alone had increased all-cause (HR 1.57 (1.21–2.04 95%CI), cardiovascular (1.48 (0.88–2.48)), diabetes (6.43 (1.88–21.97)), and cancer (excl. lung) mortality (1.51 (0.95–2.42)). PRISm-alone had increased respiratory disease mortality (HR 4.00 (1.22–13.16 95%CI)). Subjects with PRISm+RSP had intermediate characteristics and the worst prognosis. Findings were overall confirmed with non-mutually exclusive categories and GOLD criteria. InterpretationPRISm and RSP are spirometric patterns with distinct risk factors, morbidity and mortality, which should be differentiated in future studies.

Machine learning for accurate detection of small airway dysfunction-related respiratory changes: an observational study

BackgroundThe use of machine learning(ML) methods would improve the diagnosis of small airway dysfunction(SAD) in subjects with chronic respiratory symptoms and preserved pulmonary function(PPF). This paper evaluated the performance of several ML algorithms associated with the impulse oscillometry(IOS) analysis to aid in the diagnostic of respiratory changes in SAD. We also find out the best configuration for this task.MethodsIOS and spirometry were measured in 280 subjects, including a healthy control group (n = 78), a group with normal spirometry (n = 158) and a group with abnormal spirometry (n = 44). Various supervised machine learning (ML) algorithms and feature selection strategies were examined, such as Support Vector Machines (SVM), Random Forests (RF), Adaptive Boosting (ADABOOST), Navie Bayesian (BAYES), and K-Nearest Neighbors (KNN).ResultsThe first experiment of this study demonstrated that the best oscillometric parameter (BOP) was R5, with an AUC value of 0.642, when comparing a healthy control group(CG) with patients in the group without lung volume-defined SAD(PPFN). The AUC value of BOP in the control group was 0.769 compared with patients with spirometry defined SAD(PPFA) in the PPF population. In the second experiment, the ML technique was used. In CGvsPPFN, RF and ADABOOST had the best diagnostic results (AUC = 0.914, 0.915), with significantly higher accuracy compared to BOP (p < 0.01). In CGvsPPFA, RF and ADABOOST had the best diagnostic results (AUC = 0.951, 0.971) and significantly higher diagnostic accuracy (p < 0.01). In the third, fourth and fifth experiments, different feature selection techniques allowed us to find the best IOS parameters (R5, (R5-R20)/R5 and Fres). The results demonstrate that the performance of ADABOOST remained essentially unaltered following the application of the feature selector, whereas the diagnostic accuracy of the remaining four classifiers (RF, SVM, BAYES, and KNN) is marginally enhanced.ConclusionsIOS combined with ML algorithms provide a new method for diagnosing SAD in subjects with chronic respiratory symptoms and PPF. The present study’s findings provide evidence that this combination may help in the early diagnosis of respiratory changes in these patients.

Association of preserved ratio impaired spirometry with mortality and cardiovascular diseases: a systematic review and meta-analysis

BackgroundPreserved ratio impaired spirometry (PRISm) is a type of abnormal lung function. PRISm and mortality have been explored in several studies, but a comprehensive evaluation of the associations is limited. The current study aims to conduct a systematic review and meta-analysis in order to investigate the mortality and cardiovascular diseases in patients with PRISm.MethodsPubMed, Embase, and Web of Science databases, as well as gray literature sources, were searched for relevant studies published up to 7 September 2023 without language restrictions. This review included all published observational cohort studies that investigated the association of PRISm with mortality in the general population, as well as subgroup analyses in smokers and pre-bronchodilation spirometry studies. The outcomes of interest were all-cause mortality, cardiovascular mortality, and respiratory-related mortality. The Newcastle–Ottawa scale assessed study quality. Sensitivity and subgroup analyses explored heterogeneity and robustness. Publication bias was assessed with Egger’s and Begg’s tests.ResultsOverall, eight studies were included in this meta-analysis. The pooled HR was 1.60 (95% CI, 1.48–1.74) for all-cause mortality, 1.68 (95% CI, 1.46–1.94) for CVD mortality, and 3.09 (95% CI, 1.42–6.71) for respiratory-related mortality in PRISm group compared to normal group. In the subgroup analysis, participants with PRISm had a higher effect (HR, 2.11; 95% CI, 1.74–2.54) on all-cause mortality among smokers relative to participants with normal spirometry. Furthermore, the association between PRISm and mortality risk was consistent across several sensitivity analyses.ConclusionsPeople with PRISm were associated with an increased risk of all-cause mortality, CVD mortality, and respiratory-related mortality as compared to those with normal lung function in the general population.Systematic review registrationPROSPERO CRD42023426872.

