Pulmonary Function In Patients Research Articles

Early Effects of Hemodialysis on Pulmonary Function in Patients with End-Stage Renal Disease

Background: Renal failure may directly or indirectly influence pulmonary ventilation. Since hemodialysis can decrease the extra liquids, improvement in pulmonary function by decreasing liquids in the lungs is expected. Objectives: This study aimed to assess the effects of acute hemodialysis on spirometry parameters. Methods: A cross-sectional study was conducted among patients with end-stage renal disease who referred for hemodialysis to Ali Ibn Abitaleb Hospital of Zahedan City during 2016. Patient data including age, gender, and body mass index (BMI) were collected. Spirometry was performed one hour before and after hemodialysis, and spirometry parameters including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, peak expiratory flow (PEF), forced expiratory flow between 25% and 75% FVC (FEF 25% - 75%) were measured. Results: A total number of 50 patients (30 men) completed spirometry. In men, there were a significant increase in FEV1 (mean difference = 0.217; P = 0.003) and FVC (0.298; P = 0.027) and a significant decrease in FEV1/FVC (-4.153; P = 0.038) after hemodialysis. In women, there was no significant change in the means of spirometry parameters. In addition, no significant relationship was found between PFT changes and BMI, weight change, or ultrafiltration volume. Conclusions: Our results showed that hemodialysis may improve pulmonary function tests in men. Studies with larger cohorts of patients are needed to derive valid effect estimates of hemodialysis on spirometry parameters with considering the role of chronic kidney diseases, various underlying diseases, different hemodialysis methods, and other related confounders.

Association Between Serum S100A8/S100A9 Heterodimer and Pulmonary Function in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Many studies have indicated that S100A8 and S100A9 may be involved in the development and progression of chronic obstructive pulmonary disease (COPD). However, there has been no clinical study analyzing the role of the serum S100A8/S100A9 heterodimer in COPD patients. The aim of this study was to analyze the correlation of the serum S100A8/S100A9 heterodimer with pulmonary function in COPD patients during acute exacerbation (AE-COPD) based on a cross-sectional study. A total of 131 AE-COPD patients and matched healthy subjects were recruited. Pulmonary function, arterial blood gas values, and serum inflammatory cytokines were measured. Serum S100A8/S100A9 was increased in AE-COPD patients. AE-COPD patients were ranked into different grades based on FEV1%. Serum S100A8/S100A9 was higher in Grade 4 than in Grade 1-2 and Grade 3 patients with AE-COPD. Univariate regression analysis found that serum S100A8/S100A9 was negatively correlated with FEV1% in AE-COPD patients. Furthermore, serum S100A8/S100A9 was positively associated with MCP-1 in AE-COPD patients. Further stratified analysis revealed that serum S100A8/S100A9 was negatively associated with FEV1/FVC in Grade 3 (OR 0.629, P < 0.05) and in Grade 4 (OR 0.347, P < 0.05). In addition, there was a positive relationship between serum S100A8/S100A9 and PaCO2 in Grade 3 (OR 1.532, P < 0.05) and Grade 4 (OR 1.925, P < 0.01). S100A8/S100A9 was negatively associated with pulmonary function in AE-COPD patients, indicating that the serum S100A8/S100A9 heterodimer may be involved in the progression of AE-COPD, and may be a relevant serum biomarker in the diagnosis for AE-COPD.

The role of pulmonary function in patients with heart failure and preserved ejection fraction: Looking beyond chronic obstructive pulmonary disease.

