Pulmonary Function Parameters Research Articles

Handgrip strength during admission for COPD exacerbation: impact on further exacerbation risk

BackgroundLow handgrip strength (HGS) is independently associated with a higher exacerbation risk in stable chronic obstructive pulmonary disease (COPD); however, the relationship between HGS while being admitted for COPD exacerbation and further exacerbation risk after discharge remains unclear.MethodsWe enrolled patients admitted for COPD exacerbation between January 2018 and June 2019. HGS tests were done within 3 days after admission. The primary endpoint was exacerbations within 12 months after the index admission, which needed emergency room visits or hospital admission. We analyzed the relationships among demographics, HGS, pulmonary function parameters, and acute exacerbation events.ResultsAmong 43 enrolled patients, 31 (72.1%) participants (HGSw) had HGS weakness (22.1 ± 4.1 kg). The other 12 (27.9%) participants (non-HGSw) had the strength of handgrips 33.7 ± 3.1 kg. HGSw group showed a significantly higher rate of emergency room visits within 6, 9, and 12 months after the index admission than non-HGSw group (0.81 ± 1.30 vs. 0.08 ± 0.29, p = 0.045; 1.26 ± 1.59 vs. 0.17 ± 0.38, P = 0.019; 1.48 ± 1.86 vs. 0.25 ± 0.62, P = 0.027, respectively). There was a trend to have higher admission rate within 9 and 12 months in HGSw group, which did not achieve statistical significance (0.77 ± 1.38 vs. 0.08 ± 0.29, P = 0.064; 0.94 ± 1.56 vs. 0.08 ± 0.29, P = 0.062, respectively).ConclusionsHGS weakness measured upon admission for COPD exacerbation was associated with a higher risk of exacerbation in the next year.Trial registration ClinicalTrials.gov Identifier: NCT04885933.

Comparative efficacy of inspiratory, expiratory and combined respiratory muscle training on the pulmonary functions and chest expansion in acute stroke survivors

Background: Respiratory muscle strength can be reduced in patients diagnosed with stroke, which reasonably justifies the use of respiratory muscle training in this population. This study determines the comparative efficacy of inspiratory, expiratory, and combined respiratory muscle training on the pulmonary functions and chest expansion in acute stroke survivors. Method: Forty-five acute stroke survivors (15 in each group) completed all protocols of the study. Participants were randomly assigned to any one of three groups. In addition to the conventional exercise therapy, participants received any one of the three respiratory muscle training protocols (inspiratory muscle training, expiratory muscle training or combined respiratory muscle training). Chest expansion was assessed using tape measure and pulmonary function parameters were assessed using a spirometer. Results: Paired t-test analysis showed significant improvements in the chest expansion and the pulmonary function parameters following training in each group. One-way ANOVA showed significant improvements in the pulmonary function parameters across the three groups but not in the chest expansion with p - value = 0.405. Least significant difference (LSD), post-hoc analysis shows that the significant difference for FEV1, FVC and FEV1/FVC lies between inspiratory muscle training group and expiratory muscle training group. Conclusion: When the three training methods were compared, it was found that expiratory muscle training was the most beneficial in improving the pulmonary functions and chest expansion in acute stroke survivors.

Risk assessment in interstitial lung disease: the incremental prognostic value of cardiopulmonary ultrasound

