Lung Function Test Parameters Research Articles

Lung functions pre- and post-endoscopic balloon dilation treatment among patients with subglottic stenosis.

Subglottic stenosis (SGS) is an unusual clinical condition of mucosal wounding, compromising the extra-thoracic part of the tracheal airway below the vocal folds. The diagnosis of SGS is established with a detailed clinical examination and a direct endoscopic examination, and the role of spirometry is also often acknowledged. This study aimed to investigate the impact of SGS on lung functions before and after the balloon dilation procedure. The respiratory functions were performed in the Department of Clinical Physiology and the Department of Otolaryngology College of Medicine, King Saud University, Riyadh, Saudi Arabia. In this study, 50 patients with SGS were referred from the Department of Otolaryngology, and lung functions before and after the balloon dilation procedure among patients with SGS were performed using an electronic spirometer. The results revealed that the mean values for lung function test parameters VC (p=0.01), FVC (p=0.01), FEV1 (p=0.004), FEV1/FVC Ratio (p=0.01), PEFR (p=0.01), FEF-25% (p=0.01), FEF-50% (p=0.01), and FEF-75%, (p=0.01) were significantly improved in both male and female patients with SGS on one month after the balloon dilation procedure. It is concluded that the lung function test parameters were increased after the balloon dilation procedure among patients with SGS. The findings showed the impact of SGS on lung function test parameters. Spirometry is a valuable test in patients with SGS and is an appropriate marker to reveal post-airway outcomes. Physicians must suggest lung function tests in patients with SGS before and after the balloon dilation procedure.

Clinical outcomes of children using a metered dose inhaler with a sleeve attachment device to improve ease of use.

Activating pressurized metered dose inhalers (pMDIs) is often challenging for children. The Easy Squeezy (ES) is a novel sleeve attachment device that reduces activation force by 3 times. Although users have favored using the ES over using a pMDI alone, the clinical impact of the ES remains unknown. The aim of this study was to compare lung function and quality of life between ES users and users of a pMDI alone. Our aim was to measure and compare lung function of asthmatic children after they used the ES and pMDI alone. In this crossover study we recruited 65 asthmatic children between the ages of 5 and 12 years. The participants were randomized into 2 groups. One of the groups used the ES for 6 weeks whereas the other group used a pMDI. After 6 weeks the participants crossed over to the other group. Lung function test parameters were measured after randomization and after each 6 weeks of device use. Quality of life (measured by the Patient Asthma Quality of Life Questionnaire [PAQLQ]) and Childhood Asthma Control Test were measured after each period of device use. There was no significant difference in the baseline lung function between the groups. The ES group had a significantly lower percentage difference between prebronchodilator and postbronchodilator FEV1 values. Although no significant differences were observed in PAQLQ scores between the groups, more patients in the ES group had improvement of their PAQLQ score than did patients in the group using a pMDI alone. Total Childhood Asthma Control Test scores were significantly higher for the ES group. The ES device may allow users' asthma to be better controlled than by using a pMDI alone.

Clustering of COPD patients and their response to pulmonary rehabilitation

Background and objectivePulmonary rehabilitation (PR) is fundamental in the management of chronic obstructive pulmonary disease (COPD). COPD patients show a large clinical heterogeneity that may influence their response to PR. Identification of homogeneous clusters of patients who may or may not respond to PR is important to personalize patient care. This study aimed at identifying distinct clinical phenotypes of COPD patients and assessing their respective 6-min walking distance (6MWD) response to in-patient PR. MethodsThis is a cohort-based analysis of COPD patients admitted to a PR center between January 2012 and December 2017. Pre-PR patients' characteristics, lung function and 6-min walking test parameters were introduced in a hierarchical ascending clustering approach to identify distinct clusters. ResultsOut of 835 patients, 4 distinctive clusters were identified. The most likely to show clinically significant 6MWD improvement post-PR (responders) were cluster 1 (younger men, GOLD I-II, average walkers, obese; non-response rate: 16%), cluster 2 (older women, GOLD II-III, slow walkers; 18%), and cluster 3 (older men, GOLD II-III, dyspneic, slow walkers; 11%). The most likely to be non-responders were cluster 4 (older men, GOLD III-IV, dyspneic, very slow walkers, oxygen-dependent; 26%). ConclusionOur data identified homogeneous patient clusters representing clinically relevant subgroups of COPD patients regarding their 6MWD response to PR. Clusters having the largest probability of being non-responders were older, more severe, with severe oxygen desaturation and dyspnea, limited 6MWD and requiring long-term oxygen therapy. These results may improve patient phenotyping in clinical practice and allow individualization of therapy.