BackgroundThe prognostic value of chronic obstructive pulmonary disease (COPD) as a comorbidity in heart failure has been well documented. However, the role of pulmonary function indices in patients with heart failure and preserved ejection fraction (HFpEF) remains to be elucidated.MethodsSubjects with HFpEF received pulmonary function tests and echocardiogram. Total lung capacity (TLC), residual volume (RV), forced expiratory flow rate between 25% and 75% of vital capacity (FEF25-75), forced expiratory volume in the 1st second (FEV1), forced vital capacity (FVC), and vital capacity (VC) were measured. Echocardiographic indices, including pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e’), and left ventricular mass (LVM), were recorded. National Death Registry was linked for the identification of mortality.ResultsA total of 1194 patients (72.4±13.2 years, 59% men) were enrolled. PASP, E/e’ and LVM were associated with either obstructive (RV/TLC, FEV1 and FEF25-75) or restrictive (VC and TLC) ventilatory indices. During a mean follow-up of 23.0±12.8 months, 182 patients died. Subjects with COPD had a lower survival rate than those without COPD. While VC, FVC, RV/TLC, and FEV1 were all independently associated with all-cause mortality in patients without COPD, only FEF25-75 was predictive of outcomes in those with COPD.ConclusionsThe abnormalities of pulmonary function were related to the cardiac hemodynamics in patients with HFpEF. In addition, these ventilatory indices were independently associated with long-term mortality, especially in those without COPD.

Correlation between Surgical Risk Scales with Respiratory Muscle Strength and Functional Independence in Patients Submitted to Coronary Artery Bypass Grafting

Abstract Background The European Heart Surgery Risk Assessment System (EuroSCORE) and InsCor have been used to predict complications of cardiac surgery. However, their application to predict lung function and functionality is still uncertain. Objective To correlate surgical risk scales with functional independence and pulmonary function in patients undergoing coronary artery bypass grafting. Methods This was a prospective cohort study. In the preoperative period, the two surgical scales were applied, the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak [...]

Pulmonary function in patients with spinal deformity: have we been ignorant?

Spine deformity refers to a broad spectrum of abnormal spinal curvatures, which are prevalent in all ages, and are seen by family physicians, orthopedists, and spine specialists. Pulmonary symptoms...

Correlation between Grip Strength and Pulmonary Function in Patients with Acute Myeloid Leukemia

Correlation between Grip Strength and Pulmonary Function in Patients with Acute Myeloid Leukemia

A Study to Find Out the Effect of Upright Sitting and Forward Lean Sitting Position on Lung Functions in Stable COPD Patients A Comparative Study

Back Ground: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of health care burden worldwide and the only leading cause of death that is increasing in prevalence. Patients with Chronic obstructive pulmonary disease (COPD) are severely limited in the ability to carry out activities of daily living due to dyspnoea and breathlessness, this is due to reduction in lung functions. The purpose of the study was to find out the effect on lung functions in forward lean sitting position and upright sitting position in COPD patient. Aim/Purpose: To find out the effects of Upright sitting position on pulmonary functions in patients with stable COPD. To find out the effects of forward lean sitting position on pulmonary functions in patients with stable COPD. Objectives:To compare the change in FEV1, FVC, FEV1/FVC in patient with COPD in the Upright sitting and Forward lean sitting positions. Methodology: 60 COPD patients were participated in the study. All subjects had undergone spirometry in 2 different positions i.e. position A: Upright sitting position and position B: Forward lean sitting position. FEV1, FVC, FEV1/FVC of subjects were recorded. Same measures were taken for 7 consecutive days. Mean of all 7 days was taken for all measures and used for statistical analysis. Outcome Measure: FEV, FVC, FEV1/FVC Results: The results of the above study shows that there are Significant Improvements of Forward Lean Sitting on FEV1, FVC, FEV1/FVC compared to Upright Sitting.

The Protective Effects of Butorphanol on Pulmonary Function of Patients with Obesity Undergoing Laparoscopic Bariatric Surgery: a Double-Blind Randomized Controlled Trial.

