Restrictive Pulmonary Impairment Research Articles

Study on Frequency of Impaired Lung Function in Treated Tuberculosis Patients in Tertiary Care Hospital of Pakistan

Background: Pulmonary impairment is a common manifestation in previously treated pulmonary tuberculosis (PTB) patients. Approximately 40-60% of patients with history of complete anti-tuberculosis therapy (ATT) developed the obstructive, restrictive or mixed patterns of lung disease.
 Objective: To determine the frequency and type of impairment of lung function in previously treated PTB patients.
 Methods: A descriptive cross-sectional study was conducted at Ojha Institute of Chest diseases, Dow University of Health Sciences, Karachi during the period of six months from April 2021 to September 2021. One hundred and forty four previously treated PTB patients with age of 18-60 years were selected through consecutive sampling. Spirometry of each patient was performed by trained spirometry technician and lung function was assessed by an experienced pulmonologist. Data was interpreted with SPSS v. 25.0.
 Results: Out of 144 previously treated PTB patients, male were 83 (57.6%) and female were 61 (42.4%). Impaired pulmonary function was present in 87 (60.4%) patients, out of which 49 (56.3%) patients had obstructive impairment; 23 (26.4%) patients had restrictive impairment while 15 (17.2%) patients had mix pattern.
 Conclusion: Prevalence rate of impaired pulmonary function was higher in treated PTB patients who have completed ATT. Obstructive pulmonary impairment was the most common pulmonary impairment followed by restrictive and mixed pulmonary impairment.

Association of Serum MMP-9 Level and Lung Function in New Pulmonary Tuberculosis Case

Background: Histopathological abnormalities of pulmonary tuberculosis (TB) include caseous granuloma formation, tissue damage, and cavity formation, all of which could lead to per-manent changes in the pulmonary anatomy. In pulmonary TB, an increase in serum Matrix Metallo-proteinase (MMP)-9 correlates with disease severity and worse prognosis. This study aims to ana-lyze the association between serum MMP-9 levels and the values of FVC, FEV1, and FEV1/FVC. Methods: A cross-sectional study involving patients with pulmonary tuberculosis was conducted at the Tuberculosis Outpatient Clinic, Dr. Soetomo Academic Hospital, Surabaya, Indonesia. Spirome-try and serum MMP-9 levels were examined in new pulmonary TB patients prior to anti-tuberculosis therapy. The relationship between serum MMP-9 levels and results of spirometry ex-amination was then analyzed. Results: There were 44 new pulmonary TB cases with a mean age of 37.90 ± 15.15 years. The pa-tients who experienced symptoms in <1 month were 20.5%, ≥ 1 month were 59.1%, and ≥ 2 months were 20.4%. The mean MMP-9 serum level was 11.27 ± 5.47 ng/ml. Spirometry results were: FVC 1.83 ± 0.69 L, FVC predicted 56.24 ± 18.74%, FEV1 1.71 ± 0.72 L/sec, FEV1 predicted 60.85 ± 21.30%, and FEV1/FVC 104.16 ± 17.45%. In pulmonary TB patients with symptoms experienced in <1 month, a significant relationship between MMP-9 and FVC levels was found with r = -0.839 (p = 0.005). Conclusion: There is a correlation between serum MMP-9 level and restrictive pulmonary impair-ment in new pulmonary TB cases with symptoms experienced in <1 month.

Rocuronium-induced respiratory paralysis refractory to sugammadex in Charcot-Marie-Tooth disease

