Predicted Peak Expiratory Flow Research Articles

Study on the characteristics of Aspergillus fumigatus-sensitized asthma and allergic bronchopulmonary aspergillosis

Objective: To investigate the clinical characteristics of Aspergillus fumigatus(A.f)-sensitized asthma and allergic bronchopulmonary aspergillosis (ABPA), which provides a foundation for the diagnosis and differential diagnosis of A.f-sensitized asthma and ABPA, as well as the prevention of ABPA. Methods: This was a single-center retrospective case-control study. Collected the clinical data of patients who visited the Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University from December 2018 to May 2022.A total of 122 patients were included, including 64 males (52.5%) and 58 females (47.5%).The age range was 3 to 89 years.The median age was 44 years.The average age was 41.8 years.The patients were divided into three groups (48 ABPA, 35 A.f-sensitized asthma and 39 HDM-sensitized asthma).Analyzed the differences and correlations among clinical indicators in the three groups, and evaluated the risk factors for the development of ABPA in A.f-sensitized asthma.For statistical analysis, metrological data was tested by t-test or Wilcoxon Mann-Whitney. Classification variables by chi-square test or Fisher's exact test. Pearson correlation analysis for normal distribution data.Spearman correlation analysis for skewed distribution data. Influencing factor analysis was performed using multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was made, the area under the ROC curve (AUC) was calculated, and the sensitivity and specificity of the model were evaluated. Results: Compared with patients with A.f-sensitized asthma, the fractional exhaled nitric oxide (FeNO) [75.00(52.00, 87.00)ppb vs. 40.00(32.00, 52.00)ppb], eosinophils% (EO%) [10.60(6.75, 13.05) vs. 4.10(1.20, 7.30)], eosinophils (EO) [1.50(1.07, 2.20)×109/L vs. 0.33(0.10, 0.54)×109/L], A.f-specific Immunoglobulin E (sIgE) [10.24(4.09, 22.88)KU/L vs. 1.13(0.53, 3.72) KU/L], and sIgE to total IgE(tIgE) ratio (sIgE/tIgE) [0.0049(0.0027, 0.0100) vs. 0.0008(0.0004, 0.0017)] were higher in ABPA patients, the differences were statistically significant (P<0.001). In all patients, tIgE was positively correlated with EO% (r=0.206, P<0.05) and EO (r=0.302, P<0.001). sIgE/tIgE was negatively correlated with one-second rate (FEV1/FVC%) (r=-0.256, P<0.01). The percentage of predicted forced vital capacity [FVC(%)] was negatively correlated with FeNO (r=-0.184, P<0.05).In the ABPA group, the percentage of predicted peak expiratory flow [PEF(%)] was negatively correlated with FeNO (r=-0.295, P<0.05). In the HDM-sensitized asthma group, FeNO was positively correlated with EO% (r=0.49, P<0.01) and EO (r=0.548, P<0.001).The results of logistic regression analysis showed that FeNO and EO were the influencing factors for the development of ABPA in A.f-sensitized asthma. ROC curve analysis results showed that A.f-sIgE (cut-off, 4.108; AUC=0.749;95%CI, 0.632-0.867), sIgE/tIgE(cut-off, 0.0026;AUC=0.749;95%CI, 0.631-0.868), FeNO(cut-off, 55.5;AUC=0.794; 95%CI, 0.687-0.900), EO% (cut-off, 8.70;AUC=0.806;95%CI, 0.709-0.903) and EO (cut-off, 0.815;AUC=0.865;95%CI, 0.779-0.950) had differential diagnostic value in A.f-sensitized asthma and ABPA.The combination of FeNO, EO and EO% had good diagnostic efficiency in differentiating A.f-sensitized asthma from ABPA, with a sensitivity of 91.4% and a specificity of 84.4%. Conclusion: Compared with patients with A.f-sensitized asthma, patients with ABPA have more severe eosinophil inflammation. The higher the FeNO and EO, the more likely A.f-sensitized asthma will develop into ABPA.sIgE/tIgE may have differential diagnostic value in A.f-sensitized asthma and ABPA.The combination of FeNO, EO and EO% has good diagnostic efficacy in differentiating A.f-sensitized asthma from ABPA.