Obesity is a risk factor for postoperative pulmonary complications (PPCs). Recent studies have reported the pulmonary protective role of the kappa opioid receptor (KOR). Butorphanol is a narcotic with strong KOR agonist action, and the role in pulmonary protection is uncertain. Here, we hypothesized that butorphanol exerts protective effects on pulmonary function in patients with obesity undergoing laparoscopic bariatric surgery. Patients with a body mass index ≥ 30kg/m2 scheduled for laparoscopic bariatric surgery were randomized to receive butorphanol or normal saline. Butorphanol was administered as an initial loading dose of 10μg/kg at 5min before induction followed by 5μg/(kgh) during surgery. The primary outcome was arterial-alveolar oxygen tension ratio (a/A ratio). Secondary outcomes included other pulmonary variables, biomarkers reflecting pulmonary injury, and incidence of PPCs within 7days after surgery. Patients in the butorphanol group had a significantly higher a/A ratio at 1h after the operation began (68 ± 7 vs. 55 ± 8, P < 0.001), end of the operation (73 ± 8 vs. 59 ± 7, P < 0.001), and 1h after extubation (83 ± 9 vs. 70 ± 5, P < 0.001) compared with those in the control group. In addition, in the butorphanol group, dead space to tidal volume ratios were significantly lower than those in the control group at the same time points (all P < 0.001). In the control group, the levels of biomarkers reflecting pulmonary injury were significantly higher than those in the butorphanol group at 3h, 6h, 12h, and 24h postoperatively (P < 0.001). The incidence of PPCs was similar in both groups. Butorphanol administration protected pulmonary function by improving oxygenation and reducing dead space ventilation in patients with obesity undergoing laparoscopic bariatric surgery. Butorphanol may therefore provide clinical benefits in patients with obesity.

Right and left ventricle native T1 mapping in systolic phase in patients with congenital heart disease.

T1 mapping is emerging as a powerful tool in cardiac magnetic resonance (CMR) to evaluate diffuse fibrosis. However, right ventricular (RV) T1 mapping proves difficult due to the limited wall thickness in diastolic phase. Several studies focused on systolic T1 mapping, albeit only on the left ventricle (LV). To estimate intra- and inter-observer variability of native T1 (nT1) mapping of the RV, and its correlations with biventricular and pulmonary function in patients with congenital heart disease (CHD). In this retrospective, observational, cross-sectional study we evaluated 36 patients with CHD, having undergone CMR on a 1.5-T scanner. LV and RV functional evaluations were performed. A native modified look-locker inversion recovery short-axis sequence was acquired in the systolic phase. Intra- and inter-reader reproducibility were reported as complement to 100% of the ratio between coefficient of reproducibility and mean. Spearman ρ and Mann-Whitney U-test were used to compare distributions. Intra- and inter-reader reproducibility was 84% and 82%, respectively. Median nT1 was 1022 ms (interquartile range [IQR] 1108-972) for the RV and 947 ms (IQR 986-914) for the LV. Median RV-nT1 was 1016 ms (IQR 1090-1016) in patients with EDVI ≤100 mL/m2 and 1100 ms (IQR 1113-1100) in patients with EDVI >100 mL/m2 (P = 0.049). A significant negative correlation was found between RV ejection fraction and RV-nT1 (ρ = -0.284, P = 0.046). Systolic RV-nT1 showed a high reproducibility and a negative correlation with RV ejection fraction, potentially reflecting an adaptation of the RV myocardium to pulmonary valve/conduit (dys)-function.

Pulmonary Function in Patients With Multiple Endocrine Neoplasia 2B.

Multiple endocrine neoplasia type 2B (MEN2B) is a rare cancer predisposition syndrome resulting from an autosomal-dominant germline mutation of the RET proto-oncogene. No prior studies have investigated pulmonary function in patients with MEN2B. This study characterized the pulmonary function of patients with MEN2B. This is a retrospective analysis of pulmonary function tests (PFTs) and chest imaging of patients enrolled in the Natural History Study of Children and Adults with MEN2A or MEN2B at the National Institutes of Health. Thirty-six patients with MEN2B (18 males, 18 females) were selected based on the availability of PFTs; 27 patients underwent at least 2 PFTs and imaging studies. Diffusion abnormalities were observed in 94% (33/35) of the patients, with 63% (22/35) having moderate to severe defects. A declining trend in diffusion capacity was seen over time, with an estimated slope of -2.9% per year (P = 0.0001). Restrictive and obstructive abnormalities were observed in 57% (20/35) and 39% (14/36), respectively. Computed tomography imaging revealed pulmonary thin-walled cavities (lung cysts) in 28% (9/32) of patients and metastatic lung disease in 34% (11/32) of patients; patients with metastatic lung lesions also tended to have thin-walled cavities (P = 0.035). This study characterized pulmonary function within a MEN2B cohort. Diffusion, restrictive, and obstructive abnormalities were evident, and lung cysts were present in 28% of patients. Further research is required to determine the mechanism of the atypical pulmonary features observed in this cohort.

