Pulmonary Function Test Indices Research Articles

A study of the correlation between total lung volume and the percent of low attenuation volume and PFT indicators in patients with preoperative lung cancer.

The objective was to explore the relationships between computed tomography (CT) lung volume parameters and pulmonary function test (PFT) indexes and develop predictive scores to predict PFT indexes in Chinese preoperative patients suspected with lung cancer. Preoperative patients suspected with lung cancer aged 18 years or more and examined by chest CT scan and PET were consecutively recruited from April to August 2020, at Yunnan Cancer Hospital. CT and PET data were selected from medical record. Pearson correlation was used to explore the relationships between CT parameters and PFT indexes. Predictive scores of PFT indexes were developed from unstandardized coefficients of linear regression models of using CT parameters as predictors. The assessments of predictive ability of scores were conducted by receiver operating characteristics curves. A total of 124 preoperative patients suspected with lung cancer participated in this study. Total lung volume significantly correlated with total lung capacity (r = 0.708), residual volume (r = 0.411), forced expiratory volume in one second (FEV1, r = 0.535), forced vital capacity (FVC, r = 0.687), and FEV1/FVC (r = -0.319). Percent of low attenuation volume significantly correlated with total lung capacity (r = 0.200), residual volume (r = 0.215), FEV1 percentage of predictive value (FEV1%, r = -0.204) and FEV1/FVC (r = -0.345). Four predictive scores for FEV1, FEV1%, FEV1/FVC and FVC% were developed. The area under the curve of receiver operating characteristics for FEV1 <2L, FEV1% <80%, FEV1/FVC <80% and FVC% <80% were 0.856, 0.667, 0.749 and 0.715, respectively. A prediction of poor lung function in preoperative patients suspected with lung cancer, using total lung volume and percent of low attenuation volume was possible. The predictive scores should be further evaluated for external validity.

High-resolution Computed Tomography Thorax Volumetric Assessment in Coronavirus Disease 2019 Patients and Correlation with Pulmonary Function Tests.

Years after SARS coronavirus disease 2019 (COVID-19) recovery, residual pulmonary abnormalities may still exist. This brings on the question of whether or not COVID-19 could have comparable late consequences. Structural changes in the lungs after recovery can be better visualized using computed tomography (CT) thorax. Computed Tomography Lung Parenchymal changes during hospitalization by COVID-19 and after 4 months of follow-up to correlate with the volumetric high-resolution computed tomography thorax indices, Pulmonary function tests (PFTs) indices, SpO2, and 6 min Walking Test (6MWT). This is a Hospital based cross-sectional study, with a follow-up among 100 Patients from 2020 to 2022. Each patient's different CT parameters and HRCT volumetric indices Normal Lung (NL), Normal Lung Percentage (NL%), Whole Lung (WL) were correlated with the PFT indices (Forced expiratory volume in 1s [FEV1], forced vital capacity [FVC], FEV1/FVC), Oxygen Saturation (SpO2) and 6-Minute Walking Test (6MWT). The mean NL (L) and NL% during COVID were significantly lower than the mean values 4 months post-COVID. Architectural distortion, bronchiolar dilatation, interstitial thickening, and parenchymal bands were reduced considerably after 4 months post-COVID, compared to during COVID. PFTs results, such as PFT indices, were not significantly different after 4 months post-COVID, compared to during COVID. SpO2 (%) and 6 MWT (m) were significantly increased. During COVID and post-COVID, the values of NL (L) and NL (%) had a significant positive correlation with PFT indices, SpO2, and 6MWT (m). Hence, the different CT indices (NL and NL%) can be used as a surrogate for functional recovery of COVID patients since it correlates with the PFT indices (FEV1 and FEV1/FVC), SpO2, and 6MWT post-COVID.

Evaluation of the cross-sectional area of small pulmonary vessels in the diagnosis of chronic obstructive pulmonary disease by quantitative computed tomography: A case-control study.

