Significant Decline In FEV1 Research Articles

Low Mortality Associated with COVID-19 Infection in Lung Transplant Recipients at a Single Center

Lung Transplant Recipients (LTR) are particularly vulnerable to severe infection, hospitalization, and death due to community acquired respiratory viruses. As a result, the global SARS-Cov-2 pandemic poses a higher risk to this population. We aim to study the lung function, severity of infection and mortality among LTR at a single center. A retrospective chart review was performed on all LTR at the University of San Diego, California Medical Center between June 2020 and September 2022. Spirometry was performed at 1-2 months and then again 3 months after infection. Patients were closely monitored for the development of acute cellular rejection (ACR). 72 LTR were infected with COVID-19. 37.5% required hospital admission, of which 25.9% required management in the intensive care unit (ICU). 73.6% LTR had received at least one vaccination dose prior to infection. Post-infection, the median drop in FEV1 was 140 mL and FVC was 25 mL within 1-2 months. At 3 months post-infection the median reduction in FVC was slightly larger at 75 ml, while median decline in FEV1 decreased to 55 ml. Overall, the rates of ACR and mortality in this population were both 4.2%. Additionally, monoclonal antibody (mAb) therapy reduced hospitalization (20.9% vs 62%) and mortality (0% vs 10.3%), Our study found low rates of ACR and mortality in LTR with confirmed COVID-19, despite the statistically significant decline in FEV1, and trends with FVC. The use of vaccinations and mAb therapy decreased rates of hospitalizations, with mAb therapy reducing mortality as well.

SABR for Early Non-Small Cell Lung Cancer: Changes in Pulmonary Function, Dyspnea, and Quality of Life

The aim of this study is to report pulmonary function tests (PFTs), clinician-reported and patient-reported QoL outcomes on a cohort of NSCLC patients treated with SABR. 119 patients with NSCLC were treated with SABR in the prospective cohort SSBROC study of patients with T1-T2N0M0 NSCLC. PFTs and quality of life measures were obtained at baseline pre-treatment and 6 monthly. Here we report on the 6- to 18-month time points. ANCOVA methods adjusting for baseline analysed potential predictors on outcomes of PFT and patient-reported dyspnoea at 18 months. The only statistically significant decline in PFTs was seen in FEV1 at 18 months post-SABR with a decline of -0.11L (p = 0.0087, 95% CI -0.18 to -0.02). Of potential predictors of decline, only a 1 unit increase in smoking pack years resulted in a -0.12 change in DLCO (p = 0.026, 95% CI -0.02 to -0.23) and a 0.003 decrease in FEV1 (p = 0.026, 95% CI -0.006 to -0.0004). For patient reported outcomes, statistically significant worsening in both QLQC30 and QLQLC13 dyspnoea scores occurred at the 18-month time point, but not earlier. No potential predictors of worsening dyspnoea were statistically significant. There was no statistically significant decline in clinician-reported outcomes or global QoL scores. We found a statistically significant decline in FEV1 at 18 months post-treatment. Smoking pack years was a predictor for decline in DLCO and FEV1 at 18 months. Worsening of patient-reported dyspnoea scores was observed, consistent with the expected progression of lung co-morbid disease.

In Children with Sickle Cell Anemia, Low Baseline BMI Is Associated with a Longitudinal Decline in FEV1 % Predicted

