Pulmonary Function Measurements Research Articles

Relationship between obesity, body composition, and pulmonary function among Korean adults aged 40 years and older

Pulmonary function is influenced by factors such as age, sex, height, and weight. This study investigated the relationship between obesity, body composition, and pulmonary function measures (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], and the FEV1-to-FVC ratio) of Korean adults aged 40 years and older. Using the fifth Korea national health and nutrition examination survey in 2010 and 2011, multiple regression analyses were performed to identify factors associated with pulmonary function, stratified by sex. Independent variables were waist circumference (WC) and an additional measure of obesity/muscularity (weight in model 1, body mass index [BMI] in model 2, and fat-free mass index [FFMI] in model 3). Among 3918 adults, the mean FFMI was 17.7 and 15.0 kg/m2 for men and women, respectively. Weight and BMI were positively associated with only FEV1 (B = 0.003 and B = 0.006, respectively, p < 0.01) and the FEV1-to-FVC ratio (B = 0.001, p < 0.01) in women. FFMI was positively associated with FEV1 and FVC in both sexes (B = 0.019, p < 0.05 for FEV1 and B = 0.020, p < 0.01 for FVC in men; B = 0.025, p < 0.0001 for FEV1 and B = 0.022, p < 0.0001 for FVC in women). WC was inversely associated with FEV1 and FVC in men and FEV1 in women, respectively. Weight and BMI behaved as indicators of body size based on their positive associations with pulmonary function. In conclusion, FFMI can be an important and consistent predictor of pulmonary function in both men and women.

In-office Maximal Voluntary Ventilation Testing Demonstrates Pulmonary Improvement Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Pulmonary function can be impaired in patients with adolescent idiopathic scoliosis (AIS). Maximal voluntary ventilation (MVV) has been shown to be more strongly correlated with major coronal curve, and a more easily obtained measurement of pulmonary function, than forced vital capacity (FVC). We evaluated changes in pulmonary function using these 2 measures in patients with AIS in relation to changes in major coronal curves over time. Forty-seven patients with AIS with thoracic curves ≥10 degrees performed pulmonary function tests using the Carefusion MicroLoop Spirometer at enrollment and 1 year later. Major coronal curve worsening >5 degrees was considered curve progression. At enrollment, 47 patients had a mean major coronal curve of 38 degrees (range: 10 to 76 degrees). One year later, 17 patients had undergone posterior spinal fusion, 9 had curve progression >5 degrees, and 21 had no progression. MVV and major coronal curve were negatively correlated (r = -0.36, P = 0.01) at enrollment. After fusion, the major coronal curve improved by a mean of 41 degrees, and MVV improved by 23% (P < 0.01), but FVC did not improve significantly (6%, P = 0.29). In stable curves, MVV improved 12% (P = 0.01) and FVC improved 9% (P = 0.007). In patients without surgery whose curves progressed an average of 11 degrees, there was no significant change in MVV or FVC (P > 0.44). This is the first study using office-based spirometry in an orthopaedic clinic showing improved pulmonary function with posterior spinal fusion and growth in patients with AIS. It is notable that MVV improved after spinal fusion, but FVC did not, as MVV appears to be a more sensitive measurement for the assessment of pulmonary function in these patients. Level II.

House dust metagenome and pulmonary function in a US farming population

BackgroundChronic exposure to microorganisms inside homes can impact respiratory health. Few studies have used advanced sequencing methods to examine adult respiratory outcomes, especially continuous measures. We aimed to identify metagenomic profiles in house dust related to the quantitative traits of pulmonary function and airway inflammation in adults. Microbial communities, 1264 species (389 genera), in vacuumed bedroom dust from 779 homes in a US cohort were characterized by whole metagenome shotgun sequencing. We examined two overall microbial diversity measures: richness (the number of individual microbial species) and Shannon index (reflecting both richness and relative abundance). To identify specific differentially abundant genera, we applied the Lasso estimator with high-dimensional inference methods, a novel framework for analyzing microbiome data in relation to continuous traits after accounting for all taxa examined together.ResultsPulmonary function measures (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio) were not associated with overall dust microbial diversity. However, many individual microbial genera were differentially abundant (p-value < 0.05 controlling for all other microbial taxa examined) in relation to FEV1, FVC, or FEV1/FVC. Similarly, fractional exhaled nitric oxide (FeNO), a marker of airway inflammation, was unrelated to overall microbial diversity but associated with differential abundance for many individual genera. Several genera, including Limosilactobacillus, were associated with a pulmonary function measure and FeNO, while others, including Moraxella to FEV1/FVC and Stenotrophomonas to FeNO, were associated with a single trait.ConclusionsUsing state-of-the-art metagenomic sequencing, we identified specific microorganisms in indoor dust related to pulmonary function and airway inflammation. Some were previously associated with respiratory conditions; others were novel, suggesting specific environmental microbial components contribute to various respiratory outcomes. The methods used are applicable to studying microbiome in relation to other continuous outcomes.3hzq1LfdnyTZVYvBm7QT8RVideo