Pulmonary vascular volume is associated with DLCO and fibrotic score in idiopathic pulmonary fibrosis: an observational study

BackgroundIdiopathic pulmonary fibrosis (IPF) is a disease that primarily occurs in elderly individuals. However, it is difficult to diagnose and has a complex disease course. High-resolution computed tomography (HRCT) and lung function testing are crucial for its diagnosis and follow-up. However, the correlation of HRCT findings with lung function test results has not been extensively investigated.MethodsThis study retrospectively analysed the medical records and images of patients with IPF. Patients with evident emphysema and lung cancer were excluded. The diagnosis of all the included cases was confirmed following a discussion among specialists from multiple disciplines. The correlation of HRCT findings, including fibrotic score, HRCT lung volume, pulmonary artery trunk (PA) diameter and pulmonary vascular volume (PVV), with lung function test parameters, such as forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), was analysed.ResultsA total of 32 patients were included. Higher fibrotic and PVV scores were significantly correlated with lower DLCO (r = − 0.59, p = 0.01; r = − 0.43, p = 0.03, respectively) but not with FVC. Higher PVV score significantly correlated with higher fibrotic score (r = 0.59, p < 0.01) and PA diameter (r = 0.47, p = 0.006).ConclusionOur study demonstrated the structural and functional correlation of IPF. The extent of lung fibrosis (fibrotic score) and PVV score were associated with DLCO but not with FVC. The PA diameter, which reflects the pulmonary artery pressure, was found to be associated with the PVV score.

Abnormal exercise adaptation after varying severities of COVID-19: A controlled cross-sectional analysis of 392 survivors

ABSTRACT The multisystem impairment promoted by COVID-19 may be associated with a reduction in exercise capacity. Cardiopulmonary abnormalities can change across the acute disease severity spectrum. We aimed to verify exercise physiology differences between COVID-19 survivors and SARS-CoV-2-naïve controls and how illness severity influences exercise limitation. A single-centre cross-sectional analysis of prospectively collected data from COVID-19 survivors who underwent cardiopulmonary exercise testing (CPET) in their recovery phase (x = 50[36;72] days). Patients with COVID-19 were stratified according to severity as mild [M-Cov (outpatient)] vs severe/critical [SC-Cov(inpatients)] and were compared with SARS-CoV-2-naïve controls (N-Cov). Collected information included demographics, anthropometrics, previous physical exercise, comorbidities, lung function test and CPET parameters. A multivariate logistic regression analysis was performed to identify low aerobic capacity (LAC) predictors post COVID-19. Of the 702 included patients, 310 (44.2%), 305 (43.4%) and 87 (12.4%) were N-Cov, M-Cov and SC-Cov, respectively. LAC was identified in 115 (37.1%), 102 (33.4%), and 66 (75.9%) of N-CoV, M-CoV and SC-CoV, respectively (p < 0.001). SC-Cov were older, heavier with higher body fat, more sedentary lifestyle, more hypertension and diabetes, lower forced vital capacity, higher prevalence of early anaerobiosis, ventilatory inefficiency and exercise-induced hypoxia than N-Cov. M-Cov had lower weight, fat mass, and coronary disease prevalence and did not demonstrate more CEPT abnormalities than N-Cov. After adjustment for covariates, SC-Cov was an independent predictor of LAC (OR = 2.7; 95% CI, 1.3-5.6). Almost two months after disease onset, SC-CoV presented several exercise abnormalities of oxygen uptake, ventilatory adaptation and gas exchange, including a high prevalence of LAC. Highlights Weeks after the acute disease phase, one-third of mild and three-quarters of severe and critical patients with COVID-19 presented a reduced aerobic capacity. Previous studies including SARS-CoV-1 survivors observed much lower values. A severe or critical COVID-19 case was an independent predictor for low aerobic capacity. In our sample, pre-COVID-19 exercise significantly reduced the odds of post-COVID-19 low aerobic capacity. Even severe or critical patients who exercised regularly had a prevalence of low aerobic capacity 2.5 times lower than those who did not have this routine before sickening.

Integrating Clinics, Laboratory, and Imaging for the Diagnosis of Common Variable Immunodeficiency-Related Granulomatous-Lymphocytic Interstitial Lung Disease.