Introduction: Sickle cell anemia (SCA) is the most common genetic disease identified in newborns in the United States, and pulmonary complications are the second most common cause of hospital admissions. Children with SCA commonly experience impaired growth, delayed puberty, elevated metabolic rate and increased protein turnover. These factors may contribute to a decreased body weight, specifically fat-free mass, despite seemingly adequate caloric intake. Multiple studies have reported significantly lower body mass index (BMI) in children with SCA, compared to age-matched children without SCA.In children with cystic fibrosis, there is a well-established relationship between low BMI, malnutrition, and a decline in lung function. A normal body weight has been associated with a slower decline in pulmonary function and a decrease in mortality. Pulmonary cachexia syndrome is a distinct phenomenon in adults with chronic lung disease defined as a disproportionate cytokine driven loss of skeletal muscle. Patients frequently have low BMI (<20kg/m2), low fat-free body mass, with a normal caloric intake. Pulmonary cachexia has been most prominently studied in the chronic obstructive pulmonary disease (COPD) population. Although children and adults with SCA can develop chronic lung disease, pulmonary cachexia syndrome and the impact of nutritional status on pulmonary function has yet to be defined in this population. Lung function decreases with age in the sickle cell population and FEV1% predicted < 80% has been found to be associated with early death in adults with SCA.As children with SCA in the US survive into adulthood, nutritional status may be a contributing factor in chronic lung disease. In a prospective longitudinal multi-center cohort study of children with SCA we hypothesize that a lower BMI is associated with a significant decline in FEV1% predicted over time.Methods: In the NIH sponsored prospective, multicenter, Sleep and Asthma Cohort (SAC) study, children with SCA, defined as HbSS or HbSβ°, unselected for respiratory disease, were enrolled from 3 large clinical centers. Study certified pulmonary function technicians performed spirometry with central review. Participants had a minimum of 3 spirometry measurements performed at least 12 months apart (mean 4.4. years apart). Predicted values were determined for FEV1 based on the Global Lung Index (GLI) 2012 multi-ethnic reference equations. Height and weight were used to calculate BMI at study entry. In a multivariable model, the following independent covariates were used to predict a longitudinal change in FEV1 % predicted: baseline BMI, sex, history of asthma (defined as a physician diagnosis as well as the use of either inhaled corticosteroids or bronchodilator), baseline labs such as hemoglobin, reticulocyte count, white blood cell count, and the use of hydroxyurea at any point in the study period.Results: A total of 197 participants with SCA between the ages of 6 -19.3 years (mean age of 11) were included in the analysis. Mean BMI of the cohort at study entry was 16.9 kg/m2. Participants were followed over a range of 1.1 - 6.5 years from baseline to endpoint. In a multivariable model, for every one unit increase in BMI there was an increase in FEV1 % predicted of 0.68% (P=0.017). FEV1 % predicted declined by 0.4% for every additional year of age (p=0.020). Sex, asthma history, hemoglobin, reticulocyte count, white blood cell count, and hydroxyurea therapy were not significantly associated with a decline in FEV1 % predicted over time. The two significant risk factors for a decrease in FEV1 % predicted over time were increasing age and decreased BMI at baseline.Conclusions: In a large prospective cohort study of an unselected group of children with SCA, low baseline BMI is associated with a more significant decline in FEV1% predicted over time. Longer prospective studies are needed to determine if the decline in FEV1% predicted is reversible with disease modifying therapy and nutritional modifications. [Display omitted] DisclosuresRodeghier:Rodeghier consultants: Consultancy.

Asthma and fixed airflow obstruction: Long-term trajectories suggest distinct endotypes.

Long-term trajectories of asthma with fixed airflow obstruction (FAO) may reveal links to inflammatory endotypes. We investigated whether measures of asthma control and airway inflammation and remodelling differed by long-term FAO status in moderate-to-severe asthma. Adults enrolled in the Difficult Asthma Study assessed initially using serial Asthma Control Questionnaire (ACQ), exacerbation history, spirometry and sputum cytology over 12months, as well as endoscopic bronchial biopsy with airway smooth muscle (ASM) quantification, were revaluated three or more years later with questionnaires and spirometry. FAO was defined as a persistent post-bronchodilator forced expired volume in one second (FEV1 )-to-forced vital capacity ratio below 0.70. Sixty-two participants (mean±SD age 48±11years; 50% female; 75% atopic; asthma duration 24±14years) returned for follow-up assessment (median interval 7.9years; IQR: 5.4-8.8years). Compared to participants without FAO (n=28), those with FAO at baseline and long-term follow-up (n=18) had higher baseline sputum neutrophil content and ASM, and a higher exacerbation frequency that persisted at long-term follow-up. Sputum eosinophils, ACQ and long-term FEV1 decline did not differ. Participants with incident FAO at long-term follow-up (n=16) had higher baseline exacerbation frequency, sputum eosinophil content, higher ACQ scores and greater decline in FEV1 , whereas baseline ASM was similar to those without FAO. In moderate-to-severe asthma, long-term FAO is characterized by neutrophilic sputum inflammation and airway remodelling, but FEV1 decline is similar to those without FAO. Long-term incident FAO is preceded by higher exacerbation frequency, higher sputum eosinophil content and significant FEV1 decline.