BackgroundThe mortality risk of chronic interstitial lung disease (ILD) is currently assessed using the ILD-GAP score. The present study evaluates whether the addition of cardiopulmonary ultrasound parameters to the ILD-GAP score can further improve the predictive value of ILD-GAP.MethodsMedical records from 91 patients with ILD hospitalized from June 2015 to March 2016 were retrospectively examined. The Lung ultrasound (LUS) score, right ventricular (RV) function, and mechanics were obtained from the cardiopulmonary ultrasound. The ILD-GAP score was calculated from demographic characteristics and pulmonary function parameters. Patients were followed up with until May 2020. The primary endpoint was all-cause death.ResultsAfter exclusions, 74 patients with ILD were included in the analysis. During the follow-up period, 36 patients with ILD survived (ILDs), and 38 patients died (ILDd). Compared to ILDs, the ILDd cases exhibited a higher number of B-lines, LUS score, and RV end-diastolic base dimension (RVD), but lower RV function. In multivariate analysis, the ILD-GAP score (hazard ratio, 2.88; 95% CI 1.38–5.99, P = 0.005), LUS score (hazard ratio 1.13; 95% CI 1.04–1.24, P = 0.006), and RVD (hazard ratio 1.09, 95% CI 1.03–1.16, P = 0.004) were significantly related to the risk of death. Adding the LUS score and RVD to the ILD-GAP score significantly improved the predictive value compared to the ILD-GAP score alone (C statistics 0.90 vs 0.76, P = 0.018).ConclusionWe investigated the utility of a new prognostic model for ILD that includes both cardiopulmonary ultrasound parameters (LUS score and RVD) and the ILD-GAP score. This model better reflects the severity of pulmonary fibrosis and cardiac involvement, and has incremental predictive value over the ILD-GAP score alone.

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 & subsequent morbidity may be lessened.

Assessment of Metal Concentrations and Associations with Pulmonary Function among Children with Asthma in Chicago, Illinois.

Individuals living in areas with the potential for elevated metal exposure from industrial sources may have reduced pulmonary function. We evaluated cross-sectional associations of toenail concentrations of 17 metals within a community area of residence and asthma control in 75 children, and pulmonary function measures [forced expiratory volume in one second (FEV1; liters), forced vital capacity (FVC; liters), FEV1 to FVC ratio (FEV1:FVC), and mid-exhalation forced expiratory flow rate (FEF 25–75%; liters/second)], in a subsample of 39 children with diagnosed asthma in Chicago, Illinois. Linear regression models were used to estimate adjusted regression coefficients and standard errors (SE) for the associations between ≥ median versus <median metal exposures and natural log-transformed (ln) pulmonary function test parameters. Toenail levels of cadmium, cobalt, iron, manganese, and vanadium were higher among children residing near an industrial corridor than those in a comparison community. Copper concentrations were inversely associated with lnFEV1 (β = −0.10, SE = 0.04, p = 0.01), lnFEV1:FVC (β = −0.07, SE = 0.03, p = 0.02) and lnFEF 25–75% (β = −0.25, SE = 0.09, p = 0.01); manganese concentrations were inversely associated with lnFEV1 (β = −0.11, SE = 0.04, p = 0.01), lnFEV1:FVC (β = −0.07, SE = 0.03, p = 0.02), and lnFEF 25–75% (β = −0.28, SE = 0.10, p = 0.004), and vanadium concentrations were inversely associated with lnFEV1 (β = −0.08, SE = 0.04, p = 0.05) and lnFVC (β = −0.07, SE = 0.03, p = 0.03). Nickel and copper were associated with uncontrolled asthma (OR = 6.8; 95% CI 2.0, 22.8 and OR = 4.6; 95% CI 1.0, 21.0, respectively). These data suggest that selected metal exposures may be associated with impaired pulmonary function parameters and reduced asthma control among children with preexisting asthma.

CB1 R and iNOS are distinct players promoting pulmonary fibrosis in Hermansky-Pudlak syndrome.

Hermansky–Pudlak syndrome (HPS) is a rare genetic disorder which, in its most common and severe form, HPS‐1, leads to fatal adult‐onset pulmonary fibrosis (PF) with no effective treatment. We evaluated the role of the endocannabinoid/CB1R system and inducible nitric oxide synthase (iNOS) for dual‐target therapeutic strategy using human bronchoalveolar lavage fluid (BALF), lung samples from patients with HPS and controls, HPS‐PF patient‐derived lung fibroblasts, and bleomycin‐induced PF in pale ear mice (HPS1ep/ep). We found overexpression of CB1R and iNOS in fibrotic lungs of HPSPF patients and bleomycin‐infused pale ear mice. The endocannabinoid anandamide was elevated in BALF and negatively correlated with pulmonary function parameters in HPSPF patients and pale ear mice with bleomycin‐induced PF. Simultaneous targeting of CB1R and iNOS by MRI‐1867 yielded greater antifibrotic efficacy than inhibiting either target alone by attenuating critical pathologic pathways. Moreover, MRI‐1867 treatment abrogated bleomycin‐induced increases in lung levels of the profibrotic interleukin‐11 via iNOS inhibition and reversed mitochondrial dysfunction via CB1R inhibition. Dual inhibition of CB1R and iNOS is an effective antifibrotic strategy for HPSPF.

