Routine Pulmonary Function Tests Research Articles

Evidence-based guideline summary: Evaluation, diagnosis, and management of facioscapulohumeral muscular dystrophy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the Practice Issues Review Panel of the American Association of Neuromuscular & Electrodiagnostic Medicine.

To develop recommendations for the evaluation, diagnosis, prognostication, and treatment of facioscapulohumeral muscular dystrophy (FSHD) from a systematic review and analysis of the evidence. Relevant articles were analyzed in accordance with the American Academy of Neurology classification of evidence schemes for diagnostic, prognostic, and treatment studies. Recommendations were linked to the strength of the evidence and other factors. Available genetic testing for FSHD type 1 is highly sensitive and specific. Although respiratory insufficiency occurs rarely in FSHD, patients with severe FSHD should have routine pulmonary function testing. Routine cardiac screening is not necessary in patients with FSHD without cardiac symptoms. Symptomatic retinal vascular disease is very rare in FSHD. Exudative retinopathy, however, is potentially preventable, and patients with large deletions should be screened through dilated indirect ophthalmoscopy. The prevalence of clinically relevant hearing loss is not clear. In clinical practice, patients with childhood-onset FSHD may have significant hearing loss. Because undetected hearing loss may impair language development, screening through audiometry is recommended for such patients. Musculoskeletal pain is common in FSHD and treating physicians should routinely inquire about pain. There is at present no effective pharmacologic intervention in FSHD. Available studies suggest that scapular fixation is safe and effective. Surgical scapular fixation might be cautiously offered to selected patients. Aerobic exercise in FSHD appears to be safe and potentially beneficial. On the basis of the evidence, patients with FSHD might be encouraged to engage in low-intensity aerobic exercises.

The role of the small airways in the pathophysiology of asthma and chronic obstructive pulmonary disease.

Chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), represent a major social and economic burden for worldwide health systems. During recent years, increasing attention has been directed to the role of small airways in respiratory diseases, and their exact contribution to the pathophysiology of asthma and COPD continues to be clarified. Indeed, it has been suggested that small airways play a distinct role in specific disease phenotypes. Besides providing information on small airways structure and diagnostic procedures, this review therefore aims to present updated and evidence-based findings on the role of small airways in the pathophysiology of asthma and COPD. Most of the available information derives from either pathological studies or review articles and there are few data on the natural history of small airways disease in the onset or progression of asthma and COPD. Comparisons between studies on the role of small airways are hard to draw because both asthma and COPD are highly heterogeneous conditions. Most studies have been performed in small population samples, and different techniques to characterize aspects of small airways function have been employed in order to assess inflammation and remodelling. Most methods of assessing small airways dysfunction have been largely confined to research purposes, but some data are encouraging, supporting the utilization of certain techniques into daily clinical practice, particularly for early-stage diseases, when subjects are often asymptomatic and routine pulmonary function tests may be within normal ranges. In this context further clinical trials and real-life feedback on large populations are desirable.

EPS06.9 Lung disease progression and inflammatory parameters in children with cystic fibrosis chronically colonized with Burkholderia cepacia complex

Objectives The aim of this study was to compare lung disease severity and inflammatory markers in cystic fibrosis (CF) pediatric patients chronically colonized with Burkholderia cepacia complex (Bcc) and those who were free of the pathogen. Methods 95 children (mean age 11.5 years) were enrolled into the study. Besides routine examination and pulmonary function tests (PFT) performing, sputum and plasma concentrations of cytokines (TNF-α, IFNγ, IL-4, IL-10, IL-17, TGF-b1) and in situ elastase levels were assayed with commercially available kits. Individual susceptibility of peripheral blood lymphocytes (PBL) to glucocorticoids was also evaluated. Results Paradoxically, the patients with Bcc infection (n = 43) demonstrated better PFT outcomes and higher Body Mass Indexes (BMI) compared to those of uninfected children (n = 52). In the same time multiple antibiotic allergies as well as glucose tolerance abnormalities were more common among the patients of Bcc group. We did not find significant differences for in situ inflammatory markers between CF patients with and without Bcc infection. At once marked reduction of circulating IL-17 and TGF-β1 as well as increased sensitivity of PBL to glucocorticoids have been revealed in the infected group. Conclusion The paradoxical association of chronic Bcc colonization with better PFT outcomes, higher BMI and down-regulated systemic inflammatory markers in CF children may relate to more aggressive antibiotic therapy as well as Bcc-induced alterations of host inflammatory response. Further studies are needed to better understand the specific nature of the host–pathogen interactions during chronic Bcc colonization.