235-OR: Incidence of Significant Changes in Pulmonary Function during a 2-Year Study with Inhaled Technosphere Insulin

The impact of inhaled Technosphere Insulin (TI) on measures of pulmonary function remain an important component of clinical use. TI is an ultra rapid-acting prandial insulin delivered via deep pulmonary inhalation allowing for prompt absorption in the alveoli. Prior studies have demonstrated that, on average, changes in pulmonary function testing (PFT) are limited to small changes (∼1%) in forced expiratory volume in 1 second (FEV1). This comprehensive post-hoc analysis examined the incidence of significant decline in FEV1 over two years in subjects with type 1 and type 2 diabetes treated with TI. Subjects were included if they had at least five FEV1 measurements (including baseline and month 24). FEV1 must have been ≥70% of predicted at baseline. At each time point, subjects were classified as having a significant change in FEV1 if there was a ≥15% decline from baseline. Of the 377 subjects, 331 (87.8%) had no measure with ≥15% decline in FEV1 at any time point. Of subjects who had at least one measure with a decline of ≥15%, the majority (n=38) experienced this decline on a transient basis (defined as occurring at two or fewer time points). Eight individuals (2.1%) demonstrated a persistent decline in FEV1 (occurring at three or more time points). Four subjects in the comparator arm (0.7%, n=586) had persistent decline. In conclusion, persistent significant decline in FEV1 during the use of TI was uncommon. Disclosure M.C. Jones: Employee; Self; MannKind Corporation. T.S. Tran: Employee; Self; MannKind Corporation. J.A. Krueger: Employee; Self; MannKind Corporation. Stock/Shareholder; Self; Eli Lilly and Company, MannKind Corporation. P.M. Morey: Employee; Self; MannKind Corporation. B.J. Hoogwerf: Consultant; Self; MannKind Corporation. Employee; Spouse/Partner; MannKind Corporation. Stock/Shareholder; Spouse/Partner; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. D.M. Kendall: Employee; Self; MannKind Corporation. Stock/Shareholder; Self; Eli Lilly and Company.

Diverse clinical characteristics of Aspergillus growth in patients with cystic fibrosis.

Patients with cystic fibrosis (CF) have a varying spectrum of clinically significant Aspergillus disease in addition to allergic bronchopulmonary aspergillosis (ABPA). Here we aimed to review the different clinical phenotypes related with Aspergillus growth on the airway culture of patients with CF, we also aimed to investigate the effect of Aspergillus growth on lung function tests. The medical records of 100 patients with CF who had Aspergillus growth on airway culture within the period of April 2001 and June 2016 were retrospectively analyzed. Age, gender, symptoms, physical examination findings, pulmonary function tests, the diagnosis of ABPA, and airway culture results were recorded for every visit. Patients with Aspergillus growth on airway cultures were classified into different groups as ABPA, Aspergillus sensitization, Aspergillus colonization and Aspergillus bronchitis. Medical records of 83 patients and 147 sputum cultures were attained from 100 patients. The mean age of the patients was 17.6±7.6 years and the mean age of the first Aspergillus growth in sputum culture was 12.5±6.7 years. At first isolation, Aspergillus fumigatus SC was the most common Aspergillus SC in sputum (76.3%) and 14.5% of these patients required hospitalization. Aspergillus sensitization was diagnosed in 3.6% (n= 3) of the patients. Aspergillus colonization was diagnosed in 18.1% (n= 15) of all patients and led to a decline in FEV1%, FVC% and FEF25-75% which was not statistically significant, furthermore. ABPA was detected in 9.6% (n= 8) of all patients and led to a statistically significant decline in FEV1% (p= 0.02); nonsignificant decline in FVC% and FEF25-75%. Aspergillus bronchitis was detected in 43.4% (n= 36) of all patients and led to nonsignificant decline in FEV1%, FVC% and FEF25-75%. ABPA is recognized as the most common Aspergillus associated disorder in CF patients and is related to deteriorated pulmonary function tests; however Aspergillus colonization and bronchitis may also be associated with worsening lung function.