Urinary metabolites as exposure biomarkers of benzene, toluene, ethylbenzene, and xylene in footwear workers and assessment of pulmonary function

Aim: This pilot cross-sectional study focused on biological monitoring of the benzene, toluene, ethylbenzene, and xylene (BTEX) urinary metabolites trans, trans-muconic acid (tt-MA), s-phenyl mercapturic acid (SPMA), hippuric acid (HA), mandelic acid (MA), and methylhippuric acid (MHA) and measured the effects of workplace BTEX exposure on pulmonary function of workers engaged in footwear manufacturing. Materials and Methods: Urinary metabolites tt-MA, SPMA, HA, MA, and MHA concentration in urine samples of study participants (N = 35) were analyzed by reverse-phase high-pressure liquid chromatography. Pulmonary function parameters were measured by spirometer and peak flow meter. Demographic information and work exposure information of study participants were collected by questionnaire interview. Results: In exposed workers, concentration of urinary SPMA, tt-MA, and HA was significantly higher (P < 0.01, in all) than the control group. Reduction in both force expiratory volume in 1 s (Forced expiratory volume in one second) and peak expiratory flow rate (PEFR) were inversely associated (P < 0.01) with growing years of age among all workers. Inverse association was measured between urinary tt-MA and decline in forced vital capacity and PEFR (P < 0.05, for each) in workers. Based on the questionnaire interview, workers were not found to be aware of workplace exposure hazards. Conclusions: Exposure biomarkers of benzene (tt-MA and SPMA) and toluene (HA) were significantly higher in workers than the control group. Study results evident the presence of occupational exposure to benzene and toluene in footwear workers. Deterioration in FEV1 and PEFR were also measured among all workers with growing years of age. The sample size was small in the present study, so further research required to confirm our results.

Respiratory Health Implications among Wet-Blue Leather Tannery Workers of Kasur

Work-related respiratory diseases have imperative role in the globular burden of occupational lung diseases throughout the world. These respiratory disorders can be caused by environmental hazards in the workplace and account for 10-20% of all chronic lung diseases. It is surprising that in Pakistan, scarce data is available on the pulmonary health of tannery workers. Therefore, this study aimed to determine the respiratory-specific health status of wet-blue leather tannery workers in Kasur city, Pakistan. A sample of 227 tannery workers engaged in four different tanneries was selected as a sample of convenience. A control group of 112 participants independent from exposure was also selected from the local community. Respiratory health was determined through an adopted symptom-based questionnaire and pulmonary function tests (PFTs). These tests were carried out by using a portable spirometer, during September-December 2019. A multiple Linear regression analysis was performed to analyze the amount of variance in PFTs by demographics and respiratory symptoms. Among tannery workers, the complaints of respiratory symptoms were 27.8% as compared to 21.4% of the control group. While based on the PFTs, total cases of impaired- pulmonary function among tannery workers were 34.3% as compared to 19.7% of the control. A statistically significant relationship was found between age, job duration, education, respiratory symptoms, and pulmonary function parameters. This study will contribute to generate baseline data of respiratory health status of the tannery workers. Further studies are recommended to find an association between occupational factors and workplace-related respiratory problems to reduce the burden of occupational diseases. Keywords: Occupational diseases, Lung diseases, Respiratory function tests, Spirometry, Workplace

Modeling the risk of radiation pneumonitis in esophageal squamous cell carcinoma treated with definitive chemoradiotherapy.