Daily Associations of Air Pollution and Pediatric Asthma Risk Using the Biomedical REAI-Time Health Evaluation (BREATHE) Kit.

Background: Exposure to air pollution is associated with acute pediatric asthma exacerbations, including reduced lung function, rescue medication usage, and increased symptoms; however, most studies are limited in investigating longitudinal changes in these acute effects. This study aims to investigate the effects of daily air pollution exposure on acute pediatric asthma exacerbation risk using a repeated-measures design. Methods: We conducted a panel study of 40 children aged 8–16 years with moderate-to-severe asthma. We deployed the Biomedical REAI-Time Health Evaluation (BREATHE) Kit developed in the Los Angeles PRISMS Center to continuously monitor personal exposure to particulate matter of aerodynamic diameter < 2.5 µm (PM2.5), relative humidity and temperature, geolocation (GPS), and asthma outcomes including lung function, medication use, and symptoms for 14 days. Hourly ambient (PM2.5, nitrogen dioxide (NO2), ozone (O3)) and traffic-related (nitrogen oxides (NOx) and PM2.5) air pollution exposures were modeled based on location. We used mixed-effects models to examine the association of same day and lagged (up to 2 days) exposures with daily changes in % predicted forced expiratory volume in 1 s (FEV1) and % predicted peak expiratory flow (PEF), count of rescue inhaler puffs, and symptoms. Results: Participants were on average 12.0 years old (range: 8.4–16.8) with mean (SD) morning %predicted FEV1 of 67.9% (17.3%) and PEF of 69.1% (18.4%) and 1.4 (3.5) puffs per day of rescue inhaler use. Participants reported chest tightness, wheeze, trouble breathing, and cough symptoms on 36.4%, 17.5%, 32.3%, and 42.9%, respectively (n = 217 person-days). One SD increase in previous day O3 exposure was associated with reduced morning (beta [95% CI]: −4.11 [−6.86, −1.36]), evening (−2.65 [−5.19, −0.10]) and daily average %predicted FEV1 (−3.45 [−6.42, −0.47]). Daily (lag 0) exposure to traffic-related PM2.5 exposure was associated with reduced morning %predicted PEF (−3.97 [−7.69, −0.26]) and greater odds of “feeling scared of trouble breathing” symptom (odds ratio [95% CI]: 1.83 [1.03, 3.24]). Exposure to ambient O3, NOx, and NO was significantly associated with increased rescue inhaler use (rate ratio [95% CI]: O3 1.52 [1.02, 2.27], NOx 1.61 [1.23, 2.11], NO 1.80 [1.37, 2.35]). Conclusions: We found significant associations of air pollution exposure with lung function, rescue inhaler use, and “feeling scared of trouble breathing.” Our study demonstrates the potential of informatics and wearable sensor technologies at collecting highly resolved, contextual, and personal exposure data for understanding acute pediatric asthma triggers.

Airflow limitation: is there a correlation between spirometry and quantitative computed tomography measurements in patients with chronic obstructive pulmonary disease?

BackgroundThe ability of computed tomography (CT) in illustrating the pathology of lung parenchyma in patients with chronic obstructive pulmonary disease (COPD) was discussed previously in many articles. However, the correlation between airflow limitation that is evaluated by spirometry and its corresponding airway diameter that is measured by multislice computed tomography (MSCT) still under investigation. Therefore, the objective of our study was to answer the questions about possible correlation between forced expiratory volume in first second (FEV1%), forced vital capacity (FVC%), FEV1/FVC, and peak expiratory flow25–75% (PEF25–75%), both before bronchodilator and post it with the diameters of airway at 3 different levels either during inspiratory or expiratory phase of respiration.ResultsThe quantitative MSCT results at RB1 (apical bronchus of the right upper lobe), RB10 (the posterior basal bronchus of the right lower lobe), and LB3 (the anterior bronchus of the left upper lobe) showed weak positive correlation with FEV1% during inspiratory phase of respiration (r = 0.19, 0.20, and 0.18; P = 0.23, 0.22, and 0.26 respectively), but this correlation became more stronger and significant during expiratory phase of respiration (r = 0.76, 0.78, and 0.66; P < 0.001).ConclusionsExpiratory CT parameters were significantly correlated with the predicted peak expiratory flow in 1 s.