Predictive Value of Bronchiolitis Obliterans Syndrome Stage 0p in Chronic Graft-versus-Host Disease of the Lung

Bronchiolitis obliterans syndrome (BOS) is a significant post-transplant complication with low survival. BOS stage 0p (BOS 0p) is a parameter detected on pulmonary function tests (PFTs) after lung transplantation to identify patients at risk to develop BOS. We performed a retrospective study on 442 patients who underwent allogeneic stem cell transplant from 2007 to 2011 to evaluate whether development of BOS 0p is a risk factor in this population for BOS. Patients who met criteria for BOS 0p were significantly more likely to develop BOS (hazard ratio [HR], 3.22; P < .001). BOS 0p was significantly associated with a history of lung disease pretransplant (HR, 2.48; P = .001) and chronic graft-versus-host disease (GVHD) outside the lung post-transplant (HR, 23; P < .001). Finally, BOS 0p criteria were adequately sensitive in predicting BOS (85%), with a high negative predictive value (98%). Our findings suggest a routine PFT screening strategy with the intent of detecting BOS 0p, especially among patients with prior lung disease and who developed chronic GVHD, could suitably identify an at-risk population for the development of BOS.

Pulmonary function tests – an easy selection method for respiratory-gated radiotherapy in patients with left-sided breast cancer

Purpose. The purpose of this study was to establish a feasible and convenient method for selection of the subset of patients with left-sided breast cancer for whom respiratory-gated radiotherapy (RT) would be necessary to meet the national recommendation regarding radiation dose to the heart.Material and methods. The volume of heart receiving a dose equal to or higher than 25 Gy (V25Gy), the mean heart dose (Dmean) and total lung volume (TLV-CT) were obtained from treatment plans based on computer tomography (CT) series recorded during free breathing (FB), and the correlation between dose to the heart and TLV-CT was studied. Second, the correlation between TLV-CT and TLV defined from three pulmonary function tests (PFTs); spirometry, gas diffusion and plethysmograhy, was evaluated.Results. Dose to the heart (V25Gy and Dmean) decreased with increasing TLV-CT. Pearson's correlation coefficient (r) for TLV-CT versus V25Gy and Dmean was equal (r = −0.809, p < 0.01) for patients planned for tangential breast RT only, and r = −0.853 and −0.861 (p < 0.01) for patients planned for loco-regional RT. Regression analysis showed good correlation between TLV-CT and TLV calculated from pulmonary function tests (R2 ≥ 0.717, p < 0.01).Conclusion. TLV defined by routine pulmonary function tests can be used to identify the subset of left-sided breast cancer patients who require respiratory-gated RT.

Evidence-Based Medicine, Treatment Guidelines, and Literature Search Web Resources

Abstract Cardiopulmonary exercise stress testing (CPET) provides objective data to assess cardiac and pulmonary impairment. This article discusses changes in the CPET section of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The explanation of CPET in the AMA Guides, Sixth Edition, adds a single word, “static,” that significantly effects how this test should be conducted. Routine pulmonary function tests (PFTs) provide information about a person's ability to breathe, eg chronic obstructive pulmonary disease or asthma can stratify the severity of these diseases; they do not measure the ability of the lungs or heart to provide adequate oxygenation to metabolizing tissues. Static tests of lung function are the norm when diagnosing asbestosis, and the typical abnormalities seen are restriction, some airflow obstruction, and a diminished diffusing capacity. These abnormalities correlate linearly with the degree of abnormality found radiographically. In individuals with unexplained shortness of breath with exertion or fatigue that is not easily explained in the medical records, a CPET will allow secure diagnosis of causation. Thus CPET is a powerful tool to explain shortness of breath with exertion or fatigue, and CPET has a role in the impairment rating process of all individuals with interstitial lung diseases and in selected individuals with unexplained symptoms.

