Restrictive Pulmonary Function Research Articles

Pulmonary function assessments and clinical correlates in children with sickle cell disease in Cape Town, South Africa

Objectives: Among children with sickle cell disease (SCD) in Africa, there are varied reports on pulmonary function assessments. Restrictive pulmonary function is common in children with SCD in Africa; however, reports from Africa are few. We aimed to describe pulmonary function and its clinical correlates in children with SCD in Cape Town, South Africa. Materials and Methods: A prospective cross-sectional study was carried out over seven months from October 2018 to April 2019 in children 6–16 years with SCD. Children with hemoglobin (Hb) genotypes, homozygous for the BS globin mutation, and sickle-beta0-thalassemia Hb were included in the study. Children were excluded if they had acute complications. Medical record review clinical, laboratory, and pulmonary function assessments were done. Data were entered into Excel and exported to Stata Version 16.0 statistical software for analysis. Results: A total of 25 participants were recruited, mean (standard deviation) age of 10 ± (3.0) years. Thirteen (53%) children were under ten years and 15 (60%) were male. The median/interquartile range age at diagnosis was 1.7 [0.8–3.0] years. SCD-related complications were common. A review of the medical records showed a third of the patients (32%) had at least one previous episode of acute chest syndrome, 20 (80%) had a history of vaso-occlusive crisis, and 15 (76%) had required at least one blood transfusion. Spirometry was performed on 19 (76%) of the participants 9 (47%) had abnormal lung function. The most common spirometry abnormality was a restrictive pattern (forced vital capacity (FVC) < lower limit of normal (LLN)). No participant had a positive bronchodilator response. Older age was associated with a decrease in forced expiratory volume in the first second (FEV1) Z-score (−0.16, 95% confidence interval [CI] −0.31, −0.01; P = 0.04). Children on hydroxyurea similarly had reduced FEV1 Z-score (−1.5, 95%CI −2.88, −0.12; P = 0.04) and reduced FVC Z-score (−2.21, 95%CI −3.64, −0.79; P < 0.001). Conclusion: Lung function abnormalities were common among children with SCD, with restrictive abnormality predominating. Asthma and obstructive airway abnormalities were uncommon in children with SCD in South Africa.

Spo2 Analysis on Development of IoT-Based Lung Function and Spo2 Measuring Device

Pulmonary dysfunction is a widespread issue, particularly in developing nations. It encompasses restrictive, obstructive, and mixed pulmonary function disorders that lead to a decrease in vital lung capacity, an increase in functional residual capacity, and a decline in blood oxygen concentration and saturation. This study aims to combine oximetry and spirometry into a single device, using the Internet of Things (IoT) technology to display results via a smartphone app. The focus is on analyzing oxygen saturation, with normal levels ranging from 96% to 100% in adults, alongside a heart rate of 60-100 beats per minute. The MAX30102 sensor measures oxygen saturation, and the Arduino Pro Mini and D1 Mini ESP32 microcontrollers process data. The Android-based app, developed using Kodular platform, integrates a MySQL database and connects to the device module via Wi-Fi. Ten respondents underwent five measurements, revealing an average error of ±0.88% for oxygen saturation (SpO2) and ±2.82% for heart rate measurements. The average data loss rate during transmission was ±0.66% for SpO2 and ±0.89% for heart rate. These findings highlight existing errors in the module. The research aims to facilitate remote health monitoring for healthcare professionals, improving accessibility and healthcare provision.

The clinical, functional, and radiological effect of long-term used immunosuppressive therapy for post-COVID-19 interstitial lung disease.

