Pulmonary Function Test Values Research Articles

To Assess the Effect of Septoplasty on Pulmonary Function Tests: A Prospective Study.

To assess the effect of septoplasty on pulmonary function test (PFT). 50 cases were chosen between the age group 18-50. All cases had nasal obstruction due to nasal septum deviation. Demographic data, detailed clinical examination including anterior and posterior rhinoscopy was performed. PFT values (fvc, fev1, fev1/fvc, fef25%, fef50%, fef75%, fif25%, fif50%, fif75%) were taken pre operatively and 1month after the surgery by using Helios 401 spirometer. All the data were recorded and spss version 20.0 was used to analyse the data. Among 50 patient, most of the patients were males 78% (n = 39) and the rest were females (n = 11) 22%. The patient were in between 18 and 50 age group. The maximum patient belonged to age group 18-27years (n = 25) 50% of the total patients. 38% (n = 19) were in the age group of 27-37years. 12% (n = 6) of the patients were in age group of 37-50. Nasal obstruction was present in all patients (n = 50) followed by sneezing (56%), nasal discharge (42%), and headache (26%). Maximum number of patient had deviation of septum to the left (n = 28) 56% and the rest had to the right (n = 22) 44%. After the surgery there was improvement in PFT values in all types of patient with DNS, but statistical significance was seen in type II in fef25% and fif75% values (p < 0.05). In rest of the patients there was no statistical significant improvement seen. A favorable outcome was seen in PFT values after Septoplasty, thus signifying the effect of deviated nasal septum on lower airway.

The Effect of Using the Lower Limit of Normal 2.5 in Pulmonary Aeromedical Assessments.

INTRODUCTION: Many regulations for aeromedical assessments state that a ratio between forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) of < 0.7 should be evaluated by a pulmonary specialist. The Global Lung Initiative (GLI) reference values introduced the lower limit of normal (LLN 2.5), in which the lowest 2.5% of the population is regarded as abnormal, instead of a fixed ratio. This study assesses the impact of adopting GLI reference values on aeromedical evaluation and referrals.METHODS: The Royal Netherlands Air Force performed 7492 aeromedical assessments between February 2012 and April 2017. Cases with FEV1/FVC < 0.7 from three groups were selected: 1) men < 25 yr; 2) men > 40 yr; and 3) women, with twice as many matched controls. Pearson's Chi-squared and Fisher's exact tests were used to analyze the data.RESULTS: From the database, 23 (group 1), 62 (group 2), and 7 (group 3) cases were selected, with 184 controls. Respectively, 17%, 84%, and 29% would not be referred using the GLI. In the controls, this would lead to one additional referral (group 1). Qualitative analysis of the cases who would not be referred using the GLI showed that no significant diagnoses would have been missed.DISCUSSION: Using the GLI LLN 2.5 reference values for pulmonary function tests leads to significantly fewer referrals to a pulmonary specialist without missing relevant pulmonary pathology in our aircrew. This would reduce resources spent on the assessment of aircrew without compromising flight safety.Wingelaar-Jagt YQ, Wingelaar TT, Bülbül M, vd Bergh PP, Frijters E, Staudt E. The effect of using the lower limit of normal 2.5 in pulmonary aeromedical assessments. Aerosp Med Hum Perform. 2020; 91(8):636-640.

Effect of Yoga (Pranayama) in Improving Pulmonary Function Tests In Pediatric Age Group: a One Year Prospective Study

Aim: The aim of the study is to find out the effect of pranayama in improving the values of pulmonary function tests, in school going children (of adolescent age group between 12 years to 15 years) having mild to moderate asthma and also not being on any long term medication for the same.&#x0D; Method: After taking a written informed consent from the school teacher in charge, the parents and the children group from a government high school in Bengaluru, the screening of the children for asthma was done. Initial pulmonary function tests were done after inhaling a bronchodilator for the diagnosis of mild and moderate asthma. The diagnosed children were not put on any long term medication. They were educated about pranayama and were also taught the methodology of performing pranayama and other yoga asanas. They were made to perform pranayama every day for 20-30 minutes, for a period of 1 year (during June 2017 – June 2018) under the teacher’s guidance and during this period they were examined periodically(every 3 months) for the improvement in their pulmonary function tests.&#x0D; Results: FEV% deteriorated in 16 children in the second visit and 20 children in the last visit. This could be explained by the disproportionate increase of FVC compared to FEV1.FEV% improved better than FVC in 40% (20) of the children while the rest 60% (29) children’s improvement in FVC was better than FEV%. In the final visit around 11 children had no change in the PEFR values, which was significantly high when other lung functions were considered.&#x0D; Conclusion: FEV1 has increased from first visit to fourth visit, but at each visit the increase was not significant. This suggests the beneficial effect of pranayama in improving FEV1 when it is practised regularly for prolonged duration. Thus our prospective study confirms that Pranayama could be one of the better alternative therapies that should be considered in adolescent asthma.&#x0D;