Evaluation of diffusing capacity of the lung for carbon monoxide normalized per liter alveolar volume as a parameter for assessment of interstitial lung diseases

IntroductionThe single-breath (SB) diffusing capacity for carbon monoxide (DLCO) is the most clinically useful routine pulmonary function test after spirometry and lung volumes. The DLCO is the product of two measurements during breath holding at full inflation: (i) the rate constant for carbon monoxide uptake from alveolar gas and (ii) the accessible alveolar volume (VA). DLCO divided by VA (DLCO/VA), also called Krogh factor, reflects physiology more appropriately. It reflects the diffusing capacity in the available alveolar spaces.AimThe aim of the study was to assess the validity of DLCO/VA interpretation in patients with interstitial lung diseases.Patients and methodsThis study involved 53 patients diagnosed as interstitial lung disease who presented to our pulmonary function laboratory in the Chest Department at Ain Shams University Hospital. Spirometry and DLCO-SB technique were performed.ResultsFifty-three patients with mean age of 47.11 ± 13.7 years were included, 20 women and 33 men. The study showed positive correlation between age and forced vital capacity (FVC) and negative correlation between age and residual volume (RV). Height was significantly statistically related to DLCO, DLCO/VA, and total lung capacity (TLC)-SB. FVC showed no correlation with both DLCO and DLCO/VA. However, it was positively correlated with TLC-SB, VA, RV, and functional residual capacity. The mean of DLCO was 45.62 ± 17.19 and of DLCO/VA was 76.5 ± 31.7. DLCO showed a significant relationship with the following parameters: DLCO/VA, TLC, and RV/TLC. DLCO/VA showed positive statistical correlation with DLCO and TLC and negative correlation with VA. VA was positively correlated with TLC, FVC, and RV. However, it was negatively correlated with DLCO/VA.ConclusionDLCO and DLCO/VA should be interpreted coherently with each other especially in restrictive lung diseases; in addition, VA and TLC-SB give a good guide for lung volume in interstitial lung disease. Egypt J Broncho 2014 8:51–56

Correlation of Pulmonary Function Indexes Determined by Low-Dose MDCT With Spirometric Pulmonary Function Tests in Patients With Chronic Obstructive Pulmonary Disease

The objective of our study was to evaluate the correlation between pulmonary function indexes determined by low-dose MDCT and those obtained from routine spirometric pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD). Lung function of patients with COPD stages 0-III was evaluated by both MDCT and spirometric PFTs. Scanning was performed at maximum end-inspiration and maximum end-expiration. A very strong correlation was found between extrapolated expiratory lung volume (LVex) and COPD stage (r = 0.802, p < 0.001) and between extrapolated LVex and the ratio of forced expiratory volume in 1 second and percentage forced vital capacity (FEV1/FVC%) (r = -0.831, p < 0.001). Moreover, strong positive correlations were found between inspiratory lung volume (LVin) and total lung capacity (TLC) (r = 0.658, p < 0.001), LVex and residual volume (RV) (r = 0.683, p < 0.001), extrapolated LVex and RV (r = 0.640, p < 0.001), LVex and RV/TLC (r = 0.602, p < 0.001), LVex/LVin and RV/TLC (r = 0.622, p < 0.001), extrapolated LVex and RV/TLC (r = 0.663, p < 0.001), and LVex and COPD stage (r = 0.697, p < 0.001). Low-dose MDCT lung function indexes correlate well with spirometric PFT results, and the highest correlation is at end-expiration. Low-dose MDCT may be useful for evaluating lung function in patients with COPD.

Expiratory flow limitation detected by negative expiratory pressure in children with asthma