Persistent interstitial lung disease (ILD) after COVID-19 infection can lead to severe loss of respiratory function and a decrease in the quality of life. There is no consensus regarding the treatment of post-COVID-19-ILD. This study aims to investigate the effectiveness of immunosuppressive treatment for this group of patients. This retrospective observational study included patients diagnosed with post-COVID-19-ILD from 2021 to 2022. Patients who had pulmonary symptoms, required prolonged oxygen therapy, and/or had restrictive pulmonary function test (PFT) and/or DLCO <80%, with diffuse parenchymal involvement on high-resolution computed tomography (HRCT), were given immunosuppressive treatment with methylprednisolone and/or mycophenolate mofetil (MMF) and followed up for 6 months. Among the 48 patients, 35 were treated. Two patients were excluded due to discontinued treatment and passed away before the study period ended. Of 33 cases, 21 (66.6%) were treated with methylprednisolone, 11 (33%) with methylprednisolone + MMF, and 1 (0.4%) with MMF alone. Comparing baseline and 6th-month data revealed significant improvement in mMRC score, saturation (SpO2), FVC, FVC%, FEV%, and DLCO% values (p<0.005). While regression was observed in all radiologic findings, regression in ground glass and reticulation was statistically significant (p<0.005). When the 1st and 6th-month data were compared, a significant increase was observed in SpO2 and DLCO% values (p=0.016) and there was a significant regression in reticulation radiologically (p=0.01). Long-term immunosuppressive therapy may be preferred in proper cases of post-COVID-19-ILD as an effective and safe treatment option that improves the quality of life, respiratory parameters, and radiologic findings.

Reference values for six-minute walk distance and six-minute walk work in Caucasian adults

RationaleThe six-minute walk test (6MWT) is a practical and simple field-based test to assess physical capacity. Several reference equations for six-minute walking distance (6MWD, m) exist, but have a number of limitations that decrease their clinical utility. In addition, no reference equations exist for the 6MWT-derived outcome six-minute walk work (6MWORK, kg.m). ObjectivesTo establish new reference equations for 6MWD and 6MWORK on a 20 m course using data from the population-based Canadian Cohort Obstructive Lung Disease study. Methods and MeasurementsA total of 335 participants without obstructive or restrictive pulmonary function, with normal self-reported health status, normal exercise capacity, and <30 pack years cigarette smoking history were selected to create a representative sample of Canadian adults aged ≥40 years. All participants performed two 6MWTs. Reference equations were derived using multiple regression analyses. Main ResultsOn average, 6MWD and 6MWORK were 541±98 m and 41.3 ± 11.2 kg.m, respectively. All outcomes were significantly greater in males than females. Sex-specific reference equations were derived from the results of 6MWD and 6MWORK with an explained variance of 24 to 35%. ConclusionsThis study established reference equations for 6MWD and 6MWORK on a 20 m course in Caucasian males and females aged ≥40 years with normal pulmonary function, self-reported health status and exercise capacity. These newly derived reference equations add value to the assessment of functional capacity in clinical practice.

Association between serum creatinine levels and pulmonary function of Korean adults: the 2016-2019 Korea National Health and Nutrition Examination Survey.

Research on the interaction between renal and lung functions has been conducted; however, studies on the general adult population are limited. This study aimed to investigate the association between serum creatinine levels and pulmonary function in Korean adults. From the 2016-2019 Korean National Health and Nutrition Examination Survey, we recruited 11,380 participants who were 40 years or older for this study. Serum creatinine levels were divided into three groups: low, normal, and high. Pulmonary function was divided into three groups: normal, restrictive, and obstructive. The odds ratios for abnormal pulmonary function patterns were calculated using weighted multinomial logistic regression analysis. The odds ratios were 0.97 for low vs. normal (0.40-2.33) and 2.00 for high vs. normal (1.18-3.38) for the restrictive pattern, and 0.12 for low vs. normal (0.02-0.49) and 1.74 for high vs. normal (0.90-3.35) for the obstructive pattern after being adjusted for age, sex, smoking status, alcohol consumption, regular exercise, body mass index, diabetes mellitus, hypertension, cardiovascular disease, total energy, and total proteins. High serum creatinine levels were associated with an increased odds ratio for restrictive and obstructive pulmonary function patterns. The odds ratio of the restrictive pattern was higher than that of the obstructive pattern. Screening for abnormal pulmonary function in individuals with high serum creatinine levels may be useful to ensure that there is no abnormal pulmonary function before the onset of potential pulmonary problems. Thus, this study highlights the relationship between renal and pulmonary function using serum creatine levels, which can be easily tested in the primary medical environment of the general population.

