Pulmonary Function Impairment In Patients Research Articles

Investigating pulmonary and non-infectious complications in common variable immunodeficiency disorders: a UK national multi-centre study.

Common Variable Immunodeficiency Disorders (CVID) encompass a spectrum of immunodeficiency characterised by recurrent infections and diverse non-infectious complications (NICs). This study aimed to describe the clinical features and variation in NICs in CVID with and without interstitial lung disease (ILD) from a large UK national registry population. Retrospective, cross-sectional data from a UK multicentre database (previously known as UKPIN), categorising patients into those with CVID-ILD and those with NICs related to CVID but without pulmonary involvement (CVID-EP; EP= extra-pulmonary involvement only). 129 patients were included. Chronic lung diseases, especially CVID-ILD, are prominent complications in complex CVID, occurring in 62% of the cohort. Bronchiectasis was common (64% of the cohort) and associated with greater pulmonary function impairment in patients with CVID-ILD compared to those without bronchiectasis. Lymphadenopathy and the absence of gastrointestinal diseases were significant predictors of ILD in complex CVID. Although the presence of liver disease did not differ significantly between the groups, nearly half of the CVID-ILD patients were found to have liver disease. Patients with CVID-ILD were more likely to receive immunosuppressive treatments such as rituximab and mycophenolate mofetil than the CVID-EP group, indicating greater need for treatment and risk of complications. This study highlights the significant burden of CVID-ILD within the CVID population with NICs only. The lungs emerged as the most frequently affected organ, with ILD and bronchiectasis both highly prevalent. These findings emphasise the necessity of a comprehensive and multidisciplinary approach in managing CVID patients, considering their susceptibility to various comorbidities and complications.

Assessment of Pulmonary Function Tests in COVID-19 Convalescents Six Months after Infection.

Background: The aim of the study was to investigate the impact of COVID-19 on the pulmonary function tests (PFT) in COVID-19 convalescents six months after recovery. Additionally, the research question was whether PFT should be performed routinely in post-COVID-19 patients. Methods: A total of 39 patients with a history of COVID-19 6 months prior to the study were included in the study (Group I). Individuals were hospitalized or treated in the outpatients department. The control group (Group II) consisted of 39 healthy patients without a COVID-19 history. Each subject completed a questionnaire interview and underwent laboratory and pulmonary function examinations. Results: Six months after COVID-19 recovery, patients mainly complained about cough (46%, n = 18), shortness of breath (23%, n = 9), weakness (13%, n = 5), and memory/concentration disorders (8%, n = 3). In the group of patients complaining of persistent cough present 6 months after COVID-19, the following PFT parameters were decreased: FEV1, FVC, FRC, TLC, and DLCO (p < 0.05) in comparison with patients without this symptom. Conclusions: Persistent shortness of breath is not necessarily associated with pulmonary function impairment in patients 6 months after SARS-CoV-2 infection, and hence it requires appropriate differential diagnosis. Patients with a cough persisting 6 months after the acute phase of COVID-19 may benefit from PFT.

Pulmonary Emphysema Regional Distribution and Extent Assessed by Chest Computed Tomography Is Associated With Pulmonary Function Impairment in Patients With COPD.