Patients with chronic obstructive pulmonary disease (COPD) have a reduced cross-sectional area (CSA) of small pulmonary vessels and decreased pulmonary function test (PFT) indexes. This study investigated the value of small pulmonary vessel CSA in diagnosing and evaluating the severity of COPD and its correlation with PFT.This retrospective case-control study included patients with COPD who underwent multi-slice spiral computed tomography (CT) between March 2015 and December 2018. COPD severity was graded. Patients with normal CT results were included as controls. The CSA of small pulmonary vessels at the sub-segmental (5–10 mm2) and sub-sub-segmental (<5 mm2) levels was measured. Receiver operating characteristic (ROC) curves were used to evaluate the effect of CSA for COPD risk prediction. The correlation between CSA% and PFT indexes was evaluated.There were 124 and 106 patients in the COPD and control groups, respectively. The %CSA <5 and %CSA5–10 were smaller in the COPD group than in controls (P < .05). The %CSA <5 in each subgroup stratified by COPD severity was smaller than in controls (P < .05). The % CSA5–10 was significantly smaller in the moderate and severe groups than in controls (P < .05). At 0.655%CSA <5 cut-off, the ROC area under the curve (AUC) was 0.765. For %CSA5–10, a 0.565 cut-off led to an AUC of 0.752. Both %CSA <5 and %CSA5–10 were positively correlated with all PFT indexes (r = 0.180–0.462, all P < .05).CSA was positively correlated with PFT. Analysis of small pulmonary vessel CSA based on CT images contributes to diagnosing and assessing the severity of COPD.

Predictors of Diffusing Capacity in Children With Sickle Cell Disease: A Longitudinal Study.

Background: Gas exchange abnormalities in Sickle Cell Disease (SCD) may represent cardiopulmonary deterioration. Identifying predictors of these abnormalities in children with SCD (C-SCD) may help us understand disease progression and develop informed management decisions.Objectives: To identify pulmonary function tests (PFT) estimates and biomarkers of disease severity that are associated with and predict abnormal diffusing capacity (DLCO) in C-SCD.Methods: We obtained PFT data from 51 C-SCD (median age:12.4 years, male: female = 29:22) (115 observations) and 22 controls (median age:11.1 years, male: female = 8:14), formulated a rank list of DLCO predictors based on machine learning algorithms (XGBoost) or linear mixed-effect models, and compared estimated DLCO to the measured values. Finally, we evaluated the association between measured or estimated DLCO and clinical outcomes, including SCD crises, pulmonary hypertension, and nocturnal desaturation.Results: Hemoglobin-adjusted DLCO (%) and several PFT indices were diminished in C-SCD compared to controls. Both statistical approaches ranked FVC (%), neutrophils (%), and FEF25−75 (%) as the top three predictors of DLCO. XGBoost had superior performance compared to the linear model. Both measured and estimated DLCO demonstrated a significant association with SCD severity: higher DLCO, estimated by XGBoost, was associated with fewer SCD crises [beta = −0.084 (95%CI: −0.13, −0.033)] and lower TRJV [beta = −0.009 (−0.017, −0.001)], but not with nocturnal desaturation (p = 0.12).Conclusions: In this cohort of C-CSD, DLCO was associated with PFT estimates representing restrictive lung disease (FVC, TLC), airflow obstruction (FEF25−75, FEV1/FVC, R5), and inflammation (neutrophilia). We used these indices to estimate DLCO, and show association with disease outcomes, underscoring the prediction models' clinical relevance.

Pulmonary function test abnormalities in children and adolescents with non-alcoholic fatty liver disease.

Association between pulmonary function tests (PFTs) and non-alcoholic fatty liver disease (NAFLD) has been reported in adult studies; however, there is lack of pediatric studies. Our study aimed to evaluate PFTs in children with NAFLD. A total of 137 children with NAFLD and 100 healthy children of matched age and sex were included in the study. Different PFTs including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, residual volume (RV), and total lung capacity (TLC) were performed for all included children. Lipid profile, insulin resistance, fasting and postprandial glucose level, and high sensitive C reactive protein (hs-CRP) were measured. FEV1 %, FVC %, FEV1/FVC ratio, RV, and TLC were significantly lower in the patient group compared with the control group (P < 0.05), while RV and hs-CRP were significantly higher in children with NAFLD. Restrictive lung dysfunction was the commonest pulmonary dysfunction detected in children with NAFLD (21.9%). PFT indices were significantly correlated with grade and duration of NAFLD, insulin resistance, waist circumference, and hs-CRP. Regression analysis revealed that insulin resistance and hs-CRP were independently associated with decreased PFT indices.Conclusion: PFT indices were impaired in children with NAFLD and this impairment was independently associated with insulin resistance and hs-CRP. What is Known: • Pulmonary function tests (PFTs) abnormalities are common in adults with nonalcoholic fatty liver disease (NAFLD). • Studies involving PFTs abnormalities in pediatric NAFLD are lacking. What is New: • It is the first study that assessed PFT in pediatric patients with NAFLD. • PFTs abnormalities are present in children with NAFLD. • Insulin resistance and high sensitive C reactive protein are independently associated with the decline of PFTs in children with NAFLD.