Pulmonary function in patients with transfusion-dependent thalassemia and its associations with iron overload

In patients with transfusion-dependent thalassemia (TDT), pulmonary function impairment has been reported but data are conflicting. Moreover, it remains unclear whether pulmonary dysfunction is associated with iron overload. This study aimed to evaluate the pulmonary function in patients with TDT and to investigate the associations between pulmonary dysfunction and iron overload. It was a retrospective observational study. 101 patients with TDT were recruited for lung function tests. The most recent ferritin levels (pmol/L) and the magnetic resonance imaging (MRI) measurements of the myocardial and liver iron status, as measured by heart and liver T2* relaxation time (millisecond, ms) respectively, were retrieved from the computerized medical records. Only data within 12 months from the lung function measurement were included in the analysis. The serum ferritin, and the cardiac and liver T2* relaxation time were the surrogate indexes of body iron content. The threshold of abnormality in lung function was defined as under 80% of the predicted value. 101 subjects were recruited with a mean age of 25.1 years (standard deviation (SD) 7.9 years). Thirty-eight (38%) and five (5%) demonstrated restrictive and obstructive lung function deficits, respectively. A weak correlation of FVC %Predicted and TLC %Predicted with MRI myocardial T2* relaxation time (rho = 0.32, p = 0.03 and rho = 0.33, p = 0.03 respectively) was observed. By logistic regression, MRI cardiac T2* relaxation time was negatively associated with restrictive lung function deficit (B − 0.06; SE 0.03; Odds ratio 0.94; 95% confidence interval (CI) 0.89–0.99; p = 0.023) after adjusting for age, sex and body mass index. Restrictive pulmonary function deficit was commonly observed in patients with TDT, and the severity potentially correlates with myocardial iron content. Monitoring of lung function in this group of patients, particularly for those with iron overload, is important.

COVID-19 Patients in the COVID-19 Recovery and Engagement (CORE) Clinics in the Bronx.

Background: Early in the pandemic, we established COVID-19 Recovery and Engagement (CORE) Clinics in the Bronx and implemented a detailed evaluation protocol to assess physical, emotional, and cognitive function, pulmonary function tests, and imaging for COVID-19 survivors. Here, we report our findings up to five months post-acute COVID-19. Methods: Main outcomes and measures included pulmonary function tests, imaging tests, and a battery of symptom, physical, emotional, and cognitive assessments 5 months post-acute COVID-19. Findings: Dyspnea, fatigue, decreased exercise tolerance, brain fog, and shortness of breath were the most common symptoms but there were generally no significant differences between hospitalized and non-hospitalized cohorts (p > 0.05). Many patients had abnormal physical, emotional, and cognitive scores, but most functioned independently; there were no significant differences between hospitalized and non-hospitalized cohorts (p > 0.05). Six-minute walk tests, lung ultrasound, and diaphragm excursion were abnormal but only in the hospitalized cohort. Pulmonary function tests showed moderately restrictive pulmonary function only in the hospitalized cohort but no obstructive pulmonary function. Newly detected major neurological events, microvascular disease, atrophy, and white-matter changes were rare, but lung opacity and fibrosis-like findings were common after acute COVID-19. Interpretation: Many COVID-19 survivors experienced moderately restrictive pulmonary function, and significant symptoms across the physical, emotional, and cognitive health domains. Newly detected brain imaging abnormalities were rare, but lung imaging abnormalities were common. This study provides insights into post-acute sequelae following SARS-CoV-2 infection in neurological and pulmonary systems which may be used to support at-risk patients and develop effective screening methods and interventions.