Endoscopic sinus surgery and its effects on pulmonary function test in patients of chronic rhinosinusitis with nasal polyposis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The human upper and lower respiratory tract share a close relationship in respect to existence of diseases. The objectives of this study were to evaluate the outcome of endoscopic sinus surgery with the Lund- Mackay staging system and to find any objective changes between the pre and post-operative pulmonary function test values in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 50 patients of CRSwNP refractory to maximal medical treatment (for 1 month) planned for endoscopic sinus surgery were included in the study. Results were assessed on the basis of pre and post-operative endoscopic and CT scores and PFT (FEV1, FVC and FEV1/FVC) values. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Postoperatively, Lund Mackay endoscopic and CT scores improved from the preoperative values, which were statistically significant with p values&amp;lt;0.05. Comparing FEV1/FVC, FVC and FEV1 values in three situations- preoperative versus postoperative 1 month, preoperative versus postoperative 3&lt;sup&gt;rd&lt;/sup&gt; month and post-operative 1&lt;sup&gt;st&lt;/sup&gt; month versus postoperative 3&lt;sup&gt;rd&lt;/sup&gt; month, the difference between the means were found to be statistically significant (p=0.000), except for FVC between postoperative 3&lt;sup&gt;rd&lt;/sup&gt; month and 1&lt;sup&gt;st&lt;/sup&gt; month.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study provides objective evidence that patients with CRSwNP may have non clinical lower airway disease detected by PFT and ESS is effective in improvement of both nasal and lower airway disease as evident from the improvements in PFT values.&lt;/p&gt;

Evaluation of intrathoracic tracheal narrowing in patients with obstructive ventilatory impairment using dynamic chest radiography: A preliminary study

PurposeDynamic chest radiography (DCR) can observe the dynamic structure of the chest using continuous pulse fluoroscopy irradiation. However, its usefulness remains largely undetermined. The purpose of this study was to examine the relationship between changes in tracheal diameter during deep breathing and obstructive ventilation disorders using DCR. MethodTwelve participants with obstructive ventilatory impairment and 28 with normal pulmonary function underwent DCR during one cycle of deep inspiration and expiration. Three evaluators blinded to pulmonary function test results independently measured lateral diameters of the trachea in DCR images to determine whether there was a difference in the amount of change in tracheal diameter depending on the presence or absence of pulmonary dysfunction. Tracheal narrowing was defined as a decrease in the lateral tracheal diameter of more than 30 %. Participants were divided into a narrowing group and a non-narrowing group, and it was examined whether each group correlated with values of pulmonary function tests. ResultsTracheal diameter was significantly narrowed in subjects with obstructive ventilatory impairment compared to normal subjects (P < 0.01). When subjects were divided into narrowing (tracheal narrowing rate [TNr] = 41.5 ± 7.7 %, n = 9) and non-narrowing groups (TNr = 9.1 ± 7.0 %, n = 31, p < 0.01), FEV1%-G, and %V25 were significantly smaller in the narrowing group than in the non-narrowing group (p < 0.01). ConclusionsChanges in tracheal diameter during deep breathing were easily evaluated using DCR. DCR may, therefore, be useful for evaluating obstructive ventilation disorders.