Characteristics and clinical significance of pulmonary function test and KL-6 in ASSD-ILD and IPF

Objective: To study the characteristics and clinical significance of pulmonary function test and kerbs von den lungen 6 (KL-6) in anti-synthetase syndrome related interstitial lung disease (ASSD-ILD) and idiopathic pulmonary fibrosis (IPF). Methods: The clinical data of 43 patients with ASSD-ILD (ASSD-ILD group) from May 2015 to May 2017 were collected retrospectively, including 12 males and 31 females, and 34 patients with IPF (IPF group) treated in the First Affiliated Hospital of Zhengzhou University during the same period, including 28 males and 6 females, were also included. The basic information, and the value of pulmonary function test [pulmonary function parameters included the forced vital capacity expressed as percent predicted (FVC%pred), the forced expiratory volume in 1 second expressed as percent predicted (FEV(1)%pred), the ratio of FVC to FEV(1) (FVC/FEV(1)), the peak expiratory flow expressed as percent predicted (PEF%pred), the forced expiratory flow at 25%, 50%, 75% of FVC as percent predicted (FEF(25)%pred, FEF(50)%pred, and FEF(75)%pred), the maximum mid-expiratory flow as percent predicted (MMEF% pred), and the diffusing capacity for carbon monoxide as percent predicted (DLCO% pred)], and serum KL-6 level in ASSD-ILD and IPF were compared. Results: The FEV(1)%pred, FEF(50)%pred, FEF(75)%pred, and MMEF%pred values in ASSD-ILD group were significantly lower than those in IPF group (all P<0.05), while the FVC% pred, FVC/FEV(1), PEF% pred, FEF(25)%pred, and DLCO% pred values in ASSD-ILD group had no significant difference compared with IPF group (all P>0.05). There was no significant difference in serum KL-6 level between ASSD-ILD group and IPF group [(1 169±911) vs (1 210±908) U/ml, t=0.62, P=0.463]. Follow-up analysis showed that the serum KL-6 level of ASSD-ILD patients who died within two years was significantly higher than that of survivors [(2 060±1 168) vs (1 042±858) U/ml, t=2.93, P=0.041]. The serum KL-6 level of patients who died within two years of IPF patients was also significantly higher than that of patients who survived [(1 767±865) vs (1 089±894) U/ml, t=2.53, P=0.026]. The serum KL-6 level in ASSD-ILD group was negatively correlated with FVC%pred (r=-0.43, P=0.004), FEV(1)%pred (r=-0.39, P=0.010) and DLCO% pred (r=-0.41, P=0.006). There was no correlation between serum KL-6 level and pulmonary function test indexes in IPF group (all P>0.05). Conclusions: There is difference in pulmonary function test between ASSD-ILD patients and IPF patients. High serum KL-6 level will be predictive of poor prognosis.

Effect of acute respiratory infections in infancy on pulmonary function test at 3 years of age: a prospective birth cohort study

IntroductionAcute respiratory infections (ARIs) in infancy may have a long-term impact on the developing respiratory system. We planned a prospective cohort study to determine the impact of ARI during infancy...

Pulmonary Function Tests Reveal Unrecognized Lung Dysfunction and Have Independent Prognostic Significance in Patients with Systemic AL Amyloidosis