Effects of Exercise in Patients With Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis.

The aim of this study was to systematically review the efficacy and safety of exercise in patients with amyotrophic lateral sclerosis (ALS). Randomized controlled trials of exercises for ALS were searched in PubMed, EMBASE, Web of Science, Cochrane Library, China Biology Medicine database, China National Knowledge Internet, VIP database, and Wanfang database. The primary outcomes were functional ability, pulmonary function, and quality of life. The secondary outcomes were muscle strength, fatigue and adverse events. Meta-analysis was performed using the RevMan Version 5.3 software. Seven randomized controlled trials including 322 patients with ALS met the inclusion criteria. Meta-analysis showed that the functional scores at long-term (standardized means difference, 0.47; 95% confidence interval, 0.08-0.86; P = 0.02) and forced vital capacity percentage predicted (mean difference, 1.71; 95% confidence interval, 0.10-3.31; P = 0.04) of patients with ALS in the exercise group were significantly higher than those in the group of no exercise or usual care. No significant difference was observed in muscle strength and quality of life. Endurance or aerobic exercise improved the functional scores of patients with ALS (standardized means difference, 0.36; 95% confidence interval, 0.04-0.68; P = 0.03). Exercise did not aggravate fatigue or result in adverse event. Exercise can significantly improve the functional ability and pulmonary function of patients with ALS safely.

Thymus and activation-regulated chemokine (TARC/CCL17) predicts decline of pulmonary function in patients with chronic obstructive pulmonary disease

BackgroundThe deterioration of pulmonary function, such as FEV1-decline, is strongly associated with poor prognosis in patients with chronic obstructive pulmonary disease (COPD). However, few investigations shed light on useful biomarkers for predicting the decline of pulmonary function. We evaluated whether thymus and activation-regulated chemokine (TARC), a Th2 inflammation marker, could predict rapid FEV1-decline in COPD patients. MethodsWe recruited 161 patients with stable COPD and performed pulmonary function test once every six months. At the time of registration, blood tests, including serum levels of TARC were performed. We assessed the correlation between changes in parameters of pulmonary function tests and serum levels of TARC. The rapid-decline in pulmonary function was determined using 25th percentile of change in FEV1 or FEV1 percent predicted (%FEV1) per year. ResultsIn the FEV1-rapid-decline group, the frequency of exacerbations, the degree of emphysema, and serum levels of TARC was higher than in the non-rapid-decline group. When using %FEV1 as a classifier instead of FEV1, age, the frequency of exacerbations, the degree of emphysema and serum levels of TARC in the rapid-decline group was significantly greater than those in the non-rapid-decline group. In univariate logistic regression analysis, TARC was the significant predictive factor for rapid-decline group. In multivariate analysis adjusted for emphysema, serum levels of TARC are independently significant predicting factors for the rapid-decline group. ConclusionsTARC is an independent predictive biomarker for the rapid-decline in FEV1. Measuring serum TARC levels may help the management of COPD patients by predicting the risk of FEV1 decline.

A prospective randomized study of the post-operative outcomes of thoracic epidural analgesia in patients undergoing coronary artery bypass graft surgery