Pattern of Pulmonary Dysfunctions in Craniovertebral Junction Anomaly and Its Persistence after Rigid Occipitocervical Fixation

Abstract Introduction Despite a significant advancement in operative techniques of occipitocervical fixation, there is a poor postoperative patient outcome. This can be attributed to restrictive lung pattern in craniovertebral junction anomalies (CVJAs) patients resulting from repeated trauma to cervicomedullary junction by the pincer action of the bony anomalies and compression of the brainstem. We evaluate the changes in pulmonary function tests (PFTs) following rigid occipitocervical fixation in CVJA. Methods PFTs of 20 CVJA patients were measured pre and postoperatively using spirometry. Measurements included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum forced mid-expiratory flow rate (FEF25–75%), and ratio of FEV1 and FVC (FEV1%). The parameters were compared with the predicted normal values based on their age and sex. PFTs were repeated on the seventh postoperative day. McCormick grading was used to assess neurological function. Results The values of PFTs in the preoperative period were significantly lower than predicted normal values. The mean values of FVC, FEV1, FEF25–75% were 72, 68, and 71% of their mean predicted values, with FEV1% in the range of 70 to 95% with a mean of 81.4%. Postoperatively there was further significant reduction in the mean values of FVC, FEV1, FEF25–75%, and FEV1% compared with the preoperative values. There was neurological improvement in McCormick grades of patients postoperatively (from grade III and IV to grade II). Conclusion A significant restrictive lung disease is present in patients of CVJA, even though not clinically apparent, and it persists in the early postoperative period. However, a long-term follow-up is required to assess whether pulmonary function parameters improve subsequently.

Effect of Respiratory Muscle Training on Pitch Range and Sound Duration in Brass Instrument Players and Singers

Effective use of respiratory organs is important for musicians. Therefore, the impact of Respiratory Muscle Training (RMT) on phonation is open to research. The aim of this study was to investigate the measurable effects of RMT on blowing in brass instrumental and on voice performance in singers. Thirty musicians were recruited and separated into a four groups. The brass instrumental and singers groups were further subdivided into control and RMT groups for a 4 week RMT intervention giving a total four groups: singers experimental (SE; n:10), singers control (SC; n:10), brass instrument players experimental (BIPE; n:5), and BIPC (n:5). The groups selected from the musicians of Samsun State Opera and Ballet Directorate and Samsun Metropolitan Municipality Band Team participated in the study. After 4 weeks of RMT application in the study groups, significant increase in all parameters except Forced vital capacity/Forced expiratory volume in 1 second was observed in the values of pulmonary function tests and respiratory muscle strength in subjects with SE and BIPE (P < 0.05). The most significant results of this study are that in addition to changes in the duration of phonation (SE 36%), high-pitch (SE 79%, BIPE 27%) and low-pitch sounds (BIPE 61% and SE 42%), the SE (15%) and BIPE (3%) groups reached higher pitches in the high-pitch notes. It was determined that performance of the highest and lowest pitch sounds within a vocal register in a single breath and phonation times can be improved by RMT.

Quantitative analysis of Sjogren's syndrome related interstitial lung disease with different methods

PurposeTo investigate the success of different quantitative lung assessment (QLA) methods on high-resolution CT (HRCT) to assess the severity of Sjogren's syndrome (SjS) related interstitial lung disease (ILD). MethodConsecutive SjS patients who underwent both thin-section HRCT and pulmonary function tests (PFTs) were investigated. The QLA was obtained using two different DICOM (digital imaging and communications in medicine) viewer with three different methods and lung histogram values. HRCT images were semiquantitatively (SQLA) evaluated in consensus by two radiologists using the Goh score and, two groups were established: limited (< 20%), extensive (> 20%) ILD. Spearman's correlation test was used to assess the correlation between variables. ROC curve analysis was performed to determine the ability of QLA methods to distinguish ILD groups. ResultsThirty-four patients were included, and SQLA revealed limited ILD in 22 patients (64.7%). PFT values were significantly lower in the extensive ILD group. The QLA scores showed a significant difference between limited and extensive ILD groups, and all QLA indices showed a significant correlation with SQLA and PFTs. ROC analysis showed that mean lung attenuation and Method-1 (ILD: voxels between −200 and −700 HU) were the best to distinguish the ILD severity by 0.93 (CI 95 0.83 –1%) and 0.84 (CI 95 0.71−0.97%), respectively. ConclusionThe QLA methods are a promising alternative to the Goh score in the objective evaluation of SjS-related ILD. The QLA methods are capable of distinguishing extensive (which is responsible for poor prognosis in SjS patients) from limited ILD.

Genetic modifiers of respiratory function in Duchenne muscular dystrophy.