Objective: This study aimed to evaluate how emphysema extent and its regional distribution quantified by chest CT are associated with clinical and functional severity in patients with chronic obstructive pulmonary disease (COPD).Methods/Design: Patients with a post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) < 0.70, without any other obstructive airway disease, who presented radiological evidence of emphysema on visual CT inspection were retrospectively enrolled. A Quantitative Lung Imaging (QUALI) system automatically quantified the volume of pulmonary emphysema and adjusted this volume to the measured (EmphCTLV) or predicted total lung volume (TLV) (EmphPLV) and assessed its regional distribution based on an artificial neural network (ANN) trained for this purpose. Additionally, the percentage of lung volume occupied by low-attenuation areas (LAA) was computed by dividing the total volume of regions with attenuation lower or equal to −950 Hounsfield units (HU) by the predicted [LAA (%PLV)] or measured CT lung volume [LAA (%CTLV)]. The LAA was then compared with the QUALI emphysema estimations. The association between emphysema extension and its regional distribution with pulmonary function impairment was then assessed.Results: In this study, 86 patients fulfilled the inclusion criteria. Both EmphCTLV and EmphPLV were significantly lower than the LAA indices independently of emphysema severity. CT-derived TLV significantly increased with emphysema severity (from 6,143 ± 1,295 up to 7,659 ± 1,264 ml from mild to very severe emphysema, p < 0.005) and thus, both EmphCTLV and LAA significantly underestimated emphysema extent when compared with those values adjusted to the predicted lung volume. All CT-derived emphysema indices presented moderate to strong correlations with residual volume (RV) (with correlations ranging from 0.61 to 0.66), total lung capacity (TLC) (from 0.51 to 0.59), and FEV1 (~0.6) and diffusing capacity for carbon monoxide DLCO (~0.6). The values of FEV1 and DLCO were significantly lower, and RV (p < 0.001) and TLC (p < 0.001) were significantly higher with the increasing emphysema extent and when emphysematous areas homogeneously affected the lungs.Conclusions: Emphysema volume must be referred to the predicted and not to the measured lung volume when assessing the CT-derived emphysema extension. Pulmonary function impairment was greater in patients with higher emphysema volumes and with a more homogeneous emphysema distribution. Further studies are still necessary to assess the significance of CTpLV in the clinical and research fields.

Prevalence and Key Radiographic Spinal Malalignment Parameters Associated with the Risk of Pulmonary Function Impairment in Patients Treated Surgically to Correct Adult Spinal Deformity.

Introduction There is a significant relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae, and coronal imbalance in patients with childhood spinal deformity. By contrast, the pathophysiology, epidemiology, and influence of deformity on respiratory dysfunction in patients with adult spinal deformity (ASD) remain largely unknown. We sought to clarify and compare the prevalence of pulmonary function impairment in patients with ASD with that in patients with lumbar spinal stenosis (LSS), to determine radiographically which spinal malalignment parameters are associated with a risk of respiratory dysfunction, and to determine the association of respiratory dysfunction with corrective surgery. Methods We conducted a prospective study of consecutive patients with a diagnosis of ASD or LSS who underwent spinal surgery. We included data from 122 consecutive patients with ASD and 121 consecutive patients with LSS. Parameters were obtained from full-length lateral radiographs taken with the patients standing and in supine and prone positions. We compared respiratory dysfunction between a group of patients with ASD and LSS and determined correlations between respiratory dysfunction and spinopelvic parameters. Results Preoperative % forced vital capacity (FVC) of patients with ASD was significantly lower than that of patients with LSS, and the frequency of restrictive ventilatory impairment was significantly higher in those with ASD (15.7%) than those with LSS (7.4%). Thoracolumbar kyphotic curvature (TK) while the patients were in supine position was significantly greater in the group with restrictive ventilatory impairment, and a significant negative correlation was found between %FVC and TK with the patients in supine position. We found no significant improvement of respiratory dysfunction 1 year after surgery. Conclusions Spinal deformity is a potential risk factor for restrictive ventilatory impairment in the elderly. We propose that radiographs obtained when patients are in supine position are valuable for evaluating the flexibility of the TK. Rigid TK might be an etiology of restrictive ventilatory impairment in patients with ASD.

P3.16-35 Stair Climbing Exercise May Ameliorate Pulmonary Function Impairment in Patients at One Month After Lung Cancer Resection

P3.16-35 Stair Climbing Exercise May Ameliorate Pulmonary Function Impairment in Patients at One Month After Lung Cancer Resection

Using the Lower Limit of Normal Instead of the Conventional Cutoff Values to Define Predictors of Pulmonary Function Impairment in Subjects With Chronic Heart Failure.