The Acute Effect of Inhaled NaCl 5%, Per CF TRUST Protocol, on Spirometry Indices in Patients Over Six Years with Cystic Fibrosis

Background: Our aim was to investigate the acute effect of inhaled NaCl 5% on spirometry indices in patients aged over six years with cystic fibrosis (CF). Methods: 44 children over 6 years of age with CF took part in this study. Spirometry indices were measured. After receiving two puffs of salbutamol spray, the children were administered with 5 ml NaCl 5% by a medical compressed air system using a nebulizer kit and immediately a spirometric test was taken again. Spirometry results were recorded and the data were analyzed by SPSS v.18. Results: The percentages of the annual decline of forced expiratory volume in one second (FEV1) were 10.12 ± 31.28, 7.26 ± 17.10, and 13.8 ± 21.7 in children aged 6 - 8 years, 9 - 12 years, and over 13 years, respectively. There were significant differences in FVC, FEV1/FVC, MEF50, MEF75, MMEF25/27 before and after hypertonic NaCl 5% inhalation (P < 0.05). A significant decline in FEV1 was observed only in 2% of the children. Conclusions: Patients with CF exhibited a suitable response to acute inhalation of hypertonic NaCl 5%.

Pulmonary function and high-resolution computed tomography examinations among offshore drill floor workers

PurposeThe aim of this study was to assess short-term changes in pulmonary function in drill floor workers currently exposed to airborne contaminants generated as a result of drilling offshore. We also aimed to study the prevalence of pulmonary fibrosis using high-resolution computed tomography (HRCT) scans of another group of previously exposed drill floor workers.MethodsPulmonary function was measured before and after a 14-day work period in a follow-up study of 65 drill floor workers and 65 referents. Additionally, 57 other drill floor workers exposed to drilling fluids during the 1980s were examined with HRCT of the lungs in a cross-sectional study.ResultsThe drill floor workers had a statistically significant decline in forced expiratory volume in 1 s (FEV1) across the 14-day work period after adjustment for diurnal variations in pulmonary function (mean 90 mL, range 30–140 mL), while the small decline among the referents (mean 20 mL, range − 30 to 70 mL) was not of statistical significance. Larger declines in FEV1 among drill workers were associated with the fewer number of days of active drilling. There were no signs of pulmonary fibrosis related to oil mist exposure among the other previously exposed drill floor workers.ConclusionAfter 14 days offshore, a statistically significant decline in FEV1 was observed in the drill floor workers, which may not be related to oil mist exposure. No pulmonary fibrosis related to oil mist exposure was observed.

Use of rosuvastatin in HIV-associated chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is more prevalent in HIV-infected individuals and is associated with persistent inflammation. Therapies unique to HIV are lacking. We performed a pilot study of the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor rosuvastatin to determine effects on lung function. Randomized, placebo-controlled, triple-blinded trial. HIV-infected individuals with abnormal lung function were recruited from an ongoing lung function study. Participants were randomized to 24 weeks of placebo (n = 11) or rosuvastatin (n = 11) using an adaptive randomization based on change in peripheral C-reactive protein levels at 30 days of treatment. Forced expiratory volume in 1 s (FEV1) and diffusing capacity for carbon monoxide (DLco)%-predicted were compared to baseline at 24 weeks in the two groups using a Wilcoxon rank-sum test. The %-predicted change at 24 weeks in pulmonary function variables was compared between groups using simulated randomization tests. The placebo group experienced a significant decline in FEV1%-predicted (P = 0.027), and no change in DLco%-predicted over 24 weeks. In contrast, FEV1%-predicted remained stable in the rosuvastatin group, and DLco%-predicted increased significantly (P = 0.027). There was no significant difference in absolute change in either measure between placebo and rosuvastatin groups. In a pilot study, the use of rosuvastatin for 24 weeks appeared to slow worsening of airflow obstruction and to improve DLco in HIV-infected individuals with abnormal lung function, although comparison of absolute changes between the groups did not reach significance. This study is the first to test a therapy for COPD in an HIV-infected population, and large-scale clinical trials are needed.

Silica exposure and disease in semi‐precious stone craftsmen, Minas Gerais, Brazil

Brazil is an exporter of precious stones and craftsmen often work in poor conditions. We assessed silica-related diseases among crystal craftsmen and the complexity of its control. Case-series including 118 subjects evaluated from 2006 to 2015, based on medical interviews, chest X-rays, spirometry, and respirable silica samples. Median age and length of exposure were 32 and 13 years, respectively. Silicosis, with 1/0 as a threshold, was diagnosed radiologically in 57 individuals (48.3%). Respirable silica concentrations were 0.9-29.3 times greater than the Brazilian occupational exposure limit. A Receiver Operating Characteristic (ROC) curve with the same diagnosis threshold showed best discrimination at a cut point of 12.5 years of exposure, corresponding to 4.85 mg-y/m3 of cumulative silica exposure. There was a significant decline in FEV1 across radiological and cumulative silica exposure categories. Eleven individuals (9.3%) had mycobacterial diseases at baseline or follow-up. Crystal craftsmen continue to suffer from silicosis, lung function impairment, comorbidity, and death due to silicosis. To date collective protection in some work sheds has not diminished silica levels. Long-term follow-up is needed to evaluate further improvements in preventive measures. Am. J. Ind. Med. 60:239-247, 2017. © 2017 Wiley Periodicals, Inc.

