Post Bronchodilator Research Articles

The effect of nebulized N-acetylcysteine on the phlegm of chronic obstructive pulmonary disease: the NEWEST study

BackgroundPhlegm is prevalent symptom in patients with chronic obstructive pulmonary disease (COPD). Few studies have investigated the effectiveness of N-acetylcysteine (NAC) nebulizer therapy in COPD patients. We evaluated the effect of nebulized NAC on the improvement of phlegm symptom in COPD patients.MethodsThis was a 12-week, prospective, single-arm, open-label, phase IV multi-center trial (NCT05102305, Registration Date: 20-October-2021). We enrolled patients aged ≥ 40 years with post bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) < 0.7 and COPD assessment test (CAT) phlegm score ≥ 2; the patients were current or ex-smoker with smoking pack-years ≥ 10. The primary endpoint was to determine the change in CAT phlegm score at 12 weeks compared to the baseline. Patients were assessed at baseline, 4, 8, and 12 weeks of treatment using the CAT score.ResultsIn total, 100 COPD patients were enrolled from 10 hospitals. The mean age of the patients was 71.42 ± 8.20 years, with 19.78% being current-smokers and 80.22% being ex-smokers. The mean smoking pack-years was 40.32 ± 35.18. The mean FVC, FEV1, and FEV1/FVC were 3.94 L (75.44%), 2.22 L (58.50%), and 0.53, respectively. The CAT phlegm score at baseline was 3.47 ± 1.06, whereas after 12 weeks of nebulized NAC it significantly decreased to 2.62 ± 1.30 (p < 0.01). More than half (53.5%) of the patients expressed satisfaction with the effects of nebulized NAC therapy. Adverse events occurred in 8 (8.0%) patients. Notably, no serious adverse drug reactions were reported.ConclusionIn this study, we have established the effectiveness and safety of nebulized NAC over 12 weeks.

Prevalence and etiotypes of persistent airflow obstruction in the general population across the lifetime

Background and objectivesDifferent factors (etiotypes) can lead to persistent airflow obstruction (PAO) across the lifetime, including genetic factors, abnormal lung development, cigarette smoking, traffic pollution exposure, respiratory infections and asthma. Here we explore the prevalence of PAO and associated etiotypes in the general population in different age bins. MethodsWe studied 664 individuals with PAO (FEV1/FVC post bronchodilation (post-BD) below the lower limit of normal (LLN)) and 11,522 with normal lung function (FEV1/FVC, FEV1 and FVC ≥ LLN and ≤ upper limit of normal (ULN) post-BD) included in the LEAD Study (NCT01727518), a general population cohort in Vienna (Austria). For analysis, participants were stratified in three age bins (<25, 25-<50 and ≥ 50 years of age). ResultsPAO occurred in 3.8 % in females and 5.6 % in males of the cohort, and it increased with age. Most participants with PAO (57.5 %) reported respiratory symptoms, indicating a high burden of disease. PAO was associated with male sex (25-<50 years), ever smoking (>50 years), increased number of pack years (25-<50 years, >50 years), not being breastfed (<25 years) and ever diagnosis of asthma (in all age bins). Etiotypes varied by age bins with cigarette smoking being the most prevalent one, often in combination with traffic pollution exposure. ConclusionIn the general population PAO occurs in about 5 % of participants with a higher prevalence in older individuals. Etiotypes and associated factors for PAO accumulate with age.

The challenges of recruiting never-smokers with chronic obstructive pulmonary disease from the large population-based Swedish CArdiopulmonary bioImage study (SCAPIS) cohort