Peak Expiratory Flow as an Index of Frailty Syndrome in Older Adults: A Cross-Sectional Study.

to compare the obtained and predicted peak expiratory flow (PEF) values between frail, pre-frail, and non-frail older adults; verify the association between PEF and FS; and establish cut-off points for PEF as determinants of frailty syndrome (FS). Cross-sectional study. Macapá, Amapá, Brazil. Community-based study community-dwelling older people. PEF was evaluated using a peak-flow meter and FS was evaluated using Fried's frailty phenotype. The statistical analyses performed included a multinomial logistic regression model and Receiver Operating Characteristic (ROC) curves to establish cut-off points for discriminating FS. 409 older adults with a mean age of 70.09±7.22 years were evaluated; of these, 58.7% were pre-frail, and 12.7% were frail. PEF was lower in frail than in pre-frail participants, and lower in pre-frail than in non-frail. Frail and pre-frail older adults obtained lower PEF values than predicted. PEF (% Predicted) was inversely associated with frailty and pre-frailty even after adjustment. Cut-off points were established to discriminate the presence of frailty in older men (PEF≤350L/min; AUC=0.669; sensitivity=76.92%; specificity=52%) and women (PEF≤220L/min; AUC=0.597; sensitivity=71.79%; specificity=46.98%). Frail and pre-frail older adults presented significantly lower PEF than non-frail participants, and these values were lower than predicted. PEF was inversely associated with frailty and pre-frailty. PEF cut-off points can be used as a complementary method to indicate frailty in community-dwelling older adults.

Relationship between interleukin-13 rs20541 single nucleotide polymorphisms and therapeutic efficacy in children with asthma.

ObjectiveTo investigate the relationship between therapeutic efficacy in children with asthma and interleukin-13 (IL-13) rs20541 polymorphisms.MethodsFifty children with moderate-to-severe asthma were assigned to the GG, GA, and AA groups according to the IL-13 gene locus rs20541 polymorphism. The patients received budesonide inhalation suspension 1 mg twice daily combined with fluticasone propionate 80 µg/inhalation. The improvement of clinical symptoms (gasping, coughing, and wheezing), improvement of lung function, and adverse reactions were observed.ResultsLung function did not significantly differ among three groups before treatment. After treatment, the time to symptom relief was significantly shorter in the GG group than that in the other two groups. The forced expiratory volume in one second and percent predicted peak expiratory flow were also significantly better in the GG group than in the other two groups.ConclusionBudesonide inhalation suspension combined with fluticasone propionate is an effective treatment regimen for moderate-to-severe asthma. Polymorphism of the IL-13 rs20541 locus may be correlated with therapeutic efficacy. Patients carrying the GG allele were more responsive than their counterparts with the GA or AA allele.

The effect of industry-related air pollution on lung function and respiratory symptoms in school children

Heavy industry emits many potentially hazardous pollutants into the air which can affect health. However, the effects of air pollution from heavy industry on lung function and respiratory symptoms have been investigated scarcely. Our aim was to investigate the associations of long-term air pollution from heavy industry with lung function and respiratory symptoms in school children. A cross-sectional lung function study was conducted among school children (7–13 years) in the vicinity of an area with heavy industry. Lung function measurements were conducted during school hours. Parents of the children were asked to complete a questionnaire about the health of their children. A dispersion model was used to characterize the additional individual-level exposures to air pollutants from the industry in the area. Associations between PM2.5 and NOX exposure with lung function and presence of respiratory symptoms were investigated by linear and/or logistic regression analysis. Participation in the lung function measurements and questionnaires was 84% (665/787) and 77% (603/787), respectively. The range of the elevated PM2.5 and NOX five years average concentrations (2008–2012) due to heavy industry were 0.04–1.59 μg/m3 and 0.74–11.33 μg/m3 respectively. After adjustment for confounders higher exposure to PM2.5 and NOX (per interquartile range of 0.56 and 7.43 μg/m3 respectively) was associated with lower percent predicted peak expiratory flow (PEF) (B -2.80%, 95%CI -5.05% to − 0.55% and B -3.67%, 95%CI -6.93% to − 0.42% respectively). Higher exposure to NOX (per interquartile range of 7.43 μg/m3) was also associated with lower percent forced vital capacity (FVC) and percent predicted forced expiration volume in 1 s (FEV1) (B -2.30, 95% CI -4.55 to − 0.05 and B -2.73, 95%CI -5.21 to − 0.25 respectively). No significant associations were found between the additional exposure to PM2.5 or NOX and respiratory symptoms except for PM2.5 and dry cough (OR 1.40, 95%CI 1.00 to 1.94). Exposure to PM2.5 and NOX from industry was associated with decreased lung function. Exposure to PM2.5 was also associated with parents’ reports of dry cough among their children.