Brief Report: Alternative pulmonary function measures of emphysema in people with HIV

Introduction: People with HIV (PWH) have nearly twice the risk of emphysema of people without HIV. This risk, which has been associated with HIV-mediated changes in the lung immune environment and more extensive radiographic emphysema, may result in different patterns of airflow limitation on pulmonary function testing (PFT) than those traditionally used in people without HIV. Methods: In this prospective cohort of PWH in Atlanta, Georgia, we analyzed PFT and chest computed tomography (CT) data from July 2013 through June 2018. After comparing the prevalence of PFT measures of airflow limitation for those with and without radiographic emphysema, we used binary recursive partitioning to identify PFT measures that differentiated between PWH with and without radiographic emphysema. Results: Among 167 PWH who had both PFT and CT data during the study period, 89 (53%) had radiographic emphysema. Those with radiographic emphysema were more likely to have airflow limitation on PFTs. Recursive partitioning identified partitions at a forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC) of 0.78 and a residual volume (RV) of 116% predicted. These partitions enabled the identification of 84 (94%) PWH with radiographic emphysema, in contrast to the traditional diagnostic criteria of an FEV1/FVC ratio of 0.7, which only identified 49 (55%) of those with radiographic emphysema. Conclusion: Emphysema in PWH may have different patterns of airflow limitation on PFTs which are not adequately captured by traditional diagnostic criteria. Future studies can seek to validate these findings and determine optimal thresholds for diagnosing HIV-associated emphysema.

Association between swallowing dynamics, tongue pressure and pulmonary function in patients with idiopathic pulmonary fibrosis

BackgroundSwallowing is a complex process that requires the coordination of muscles in the mouth, pharynx, larynx, and esophagus. Dysphagia occurs when a person has difficulty swallowing. In the case of subjects with respiratory diseases, the presence of oropharyngeal dysphagia potentially increases lung disease exacerbations, which can lead to a rapid decline in lung function. This study aimed to analyze the swallowing of patients with idiopathic pulmonary fibrosis (IPF).MethodsPatients with IPF were evaluated using the Eating Assessment Tool (EAT-10), tongue pressure, the Timed Water Swallow Test (TWST), and the Test of Mastication and Swallowing Solids (TOMASS). The findings were related to dyspnea severity assessed by the modified Medical Research Counsil (mMRC) score; the nutritional status screened with Mini Nutritional Assessment (MNA) tool; and pulmonary function tests, specifically spirometry and measurement of the diffusing capacity for carbon monoxide (DLCO), the maximal inspiratory pressure (PImax), and the maximal expiratory pressure (PEmax).ResultsThe sample consisted of 34 individuals with IPF. Those who exhibited swallowing modifications scored lower on the MNA than those who did not (9.6 ± 0.76 vs. 11.64 ± 0.41 points; mean difference 1.98 ± 0.81 points; p = 0.02). They also showed poorer lung function when considering the predicted force vital capacity (FVC; 81.5% ± 4.61% vs. 61.87% ± 8.48%; mean difference 19.63% ± 9.02%; p = 0.03). The speed of liquid swallowing was altered in 31of 34 of the evaluated subjects (91.1%). The number of liquid swallows correlated significantly with the forced expiratory volume in 1 s (FEV1)/FVC ratio (r = 0.3; p = 0.02). Solid eating and swallowing assessed with the TOMASS score correlated with lung function. The number of chewing cycles correlated negatively with PImax% predicted (r = -0.4; p = 0.0008) and PEmax% predicted (r = -0.3; p = 0.02). FVC% predicted correlated with increased solid swallowing time (r = -0.3; p = 0.02; power = 0.6). Swallowing solids was also impacted by dyspnea.ConclusionPatients with mild-to-moderate IPF can present feeding adaptations, which can be related to the nutritional status, lung function, and the severity of dyspnea.