To develop and validate a nomogram for the prediction of symptomatic radiation pneumonitis (RP) in patients with esophageal squamous cell carcinoma (ESCC) who received definitive concurrent chemoradiotherapy. Clinical factors, dose-volume histogram parameters, and pulmonary function parameters were collected from 402 ESCC patients between 2010 and 2017, including 321 patients in the primary cohort and 81 in the validation cohort. The end-point was the occurrence of symptomatic RP (grade ≥ 2) within the first 12months after radiotherapy. Univariate and multivariate logistic regression analyses were applied to evaluate the predictive value of each factor for RP. A prediction model was generated in the primary cohort, which was internally validated to assess its performance. In the primary cohort, 31 patients (9.7%) experienced symptomatic RP. Based on logistic regression model, patients with larger planning target volumes (PTVs) or higher lung V20 had a higher predictive risk of RP, whereas the overall risk was substantially higher for three-dimensional conformal radiotherapy (3DCRT) than intensity-modulated radiotherapy. On multivariate analysis, independent predictive factors for RP were smoking history (P = 0.035), radiotherapy modality (P < 0.001), PTV (P = 0.039), and lung V20 (P < 0.001), which were incorporated into the nomogram. The areas under the receiver operating characteristic curve of the nomogram in the primary and validation cohorts were 0.772 and 0.900, respectively, which were superior to each predictor alone. Non-smoking status, 3DCRT, lung V20 (> 27.5%), and PTV (≥ 713.0cc) were significantly associated with a higher risk of RP. A nomogram was built with satisfactory prediction ability.

The Identification and Impact of Abnormal Spirometry Patterns on Exercise Capacity in Pediatric Patients with Fontan Palliation.

Reduced exercise capacity and restrictive lung physiology are common in patients after Fontan palliation (FP). However, there is paucity of data regarding the association between specific spirometry patterns and key exercise parameters in this population. This is a single-center, cross-sectional, study correlating pulmonary function and exercise parameters in children with FP. Patients who were ≤ 18years of age and underwent a comprehensive cardiopulmonary treadmill exercise stress test (CPT) and spirometry at the same time, were included. Patients were categorized as (i) normal or (ii) abnormal based on the results of spirometry. The abnormal group was subdivided into (a) restrictive, (b) obstructive, and (c) mixed patterns. Demographic and key exercise parameters were compared between groups. Our study included 82 patients who underwent CPT at 13.6 (IQR, 11.3-15.4) years of age. A reduced exercise capacity (%VO2 ≤ 85%) was noted in the majority (n = 50, 61%). Spirometry was abnormal in 47 (57%) patients [restrictive (n = 25, 30%), obstructive (n = 12, 15%), and mixed (n = 10, 12%)]. The abnormal spirometry group had significant lower %VO2 (77% vs. 92%, p = 0.01) and METS (8.4 vs. 9.6, p = 0.02). Subgroup analysis revealed that obstructive (p = 0.04) and mixed (p = 0.02) patterns were associated with a significant decrease in % VO2. Majority of the children demonstrated an abnormal spirometry pattern post-FP. Abnormal pulmonary function was associated with the reduced exercise capacity. Identification and treatment of the abnormal lung function may improve the exercise capacity in these patients and improve the morbidity.

Aberrant Methylation of Aging-Related Genes in Asthma.

Background: Asthma is a complex pulmonary inflammatory disease which is common among older adults. Aging-related alterations have also been found in structural cells and immune cells of asthma patients. Nonetheless, the underlying mechanism by which differenced aging-related gene contributes to asthma pathology remains unclear. Of note, DNA methylation (DNAm) has been proven to play a critical mechanism for age-related gene expression changes. However, the methylation changes of aging-related genes in asthma patients are still obscure. Methods: First, changes in DNAm and gene expression were detected with multiple targeted bisulfite enrichment sequencing (MethTarget) and qPCR in peripheral blood of 51 healthy controls (HCs) and 55 asthmatic patients. Second, the correlation between the DNAm levels of specific altered CpG sites and the pulmonary function indicators of asthma patients was evaluated. Last, the receiver operator characteristic (ROC) curve and principal component analysis (PCA) were used to identify the feasibility of the candidate CpG sites as biomarkers for asthma. Results: Compared with HCs, there was a differential mRNA expression for nine aging-related genes in peripheral blood of asthma patients. Besides, the methylation levels of the nine aging-related genes were also altered in asthma patients, and a total of 68 CpG sites were associated with the severity of asthma. Notably, 9 of the 68 CpG sites were significantly associated with pulmonary function parameters. Moreover, ROC curve and PCA analysis showed that the candidate differential methylation sites (DMSs) can be used as potential biomarkers for asthma. Conclusions: In summary, this study confirmed the differentially expressed mRNA and aberrant DNAm level of aging-related genes in asthma patients. DMSs are associated with the clinical evaluation indicators of asthma, which indicate the involvement of aging-related genes in the pathogenesis of asthma and provide some new possible biomarkers for asthma.

Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study

BackgroundExoskeleton-assisted walking (EAW) is expected to improve the gait of spinal cord injury (SCI) individuals. However, few studies reported the changes of pulmonary function (PF) parameters after EAW trainings. Hence, we aimed to explore the effect of EAW on PF parameters, 6-min walk test (6MWT) and lower extremity motor score (LEMS) in individuals with SCI and to compare those with conventional trainings.MethodsIn this prospective, single-center, single-blinded randomized controlled pilot study, 18 SCI participants were randomized into the EAW group (n = 9) and conventional group (n = 9) and received 16 sessions of 50–60 min training (4 days/week, 4 weeks). Pulmonary function parameters consisting of the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow (FEF), peak expiratory flow, and maximal voluntary ventilation, 6MWT with assisted devices and LEMS were reported pre- and post-training.ResultsValues of FVC (p = 0.041), predicted FVC% (p = 0.012) and FEV1 (p = 0.013) were significantly greater in EAW group (FVC: 3.8 ± 1.1 L; FVC% pred = 94.1 ± 24.5%; FEV1: 3.5 ± 1.0 L) compared with conventional group (FVC: 2.8 ± 0.8 L; FVC% pred = 65.4 ± 17.6%; FEV1: 2.4 ± 0.6 L) after training. Participants in EAW group completed 6MWT with median 17.3 m while wearing the exoskeleton. There was no difference in LEMS and no adverse event.ConclusionsThe current results suggest that EAW has potential benefits to facilitate PF parameters among individuals with lower thoracic neurological level of SCI compared with conventional trainings. Additionally, robotic exoskeleton helped walking. Trial registration: Registered on 22 May 2020 at Chinese Clinical Trial Registry (ChiCTR2000033166). http://www.chictr.org.cn/edit.aspx?pid=53920&htm=4.

A portable triboelectric spirometer for wireless pulmonary function monitoring

Coronavirus disease 2019 (COVID-19) as a severe acute respiratory syndrome infection has spread rapidly across the world since its emergence in 2019 and drastically altered our way of life. Patients who have recovered from COVID-19 may still face persisting respiratory damage from the virus, necessitating long-term supervision after discharge to closely assess pulmonary function during rehabilitation. Therefore, developing portable spirometers for pulmonary function tests is of great significance for convenient home-based monitoring during recovery. Here, we propose a wireless, portable pulmonary function monitor for rehabilitation care after COVID-19. It is composed of a breath-to-electrical (BTE) sensor, a signal processing circuit, and a Bluetooth communication unit. The BTE sensor, with a compact size and light weight of 2.5 cm3 and 1.8 g respectively, is capable of converting respiratory biomechanical motions into considerable electrical signals. The output signal stability is greater than 93% under 35%–81% humidity, which allows for ideal expiration airflow sensing. Through a wireless communication circuit system, the signals can be received by a mobile terminal and processed into important physiological parameters, such as forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). The FEV1/FVC ratio is then calculated to further evaluate pulmonary function of testers. Through these measurement methods, the acquired pulmonary function parameters are shown to exhibit high accuracy (>97%) in comparison to a commercial spirometer. The practical design of the self-powered flow spirometer presents a low-cost and convenient method for pulmonary function monitoring during rehabilitation from COVID-19.

Sagittal Balance, Pulmonary Function, and Spinopelvic Parameters in Severe Post-Tubercular Thoracic Kyphosis.