THE EFFECTS OF ACTIVE AND PASSIVE SMOKING TO PREDICTED PEAK EXPIRATORY FLOW RATE AND OXYGEN SATURATION AMONG INDONESIAN PRIMARY SCHOOL CHILDREN (AGED 10–13 YEARS) IN BANDAR LAMPUNG, INDONESIA

Smoking is a big problem in Indonesia (1). The treatment cost of smoking in Indonesia was very burdensome to state finances (2). Young smokers are increasing in Indonesia, the causes include following trends, and the desire to look impressive in front of a playmate with smoking behavior of primary school-age children (3). Infants and children exposed to environmental tobacco smoke are high risk of suffering asthma, respiratory infections, and reduced lung function (4). Although active and passive smoking have been correlated to changes in airflow and airway obstruction, correlation between active and passive smoking to peak expiratory flow and oxygen saturation in primary school children population has not been reported before. The objective of this study was to find out the effects of active and passive smoking to the value of predicted peak expiratory flow rate (PEFR) and oxygen saturation in the primary school children. In addition, based on the Kolmogorov-Smirnov normality test on predicted PEFR value and oxygen saturation value of each group was found that the data were not normally distributed, so further data analysis was performed using the Mann-Whitney Test.�Moreover, the statistical analysis showed a significant difference in mean predicted PEFR in the group of active smokers (88.47 SD ±11.647) to the control group 92.56 (SD ± 11.996) (P-value = 0.04) and the passive smoker group (87.81 SD ±11.056) to the control group (P-value = 0.01), while the active and passive smokers groups did not show significant difference in predicted PEFR (P-value = 0.683). We observed a significant lower value in predicted PEFR in the group of active smokers, and passive smokers compared to the control group (Table 2). In line with the oxygen saturation, the value in active smokers group (94. 76 SD 2.577) was significantly different compared to passive smokers (95.45 SD ± 2.509) and control group (95.92 SD ± 2.236), p = 0.000, whereas oxygen saturation in passive smokers group was not significantly different with control group, p =0.085 (Table 3). In this study, we can conclude that the value of predicted PEFR in primary school children active and passive smokers were significantly lower than control. In the case of oxygen saturation, the researchers found that there was significantly lower value in the active smoker group compared to control. It confirms that smoking both active and passive disrupts the children's airways.

Clinical effect of fluticasone propionate, montelukast sodium and ketotifen in treatment of cough variant asthma in children