Body Mass Index and Thoracic Expansion in Post-COVID Dyspnea: A Secondary Analysis.

Dyspnea secondary to lung impairment can persist following the acute phase of COVID-19. Thoracic expansion measurements have been used as a diagnostic tool to evaluate chest wall mobility, respiratory function, and the effects of respiratory muscle strength training. Changes in chest wall mobility may occur because of altered chest biomechanics in individuals with respiratory diseases and an elevated body mass index (BMI). The purpose of this secondary analysis was to evaluate whether BMI influences thoracic expansion or forced expiratory volume over 1 second (FEV1) in individuals with persistent dyspnea following COVID-19. This study assessed the relationship between BMI and thoracic expansion, pulmonary symptoms, and exercise capacity following a home-based pulmonary rehabilitation intervention. A secondary data analysis was conducted with a sample of 19 adults with persistent dyspnea following COVID-19 infection who participated in a 12-week, home-based pulmonary rehabilitation study. Participants received expiratory muscle strength training devices and were instructed to perform pulmonary rehabilitation exercises three times per week over the study period. Pulmonary function, pulmonary symptoms, exercise capacity, and BMI measurements were collected. For analysis, study participants were divided into obese (BMI > 30 kg/m2) or nonobese (BMI < 30 kg/m2) categories. Correlations using the change scores from baseline to 12 weeks between thoracic expansion, FEV1, pulmonary symptoms, and exercise capacity were assessed. In addition, the minimal detectable change (MDC) in thoracic expansion was explored. Thoracic expansion was significantly improved after 12 weeks of training (p = .012) in the nonobese group. There was a significant correlation between the change in walking distance and pulmonary symptoms (r = -.738, p < .001) and in thoracic expansion (r = .544, p = .020), and walking distance, when controlling for BMI, but no change in FEV1. Average MDC was 1.28 for inspiration and 0.91 for expiration. Measurements of thoracic expansion were significantly lower in post-COVID individuals with an increased BMI. Individuals with persistent dyspnea and a higher BMI may require additional measures to increase chest mobility or to detect pulmonary changes following COVID-19.

Ventilatory Variability Is Increased at Rest in Pulmonary Arterial Hypertension

Ventilatory instability is associated with adverse outcomes in left heart failure, with periodic breathing during awake, rest, sleep and exercise (exercise oscillatory ventilation) associated with increased mortality. Increased peripheral and central chemoreflex sensitivities and impairment of cardiac output have been implicated as causative mechanisms of ventilatory instability in heart failure. As these factors are also present in pulmonary arterial hypertension (PAH), we tested the hypothesis that variability of breath-by-breath ventilation at rest would be increased in PAH compared with healthy controls. In fourteen patients with PAH (9 female, age 48.4±12.8 years, mean ± SD) and 14 healthy participants (9 female, age 49.4±14.2 years) breath-by-breath measurement of tidal volume and breathing frequency was undertaken with a pneumotachometer connected via a mouthpiece with nose-clip for 10 minutes while they rested awake and supine. Ventilatory (V̇E) variability was assessed using root mean square of successive differences (RMSSD), standard deviation (SD), average real variability (ARV, i.e., sum of absolute differences in successive observations), coeffcient of variation (CoV), as well as Poincaré analysis and compared between PAH and healthy controls (Student’s t-test). Correlations between measures of ventilatory variability and pulmonary hemodynamic characteristics, exercise capacity and function were assessed with Pearson’s correlation coeffcient. Resting V̇E was higher in PAH compared to healthy controls (14.3±1.1 and 12.1±0.5 L·min−1 respectively; p=0.009). Measures of variability for V̇E were increased in PAH compared to healthy controls. More specifically, RMSSD (3.59±1.36 vs. 2.48±0.87 L·min−1, p=0.017), SD (2.92±1.14 vs. 1.98±0.53 L·min−1, p=0.012), ARV (2.47±0.97 vs. 1.67±0.60 L·min−1, p=0.016), Poincaré SD1 (short-term variability, p=0.020) and SD2 (long-term variability, p=0.028) were increased in PAH compared to healthy controls, respectively. No correlations were found between measures of ventilatory variability and pulmonary hemodynamics (mean pulmonary artery pressure, pulmonary vascular resistance, and cardiac output), six-minute walk distance or WHO functional class. In summary, resting ventilatory variability is increased in PAH and not associated with haemodynamic factors and exercise capacity. Whether such raised ventilatory variability in PAH is related to increased chemoreflex sensitivity requires exploration. This study received funding support from the Greenlane Research and Educational Fund (21/01/4153), Health Research Council of New Zealand (19/687), and the Sidney Taylor Trust. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

