Pulmonary Function Test Measurements Research Articles

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.

The Effect of Conventional Open Thyroidectomy on Clinical Results and Respiratory Function Tests in Multinodular Goitre.

The primary aim of our study was to measure the effect of conventional open thyroidectomy performed for patients with multinodular goiter (MNG) on pulmonary volumes measured with respiratory function tests independent from surgical indications. A secondary aim was to determine whether there was a significant improvement in the complaints due to obstructive symptoms after MNG surgeries. This study was conducted between October 2020 and June 2022. Patients who were hospitalized to undergo surgery for giant multinodular goiter were prospectively included in the study. Patients were questioned about complaints of pressure, hoarseness, dyspnea, sleep apnea, snoring, and dysphagia before the surgery and during the follow-up 6 months after surgery. In addition, pulmonary function tests were performed preoperatively, 48 hours after surgery and 6 months after surgery. Forced expiratory volume in 0.5 seconds forced expiratory volume in 1 second and forced vital capacity values in pulmonary function test (PFT) measurements were recorded. A total of 55 patients, 42 females and 13 males, mean age 49.54 ± 13.6 years, were included in the study. Although there was a significant decrease in clinical symptoms caused by the thyroid volume within 6 months in patients who were operated for giant MNG there was no significant change in pulmonary function tests. There was a positive correlation between the thyroid volume and nodule weight in patients with MNG. Our results suggest that it is not necessary to follow up with patients without obstructive findings in preoperative pulmonary function tests with pulmonary function tests in the postoperative period.

Effects of Auricular Vagus Nerve Stimulation on Cardio-Respiratory Functions After Aerobic Exercise

The aim of our study is to find out whether the return rate of parasympathetic activity (PA) can be accelerated with auricular transcutaneous vagus nerve stimulation (TVNS). Pulmonary function test, ANS activity, pulse and blood pressure measurements were made. Individuals ran for 15 minutes. Those in the TVNS group received 5 minutes of auricular VNS. In the control group, headphones were attached but no current was given. After the end of their procedures, they were compared with pre-exercise. In the TVNS group, the pulse parameter was higher than in the initial measurement (p=0.001). There was a significant (p=0.007) rise in the FEV1 value in the VNS group. The sympathetic nervous system (SNS) index (p<0.05) increased in both groups when compared to the initial measurement, although there was no significant difference in the index values between the groups. The TVNS group showed an increase from the first measurement (p<0.05), but there was no significant difference in the parasympathetic nervous system (PNS) Index between the groups (p>0.05). The groups' values for the first and second measures were equal (p>0.05), and the root mean square of the successive differences (RMSSD) values did not reveal a significant difference. TVNS can improve respiratory parameters in healthy individuals in the acute period after exercise, and it seems that it can also increase activation in both the sympathetic and parasympathetic system. It can be stated that TVNS may lead to variable results in different circumstances in sports

Characteristics and determinants of pulmonary long COVID.