Lung involvement in patients with systemic AL amyloidosis is not very common and consensus criteria require direct biopsy verification with symptoms or typical radiographic changes of diffuse interstitial lung disease. Dyspnea and other symptoms are commonly attributed to cardiac dysfunction and thus, lung dysfunction may go unrecognized while, in some series evidence suggest that lung involvement is probably more frequent than reported. No prospective comprehensive evaluation of lung function has been performed in patients with AL amyloidosis; the aim of our study was to prospectively assess lung function by performing comprehensive pulmonary function tests (PFTs) in consecutive patients with systemic AL amyloidosis. This was a non-interventional prospective study that included consecutive patients with systemic AL amyloidosis treated in the Department of Clinical Therapeutics (Athens, Greece). Patients with localized lung amyloidosis were excluded. PFTs were performed in a Master screen Body (Jaeger, Germany), according to manufacturer's instructions and standard European Respiratory Society / American Thoracic Society guidelines. We performed spirometry, lung volumes measurement, single-breath determination of carbon monoxide uptake in the lung corrected for hemoglobin (carbon monoxide diffusion capacity, DLCO) and maximal expiratory (Pe) and inspiratory (Pi) pressures measurement, in a sitting position. The patient's age, height and weight were recorded for use in the calculation of reference values. We adjusted DLCO for Hb prior to the interpretation of the maneuver in the predicted values. Smoking habits were recorded (smoker or no, pack/years, years of smoking cessation). We report on the first 84 patients with systemic AL amyloidosis that were included in the study. Median age was 63 years (range 44-84), 60% were males, median baseline dFLC was 162 mg/L, median BM infiltration was 15% (range 0-30%). Kidney involvement was present in 73%, median eGFR was 63 ml/min/1.73 m2. Heart was involved in 72% and 12%, 62%, 17% &amp; 8% of patients were Mayo stage 1,2, 3A and 3B respectively. Liver was involved in 25%, peripheral/autonomic nerve in 21% and soft tissue in 12%. Based on imaging and/or lung biopsy, lung involvement was present in 2 (2%) patients; 48% of the patients were current or ex-smokers. Primary treatment was bortezomib-based in 89% of the patients. According to PFTs, breathing pattern was normal in 49%, restrictive in 37%, obstructive in 11% and mixed in 3%. The presence of a restrictive pattern was marginally associated with heart involvement (p=0.056) but not with Mayo stage and was more common in patients with liver (p=0.022) and soft tissue involvement (0.031) and there was no association with renal or nerve involvement or FLC levels. In univariate analysis, restrictive pattern was associated with worse survival (24 months vs not reached for obstructive and normal, p=0.015); 1-year mortality was 42% for restrictive vs 13% for obstructive and 5% for normal breathing patterns. When adjusted for Mayo stage, restrictive pattern (HR 2.63, p=0.033) and Mayo stage 3B (HR: 12, p=0.033) were independently associated with survival. Among individual PFTs indices, corrected DLCO (p=0.02), TLC% (p=0.012) and Pe% (p=0.019) were associated with survival. A DLCO &lt;60% was associated with poor survival (7 months vs not reached, p=0.002) and remained significant even after adjustment for Mayo stage (HR: 2.5, p=0.027). Pe%, (maximum expiratory pressure, a simple to do and helpful indicator of muscle weakness and lung compliance), was associated with shorter survival when was &lt;70% of the predicted (not reached vs 27 months, p=0.002), even after adjustment for Mayo stage (HR: 6.4, p=0.003). TLC%, a measure of total lung capacity, when &lt;75% of predicted was associated with a median survival of 8.5 months vs not reached (p=0.012), even after adjustment for Mayo stage (HR: 3.1, p=0.027). Among these indices, however, a Pe%&lt;70% was the most important in multivariate analysis (HR: 7, p=0.003) along with stage 3B (HR:17.7, p=0.017) In this comprehensive evaluation of lung function by PFTs we found that restrictive breathing pattern is common among patients with systemic AL, and indices of lung function are associated with prognosis independently of cardiac dysfunction. Our results point to the presence of unrecognized pulmonary involvement, despite the absence of typical imaging findings. Disclosures Kastritis: Genesis: Honoraria; Prothena: Honoraria; Takeda: Honoraria; Pfizer: Honoraria; Amgen: Honoraria, Research Funding; Janssen: Honoraria, Research Funding. Gavriatopoulou:Janssen: Honoraria, Other: Travel expenses; Amgen: Honoraria; Takeda: Honoraria, Other: Travel expenses; Genesis: Honoraria, Other: Travel expenses. Terpos:Medison: Honoraria; Genesis: Honoraria, Other: Travel expenses, Research Funding; Amgen: Honoraria, Research Funding; Takeda: Honoraria, Other: Travel expenses, Research Funding; Celgene: Honoraria; Janssen: Honoraria, Other: Travel expenses, Research Funding. Dimopoulos:Sanofi Oncology: Research Funding.

Effect of Zataria multiflora on serum cytokine levels and pulmonary function tests in sulfur mustard-induced lung disorders: A randomized double-blind clinical trial.