ObjectiveRespiratory insufficiency is a major complication of Duchenne muscular dystrophy (DMD). Its progression shows considerable interindividual variability, which has been less thoroughly characterized and understood than in skeletal muscle. We collected pulmonary function testing (PFT) data from a large retrospective cohort followed at Centers collaborating in the Italian DMD Network. Furthermore, we analyzed PFT associations with different DMD mutation types, and with genetic variants in SPP1, LTBP4, CD40, and ACTN3, known to modify skeletal muscle weakness in DMD. Genetic association findings were independently validated in the Cooperative International Neuromuscular Research Group Duchenne Natural History Study (CINRG‐DNHS).Methods and ResultsGeneralized estimating equation analysis of 1852 PFTs from 327 Italian DMD patients, over an average follow‐up time of 4.5 years, estimated that forced vital capacity (FVC) declined yearly by −4.2%, forced expiratory volume in 1 sec by −5.0%, and peak expiratory flow (PEF) by −2.9%. Glucocorticoid (GC) treatment was associated with higher values of all PFT measures (approximately + 15% across disease stages). Mutations situated 3’ of DMD intron 44, thus predicted to alter the expression of short dystrophin isoforms, were associated with lower (approximately −6%) PFT values, a finding independently validated in the CINRG‐DNHS. Deletions amenable to skipping of exon 51 and 53 were independently associated with worse PFT outcomes. A meta‐analysis of the two cohorts identified detrimental effects of SPP1 rs28357094 and CD40 rs1883832 minor alleles on both FVC and PEF.InterpretationThese findings support GC efficacy in delaying respiratory insufficiency, and will be useful for the design and interpretation of clinical trials focused on respiratory endpoints in DMD.

Efficacy and Safety of the 9-mm Intrabronchial Valve in Patients with Advanced Emphysema

Background: Endoscopic valve therapy aims at lung volume reduction that is associated with improved lung function, exercise tolerance and quality of life in emphysema patients. The size of intrabronchial valves of the Spiration® Valve System (SVS) selected to achieve lobar occlusion may have an influence on treatment outcomes. Methods: 49 severe emphysema patients (M/F: 24/25, age: 64 ± 7 years), with complete interlobar fissures on the side intended to be treated, underwent treatment with at least one 9-mm intrabronchial valve implantation at 3 centers and were followed up at 30, 90 and 180 days after intervention. Changes in pulmonary function tests (PFT), 6-min walk test (6MWT), modified Medical Research Council (mMRC) dyspnea scale and chronic obstructive pulmonary disease assessment test scores as well as possible complications were recorded. Results: Forced expiratory volume in 1 s (FEV₁) improved significantly over the 6-month period of the study, and the proportion of patients achieving a minimal clinically important difference (MCID) for FEV₁ was 46.4% at 6 months. Regarding the remaining PFT values, the changes were not statistically significant at 6 months, but when looking at the MCIDs, 44.4% of the patients achieved the MCID decrease for residual volume. The 6MWT distance also improved statistically significantly, and an MCID increase of ≥26 m was reached by 41.7% of the patients. Furthermore, there was a statistically significant improvement in the mMRC score. The incidence of pneumothoraxes requiring drainage was 26.5% while a valve dislocation rate of 24% was observed but only in the lower lobes. Conclusions: Endoscopic lung volume reduction with the 9-mm SVS valves was associated with statistically significant but modest improvement of FEV₁, mMRC and 6MWT up to 6 months after intervention. These results were accompanied by an anticipated and acceptable risk profile. The relative increased incidence of device dislocation observed needs to be further elucidated.

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.

The Prognostic Value of Preoperative Pulmonary Function Testing in Patients Undergoing Left Ventricular Assist Device Implantation