ABSTRACT Background A substantial proportion of individuals with COPD have never smoked, and it is implied to be more common than previously anticipated but poorly studied. Aim To describe the process of recruitment of never-smokers with COPD from a population-based cohort (n = 30 154). Methods We recruited never-smokers with COPD, aged 50–75 years, from six University Hospitals, based on: 1) post broncho-dilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) < 0.70 and 2) FEV1 50–100% of predicted value and 3) being never-smokers (self-reported). In total 862 SCAPIS participants were identified, of which 652 were reachable and agreed to a first screening by telephone. Altogether 128 (20%) were excluded due to previous smoking or declined participation. We also applied a lower limit of normal (LLN) of FEV1/FVC (z-score<-1.64) according to the Global Lung Initiative to ensure a stricter definition of airflow obstruction. Results Data on respiratory symptoms, health status, and medical history were collected from 492 individuals, since 32 were excluded at a second data review (declined or previous smoking), prior to the first visit. Due to not matching the required lung function criteria at a second spirometry, an additional 334 (68%) were excluded. These exclusions were by reason of: FEV1/FVC ≥0.7 (49%), FEV1 > 100% of predicted (26%) or z-score ≥ −1,64 (24%). Finally, 154 never-smokers with COPD were included: 56 (36%) women, (mean) age 60 years, FEV1 84% of predicted, FEV1/FVC: 0.6, z-score: −2.2, Oxygen saturation: 97% and BMI: 26.8 kg/m2. Conclusions The challenges of a recruitment process of never-smokers with COPD were shown, including the importance of correct spirometry testing and strict inclusion criteria. Our findings highlight the importance of repeated spirometry assessments for improved accuracy in diagnosing COPD.

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable lung disease. It is characterized by chronic respiratory symptoms and airflow limitation due to abnormalities of the airways caused by continuous exposure to noxious particles or gases. COPD occupies the third position for the cause of death worldwide. The major risk factor for the development of COPD is tobacco smoking. The inhalation of toxic particles, biomass exposure and outdoor air pollution along with other host factors including abnormal lung development and accelerated lung aging can also contribute. Spirometry characterized by non-fully reversible airflow limitation i.e., FEV1/FVC &lt; 0.7 post bronchodilation, confirms the diagnosis of COPD. The major goals of management are to reduce risk factors, manage stable COPD, prevent and treat acute exacerbations, and manage associated illnesses. The conservative management comprising of antibiotics, inhaled corticosteroids, mucolytics etc. offer promising results in this condition. But tachycardia, glossitis, glaucoma, nausea are some of the common adverse reactions noticed on chronic use of these group of drugs. The contemporary health scenario demands more contribution in this regard from the indigenous system of medicine. In Āyurvedic view, COPD can be considered under the spectrum of Prāṇavaha srotodushti vikaras. The clinical features and etiology mentioned for diseases mentioned in Ayurveda such as Kāsa, Tamaka śvāsa, Rajayakshma etc has similarity with that of COPD. Though COPD cannot be correlated to any single condition of Prāṇavaha sroto duṣti, Tamaka śvāsa can be considered as includes most of the clinical features including cough. When the etiological factors favour, the vitiated and aggravated Kapha dosha blocks the channels of Prāna and Udāna vāta causing the onset and symptoms of the disease.

Bhramari Pranayama and Thoracic Mobility Exercises for Moderate Chronic Obstructive Pulmonary Disease (COPD): A Case Study

Chronic obstructive pulmonary disease (COPD) is a global health issue and a significant cause of morbidity, disability, and mortality due to persistent respiratory symptoms and airflow limitations. COPD is diagnosed through pulmonary function testing, particularly spirometry, which measures the post bronchodilator FEV1/FVC ratio. The purpose of this study was to determine the effectiveness of Bhramari pranayama combined with thoracic mobility exercises on increasing exercise/activity tolerance in patient with moderate COPD. This case study is about a 60-year-old male with COPD who presented with breathlessness, cough, and mMRC grade 2 dyspnoea. His FEV1 was 58%, FVC was 75%, and FEV1/FVC (post bronchodilator) was 63%. The patient was given Bhramari pranayama and thoracic mobility exercise for a period of 4 days. After 4 days, there was improvement in dyspnoea severity, exercise capacity, thoracic expansion, FEV1, FVC, FEV1/FVC, and CAT questionnaire score. Hence, we concluded that Bhramari Pranayama and thoracic mobility exercises are effective in increasing exercise/activity tolerance in patient with moderate COPD.