BACKGROUNDPersistent cough and dyspnea are prominent features of postacute sequelae of SARS-CoV-2 (also termed "long COVID"); however, physiologic measures and clinical features associated with these pulmonary symptoms remain poorly defined. Using longitudinal pulmonary function testing (PFT) and CT imaging, this study aimed to identify the characteristics and determinants of pulmonary long COVID.METHODSThis single-center retrospective study included 1,097 patients with clinically defined long COVID characterized by persistent pulmonary symptoms (dyspnea, cough, and chest discomfort) lasting for 1 or more months after resolution of primary COVID infection.RESULTSAfter exclusion, a total of 929 patients with post-COVID pulmonary symptoms and PFTs were stratified as diffusion impairment and pulmonary restriction, as measured by percentage predicted diffusion capacity for carbon monoxide (DLCO) and total lung capacity (TLC). Longitudinal evaluation revealed diffusion impairment (DLCO ≤ 80%) and pulmonary restriction (TLC ≤ 80%) in 51% of the cohort overall (n = 479). In multivariable modeling regression analysis, invasive mechanical ventilation during primary infection conferred the greatest increased odds of developing pulmonary long COVID with diffusion impairment and restriction (adjusted odds ratio [aOR] = 9.89, 95% CI 3.62-26.9]). Finally, a subanalysis of CT imaging identified radiographic evidence of fibrosis in this patient population.CONCLUSIONLongitudinal PFTs revealed persistent diffusion-impaired restriction as a key feature of pulmonary long COVID. These results emphasize the importance of incorporating PFTs into routine clinical practice for evaluation of long COVID patients with prolonged pulmonary symptoms. Subsequent clinical trials should leverage combined symptomatic and quantitative PFT measurements for more targeted enrollment of pulmonary long COVID patients.FUNDINGNational Institute of Allergy and Infectious Diseases (AI156898, K08AI129705), National Heart, Lung, and Blood Institute (HL153113, OTA21-015E, HL149944), and the COVID-19 Urgent Research Response Fund at the University of Alabama at Birmingham.

Dynamic Digital Radiography Pulmonary Function Testing: A Machine Learning Lung Study Alternative

BackgroundCommon diagnostic tests for pulmonary disorders include chest radiography and pulmonary function tests (PFTs). Although essential, these tests only offer a static assessment. Chest dynamic digital radiography (DDR) integrates lung and diaphragm motion in one study with limited radiation exposure. DDR is relatively easy to obtain, but barriers to its clinical adoption include time consuming manual analysis and unclear correlation with PFTs. Research questionsCan a machine learning pipeline automate DDR analysis? What is the strength of the relationship between PFT-measures and automated DDR-based lung area measurements? Study design and MethodsPFT and DDR studies were obtained in fifty-five participants. We developed an analysis pipeline utilizing convolutional neural networks (CNN) capable of quantifying lung areas in DDR images to generate DDR-based PFTs (dPFTs). PFT and dPFT measures were correlated in patients with normal, obstructive and restrictive lung physiology. ResultsWe observed statistically significant (p values < 1x10-6), strong correlations between dPFT areas and PFT volumes including TLC (r=0.764), FEV1 (r=0.591), VC (r=0.763) and FRC (r=0.756). Automated DDR and lung shape tracking revealed differences between normal, restrictive and obstructive physiology using diaphragm curvature indices and strain-analysis measurements. Linear regressions allowed for derivation of PFT values from dPFT measurements. InterpretationStatistically significant correlations found between dPFTs and PFTs suggest that dPFTs can act as a surrogate to PFTs when these are not available or unable to be performed. This study contributes to the potential integration of DDR as a reliable alternative to PFTs.

Quantification of Proteus syndrome-associated lung disease

BackgroundProteus syndrome is an ultra-rare mosaic overgrowth disorder. Individuals with Proteus syndrome can develop emphysematous and cystic changes of the lung that may lead to progressive respiratory symptoms and require surgical intervention. This retrospective study seeks to quantify the radiographic features of Proteus syndrome-associated lung disease using computed tomography (CT) of the chest. The first method derives a Cystic Lung Score (CLS) by using a computer-aided diagnostic tool to quantify the fraction of cystic involvement of the lung. The second method yields a Clinician Visual Score (CVS), an observer reported scale of severity based on multiple radiographic features. The aim of this study was to determine if these measurements are associated with clinical symptoms, pulmonary function test (PFT) measurements, and if they may be used to assess progression of pulmonary disease.ResultsOne hundred and thirteen imaging studies from 44 individuals with Proteus syndrome were included. Dyspnea and oxygen use were each associated with higher CLS (p = 0.001 and < 0.001, respectively) and higher CVS (p < 0.001 and < 0.001). Decreases in percent predicted FVC, FEV1, and DLCO each correlated with increased CLS and CVS. The annual increase of CLS in children, 5.6, was significantly greater than in adults, 1.6. (p = 0.03). The annual increase in CVS in children, 0.4, was similar to adults, 0.2 (p = 0.36).ConclusionsProteus syndrome-associated lung disease is progressive. The rate of cystic progression is increased in children. Increased scores in CLS and CVS were associated with clinical symptoms and decreased pulmonary function. Both methods were able to detect change over time and were associated with clinically meaningful outcomes which may enable their use in interventional studies.