BackgroundGranulomatous–lymphocytic interstitial lung disease (GLILD) is a distinct clinic-radio-pathological interstitial lung disease (ILD) that develops in 9% to 30% of patients with common variable immunodeficiency (CVID). Often related to extrapulmonary dysimmune disorders, it is associated with long-term lung damage and poorer clinical outcomes. The aim of this study was to explore the potential use of the integration between clinical parameters, laboratory variables, and developed CT scan scoring systems to improve the diagnostic accuracy of non-invasive tools.MethodsA retrospective cross-sectional study of 50 CVID patients was conducted in a referral unit of primary immune deficiencies. Clinical variables including demographics and comorbidities; analytical parameters including immunoglobulin levels, lipid metabolism, and lymphocyte subpopulations; and radiological and lung function test parameters were collected. Baumann’s GLILD score system was externally validated by two observers in high-resolution CT (HRCT) scans. We developed an exploratory predictive model by elastic net and Bayesian regression, assessed its discriminative capacity, and internally validated it using bootstrap resampling.ResultsLymphadenopathies (adjusted OR 9.42), splenomegaly (adjusted OR 6.25), Baumann’s GLILD score (adjusted OR 1.56), and CD8+ cell count (adjusted OR 0.9) were included in the model. The larger range of values of the validated Baumann’s GLILD HRCT scoring system gives it greater predictability. Cohen’s κ statistic was 0.832 (95% CI 0.70–0.90), showing high concordance between both observers. The combined model showed a very good discrimination capacity with an internally validated area under the curve (AUC) of 0.969.ConclusionModels integrating clinics, laboratory, and CT scan scoring methods may improve the accuracy of non-invasive diagnosis of GLILD and might even preclude aggressive diagnostic tools such as lung biopsy in selected patients.

Correlation of presence and severity of thrombocytopenia with types and severity of malaria: A study from tertiary care center of North India

Malaria is a major public health problem in India. Malaria is commonly associated with thrombocytopenia, but its significance is not well established. A prospective study was conducted to correlate the presence and severity of thrombocytopenia with types and severity of malaria. This prospective observational study was performed in the Department of General Medicine at a tertiary care center of north India from January 2019 to June 2020. A total of 100 adult patients found positive for malaria parasites on peripheral smear examination were enrolled for the analysis. The incidence of thrombocytopenia was seen in 80% of total malaria patients. There was a significant (P = 0.0001) association of severity of thrombocytopenia with symptoms and signs of malaria except for rigor. There was no significant (P > 0.05) association of severity of thrombocytopenia with age. There was a significant (P = 0.003) association of severity of thrombocytopenia with M antigen. The analysis of variance showed that there was a significant (P = 0.0001) difference in Lung Function Test (LFT) and Kidney Function Test (KFT) parameters with severity of thrombocytopenia; whereas in blood parameters, only red blood cell counts were associated significantly with the severity of thrombocytopenia. Thrombocytopenia is a frequent overall manifestation of both falciparum and vivax malaria. Severe thrombocytopenia is identified in all age groups, commonly in males, and increases the risk of death from falciparum or vivax malaria, particularly in those with concurrent severe anemia. Early diagnosis and prompt treatment of malaria reduces the complications and adverse outcomes of the disease.

A study on pulmonary function tests in smokers and after cessation of smoking (Quitters)

Smoking leads to development of cancers, cardiovascular, respiratory diseases including COPD. it poses a health challenge in reducing morbidity and mortality in developing countries like India. Spirometry in Smokers may show reduction in lung function parameters. Cessation of smoking leads to decrease in rate of decline in pulmonary functions to almost the same level of nonsmokers. A cross-sectional study was conducted in a tertiary healthcare level institute in Greater Noida on 100 smokers, 50 Quitters and 100 Nonsmokers total 250 healthy asymptomatic male subjects. Spirometry by RMS Helios spirometer 401 was Conducted according to American Thoracic society guidelines after enrolling the subject based on inclusion and exclusion criteria and collected data was analysed with epi info 7 software using appropriate statistical methods. Smokers and Nonsmokers were not much different in mean age and other physical parameters. Pulmonary function parameters like FVC, and FEV1 were significantly less in Smokers as compared to Nonsmokers and after cessation of smoking. Lung function parameters in Quitters were not significantly different from Nonsmokers. All the lung function test parameters show a significant decline in asymptomatic Smokers as compared to Nonsmokers and Quitters. After cessation of smoking there was not any significant difference in lung functions between Quitters and Nonsmokers. Therefore, by conducting spirometry, especially in smokers, cases may be detected at early stage and by quitting smoking the decline in lung functions &amp; subsequent morbidity may be lessened.