Ventilation Heterogeneity Is a Treatable Trait in Severe Asthma

BackgroundVentilation heterogeneity is a feature of asthma and indicates small airway disease. Nuclear imaging methods assess ventilation heterogeneity which can facilitate clinical diagnosis and further our understanding of disease aetiology. ObjectiveWe sought to assess ventilation heterogeneity in severe eosinophilic asthma using ventilation/perfusion single-photon emission computed tomography (V/P SPECT), and to assess its use as an objective test of the effect of biologic treatment for ventilation defects in severe eosinophilic asthma. MethodsAdults (≥18 years) with severe asthma were recruited to participate in a cross-sectional observational study. Participants underwent a clinical assessment and V/P SPECT/CT using Technegas as the ventilation agent. Measures were repeated for a nested before-after treatment study in people with severe eosinophilic asthma commencing biologics. ResultsA total of 62 participants with severe asthma were recruited. From this, 38 participants with severe eosinophilic asthma were included in the before-after study. Ventilation heterogeneity was associated with clinical variables such as lung function impairment and significantly improved after monoclonal antibody treatment in the severe asthma group. The changes in ventilation heterogeneity correlated with change in post bronchodilator FEV1%predicted (r=-0.503, p=0.001) and post bronchodilator FEV1/FVC (r=-0.415, p=0.01). ConclusionVentilation heterogeneity is clinically significant, measurable, and treatable, which establishes ventilation heterogeneity as a treatable trait in severe asthma.

Anticipating undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry: a decision tool for bronchial challenge testing

BackgroundSome patients with asthma demonstrate normal spirometry and remain undiagnosed without further testing.ObjectiveTo determine clinical predictors of asthma in symptomatic adults with normal spirometry, and to generate a tool to help clinicians decide who should undergo bronchial challenge testing (BCT).MethodsUsing random-digit dialling and population-based case-finding, we recruited adults from the community with respiratory symptoms and no previous history of diagnosed lung disease. Participants with normal pre- and post-bronchodilator spirometry subsequently underwent BCT. Asthma was diagnosed in those with symptoms and a methacholine provocative concentration (PC20) of < 8 mg/ml. Sputum and blood eosinophils, and exhaled nitric oxide were measured. Univariate analyses identified potentially predictive variables, which were then used to construct a multivariable logistic regression model to predict asthma. Model sensitivity, specificity, and area under the receiver operating curve (AUC) were calculated.ResultsOf 132 symptomatic individuals with normal spirometry, 34 (26%) had asthma. Of those ultimately diagnosed with asthma, 33 (97%) answered ‘yes’ to a question asking whether they experienced cough, chest tightness or wheezing provoked by exercise or cold air. Other univariate predictors of asthma included female sex, pre-bronchodilator FEV1 percentage predicted, and percent positive change in FEV1 post bronchodilator. A multivariable model containing these predictive variables yielded an AUC of 0.82 (95% CI: 0.72–0.91), a sensitivity of 82%, and a specificity of 66%. The model was used to construct a nomogram to advise clinicians which patients should be prioritized for BCT.ConclusionsFour readily available patient characteristics demonstrated a high sensitivity and AUC for predicting undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry. These characteristics can potentially help clinicians to decide which individuals with normal spirometry should be investigated with bronchial challenge testing. However, further prospective validation of our decision tool is required.

Frequency of Occurrence of Leukocytosis in Patients with Acute Exacerbation of Copd at a Tertiary Centre

COPD is a major cause of chronic morbidity and mortality; it is currently the fourth highest cause of death in the world, and is predicted to be the third leading cause of mortality worldwide by the year 2020 [1-2]. COPD is identified mainly according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines; [post bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio less than 0.7; severity determined by FEV1 alone] combined with a history of exposure to risk factors [2]. Exacerbations of respiratory symptoms in COPD are of major importance because of their profound and long lasting adverse effects on patients [3]. Frequent episodes accelerate loss of lung function, affect the quality of life of patients, and are associated with poor survival. There are some specific blood biomarkers for predicting lung function decline, acute exacerbation, or even mortality from big longitudinal cohort studies. However, their performance is depressing [4] . Peripheral blood leukocytosis has already been well investigated in the aspect of inflammatory biomarkers for COPD. The level of leukocytes is a key parameter in the clinical assessment of patients with COPD exacerbation, with and without fever. The presentation of high WBC count makes it important to distinguish the effect of the glucocorticosteroid from the effect of the possible infection [5-7].