BUOYANCY ASSESSED WITH FLOATING TESTS AND UNDERWATER WEIGHING. A PILOT STUDY

The aim of the present study was to compare the buoyancy assessed by floating tests with the buoyancy calculated using the variables measured during underwater weighing. We also aimed to evaluate the relationship between assessed buoyancy and body composition. Twenty-seven women (age: 20 ± 3 years, height: 1.66 ± 0.34 m, weight: 62 ± 7 kg; body mass index: 22 ± 2; vital capacity: 4.26 ± 0.47 l) and twenty-six men (age: 19 ± 2 years, height: 1.81 ± 6.76 m, weight: 79 ± 10 kg body mass index: 24 ± 3; vital capacity: 6.05 ± 0.7 l) volunteered to participate in the study. They performed floating tests, underwater weighing, pulmonary function measurement, and body composition procedure on the same day in random order with a 30-minute break. Floating testing consisted of one horizontal (HT) and two vertical tests with different arm positions, i.e., arms adducted to the body (VT1) or arms extended overhead (VT2). We assessed participants' buoyancy (B-HT, B-VT1, and B-VT2). In addition, we calculated participants' body volume and buoyancy (B-c) using variables measured during underwater weighing. Results showed that B-c was moderately correlated with B-VT1 (Spearman's ρ = 0.51; p &lt; 0.001) and B-VT2 (Spearman's ρ = 0.55; p &lt; 0.001), but not with B-HT. Multiple regression analysis showed that vital capacity and muscle mass had a positive and negative effect, respectively, on the scores of buoyancy assessed by vertical floating tests. In addition, the mass of the arms correlated negatively with the scores of buoyancy assessed by VT2 (β = -6.26; p = 0.005). According to the obtained results, we can conclude that both vertical floating tests i.e. with arms adducted to the body or arms extended overhead are suitable substitutes for underwater weighing to determine buoyancy, which is strongly related to vital capacity and lesser extent to muscle mass. Muscle mass is not a factor that can be changed immediately, while the amount of inspiration can be regulated. Therefore, the control of breathing and thus the reduction or increase of buoyancy is an important skill that novice swimmers should acquire as part of the learn-to-swim program.

Endothelin-1-mediated Brainstem Glial Activation Produces Asthmatic Airway Vagal Hypertonia Via Enhanced ATP-P2X4 Receptor Signaling in Sprague-Dawley Rats.

The occurrence of major asthma symptoms is largely attributed to airway vagal hypertonia, of which the central mechanisms remain unclear. This study tests the hypotheses that endothelin-1-mediated brainstem glial activation produces asthmatic airway vagal hypertonia via enhanced action of adenosine 5'-triphosphate on neuronal purinergic P2X4 receptors. A rat model of asthma was prepared using ovalbumin. Airway vagal tone was evaluated by the recurrent laryngeal discharge and plethysmographic measurement of pulmonary function. The changes in the brainstem were examined using ELISA, Western blot, luciferin-luciferase, quantitative reverse transcription-polymerase chain reaction, enzyme activity assay and immunofluorescent staining, respectively. The results showed that in the medulla of rats, endothelin receptor type B and P2X4 receptors were primarily expressed in astrocytes and neurons, respectively, and both of which, along with endothelin-1 content, were significantly increased after ovalbumin sensitization. Ovalbumin sensitization significantly increased recurrent laryngeal discharge, which was blocked by acute intracisternal injection of P2X4 receptor antagonist 5-BDBD, knockdown of brainstem P2X4 receptors, and chronic intraperitoneal injection of endothelin receptor type B antagonist BQ788, respectively. Ovalbumin sensitization activated microglia and astrocytes and significantly decreased ecto-5'-nucleotidase activity in the medulla, and all of which, together with the increase of medullary P2X4 receptor expression and decrease of pulmonary function, were reversed by chronic BQ788 treatment. These results demonstrated that in rats, allergic airway challenge activates both microglia and astrocytes in the medulla via enhanced endothelin-1/endothelin receptor type B signaling, which subsequently causes airway vagal hypertonia via augmented adenosine 5'-triphosphate/P2X4 receptor signaling in central neurons of airway vagal reflex.