Objective The purpose of this study was to evaluate the feasibility of expiratory flow limitation(EFL) detected by negative(NEP) and the correlation between EFL and routine lung function measurements(Forced expiratory volume in first second,FEV1),EFL and MRC dyspnea scale,in patients with stable and acute asthma,to find a simple,reliable and objective method for the diagnosis,differential diagnosis,the severity of disease and evaluation of severity and efficacy of treatment for asthma,and a objective method reflecting the severity of dyspnea.Methods Sixty-four children enrolled in No.306 Hospital of PLA from Jun.to Dec.in 2012 were included in this study.The severity of dyspnea was rated according to the dyspnea scale proposed by the Medical Research Council(MRC).Then routine pulmonary ventilation function tests and NEP technique were performed respectively.Result (1) All asthmatic patients tolerated NEP well.(2) Pulmonary ventilation function tests:The mean FEV1 in 64 was 71.33 ± 13.92％ pred.(3) MRC dyspnea scale:MRC dyspnea scale was 2 in 10,1 in 54 of 64 children with stable asthma.The Spearman' s correlation coefficient of MRC dyspnea scale with FEV1 was-0.635(P ＜0.05).(4)EFL detected by NEP:There were no EFL in 46 children with asthma both in seated and supine positions.There were EFL in 8 children both in seated and supine positions and in 10 only in supine position..The Spearman's correlation coefficient of three-point EFL score with FEV1 and MRC dyspnea scale was-0.607 and 0.964(P ＜ 0.05) respectively.The Spearman's correlation coefficient of five-point EFL score with FEV1 and MRC dyspnea scale was-0.626 and 0.966 (P ＜ 0.05)respectively.Conclusion (1) NEP technique can be used in children with asthma.(2) There was a significant correlation between EFL detected by NEP technique and FEV1.(3) There is a stronger correlation between EFL and MRC dyspnea scale than that between FEV1 and MRC dyspnea scale. Key words: Asthma; Children; Negative expiratory pressure(NEP) ; Expiratory flow limitation(EFL) ; Forced expiratory volume in first second

Three-dimension quantitative CT assessment of lung volume on paired inspiratory and expiratory CT scans in chronic obstructive pulmonary disease

Objective To evaluate the relationship between the lung volume (LV) in inspiration and expiration,pulmonary function tests (PFT),and other CT measurements of emphysema index (EI) and mean lung density (MLD) in patients with chronic obstructive pulmonary disease (COPD). Methods Seventy-six patients with COPD were included.Three-dimension analysis was performed to obtain the following CT parameters on the inspiratory and expiratory phases: EI,MLD,LV.The ratios and differences of MLD and LV between the two phases were calculated (ΔMLD,ΔLV,MLDex/in,LVex/in).Not only the linear correlations between the lung volume parameters and PFT but also the correlations of lung volume parameters with the other CT parameters were tested by the Spearman rank correlation test and multivariant step wise regression. Results LVex/inhad negative correlations with forced expiratory volume in 1 second% predicted[FEV1%,(54.32±7.11) ]and the ratio of forced expiratory volume in 1 second to forced vital capacity[FEV1/FVC,(49.12±8.01) %] (r=-0.69,-0.56,P<0.01),but it had the positive correlation with the ratio of residual volume to total lung capacity[RV/TLC,(58.03±8.55) %,Spearman coefficients 0.66,P<0.01].LVex/in (0.67±0.12) was positively correlated with MLDex/in (0.89±0.04,r=0.88,P<0.01).The further multivariate step wise regression demonstrated that EI,LV and MLD could introduce a regression equation withR2=0.77 and 0.73,respectively (P<0.01). Conclusions There is an association between LVex/in and the parameters of routine PFT,which can reflect the collapsibility of lung.Moreover,LVex/incan be considered to be equivalent to MLDex/in.Taking into account the impact of scanning parameters on MLDex/in,LVex/inmay play a complementary role in the assessment of pulmonary function. Key words: Pulmonary disease,chronic obstructive; Respiratory function tests;

Donor Surfactant Protein D (SP-D) Polymorphisms Are Associated With Lung Transplant Outcome

Chronic lung allograft dysfunction (CLAD) is the major factor limiting long-term success of lung transplantation. Polymorphisms of surfactant protein D (SP-D), an important molecule within lung innate immunity, have been associated with various lung diseases. We investigated the association between donor lung SP-D polymorphisms and posttransplant CLAD and survival in 191 lung transplant recipients consecutively transplanted. Recipients were prospectively followed with routine pulmonary function tests. Donor DNA was assayed by pyrosequencing for SP-D polymorphisms of two single-nucleotide variations altering amino acids in the mature protein N-terminal domain codon 11 (Met11Thr), and in codon 160 (Ala160Thr) of the C-terminal domain. CLAD was diagnosed in 88/191 patients, and 60/191 patients have died. Recipients of allografts that expressed the homozygous Met11Met variant of aa11 had significantly greater freedom from CLAD development and better survival compared to those with the homozygous Thr11Th variant of aa11. No significant association was noted for SP-D variants of aa160. Lung allografts with the SP-D polymorphic variant Thr11Th of aa11 are associated with development of CLAD and reduced survival. The observed genetic differences of the donor lung, potentially with their effects on innate immunity, may influence the clinical outcomes after lung transplantation.