Risks of Dementia in a General Japanese Older Population With Preserved Ratio Impaired Spirometry: The Hisayama Study.

Studies on the association between preserved ratio impaired spirometry (PRISm) and dementia are limited. Indeed, PRISm has often been overlooked or ignored as an index of lung function impairment. Therefore, we investigated the association of PRISm with the risk for the development of dementia in an older Japanese population. A total of 1,202 community-dwelling, older Japanese participants aged ≥65 years without dementia were followed up for a median of 5.0 years. Participants were categorized by spirometry as follows: normal spirometry (FEV1/FVC ≥0.70 and FEV1 ≥80% predicted), PRISm (≥0.70 and <80%), airflow limitation (AFL) Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 (<0.70 and ≥80%), and AFL GOLD 2 to 4 (<0.70 and <80%). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were computed using a Cox proportional hazards model. During the follow-up period, 122 participants developed dementia. The age- and sex-adjusted incidences of dementia in the participants with normal spirometry, PRISm, AFL GOLD 1, and AFL GOLD 2 to 4 were 20.5, 37.0, 18.4, and 28.6 per 1,000 person-years, respectively. Participants with PRISm had a higher risk of dementia (HR 2.04; 95% CI, 1.19-3.49) than those with normal spirometry after adjusting for confounders. Moreover, both reduced FEV1% predicted values and FVC% predicted values were associated with the risk of dementia. PRISm was associated with an increased risk of dementia in a general older Japanese population.

Long-term lung function follow-up of preterm infants less than 32 weeks of gestational age.

Preterm infants, particularly those with bronchopulmonary dysplasia (BPD), are at risk of lung development problems. Over the last decades, lung protective strategies have been used, decreasing the risk of chronic lung disease. To evaluate the pulmonary function test (PFT) of preterm infants born after the introduction of lung protective strategies and to assess perinatal determinants of impaired lung function in this population. A prospective, observational, single-center study was conducted in the neonatal unit of a high-complexity hospital. The study included newborns withless than 32 weeks gestational age born between 2012 and 2014, who were followed up until they reach school age. For the main outcome, two groups were stablished: no BPD or grade 1 BPD (no BPD/1) and grade 2 or 3 BPD (BPD 2/3). Out of 327 patients, 116 were included. BPD was diagnosed in 49.1% (47), with 50.9% (29) classified as grade 1, 35.1% (20) as grade 2, and 14.0% (8) as grade 3. Mean age at PFT was 8.59 years (SD 0.90). Mean FEV1% was 95.36% (SD 13.21) and FEV1 z-score -0.36 (SD 1.12); FVC% 97.53% (SD 12.59) and FVC z-score -0.20 (SD 1.06); FEV1/FVC ratio 85.84% (SD 8.34) and z-score -0.24 (SD 1.34). When comparing patients with no BPD/1 and BPD 2/3, we observed differences in all pulmonary function parameters, which persisted after adjusting for gestational age. No differences in PFT were observed between patients without BPD and those with grade 1 BPD. Most patients (76.7%, 89) had normal spirometry pattern, with obstructive pattern observed in 12.9% (15), restrictive pattern in 9.5% (11), and mixed pattern in 0.9% (1) of patients. Preterm infants with BPD 2/3 showed a decrease in all pulmonary function parameters compared to preterm infants with no BPD/1; an effect that was independent of gestational age. Among patients with BPD who had an altered PFT pattern, the most common pattern was obstructive, followed by restrictive and then, mixed.

Evaluation of Pulmonary Status of Post-Tuberculosis Patients with Spirometry and Chest X-Ray