Prevalence of preserved ratio impaired spirometry (PRISM) in patients undergoing spirometry in a medical college hospital

Background: Many patients come with respiratory symptoms of cough, expectoration and shortness of breath. They also exhibit history of risk factors like smoking etc. but on spirometry they do not meet spirometric criteria of chronic obstructive pulmonary disease (COPD). GOLD 2023 updates have considered such patients in the category of pre-COPD and preserved ratio impaired spirometry (PRISm) and advised to treat and follow these patients and try to prevent them from progressing to COPD. With this objective we tried to look for PRISm and its characteristics in our area. Material and methods: We analyzed the spirometric pattern of all the patients who underwent spirometry in our institution (GS Medical College &amp; Hospital, Pilkhuwa) from January 2022 to December 2022. After applying inclusion and exclusion criteria, the patients were divided into three groups: (I) Normal Group: Patients having post bronchodilator FEV1/FVC ratio ≥ 0.7 and normal FEV1 and FVC. (II) PRISm Group: Patients having post bronchodilator FEV1/FVC ratio ≥ 0.7 but decreased FEV1 (&lt; 80 %) and / or FVC (&lt; 80 %). (III) Unrevealed COPD Group: Patients having post bronchodilator FEV1/FVC ratio &lt; 0.7 irrespective of FEV1 and FVC. Data observed was compared among various groups and analyzed for various parameters. Results: A total of 986 patients underwent spirometry between 1st January 2022 and 31st December 2022. Of this, 302 patients were not considered for study because of exclusion criteria. 684 patients were considered for the study, of whom 261 (38.16%) had normal spirometry, 207 (30.26%) were in the PRISm group and 216 (31.58%) were found to have unrevealed COPD. Conclusion: Occurrence of PRISm is quite high (30.26%) in patients undergoing spirometry for various reasons in our area. Higher age and higher BMI may have contributed to the observations. Additionally, a considerable number of patients (31.58%) were found to have unrevealed COPD. Another finding is that smoking history is seen in more than 70% of male subjects in both PRISm and unrevealed COPD groups. However, the results need confirmation in more studies from different geographical areas. Keywords: spirometry; PRISm; COPD; pulmonary disease

Association of Non-Alcoholic Fatty Liver Disease with Chronic Obstructive Lung Disease Patients: An Egyptian Study

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) and Non-Alcholic Fatty Liver Disease (NAFLD) share common risk factors, such as reduced physical activity, and pathophysiological mechanisms including oxidative stress, low grade inflammation, and metabolic syndrome. COPD severity is also recognized as an independent risk factor of NAFLD. Interestingly, the literature reports a higher prevalence of all-cause liver disease in patients with COPD, but only a small number of patients with NAFLD. Therefore, the specific links between NAFLD and COPD need to be confirmed and further evaluated. Aim of the Work The aim of the study is to determine the possible association between Chronic Obstructive Lung Disease and Non-Alcoholic Fatty Liver Disease. Patients and Methods This cross-sectional study was conducted at outpatient clinics at Ain Shams Hospital during a Period 1 year. This study was performed on 60 Egyptian Patients divided into two groups as follow: Group 1:40 Patients diagnosed with COPD (Patients diagnosed by history of disease, smoking history and A ration of post bronchodilator FEV1 10 FVC of less than 70% of the predicted value). Group2: 20 Normal Healthy People (Control Group) Results There was no statistically significant difference with p-value &amp;gt;0.05 between both groups as regards age and sex, which indicated proper matching between groups. The present study showed that there was a statistically significant difference with p-value &amp;lt;0.05 between study groups as regards obstructive sleep apnea with high percentage of obstructive sleep apnea among cases. On the other hands, there was no statistically significant difference with p-value &amp;gt;0.05 between both groups as regards smoking and hypertension. The current study showed that there was no statistically significant difference with p-value &amp;gt;0.05 between study groups as regards systolic blood pressure, weight, height, waist circumference and BMI. On the other hand, there was a statistical significance difference with p-value &amp;lt;0.05 with higher mean of diastolic blood pressure among cases. Conclusion This study showed that NAFLD is associated with COPD. Physicians should be aware of possible liver comorbidities in COPD patients and that extrahepatic disease in NAFLD patients may vary more than previously thought. Further studies concerning the biochemical and metabolic mechanisms of NAFLD and COPD are required.