Association of firefighting exposures with lung function using a novel job exposure matrix (JEM).

Characterisation of firefighters' exposures to dangerous chemicals in smoke from non-wildfire incidents, directly through personal monitoring and indirectly from work-related records, is scarce. The aim of this study was to evaluate the association between smoke particle exposures (P) and pulmonary function. The study period spanned from January 2010 through September 2021. Routine firefighting P were estimated using fire incident characteristics, response data and emission factors from a novel job exposure matrix. Linear mixed effects modelling was employed to estimate changes in pulmonary function as measured by forced expiratory volume in one second (FEV1). Models controlled for age, race/ethnicity, height, smoking and weight. Every 1000 kg P was associated with 13 mL lower FEV1 (β=-13.34; 95% CI=-13.98 to -12.70) over the entire 12-year follow-up period. When analysing exposures within 3 months before PFT measurements, 1000 kg P was associated with 27 mL lower FEV1 (β=-26.87; 95% CI=-34.54 to -19.20). When evaluating P estimated within 3 months of a pulmonary function test (PFT), stronger associations were observed among those most highly exposed to the World Trade Center (WTC) disaster (β=-12.90; 95% CI=-22.70 to -2.89); the association of cumulative exposures was similar for both highly and less highly exposed individuals. Smoke particle exposures were observed to have modest short-term and long-term associations with pulmonary function, particularly in those who, previously, had high levels of WTC exposure. Future work examining the association between P and pulmonary function among non-WTC exposed firefighters will be essential for disentangling the effects of ageing, routine firefighting and WTC exposures.

Effect of overweight/obesity on relationship between fractional exhaled nitric oxide and airway hyperresponsiveness in Chinese elderly patients with asthma.

Purpose: This retrospective study investigates the influence of overweight and obesity status on pulmonary function, airway inflammatory markers, and airway responsiveness in elderly asthma patients. Methods: Patients with asthma older than 65years old who completed a bronchial provocation test (BPT) or bronchial dilation test (BDT) and a fractional exhaled nitric oxide (FeNO) test between December 2015 and June 2020 were identified retrospectively for this study. All of the patients were categorized into overweight/obesity and non-obesity groups based on their BMI. Pulmonary function test (PFT) and FeNO measurements were accomplished according to the 2014 recommendations of the Chinese National Guidelines of Pulmonary Function Test and American Thoracic Society/European Respiratory Society recommendations, respectively. Results: A total of 136 patients with an average age of 71.2 ± 5.40years were identified. The average BMI was 23.8 ± 3.63, while the value of FeNO was 42.3 ± 38.4 parts per billion (ppb). In contrast to the non-obesity group, which had a value of 48.8 ± 43.1 ppb for FeNO, the overweight/obesity group had a significant lower value of 35.4 ± 31.4 ppb. There was no significant difference in the proportion of individuals with high airway hyperresponsiveness between the overweight/obesity and non-obesity groups (96 patients in total). Multiple linear regression analysis established an inverse correlation between FeNO and Provocation concentration causing a 20% fall in FEV1(PC20) but excluded significant relationships with age and BMI. The model's R is 0.289, and its p value is 0.045. Conclusion: The elderly Chinese Han asthmatics with overweight/obesity had lower FeNO levels than those with non-obese according to our findings. In addition, the FeNO level was inversely correlated between FeNO levels and PC20 in elderly asthmatics.