To assess the efficacy of thoracic epidural analgesia (TEA) for postoperative pain and effect on haemodynamics, pulmonary functions postoperatively in patients undergoing coronary artery bypass graft (CABG).: Ninety patients posted for elective CABG were randomly allocated using sealed envelope method into two groups, Group A received injection fentanyl for intraoperative analgesia and injection tramadol for postoperative analgesia intravenously and Group B received 10 ml of 0.5% ropivacaine with 50 µg fentanyl as bolus dose epidurally and thereafter, continuous epidural infusion of 0.2% ropivacaine with 2µg/ml fentanyl at the rate of 8ml/h till the end of surgery for intraoperative analgesia and then 6-10ml/h till 48h for postoperative analgesia. All patients were given general anaesthesia. Haemodynamics, arterial blood gases, visual analog scale (VAS) score and peak expiratory flow rate (PEFR) were reported in ICU till 48h postoperatively.Statistical analysis used: unpaired - test and Chi-square test. Group B showed significantly lesser VAS score, higher PEFR, higher PaO2 and normal values of PaCO2. TEA reduces postoperative pain and improves postoperative pulmonary function in patients undergoing CABG. Also, it is associated with earlier extubation and a wakening, stable haemodynamics and lesser ICU stay after CABG surgery.

Effects of N-acetylcysteine on Pulmonary Functions in Patients with Systemic Sclerosis: A Randomized Double Blind, Placebo Controlled Study.

Systemic sclerosis (SSc) is a systematic and rare autoimmune disease that affects many organs. N-acetylcysteine (NAC), thiol-containing compound, can act both as the precursor of reduced glutathione and direct scavenger of reactive oxygen species. We assessed the clinical effect of NAC on the pulmonary function test of patients with diffuse scleroderma. This study is a randomized double-blind clinical trial that was done on 25 patients with diffuse SSc without lung involvement on primary chest high-resolution computed tomography. Placebo was administered for 13 patients and 1200 milligram NAC for 12 patients. Body plethysmography parameters were assessed at the beginning of the study and after 24 weeks. Patients in the two groups were matched in the basic demographic data like age, duration of disease, and modified Rodnan skin score. The analysis showed no significant differences in parameters of plethysmography between the two groups. After importing the data of 2 patients in the placebo-treated group, who developed interstitial lung disease, DLCO in the placebo-treated group was 90.69 ± 21.29 milliliter at the end of the study, which significantly decreased compared with the beginning of the study (102.30 ± 13.83 ml). Also, changes of DLCO between the two groups were significantly different. In this trial, the sensitivity of DLCO as the first marker in the evaluation of pulmonary function in patients with SSc was confirmed. On the other hand, NAC had no effect versus placebo in a period of 24 weeks.

Dynamic-Ventilatory Digital Radiography in Air Flow Limitation: A Change in Lung Area Reflects Air Trapping

Objective: The aim of this study was to determine the utility of dynamic-ventilatory digital radiography (DR) for pulmonary function assessment in patients with airflow limitation. Methods: One hundred and eighteen patients with airflow limitation (72 patients with lung cancer before surgery, 35 patients with chronic obstructive pulmonary disease [COPD], 6 patients with asthma, and 5 patients with asthma-COPD overlap syndrome) were assessed with dynamic-ventilatory DR. The patients were instructed to inhale and exhale slowly and maximally. Sequential chest X-ray images were captured in 15 frames per second using a dynamic flat-panel imaging system. The relationship between the lung area and the rate of change in the lung area due to respiratory motion with respect to pulmonary function was analyzed. Results: The rate of change in the lung area from maximum inspiration to maximum expiration (Rs ratio) was associated with the RV/TLC ratio (r = 0.48, p < 0.01) and the percentage of the predicted FEV₁ (r = –0.33, p < 0.01) in patients with airflow limitations. The Rs ratio also decreased in an FEV₁-dependent manner. Conclusion: The rate of change in the lung area due to respiratory motion evaluated with dynamic DR reflects air trapping. Dynamic DR is a potential tool for the comprehensive assessment of pulmonary function in patients with COPD.

Pulmonary Function Test in Patients with Type 2 Diabetes Mellitus &amp; Its Correlation with Anthropometry and Glycemic Control