Zataria multiflora (Z. multiflora) belongs to the Lamiaceae family and has several traditional uses owing to its antiseptic, aesthetic, antispasmodic, analgesic, and antidiarrheal properties. We aimed to investigate the effect of Z. multiflora on serum cytokine levels and pulmonary function tests (PFT) in patients exposed to sulfur mustard (SM) for a long term (27-30 years). Thirty-five patients were randomly assigned to the placebo group (P) and two experimental groups treated with Z. multiflora extracts, i.e., 5 and 10 mg/kg/day (Z5 and Z10). Serum levels of cytokines including IL (2, 4, 6, 8, and 10) and IFN-γ as well as PFT indices such as maximum mid-expiratory flow (MMEF) and maximum expiratory flow at 25, 50, and 75% of vital capacity (VC) (MEF25, 50, and 75) were assessed at the beginning (phase 0) and at the end of 4 and 8 weeks (phases I and II, respectively) after starting the treatment. Serum levels of IL-2, IL-6, and IL-8 were significantly decreased, while serum levels of IL-10 and IFN-γ were significantly increased in the Z5 and Z10 treatment groups in phases I and II as compared to those in phase 0 (p < 0.05 to p < 0.001). MMEF and MEF25, 50, and 75 values were significantly increased in the Z5 group in phase II and in the Z10 group in phases I and II compared to those in phase 0 (p < 0.05 to p < 0.001). The percent change in serum cytokine levels and the change in MEF25, 50, and 75 during the two-month treatment period were significantly higher in the treatment groups than in the placebo group. Two months of treatment with Z. multiflora reduced inflammation, while it enhanced anti-inflammatory cytokines and improved PFT indices in SM-exposed patients.

Correlation of SOCS3 gene polymorphism with childhood asthma.

To explore the correlation of the suppressor of cytokine signaling 3 (SOCS3) gene polymorphism with childhood asthma. A total of 204 asthma children (observation group) and 235 healthy children (control group) were enrolled. General clinical information of enrolled subjects was collected. Inflammatory factors and pulmonary function test indexes in each subject were examined. Moreover, the polymorphism of SOCS3 gene rs9914220 was detected with the TaqMan-MGB probe. Asthma children in the observation group exhibited higher levels of interleukin-4 (IL-4), IL-17, and IL-33 than those of the control group (p<0.05). The forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity (FVC) ratio (%), peak expiratory flow (PEF), and FVC in the observation group were lower than those in the control group. However, the residual volume (RV), and RV/total lung capacity (TLC) ratio were higher in observation group than those in control group (p<0.05). Distribution frequency of the genotypes varied a lot between the two groups (p<0.05). However, we did not observe a significant difference in SOCS3 alleles between the two groups (p>0.05). According to the analysis of the genetic model, there were differences in dominant and cumulative models between the two groups (p<0.05), whereas the recessive model was not different between the two groups (p>0.05). Levels of inflammatory factors and pulmonary functions help to effectively monitor the progression of childhood asthma, thus increasing the clinical diagnosis rate. The polymorphism of the SOCS3 gene rs9914220 site is correlated with the onset of childhood asthma.

Prediction of Pulmonary Function in Patients with Chronic Obstructive Pulmonary Disease: Correlation with Quantitative CT Parameters.

ObjectiveWe aimed to evaluate correlations between computed tomography (CT) parameters and pulmonary function test (PFT) parameters according to disease severity in patients with chronic obstructive pulmonary disease (COPD), and to determine whether CT parameters can be used to predict PFT indices.Materials and MethodsA total of 370 patients with COPD were grouped based on disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I–IV criteria. Emphysema index (EI), air-trapping index, and airway parameters such as the square root of wall area of a hypothetical airway with an internal perimeter of 10 mm (Pi10) were measured using automatic segmentation software. Clinical characteristics including PFT results and quantitative CT parameters according to GOLD criteria were compared using ANOVA. The correlations between CT parameters and PFT indices, including the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) and FEV1, were assessed. To evaluate whether CT parameters can be used to predict PFT indices, multiple linear regression analyses were performed for all patients, Group 1 (GOLD I and II), and Group 2 (GOLD III and IV).ResultsPulmonary function deteriorated with increase in disease severity according to the GOLD criteria (p < 0.001). Parenchymal attenuation parameters were significantly worse in patients with higher GOLD stages (p < 0.001), and Pi10 was highest for patients with GOLD III (4.41 ± 0.94 mm). Airway parameters were nonlinearly correlated with PFT results, and Pi10 demonstrated mild correlation with FEV1/FVC in patients with GOLD II and III (r = 0.16, p = 0.06 and r = 0.21, p = 0.04, respectively). Parenchymal attenuation parameters, airway parameters, EI, and Pi10 were identified as predictors of FEV1/FVC for the entire study sample and for Group 1 (R2 = 0.38 and 0.22, respectively; p < 0.001). However, only parenchymal attenuation parameter, EI, was identified as a predictor of FEV1/FVC for Group 2 (R2 = 0.37, p < 0.001). Similar results were obtained for FEV1.ConclusionAirway and parenchymal attenuation parameters are independent predictors of pulmonary function in patients with mild COPD, whereas parenchymal attenuation parameters are dominant independent predictors of pulmonary function in patients with severe COPD.