To study the clinical effect of different combinations of fluticasone propionate (Flu), montelukast sodium (Mon) and ketotifen (Ket) in the treatment of children with cough variant asthma (CVA). A total of 280 children with CVA who were admitted to the department of respiratory medicine from June 2015 to January 2018 were randomly divided into Flu+Mon+Ket, Flu+Mon, Flu+Ket, Mon+Ket, Flu, Mon and Ket groups, with 40 children in each group. The children in each group were given corresponding drug(s), and the course of treatment was 3 months for all groups. The condition of cough, cough symptom score, pulmonary function and adverse drug reactions were evaluated after 2 and 3 months of treatment. The children were followed up to observe recurrence. After treatment, cough symptom score tended to decrease in all 7 groups, with increases in percentage of forced expiratory volume in 1 second (FEV1%) and percentage of predicted peak expiratory flow (PEF%). After 2 months of treatment, the Flu+Mon+Ket group had a significantly lower cough symptom score and significantly higher FEV1% and PEF% than the other groups (P<0.05). After 2 and 3 months of treatment, the Ket group had a significantly higher cough symptom score and significantly lower FEV1% and PEF% than the other groups (P<0.05). After 3 months of treatment, there were no significant differences in cough symptom score, FEV1% and PEF% among the other groups (P>0.05). There was a low incidence rate of adverse events in all 7 groups, and there was no significant difference among the 7 groups (P>0.05). The Ket group had a significantly higher recurrence rate of cough than the other groups (P<0.001), while there was no significant difference in this rate among the other groups (P>0.0024). For children with CVA, a combination of Flu, Mon and Ket has a better clinical effect than a combination of two drugs and a single drug at 2 months of treatment and is safe. After 3 months of treatment, Flu or Mon alone has a similar effect to drug combination. Ket alone has a poor clinical effect and a high recurrence rate after drug withdrawal.

The effect of industry-related air pollution on lung function and respiratory symptoms in school children

BackgroundHeavy industry emits many potentially hazardous pollutants into the air which can affect health. However, the effects of air pollution from heavy industry on lung function and respiratory symptoms have been investigated scarcely. Our aim was to investigate the associations of long-term air pollution from heavy industry with lung function and respiratory symptoms in school children.MethodsA cross-sectional lung function study was conducted among school children (7–13 years) in the vicinity of an area with heavy industry. Lung function measurements were conducted during school hours. Parents of the children were asked to complete a questionnaire about the health of their children. A dispersion model was used to characterize the additional individual-level exposures to air pollutants from the industry in the area. Associations between PM2.5 and NOX exposure with lung function and presence of respiratory symptoms were investigated by linear and/or logistic regression analysis.ResultsParticipation in the lung function measurements and questionnaires was 84% (665/787) and 77% (603/787), respectively. The range of the elevated PM2.5 and NOX five years average concentrations (2008–2012) due to heavy industry were 0.04–1.59 μg/m3 and 0.74–11.33 μg/m3 respectively. After adjustment for confounders higher exposure to PM2.5 and NOX (per interquartile range of 0.56 and 7.43 μg/m3 respectively) was associated with lower percent predicted peak expiratory flow (PEF) (B -2.80%, 95%CI -5.05% to − 0.55% and B -3.67%, 95%CI -6.93% to − 0.42% respectively). Higher exposure to NOX (per interquartile range of 7.43 μg/m3) was also associated with lower percent forced vital capacity (FVC) and percent predicted forced expiration volume in 1 s (FEV1) (B -2.30, 95% CI -4.55 to − 0.05 and B -2.73, 95%CI -5.21 to − 0.25 respectively). No significant associations were found between the additional exposure to PM2.5 or NOX and respiratory symptoms except for PM2.5 and dry cough (OR 1.40, 95%CI 1.00 to 1.94).ConclusionExposure to PM2.5 and NOX from industry was associated with decreased lung function. Exposure to PM2.5 was also associated with parents’ reports of dry cough among their children.

Lung Function, Inflammation, and Endothelin-1 in Congenital Heart Disease-Associated Pulmonary Arterial Hypertension.