Specific bronchial hyperreactivity and hypersensitivity in patients with allergic asthma

Background/Aim. Bronchial asthma is a disease that is characterized by the variability of the clinical picture, physical and functional status and the existence of bronchial hypersensitivity and hyperreactivity with varying degrees. Bronchial responsiveness and sensitivity are tested in patients with clinically suspected existence of asthma and normal spirometry test. The aim of the study was to analyze the patients with atopic asthma and study test results of skin sensitization to inhaled allergens, nonspecific bronchial hyperreactivity and specific hyperreactivity estimated by bronchial provocation tests with inhalant allergens. Methods. The prospective study at the Pulmonology Clinic of the Military Medical Academy in Belgrade Serbia, during 2014, included 70 male subjects aged 18?30 years, who had perennial asthma symptoms. All subjects were nonsmokers, with normal spirometry findings, with normal radiological chest findings and with no symptoms of respiratory infection over the past two months. All respondents were tested with skin prick tests with inhalant allergens and nonspecific bronchial provocation test with histamine. On the basis of histamine test, subjects were divided into two groups: the group I, in which there was a slight degree of hypersensitivity [provocation concentration of histamine causing a 20% fall in forced expiratory volume ? PC20 = 6.09 ? 1.1 mg/mL], and the group II with negative histamine test (PC20 = 14.58 ? 6.34 mg/mL). Specific bronchial provocation test was performed in all patients, and the selection of the allergens was carried out based on the results of testing of skin hypersensitivity. Results. Results of skin sensitization show the highest incidence of mites Dermatophagoides pterronissinus (83.3% group I and 85.0% group II) followed by grass pollen (53.3% group I and 52.0% group II), and house dust (33.3% group I and 50.0% group II). There were no statistically significant differences in allergens between groups (p &gt; 0.05). In both groups, spirometry findings were within normal values [forced vital capacity ? FVC and forced expiratory volume 1 ? FEV1 &gt; 80% predictive value], but statistically significant difference was found in FEV1 between groups (p &lt; 0.05). Specific bronchial provocation tests with solutions of inhaled allergens in both groups caused a significant decline in FEV1 (? 20%) in all patients individually. No statistically significant differences were found neither between groups, nor between individual allergens (average decline in FEV1: Group I 32.9 ? 2.4% and group II 31.5 ? 2.2%). Conclusion. There is no relationship between the degree of specific and non-specific bronchial hyperreactivity in patients with allergic asthma.

Evaluation of Individuals at Risk for COPD: Beyond the Scope of the Global Initiative for Chronic Obstructive Lung Disease.

The Global initiative for chronic Obstructive Lung Disease (GOLD) Strategy is a valuable tool for clinicians in the diagnosis and management of patients with established chronic obstructive pulmonary disease (COPD). However, there are no recommendations for the evaluation of individuals, exposed to risk factors, who are most likely to develop COPD. Consequently, it is necessary to consider all of the factors that may play a role in the pathogenesis of COPD: genetic factors, gender, socioeconomic status, disadvantageous factors in childhood, lung diseases and exposure to risk factors such as smoking, biomass fuel smoke, occupational hazards and air pollution. Along with the clinical assessment, periodic spirometry should be performed to evaluate lung function and make possible early detection of individuals who will develop the disease through the rate of forced expiratory volume in 1 second (FEV1) decline. The first spirometry, periodicity, and clinically significant decline in FEV1 will encompass the cornerstones of clinical follow up. This approach allows the implementation of important interventions in order to help individuals to cease contact with risk factors and prevent progressive respiratory impairment with the consequent deterioration of quality of life and increased morbidity and mortality.

Comparison between Thoracic Epidural Block and Thoracic Paravertebral Block for Post Thoracotomy Pain Relief.