Study DesignCross-sectional study.PurposeTo evaluate sagittal balance, pulmonary function, and spinopelvic parameters in patients with healed spinal tuberculosis with severe thoracic kyphosis.Overview of LiteratureDeterioration of neurological function is an absolute indication of surgical intervention in severe post-tubercular kyphosis, but the relationship of compromise in lung function and spinal alignment with severity of kyphosis is still unclear.MethodsTwenty patients (age, 14–60 years) with healed spinal tuberculosis with thoracic kyphosis >50° were included. Lateral-view radiography of the whole spine, including both hips, was performed for assessment of kyphotic angle (K angle), sagittal balance, lumbar lordosis, and spinopelvic parameters. Pulmonary function was assessed by measuring the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and their ratio (FEV1/FVC) by spirometry.ResultsA positive correlation between severity of kyphosis and sagittal imbalance was noted, with compensatory mechanisms maintaining the sagittal balance in only up to 80° of dorsal kyphosis. In >80° of kyphosis, FVC was found to be markedly decreased (mean FVC=50.6%). The mean K angle was lower in subjects with lower thoracic kyphosis. In lower thoracic kyphosis, due to short lordotic and long kyphotic curves, both lumbar lordosis and pelvic retroversion worked at compensation, whereas, in middle thoracic kyphosis, due to long lordotic curve, only lumbar lordosis was required. Normal pulmonary function (mean FVC, 83.0%) and lesser kyphotic deformity (mean K angle in adolescents, 69.8°; in adults, 94.4°) were found in adolescents.ConclusionsIn >80° of thoracic kyphosis, there is sagittal imbalance and a markedly affected pulmonary function. Such patients should be offered corrective surgery if they are symptomatic and medically fit to undergo the procedure. However, whether the surgical procedure would result in improved pulmonary function and sagittal balance needs to be evaluated by a follow-up study.

Effect of Nasal Dominance on Pulmonary Function Test and Heart Rate: A Pilot Study.

Background: The nasal cycle is one of the many cyclic events in a human being. Nasal airflow is greater in one nostril at any given point in time and this alternates between right and left nostrils over time. Its periodicity ranges from 25 min to 8 h. This alteration has been known to be controlled by the autonomic nervous system. The current study was designed to assess the effect of nasal dominance during rest on pulmonary function parameters and heart rate.Materials and Methods: A cross-sectional study was done on 35 apparently healthy individuals of the age group of 18–30 years. Based on a cold mirror test, the participants were categorized into two groups of right nasal dominance (RND) and left nasal dominance (LND). The parameters recorded were forced expiratory volume in the first sec (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow rate, forced expiratory flow between 25%-75%, SpO2, and pulse rate. Data were expressed as mean ± standard deviation and were analyzed using SPSS version 20.Results: All pulmonary function parameters exhibited higher values in RND participants compared to LND participants and the difference was found to be statistically significant (P < 0.05).Conclusion: Nasal dominance has a measurable effect on pulmonary functions and heart rate hence emphasizing the role of autonomic control of airways. This influence can be used as adjuvant therapy for certain disorders.

Maximal Voluntary Breath-Holding Tele-Inspiratory Test in Patients with Chronic Obstructive Pulmonary Disease.

Maximal voluntary inspiratory breath-holding time (MVIBHT) has proved to be of clinical utility in some obstructive ventilatory defects. This study aims to correlate the breath-holding time with pulmonary function tests in patients with chronic obstructive pulmonary disease (COPD) and to determine the feasibility of using a breath-holding test in assessing the severity of COPD.A cross-sectional study including male patients with stable COPD were conducted. Patients with respiratory comorbidities and severe or unstable cardiac diseases were excluded. Patients were interviewed and examined. Six-minute walk test (6MWT) and plethysmography were performed.For MVIBHT collection, the subject was asked to inspire deeply and to hold the breath as long as possible at the maximum inspiratory level. This maneuver was repeated three times. The best value was used for further analysis.A total of 79 patients (mean age: 64.2 ± 8) were included in this study. The mean value of MVIBHT was 24.2 ± 8.5 s. We identified a positive and significant correlations between MVIBHT and forced vital capacity (r = .630; p < .001) as well as MVIBHT and forced expiratory volume in 1 s (FEV1%) (r = .671; p < .001). A significant inverse correlation with total lung capacity (r = −.328; p = .019) and residual volume to total lung capacity ratio (r = −.607; p < .001) was noted. MVIBHT was significantly correlated to the distance in the 6MWT (r = .494; p < .001). The mean MVIBHT was significantly different within spirometric grades (p < .001) and GOLD groups (p = .002). At 20.5 s, MVIBHT had a sensitivity of 72% and specificity of 96% in determining COPD patients with FEV1 <50%.Our results provide additional evidence of the usefulness of MVIBHT in COPD patients as a pulmonary function parameter.