Problems in diagnosing pre-COPD (case report)

Cigarette smoke is a key risk factor for developing COPD (GOLD, 2024). One of the factors responsible for tissue damage and bronchial remodeling in the early stages of the disease is patients’ hypersensitivity to nicotine and components of cigarette smoke. Because of early life adversity combined with environmental and genetic interactions, pulmonary function measures alone may not be appropriate for the early recognition and diagnosis of COPD. It seems necessary to identify biomarkers of the risk of developing pre-COPD to identify the early stage of the disease. In the article we describe the clinical case of patient M., 21 years old, a smoker with a history of respiratory symptoms, who has signs of chronic obstructive pathology with the formation of bronchial hypersensitivity and persistent obstruction that does not reach the threshold for COPD, which reflects a common clinical problem. Сertainly, the formation of the concept of pre-COPD and the development of clinical and instrumental diagnostic criteria are necessary. Previously, we developed and tested a prick-prick test method with nicotine. We propose to use skin testing with a nicotine solution as one of the diagnostic biomarkers to identify hypersensitivity at the first stage of tissue damage.

Evaluating performance on the Glittre-ADL test in men with long COVID 3 years after a SARS-CoV-2 infection

Background/objectiveMany COVID-19 survivors, especially those who have been hospitalized, have been suffering numerous complications that limit their activities of daily living, although changes that persist 3 years after infection are still not known. We aimed to investigate the impact of long COVID on the Glittre-ADL test (TGlittre) 3 years after acute infection in men who needed hospitalization and explore whether the performance on the TGlittre is associated with impairments in lung function, muscle strength, physical function and quality of life (QoL). MethodsCross-sectional study with 42 men with long COVID who took the TGlittre. They underwent pulmonary function tests and measurements of handgrip strength and quadriceps strength (QS). Additionally, they also completed the Saint George Respiratory Questionnaire (SGRQ) and Functional Independence Measure (FIM). ResultsThe mean age was 52 ± 10.6 years, while the mean time after diagnosis of COVID-19 was 37 ± 3.5 months. The mean TGlittre time was 3.3 (3.1–4.1) min, which was 10% greater than the time expected for normal individuals to complete it. The TGlittre time was correlated significantly with the QS (rs = −0.397, p = 0.009), pulmonary diffusion (rs = − 0.364, p = 0.017), FIM (rs = −0.364, p = 0.017) and the “activity” domain score of the SGRQ (rs = 0.327, p = 0.034). ConclusionFunctional capacity on exertion as measured by the TGlittre time is normal in most men with long COVID 3 years after hospitalization. However, this improvement in functional capacity does not seem to be reflected in muscle strength or QoL, requiring continued monitoring even after 3 years.

A Real-World Study of Nusinersen Effects in Adults with Spinal Muscular Atrophy Type 2 and 3.