Effect of Glycated Hemoglobin (HbA1c) and Duration of Disease on Lung Functions in Type 2 Diabetic Patients.

Diabetes mellitus is a highly challenging global health care problem. This study aimed to assess the effect of glycated hemoglobin (HbA1c) and duration of diabetes on lung function in type 2 diabetic patients and assess whether duration or high HbA1c is more noxious to damage the lung functions. A total of 202 participants, 101 patients with type 2 diabetes mellitus (T2DM), and 101 age-, gender-, height-, and weight-matched controlled subjects were recruited. The HbA1c was measured through a clover analyzer, and lung function test parameters were recorded by spirometry. The results revealed a significant inverse correlation between HbA1c and Vital Capacity (VC) (r = −0.221, p = 0.026), Forced Vital Capacity (FVC) (r = −0.261, p = 0.008), Forced Expiratory Volume in First Second (FEV1) (r = −0.272, p = 0.006), Forced Expiratory Flow 25% (FEF-25%) (r = −0.196, p = 0.050), Forced Expiratory Flow 50% (FEF-50%) (r = −0.223, p = 0.025), and Forced Expiratory Flow 75% (FEF-75%) (r = −0.169, p = 0.016). Moreover, FEV1 (p = 0.029), FEV1/FVC% (p = 0.006), FEF-50% (p = 0.001), and FEF-75% (p = 0.003) were significantly lower in the diabetic group with duration of disease 5–10 and >10 years compared to the control group. The overall results concluded that high HbA1c or uncontrolled diabetes mellitus has a more damaging effect on lung function impairment compared to the duration of diabetes mellitus. Physicians must regularly monitor the HbA1c level while treating diabetic patients, as good glycemic control is essential to minimize the complications of DM, including lung function impairment in patients with T2DM.

A comparative study on pulmonary function tests in smokers &amp; nonsmokers

Cigarette smoking leads to development of cancers, cardiovascular, respiratory diseases including COPD. It poses a health challenge in reducing morbidity and mortality in developing countries like India. Spirometry in smokers may show reduction in lung function parameters.A cross-sectional study was conducted in a tertiary healthcare level institute in Greater Noida on 100 smokers and 100 Nonsmokers total 200 healthy asymptomatic male subjects. Spirometry by RMS Helios spirometer 401 was conducted according to American Thoracic society guidelines after enrolling the subject based on inclusion and exclusion criteria and collected data was analysed with epi info 7 software using appropriate statistical methods. Smokers and Nonsmokers were not much different in mean age and other physical parameters. Pulmonary function parameters like FVC, FEV1, FEV1/FVC, PEFR, FEF are significantly less in Smokers as compared to Nonsmokers. With increasing smoking index (duration in years x number of cigarettes smoked per day) heavy smokers showed greater decline in lung function FVC and FEV1 like they showed with increasing age.All the lung function test parameters showa significant decline in asymptomatic Smokers as compared to Nonsmokers. Therefore, by conducting spirometry, especially in smokers, cases may be detected at early stage and subsequent morbidity may be lessened.

Anthropometric determinants of lung function in apparently healthy individuals.

BackgroundForced vital capacity (FVC) and peak expiratory flow rate (PEFR) are used to assess and monitor the management of lung pathology.ObjectivesOur study documented spirometry reference values for apparently healthy Nigerians and developed predictive equations for pulmonary function.MethodA cross-sectional survey involving healthy adult Nigerians included anthropometric measurements of weight, height, waist, hip circumference (HC), sagittal abdominal diameter (SAD) and percentage body fat. Anthropometric indices (body mass index [BMI] and waist-to-hip ratio [WHR]) were estimated and pulmonary function tests (FVC, forced expiratory volume in 1 s [FEV1], PEFR, FEV1/FVC ratio) measured. The association amongst selected anthropometric and socio-demographic variables and pulmonary function test parameters were established using t-tests and Pearson’s product moment correlation tests. The predictors of pulmonary function were established using stepwise multiple linear regression models.ResultsFour hundred and forty-four adults (156 [35.1%] men) were included, mean age 37.3 ± 8.25 (range 22–25) years. Male participants had significantly higher lung volumes than females (p < 0.05). Age, height, weight and percentage body fat had significant low correlations with lung function test parameters (p < 0.05). Fat-free mass (FFM), fat mass (FM), SAD, height and age of participants were main predictors of FVC and FEV1 (R2 = 0.43 and 0.41, respectively). Fat-free mass and SAD were main predictors of PEFR (R2 = 0.53). Sagittal abdominal diameter and age were main predictors of FEV1/FVC ratio (R2 = 0.34).ConclusionFat-free mass, FM, height, age and SAD are important determinants of lung volumes and key variables for predictive equations of pulmonary function.Clinical implicationsAn accurate documentation of pulmonary function values for apparently healthy Nigerian adults may be useful in identifying deviations from normative values thereby giving an index of suspicion for the diagnosis of pulmonary dysfunction.Keywordsanthropometric; lung function; spirometry; fat-free mass; apparently healthy.