BackgroundBreathlessness is the most common symptom in people with pulmonary arterial hypertension and congenital heart disease (CHD‐APAH), previously thought to be caused by worsening PAH, but perhaps also by inflammation and abnormalities of lung function. We studied lung function and airway inflammation in patients with CHD‐APAH and compared the results with controls.Methods and ResultsSixty people were recruited into the study: 20 CHD‐APAH, 20 CHD controls, and 20 healthy controls. Spirometry, gas transfer, whole body plethysmography and lung clearance index, 6‐minute walk distance, and medical research council dyspnea scoring were performed. Inflammatory markers and endothelin‐1 levels were determined in blood and induced sputum. The CHD‐APAH group had abnormal lung function with lung restriction, airway obstruction, and ventilation heterogeneity. Inverse correlations were shown for CHD‐APAH between medical research council dyspnea score and percent predicted peak expiratory flow (r=−0.5383, P=0.0174), percent predicted forced expiratory flow rate at 50% of forced vital capacity (r=−0.5316, P=0.0192), as well as for percent predicted forced expiratory volume in 1 s (r=−0.6662, P=0.0018) and percent predicted forced vital capacity (r=−0.5536, P=0.0186). The CHD‐APAH patients were more breathless with lower 6‐minute walk distance (360 m versus 558 m versus 622 m, P=0.00001). Endothelin‐1, interleukin (IL)‐β, IL‐6, IL‐8, tumor necrosis factor α, and vascular endothelial growth factor were significantly higher in CHD‐APAH than controls. Serum endothelin‐1 for CHD‐APAH correlated with airflow obstruction with significant negative correlations with percent predicted forced expiratory flow rate at 75% of forced vital capacity (r=−0.5858, P=0.0135).ConclusionsRaised biomarkers for inflammation were found in CHD‐APAH. Significant abnormalities in airway physiology may contribute to the dyspnea but are not driven by inflammation as assessed by circulating and sputum cytokines. A relationship between increased serum endothelin‐1 and airway dysfunction may relate to its bronchoconstrictive properties.

Inhaled magnesium sulfate in the treatment of acute asthma.

Inhaled magnesium sulfate in the treatment of acute asthma.

Calculation of Predicted Peak Expiratory Flow in Children with a Formula

To determine whether a child has asthma exacerbation, we should obtain the value of peak expiratory flow.

Longitudinal study of lung function in pregnant women: Influence of parity and smoking

OBJECTIVES:To evaluate pulmonary function in the first and third trimesters of pregnancy and analyze the influence of parity and smoking on spirometry parameters.METHODS:This longitudinal prospective study included a cohort of 120 pregnant women. The inclusion criteria were as follows: singleton pregnancy, gestational age less than 13.86 weeks, and no preexisting maternal diseases. The exclusion criteria were as follows: change of address, abortion, and inadequate spirometry testing. ClinicalTrials.gov: NCT02807038.RESULTS:A decrease in values of forced vital capacity and forced expiratory volume were noted in the first second from the first to third trimester. In the first and third trimesters, multiparous women demonstrated lower absolute forced vital capacity and forced expiratory volume values in the first second compared with nulliparous women (p<0.0001 and p=0.001, respectively). Multiparous women demonstrated reduced forced expiratory flow in 25% to 75% of the maneuver compared with nulliparous women in the first (p=0.005) and third (p=0.031) trimesters. The absolute values of forced expiratory flow in 25% to 75%, forced expiratory volume in the first second and predicted peak expiratory flow values in the third trimester were higher in smokers compared with nonsmokers (p=0.042, p=0.039, p=0.024, and p=0.021, respectively).CONCLUSION:There was a significant reduction in forced vital capacity and forced expiratory volume values in the first second during pregnancy. Parity and smoking significantly influence spirometric variables.

Serum Vitamin D Levels and Vitamin D Supplement in Adult Patients with Asthma Exacerbation.

Introduction. Vitamin D deficiency has been linked to an increased risk of asthma exacerbations. Objective. This study aimed to compare vitamin D status during the period of severe asthma exacerbations and investigate if vitamin D supplementation improves asthma control. Methods. A total of 47 asthmatic patients and 40 healthy subjects participated in this study. Serum 25-hydroxyvitamin D (25(OH)D), asthma control test (ACT) score, and % predicted peak expiratory flow rate were evaluated in the period with and without severe asthma exacerbations. After that, we provided vitamin D2 supplements to the patients with low vitamin D levels for 3 months. Results. At the period of asthma exacerbation, the prevalence of vitamin D deficiency and insufficiency was 38.29% and 34.04%. There was no significant difference in the levels of serum 25(OH)D with and without asthma exacerbations but the levels were significantly higher in the healthy group. Serum 25(OH)D levels significantly correlated with ACT score. Moreover, vitamin D2 supplementation improved asthma control in uncontrolled asthma group. Conclusions. Hypovitaminosis D was common in asthmatic patients but was not the leading cause of asthma exacerbations. Serum 25(OH)D levels correlated with the ability to control asthma. Improving vitamin D status might be a benefit in uncontrolled asthmatic patients.