PurposeProlonged postoperative neuromuscular respiratory paralysis after administration of a nondepolarizing neuromuscular blocking agent is a serious concern during anesthetic management of patients with Charcot-Marie-Tooth disease (CMTD). Some recent reports have described rocuronium use without respiratory paralysis in CMTD patients when sugammadex was used for its reversal. We report a case in which an induction dose of rocuronium caused a prolonged respiratory paralysis in a patient with undiagnosed type 1A CMTD (CMT1A).Clinical featuresA 63-yr-old-male with an American Society of Anesthesiologists Physical Status score of III underwent a left hip arthroplasty under general anesthesia for osteoarthritis. Preoperative pulmonary function testing indicated a restrictive impairment. Anesthesia was induced with fentanyl, remifentanil, propofol, and 0.73 mg·kg-1 of rocuronium. The train-of-four (TOF) count was 0 for the 273-min duration of surgery. After repeated doses of sugammadex failed to recover the TOF count and spontaneous respirations, a total of 1,200 mg (17.3 mg·kg-1) of sugammadex, which was assumed to be a sufficient amount for capturing the residual rocuronium, was administered. Although the patient expressed that he was awake via eye blinking, he could not breathe. Thus, he was placed on mechanical ventilation for 18 hr after surgery. A postoperative neurology consultation revealed a delayed nerve conduction velocity of 20 m·sec-1 and a mutated duplication of the PMP22 gene; a diagnosis of CMT1A was made.ConclusionsOur case shows that rocuronium can cause a prolonged neuromuscular respiratory paralysis refractory to sugammadex in patients with CMT1A and impaired respiratory function. Our case may also indicate that restrictive pulmonary impairment and low nerve conduction velocity of 20 m·sec-1 are predictive factors that cause prolonged neuromuscular respiratory paralysis refractory to sugammadex in CMT1A.

Pulmonary function parameters among marble industry workers in Lahore, Pakistan

Background: Occupational contact with dust particles is a well-known phenomenon, particularly in developing countries of the world. Crystalline silica present in marble dust is the main etiology of a rising prevalence of obstructive lung diseases in marble stone workers, who are in direct contact with marble dust in the surrounding environment during their regular work. The purpose of this study was to compare the pulmonary function parameters of workers in marble workshops and age matched healthy individuals in the Lahore District of Pakistan. Methods: The study included 164 male individuals, 82 individuals working in marble workshops and 82 healthy individuals from the same community. Data were collected through in-person interviews using a structured questionnaire after obtaining written consent. A Spiro Lab spirometry for pulmonary function tests was used to identify any change in the lung function parameters. FVC% (forced vital capacity), FEV 1 (forced expiratory volume in first second) and FEV1 / FVC ratio were evaluated. Results: Mean age in the exposed group (marble workers) and non-exposed group (healthy individuals) were 29.92 ± 6.19 and 30.58 ± 6.37 years, respectively. The mean years of work experience of the exposed group was 11.92 ± 5.67 years. A statistically insignificant difference was observed between marble exposed workers & healthy individuals from the demographic variables. Lung function parameters in marble workers exhibited a highly significant (P < 0.001) decrease in FVC%, FEV 1 & FEV 1 / FVC ratio when compared to healthy individuals. Seventy-one percent of marble workers had abnormal pulmonary parameters whereas 34% of workers had restrictive pulmonary impairment. Marble workers who had worked for more than 15 years had a highly significant risk of developing abnormal pulmonary function (P < 0.001). Conclusion: Continuous exposure to marble dust deteriorates the lung function of marble workers.

Pulmonary function parameters among marble industry workers in Lahore, Pakistan.

Background: Occupational contact with dust particles is a well-known phenomenon, particularly in developing countries of the world. Crystalline silica present in marble dust is the main etiology of a rising prevalence of obstructive lung diseases in marble stone workers, who are in direct contact with marble dust in the surrounding environment during their regular work. The purpose of this study was to compare the pulmonary function parameters of workers in marble workshops and age matched healthy individuals in the Lahore District of Pakistan. Methods: The study included 164 male individuals, 82 individuals working in marble workshops and 82 healthy individuals from the same community. Data were collected through in-person interviews using a structured questionnaire after obtaining written consent. A Spiro Lab spirometry for pulmonary function tests was used to identify any change in the lung function parameters. FVC% (forced vital capacity), FEV 1 (forced expiratory volume in first second) and FEV1 / FVC ratio were evaluated. Results: Mean age in the exposed group (marble workers) and non-exposed group (healthy individuals) were 29.92 ± 6.19 and 30.58 ± 6.37 years, respectively. The mean years of work experience of the exposed group was 11.92 ± 5.67 years. A statistically insignificant difference was observed between marble exposed workers & healthy individuals from the demographic variables. Lung function parameters in marble workers exhibited a highly significant (P < 0.001) decrease in FVC%, FEV 1 & FEV 1 / FVC ratio when compared to healthy individuals. Seventy-one percent of marble workers had abnormal pulmonary parameters whereas 34% of workers had restrictive pulmonary impairment. Marble workers who had worked for more than 15 years had a highly significant risk of developing abnormal pulmonary function (P < 0.001). Conclusion: Continuous exposure to marble dust deteriorates the lung function of marble workers.