Using the newer lower limit of normal criterion instead of the conventional cutoff values to define pulmonary function abnormalities may result in different predictors of pulmonary function impairment in patients with heart failure. Therefore, we assessed predictors of pulmonary function impairment in subjects with chronic heart failure according to the lower limit of normal in comparison with conventional cutoff values. In this prospective cross-sectional study, 164 chronic heart failure subjects (age 68 ± 10 y, 78% men, 88% New York Heart Association class I-II) with left ventricular ejection fraction <40% underwent pulmonary function tests. Predictors of pulmonary function impairment were assessed using the lower limit of normal and conventional cutoff values (ie, 80% predicted value and the fixed ratio of FEV1/FVC <0.7). The lower limit of normal criterion identified an extra independent predictor of diffusion impairment compared with the 80% predicted value; in addition to body mass index, pack-years, and alveolar volume, female sex also turned out to be an independent predictor. A smoking history of ≥10 pack-years was a significant predictor of diffusion impairment and airway obstruction using the lower limit of normal criterion but not using the conventional cutoff values. However, lowering the cutoff points of conventional criteria to match the more stringent lower limit of normal and thus avoid overdiagnosis of diffusion impairment and airway obstruction in the elderly produced similar results as the lower limit of normal. The lower limit of normal identifies more predictors of diffusion impairment and airway obstruction compared with conventional cutoff values in subjects with chronic heart failure with left ventricular systolic dysfunction. However, lowering the conventional cutoff points yielded similar results as the lower limit of normal. (ClinicalTrials.gov registration NCT01429376.).

Pulmonary function impairment in patients with chronic heart failure: Lower limit of normal versus conventional cutoff values

ObjectiveTo determine the prevalence of pulmonary function abnormalities in patients with chronic heart failure (HF) according to recent American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines using the lower limit of normal (LLN) compared to conventional cutoff values. BackgroundRecent ATS/ERS guidelines recommend the use of the LLN instead of the conventional cutoff values to define pulmonary function impairment to avoid misclassification of patients. However, studies addressing the prevalence of pulmonary function abnormalities according to both definitions in patients with chronic HF are lacking. MethodsIn this prospective cross-sectional study, 164 chronic HF outpatients (age 68 ± 10 years, 78% men, 88% New York Heart Association class I–II) with left ventricular ejection fraction < 40% underwent spirometry and measurement of diffusing capacity. Body plethysmography was performed in patients with abnormal spirometry results. ResultsDiffusion impairment and airway obstruction were found in 44–58% and 26–37% of the patients, respectively, depending on the definition used (LLN versus conventional cutoff values, p < 0.05). However, restriction was infrequent, irrespective of the definition used (7% versus 5%, respectively, p > 0.05). The LLN identified fewer patients with abnormal lung function, whereas the conventional cutoff values classified more patients with diffusion impairment, airway obstruction, or a mixed category. Twenty-seven percent of patients were misclassified by the conventional cutoff values. ConclusionPulmonary function abnormalities, especially diffusion impairment and airway obstruction, were highly prevalent in patients with chronic HF. Conventional cutoff values classified more patients with diffusion impairment, airway obstruction, or a mixed category compared to the LLN.