Decreased Pulmonary Function in Asymptomatic Long Term Survivors After Busulfan-Based Myeloablative Allogeneic Hematopoietic Stem Cell Transplant

Abstract 4474 Pulmonary function post allogeneic hematopoietic stem cell transplant (HSCT) can be impaired by previous exposure to chemotherapy, infection, or underlying chronic graft versus host disease (cGVHD). In this retrospective study, we selected 21 long term transplant survivors with a median follow up of 48 months who had received a related (60%) or unrelated (40%) HSCT conditioned with a myeloablative busulfan-based regimen. All patients had routine pulmonary function tests (PFTs) repeated within two years from transplant and none had respiratory symptoms or a history of chronic lung infection at the time of analysis. Median age was 45 years (range 18–54). Patients had a diagnosis of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) (52%), acute lymphoblastic leukemia (ALL) (14%), chronic myeloid leukemia (CML) (14%), non-Hodgkin lymphoma (NHL) (9%), or chronic lymphocytic leukemia (CLL) (2%). Survival rate at the time of analysis is 90%. We initially compared single parameters of PFTs including corrected diffusion limiting capacity of oxygen (DLCO), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and total lung capacity (TLC) obtained before and after transplant. Post transplant, all PFT parameters showed some degree of reduction compared to pre-transplant values (Figure 1). FEV1 and FEV1/FVC were significantly decreased (108 vs 92,p=0.04 and 86 vs 80%, p=0.04, respectively). Median values of corrected DLCO prior to and after transplant were 83% (range 55–148) and 77%(range 44–146) (p=0.2), respectively. In order to test whether patients with >10% reduction of PFTs had an increased rate of overall cGVHD, we analyzed intra-patient changes in DLCO and FEV1 values. We then divided patients into groups with extensive, limited, or no cGVHD. No correlation was found between the degree of cGVHD and FEV1 or DLCO values. A decrease in pulmonary function was detected in patients who received a busulfan based myeloablative HSCT despite the absence of lung infection or pulmonary cGVHD. This finding, however, did not affect long term survival. Disclosures: No relevant conflicts of interest to declare.

Dynamic Hyperinflation Correlates with Exertional Oxygen Desaturation in Patients with Chronic Obstructive Pulmonary Disease

Dynamic hyperinflation (DH) causes exercise limitation and exertional dyspnea in patients with chronic obstructive pulmonary disease (COPD). Exertional desaturation (ED) also occurs commonly in COPD but neither routine physiologic parameters nor imaging predict ED accurately. In this study we evaluated the relationship between DH and ED during 6-min walk testing (6MWT). We measured ED and DH in patients with stable COPD. SpO2 was measured by continuous pulse oximetry during 6MWT. ED was defined as a decline in SpO2 (ΔSpO2) ≥4%. DH was determined by measuring inspiratory capacity (IC) before and after the 6MWT using a handheld spirometer. DH was defined as ΔIC >0.0L. We correlated DH and ED with clinical and pulmonary physiologic variables by regression analysis, χ (2), and receiver operator curve (ROC) analysis. Thirty males [age=65±9.4years, FEV1 % predicted=48±14%, and DLCO % predicted=50±21% (mean±SD)] were studied. ΔSpO2 correlated with ΔIC (r=0.49, p=0.005) and age (r=0.39, p=0.03) by univariate analysis; however, only ΔIC correlated on multivariate regression analysis (p=0.01). ΔSpO2 did not correlate with FEV1, FVC, FEF25-75, RV, DLCO % predicted, BMI, smoking, BORG score, or distance covered in 6MWT. DH strongly correlated with ED (p=0.001). On ROC analysis, DH had an area under the curve of 0.92 for the presence of ED (sensitivity=90%; specificity=77%, p<0.001). Routine pulmonary function test results and clinical variables did not correlate with ED in patients with stable COPD. Dynamic hyperinflation strongly correlates with exertional desaturation and could be a reason for this desaturation.