Psychological Experience of the First Pulmonary Function Test in Elderly Patients with Poor Cooperation: A Qualitative Study

Objectives: In this study, we aimed to understand the real psychological experience of the first pulmonary function test (PFT) of elderly patients with poor cooperation, provide a reference for reporting their psychological characteristics and needs, and offer suggestions for developing appropriate guidance strategies to improve cooperation and compliance of patients. Methods: We used a phenomenological approach. We selected 21 elderly patients with poor cooperation who underwent PFT in a Tertiary Grade A comprehensive hospital in Nanning from December 2021 to June 2022 for a semi-structured interview using an objective sampling method. We used the Colaizzi analysis method to collate and analyze the data. Results: We extracted 6 distinct psychological experiences of elderly patients with poor cooperation in the first PFT, including distrust, tension and worry, the desire to understand PFT-related information, high psychological sensitivity, frustration and positive self-adjustment, and negative self-perception of aging. According to participants′ own explanation, most of the psychological experience was mainly related to the lack of understanding of PFT related knowledge, which was greatly affected by the way of information acquisition and the allocation of PFT resources. In addition, elderly patients also revealed that unfamiliarity with their own disease history and physical status affected their psychological enthusiasm during the examination. Conclusions: Elderly patients who failed to cooperate during the first PFT have complex psychological states and a wide range of psychological needs. In clinical practice, medical staff should focus on patients, thoroughly investigate the psychological experiences of elderly patients undergoing PFT and implement corresponding measures to encourage elderly patients′ cooperation and improve examination compliance.

Impact on Pulmonary Function in a Randomized Trial of Single-Fraction and Multifraction Stereotactic Body Radiation Therapy for Pulmonary Oligometastatic Disease: An Analysis of TROG 13.01 (SAFRON II)

Background[Anonymized] was a phase 2 multicentre trial comparing single fraction and multi-fraction SBRT. Patients with 1-3 peripheral pulmonary oligometastases were randomized 1:1 between 28Gy in 1 fraction and 48Gy in 4 fractions. There were no differences between arms in efficacy or toxicity. We performed an analysis to assess changes in pulmonary function tests (PFTs) between arms over time and assessed the impact of the number and total volume of targets on PFT change over time. MethodsA linear mixed model was used to describe the PFTs by treatment arm over time. The effect of number and volume of targets on PFTs at 6 and 12 months was assessed by a simple linear model. ResultsNinety patients were randomised; 87 were treated for 133 pulmonary oligometastases. Forty-four were randomised to the SF arm and 43 to the MF arm. There were no differences in absolute or relative PFT measures of forced expiratory volume in 1 second (FEV1),diffusing capacity of the lungs for carbon monoxide (DLCO) or Forced Vital Capacity (FVC) between the two arms. At 12 months, there was a reduction in absolute DLCO from baseline (−1.7ml/min/mmHg, [95%CI: −2.5; −1.0]), relative DLCO (−5.5% [−8.4;-2.6]),absolute FEV1 (−0.17L [−0.23;-0.11]) and absolute FVC (-0.20L [−0.27;-0.13]). In patients with multiple pulmonary targets, increase in target number (per lesion) was associated with a reduction in the absolute FEV1 at 6 months of −0.10L [−0.18; −0.03] (p = 0.007),FEV1 at 12 months −0.10L [−0.20; −0.01] (p = 0.04), FVC at 6 months of −0.11L [−0.20; −0.03] (p = 0.014), FVC at 24 months −0.13L [−0.25; −0.01] (p = 0.036) Reduction in FEV1 was also seen per 10ml increase in PTV at 12 months −0.03L [−0.06; −0.00] (p = 0.036). Number of targets and PTV were not associated with DLCO. ConclusionTreating multiple targets resulted in increased loss of FEV1 and FVC but not DLCO. There were no significant differences in PFT decline between SF and MF SBRT.