Abdominal wall reconstruction for large incisional hernia restores expiratory lung function

Respiratory complications secondary to intermittent intra-abdominal hypertension and/or atelectasis are common after abdominal wall reconstruction for large incisional hernias. It is unknown if the respiratory function of this patient group is affected long term or impairs activities of daily living. We hypothesized that abdominal wall reconstruction for large incisional hernia would not lead to improved, long-term pulmonary function or respiratory quality of life. Eighteen patients undergoing open abdominal wall reconstruction with mesh for a large incisional hernia (horizontal fascial defect width >10cm) were compared with 18 patients with an intact abdominal wall who underwent colorectal resection. Patients were examined pre- and 1-year postoperatively. Examined measures included forced vital capacity, forced expiratory volume in first second, peak expiratory flow, maximal in- and expiratory mouth pressure, and 2 validated questionnaires on respiratory quality of life. In order to decrease heterogeneity, objectively examined parameters were presented relative to the predicted values, which were normality adjusted pulmonary measures. At 1-year follow-up, the abdominal wall reconstruction group showed significant improvement in percent predicted peak expiratory flow and maximal expiratory mouth pressure, whereas all other measurements of lung function remained unchanged. Respiratory quality of life did not change significantly. Patients who underwent abdominal wall reconstruction showed a significantly greater improvement of percent predicted peak expiratory flow compared with patients undergoing colorectal resection. Abdominal wall reconstruction for large incisional hernia improved long-term expiratory lung function. Respiratory quality of life did not change significantly after abdominal wall reconstruction.

Tracheobronchoplasty for the treatment of tracheobronchomalacia

Patients with tracheobronchomalacia (TBM) typically present with dyspnea, recurrent infections, intractable cough, or retained secretions. Airway stabilization may be accomplished with silicone stenting, which provides patients with symptom relief in a minimally invasive manner. However, this technique is not without complications, which mostly occur by 3 weeks. Surgical stabilization is the definitive treatment of TBM. We review the evaluation of TBM and options for treatment.

The Asthma Control Test (ACT) as an alternative tool to Global Initiative for Asthma (GINA) guideline criteria for assessing asthma control in Vietnamese outpatients

To determine the reliability and validity of the Asthma Control Test (ACT) to detect Global Initiative for Asthma (GINA)-defined uncontrolled or partly controlled asthma, and to determine the agreement between ACT and GINA in classifying asthma control among Vietnamese patients. A cross-sectional study was performed in 323 of 360 invited outpatients with asthma in Ho Chi Minh City to compare the ACT and GINA classification for asthma control. Internal consistency of the ACT (Cronbach's alpha) was 0.83. The kappa coefficient of 0.55, based on the ternary split, represents moderate agreement between the two rating systems with a correctly classified rate of 75%. The area under the receiver operating characteristics curve for the ACT score predicting GINA control was 0.85. To detect GINA-defined 'not controlled asthma', the ACT had a sensitivity of 70%, specificity of 93%, and a positive predictive value of 89%, with a cut-off point of 19. The validity of the ACT with regard to agreement with the GINA classification was consistent across both sexes, but less so in adolescents or younger adults. The ACT score was significantly correlated with the percentage predicted forced expiratory volume in 1 second (r=0.35, p<0.001) and percentage predicted peak expiratory flow (r=0.26, p<0.001). The Vietnamese ACT is useful for identifying outpatients with GINA-defined uncontrolled or partly controlled asthma.

The efficacy of nebulized procaterol versus nebulized salbutamol for the treatment of moderate acute asthma: a randomized, double-blind, parallel group study