Direct and indirect effects of Growth Hormone Deficiency (GHD) on lung function in children: A mediation analysis

Studies on pulmonary function tests (PFTs) in Growth Hormone Deficiency (GHD) children are lacking. The aims of this study were: (i) to investigate PFTs in GHD pre-pubertal children with respect to Controls, before starting Growth Hormone Therapy (GHT) (T0); (ii) to evaluate changes of PFTs in GHD vs Controls, after 1-year GHT (T1). For both aims the mediation analysis (MA) was applied to evaluate the extent to which the relationship between GHD and PFTs could be ascribed to a height-mediated (indirect) or a GH direct effect. 47 pre-pubertal GHD children (aged 5-14 years) underwent PFTs at T0 and T1. At T0, 47 healthy children matched for age and sex were enrolled as Controls. A MA was performed to assess the relationship between GHD and PFTs and height. Statistical analyses were performed using the statistical software R (https://cran.r-project.org/mirrors.html). A p-value <0.05 was considered significant. At T0, PFTs indices were significantly lower in GHD than in Controls. From T0 to T1 a significant improvement was found in PFTs. The percentages of the mediated effect on FVC, FEV1, FEF25-75% and TLC were <50% at T0, suggesting that the direct effect was prevalent. At T1, the percentages of the mediated effect for spirometry indices were ≥50%, indicating that the indirect (height-mediated) effect was the most relevant. The study shows that pre-pubertal children with GHD have an impairment of lung function not exclusively attributable to the indirect (height-mediated) effect, but also to the direct GH action which is mitigated after 1-year of GHT.

Relationship between radiologic patterns, pulmonary function values and bronchoalveolar lavage fluid cells in newly diagnosed sarcoidosis.

The aim of the present study was to identify specious radiologic and/or physiologic prognostic marker(s), which lead to optimize of the patient follow-up frequency. Eighty consecutive patients with newly diagnosed pulmonary sarcoidosis. Patients underwent chest radiography, high-resolution computed tomography (HRCT) examination, pulmonary function tests (PFT), bronchoscopy with bronchoalveolar lavage (BAL) and lung biopsy, and bronchoalveolar lavage fluid (BALF) cell examination. The reduction in PFT values seen in radiological sarcoidosis stage III was greater than that seen in stages I and II. The percentage of neutrophils in the lungs was found to increase in stages II and III. PFT indices were correlated negatively with the consolidation and ground glass opacities CT scores, but not with the micronodule or macronodule scores. The rise in the percentage of BALF lymphocytes was associated with the restriction pattern of PFT. The diagnostic value of BALF for sarcoidosis was higher when the typical radiologic patterns of stage I disease were found and that smoking decreased the diagnostic value of CD4/CD8 ratio. This study supports the opinion that the staging of the pulmonary sarcoidosis with chest X-rays is still valuable from the prognostic point of view, because significant correlations between the radiologic stages of sarcoidosis and PFT parameters were found. Chest HRCT was significantly superior to chest X-ray in detecting mediastinal and pulmonary parenchymal changes. However, the prognostic role of HRCT needs to be better investigated evaluating serial examinations. Only consolidation and ground glass scores (neither of which are frequently found in sarcoidosis) hold prognostic value, since these were negatively correlated with PFT parameters.

Correlation of 68Ga Ventilation–Perfusion PET/CT with Pulmonary Function Test Indices for Assessing Lung Function

Pulmonary function tests (PFTs) are routinely used to assess lung function, but they do not provide information about regional pulmonary dysfunction. We aimed to assess correlation of quantitative ventilation-perfusion (V/Q) PET/CT with PFT indices. Thirty patients underwent V/Q PET/CT and PFT. Respiration-gated images were acquired after inhalation of (68)Ga-carbon nanoparticles and administration of (68)Ga-macroaggregated albumin. Functional volumes were calculated by dividing the volume of normal ventilated and perfused (%NVQ), unmatched and matched defects by the total lung volume. These functional volumes were correlated with forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and diffusing capacity for carbon monoxide (DLCO). All functional volumes were significantly different in patients with chronic obstructive pulmonary disease (P < 0.05). FEV1/FVC and %NVQ had the highest correlation (r = 0.82). FEV1 was also best correlated with %NVQ (r = 0.64). DLCO was best correlated with the volume of unmatched defects (r = -0.55). Considering %NVQ only, a cutoff value of 90% correctly categorized 28 of 30 patients with or without significant pulmonary function impairment. Our study demonstrates strong correlations between V/Q PET/CT functional volumes and PFT parameters. Because V/Q PET/CT is able to assess regional lung function, these data support the feasibility of its use in radiation therapy and preoperative planning and assessing pulmonary dysfunction in a variety of respiratory diseases.