Three-month outcomes of recovered COVID-19 patients: prospective observational study.

Aims:A novel coronavirus SARS-CoV-2 has resulted in an ongoing global pandemic of Coronavirus disease 2019 (COVID-19). However, the outcomes of recovered patients have not been well defined.Methods:This is a prospective observational follow-up study of survivors with COVID-19 from a designated tertiary center in Hefei, China. We examined chest computed tomography (CT) scanning, pulmonary function, 6-min walk distance (6MWD), and 36 item Short Form General Health Survey (SF-36).Results:Among 81 enrolled patients, 62 (77%) patients and 61 (75%) patients, respectively, completed 1-month and 3-month follow-ups. Abnormal CT findings were still present in 73% of patients at 1 month and 54% at 3 months, whereas chest CT scan scores improved progressively at 1-month (5.0 ± 5.1) and 3-month follow up (3.0 ± 4.5) compared with that during hospitalization (11 ± 6.8). Mild restrictive pulmonary impairment was detected in 11% and 10% of patients at 1-month and 3-month follow up, respectively. The 6MWD was 523 ± 77 m in male patients and 484 ± 58 m in female patients, which was significantly lower than in healthy controls (606 ± 68 m, 568 ± 78 m, p < 0.001). SF-36 scores were significantly impaired in the domains of role physical (RP), role emotional (RE), and social functioning (SF) compared with the normal age-matched population. RP was improved at 3-month compared with 1-month follow up in the 41–64 years group (p < 0.01). Multivariable analysis showed that older age (over 40 years) and steroid administration during hospitalization were independently associated with worse chest CT scores at 3-month follow up.Conclusions:At 3 months, chest CT abnormalities were present in one half of COVID-19 survivors and worse chest CT scores were independently associated with older age and steroid administration during hospitalization. Residual pulmonary function impairments were modest, whereas exercise capacity and SF-36 scores were significantly lower than the general population. Support program and further follow-up evaluations may be needed. The reviews of this paper are available via the supplemental material section.

Correlation of Pulmonary Function Tests with Anthropometry and Glycaemic Control in Type 2 Diabetes Mellitus-A Cross-sectional Study

Introduction: Diabetic patients are found to have reduced lung functions compared to their controls and their relationship with the duration of diabetes, glycaemic control, and Body Mass Index (BMI) is poorly characterised. Aim: To determine the correlation between the pulmonary function abnormalities with anthropometry, glycaemic control, and duration of diabetes in type 2 diabetic patients. Materials and Methods: A total of 80 type 2 diabetic patients were studied. BMI, Waist Circumference (WC), Waist-Hip Ratio (WHR), Fasting, postprandial blood sugar and glycosylated haemoglobin (HbA1c) were assessed from July to September 2018. Spirometry was done in accordance with the guidelines from the American Thoracic Society (ATS). Reduced pulmonary functions were defined as patients with restrictive (FEV1/FVC≥0.7 and FVC&lt; 80% predicted) or obstructive (FEV1/FVC&lt;0.7) impairment. Statistical analysis was done using ANOVA test and Karl Pearson Correlation coefficient. Results: The mean values of FEV1/FVC (0.8±0.08) and FVC% predicted (60.29±11.39) showed a restrictive pattern. FEF (25-75%) (r=0.241, p=0.031) and PEFR (r=0.245, p=0.029) positively correlated with duration of diabetes. BMI had a negative correlation with FVC% predicted (r=0.239, p=0.033). A negative correlation between FEV1% and Waist Circumference (WC) was observed (r=-0.232, p=0.038). HbA1c negatively correlated to FEV1/FVC (r=-0.227, p=0.043). Conclusion: Patients with type 2 Diabetes Mellitus (DM) were found to have an asymptomatic restrictive pulmonary impairment. Increased duration of diabetes, increased BMI, increased WC was associated with decreased lung functions in diabetics.