This study evaluates the prognostic value of preoperative pulmonary function tests (PFTs) on post implant outcomes in LVAD patients. Durable LVAD implants from January 2004 to December 2018 at a single institution were included. The primary outcome was rates of respiratory adverse events (AEs): prolonged intubation >72 hours, pneumonia, reintubation or tracheostomy. Secondary outcome included survival. Criteria for abnormal PFTs was met with an FEV1 <80% predicted, FEV1/FVC <0.70, DLCO <45% predicted or TLC <80% predicted. Multivariable Cox regression was used for risk adjustment. 333 patients underwent LVAD implant, including 40.8% (n=136) with normal PFTs and 59.2% (n=197) with abnormal PFTs. Patients with abnormal PFTs had higher rates of respiratory AEs overall (26.1% vs 14.6%, p=0.04) (Figure A). Patients with abnormal PFTs had a 2-fold increased risk for respiratory AEs (HR 1.93, 95%CI 1.02, 1.64). After risk-adjustment, the impact of abnormal PFTs was most pronounced when FEV1 was <60% (HR 2.8, 95% CI 1.5, 6.7) and FEV1/FVC ratio was <0.5 (HR 43.6, 95% CI 5.8, 68.1). Although 43% (n=144) had a history of smoking and 25% (n=50) had a diagnosis of COPD, these factors did not influence the hazards for respiratory AEs. The rates of other AEs including bleeding, renal failure and right heart failure were similar (all p>0.05). Post-implant survival at 1 year follow-up was comparable between the groups (58.1% vs 73.7%, p=0.09) (Figure B), although patients in the lowest strata of FEV1 (<60%) and FEV1/FVC (<0.5) also had elevated hazards for risk-adjusted mortality (HR 2.7 95% CI 1.5, 4.9 and HR 36.4, 95% CI 4.2, 75.6). PFTs are a useful preoperative risk assessment tool for stratification and patient counseling regarding the likelihood of post-LVAD respiratory AEs. Patients with a FEV1 <60% or FEV1/FVC ratio <0.5 are at particularly high risk, demonstrating substantially increased hazards for respiratory AEs and 1-year mortality.

Pulmonary Function Reference Equations: A Brief History to Explain All the Confusion.

Predicted values for pulmonary function tests differ significantly from the reference values used for many other diagnostic tests. Historically, simple equations using age, height, and sex were used to "predict" normal lung function. However, these multiple factors interact in complex ways to determine what the expected lung function values are in healthy subjects. Healthy individuals exhibit a wide range of variability for most pulmonary function variables, and this variability is not consistent across all age ranges. Recent analysis of large groups of healthy subjects has allowed the development of sophisticated prediction models that take into account not only variability but also skew that occurs as the lungs develop and mature. These modern reference equations provide uninterrupted expected values from early childhood, through adolescence and adulthood, and extending into the ninth decade. Modern equations use upper and lower limits of normal to offer a statistically robust means of defining who is within normal limits. Despite these advances, interpretation of pulmonary function test results has not been highly standardized, largely because interpretation depends on the reference equations used and, more importantly, how they are applied. This review discusses the strengths and limitations of using reference equations to interpret pulmonary function data in the context of research and clinical practice.

Expression of herpesvirus entry mediator gene as a potential biomarker for disease severity in patients with persistent asthma

Objectives: Herpes virus entry mediator (HVEM) is a costimulatory molecule, and has been proved to play an important role in airway inflammatory and remodeling processes of asthma. We aimed to investigate the expression of HVEM gene in patients with asthma as a means of assessing disease severity.Methods: This study was carried out on 59 subjects, 16 patients with mild persistent asthma, 11 patients with moderate persistent asthma, 13 patients with severe persistent asthma, and 19 age and gender matched healthy controls. The HVEM mRNA expressions of all subjects were determined by real time PCR. Correlations between HVEM mRNA expression and fractional exhaled nitric oxide (FeNO), pulmonary function test values, total blood white cell count and differential, total immunoglobulin E (IgE) level, and Asthma Control Test (ACT) score were analyzed, respectively. The discrimination abilities of HVEM mRNA between different groups were tested using receiver operating characteristics (ROC) curve analyses.Results: This study showed the expressions of HVEM mRNA were significantly higher in the patients with severe and moderate persistent asthma than in patients with mild persistent asthma and healthy subjects (2.97 ± 1.23 vs. 1.17 ± 0.42 vs. 0.62 ± 0.38 vs. 0.46 ± 0.18/NAPDH, p < 0.001), but there was no significant difference between patients with mild persistent asthma and health controls (0.62 ± 0.38 vs. 0.46 ± 0.18/NAPDH, p = 0.557). HVEM mRNA expression at cut off point [1.01/NAPDH, area under the ROC curve (AUC) = 0.99] is sufficient to discriminate severe patients from mild-to-moderate patients, and at cut off point (0.93/NAPDH, AUC = 0.91) for discrimination of moderate-to-severe patients from mild ones, while at cut off point (0.76/NAPDH, AUC = 0.75) for discrimination of asthmatic patients from controls. Furthermore, HVEM mRNA expression was positively correlated with FeNO level (r = 0.524, p = 0.015), and total lymphocyte count (r = 0.426, p = 0.017) in patients with persistent asthma.Conclusions: HVEM gene expressions can be used as a potential biomarker for evaluating the severity of patients with persistent asthma.