Spinal muscular atrophy (SMA) is a progressive genetic disorder characterized by muscle weakness ultimately leading to pulmonary impairments that can be fatal. The recent approval of nusinersen, a disease-modifying therapy, substantially changed the prognosis for patients, particularly in children. However, real-world evidence about its long-term effectiveness in adults remains limited. This study aimed to document longitudinal data on motor function, pulmonary function and patient-reported outcome measures of Canadian adults with SMA type 2 and 3 treated with nusinersen. Outcomes from 17 patients were collected at the Institut de réadaptation en déficience physique de Québec during routine clinical visits over 36 months post nusinersen treatment, using the Hammersmith Functional Motor Scale Expanded for SMA (HFMSE), Revised Upper Limb Module (RULM), 6-Minute Walk Test (6MWT), Children's Hospital of Philadelphia Adult Test of Neuromuscular Disorders (CHOP-ATEND), SMA functional rating scale (SMAFRS), pulmonary function testing and subjective changes reported by patients. After 36 months, 9 patients showed motor function improvement. Changes beyond the minimal clinically important difference were seen for four patients on the HFMSE, four patients on the RULM and five patients on the 6MWT. Pulmonary function remained stable for most subjects. Subjective positive changes were reported in 88% of patients and five patients showed improvement in the SMAFRS. This real-world study demonstrates the positive effects of nusinersen in adults with SMA types 2 and 3. Although stabilizing the patient's condition is considered therapeutic success, this study shows an improvement in motor function and subjective gains in several patients.

Preoperative pulmonary function is associated with left ventricular assist device outcomes

IntroductionAlthough left ventricular assist device (LVAD) implantation is associated with improved survival in patients with end-stage heart failure, the impact of preoperative pulmonary function on short-term outcomes is unclear. MethodsWe conducted a retrospective review of all primary LVAD implants at a single institution. Common measures of preoperative pulmonary function were evaluated. Survival was estimated using the Kaplan-Meier method. ResultsFrom 2017–2022, 107 patients underwent primary LVAD implantation. Prior to implantation, 68 (63.6 %) were on room air, 28 (26.4 %) were on nasal cannula, 2 (1.9 %) were on noninvasive positive pressure ventilation, and 9 (8.5 %) were on the ventilator. The average preoperative fraction of inspired oxygen (FiO2) was 25.3 ± 8.2 % while the mean percentage predicted forced expiratory volume in 1 second (FEV1) was 71.4 ± 20.9 %. Overall, 1-year survival was 86.8 %, the median postoperative ventilator time was 20.4 [4.2-77.7] h, and 18 (16.8 %) patients required postoperative tracheostomy. When stratified by pulmonary function, lower FEV1 and increased preoperative FiO2 were associated with decreased 1-year survival ConclusionsIn conclusion, preoperative pulmonary function is associated with short-term LVAD survival, postoperative ventilatory time, and need for tracheostomy. Therefore, rigorous pulmonary function evaluation may help in appropriate preoperative risk stratification.

Patient Engagement With and Perspectives on a Mobile Health Home Spirometry Intervention: Mixed Methods Study.

Patient engagement attrition in mobile health (mHealth) remote patient monitoring (RPM) programs decreases program benefits. Systemic disparities lead to inequities in RPM adoption and use. There is an urgent need to understand patients' experiences with RPM in the real world, especially for patients who have stopped using the programs, as addressing issues faced by patients can increase the value of mHealth for patients and subsequently decrease attrition. This study sought to understand patient engagement and experiences in an RPM mHealth intervention in lung transplant recipients. Between May 4, 2020, and November 1, 2022, a total of 601 lung transplant recipients were enrolled in an mHealth RPM intervention to monitor lung function. The predictors of patient engagement were evaluated using multivariable logistic and linear regression. Semistructured interviews were conducted with 6 of 39 patients who had engaged in the first month but stopped using the program, and common themes were identified. Patients who underwent transplant more than 1 year before enrollment in the program had 84% lower odds of engaging (odds ratio [OR] 0.16, 95% CI 0.07-0.35), 82% lower odds of submitting pulmonary function measurements (OR 0.18, 95% CI 0.09-0.33), and 78% lower odds of completing symptom checklists (OR 0.22, 95% CI 0.10-0.43). Patients whose primary language was not English had 78% lower odds of engaging compared to English speakers (OR 0.22, 95% CI 0.07-0.67). Interviews revealed 4 prominent themes: challenges with devices, communication breakdowns, a desire for more personal interactions and specific feedback with the care team about their results, understanding the purpose of the chat, and understanding how their data are used. Care delivery and patient experiences with RPM in lung transplant mHealth can be improved and made more equitable by tailoring outreach and enhancements toward non-English speakers and patients with a longer time between transplant and enrollment. Attention to designing programs to provide personalization through supplementary provider contact, education, and information transparency may decrease attrition rates.