Clinical status and lung function 10 weeks after severe SARS-CoV-2 infection

IntroductionSince studies about clinical status after COVID-19 are scarce, we conducted a cross sectional study with assessment of residual symptoms, lung function and chest CT. Materials and MethodsDuring an outpatient follow-up visit, chest CT, pulmonary function and COVID-19 related symptoms were assessed approximately 10 weeks after diagnosis. Demographics, baseline (time of diagnosis) CT score and blood results were collected from patient files. Association between lung function and clinical characteristics (baseline), blood markers (baseline), chest CT (baseline and follow-up) and symptom score (followup) was analysed. Mann-Whitney U tests and Chi squared tests were used for statistical comparison between subgroups with and without restriction. Results and discussionTwo hundred-twenty subjects were evaluated at a median follow-up of 74±12 (SD) days. Median symptom and median CT score at follow-up were 1(IQR=0- 2) and 2(IQR=0-6) respectively. Forty-six percent of patients had normal lung function, while TLC and TLCO below the lower limit of normal were observed in 38% and 22% of subjects respectively. This restrictive pulmonary impairment was associated with length of hospital stay (8 vs 6 days; p=0.003), admission to the intensive care unit (27% vs 13%;p=0.009), and invasive mechanical ventilation (10% vs 0.7%;p=0.001), but not with symptom score or CT score at baseline and follow-up. ConclusionsFifty-four percent of COVID-19 survivors had abnormal lung function 10 weeks after diagnosis. Restriction was the most prevalent pulmonary function, with the more critically ill patients being more prone to this condition. Yet, restriction could not be linked with abnormal imaging results or residual symptoms.

Occupational impact of increased dust duration on pulmonary capacities of workers.

Occupational lung diseases are usually caused due to chronic exposure to dust or irritating toxic substance. In India, morbidity due to occupational lung diseases has been reported to be high. Therefore present study was carried out to determine the impact of long term occupational barites dust exposure on pulmonary capacities of workers. Methods: The present cross-sectional study was conducted on 322 participants within age group of 22-60 years in 2013. Data regarding demographic, behavioural & occupational characteristics were collected by pre-designed questionnaire. Spirometry is an important tool for detection of pulmonary diseases in its earlier stages. Pulmonary functions were assessed by Schiller spirometry in 240 surface mine exposed workers who engaged in direct mining activities & 92 age matched healthy administrative staff workers as non exposed workers. Results: It was observed that 15.8% of exposed workers had restrictive pulmonary impairment as compared to 6.5% among non-exposed workers and the difference was statistically significant (p

Unilateral Upper Lung Field Pulmonary Fibrosis Radiologically Consistent with Pleuroparenchymal Fibroelastosis after Thoracotomy: A New Disease Entity Related to Thoracotomy

Background: Pleuroparenchymal fibroelastosis (PPFE) is a rare bilateral idiopathic interstitial pneumonia defined by pleural-parenchymal involvement. In clinical practice, we encountered patients with upper lung field pulmonary fibrosis (Upper-PF), which was radiologically consistent with PPFE, but apparently limited to the unilateral lung. Objectives: The purpose of the study was to clarify the clinical characteristics in those patients. Methods: We examined the medical records of all the consecutive patients from 2012 to 2016 to see whether there were patients having unilateral Upper-PF. Results: We found 6 patients with unilateral Upper-PF. The most common symptom was dyspnea, and all patients had a low body mass index and severe restrictive pulmonary impairment. Notably, all patients had a history of thoracotomy for resecting lung or esophageal cancer, and the lesions were limited to the operated side. Dynamic breathing chest MRI showed an impaired thoracic movement in the operated side. Serial chest CT from prethoracotomy to the first visit was obtained in 5 patients: before thoracotomy, only a slight apical cap, defined as a wedge- and triangle-shaped opacity with broad pleural contact, was observed only in the operated side, but progressed into the lesion after a median of 8.4 years following thoracotomy. After the first visit, the unilateral lesion rapidly deteriorated in all patients. Conclusions: Unilateral Upper-PF had some characteristics in common with PPFE. Because the lesion was limited to the operated side, unilateral Upper-PF would be a new disease entity related to thoracotomy. Our results indicate that thoracotomy impairs thoracic movement in the operated side and subsequently triggers unilateral Upper-PF development, especially in patients with an apical cap.