Assess Restricted Pulmonary Function in Chronic Hepatitis C Patients at Various Phases

Background: Chronic hepatitis C infection has both hepatic and extra-hepatic symptoms, both of which are influenced by the inflammatory response triggered by HCV. Chronic HCV induces inflammation that manifests itself in the liver and beyond. Persistent HCV infection may be associated with reduced pulmonary functions especially in patients with high viremia levels. Objective: The objective of study was to examine restricted pulmonary function in chronic hepatitis C patients during different phases. Study Design: Cross-sectional study Place and Duration: Department of Medicine Social Security Teaching Hospital Ferozepure Road Lahore. From 01.02.2022 to 30.08.2022. Methods: There were 94 cases of chronic hepatitis included in this study. After gaining the participants' informed consent, we documented their age, sex, BMI, and smoking status in detail. Patients underwent for abdominal ultrasound. The anti-HCV antibody test was run with a third-generation ELISA (Ortho HCV ELISA) kit using 3 ml of blood and pulmonary function test were performed to eavaluate restrictive lung disease. Data was entered and analyzed in SPSS 24.0 and presented as frequency and percentages. Results: Among 94 cases, 57 (60.6%) were males and 37 (39.4%) were females. Mean age of the patients was 46.9±4.53 years and mean BMI was 25.4±6.29 kg/m2. Majority of the cases 51 (54.3%) had rural residency. There were 64 (68.1%) cases had smoking history. We found that 17 (18.1%) cases had severe HCV, 45 (47.9%) cases had moderate and 32 (34.04%) patients had mild HCV. There were 37 (39.4%) cases had restrictive pulmonary function among all cases. Among 37 cases of pulmonary disease, majority had severe HCV infection. Conclusion: We concluded in this study that the patient with HCV infection had higher incidence of restrictive pulmonary disease. Majority of the patients were males and had smoking history. Severe cases of HCV mostly had restrictive disease. Keywords: HCV, Restrictive Pulmonary Disease, Males, Smoking

Long-Term Pirfenidone for Restrictive Allograft Syndrome: A Case Series

<h3>Purpose</h3> Restrictive allograft syndrome (RAS) after lung transplantation (LTx) carries a bad prognosis, with generally a poor survival limited to 1-2 years after diagnosis. RAS is typically characterized by parenchymal fibrosis and distortion of lung architecture, a restrictive pulmonary function decline and persistent pleuroparenchymal abnormalities on computed tomography. There is no established treatment for RAS, although case series have reported on off-label treatment with antifibrotic drugs, such as pirfenidone (PFD), in RAS. However, reported treatment duration with PFD up to now was <2 years. We aim to report on RAS patients treated with PFD for at least 2 years in our center, in whom we evaluated evolution of pulmonary function during treatment with PFD. <h3>Methods</h3> Patients treated with off-label PFD for RAS were retrospectively assessed; and patients treated with PFD for at least 2 years were included for analysis. FVC, FEV1, TLC and TLCO at start of PFD and during the last visit on PFD were evaluated. GraphPad Prism 9.0 was used to compare parameters at different time points (start vs. last). <h3>Results</h3> In our cohort of 28 RAS patients treated with PFD since 2013 (median duration 177.5 (64.5-359.8) days), we identified 4 RAS patients who were treated with PFD for a mean (±SD) duration of 5.2 (±1.1) years (range 3.8-6.3 years). In these patients, total follow-up was 10.4±3.1 years (3/4 patients currently alive), RAS was diagnosed 4.6 (±1.7) years post-LTx (2/4 patients had prior BOS) and PFD was started 6.0 (±2.5) years post-LTx. FVC at start of PFD was 2.40 (±1.24) L vs. 1.85 (±0.91) L (p=0.091) at last measurement, with a monthly decline of 9.5 (±7.7) mL/month during PFD treatment. FEV1 at start was 1.69(±0.86) L vs. 1.28 (±0.55) L (p=0.147) at last measurement, with a monthly decline of 8.0 (±10.0) mL/month during PFD treatment. TLC at start was 4.00 (±1.58) L vs. 2.82 (±0.60) L (p=0.080) at last measurement, with a monthly decline of 11.3 (±8.6) mL/month during PFD treatment. Also, TLCO did not significantly differ over time (p=0.258). <h3>Conclusion</h3> A subset of RAS patients may demonstrate significantly better long-term survival, in these patients progressive fibrosing interstitial lung disease may possibly be attenuated by antifibrotic drugs, such as PFD, which requires further investigation.