Clinical utility of the Borg dyspnoea score in 6-minute walk tests in interstitial lung disease: A systematic review

BackgroundExertional dyspnoea, a cardinal symptom in interstitial lung disease (ILD), can be objectively measured during a 6-min walk test (6MWT) using the Borg Dyspnoea Score (BDS). However, the clinical utility of this measurement is unclear. The purpose of this systematic review was to determine the association between 6MWT BDS and prognosis (mortality and lung transplantation), other 6MWT variables and measures of pulmonary function. MethodsMEDLINE, EMBASE, Cochrane and SCOPUS databases were used to identify studies reporting an association between post-6MWT BDS and the relevant outcomes in adults with ILD. Language was limited to English. Study quality was assessed using the Quality in Prognosis Study risk of bias tool. A narrative synthesis for each outcome was performed. ResultsTen full-text studies (n = 518) were included. Four studies had high overall risk of bias. Two studies (n = 127) reported prognosis and both found that higher 6MWT BDS was associated with increased all-cause mortality. However, the certainty of evidence was very low due to study design and likely publication bias. Higher post-6MWT BDS may be associated with shorter, or no effect on 6MWD; and lower pulmonary function. There was insufficient evidence that BDS correlated with 6MWT oxygen saturation. ConclusionsPost-6MWT BDS has a potential role as a predictor of all-cause mortality in ILD, 6MWD and lower pulmonary function. Larger studies designed to confirm these relationships and assess the independent association between the 6MWT BDS and clinical outcomes are required.

The Effects of High Intensity Interval Training (HIIT) on Asthmatic Adult Males

Background – This study explored the effects of High-Intensity Interval Training (HIIT) on pulmonary function, exercise tolerance, and fractional concentration of exhaled nitric oxide (FeNO) in asthmatic and healthy adults. FeNO levels, associated with lung inflammation, are a diagnostic tool for asthma treatment, making this study significant for understanding HIIT's impact on asthma management. Materials and Methods: Fourteen male subjects (7 asthmatic, 7 healthy) participated in a two-week HIIT protocol. Pulmonary function was assessed using peak expiratory flow (PEF), forced vital capacity (FVC), and the FEV1/FVC ratio. FeNO was measured with a NIOX portable device. Subjects underwent a progressive exercise test on a cycle ergometer to determine peak oxygen uptake (VO2 peak), CO2 output (VCO2 peak), ventilation (VE), and time to exhaustion (TTE). HIIT sessions included warm-ups, 10 x 60-second high-intensity bouts with 60-second recovery intervals, and cool-downs. Intensity targeted 75% peak work rate (WR) for asthmatics and 80% for controls. Results: Significant differences were observed between groups in FeNO, VO2 peak, TTE, and peak WR, with no significant changes in pulmonary function measures. Pre-HIIT, asthmatics showed a mean FeNO of 28 ± 2 ppb compared to controls at 18 ± 1 ppb, with post-HIIT levels remaining stable. TTE and peak WR improved in both groups post-HIIT, indicating enhanced exercise tolerance and performance capacity. Specifically, asthmatics showed an increase in TTE from 691 ± 40 s to 781 ± 41 s and in peak WR from 175 ± 13 W to 203 ± 14 W. Conclusion: HIIT was well-tolerated by asthmatic subjects, leading to improved exercise tolerance, higher ventilation, CO2 output, and work rate performance, without significant changes in pulmonary function or FeNO levels. These findings suggest that HIIT can be a safe and effective exercise intervention for asthmatic individuals to enhance exercise performance.

Subglottal resonances in healthy older adults

Resonances of the subglottal airways impact the vocal tract transfer function and voice production during speech through linear and non-linear acoustic coupling. It has been posited that subglottal resonances form acoustic boundaries between contrasting sets of vowels and consonants based on their coupling effects on formant frequencies. Thus far, studies of subglottal resonances have reported data almost exclusively from children and young adults; data from older adults are rare. This study investigates subglottal resonances in eight healthy older adults between 50 and 80 years of age (5 males, 3 females). Initial analyses indicate that the first and especially the second subglottal resonances are at lower frequencies than expected when compared against height-matched young adults but that the subglottal resonance frequencies are not dependent on posture, vowel acoustics, or standard measures of pulmonary function.