Pulmonary function of automobile repair workers in the informal sector of Raichur urban

Background: Automobile repair workers of the informal sector are exposed to dusts, toxic fumes and aerosols. Long term occupational exposure may lead to pulmonary function impairment. Hence, the objectives were to study the occurrence of obstructive and restrictive pulmonary impairment among the automobile repair workers by using pulmonary function test and the factors associated with it.Methods: A cross sectional study was carried out in automobile repair workers who work in informal sector in the urban area of Raichur in Karnataka. The pulmonary function tests viz. Forced Expiratory volume in one second, Forced vital capacity, Peak Expiratory Flow Rate per liter and FEV1/FVC ratio in percentage were measured for each worker in sitting posture using a digital spirometer. Data collected were analyzed in SPSS 16.0 software. Chi-square test and t test was used.Results: Out of the 97 automobile repair workers, 42 (43.3%) had normal pulmonary function. Among the abnormal PFT, 20 (20.6%) had obstructive lung function, 25 (25.8%) had restrictive lung function and 10 (10.3%) had mixed obstructive and restrictive lung function. The workers with abnormal PFT consisted of body repair workers (25.0%), mechanical workers (38.1%), spray painters (75.0%), battery repair workers (100.0%) and tyre retreading workers (88.9%).Conclusions: In this study, 56.7% of workers had some form of pulmonary function impairment. Smoking, increase in duration of work hours and years of work showed significant pulmonary impairment. The study highlights the need for creating awareness and encouraging the use of protective gears such as masks, early screening, diagnosis and treatment of respiratory diseases among the garage workers.

Prevalence and risk factors for reduced pulmonary function in diabetic patients: The Korea National Health and Nutrition Examination Survey.

Background/AimsAn association between reduced pulmonary function and diabetes has been observed. Our aim was to evaluate the prevalence and risk factors associated with reduced pulmonary function in diabetic patients.MethodsWe analyzed data from the Korea National Health and Nutrition Examination Survey 2011 to 2013. The study population included data from 8,784 participants (including 1,431 diabetics) aged ≥ 40 years. Reduced pulmonary function was defined as patients with restrictive (forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] ≥ 0.7 and FVC < 80% of predicted value) or obstructive (FEV1/FVC < 0.7) patterns.ResultsSubjects with diabetes had a higher prevalence of restrictive (18.4% vs. 9.4%, p < 0.001) and obstructive impairments (20% vs. 12.6%, p < 0.001) than those without diabetes. The adjusted odds ratios (aORs) (95% confidence interval [CI]) for obstructive and restrictive pulmonary impairment were 0.91 (0.75 to 1.11) and 1.57 (1.30 to 1.89), respectively. In the diabetes population, age (aOR, 1.04; 95% CI, 1.02 to 1.06), male sex (aOR, 1.40; 95% CI, 1.04 to 1.88), and body mass index (aOR, 1.15; 95% CI, 1.10 to 1.21) were independently associated with restrictive pulmonary impairment. Age (aOR, 1.12; 95% CI, 1.09 to 1.14), male sex (aOR, 4.24; 95% CI, 2.42 to 7.44), and smoking at any point (ever-smoker: aOR, 1.96; 95% CI, 1.16 to 3.33) were independent risk factors for obstructive pulmonary impairment in diabetics. Diabetes duration or glycated hemoglobin had no association with pulmonary impairment in diabetes.ConclusionsSubjects with diabetes had a higher risk of restrictive pulmonary impairment than those without diabetes after adjusting for confounding factors. Older age, male sex, body mass index, and smoking were associated with reduced lung function in diabetes.

Pulmonary complications after cardiac surgery: breathing down the patient’s neck

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Lung volume change after pedicle subtraction osteotomy in patients with ankylosing spondylitis with thoracolumbar kyphosis.

A retrospective clinical study. To investigate the lung volume (LV) change in patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis after the pedicle subtraction osteotomy procedure. Thoracolumbar kyphosis with respiratory impairment is the consequence of most untreated AS patients. Restrictive pulmonary function is prevalent in these patients. The ideal evidence for restrictive pulmonary function impairment is to investigate the LV. A computed tomography (CT)-based method can help to obtain accurate LV change during the osteotomy. Twenty-eight patients with AS with thoracolumbar kyphosis were included. All of these patients underwent pedicle subtraction osteotomy to correct their sagittal deformity. Pre- and postoperative full-length radiographs and CT scans were reviewed. The sagittal correction of the spine was measured. CT scans were used to estimate the pre- and postoperative LV with software. The relationship between the sagittal correction and the LV change was investigated. All the patients were followed up for 2 years at least. The pedicle subtraction osteotomy procedure was performed safely on each patient without serious complications. The average preoperative T1-S1 Cobb was 67.7° (42°∼88°) and the postoperative was 7.6° (-11°∼21°). T1-S1 Cobb change was 60.0° in average (P < 0.05). The LV increased by 396 mL in average. Significant correlation was found between the percentage of LV change and T1-S1 Cobb change (r = 0.7219, P < 0.05). The location we selected for pedicle subtraction osteotomy varied from T12 to L3. No relationship was found between the osteotomy location and the LV change. The pedicle subtraction osteotomy effectively corrected the sagittal deformity of patients with AS. LV increased significantly after the osteotomy. 4.