Decreased Pulmonary Function in Asymptomatic Long Term Survivors After Busulfan-Based Myeloablative Allogeneic Hematopoietic Stem Cell Transplant

AbstractAbstract 4474Pulmonary function post allogeneic hematopoietic stem cell transplant (HSCT) can be impaired by previous exposure to chemotherapy, infection, or underlying chronic graft versus host disease (cGVHD). In this retrospective study, we selected 21 long term transplant survivors with a median follow up of 48 months who had received a related (60%) or unrelated (40%) HSCT conditioned with a myeloablative busulfan-based regimen. All patients had routine pulmonary function tests (PFTs) repeated within two years from transplant and none had respiratory symptoms or a history of chronic lung infection at the time of analysis.Median age was 45 years (range 18–54). Patients had a diagnosis of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) (52%), acute lymphoblastic leukemia (ALL) (14%), chronic myeloid leukemia (CML) (14%), non-Hodgkin lymphoma (NHL) (9%), or chronic lymphocytic leukemia (CLL) (2%). Survival rate at the time of analysis is 90%.We initially compared single parameters of PFTs including corrected diffusion limiting capacity of oxygen (DLCO), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and total lung capacity (TLC) obtained before and after transplant. Post transplant, all PFT parameters showed some degree of reduction compared to pre-transplant values (Figure 1). FEV1 and FEV1/FVC were significantly decreased (108 vs 92,p=0.04 and 86 vs 80%, p=0.04, respectively). Median values of corrected DLCO prior to and after transplant were 83% (range 55–148) and 77%(range 44–146) (p=0.2), respectively.In order to test whether patients with >10% reduction of PFTs had an increased rate of overall cGVHD, we analyzed intra-patient changes in DLCO and FEV1 values. We then divided patients into groups with extensive, limited, or no cGVHD. No correlation was found between the degree of cGVHD and FEV1 or DLCO values.A decrease in pulmonary function was detected in patients who received a busulfan based myeloablative HSCT despite the absence of lung infection or pulmonary cGVHD. This finding, however, did not affect long term survival. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

A COMPARATIVE STUDY OF BLOOD LEUCOCYTE COUNT AND CHRONIC OBSTRUCTIVE PULMONARY CONDITION IN YOUNG ADULT MEN

Background and Objective: There is hardly any system, which has not been affected directly or indirectly by smoking, no matter however significant or insignificant it might be. In the present study we investigated the blood leucocyte count in chronic obstructive pulmonary disease in young adult men. Materials and Methods: The present study was conducted at Kasturba Medical College, Mangalore, after the institutional ethical clearance and informed consent from all the participants. Under aseptic condition blood was collected for total leucocyte count and differential leucocyte count using automated haematology analyzer. Routine pulmonary function testing was done on them by using Patrick Morgan’s Benchmark computerized spirometry. Students’t’ test was used to find out the significance of difference using SPSS version 11. P values less than 0.05 was considered the level of significance. Result: The mean blood leucocyte count and differential leucocyte count among smokers with COPD and non-smokers were well within the normal limits. P value was above the level of significance. Conclusion: This shows that smoking alone doesn’t invoke any rise in total leucocyte count in blood.

FEV1 % and FEV1/FVC % in smokers with special reference to Chronic Obstructive Pulmonary Diseases

Background and Objective: It was observed that chronic obstructive pulmonary diseases (COPD) cases develop acute exacerbation of breathlessness leading initially to type I respiratory failure which may lead to type II respiratory failure. The present study was undertaken to find out the FEV1 % and the ratio of FEV1/FVC % in chronic obstructive pulmonary disease conditions. Materials and Methods: The present study was conducted at Kasturba Medical College, Mangalore, after the institutional ethical clearance and informed consent from all the participants. Routine pulmonary function testing was done on them by using Patrick Morgans Benchmark computerized spirometry. Students t test was used to find out the significance of difference using SPSS version 11. P values less than 0.05 was considered the level of significance. Result: COPD cases have the airway obstruction increases with passing of and increasing severity of the disease, which in turn characterized by deteriorating FEV1% and FEV1/FVC%. Conclusion: FEV1% and FEV1/FVC% have a definite role in defining various stages of COPD. Hence, it is an automatic choice for identifying and there by classifying various stages of COPD.