β2 agonists have been used widely as relievers in asthma management. Procaterol is a selective β2 agonist, claimed to be more selective than salbutamol. The present study aimed to compare the efficacy of nebulized procaterol with nebulized salbutamol in the treatment of moderate acute asthma. This was a randomized, double-blind, parallel group study in 140 patients with moderate acute asthma according to modified GINA 1998 who visited emergency department of Persahabatan Hospital, Jakarta. Patients were randomly assigned to receive three doses of either nebulized procaterol or salbutamol. The primary efficacy variable was the improvement in predicted peak expiratory flow rate (PEFR), while the secondary efficacy variable was the improvement in asthma score and the incidence and severity of adverse events. This study is registered at Current Controlled Trials, number ISCTRN25669625. Baseline characteristics were similar in both groups. After treatment, there were significant improvement of % PEFR (p < 0.001) and asthma score (p < 0.001) in procaterol (n = 68) and salbutamol (n = 69) groups. It was shown that procaterol and salbutamol produced similar efficacy in improving % predicted PEFR and decreasing asthma score. Both treatments were well tolerated. Palpitation and sinus tachycardia were found as adverse events with low incidence. In moderate acute asthma, nebulized procaterol and nebulized salbutamol were both effective in improving PEFR and decreasing asthma score. Both treatments were well tolerated, adverse reactions were rare.

Predicting asthma exacerbations: Peak expiratory flow revisited

The ability to predict and prevent future exacerbations has been a consistent focus of asthma research. Although some progress has been made on identifying factors associated with an increased risk of exacerbation at the population and individual levels, no measure or instrument is available for widespread use in the asthma community. In this issue of the Journal, Thamrin et al present a statistical method used to calculate the future exacerbation risk for a patient (as defined by deterioration in percent predicted peak expiratory flow [PEF]) based on the history of fluctuations in lung function (percent predicted PEF). The authors challenge us to reframe our analytic approach to asthma. Frey et al have suggested that a patient with asthma should be thought of as a complex, nonlinear dynamic systems network; such a network exhibits fluctuations over time in physiologic and clinical variables. However, such a system also exhibits memory effects, and although changes can occur over time, the recent past will include most of the pertinent information needed to predict the short-term future risk. Viewingasthma through this framework, it follows that the single best individual parameter to predict the risk of an exacerbation over the next year is the history of an exacerbation in the prior year. The natural history of asthma in any given patient is a summation of personal characteristics (eg, demographics, inflammatory profile, and lungmechanics), genetics, both the physical (exposure to environment [environmental tobacco smoke, pollution, and allergens]) and psychosocial (access to care) environment, and therapy (including adherence). The complex interaction of these factors results in the overall clinical phenotype expressed by a patient, and this helps explain why the recent past is a strong predictor of future events. Modeling asthma as a complex, nonlinear dynamic system also fits with our increasing recognition of the heterogeneity of asthma. Patients with asthma present differently in regard to symptoms, physiologic measures, inflammatory indices, and perception of obstruction; measuring a single parameter at a single point might not

Pulmonary Function Analysis of Japanese Athletes: Possibly Even More Asthmatics in the Field

The prevalence of bronchial asthma (BA) in youth is increasing in Japan, but very few athletes are reported to be affected with BA. The aim of this study is to analyze pulmonary function test (PFT) in athletes from the aspect of BA retrospectively. Medical history questionnaires of 2111 athletes (male: 1549, female: 562) were reviewed. All athletes participated in the institute's athletic test for the first time, from April 2003 through March 2006. Athletes were categorized into three groups; current-BA confirmed and treated by the physician, possible-BA according to the allergic history and/or BA symptoms, and non-BA that is neither of the above two groups. The PFT data were then analyzed. There were 24 current-BA (1.1%), 137 possible-BA (6.5%), and 183 cases with a past history of BA (PH; 8.7%). Percent of predicted forced expiratory volume in 1 second (%FEV1) and of predicted peak expiratory flow rate (%PEF) in current-BA (86.2+/-17.7% and 81.6+/-19.1%, respectively) and possible-BA (84.7+/-14.6% and 81.2+/-17.3%, respectively) were significantly lower than those in non-BA (93.9+/-13.7% and 93.8+/-19.8%, respectively), without any significant difference between current-BA and possible-BA. Athletes with PH show impaired obstructive indices; even in non-BA with PH showed lower %FEV1 (91.3+/-13.9%, p<0.05) and %PEF (86.8+/-17.8%, p<0.001) than non-BA without PH (94.0+/-13.7% and 94.2+/-19.9%, respectively). The incidence of BA in Japanese athletes may be higher than currently recognized. More intervention is encouraged for the diagnosis of BA, to avoid any fatal asthma during sports by initiating preventive therapy.