Effect of active pulmonary rehabilitation on pulmonary function in patients with brain lesion.

The patients with brain lesion have a high risk of pulmonary complication due to restrictive pulmonary impairment. To investigate the effectiveness of active pulmonary rehabilitation on pulmonary functional improvement in these patients. Twnety-two patients of hemiplegia or quadriplegia with brain lesion were recruited who had restrictive pulmonary impairment. The patients were randomly assigned to an experimental group that receive active pulmonary rehabilitation training and a control group without it. The active pulmonary rehabilitation training is composed of air-stacking exercise by ambu-bagging and functional electrical stimulation (FES) on phrenic nerve and abdominal muscle. We examined respiration function test of all patients composed of peak cough flow (PCF), pulmonary function test (PFT), diaphragmatic motion evaluation and oxygen saturation (SaO2) at the beginning and 4 weeks after treatment. There was no significant difference in pulmonary function between experimental group and control group at the beginning. After 4 weeks treatment, FVC and FEV1 of PFT, PCF, diaphragmatic motion, SaO2 have significantly improved (p < 0.05) in experimental group, but no significant changes were detected in control group. It is suggested that active pulmonary rehabilitation with air-stacking exercise and FES would be useful to improve pulmonary function in patients with brain lesion.

Association between right ventricular dysfunction and restrictive lung disease in childhood cancer survivors as measured by quantitative echocardiography.

Restrictive lung disease is a complication in childhood cancer survivors who received lung-toxic chemotherapy and/or thoracic radiation. Left ventricular dysfunction is documented in these survivors, but less is known about right ventricular (RV) function. Quantitative echocardiography may help detect subclinical RV dysfunction. The aim of this study was to assess RV function quantitatively in childhood cancer survivors after lung-toxic therapy. We identified records of 33 childhood cancer survivors who (1) were treated with lung-toxic therapy and/or radiation, (2) were cancer-free for ≥ one year after therapy, and (3) had pulmonary function tests and echocardiograms from their most recent follow-up visit. Participants' mean age was 11.6 ± 4.5 years at cancer diagnosis and 23 ± 8.6 years at evaluation. The most common diagnosis was lymphoma/leukemia (n = 27). Twenty-nine subjects had anthracycline exposure. Eleven of the 33 subjects demonstrated restrictive pulmonary impairment (total lung capacity 3.69 ± 1.5 L [69.3 ± 22.4% predicted]). Among quantitative measures of RV function, isovolumetric acceleration (IVA), a measure of contractility, was significantly lower in the group with restrictive lung disease (2.42 ± 0.56 vs. 1.83 ± 0.78 m/sec(2); P < 0.05). There was a trend towards lower tissue Doppler derived S' and tricuspid annular plane systolic excursion in the group with restrictive lung disease. Subjects with restrictive lung disease were found to have ≥ 2 abnormal parameters (P < 0.01). IVA may detect early RV dysfunction in childhood cancer survivors with restrictive lung disease. Our findings require confirmation in a larger study population and validation by cardiac MRI.

Pulmonary function and autoantibodies in a long-term follow-up of juvenile dermatomyositis patients