Postoperative pain after thoracotomy is being considered one of the most severe pain and if not treated well, can result in various respiratory and other complications. Present study was conducted with the aim to compare continuous thoracic epidural infusion with continuous paravertebral infusion for postoperative pain using Visual Analogue Scale (VAS) score and four point observer ranking. The secondary outcomes measured were pulmonary functions and any complication like hypotension, bradycardia, nausea, vomiting, urinary retention and neurological complications if any. Sixty patients of age group 18-60 years posted for anterolateral thoracotomy surgery for lung resection were randomised either to epidural or paravertebral group in this randomised prospective double blind study. In Epidural group 7.5ml bolus of 0.125% Bupivacaine with 50μg Fentanyl and in Paravertebral group 15ml bolus of 0.125% Bupivacaine with 50μg Fentanyl was given 30 minutes before the anticipated end of surgery. Bolus dose was followed by infusion of 0.125% Bupivacaine with 2μg/ml Fentanyl at the rate of 5 ml/hr in both groups. Parameters noted were Mean Arterial Pressure (MAP), Heart Rate (HR), Oxygen Saturation (SpO2), Arterial Blood Gas (PaCO2, P/F ratio), Visual Analogue Scale (VAS) and Four Point Observer Ranking Scale (FPORS) for pain, number of sensory segments blocked (by checking for pinprick sensation), requirement of infusion top ups and rescue analgesia (Tramadol), pre and postoperative pulmonary function test {(Forced Expiratory Volume (FEV)1, Forced Vital Capacity (FVC), FEV1/FVC, Peak Expiratory Flow Rate (PEFR)} and complications from start of infusion till 24 hours in the postoperative period. Both the techniques were effective in relieving pain but pain relief was significantly better with epidural. Postoperatively, HR, SpO2, P/F ratio and PaCO2 were comparable between group E and P. There was significant decline in FeV1, FVC, FeV1/FVC and PEFR in postoperative period as compared to preoperative value in both the groups. Hypotension and bradycardia were more in group E. Both the techniques, continuous thoracic epidural block and continuous thoracic paravertebral block were effective for post-thoracotomy pain relief; however, epidural block provides better pain relief. The incidence of sympatholytic complications was more in epidural group. The effect on respiratory mechanics was equivalent. Hence, paravertebral block can be used in post thoracotomy pain relief in those patients where thoracic epidural is contraindicated.

Gender Disparity in Lung Function Abnormalities among a Population Exposed to Particulate Matter Concentration in Ambient Air in the National Capital Region, India.

The World Health Organization (WHO) global air quality study shows that 27 Indian cities, including New Delhi, are among the one hundred cities with the worst air quality globally. The scope of airway obstruction cases among residents in locations with critical air pollution levels like particulate matter (PM) pollutants PM2.5 and PM1 has not been addressed in the National Capital region, India. The present cross-sectional study was undertaken to assess the forced expiratory volume in one second (FEV1) % predicted abnormalities among residents living in the National Capital Region, India with respect to their exposure to particulate matter pollutants (PM1, PM2.5) in ambient air. Eight hundred and fifty-four residents, including 433 men and 421 women ranging in age from 18-70 years, living in the National Capital Region (NCR) of India participated in the study. Particulate matter concentrations in ambient air (PM2.5 and PM1) were monitored at 10 residential locations in the National Capital Region, India (New Okhla Industrial Development Authority (NOIDA) and Gurgaon). The lung function test (FEV1) was conducted using a spirometer. The Indian Air Quality Index showed either very poor or severe levels for PM2.5 at all study locations. A significant negative linear relationship was found between higher concentrations of PM1 and reduced FEV1% predicted values (r = -0.8, p < 0.05). The prevalence of airway obstruction cases (79.6%, odds ratio 1.96, confidence interval 1.42-2.71) was higher (p<0.001) among female subjects compared to their male counterparts. Even though there was a significant decline in FEV1% predicted among 80% of cases in women, only 19.24% cases were in the moderate category and 6.18% cases in the severe category. The severe category of FEV1% predicted cases showed greater respiratory symptoms than the other two categories, which denotes higher risk among those in the severe category. The present study shows that obstruction cases increased from 1.97 to 7.40% and 2.73 to 14.93% in women, with a corresponding increase in PM1 and PM2.5 from the minimum to maximum concentration. Since the women in this study were non-smokers, the PM in ambient air can be considered to be the major reason for the decline in lung function. The sources of PM pollutants in the study locations are large scale infrastructural development activities such as building and road construction activities. Narrowed lung airways can alter the airway caliber or resistance and flow rates proportional to the airway radius, especially in smaller airways. The present study suggests the need for policy makers and stake holders to take the necessary steps to identify PM sources and reduce the emissions of PM concentrations in ambient air.