Modified radical mastectomy under paravertebral block in a patient diagnosed with active pulmonary tuberculosis with moderate restriction of pulmonary function

Mastectomy is mostly performed as definitive management for resectable breast cancer (BC). Implementing paravertebral nerve block for patients with metastasis features of cancer to lungs and other organs, patients with co-morbidity, geriatrics and malnourished individuals will eliminate the risks and complications of general anaesthesia (GA). Although thoracic paravertebral block is an established technique as post-operative pain management for breast surgery, there is no conclusive evidence on its use as a sole anaesthetic for modified radical mastectomy (MRM). In this case report, we present a 45-year-old woman who underwent a successful MRM for Stage IIIb BC associated with pulmonary tuberculosis with moderately restricted pulmonary function test under paravertebral nerve block. We believe that paravertebral nerve block can be used as an alternative anaesthetic technique for MRM in a resource-limited setting for patients who are expected to have a high risk of perioperative complications under GA.

Characteristics of musculoskeletal ultrasound and its relationship with systemic inflammation in systemic sclerosis patients

Aim of the workTo describe musculoskeletal ultrasound (MSUS) findings in patients with systemic sclerosis (SSc) and to study their relation with cardiopulmonary and skin affection. Patient and methodsIn 50 SSc patients, hands, wrists and six entheses sites were evaluated by MSUS. Entheses were scored using the Madrid Sonography Enthesitis Index (MASEI). The modified Rodnan skin score (mRSS) was assessed. ResultsThey were 42 females/8males with a mean age 36.2 ± 11.6 years, disease duration 3.5 ± 4.2 years, 27 had limited skin affection and 23 diffuse and the mRSS was 4.1 ± 15.3. 54% had arthritis, 10% tendon friction rub, 16% joint contractures and 10% calcinosis. 18% had left ventricular hypertrophy, 34% had pulmonary hypertension, 20% had restrictive pulmonary function test (PFT) and 24% had interstial lung disease (ILD). Synovitis was detected in 58% and was significantly related to mRSS, left ventricular hypertrophy, PFT, pulmonary hypertension and ILD (p = 0.023, p = 0.03, p = 0.006, p = 0.026 and p = 0.039 respectively). Common extensor tenosynovitis was detected in 82% and was significantly related to mRSS, PFT and ILD (p = 0.019, p = 0.043 and p = 0.032 respectively). Joint erosions were detected in 36% and were significantly related to age and C-reactive protein (CRP) (p = 0.01 and p = 0.034). Enthesopathy showed a significant relation with erythrocyte sedimentation rate (ESR), CRP and mRSS (p = 0.014, p = 0.013, p = 0.025, respectively). ConclusionArticular involvement is common in SSc and underestimated by clinical examination. Synovitis is associated with cardiovascular complication in SSc. Tenosynovitis is clinically related to restrictive pulmonary function. Enthesopathy should be kept in mind in symptomatic patients with systemic sclerosis.

Association of Olfactory and Pulmonary Function in Middle-Aged and Older Adults: The Korea National Health and Nutrition Examination Survey.