Response to Bronchodilators Administered via Different Nebulizers in Patients With COPD Exacerbation.

The recommended treatment of COPD exacerbations includes administration of short-acting bronchodilators that act to reverse bronchoconstriction, restore lung volumes, and relieve breathlessness. In vitro studies demonstrate vibrating mesh nebulizers (VMNs) provide greater drug delivery to the airway compared to standard small-volume nebulizers (SVNs). We examined whether the physiological and symptom response to nebulized bronchodilators during a COPD exacerbation differed between these 2 modes of bronchodilator delivery. Subjects hospitalized with a COPD exacerbation participated in a comparative clinical effectiveness study of 2 methods of nebulization. Using block randomization, 32 participants in this open-label trial were administered salbutamol 2.5 mg/ipratropium bromide 0.5 mg via vibrating mesh (VMN group, n = 16) or small-volume jet nebulizer (SVN group, n = 16) on one occasion. Spirometry, body plethysmography, and impulse oscillometry were performed and Borg breathlessness scores recorded pre bronchodilator and at 1 h post bronchodilator. Baseline demographics were comparable between groups. Mean FEV1 was 48% predicted. Significant changes in lung volumes and airway impedance were seen in both groups. Inspiratory capacity (IC) increased by 0.27 ± 0.20 L and 0.21 ± 0.20 L in the VMN and SVN group, respectively, between group difference P = .40. FVC increased in the VMN group by 0.41 ± 0.40 L compared to 0.19 ± 0.20 L with SVN, between group difference P = .053; and residual volume (RV) decreased by 0.36 ± 0.80 L and 0.16 ± 0.50 L in the VMN and SVN group, respectively, between group difference P = .41. The VMN group had a significant reduction in Borg breathlessness score, P = .034. Greater improvement in symptoms, and larger absolute change in FVC, was observed in response to equivalent doses of standard bronchodilators administered by VMN, compared to SVN, but no substantial difference in change in IC.

Association between FOXO3a Gene Polymorphism and Susceptibility to Asthma in South Indian Population

Background: Asthma is an important cause of morbidity worldwide. The FOXO3a gene plays an important role in human immune regulation and homeostasis. Loss of function may lead to chronic inflammation and asthma. Objective: To evaluate the association between Foxo3a gene polymorphism and susceptibility to asthma. Methods: We conducted a case-control study in a tertiary care hospital. Participants answered a questionnaire that collected demographic and clinical information. Asthma was confirmed by pre and post bronchodilator spirometry. Genotyping of the FOXO3a polymorphisms was performed us-ing PCR-RFLP. Results: The study population included 41 cases and 33 controls. Among cases, the heterozygous (CT) genotype frequency was greater compared to wild homozygous (CC) and mutant homozygous (TT) variants. In controls, the wild homozygous (CC) genotype frequency was greater compared to heterozygous and mutant homozygous variants. In the general model, the mutant homozygous (TT) group had significantly higher odds of 7.8 (1.78-34.07) of having asthma compared to the wild ho-mozygous (CC) group. The mutant homozygous (TT) group had greater severity of asthma as com-pared to the wild homozygous (CC) group. The mutant homozygous group (TT) had much lower lung functions, as compared to the wild homozygous (CC) group in asthmatics. Among non-asthmatic controls, lower lung functions were seen in the mutant (TT) group as compared to the wild (CC) group. Conclusion: We found a significant association between the Foxo3a gene polymorphism and asth-ma. The T allele, a variant of the Foxo3a gene polymorphism, is associated with a higher risk of asthma, and greater asthma severity. It is also associated with lower lung functions in both asthmat-ics and apparently healthy control subjects.