DIURNAL VARIATION IN SPIROMETRIC PARAMETERS WITH BODY MASS INDEX AND MEAN ARTERIAL PRESSURE AMONG APPARENTLY HEALTHY ADULTS

Introduction: The purpose of the study was to identify diurnal variations in forced expiratory volume in 1 second (FEV1), Mean Arterial Pressure (MAP) and Body Mass Index (BMI) and a possible association between them. Materials and methods: 40 healthy adults fullling the eligibility criteria were recruited. Spirometric analysis of FEV1 was performed. Results: FEV1 showed statistically signicant differences according to time of day. FEV1 values in the morning was 2.83 + .62 and in the evening, raised to 2.95 + .522 in study population. The highest value was noted in the evening as compared to morning. MAPmean values in the morning was 87.37 + 5.204. MAPmean values in the evening was 88.40 + 7.519, which again showed an increase in the evening. Conclusion: The present study indicated a denite diurnal variation in the pulmonary function and cardiovascular parameter.

Longitudinal Examination of the Shape of the Maximum Expiratory Flow‐Volume Curve in Young Adults Following SARS‐CoV‐2 Infection

Examination of the shape of the maximum expiratory flow‐volume curve represents a method to noninvasively describe lung and airway function in health and disease. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection can result in pulmonary dysfunction and may result in changes to the shape of the maximum expiratory flow‐volume curve during the recovery period following SARS‐CoV‐2 infection.PurposeThe purpose of this study was to quantitatively examine the shape and the area of the maximum expiratory flow volume curve in otherwise healthy, young adults during the three months following SARS‐CoV‐2 infection.MethodsOtherwise healthy, young adults (4M/3F, age: 21 ± 1 y, height: 174.9 ± 11.2 cm, body mass index: 23.6 ± 1.6 kgᐧm‐2) who tested positive for SARS‐CoV‐2 completed spirometry testing on three occasions. The first visit (BL) took place three‐to‐four weeks after positive test confirmation. Approximately four weeks separated each subsequent visit (1M and 2M, respectively). Following each spirometry test, the flow‐volume loop with the greatest sum of forced vital capacity (FVC) and forced expiratory volume in one second was chosen for analysis. The angle beta (β°) and flow ratio were calculated using standard pulmonary function parameters. Slope ratios at increments of 5% of FVC were determined from 80% to 20% FVC. Additionally, the area under the maximum expiratory flow‐volume curve was calculated. Data were compared using repeated measures analysis of variance. Statistical significance was set at p = 0.05.ResultsFVC remained similar over the study period (p > 0.05). The β° was significantly reduced at 2M compared with BL (BL: 188.8 ± 15.7°, 1M: 180.9 ± 6.9°; 2M: 176.8 ± 5.0°, p = 0.012). Flow ratios were similar between visits (BL: 20.3 ± 11.7%, 1M: 13.0 ± 6.4%, 2M: 18.1 ± 5.9%; p = 0.53). Additionally, the slope ratios at each lung volume were similar between visits. However, while not statistically different, the slope ratio at 80% FVC approached significance (BL: 1.22 ± 0.98, 1M: 2.37 ± 1.00, 2M: 2.13 ± 0.86; p = 0.07). The total area under the maximum flow‐volume curve was not different between visits (BL: 21.0 ± 5.1 L2∙s‐1, 1M: 21.5 ± 4.5 L2∙s‐1; 2M: 21.9 ± 4.7 L2∙s‐1; p = 0.49). The percentages of the total area under the curve that were contained between peak expiratory flow (PEF) and 75% FVC and between 50% FVC and 25% FVC were altered at 1M and 2M compared with BL (p < 0.05). PEF tended to be greater during 2M compared with BL (BL: 8.49 ± 1.34 L2∙s‐1, 1M: 9.34 ± 1.92 L2∙s‐1, 2M: 9.44 ± 1.53 L2∙s‐1; p = 0.056) and the changes in PEF from BL to 2M were significantly correlated with the changes in β° and area under the curve subdivisions over the same time period (p < 0.05).ConclusionThese data demonstrate that the shape of the maximum expiratory flow‐volume curve changes marginally during the initial three months following SARS‐CoV‐2 infection. Yet, the changes appear to be largely driven by increases in peak expiratory flow and suggests that SARS‐CoV‐2 infection is acutely involved in large airway dysfunction.