Pulmonary disease is a rare complication in JDM, described in only a few studies. This long-term follow-up study aimed to (i) describe pulmonary involvement in a national cohort of JDM patients estimated by conventional spirometry, (ii) compare pulmonary impairment with overall JDM outcome, and (iii) identify possible associations between pulmonary impairment and myositis-specific autoantibodies (MSAs). Fifty-one JDM patients performed conventional spirometry in a cross-sectional follow-up study. The scores of the Myositis Damage Index (MDI), Myositis Damage by visual analogue scale (MYODAM-VAS) and physician's global damage assessment were used to estimate JDM outcome. ANAs, MSAs and myositis-associated autoantibodies were analysed in all patients. Forty-two patients (82%) (mean follow-up time 14.3 years) had normal lung function. Four patients (8%) were diagnosed with JDM-related restrictive interstitial lung disease. No patients reported pulmonary symptoms. Patients with restrictive pulmonary function had increased long-term damage estimated by MDI (P = 0.008), MYODAM-VAS (P = 0.04), global assessment (P = 0.03) and number of organ systems involved (P = 0.009). We found significant correlation between the restrictive pulmonary function test and damage by the MDI (r = 0.43, P = 0.003), MYODAM-VAS (r = 0.44, P = 0.002), and global damage assessment (r = 0.43, P = 0.003). No association was found between the restrictive pulmonary function test and autoantibodies. In a long-term follow-up study of JDM patients, the majority of patients demonstrated normal lung function. However, restrictive pulmonary impairment was identified in 8% of patients, indicating a need for repetitive pulmonary follow-up in JDM patients. Restrictive pulmonary involvement was associated with increased long-term JDM damage.

Relation of Pulmonary Function Impairment and Coronary Artery Calcification by Multi-detector Computed Tomography in Group Exposed to Inorganic Dusts

BackgroundThe purpose of this study was to evaluate the relationship of pulmonary function impairment (PFI) and coronary artery calcification (CAC) by multi-detector computed tomography (MDCT), and the effect of pneumoconiosis on CAC or PFI.MethodsSeventy-six subjects exposed to inorganic dusts underwent coronary artery calcium scoring by MDCT, spirometry, laboratory tests, and a standardized questionnaire. CAC was quantified using a commercial software (Rapidia ver. 2.8), and all the subjects were divided into two categories according to total calcium scores (TCSs), either the non-calcified (<1) or the calcified (≥1) group. Obstructive pulmonary function impairment (OPFI) was defined as forced expiratory volume in one second/forced vital capacity (FEV1/FVC, %)<70, and as FEV1/FVC (%)≥70 and FVC<80 for restrictive pulmonary function impairment (RPFI) by spirometry. All subjects were classified as either the case (profusion≥1/0) or the control (profusion≤0/1) group by pneumoconiosis findings on simple digital radiograph.ResultsOf the 76 subjects, 35 subjects (46.1%) had a CAC. Age and hypertension were different significantly between the non-calcified and the calcified group (p<0.05). Subjects with pneumoconiosis were more frequent in the calcified group than those in the non-calcified group (p=0.099). FEV1/FVC (%) was significantly correlated with TCSs (r=-0.316, p=0.005). Subjects with OPFI tended to increase significantly with increasing of TCS (4.82, p=0.028), but not significantly in RPFI (2.18, p=0.140). Subjects with OPFI were significantly increased in the case group compared to those in the control group.ConclusionCAC is significantly correlated with OPFI, and CAC and OPFI may be affected by pneumoconiosis findings.

Preoperative Assessment of Respiratory Function in Severely Obese Patients Undergoing Biliopancreatic Diversion

Since severe obesity is often associated with a pulmonary function defect and abdominal surgery increases the risks of respiratory postoperative complications (RPC), an increased incidence of RPC might occur after bariatric operations. A cohort of 146 severely obese patients undergoing biliopancreatic diversion (BPD) was retrospectively evaluated for the occurrence of RPC. Respiratory function was evaluated prior to BPD from the quotient between measured and predicted values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁) and the Tiffeneau index (TI: FEV₁/FVC). In this cohort of obese individuals the BMI degree prior to the operation was totally unrelated to the standardized values of TI and to the presence of restrictive or obstructive pulmonary disease. Globally, a very low rate of RPC (7.5%) was found; in patients with suspected restrictive pulmonary impairment, a high occurrence of RPC was observed (p < 0.05). When data are controlled for preoperative BMI values, smoking status and presence of sleep apnoea, a logistic regression model indicates that respiratory function data cannot predict the occurrence of RPC after bariatric surgery.

Pulmonary function impairment measured by pulmonary function tests in long-term survivors of childhood cancer

BackgroundChildhood cancer survivors (CCSs) have an increased risk of morbidity and mortality. The prevalence and risk factors of pulmonary function impairment were investigated in a large cohort of CCSs treated...