Respiratory reactance in forced oscillation technique reflects disease stage and predicts lung physiology deterioration in idiopathic pulmonary fibrosis

BackgroundIdiopathic pulmonary fibrosis (IPF) is a chronic progressive disease. Although pulmonary function test (PFT) is useful for evaluating the progression of IPF, obtaining adequate results in advanced cases can be challenging. Conversely, the forced oscillation technique (FOT) can be noninvasively performed, even in patients with severely deteriorated lung function. In this study, the usefulness of FOT for the evaluation of IPF disease status was investigated. MethodsWe analyzed the PFT and FOT data of 97 patients with IPF. ResultsThe respiratory reactance (Xrs) components of FOT, especially in the inspiratory phase, correlated with the PFT values. Patients with advanced disease had significantly lower reactance at 5 Hz (X5), higher resonant frequency (Fres) and low-frequency reactance area (ALX). The longitudinal deterioration of Xrs was also observed. Moreover, X5 in the inspiratory phase predicted subsequent lung capacity deterioration. ConclusionThe Xrs components of FOT, especially in the inspiratory phase, reflected restrictive ventilatory impairment and disease severity in patients with IPF.

Treatment of primary sjögren's syndrome-related interstitial lung disease: a retrospective cohort study.

Background:Interstitial lung disease (ILD) is a common complication of primary Sjögren’s syndrome (pSS). Because there is a paucity of literature on the management of pSS-associated ILD (pSS-ILD), this retrospective cohort study assessed the efficacy of azathioprine and mycophenolate therapy in adult patients with pSS-ILD.Methods:A retrospective cohort study was performed using electronic health records to identify adults meeting the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for pSS. The presence of pSS-ILD was confirmed by characteristic high-resolution computed tomography and/or histopathology findings. Sociodemographic, clinical, and pulmonary function test (PFT) data were abstracted for patients meeting the criteria and followed longitudinally from the date of their ILD diagnosis. PFT values were anchored on time of treatment start, and linear mixed-effects modeling was used to analyze changes in diffusion capacity for carbon monoxide (DLCO) and forced vital capacity (FVC) before and after treatment initiation.Results:We identified 19 subjects who had pSS-ILD, of whom seven were treated with azathioprine and seven were treated with mycophenolate. Within the azathioprine treated group, FVC% slope change trended toward improvement from a rate of -9.8% per month pre-treatment to 2.1% per month post-treatment (p = 0.13). Within the mycophenolate treated group, FVC% slope change improved from a rate of 1.5% per month pre-treatment to 4.3% per month post-treatment (p = 0.02) and DLCO% slope changed from a rate of -3.8% to –1.3% per month (p = 0.01) after therapy start.Conclusions:Mycophenolate treatment was associated with significant improvement in PFTs of pSS-ILD patients over time, and azathioprine treatment followed a similar non-significanttrend. Additional prospective studies are needed to further evaluate these findings. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 136-147)

Cardiopulmonary functions of Nigerian female flour mill workers occupationally exposed to flour dust

Sir, It is worthy to comment on the interesting study by Maduka et al.[1] published in April–June 2019 issue of The Egyptian Journal of Chest Diseases and Tuberculosis. On applying spirometry, the authors measured different parameters of pulmonary function tests (PFT). They found that the peak expiratory flow rate, forced vital capacity, and forced expiratory volume measured at the first second were significantly lower in the studied patients relative to the controls (P<0.05)[1]. Moreover, the PFT parameters decreased with the increased duration of flour dust exposure[1]. I presume that such results ought to be taken cautiously owing to the presence of the following methodological limitation: defining which PFT values are normal and which are below the lower limit of normal in a particular population relies upon employing reference equations derived from that population[2]. Truly, many population-specific PFT references have been constructed to be employed in the clinical field and research studies[234]. In the methodology, the authors regrettably did not mention which PFT reference was used to evaluate the recorded PFT components. To my knowledge, the reference equations for spirometric indices in the general adult population in Nigeria have been launched in 2017[5]. I presume that employing Nigerian-specific spirometric equations could yield a better idea on the consequence of flour dust exposure on the pulmonary functions in the studied Nigerian female flour mill workers. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Comparison of pulmonary functions in petrol pump workers and residents of oil refinery