Flow Volume Loop and Regional Ventilation Assessment Using Phase-Resolved Functional Lung (PREFUL) MRI: Comparison With 129 Xenon Ventilation MRI and Lung Function Testing.

Regional flow volume loop ventilation-weighted noncontrast-enhanced proton lung MRI in free breathing has emerged as a novel technique for assessment of regional lung ventilation, but has yet not been validated with 129 Xenon MRI (129 Xe-MRI), a direct visualization of ventilation in healthy volunteers, cystic fibrosis (CF), and chronic obstructive pulmonary disease (COPD) patients. To compare regional ventilation and regional flow volume loops measured by noncontrast-enhanced ventilation-weighted phase-resolved functional lung MRI (PREFUL-MRI) with 129 Xe-MRI ventilation imaging and with lung function test parameters. Retrospective study. Twenty patients with COPD, eight patients with CF, and six healthy volunteers. PREFUL and 129 Xe-MRI gradient echo sequences were acquired at 1.5T. Coronal slices of PREFUL-MRI (free breathing) and 129 Xe-MRI (single breath-hold) were acquired on the same day, matched by their ventrodorsal position and coregistered for evaluation. Ventilation defect percentage (VDP) was calculated based on regional ventilation (RV), regional flow volume loops (RFVL), or 129 Xe-MRI with two different threshold methods. A combined VDP was calculated for RV and RFVL. Additionally, lung function testing was performed (such as the forced expiratory volume in 1 second [FEV1 ]) was used. The obtained parameters were compared using Wilcoxon tests, correlated using Spearman's correlation coefficient (r), and agreement between PREFUL and 129 Xe-MRI parameters was assessed using Bland-Altman analysis and Dice coefficients. VDP measured by PREFUL and 129 Xe were significantly correlated with both thresholding techniques (r = 0.62-0.69, P < 0.05 for all) and with lung function test parameters. Combined RV and RFVL PREFUL defect maps correlated with lung function testing (eg, with FEV1 r = -0.87 P < 0.05), and showed better regional agreement to 129 Xe-MRI ventilation defects (Dice coefficient defect 0.413) with significantly higher VDP values (10.2 ± 27.3, P = 0.04) than either PREFUL defect map alone. Combined RV and RFVL PREFUL defect maps likely increase sensitivity to mild airway obstruction with increased VDP values compared to 129 Xe-MRI, and correlate strongly with lung function test parameters. 3 TECHNICAL EFFICACY STAGE: 2.

Prognostic risk factors for respiratory failure after esophagectomy.

BackgroundEsophagectomy is a high-risk surgical procedure with significant postoperative morbidity and mortality. Respiratory failure is one of the most common complications after esophageal cancer surgery. The purpose of this study was to explore risk factors that affect the recovery of respiratory failure in this kind of patients.MethodsTotally 2,360 patients underwent esophagectomies with cervical anastomosis or intrathoracic anastomosis in our center from January 2012 to December 2017. Among them, 130 patients with respiratory failure requiring mechanical ventilation were included in the study. The Spearman’s rank correlation test and Mann-Whitney U test were performed to identify the influential factors for the duration of mechanical ventilation.ResultsMost patients (81.5%) in this study recovered in the first two weeks of mechanical ventilation, the average duration of mechanical ventilation was 10.1 days. Statistical analysis indicated that lung function test parameters such as FEV1/FVC ratio and RV/TLC ratio could have significant influence on the duration of mechanical ventilation. The abnormally increased FEV1/FVC ratio and RV/TLC ratio could obviously prolong the ventilation duration. Old age, thrombocytopenia, the elevated creatinine, C-reactive protein (CRP) and lactate could also significantly lengthen the duration of mechanical ventilation.ConclusionsAbnormally increased FEV1/FVC ratio and RV/TLC ratio as well as old age, thrombocytopenia, elevated creatinine, CRP and blood lactate were found to be risk factors for the recovery of patients with respiratory failure after esophagectomies.