The Lower Limit of Normal in the evaluation of pulmonary function

Pulmonary function tests (PFTs) are widely used in the clinical evaluation of patients with pulmonary and cardiovascular disease. The underlying premise is that lung volumes and air flow through the airways are correlated with measurements of body size and are influenced by age. The result is a set of equations that have lung volume and airway flow as dependent variables of height, age, sex, race and weight and their appropriate coefficients as independent predictors. Higher order exponential relationships are accommodated using logarithms. 1 Quanjer P.H. Stanojevic D. Stocks J. Cole C.G. GAMLSS in Action. 2012http://www.lungfunction.org/gamlss.html Google Scholar The assumption that measurements of body size determine lung size and airway flow is derived form basic biological observations that establish that organ size in mammals scales with the square of the length and that measurements of body size determine metabolic rate, heat losses and the mechanical energy necessary for distribution of oxygen through the tissues. 2 Apell S.P. Wahlsten O. Gawlitza H. Body Mass Index – A Physics Perspective. ArXiv e-prints, 2011: 296 Google Scholar , 3 West G.B. Brown J.H. Enquist B.J. A general model for the origin of allometric scaling laws in biology. Science. 1997; 276: 122-126 Crossref PubMed Scopus (3466) Google Scholar , 4 McMahon T. Size and shape in biology. Science. 1973; 179: 1201-1204 Crossref PubMed Scopus (844) Google Scholar Reference equations that establish expected or predicted values for lung volume and for spirometry based on age and height derived from datasets of healthy individuals are widely used. 5 Pulmonary Function Predicted Values. Johns Hopkins Pulmonary Function Laboratory, Baltimore, Maryland, USA2001http://www.hopkinsmedicine.org/pftlab/pfpred.htm Google Scholar , 6 Quanjer P.H. Stocks J. Cole T.J. Hall G.L. Stanojevic S. Influence of secular trends and sample size on reference equations for lung function tests. Eur Respir J. 2011; 37: 658-664 Crossref PubMed Scopus (134) Google Scholar Pulmonary function impairment in patients with chronic heart failure: Lower limit of normal versus conventional cutoff valuesHeart & Lung: The Journal of Cardiopulmonary and Acute CareVol. 43Issue 4PreviewTo determine the prevalence of pulmonary function abnormalities in patients with chronic heart failure (HF) according to recent American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines using the lower limit of normal (LLN) compared to conventional cutoff values. Full-Text PDF

Clinical significance of pulmonary function test in patients with chronic rhinosinusitis with nasal polyps

To investigate the incidence and severity of pulmonary function impairment in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). In this prospective study, fifty-six patients with bilateral CRSwNP who were scheduled for functional endoscopic sinus surgery during a period from March to June 2010 in the Department of Otolaryngology of Qilu Hospital, were recruited in this study. Routine medical and rhinological examinations such as nasal endoscopy, sinus CT scan, and skin prick tests (SPT) for common inhalant and food allergens, and cytological examination of the paraffin-embedded NP tissues were performed together with a full assessment of the pulmonary functions. Based on the pulmonary function tests, the rate of patients showing bronchial hyperresponsiveness (BHR), asthma, and abnormal pulmonery functions were 37.5%, 44.6%, and 53.6%. In patients who did not have a history of lower airway symptoms, the rate of abnormal pulmonary functions was 50.0%, the rate of BHR was 43.2%. There was an increased rate of BHR, asthma and abnormal pulmonary functions in patients with a higher polyp grading score or Lund Mackay CT scan score (polyp grading score: χ(2) were 8.077, 3.989 and 7.445, P < 0.01 or < 0.05. CT scan score: χ(2) were 3.863, 5.380 and 4.309; 4.293, 4.293 and 4.572; 10.572, 13.504 and 13.295, P < 0.01 or < 0.05). The rate of BHR and asthma in patients with positive SPT were higher (P < 0.05). In patients with eosinophils hyperplasia in nasal polyps, the rate of BHR, asthma and abnormal pulmonary functions were higher (χ(2) were 4.065, 5.217 and 3.376, P < 0.05 or P < 0.01). There is a high risk of developing lower airway diseases in patients with CRSwNP.

The Validity of Static Lung Compliance in Asbestos-induced Diseases

Pulmonary compliance can be viewed as an indicator of distensibility of the lungs, not only in asbestos-induced pulmonary disorders but also in visceral pleural fibrosis extending into the lung parenchyma. In this study we evaluated static compliance measurements in asbestos-derived diseases, especially in patients with parietal pleura plaques. Lung function analyses, especially static lung compliance, were correlated with high-resolution computer tomography examinations. Sixty-three patients with parietal pleural plaques, 10 with visceral pleural fibrosis, 39 with parenchymal pulmonary asbestosis together with parietal pleural plaques, and 42 with parenchymal pulmonary asbestosis together with visceral pleural fibrosis were enrolled in the study. In comparison with patients having only parietal pleural plaques, those having asbestosis and visceral pleural fibrosis showed significant decreases in static lung compliance, diffusing capacity, and vital capacity. Visceral pleural thickening was also associated with significantly reduced FEV(1), MEF(50), and FEV(1)/FVC ratios. Multiple regression analyses indicated that the existence of visceral pleural fibrosis (p = 0.017) is the most important factor accounting for a decrease in static compliance. Reference values of static lung compliance differ notably. In comparison with mean reference values, the sensitivity of detecting reduced lung compliance was calculated to be between 9.7 and 45.5 %. Other respiratory function variables failed to show any significant differences. Our data indicate that the measurement of static compliance is not sufficient for early detection of pulmonary function impairment in patients with parietal pleural plaques.