Background: Diabetes mellitus is a chronic disease with microvascular complications and affecting almost all organs in the body. Effect of diabetes on lung functions has been studied previously with variable results. This study was performed to see the lung functions in patients with type 2 DM and to assess the pattern of abnormality in lung functions.Aim &amp; Objective:Our study aimed to evaluate pulmonary functions in patients with type 2 diabetes mellitus (T2DM) and to determine their correlations with anthropometric profile, glycaemic control, and diabetic microangiopathic complications.Subjects and Methods: 70 T2DM patients and 70 healthy control subjects were taken for the study. After taking an informed consent, all underwent screening with detailed history, anthropometry, blood sugar (fasting and post Prandial), glycosylated haemoglobin (HbA1C), renal profile, lipid profile and Pulmonary functions (spirometry).Statistical Analysis:Student’s t-test was used to compare PFTs of diabetic and control groups. Frequencies were generated for categorical variables and compared using the chi square test.Results: There was significant reduction in all PFT parameters (PEFR (L/s), FEV1 %, FVC ) in diabetics as compared to controls. The FEV1/FVC% was higher in the diabetes group and there was a mixed restrictive and obstructive pattern of pulmonary dysfunction seen in diabetics.BMI was inversely related to PEFR, FEV1, and FVC. Age was inversely related to FEV1, and FVC. It was found that HbA1c was not significant for any ventilator (spirometric) index.Restrictive pattern rather than obstructive impairment of lung function is likely to be chronic complication of T2DM, the severity of which relates to longer duration of symptoms of diabetes, higher BMI, and advancing age.Conclusion: Spirometry is an easily available, non invasive screening tool to assess the lung functions and should be performed in patients with type 2 diabetes having microangiopathic complications.

The Effect of Vidian Neurectomy on Pulmonary Function in Patients with Allergic Rhinitis and Chronic Rhinosinusitis with Nasal Polyps

At present, the effect of operation intervention on pulmonary function is not clear in patients with allergic rhinitis and chronic rhinosinusitis with nasal polyps (AR&CRSwNP). This study was conducted to investigate the effect of vidian neurectomy on pulmonary function and airway hyperresponsiveness (AHR) in patients with AR&CRSwNP. The incidences of AHR, bronchial asthma (BA) and pulmonary function impairment in 112 patients with AR&CRSwNP were investigated. Subsequently, we evaluated the outcome of vidian neurectomy and its effect on pulmonary function and AHR. Furthermore, we explored the correlation between postoperative level of eosinophilic cationic protein (ECP) and the changes of pulmonary function indices or dose of methacholine. In this study, the incidences of pulmonary function impairment, bronchial asthma, and AHR in patients with AR&CRSwNP were 61.61%, 69.64%, and 66.96%, respectively. Particularly, vidian neurectomy effectively alleviated nasal symptoms, improved pulmonary function, and reduced AHR in AR&CRSwNP patients. Furthermore, the postoperative level of ECP, IgE, Interleukin-4 and Interleukin-IL-5 was dramatically decreased, and there was an obvious inverse correlation between ECP level and pulmonary function index or dose of methacholine. Vidian neurectomy is effective in alleviating nasal symptoms, improving pulmonary function, and reducing the risk of AHR of patients with AR&CRSwNP by decreasing the level of ECP.

Diaphragm ultrasound: A novel approach to assessing pulmonary function in patients with traumatic rib fractures.

Rib fractures following blunt trauma are a major cause of morbidity. Various factors have been used for risk stratification for complications. Ultrasound (US) measurements of diaphragm thickness (Tdi) and related measures such as thickening fraction (TF) have been verified for use in the evaluation of diaphragm function. In healthy individuals, Tdi by US is known to have a positive and direct relationship with lung volumes including inspiratory capacity (IC). However, TF has not been previously been described in, or used to assess, pulmonary function in rib fracture patients. We examined TF and IC to elucidate the association between acute rib fractures and respiratory function. We hypothesized that TF and IC were related. Secondarily, we examined the relationship of TF in rib fractures patients, in the context of values reported for healthy controls in the literature. We prospectively enrolled adults with acute blunt traumatic rib fractures within 48 hours of admission to a level 1 trauma center. Patients requiring a chest tube or mechanical ventilation at time of consent were excluded. Inspiratory capacity was determined via incentive spirometry. Thickening fraction was determined by bedside US measurements of minimum and maximum Tdi during tidal breathing (TFtidal) or deep breathing (TFDB) was calculated (TF = [TdimaxTdi - TdiminTdi]/TdiminTdi). TFDB values were also compared with previously reported mean ± SD values of 2.04 ± 0.62 in healthy males and 1.70 ± 0.89 in females. Univariate and multivariate analyses were performed. A total of 41 subjects (58.5% male) with a median age of 64 years (interquartile range [IQR], 53-77 years) were enrolled. Diaphragm US demonstrated a median TFtidal of 0.30 (IQR, 0.24-0.46). Median IC was 1,750 mL (IQR, 1,250-2,000 mL). As compared with previously reported controls, our mean ± SD TFDB in males 0.90 ± 0.51 and 0.88 ± 0.89 in females were significantly lower. Multivariate analysis revealed a significant inverse correlation (-0.439, p = 0.004) between TFtidal and IC, and no relationship between TFDB and IC. To our knowledge, this is the first report of TF in rib fracture patients. The significant inverse association between TFtidal and IC, along with lower than normal TFDB ranges, suggests that, in the setting of rib fractures, there are alterations in the diaphragm-chest cage mechanics, whereby other muscles may play more prominent roles. Diagnostic tests or criteria, Level III.