Lung function disorders among sickle cell disease patients in Basra City, Iraq

Background: In sickle cell disease (SCD), lung function impairments might be obstructive, restrictive, or both. Due to a lack of extensive epidemiological investigations, the exact prevalence of sickle cell chronic lung illnesses and the way to identify them have yet to be determined. The aim of this study is to determine the impact of SCD on pulmonary function tests (PFTs) in adult patients in Basrah, Iraq, as well as to describe the patients' respiratory disorder .Materials and Methods: This a cross-sectional study conducted in Basrah City, Iraq, in which two groups of individual were enrolled: 110 healthy subjects (group1) and 102 sickle cell disease patients (group 2).Measurements of PFTs and several hematological tests were done for each individual of the two groups. Results: Significant decline (p &gt; 0.05) in different tests of pulmonary function (FEV1; FVC; FEV1%PEF and MVV) were found in SCD patients with a significant elevation in estimated lung age. Several hematological tests (WBC;RBC;HGB; Neutrophils and lymphocytes were also showed significant changes(p &gt;0.05)in the patients.&#x0D; In conclusion: Lung functions differ significantly in patients with SCD compared with matched healthy control individuals of a similar age, gender and standing height. This study has also shown that PFT abnormality in SCD patients was restrictive disease pattern.

Clinical implications of the concentration of alveolar nitric oxide in non-small cell lung cancer.

Clinical implications of the concentration of alveolar nitric oxide in non-small cell lung cancer.

Prognostic Significance of Early Declines in Pulmonary Function After Allogeneic Hematopoietic Stem Cell Transplantation.

Pulmonary function test (PFT) impairments are common after allogeneic hematopoietic stem cell transplantation. The prognostic significance of these declines on outcomes is not well understood.The objectives were to determine the frequency of declines in pulmonary function (FVC, FEV1, and diffusing capacity for carbon monoxide [DLCO]) in the early post-transplantation period; and to determine the prognostic significance of these declines on mortality or development of bronchiolitis obliterans syndrome. This was a retrospective cohort study conducted at Mayo Clinic, Rochester, Minnesota. PFTs were obtained at baseline and at day +100. Competing risk survival models were developed, which accounted for pre-transplantation pulmonary function and relapse status. Between January 1, 2005, and December 31, 2020, 1,145 subjects underwent allogeneic hematopoietic stem cell transplantation and had a pre-transplantation PFT performed. Of these, 900 (78.6%) survived to day 100 and had post-transplantation PFTs performed (median [interquartile range] 97 [94-103] d). A decline of ≥10% in FEV1, FVC, or DLCO was seen in 401 of 900 subjects (44.5%). Declines of ≥20% in FEV1 (hazard ratio 1.65, 95% CI 1.07-2.56; P = .02), FVC (hazard ratio 1.72, 95% CI [1.11-2.67]; P = .02), and DLCO (hazard ratio 1.46, 95% CI 1.04-2.07; P = .028) were all associated with reduced survival when compared with those with < 10% decline in PFT measures. These findings were independent of pre-transplantation pulmonary function or relapse status. Bronchiolitis obliterans syndrome was diagnosed in 118 subjects (10.3%), and there was no relationship between early PFT decline and a subsequent diagnosis of bronchiolitis obliterans syndrome. The subjects who received myeloablative conditioning with cyclophosphamide plus total body irradiation or cyclophosphamide plus fludarabine plus total body irradiation were more likely to have lower spirometry values after hematopoietic stem cell transplantation. The subjects who received reduced intensity conditioning or nonmyeloablative conditioning with fludarabine plus total body irradiation were more likely to have higher post-hematopoietic stem cell transplantation FEV1, FVC, and DLCO. An absolute decline of ≥20% in FEV1, FVC, or DLCO were associated with reduced survival independent of pre-transplantation pulmonary function or relapse status. In contrast to previous work, early declines in PFT measures were not associated with future development of bronchiolitis obliterans syndrome.