Correlation between COPD duration and abnormality in FEV1, FVC, and BODE index in 100 COPD patients

Background: Progression of any disease depends on several factors and one such factor is duration. To determine the progression of chronic obstructive pulmonary disease (COPD), post-bronchodilator forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and BMI, Obstruction, Dyspnea, Exercise (BODE) index are considered. We have tried to find a correlation between these factors and the duration of disease; to check how these factors fare as the disease progresses. Aims and Objectives: The aim of the study was to correlate COPD duration with post bronchodilator FEV1, FVC, and BODE index, respectively. Materials and Methods: A hospital-based and cross-sectional study was conducted at department of respiratory medicine, GCS Medical College, Hospital, and Research Centre, Ahmedabad, Gujarat among COPD patients. Informed consent was obtained from each patient. We analyzed 100 patients of COPD diagnosed by symptoms, presence of risk factors, and spirometry. Detailed clinical history, physical examination, and necessary investigations were conducted in all patients. Results: Out of which 71 were newly diagnosed cases while 29 were known cases of COPD. On correlating COPD duration with post-bronchodilator FEV1, FVC, and BODE index; we did not find any correlation between them. Conclusion: We would like to recommend a similar study with a larger population size to arrive at some form of conclusion.

"Study on factors associated with post bronchodilator reversibility among patients presenting with dyspnea".

"Study on factors associated with post bronchodilator reversibility among patients presenting with dyspnea".

Study on Asthma and Chronic Obstructive Pulmonary Disease Overlaps among Patients with Obstructive Airway Diseases

Background and Aim: Although asthma and chronic obstructive pulmonary disease (COPD) are clinically distinct diseases, they represent biologically diverse and overlapping clinical entities and it has been observed that they often co-occur. Some research and theorizing suggest there is a common comorbid condition termed asthmachronic obstructive pulmonary disease overlap (ACO). However, the existence of ACO is controversial.Material and Methods: This is prospective, observational and descriptive study conducted at tertiary care institute of Gujarat for the duration of 1 year. Among chronic airway diseases who were classified into three groups (COPD, asthma and ACO). Patients with COPD and ACO were diagnosed according to GOLD guidelines 2020 and patients with asthma were diagnosed according to Global Initiative for Asthma (GINA) guidelines 2020. Total 150 participants were included in the research. All patients are subjected to full history taking, clinical examination, full laboratory examinations, chest radiography, spirometry and post bronchodilator reversibility test was performed and sputum analysis, where induction of sputum by hypertonic saline or mannitol is done by a trained staff with strict airborne respiratory precautions.Results: We found that 71.42% of ACO group, 79.48% of asthma group and 25% of COPD group had a positive history of atopy. Comparison of study groups regarding sputum eosinophils revealed that 30.15 % of ACO group, 76.92% of asthma group and 31.25% of COPD group had positive sputum eosinophils.Conclusion: ACO addresses an enormous rate among patients with obstructive airway diseases. It shares a few highlights of asthma like atopy and positive sputum eosinophilia, and a few highlights of COPD like old age of shows and positive smoking history

Factors Associated With Persistence of Severe Asthma From Late Adolescence to Early Adulthood