MON-453 Dramatic Clinical Response to Lenvatinib in a Pediatric Patient with Advanced Metastatic Papillary Thyroid Carcinoma

Introduction: Papillary thyroid cancer (PTC) is the most common thyroid tumor in childhood. Most patients are referred with locally advanced and/or distant disease at the time of diagnosis. Whenever possible, these patients should be offered total thyroidectomy and radioiodine remnant ablation; however, this approach is not always feasible, rendering these tumors unresectable. These critical cases could benefit from neoadjuvant treatment with multikinase inhibitors (MKI) so that standard treatment can be performed. Lenvatinib is an MKI recently approved in many countries throughout the world for the treatment of radioiodine refractory adult differentiated thyroid cancer. Only few pediatric cases have been reported. Case report: A 10-year-old female patient with locally advanced PTC and metastasis to the lungs, who required 3 liters of oxygen due to respiratory failure caused by bilateral miliary lung disease, mistakenly treated as tuberculosis two months previously and referred to our Hospital. A large thyroid mass adhered to deep tissues was confirmed on CT scan, showing a large heterogeneous neck mass with multiple microcalcifications associated with multiple lymph nodes. Both lungs had multiple micro-nodular disease with interstitial involvement. Total thyroidectomy together with lymph-node dissection was planned, but extensive local infiltration made the lesion unresectable and surgery was limited to a thyroid biopsy. The patient required respiratory assistance. Histopathology confirmed the presence of a PTC (diffuse sclerosing variant) with a RET-PTC3 oncogene rearrangement. Eight days after surgery the patient was critical and we decided to indicate the compassionate use of Lenvatinib. The patient was started on oral lenvatinib at a dose of 14 mg daily (14 mg/m/day). Three days later, she clinically improved and nine days post-lenvatinib initiation, the patient was discharged from hospital without need for oxygen therapy. Lab studies showed a rise in thyroglobulin levels in the first month of treatment followed by a significant drop. All Lung Function Test parameters significantly improved. The patient initially had severe restrictive breathing and due to the resting dyspnea with hypoxemia she could not perform the walking test. Two months after treatment onset she could walk 360 meters in six minutes with 96% oxygen saturation. After 4 months on Lenvatinib, imaging studies showed a stable thyroid mass while the pulmonary nodules appeared stable to slightly smaller without evidence of new or progressive disease. Conclusion: On lenvatinib treatment, our patient showed significant clinical improvement, arrest of disease progression, and stable disease on imaging studies. This case shows that lenvatinib may be a beneficial option for children with advanced PTC not amenable to surgery/RAI treatment and may be used as a bridge to these first-line therapies.

Effect of motor vehicle pollution on lung function, fractional exhaled nitric oxide and cognitive function among school adolescents.

Motor vehicle emission is a major cause of environmental pollution, which threatens human health. This study aimed to investigate the effect of motor vehicle pollution on lung function, fractional exhaled nitric oxide (FeNO), and cognitive function among students studying in a school located in a traffic-polluted area. In this cross-sectional study, students were recruited based on their apparent healthy status, same age, gender, height, weight, ethnicity, and homogenous educational, socio-economic status, and living backgrounds. Initially, 200 students, 100 from school-1 located in motor vehicle polluted area (exposed group) and 100 from school-2, located away from motor vehicle polluted area (control group) were recruited. After clinical history, 68 students were selected, 34 from school-1 and 34 from school-2. These students were exposed to motor vehicle pollution for 6 h a day, 5 days a week for a total period of 2 years. Lung function test parameters were recorded using a Spirometer, fractional exhaled nitric oxide (FeNO) was measured by Niox Mino, and cognitive function was recorded using the Cambridge Neuropsychological Test Automated Battery (CANTAB). The lung function test parameters, Forced Vital Capacity (FVC) (p=0.03); Forced Expiratory Volume in First Second (FEV1) (p=0.02); and cognitive function parameter motor screening task (MOT) mean latency (p=0.04) were decreased among the students who were studying in school situated in traffic-polluted area compared to those students who were studying in school which was located away from the traffic-polluted area. However, no significant difference was noted in FeNO between the groups. Motor vehicle pollution showed an association with decreased respiratory and cognitive functions among students studying in schools located in traffic-polluted areas. Environmental protection organizations must establish standards to minimize motor vehicle pollutants and develop strategies to control vehicle emission to reduce pollution and disease burden.