Pulmonary Capillary Recruitment Is Attenuated Post Left Ventricular Assist Device Implantation

There is limited knowledge of pulmonary physiology and pulmonary function after continuous flow-left ventricular assist device (CF-LVAD) implantation. Therefore, this study investigated whether CF-LVAD influenced pulmonary circulation by assessing pulmonary capillary blood volume and alveolar-capillary conductance in addition to pulmonary function in patients with heart failure. Seventeen patients with severe heart failure who were scheduled for CF-LVAD implantation (HeartMate II, III, Abbott, Abbott Park, IL or Heart Ware, Medtronic, Minneapolis, MN) participated in the study. They underwent pulmonary function testing (measures of lung volumes and flow rates) and unique measures of pulmonary physiology using a rebreathe technique that quantified the diffusing capacity of the lungs for carbon monoxide (DLCO) and diffusing capacity of the lungs for nitric oxide before and 3months after CF-LVAD implantation. After CF-LVAD, pulmonary function was not significantly changed (p >0.05). For lung diffusing capacity, alveolar volume (VA) was not changed (p=0.47), but DLCO was significantly reduced (p=0.04). After correcting for VA, DLCO/VA showed a trend toward reduction (p=0.08). For the alveolar-capillary component, capillary blood volume (Vc) was significantly reduced (p=0.04), and alveolar-capillary membrane conductance trended toward a reduction (p=0.06). However, alveolar-capillary membrane conductance/Vc was not altered (p=0.92). In conclusion, soon after CF-LVAD implantation, Vc is reduced likely because of pulmonary capillary derecruitment, which contributes to the decrease in lung diffusing capacity.

Hyperpolarized Xenon-129: A New Tool to Assess Pulmonary Physiology in Patients with Pulmonary Fibrosis.

The existing tools to quantify lung function in interstitial lung diseases have significant limitations. Lung MRI imaging using inhaled hyperpolarized xenon-129 gas (129Xe) as a contrast agent is a new technology for measuring regional lung physiology. We sought to assess the utility of the 129Xe MRI in detecting impaired lung physiology in usual interstitial pneumonia (UIP). After institutional review board approval and informed consent and in compliance with HIPAA regulations, we performed chest CT, pulmonary function tests (PFTs), and 129Xe MRI in 10 UIP subjects and 10 healthy controls. The 129Xe MRI detected highly heterogeneous abnormalities within individual UIP subjects as compared to controls. Subjects with UIP had markedly impaired ventilation (ventilation defect fraction: UIP: 30 ± 9%; healthy: 21 ± 9%; p = 0.026), a greater amount of 129Xe dissolved in the lung interstitium (tissue-to-gas ratio: UIP: 1.45 ± 0.35%; healthy: 1.10 ± 0.17%; p = 0.014), and impaired 129Xe diffusion into the blood (RBC-to-tissue ratio: UIP: 0.20 ± 0.06; healthy: 0.28 ± 0.05; p = 0.004). Most MRI variables had no correlation with the CT and PFT measurements. The elevated level of 129Xe dissolved in the lung interstitium, in particular, was detectable even in subjects with normal or mildly impaired PFTs, suggesting that this measurement may represent a new method for detecting early fibrosis. The hyperpolarized 129Xe MRI was highly sensitive to regional functional changes in subjects with UIP and may represent a new tool for understanding the pathophysiology, monitoring the progression, and assessing the effectiveness of treatment in UIP.

Assessment of diaphragmatic function by ultrasonography in patients with systemic sclerosis and its relation to clinical parameters : Acase-control study.