To determine risk factors in childhood that predict severe persistent asthma in late adolescence and early adulthood.Patients aged 5 to 12 years with mild to moderate asthma and a positive methacholine challenge enrolled in the Childhood Asthma Management Program (CAMP) trial.The CAMP participants above who had data available from late adolescence to early adulthood were included. The first study visit at age 18 years was used to determine asthma activity in late adolescence, whereas the first study at age 22 years was used to determine asthma activity in early adulthood. The American Thoracic Society definition of severe asthma was used for patients on high dose inhaled corticosteroids and the National Asthma Education and Prevention Program Expert Panel Report (NAEPP EPR) 3 definition of severe asthma was used for those not receiving high dose inhaled corticosteroids. Additional criteria for intermittent and persistent asthma were included. The following factors were analyzed: secondhand smoke exposure, maternal smoking during pregnancy, body mass index percentile, hay fever, eczema, food allergy, parental asthma being sensitized and exposed to any perennial aeroallergen, bronchial hyperreactivity, prebronchodilator FEV1/FVC ratio, post bronchodilator FEV1/FVC ratio, bronchial hyperresponsiveness to methacholine challenge, log10 of serum total IgE and log10 of serum absolute eosinophil count. Characteristics were compared from baseline to late adolescence and from baseline to early adulthood.Six hundred eighty-two CAMP participants were included. Of these participants, severe asthma was present in 81 (12%) participants in late adolescence and 131 (19%) participants in early adulthood. Half of the patients with severe asthma in late adolescence continued to have severe asthma into early adulthood. About 18% of patients improved severity, 61% did not change, and 21% of patients worsened in severity from late adolescence to early adulthood. The postbronchodilator percent predicted FEV1 and pre and post bronchodilator FEV1/FVC ratio significantly decreased from childhood to late adolescence and from late adolescence to early adulthood (P < .0001), whereas prebronchodilator FEV1 values increased from childhood to late adolescence (P < .0001) and stabilized in early adulthood (P = .040). Bronchodilator reversibility and bronchial hyperresponsiveness each decreased from childhood to late adolescence (P < .0001), whereas bronchial hyperresponsiveness also significantly decreased from childhood to early adulthood (P = .0003). Patients with persistent and severe asthma had higher serum IgE in late adolescence and were more likely to have a positive aeroallergen skin test, along with sensitization and exposure to perennial allergens in childhood. Significant factors in early childhood that were associated with persistence of severe asthma from late adolescence to early adulthood included a younger age, male sex, no reported hay fever, a low prebronchodilator FEV1/FVC ratio, a low postbronchodilator FEV1/FVC ratio, and a physician diagnosis of moderate asthma during the screening period. Notably, for every 5% decrease in post bronchodilator FEV1/FVC ratio in childhood, the odds of severe asthma persistence increased by 2.36-fold (P < .0001) as well as maternal smoking during pregnancy increased odds of severe asthma persistence by 3.17-fold (P = .020). There was a strong association between a reduced-growth lung function trajectory and severe asthma persistence.Lower FEV1/FVC ratio in childhood and maternal smoking during pregnancy were the strongest predictors for severe asthma between late adolescence and early adulthood.Understanding early factors for persistence of asthma into adulthood can help develop targeted primary prevention measures such as reduction of smoking during pregnancy as well as early intervention measures with therapies to preserve lung function in childhood.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1164/rccm.202010-3763OC

Study on factors associated with post bronchodilator reversibility among patients presenting with dyspnea: An experience at a tertiary care academic hospital in Kerala.

Background:The change in FEV1 after administration of a short-acting bronchodilator has been widely used for diagnosis of obstructive airway diseases. Many factors can influence the post bronchodilator reversibilityAim:The aim of the present study was to estimate the presence of reversibility among the patients of obstructive airway disease and to identify the factors affecting itMethods:Patients who presented to the department of respiratory medicine with symptoms of dyspnea were evaluated with spirometry. Spirometry and post bronchodilator reversibility (BDR) was defined as per international guidelines. SPSS 17 was used for statistical analysis and P < 0.05 was considered significantResults:Out of 100 patients studied, 33 had BDR. Median age of the population was 58 ± 17 years. There were 72 non-smokers and 58 men. A total of 32 had chronic obstructive pulmonary disease (COPD), 56 had asthma, and 12 had normal spirometry. The median pre and post bronchodilator FEV1 was 1.34L/Sec and 1.46 L/sec respectively. Twenty-seven of asthma (41%) and 6 of COPD (19%) had BDR (P = 0.05). Other factors associated with BDR were smoking (P = 0.035). There was no statistically significant correlation found between eosinophilia, gender, severity of obstruction, BMI, height, weight and ageConclusion:The prevalence of post BDR in the study population was 33%. The factors affecting BDR were smoking status, and asthma. The study did not show any significant correlation between BDR and eosinophilia, gender, height and age.

Prevalence and health status of COPD in rural West Bengal.