Evaluation of the relationship between radiological abnormalities and both pulmonary function and pulmonary hypertension in coal workers’ pneumoconiosis

The aim of this study was to investigate the effect of the radiological evidence of emphysema, and the extent of interstitial involvement, on lung function and pulmonary arterial pressure (PAP) in patients with coal workers' pneumoconiosis (CWP). The records of 48 patients with suspected CWP were evaluated retrospectively. Pulmonary function tests, arterial blood gas analyses and right heart catheterization were evaluated in all patients. Radiological scoring was according to International Labour Organization criteria, and emphysema was scored by CT scanning. Patients were grouped according to the mean PAP (> or =20 mm Hg or < or =19 mm Hg). All patients showed a mild decrease in FEV(1)/FVC and a mild increase in FRC. Forty-four per cent of patients developed mild to moderate pulmonary hypertension. Emphysema scores correlated significantly with airflow rates, including FEV(1)%, FEV(1)/FVC and FEF(25-75%), and with carbon monoxide diffusing capacity (DLCO)% predicted as well as FRC% predicted and the ratio RV/TLC, which are indices of air trapping. Additionally, profusion and global profusion scores showed significant correlation with FEV(1)/FVC, DLCO% predicted, specific airway conductance and smoking. Mean PAP showed a significant negative correlation with FEF(50%) predicted, DLCO% predicted and profusion score. The impairment of pulmonary function (mainly disturbance in airflow rates and air trapping) and pulmonary hypertension may be present, even in a simple form of CWP. The pulmonary function impairment in patients with CWP is likely to be attributable to the occurrence of emphysema. However, pulmonary hypertension was directly related to the profusion of pneumoconiotic nodules, which may result in obliteration of the vascular bed.

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Dose-Response Relationship and Irreversible Obstructive Ventilatory Defect in Patients With Consumption of Sauropus androgynus

To determine the dose-response aspect of pulmonary function impairment in patients with consumption of Sauropus androgynus for weight reduction. A questionnaire and pulmonary function tests were performed in 194 patients with a history of consumption of S androgynus with or without chest symptoms. Patients with obstructive ventilatory defect received follow-up spirometry 22 to 24 months after beginning consumption of the vegetable. Data from 178 patients were analyzed. Patients generally consumed 150 g of S androgynus daily as raw juice (60.7%), sauteed (16.9%), mixed preparation (20.8%), or boiled (1.7%) for various periods of time. We divided patients into five groups according to the total dose consumed (group A, 0 to 1,799 g; group B, 1,800 to 3,599 g; group C, 3,600 to 5,399 g; group D, 5,400 to 7,199 g; and group E, > or =7,200 g). The frequency of obstructive ventilatory defect was higher in the high-dose group than in the low-dose group (A, 4/43=9.3%; B, 13/64=20.3%; C, 14/32=43.8%; D, 5/12=41.7%; and E, 13/27=48.1%; p < 0.01). In total, 49 patients (27.5%) had moderate to severe obstructive ventilatory defects without bronchodilator response. The FEV1 and FEV1 percent predicted in these 49 patients were 0.96+/-0.38 L (mean+/-SD) and 41.8+/-16.9%, respectively. Sixty-five percent of these 49 patients began to suffer from dyspnea in the third, fourth, or fifth month after taking the vegetable and no patient began to develop dyspnea later than 7 months after beginning consumption of the vegetable. Using stepwise multiple regression, we found that the FEV1 percent predicted was negatively associated with the total dose ingested (r=0.24, p < 0.01). Follow-up spirometry showed that the obstructive ventilatory defect was irreversible in all patients. Consumption of S androgynus can result in moderate to severe obstructive ventilatory defect within 7 months, and the disorder was irreversible in the observation period for 22 months.