59 Ralstonia mannitolilytica – an emerging threat in cystic fibrosis and lung transplantation

Background Ralstonia mannitolilytica is a rarely reported pathogen in cystic fibrosis. It is frequently resistant to antimicrobials and can be misidentified as Burkholderia cepacia complex using biochemical techniques. Methods We identified 7 CF patients from 4 centres in Ireland, all with advanced lung disease that were colonized or infected with this organism. Each isolate was confirmed by gyrB sequence analysis and genetic relatedness was determined using PFGE. MIC testing was performed as well as combination testing using the multiple combination bactericidal test (MCBT). Whole genome sequencing was also performed. Results Four patients from the same institution had strains that were indistinguishable by PFGE. One patient died aged 14 years awaiting lung transplantation 18 months after acquisition; another patient underwent successful lung transplantation and remains culture negative. The remaining two patients are siblings who are at present requiring frequent courses of IV antibiotics and have significant decline in FEV1 since acquisition. Three other patient strains were unique by PFGE; one patient died age 38 y. Tigecycline and minocyline were the most active single agents showing inhibition by MIC to six and five strains, respectively. Minocycline/piperacillin–tazobactam was the most active combination but was not bactericidal against any strain. Tobramycin/piperacillin–tazobactam demonstrated bactericidal activity against three strains. Conclusion Ralstonia mannitolilytica is emerging as a significant pathogen in advanced CF. Early recognition and targeted treatment may reduce cross infection and improve clinical outcome in patients undergoing transplantation.

Differences in hyperpolarized (3) He ventilation imaging after 4 years in adults with cystic fibrosis.

To evaluate cystic fibrosis (CF) subjects over 4 years using (3) He magnetic resonance imaging (MRI), pulmonary function tests, and track hospitalization and physician visits. Five CF adults provided written informed consent to an approved protocol and underwent MRI, spirometry, and plethysmography at baseline, 7 days, and 4 ± 1 years later. (3) He MRI ventilation defect percent (VDP) was generated for all subjects and timepoints. After 4 years, mean forced expiratory volume in 1 second / forced vital capacity (FEV1 /FVC) was lower (P = 0.01) in all subjects and there were no other pulmonary function test changes. Two CF adults showed significantly elevated (worse) (3) He VDP at baseline and after 4 years they had significantly greater (worsened) VDP (P = 0.02), without a significant FEV1 decline (P = 0.06) but with a greater number of exacerbations (P < 0.05). Baseline VDP strongly correlated with FEV1 (r(2) = 0.98, P = 0.0007) at 4-year follow-up. For two CF subjects, VDP was significantly worse at baseline and worsened over 4 years, which was in agreement with a greater number of hospitalizations and clinic visits. These results are limited by the very small sample size, but the strong VDP correlation with longitudinal changes in FEV1 generates the hypothesis that abnormal VDP may temporally precede FEV1 decline in CF subjects; this must be tested in a larger CF study.

Effects of exposure to flour dust on respiratory symptoms and pulmonary function of mill workers

ObjectiveTo assess the effect of exposure to flour dust on respiratory symptoms and lung function of flour mill workers and to estimate the additive effect of smoking on pulmonary function. Patients and methodsThis study was carried out at flour mills in Sohag Governorate. Two hundred male workers with current exposure to flour dust and two hundred non-exposed male as a control group were interviewed and self designed study questionnaire was administered to them and the parameters of their pulmonary function were measured. ResultsRespiratory symptoms such as cough, expectoration, wheezing, and shortness of breath, were significantly (p<0.0001) higher among exposed workers as compared to unexposed. Furthermore highly significant (p<0.0001) decrements in the pulmonary function of exposed subjects were noted. Moreover, a highly significant decline in FEV1%, FVC% and FEV1/FVC% was noticed regarding the duration of exposure to flour dust (p<0.0001). Also, there was a highly significant difference between heavily exposed compared to lightly exposed subjects (p<0.001).The additive effect of smoking was noticed as there was a highly significant decline of FVC%, FEV1%, FEV1/FVC%, FEF25% and FEF75% in smokers compared to non-smokers (p<0.0001). ConclusionFlour mill workers in Sohag Governorate, like grain workers elsewhere, were at an increased risk of developing pulmonary symptoms, a strong association exists between exposure to flour dust and the prevalence of respiratory symptoms and functional impairments of the lungs. The result has implications for improved dust control measures in the grain industry in Egypt.