Objectives: To identify the relationship between pulmonary function and subjective olfactory dysfunction in middle-aged and older adults. Materials and Methods: We used Korea National Health and Nutrition Examination Survey data from 2010 to 2012 to analyze 6191 participants in their 50s or older. Results: The frequency of olfactory dysfunction was 6.8% among the subjects with normal pulmonary function tests, but was significantly more frequent in those diagnosed with restrictive (9.6%) or obstructive (10.1%) pulmonary function. Forced volume vital capacity, forced expiratory volume (FEV)1, FEV6, and peak expiratory flow were significantly lower in the olfactory dysfunction group. The risk of olfactory dysfunction was significantly associated with obstructive pulmonary function (odds ratio (OR) [95% confidence interval (CI)]: 1.449 [1.010–2.081]) after adjusting for confounders (sex, rhinitis, chronic rhinosinusitis, hypertension, dyslipidemia, education level, stress, depressed mood, and suicidal ideation). Conclusion: Middle-aged and older adults with obstructive pulmonary function had a higher incidence of subjective olfactory dysfunction than the normal pulmonary function group. Early olfactory testing may improve the quality of life of patients with obstructive pulmonary function.

Frequency of restrictive pulmonary function tests in patients with chronic Hepatitis C

Hepatis C infection is a common health problem world wide and is the major cause of chronic liver disease in Pakistan. Common complications of chronic hepatitis c infection are cirrhosis, ascities and hepatocellular carcinoma. Also HCV infection is associated with several extra hepatic manifestations including interstitial lung fibrosis. It has been found that frequency of pulmonary fibrosis is increased in patients with cirrhosis of liver as the stage of cirrhosis advances.This lung fibrosis can cause restrictive pattern of pulmonary function tests. This study was conducted to determine frequency of restrictive pulmonary function in patients with different stages of chronic hepatitis C infection, based on child pough classification.&#x0D; Study design&#x0D; This is descriptive case study&#x0D; Method&#x0D; 99 patients of age range 20 to 80 year, both males and females having chronic hepatitis C infection and interferon based treatment naïve patients were included from outpatient and inpatient department were selected. Patients were divided into three groups according to child’s criteria i.e. group A, group B, and group C. Pulmonary function tests were performed on patients in all three groups to look for FEV1/FVC ratio in all patients. FEV1/FVC ratio more than 80 was considered as restrictive pulmonary function.&#x0D; Results&#x0D; Out of 99 patients 32(35%) were found to have restrictive pattern of pulmonary functions&#x0D; Conclusion&#x0D; Chronic hepatitis C infection is associated with restrictive pattern of pulmonary function, suggestive of pulmonary fibrosis.

Deterioration of pulmonary function: An early complication in Fibrodysplasia Ossificans Progressiva

Fibrodysplasia Ossificans Progressiva (FOP) is a genetic disease characterized by the formation of heterotopic ossification (HO) in connective tissues. HO first develops in the thoracic region, before more peripheral sites are affected. Due to HO along the thoracic cage, its movements are restricted and pulmonary function deteriorates. Because development of HO is progressive, it is likely that pulmonary function deteriorates over time, but longitudinal data on pulmonary function in FOP are missing.Longitudinal pulmonary function tests (PFTs) from seven FOP patients were evaluated retrospectively to assess whether there were changes in pulmonary function during aging. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), total lung capacity (TLC), residual volume (RV) and diffusing lung capacity for carbon dioxide divided by alveolar volume (DLCO/VA) were included. In addition, HO volume along the thorax together with its progression as identified by whole body low dose CT scans were correlated to PFT data.Per patient, aged 7–57 years at the time of the first PFT, three to nine PFTs were available over a period of 6–18 years. Restrictive pulmonary function, identified by TLC or suspected by FVC, was found in all, but one, patients. In three patients, TLC, FVC or both decreased further during the follow-up period. All, but one, patients had an increased RV. The DLCO/VA ratio was normal in all FOP patients. Interestingly, FEV1 increased after a surgical intervention to unlock the jaw. In four out of five patients total HO volume in the thoracic region progressed beyond early adulthood, but no further decline in FVC was observed.In conclusion, restrictive pulmonary function was found in the majority of patients already at an early age. Our data suggest that the deterioration in pulmonary function is age dependent.