Diaphragmatic function can be affected in many diseases and disorders. Although systemic sclerosis (SSc) is aserious connective tissue disease that affects not only the skin but also the pulmonary and musculoskeletal systems, there is insufficient information about diaphragm function. To compare the diaphragmatic parameters by ultrasonography (USG) in patients with SSc and healthy individuals and examine the relationship between these parameters and clinical features in patients with SSc. This study included 13 patients with SSc and 15healthy individuals. Muscle thickness (in deep inspiration Tins and at the end of calm expiration Texp), changes in thickness (∆T), and thickening fraction at deep breathing were evaluated by USG. Skin thickness, pulmonary function tests, respiratory muscle strength, and the perception of dyspnea were measured as clinical features. The results of Texp, Tins, and ∆T were similar in both groups (p > 0.05), albeit patients in the SSc group had less thickening fraction compared to the control group (79.9 ± 36.7 cm and 103.8 ± 20.6 cm, respectively, p < 0.05). The Tins, ∆T, and thickening fraction of the diaphragm were associated with skin thickness, pulmonary function test parameters, and respiratory muscle strength (p < 0.05). Besides, there was significant correlation between muscle thickening fraction and perception of dyspnea (p < 0.05). These results confirm that diaphragm thickness and contractility can be affected in patients with SSc. Therefore, ultrasonographic evaluation of the diaphragm can play acomplementary role to pulmonary function test and respiratory muscle strength measurement in the diagnosis and follow-up of patients with SSc.

Change of pulmonary function tests in hospitalized COVID-19 patients at third and sixth month follow-up.

The effect of COVID-19 infection on pulmonary function is unknown. This study aimed to evaluate pulmonary function tests (PFTs) of patients hospitalized with the diagnosis of COVID-19 pneumonia at 3 and 6 months post-discharge. Patients aged 18 years and over who had positive COVID-19 PCR test results and were hospitalized in the pandemic service between 1 May 2020 and 31 October 2020, were included in the study. All patients were evaluated with PFTs FVC, FEV1, FEV1/FVC, and FEF25-75 at 3 and 6 months after discharge. The mean age of 34 patients included in the study was 47.7 ± 12.7 years. The FVC, FEV1, FEV1/FVC, and FEF25-75 measurements at 3 and 6 months post-discharge showed no significant difference (P = 0.765, P = 0.907, P = 0.707, and P = 0.674, respectively). There was no significant difference in any PFT measurements at the third month follow-up, regardless of the pharmacological treatment protocols applied during hospitalization (P > 0.05). However, FEV1/FVC and FEF25-75 levels were 83.1 [3.4]% and 91.0 [10.0]%, respectively, in those who received systemic steroid treatment, and 78.3 ± 8.5% and 72.5 ± 25.7% in those who did not (P = 0.019 and P = 0.048, respectively). In addition, FVC and FEV1 levels increased significantly from the third to the sixth month follow-up in patients who received systemic steroid therapy (P = 0.035 and P = 0.018, respectively). Although there is no significant difference in PFT measurements from 3 to 6 months in COVID-19 patients, systemic steroid therapy may have a beneficial effect on respiratory function in COVID-19 patients.

Comparison of Lung, Lobe, and Airway Volumes between Supine and Upright Computed Tomography and Their Correlation with Pulmonary Function Test in Patients with Chronic Obstructive Pulmonary Disease

Background: Correlations between upright CT and pulmonary function test (PFT) measurements, and differences in lung/lobe/airway volumes between supine and standing positions in patients with chronic obstructive pulmonary disease (COPD) remain unknown. Objectives: The study aimed to evaluate correlations between lung/airway volumes on both supine and upright CT and PFT measurements in patients with COPD, and compare CT-based inspiratory/expiratory lung/lobe/airway volumes between the two positions. Methods: Forty-eight patients with COPD underwent both conventional supine and upright CT in a randomized order during inspiration and expiration breath-holds, and PFTs within 2 h. We measured the lung/lobe/airway volumes on both CT. Results: The correlation coefficients between total lung volumes on inspiratory CT in supine/standing position and PFT total lung capacity and vital capacity were 0.887/0.920 and 0.711/0.781, respectively; between total lung volumes on expiratory CT in supine/standing position and PFT functional residual capacity and residual volume, 0.676/0.744 and 0.713/0.739, respectively; and between airway volume on inspiratory CT in supine/standing position and PFT forced expiratory volume in 1 s, 0.471/0.524, respectively. Inspiratory/expiratory bilateral upper and right lower lobe, bilateral lung, and airway volumes were significantly higher in the standing than supine position (3.6–21.2% increases, all p < 0.05); however, inspiratory/expiratory right middle lobe volumes were significantly lower in the standing position (4.6%/15.9% decreases, respectively, both p < 0.001). Conclusions: Upright CT-based volumes were more correlated with PFT measurements than supine CT-based volumes in patients with COPD. Unlike other lobes and airway, inspiratory/expiratory right middle lobe volumes were significantly lower in the standing than supine position.