Non-CF Bronchiectasis as a Possible Indicator of a Primary Immunodeficiency: Diagnosis, Clinical Course, and Quality of Life in a Pediatric Cohort.

Non cystic fibrosis bronchiectasis (NCBE) is an increasingly recognized chronic, progressive respiratory disorder with significant morbidity also in children and adolescents. We longitudinally assessed a cohort of 35 pediatric patients with NCBE and investigated underlying diagnosis, symptoms, clinical course, treatment, and quality of life. NCBE were diagnosed at a mean age of 9.5 (±5.3) years. In half of the children NCBE were found prior to identification of the causative diagnosis. Primary immunodeficiency (PID) was identified as the underlying diagnosis in 24/35 (68%) cases, of which two-thirds showed antibody deficiency. In the 11 non-PID cases ciliopathies were most common (n=7). Clinical aspects such as manifestation age, cough or dyspnea symptoms, and exacerbation frequency did not differ significantly between PID and non-PID patients. Likewise, quality of life (QoL) was equally reduced in both groups. Lung function test parameters were stable under appropriate therapy in all children. The majority in both groups was insufficiently vaccinated against influenza and pneumococci. Our data indicates that NCBE need to be especially appreciated as a presenting sign of PID in pediatric patients. Thus, occurrence of NCBE should warrant rigorous diagnostics to identify the underlying condition. In our cohort NCBE themselves rather than the causative diagnoses seem to dictate the clinical course of disease and reduce QoL in children. More intensive efforts have to be undertaken to vaccinate patients according to recommendations.

Evaluation of Indian Prediction Models for Lung Function Parameters: A Statistical Approach.

Background:Interpretation of lung function test parameters is usually based on comparisons of data with reference (predicted) values based on healthy subjects. Predicted values are obtained from studies of “normal” or “healthy” subjects with similar anthropometric and ethnic characteristics. Regression models are generally used to obtain the reference values from measurements observed in a representative sample of healthy subjects.Objectives:The study aims to carry out a statistical evaluation of the Indian prediction models of lung function parameters and critically evaluate the reference values for the same in an Indian context.Methods:The screening and inclusion of the articles for the study was done using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Evaluation of the prediction models has been done with respect to modeling approach, regression diagnostics and methodology protocol. The suitability of the models has also been evaluated using a checklist comprising of 8 criteria developed using the American Thoracic Society (ATS) guidelines.Results:Using the PRISMA guidelines 32 articles with a total sample size of 25,289 subjects were included in the final synthesis. Multiple linear regression models were used in 27 articles, with one additionally using weighted least squares technique and 4 using step-wise regression method. Regression diagnostics as per the ATS guidelines were performed and reported by 22 articles. The prediction models were traditionally developed using ordinary least squares method (OLS) without examining the homoskedasticity of residuals. The quality assessment using the checklist developed revealed that only 5 articles satisfied more than 7 out of 8 criteria, and a further 8 articles satisfied less than 3 criteria of suitability of prediction models.Conclusions:Indian prediction models for lung function models are traditionally based on linear regression models, however with more advancement in computational power for sophisticated statistical techniques, more robust prediction models are required in the Indian context.

Effect of wearing cotton towel Ihram and plain Ihram on lung function among Hajj Pilgrims