Videonystagmography in patients with interstitial lung diseases

Background: Interstitial lung diseases are a group of diffuse parenchymal lung disorders associated with cough, dyspnea, hypoxemia and restrictive pulmonary function. Vertigo and dizziness are early symptoms of cerebral hypoxia Aim: The aim of this study was to assess the effect of hypoxia and chronic cough in patients with ILD on central and peripheral vestibular functions.method: A cross sectional study was conducted in Audio-vestibular unit, ENT Department and Chest Department, Zagazig University Hospitals. Sixty two patients diagnosed to have ILD were included. Full VNG test battery was done. Results: there was statistical significance decrease in mean of optokinetic speed and smooth pursuit gain at high frequency (0.6) in both Rt & LT sides among cases had moderate hypoxia compared to cases had mild hypoxia. No difference was found between mild and moderate cases in other oculomotor tests parameters. Also, there was statistical significance increase in frequency of BPPV among cases had moderate hypoxia compared to cases had mild hypoxia.Conclusions: degree of hypoxia correlated with both central and peripheral vestibular functions.

Nintedanib can be used safely and effectively for idiopathic pulmonary fibrosis with predicted forced vital capacity ≤ 50%: A multi-center retrospective analysis

BackgroundNintedanib is a multi-kinase inhibitor approved for idiopathic pulmonary fibrosis (IPF); however, its efficacy and safety for patients with IPF and restricted pulmonary function remain unclear. Therefore, the objective of this study was to determine the efficacy and safety of nintedanib for patients with IPF and forced vital capacity (FVC) ≤ 50%.MethodsThis was a multi-center retrospective study performed by the Okayama Respiratory Disease Study Group. Patients were allocated into FVC ≤ 50% and FVC > 50% groups based on their predicted FVC. The primary endpoints were FVC changes from baseline after 6 and 12 months.Results45 patients were eligible for the study. 18 patients had FVC ≤ 50%, and 27 patients had FVC > 50%. Overall, 31 and 19 patients underwent pulmonary function tests at 6 and 12 months after initiating nintedanib, respectively. FVC changes from baseline at 6 and 12 months after initiating nintedanib were comparable between the two groups. Adverse events were seen in all patients, and the rates of patients who discontinued nintedanib were also comparable (38.9% vs. 37.0%, p = 1.000). Multiple regression analysis showed that age and forced expiratory volume in 1 second (FEV1)/FVC were negatively correlated with changes in FVC at 6 months after initiating nintedanib.ConclusionsOur data suggest that nintedanib can be a useful agent for IPF patients, including those with a low FVC, and that age and FEV1/FVC are predictive markers for changes in FVC following nintedanib treatment.

Relationship between pulmonary function and albuminuria in type 2 diabetic patients with preserved renal function