In 2022, 7.5 million new cases of tuberculosis were reported worldwide. Mycobacterium tuberculosis results in tuberculosis, an infectious disease mostly affecting the lungs. However, many completely treated post-tubercular patients experience persistent changes in lung anatomy (bronchial and parenchymal structure), Increasing their risk of lung complications and early death. These changes affect the airway's size, leading to higher resistance and decreased airflow. Our study aimed to assess the overall clinical status and lung function of treated post tuberculosis patients using spirometry. The study constituted patients over the age of 18 who presented to the Outpatient department of the Pulmonary Medicine Department, Chettinad Hospital and research institute, Kelambakkam, after receiving complete treatment and being certified cured. Convenience sampling technique was used, 87 patients participated in this trial. The Institutional Ethical Committee approved the study, which lasted 18 months. A proforma was used to collect a complete socio-demographic history and clinical history, particularly in terms of pulmonary symptomatology, and information about previous anti-tb treatment. Each of these patients had chest radiography, smear microscopy, and lung function testing. Mean age was 44.1± 15.2 years, mean BMI was 22.27 ± 3.66 kg/m2. There were 66.2% men and 33.8% females. 42% employed and 52% literate. In the current study, 41(53.25%) of the individuals reported dyspnea and 22(28.57%) had dry cough, cough with expectoration 12(15.58%), Fever 8(10.4%), Haemoptysis 7(9%), chest pain 2(2.6%). Following Post tuberculosis treatment, 38(44%) had normal chest radiographs, 31(35.6%) of the patients had fibrosis/Fibrotic strand, 8(9.1%) had consolidation, 5(5.7%) had ectatic changes, 3(3.4%) had fibrocavity, 1(1%) had calcification and cicatricial collapse. In the current study, we found that 31(40.25%) had normal spirometry followed by 23(29.87%) had mixed pattern and 12(15.6%) had restrictive pattern findings, 11(14.28%) had obstructive pattern findings. In spite of appropriate suggestions, the majority of post-tb pulmonary impairment individuals suffer in quiet or undergo poor medical care. As a result, comprehensive recommendations for patient follow-up following tuberculosis treatment are required in order to monitor lung function and provide appropriate care to improve quality of life.

The cardiovascular implications for exercise intolerance and dyspnoea in electronic cigarette users

Background: Electronic cigarettes (EC) have been proposed as a safe alternative to tobacco smoking, however, several studies have shown adverse health effects of EC. The chronic implications of EC on cardiorespiratory response and exertional dyspnoea are unknown. Aim: To examine the chronic effects of electronic cigarettes (EC) and tobacco cigarettes (TC) on resting vascular function, inflammatory markers, cardiorespiratory responses during exercise and exertional dyspnoea. Methodology: Three groups of young adults (16 each) with normal spirometry (EC users, TC smokers, and never-smokers [NS]) consented to participate in this study following institutional ethics approval. Participants performed spirometry and an incremental cardiopulmonary exercise test (CPET) 20W/2mins on an electronically braked cycle ergometer with blood lactate (BLa) measurements. Flow-mediated dilation (FMD%) of the brachial artery was assessed using Doppler ultrasonography. Venous blood samples were collected to assess inflammatory biomarkers associated with vascular function. Results: EC and TC groups had a lower peak work rate compared to NS controls (184 ± 30; 185 ± 35 vs. 228 ± 44 W, respectively; P &lt; 0.05). During submaximal exercise, EC and TC groups displayed higher ventilation (VE), higher ratings of dyspnoea and more intense leg fatigue compared to NS controls (e.g. 140 W, VE: 62 ± 10; 64 ± 12 vs. 54 ± 7 L/min, Dyspnoea: 5.0 ± 1.9; 6.1 ± 1.9 vs. 3.4 ± 1.7 Borg units, 6.1 ± 2.05; 7.0 ± 1.9 vs. 4.1 ± 2.1 Borg units, respectively; all P &lt; 0.05). The TC group displayed lower ventilatory efficiency (higher V̇E/V̇CO2) and higher blood lactate compared to NS during submaximal exercise (e.g. 140 W, V̇E/V̇CO2: 31.8 ± 5.6 vs. 28.2 ± 2.41, Blood lactate: 6.5 ± 2.4 vs. 4.3 ± 2.5 mmol/L, respectively; P &lt; 0.05 for both). Like the TC group, the EC group showed a trend for lower ventilatory efficiency and higher BLa during submaximal exercise, but they did not reach statistically significant differences compared to NS controls (P = 0.07 for both). FMD was significantly lower in EC and TC groups compared with NS controls (5.4 ± 2.4; 4.6 ± 2.9 vs. 7.9 ± 3.4%, respectively; P &lt; 0.05) and that was associated with elevated Thrombospondin-1 levels. Conclusion: EC and TC impair vascular function and cardiorespiratory responses to exercise and exertional dyspnoea similarly. EC has a detrimental impact on vascular function and exercise capacity and should not be recommended as a ‘healthier’ alternative to TC.