External Tracheal Stabilization Technique for Acquired Tracheomalacia Using a Tailored Silicone Tube

Here, we describe an external tracheal stabilization technique used in a patient with tracheomalacia. A 56-year-old man presented with tracheomalacia due to prolonged mechanical ventilation. The malacic tracheal segment was approximately 2 cm in length. The malacic segment was covered with a silicone tube sutured in place using Prolene sutures (Ethicon, Somerville, NJ). Several anchoring sutures were placed between the tracheal mucosa and the silicone tube without violating the mucosal continuity. The patient was discharged on postoperative day 5 without complication. This method of external tracheal stabilization is a less invasive alternative for the management of this particular patient.

Chemotherapeutic Agents Increase the Risk for Pulmonary Function Test Abnormalities in Patients With Multiple Myeloma

Case reports of pulmonary toxicity have been published regarding bortezomib, lenalidomide, and thalidomide but there are no published reports looking at the possible long-term pulmonary effects of these medications. This article describes a possible relationship between the administration of bortezomib and thalidomide and the development of pulmonary function test (PFT) abnormalities. It also suggests that routine pulmonary function testing may be required in patients receiving these medications until larger studies can be performed to confirm this observation. Multiple myeloma is a common malignancy accounting for approximately 1% of all malignancies worldwide. Bortezomib, lenalidomide, and thalidomide are immunomodulatory derivatives that are used in the treatment of multiple myeloma (MM). There have been case reports of pulmonary disease associated with these agents, but the effect of these agents on pulmonary function test (PFT) results is unknown. We reviewed the records of 343 patients with MM who underwent PFTs before autologous stem cell transplantation. One hundred nine patients had not received any of the 3 medications, whereas 234 had received 1 or more of these agents. Patients exposed to bortezomib were more likely to have obstructive PFT results (P = .015) when compared with patients not exposed to this medication. Restrictive PFT results were more likely after exposure to thalidomide (P = .017). A logistic regression model was performed and when adjusted for age, sex, Durie-Salmon (DS) stage, body mass index (BMI), time from diagnosis to transplantation in days, and smoking history, the odds of obstruction were 1.96 times higher for patients who received bortezomib. The odds of restriction were 1.97 times higher after exposure to thalidomide. There appears to be a risk of PFT abnormalities developing in patients treated with bortezomib and thalidomide.

Respiratory management strategies for Duchenne muscular dystrophy: practice variation amongst canadian sub‐specialists

Respiratory management of Duchenne muscular dystrophy (DMD) is not well studied and may vary across centers and practitioners. Our objective was to describe and compare the respiratory management practices of Canadian Pediatric Respirologists and Neuromuscular specialists for children with DMD. A web-based survey was sent to all 56 practicing Canadian Pediatric Respirologists and to all 24 members of the Canadian Pediatric Neuromuscular Group (CPNG) who follow children with neuromuscular diseases. The survey included 28 questions about timing and indications for respiratory consultation, sleep disordered breathing (SDB) assessments, and treatments. Thirty eight (68%) pediatric respirologists and 17 (71%) CPNG members responded. Respirologists provide initial consultation after a patient's first admission to hospital with respiratory complications (14/38, 37%) and when symptoms of SDB are present (14/38, 37%). Half of the CPNG members request initial Respirology consultation at the time of DMD diagnosis. Both groups request routine pulmonary function tests. Ninety-six percent of respirologists use maximal inspiratory (MIP) and expiratory pressures (MEP) to assess respiratory muscle strength, whereas 82% of CPNG members additionally use peak cough flow. Assessment for SDB is requested by both groups when pulmonary function is abnormal or patients are symptomatic. Respirologists favor polysomnography, whereas CPNG members use overnight pulse oximetry. Nocturnal non-invasive ventilation and lung volume recruitment (LVR) are used in a minority of patients. Respirologists and CPNG members provide similar respiratory management of DMD patients, but differ in timing of consultation and choice of tests for pulmonary function and SDB. Canadian practices differ from the American Thoracic Society and Centre for Disease Control guidelines.

Dynamic Hyperinflation Correlates With Exertional Desaturation in Patients With Chronic Obstructive Pulmonary Disease (COPD)

PURPOSE: Dynamic hyperinflation (DH) causes exercise limitation and exertional dyspnea in patients with COPD. Exertional desaturation (ED) also occurs commonly in COPD and multiple mechanisms have been postulated to cause ED. However, neither routine pulmonary function testing nor imaging predicts ED accurately. In this study, we evaluated the relationship between DH and ED during six-minute walk testing (6MWT).