Development and Evaluation of an Improved Technique for Pulmonary Function Testing Using Electrical Impedance Pneumography Intended for the Diagnosis of Chronic Obstructive Pulmonary Disease Patients

Spirometry is regarded as the only effective method for detecting pulmonary function test (PFT) indices. In this study, a novel impedance pulmonary function measurement system (IPFS) is developed for directly assessing PFT indices. IPFS can obtain high resolution values and remove motion artifacts through real-time base impedance feedback. Feedback enables the detection of PFT indices using only both hands for convenience. IPFS showed no differences in the sitting, supine, and standing postures during the measurements, indicating that patient posture has no effect on IPFS. Mean distance analysis showed good agreement between the volume and flow signal of IPFS (p < 0.05). PFT indices were detected in subjects to differentiate a chronic obstructive pulmonary disease (COPD) patient group from a normal group. The forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, and peak expiratory flow (PEF) in the COPD group were lower than those in the normal group by IPFS (p < 0.05). IPFS is therefore suitable for evaluating pulmonary function in normal and COPD patients. Moreover, IPFS could be useful for periodic monitoring of existing patients diagnosed with obstructive lung disease.

Pulmonary Functions Before and After Pediatric Cardiac Surgery

This study aimed to assess pulmonary functions before and after cardiac surgery in infants with congenital heart diseases and pulmonary overflow and to clarify which echocardiographic parameter correlates best with lung mechanics. Between 2008 and 2009, 30 infants with left-to-right shunt congenital acyanotic heart diseases who had indications for reparative surgery of these lesions were assessed by echocardiography and infant pulmonary function tests before the operation and 6 months afterward. Tests using baby body plethysmography were performed to assess the following infant pulmonary functions: tidal volume, respiratory rate, respiratory system compliance (C(rs)) and respiratory system resistance, functional residual capacity (FRC), and airway resistance. The mean age of the patients was 10.47 ± 3.38 months, and their mean weight was 6.81 ± 1.67 kg. Ventricular septal defect and combined lesions were the predominant cardiac diseases (26.7%). Comparison of the infant pulmonary function tests showed a highly significant improvement in all the parameters between the preoperative and 6-month postoperative visits (p < 0.0001). Systolic pulmonary artery pressure had a statistically significant negative correlation with C(rs) (r = -0.493, p = 0.006) and a positive correlation with FRC (r = 0.450, p = 0.013). The findings showed that C(rs) had a statistically significant negative correlation with the pulmonary artery size (r = -0.398, p = 0.029) and the left atrium size (r = -0.395, p = 0.031), whereas the pulmonary artery size had a statistically positive correlation with effective resistance (r = 0.416, p = 0.022) and specific effective resistance (r = 0.604, p = 0.0001). Surgical correction of left-to-right shunt congenital heart diseases had a positive impact on lung compliance, airway resistance, and FRC. Noninvasive echocardiographic parameters assessing pulmonary vascular engorgement and pulmonary artery pressure were closely related to these infant pulmonary function test indexes.

Effect of TGFß1 and TIMP2 on disease activity in asthma and COPD.

The process of bronchial tissue repair/remodeling depends on balance between production and degradation achieves the regulation of extracellular matrix turnover. We designed this study to evaluate relation between Transforming Growth Factor Beta1 (TGFß1) and Tissue Inhibitory of Metaloproteinase 2 (TIMP2) as two main tissue mediators on activity and reversibility of asthma and chronic obstructive pulmonary disease (COPD). In a cross sectional study we evaluated TIMP2 and TGFß1 expression in two groups of 29 asthmatic (14 males and 15 females) and 13 male COPD patients using semi-quantitative PCR on induced sputum samples. The relation between TIMP2 and TGFß1 and PFT indices and disease free period were assessed. The COPD patients with raised expression of both TGFß1 and TIMP2 had better pulmonary function test (PFT) indices and also longer disease free period. In contrast patients with chronic asthma could remain in well pulmonary function status with raised TIMP2 and decreased TGFß1 expression. We supposed that underlying inflammatory process is the main reason for the different effect of cytokines in asthma and COPD. It raises concern about critical role of corticosteroids consumption on various cytokines expression. Furthermore TGFBeta1 may be served as a biomarker in sputum for assessing disease activity and evidence based prescribing corticosteroids in patients with COPD and asthma.