Background: Health of human beings depends on their environment. Petrol pump workers (PPWs) are exposed to petrol/diesel fumes containing toxic compounds, which may affect the capability of lungs. Similarly, residents living around the oil refinery are exposed to pollutants, which may have deleterious effects on pulmonary health. Objectives: The study aimed to assess pulmonary function tests (PFTs) in residents living near an oil refinery and PPWs and compared with the control group. Materials and Methods: The study group (age: 20–45 years) comprised PPWs in Mathura district generally exposed to petrol fumes as well as dust particles and residents living within 5 km of Mathura oil refinery. Control group comprised unexposed staff residing in the campus. PFT values were recorded and compared in the three groups. Results: Lowering of mean PFT values in residents and PPWs was observed. Forced vital capacity (FVC) (L), forced expiratory volume in 1 s (FEV1) (L), FEV1/FVC, and peak expiratory flow rate (L/s) were, respectively, 3.37, 2.93, 87.25, and 8.44 in control group (C); 3.09, 2.61, 85.2, and 7.94 in PPW and 3.0, 2.58, 86.0, and 7.94 in residents (R). Maximum ventilatory volume and forced expiratory flow rate 25–75% were also reduced in the latter groups. Conclusion: Acute exposure to a polluted environment results in an alteration of pulmonary functions.

Bronchoscopic lung volume reduction by histoacryl

Background Lung volume reduction can be accomplished by bronchoscopy, a procedure that represents a potential alternative to lung volume reduction surgery. The initial physical approach to bronchoscopic lung volume reduction (BLVR) was based on the simple concept that collapse of target regions could be initiated using a washout solution to disrupt the surfactant function and be maintained with a biocompatible ‘tissue sealant’ to prevent re-expansion. Aim The aim was to evaluate the safety and efficacy of BLVR using an adhesive material (histoacryl blue glue) in patients with emphysema and emphysematous bullae. Settings and design Prospective interventional analysis from two centers’ registry, namely The Bronchology Unit at Chest Department, Ain Shams University and The Bronchoscopy Unit of Kobry El Kobba Military Chest Hospital. Patients and methods The study included 40 patients having emphysema. All the patients had spirometry, arterial blood gases, 6 min walking test, and body plethysmography. All these tests were performed before and 90 days after the procedure. Results Residual volume decreased by 15.30% (P=0.567), forced expiratory volume in the first second increased by 11.43% (P=0.088), forced vital capacity increased by 22.92% (P=0.007), and 6-min walking distance increased by 70.39% (P=0.021). Postprocedure complications were minor with no mortality. Conclusion BLVR therapy using histoacryl blue glue is well tolerated and safe in patients with emphysematous bulla and diffuse emphysema. Treatment is associated with modest improvement in pulmonary function test values, increased exercise performance, and reduced dyspnea.

Effect of obesity on pulmonary function test in adolescent boys

Background: Obesity is an emerging problem, especially among adolescents due to their lifestyle changes related to the low level of physical activity and high-calorie diet. Excess adipose tissue is often associated with respiratory abnormalities such as a reduction in lung volumes, capacities, and expiratory flow rates. Hence, there is a need to find the pulmonary functions test values among obese adolescents and create awareness of the drawbacks of obesity as this is the high-risk period for the onset of obesity which predicts body mass index in adulthood. Aims and Objectives: The aims of the study were to study the effect of obesity on pulmonary function test (PFT) values in adolescent boys. Material and Methods: PFT was done on 10 obese and 10 nonobese adolescent boys of the age group 12–17 years from Dr. Ulas Patil English Medium School, Bhusawal. Forced vital capacity (FVC), forced expiratory volume at 1st s (FEV1), (FEV1/FVC) ratio, and maximum voluntary ventilation (MVV) were taken as parameters for study. Results: FVC, FEV1, FEV1/FVC, and MVV are reduced in obese subjects as compared to nonobese boys and it is statistically highly significant. Conclusion: Results of the study conclude that obesity affects the pulmonary functions and obese adolescents have significantly lower pulmonary functions.