Association of obesity-related inflammatory pathways with lung function and exercise capacity

BackgroundObesity has multifactorial effects on lung function and exercise capacity. The contributions of obesity-related inflammatory pathways to alterations in lung function remain unclear.Research Question:To examine the association of obesity-related inflammatory pathways with pulmonary function, exercise capacity, and pulmonary-specific contributors to exercise intolerance. MethodWe examined 695 patients who underwent cardiopulmonary exercise testing (CPET) with invasive hemodynamic monitoring at Massachusetts General Hospital between December 2006–June 2017. We investigated the association of adiponectin, leptin, resistin, IL-6, CRP, and insulin resistance (HOMA-IR) with pulmonary function and exercise parameters using multivariable linear regression. ResultsObesity-related inflammatory pathways were associated with worse lung function. Specifically, higher CRP, IL-6, and HOMA-IR were associated with lower percent predicted FEV1 and FVC with a preserved FEV1/FVC ratio suggesting a restrictive physiology pattern (P ≤ 0.001 for all). For example, a 1-SD higher natural-logged CRP level was associated with a nearly 5% lower percent predicted FEV1 and FVC (beta −4.8, s.e. 0.9 for FEV1; beta −4.9, s.e. 0.8 for FVC; P < 0.0001 for both). Obesity-related inflammatory pathways were associated with worse pulmonary vascular distensibility (adiponectin, IL-6, and CRP, P < 0.05 for all), as well as lower pulmonary artery compliance (IL-6 and CRP, P ≤ 0.01 for both). InterpretationOur findings highlight the importance of obesity-related inflammatory pathways including inflammation and insulin resistance on pulmonary spirometry and pulmonary vascular function. Specifically, systemic inflammation as ascertained by CRP, IL-6 and insulin resistance are associated with restrictive pulmonary physiology independent of BMI. In addition, inflammatory markers were associated with lower exercise capacity and pulmonary vascular dysfunction.

발성을 통한 호흡훈련이 목 척수손상 환자의 노력성 폐활량과 최대 호기속도의 차이 비교

This study aims to investigate the effects of a vocalization-based respiratory training intervention on forced vital capacity (FVC) and peak expiratory flow rate (PEFR) in patients with a cervical spinal cord injury in a recovery phase, ultimately to present clinical evidence for an efficient respiratory physical therapy. Fifteen participants with a cervical spinal cord injury were randomized to the vocalization-based respiratory training group (n=8) and incentive spirometry training group (n=7). The participants underwent 30 minutes of conservative physical therapy and additionally underwent 15 minutes of their corresponding intervention (respiratory training and incentive spirometry) five times a week for four weeks. Prior to the intervention, pulmonary function tests were performed to analyze FVC and PEFR, both of which were measured again after four weeks of intervention. The values were compared within and between groups. Both groups showed significantly increased FVC and PEFR after the intervention, and the FVC and PEFR in a seated posture significantly differed between the vocalization-based respiratory training group and the incentive spirometry group (p<.01). In the supine position, FVC did not significantly differ between the two groups (p>.05). The results of this study show that vocalization-based respiratory training is more effective in improving FVC in a seated posture and PEFR in the supine position. Vocalization-based respiratory training would improve pulmonary function parameters in patients with cervical spinal cord injury, and additional studies are needed based on these results to examine a variety of variables according to the type of respiratory training technique.