Objectives:Hajj is the world’s largest gathering to Makkah, Saudi Arabia. Wearing cotton made Ihram is a basic and an essential component of Hajj. The aim of this study was to investigate the lung functions among Hajj pilgrims who were wearing cotton towel ihram (ihram with fibers) compared to those who were wearing plain cotton ihram (ihram without fibers).Methods:Ninety male, non-smoker, Hajj pilgrim volunteers with age ranged 20-60 years were selected. Forty five of them wore cotton towel ihram and 45 wore plain ihram. A day before leaving for Hajj and wearing ihram (6th Dhu-al-Hijjah) lung function base line parameters of Hajj pilgrims were determined. Hajj Pilgrims continuously wear ihram from 7-10th Dhu-al-Hijjah. In the afternoon of 10th Dhu-al-Hijjah, after removal of ihram, all parameters were repeated and at the completion of Hajj when all pilgrims return to their homes at Riyadh, all parameters were recorded again.Results:Before wearing Ihram, anthropometric and lung function baseline parameters were recorded, no significant difference was found between the study population. After wearing Ihram on the 7th Dhu-al-Hijjah and its removal on the 10th Dhu-al-Hijjah significant decline in the lung function test parameters was observed among Hajj pilgrims who were wearing cotton towel ihram. Forced Vital Capacity (FVC) 4.30±1.18 vs. 5.03±1.41 (p=0.01); Forced Expiratory Flow 25% (FEF-25%) 4.39±1.94 vs. 5.69±2.84 (p=0.03); Forced Expiratory Flow-50% (FEF-50%) 2.93±1.65 vs. 4.07±2.08 (p=0.01); Forced Expiratory Flow-75% (FEF-75%) 1.02±0.70 vs. 1.66±0.94 (p=0.002) compared to those who were wearing plain ihram.Conclusions:Lung function test parameters were decreased among the Hajj pilgrims who were wearing cotton towel ihram compared to those who were wearing plain cotton ihram. The pattern of impairment of lung function shows an obstructive peripheral airway lung involvement. It is suggested to conduct further large sample size studies to confirm the present study observations and reach at better conclusions.

Electronic Cigarettes: Impact on Lung Function and Fractional Exhaled Nitric Oxide Among Healthy Adults.

Electronic cigarettes (e-cigarettes) are rapidly becoming an alternative form of nicotine consumption worldwide and a disruptive element in the global health diplomacy. This study aimed to investigate the impact of e-cigarettes on lung function and fractional exhaled nitric oxide (FeNO) among young healthy male adults. Sixty apparently healthy male volunteers were recruited and divided into two groups. Group 1 (e-cigarette-exposed group) consisted of 30 males who were daily e-cigarette users (age 27.07 ± 6.00 [mean ± SD] years). Group 2 (control group) consisted of 30 males who were not e-cigarette users (age 25.90 ± 7.72 [mean ± SD] years). Both groups were neither current nor former traditional tobacco users. Age, ethnicity, height, weight, and socioeconomic status were considered using a matched design to investigate the impact of e-cigarette use on lung function and FeNO. The lung function test parameters that were found to be significantly decreased in e-cigarette users compared to their control group were forced expiratory volume in the first second (FEV1), forced expiratory ratio (FEV1/FVC), forced expiratory flow—25% (FEF25%), forced expiratory flow—50% (FEF50%), forced expiratory flow—75% (FEF75%), forced expiratory flow—25%–75% (FEF25%–75%), and forced expiratory flow—75%–85% (FEF75%–85%). FeNO was also decreased in e-cigarette users, but it did not reach the level of significance. The use of e-cigarettes significantly impaired various lung function parameters and the pattern of impairment exhibited a peripheral obstructive airway involvement. These findings have a general message for the global health community on the potential harm of e-cigarettes on lung function.

Pirfenidone and Nintedanib in idiopathic pulmonary fibrosis: Real-life experience in an Italian referral centre

BackgroundIdiopathic pulmonary fibrosis has a median survival time after diagnosis of 2–5 years. The main goal of treating IPF is to stabilize or reduce the rate of disease progression. Nintedanib and Pirfenidone have been a breakthrough in the management of IPF. Here we evaluated the effectiveness of Pirfenidone and Nintedanib in a population of IPF patients diagnosed in the last 12 months at Florence ILD Referral Centre. MethodsIn the last 12 months, 82 IPF patients (66 male, mean age 78.3±23.8 years) were diagnosed and started antifibrotic therapy with Pirfenidone or Nintedanib. Their clinical and functional details were analyzed retrospectively at time 0 and after 6 and 12 months of therapy. ResultsThe median age of the patients treated with Nintedanib was higher than that of the Pirfenidone group (p<0.0001). The most common symptoms at disease onset were exertional dyspnoea and dry cough with no differences between the two groups (p<0.05). All IPF patients manifested bibasal crackles at the time of diagnosis. No significant differences in FVC, FEV1, TLC and DLCO were found at time 0 or after 6 months between patients treated with Pirfenidone and Nintedanib (p>0.05). After 1 year, lung function test parameters of patients treated with Pirfenidone had remained stable from baseline. DiscussionThis study emphasizes that both antifibrotic drugs appeared to be a good therapeutic choice in terms of functional stabilization, also in older patients.