Asthma, allergic sensitization and lung function in sickle cell disease

BackgroundPulmonary disease is a frequent acute and chronic manifestation in sickle cell disease (SCD), presenting high morbidity and mortality. ObjectivesTo identify the prevalence and association of asthma, allergic sensitization and altered pulmonary function in patients with SCD (SS and Sβo). MethodsA single-center, cross-sectional study was conducted, in which 70 patients with SCD and 44 controls, aged six to 18 years, responded to the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), complemented with an anamnesis regarding the associated clinical outcomes. All patients underwent immediate hypersensitivity skin tests with aeroallergens and a pulmonary function evaluation (spirometry). Regarding the statistical analysis, parametric and non-parametric methods were used, depending on the variables studied. Tests were considered significant when p<0.05. ResultsThere was no significant difference between the patients and controls regarding the prevalence of asthma and allergic sensitization (p>0.05). The number of occurrences of acute chest syndrome per patient per year was significantly higher for asthmatic patients than for non-asthmatic patients (p=0.04). Obstructive pulmonary function occurred in 30.9% of the patients and in 5.4% of the controls, and restrictive pulmonary function occurred in 5.5% of the patients and 5.4% of the controls. Asthma and wheezing in the last 12months had significant associations with obstructive pulmonary function (p=0.014 and p=0.027, respectively). ConclusionsThe occurrence of asthma, allergic sensitization and alteration in lung function in patients with SCD reinforces the importance of routine monitoring of these diagnoses, which allows for early treatment and prevention of the evolution of pulmonary disease in adulthood.

A robust and novel electrical impedance metric of pulmonary function in ALS patients

Objective: Pulmonary function tests (PFTs) are important for assessing respiratory function in amyotrophic lateral sclerosis (ALS) patients. However, weakness of oral and glottal closure, due to concomitant bulbar dysfunction, may result in unreliable PFT values stemming from leakage of air around the breathing tube and through the glottis. In this study, we assessed whether standard thoracic electrical impedance tomography (EIT) could serve as a surrogate measure for PFTs. Approach: Thoracic EIT was performed simultaneously with standard PFTs on seven ALS patients without clinical bulbar weakness (six men and one woman, mean age of 63 years) and ten healthy volunteers (seven men and three women, mean age of 57 years). A raw impedance metric along with more standard EIT measures were computed and correlated with the normalized forced vital capacity (FVC). Additionally, test/re-test metrics and EIT images were analyzed. Main results: The impedance metric was found to be robust and sensitive to lung activity. We also identified qualitative EIT differences between healthy volunteers and ALS patients, with the ALS images showing greater heterogeneity. Significant correlations with FVC were found for both impedance and EIT metrics in ALS patients (r2 = 0.89) and for the impedance metric only in healthy volunteers (r2 = 0.49). Significance: This suggests that EIT, using our novel impedance metric, has the potential to serve as an alternative technology to standard PFTs for assessing pulmonary function in patients with ALS, offering new metrics of disease status for those with bulbar weakness.