Spirometric Evaluation of Effect of Air Pollution on Pulmonary Functions of Traffic Police in Kathmandu Valley

Background and objectives: Traffic police personnel are exposed to ambient air pollution which leads to important health hazards like impairment of lung functions. The objectives of this study were to measure and compare the pulmonary function parameters of traffic police and general duty police and also aimed to evaluate the effect of job duration on those parameters in Kathmandu valley. Materials and methods: A cross-sectional comparative study was done in a total of 133 healthy, non-smoker, male policemen working in Kathmandu valley for a minimum of one year. Out of them, 70 were from traffic police and 63 were from general duty police. MIR Spirolab II was used for pulmonary function test (PFT) measurement. Statistical analysis was done using SPSS version 20. The results were presented as mean ±SD and Independent sample t-test: was used. The p-value &lt;0.05 was considered statistically significant. Pulmonary functions of the two groups were compared. Results: There was a statistically significant decrease in FEV1, FEV1/FVC and FEF25%=75% among policemen working in Kathmandu valley for seven years or more as compared to those working for less than seven years. Although the traffic police had lower FVC, FEV1, FEV1/FVC and PEF in comparison to the general duty police, these differences were not statistically significant. Conclusion: The findings of this study demonstrated that pulmonary functions of both the traffic and the general duty police decrease with increase in duration of job in Kathmandu valley. The pulmonary functions of the traffic police were lower than their predicted values although they were not significantly lower than those of the general duty police. Keywords: Lung function, Spirometry, Traffic policemen, FVC, FEV1, PEF, FEF25%-75%

Pulmonary function in children and adolescents with sickle cell disease after nonmyeloablative hematopoietic cell transplantation.

Pulmonary complications are common in sickle cell disease (SCD). The use of standard myeloablative conditioning regimens may increase the risk of lung injury. We report serial pulmonary function testing (PFT) outcomes in children with SCD who underwent a matched-sibling donor hematopoietic cell transplantation (HCT) using nonmyeloablative (NMA) protocol. This is a retrospective chart review describing pulmonary outcomes in pediatric patients post HCT. The conditioning regimen consisted of alemtuzumab and a single fraction of 300cGy of total body irradiation (TBI), and sirolimus for graft-versus-host disease (GVHD) prophylaxis. Serial PFT testing was performed pre and post HCT. The evaluated pulmonary measures included: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1 ), FEV1 /FVC, and forced expiratory flow (FEF25-75 ). Twelve subjects were included in the analysis. All had HbSS genotype, and five of the 12 patients had one or more episodes of acute chest syndrome prior to HCT. Serial PFT measures were completed per patient. No patient was diagnosed with chronic GVHD of any organ post HCT. The baseline median FVC, FEV1 , FEV1 /FVC, and FEF25-75 were within the normal range and remained relatively unchanged post HCT. A linear mixed effects model, adjusting for gender and time from HCT, suggested no significant relationship between HCT and PFT parameters, including FVC, FEV1 , and FEV1 /FVC. Interestingly, the FEF25-75 results exhibited a shift in the means post HCT (pre-HCT 86.2% predicted and post-HCT 93.05% predicted, p-value = .018). Our study suggests that HCT in children with SCD may prevent the anticipated decline in pulmonary function over time.