Background:Understanding the spirometry-based prevalence with concomitant assessment of the health status is important to appreciate the chronic obstructive pulmonary disease (COPD)-scenario in a geographic area. There is hardly any such rural data available from the developing world.Methods:We screened the adult population (>40 but <75 years) of seven villages in two different blocks of Birbhum district, West Bengal, for the presence respiratory symptoms (active or historical within 1 year). Those screened positive were tested with spirometry to diagnose COPD on having post bronchodilator FEV1/FVC <0.7. The COPD subjects were then applied with COPD assessment test (CAT).Results:Out of 6255 subjects residing in the villages, 1984 subjects belonged to the target age group and 51.56% (1013 of 1984) of them qualified for spirometry which was possible in 953 (88.81%) of them. COPD was identified in 166 (16.36%) of symptomatic individuals. The calculated prevalence of COPD was 2.65% in overall population and 8.367% in population above 40 years. The COPD patients (mean age 59.77 ± 9.47 years) had a male preponderance (120 [72.29%] of 166). They were mostly malnourished (body mass index = 17.15 ± 2.97), with poorhealth status (CAT = 15) and moderate degree (GOLD category-II) of airflow limitation showing FEV1/FVC as 0.60 ± 0.07 and the mean post bronchodilator FEV1 as 52% of predicted (1.26 ± 0.42 L). Most of the sufferers (74.09%) were either active (n = 88) or ex-smokers (n = 35) (>10 pack-years). The nonsmokers constituted 25, 90% (n = 43).Conclusion:The rural COPD prevalence in Bengal is far higher than the estimated national average with the health status of the sufferers been poor.

Balance impairment and lower limbs strength in patients with COPD who fell in the previous year.

Fall-related causes in patients with COPD might be associated to functional balance impairments and greater disease severity. We aimed to evaluate the reasons for falls in patients with COPD who had presented any fall during the previous year. This is a cross-sectional study. All COPD's GOLD classifications (mild, moderate, severe, and very severe) patients were recruited. In order to participate, patients ought to be clinically stable and without any exacerbation within 30 days prior to study entry. History of falls was self-reported by patients through an interview. Pre and post bronchodilator (salbutamol 400 μg) spirometry was performed. All patients accomplished postural balance tests such as the Berg Balance Scale, Falls Efficacy Scale-International, Time up and Go, Functional Reach test, Tinetti test and Chalder Scale; furthermore, lower limbs muscle strength (muscle dynamometry) and the COPD Assessment Test (CAT) were assessed. Ninety-six patients with COPD were evaluated and divided into two groups stratified according to any positive history of falls in the previous year. Patients with COPD who had any fall in the previous year presented older age (p=0.01), higher BMI (p=0.04) and worse pulmonary function than those who did not fall. The risk of falls was increased in patients with lower muscle strength in the lower limbs (OR 2.9, CI 95%;1.6 to 3.9), age greater than 65 years (OR 2.7, CI 95%;1.3 to 3.4), BMI greater than 28.8 kg/m2 (OR 3.2, CI 95%;1.1 to 5.6), very severe airway obstruction (OR 3.9, CI 95%;2.2 to 3.9) and fatigue (OR 3.2, CI 95%;1.5 to 5.3). Impaired body balance, reduced lower limb strength, disease severity, presence of fatigue and elevated BMI are important factors for falls in patients with COPD.

Comparison of therapeutic response between asthma,COPD, and ACOS patients by evaluation of spirometric findings

Asthma and Chronic obstructive pulmonary disease (COPD ) both are a common public health problem that affects a large portion of population. Nearly 20% of patients with obstructive lung disease have features of both asthma and COPD called ACOS that GOLD_GINA guidelines defines as persistent airflow limitation with several features of asthma and several features of COPD. Yet there is a little data available about diagnosis and treatment of this entity and current study aimed to compare therapeutic response between asthma, COPD and Asthma-COPD overlap syndrome (ACOS) subjects through spirometric data. In the present cross-sectional study, 30 known patients with mild to moderate asthma, 30 known patients with mild to moderate COPD and 30 known patients with mild to moderate ACOS according to GOLD_GINA guidelines were enrolled. We assessed post bronchodilator the ratio of the forced expiratory volume in the first one second to the forced vital capacity of the lungs (fev1) and the forced expiratory volume in the first one second to the forced vital capacity of the lungs (fev1/fvc) in all patients. Then they took standard treatment for 2 months and after this period spirometry was repeated. Spirometric data's changes was compared between the three groups by SPSS26 statistical software. Fev1 changes in response to treatment did not differ significantly between three groups (p > 0.05) but fev1/fvc changes differed significantly and this parameter in asthma was more than ACOS and in COPD was least. (In asthma, spirometric symbolized therapeutic response is more significant than ACOS, and in ACOS, it is more important than COPD in terms of fev1/fvc changes) and there was not any difference between the three groups regarding to FEV1 changes.