Clinical and functional outcomes associated with pulmonary complications after coronary artery bypass grafting

IntroductionCoronary artery bypass grafting(CABG) is a surgical treatment for coronary artery disease aiming at improving symptoms and life expectancy. Despite this, there are pulmonary and functional complications that may arise during the postoperative period due to invasive mechanical ventilation(IMV), cardiopulmonary bypass and immobility, leading to longer hospital stays.ObjectiveTo evaluate the clinical and functional outcomes related to pulmonary complications in the postoperative period of CABG.MethodsProspective cohort. During the ICU stay the patients were divided into: Non Complicated Group(NCG) who did not present complications and Complicated Group(CG) who presented complication. Functional variables were applied as the six-minute walk test(6MWT), gait speed, sit up and stand up test, Timed Up and Go, peripheral muscle strength, ventilatory, pulmonary function and Functional Independence Measure. These tests were applied preoperatively, at ICU discharge, hospital discharge and six months after surgery.ResultsThe study evaluated 90 patients, 59 in the NCG and 31 CG. In the 6MWT there was a 2%(p = 0.43) decrease in the NCG, while the decrease was 13%(p < 0.01) in the CG. In the MRC the drop was 2%(p = < 0.01) in the CNG, while in the CG the drop was 14%(p = < 0.01). In MIP the NCG had a 6%(p = 0.67) decrease, while the CG had a 16%(p = < 0.01) decrease.ConclusionPatients with postoperative complications of CABG may have reduced functional performance, muscle strength, and pulmonary function at hospital discharge and after six months.

Design and Development of an IoT-based Pulmonary Function and Oxygen Saturation Measurement Device

Health information technology plays a crucial role in managing the healthcare of patients and their families during illness. One of the frequently encountered diseases is Asthma, a chronic inflammatory disorder of the respiratory tract that is reversible and fluctuating, capable of causing exacerbations with mild to severe symptoms and even death. The objective of this research is to develop a device to facilitate the monitoring and input of data regarding pulmonary volume measurements (spirometry) and biosignals (SpO2). The sensors used for measuring pulmonary volume are the flow turbine sensor, while the SpO2 sensor used is the MAX30102. The data obtained from the sensor measurements will be processed on the ESP32. A health monitoring application is created using Kodular software, which incorporates a MySQL database for data storage. Furthermore, the examination results can be accessed through an Android application on a tablet or smartphone. The results obtained from this research indicate an error value of 8.78% for FVC, 14% for FEV1, and a FEV1/FVC ratio of 4.6%, with zero data loss. It is expected that the spirometer with Internet of Things (IoT) capabilities will be implemented, as monitoring can be easily conducted anywhere. The portable design will facilitate future examinations.

Short term effects of MET programme in patients diagnosed with Chronic Obstructive Pulmonary Disease: a randomised controlled trial

Background Muscle Energy Techniques have been reported to provide beneficial effects on range of movement in multiple musculoskeletal dysfunctions. Noting these physiological effects and clinical recommendations, the effects of METs are given importance through investigations on their input in managing COPD symptoms. The maintenance of such outcomes has though not been investigated. Therefore, the aim is to look into the short-term effects, 4-week post completion of the intervention, on pulmonary function, chest measurements, exercise tolerance and ADLs. Method This paper reports outcomes from a randomised controlled trial. 108 patients with COPD were recruited and assigned to 2 groups. The intervention group underwent a 4-week MET programme applied to the accessory muscles of respiration. The control group on the other hand continued with standard medical treatment. Outcome measures were assessed at baseline, at the 4th week time point on completion of the intervention, and again 4 weeks after. The outcome measures were performed in both groups which consisted of the pulmonary function tests, 6-min walk test (6MWT), chest measurements and the Manchester Respiratory Activities of Daily Living (MR-ADL) questionnaire. Results Significant improvements were observed after 4 weeks from cessation of MET intervention when compared to baseline for pulmonary function measures (p < 0.001), chest measurements (p < 0.001) and ADLs (p < 0.001), in subjects enrolled in the intervention group. Conclusions Significant short-term effects in outcome measures following 4 weeks from completion of the MET programme were observed in the intervention group. Clinical trial registration: The study was clinically registered in ClinicalTrials.gov (NCT04773860)