Type B Niemann-Pick Disease: Findings at Chest Radiography, Thin-Section CT, and Pulmonary Function Testing

To evaluate findings at radiography, computed tomography (CT), and pulmonary function testing in patients with type B Niemann-Pick disease. The study was approved by the institutional review board or ethics committee at each study site and was compliant with HIPAA at the U.S. site. Written informed consent was obtained from each patient or guardian and minor assent was obtained from all children before any study-related procedures. Pulmonary involvement in 53 patients (27 male and 26 female patients; age range, 7-65 years; mean age, 23.3 years) with type B Niemann-Pick disease was evaluated with imaging and pulmonary function tests. All patients underwent chest radiography and thin-section CT, and images were independently interpreted by one of two radiologists. Spirometry (forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV1]) was performed and diffusing capacity of lung for carbon monoxide (Dlco) was evaluated in all patients who could comply. A score for the degree of interstitial lung disease was derived at both radiography and CT, and the CT scores were then compared with results of pulmonary function testing and patient age by means of linear regression. CT scores were compared between the upper and lower lung zones by using the Wilcoxon signed rank test. Chest radiography and CT, respectively, revealed interstitial lung disease in 47 (90%) and 51 (98%) of the 52 patients who completed both imaging examinations. There was a basilar predominance of interstitial lung disease at CT. Six patients had pulmonary nodules, one of which was calcified at chest radiography. There were no statistically significant correlations between interstitial lung disease score at CT and age or percentage predicted FVC, FEV1, or Dlco values. Although pulmonary function test indexes may be abnormal, imaging findings do not necessarily correlate with pulmonary function in patients with type B Niemann-Pick disease.

Incidence, outcome, and risk factors of late-onset noninfectious pulmonary complications after unrelated donor stem cell transplantation.

We evaluated the incidence, the risk factors, and the outcome of late-onset noninfectious pulmonary complications (LONIPCs) among 50 patients who underwent allogeneic stem cell transplantation from unrelated donors. Of the 39 patients surviving at least 3 months, 10 (26%) fulfilled the diagnostic criteria of LONIPCs and were further subclassified as having bronchiolitis obliterans (four patients), bronchiolitis obliterans with organizing pneumonia (four patients), and interstitial pneumonia (two patients). Two patients had a durable partial remission after treatment with prednisone and cyclosporine; the remaining eight patients did not respond to treatment and five of them died of respiratory failure. Advanced stage of disease at transplant and chronic extensive graft-versus-host disease (GVHD) were significantly associated with the development of LONIPCs. Pulmonary function test (PFT) results before transplantation were similar in all patients, but patients with LONIPCs had a significant decrease in PFT indexes at the third month after BMT compared with controls. Moreover, the rate of cyclosporine taper during the fourth and fifth months after BMT was significantly more rapid in patients with LONIPCs than in controls, suggesting that the risk of LONIPCs may be influenced by a faster reduction of GVHD prophylaxis.

Pulmonary function threshold for distinguishing ventilatory- and nonventilatory-limited patients with airflow obstruction

Patients with chronic obstructive pulmonary disease (COPD) may demonstrate great variability between results on the pulmonary function test (PFT) compared to those on the cardiopulmonary exercise test (CPXT). The purpose of this study was to correlate PFT and CPXT indices and to identify PFT threshold values for predicting exercise capacity in patients with airflow limitation. Fifty-seven patients (48 men and 9 women) of mean age 66·4 ± 4·8 years with COPD and 40 age-matched control patients underwent PFT and CPXT. Based on the CPXT results, the patients were divided into ventilatory-limited (VL) and nonventilatory-limited (NVL), and the findings were correlated with the PFT indices. Linear regression analysis was used to determine the relationship between dyspnea index ( V e max/MVV) and forced expiratory volume in one second (FEV 1). The cutoff value for VL was FEV 1 <38% and for NVL FEV 1 >68%. The prominent limiting symptom (61%) in the VL group was dyspnea sensation, with leg discomfort presenting in only 14%; corresponding rates in the NVL group were 38% and 31%. We conclude that the FEV 1 is a reliable index for distinguishing VL from NVL COPD patients during CPXT at two extremes: below 38% of the predicted value (VL) and above 68% of the predicted value (NVL).