BackgroundAlbuminuria is the early manifestation of the pathogenesis of diabetic nephropathy (DN). The current study was to investigate the relationship of pulmonary function with albuminuria in type 2 diabetic patients with preserved renal function to evaluate the role of pulmonary function in the early stage of DN.MethodsA total of 326 patients with type 2 diabetes mellitus (T2DM) including 270 without albuminuria and 56 with albuminuria, and 265 non-diabetic patients were enrolled. The patients’ general information, and the parameters of pulmonary function, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, total lung capacity (TLC), diffusion capacity for carbon monoxide of lung (DLCO) were compared between T2DM and control groups, as well as T2DM patients with and without albuminuria groups. All pulmonary function parameters were expressed as a percentage of those predicted (%pred). Logistic regression models were constructed to test the association of albuminuria and pulmonary function.ResultsThe values of FVC%pred, FEV1%pred, TLC%pred and DLCO%pred were lower, and the proportion of subjects with FVC%pred < 80, FEV1%pred < 80, and DLCOc%pred < 80 was higher in T2DM subjects than controls (all P < 0.05). Subgroup analysis of diabetic patients showed that the values of FVC%pred, FEV1%pred, TLC%pred, and DLCOc%pred (97.18 ± 13.45, 93.95 ± 14.51, 90.64 ± 9.97, 87.27 ± 13.13, respectively) were significantly lower in T2DM subjects with albuminuria than those without albuminuria (103.94 ± 14.12, 99.20 ± 14.25, 93.79 ± 10.36, 92.62 ± 13.45, all P < 0.05). There was a significantly negative correlation between the urine albumin-to-creatinine ratio (UACR) and DLCOc%pred (r = − 0.143, P = 0.010) in spearman linear correlation test. In logistic regression analysis, the FVC%pred (OR 0.965, 95%CI 0.944–0.988), FEV1%pred (OR 0.975, 95%CI 0.954–0.996), and DLCOc%pred (OR 0.974, 95%CI 0.951–0.998) were independently associated with albuminuria after adjustments for smoking index, duration, HbA1c, FBG, and TG.ConclusionOur results demonstrated albuminuria is associated with a restrictive pulmonary function as well as pulmonary diffusion function in T2DM with preserved renal function, which remind us to be alert of the pulmonary function decline even in the early stage of DN.

Mixed Airway and Pulmonary Parenchymal Disease in Patients With Primary Sjögren Syndrome: A 6-year Follow-up.

To assess pulmonary function and chronic obstructive pulmonary disease (COPD) development over time in patients with primary Sjögren syndrome (pSS), as well as the association between pulmonary function, radiographic findings, respiratory symptoms, and clinical features of pSS, taking cigarette consumption into account. Forty patients with pSS (mean age 66 yrs; range 42-81 yrs; 39 women), previously participating in a cross-sectional study on pulmonary involvement in pSS, were reassessed by pulmonary function tests after a mean follow-up time of 6 years. At follow-up, patients were also assessed by high-resolution computed tomography of the chest, as well as for pSS disease activity, respiratory symptoms, and cigarette consumption. Patients with pSS showed significantly decreased percentages of predicted total lung capacity (TLC), residual volume (RV), RV/TLC ratio, and diffusing capacity of the lungs for carbon monoxide, as well as an increase in predicted forced expiratory volume in 1 second/vital capacity (FEV1/VC) ratio from baseline to follow-up. The proportion of COPD in patients with pSS did not change significantly from baseline to follow-up (38% vs 40%, respectively). Radiographic signs of bronchial involvement and interstitial lung disease were each found in 38% of the patients. Both airway and pulmonary parenchymal disease were commonly found in patients with pSS, with a coexistence of both an obstructive and restrictive pulmonary function pattern, where the latter tended to deteriorate over time. COPD was a common finding. Airway and pulmonary involvement may be underdiagnosed in pSS, which is why special attention to clinical assessment of pulmonary involvement in patients with pSS is mandated.

Association between periodontitis and pulmonary function based on the Third National Health and Nutrition Examination Survey (NHANES III).

The purpose of this study was to investigate the association between impaired pulmonary function and periodontitis. From the Third National Health and Nutrition Examination Survey data, we examined the association between pulmonary function and severity of periodontitis using the univariate and multivariate regression models. Moreover, the association between obstructive or restrictive spirometry patterns and periodontitis status was also determined by multivariable logistic regression analysis. A total of 10,645 participants were included in our study. The values of predicted FEV1%, predicted FVC%, and FEV1/FVC were found to gradually decline with increasing severity of periodontitis (p<.001). Obstructive and restrictive pulmonary functions were significantly associated with severity of periodontitis. Individuals with a greater degree of periodontitis had poor pulmonary function. However, further long-term cohort studies are required for a comprehensive evaluation.

Asthma, allergic sensitization and lung function in sickle cell disease

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