Longitudinal Changes in Clinical Outcomes in Older Patients with Asthma, COPD and Asthma-COPD Overlap Syndrome

Background: The progression of obstructive airway diseases (OADs) including asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome in older adults is not well understood. Objective: To examine the prognosis of OADs and to identify potential determinants for longitudinal changes in clinical outcomes. Methods: We consecutively recruited 99 older adults (>55 years) with OADs who underwent a multidimensional assessment at baseline and 4 years which involved spirometry, 6-min walk distance (6MWD), assessments of health status (Saint George's Respiratory Questionnaire, SGRQ), comorbidity, and serum and sputum biomarkers. All-cause mortality and respiratory hospitalisation during the follow-up period were recorded. Clinical outcomes were compared between basal and final visits, and changes in clinical outcomes were compared among asthma, COPD and asthma-COPD overlap groups. Associations between clinical parameters, biomarkers and prognosis were examined. Results: After a median follow-up of 4.2 years, outcome data were available for 75 (75.8%) patients. There were 16 (16.2%) deaths. The BODE index predicted all-cause mortality in older people with OADs. While spirometry, 6MWD and SGRQ deteriorated significantly over the 4 years, there was significant heterogeneity in the longitudinal changes in these clinical outcomes. Participants with COPD had a significant decline in FEV₁ (p = 0.003), SGRQ (p = 0.030) and 6MWD [decline of 75.5 (93.4) m, p = 0.024]. The change in 6MWD was lower in the asthma-COPD overlap group. Airflow reversibility was associated with a reduced decline in 6MWD. Conclusion: COPD patients had a poor prognosis compared with asthma and asthma-COPD overlap patients. The BODE index is a useful prognostic indicator in older adults with OADs. Both airway disease diagnosis and BODE index warrant specific attention in clinical practice.

The adult with chronic cough and cat allergy

Case report A 31-year old man, tenor, present with a history of chronic cough of two years duration. The cough was present day and night, much more during singing, with little mucus production and some associated feeling of shortness of breath and choking sensation, especially at night. Additional complaints included postnasal drip, runny nose, sensation of mucus in the throat and symptoms of heartburn and acid indigestion. The patient was referred in our clinic, after inadequate response to previous treatments prescribed by previous specialists, including antihistamines, nasal steroid sprays, oral prednisone, antibiotics, combine therapy and proton-pump inhibitors. Physical examination was unremarkable. Spirometric values were normal. Results of chest radiography, computed tomographic scans of the sinuses, and high-resolution computed tomographic scans of the chest were all normal. The patient underwent a methacholine inhalation challenge. FEV1 was reduced 7% at the highest concentration (25 mg/ml). Bronchoscopy was normal . The esophageal pH monitoring was resulted positive. Skin prick test and RASTs resulted positive for cat dander. As the methacoline test was negative, patient was challenged in Italy, with a well-characterized cat-exposure model. Challenge result was considered positive for the upper respiratory symptoms, but there was no significant decline in FEV1 at 6 or 23 hours after cat exposure, the maximum fall was 9%. The patient was treated with cat-immunotherapy 15 μg of Fel d 1 at maintenance dose, and conservative therapy with combine therapy for 1 year, with no clinical improvement. He performed surgical intervention of the Nissen fundoplication, laparoscopically. There was significant improvement in quality of life only at 3 months after surgery. Because the patient’s symptoms did not improve, we advised him to continue catimmunotherapy, nasal steroid sprays, treatment with combine therapy and to stay away from the work and home environment for a period of time. Some months later the symptoms were significantly improved. Cat and dog allergens are commonly present in homes without pets, as well as in a variety of public buildings, and these are carried from one home to another on the clothing of pet owners. Non-cat owners can collect cat allergen on their clothing, most likely by both airborne and direct contact. Repeated low-level allergen exposure may induce chronic airway changes, specifically increases in airway hyperresponsiveness.

Molecular Epidemiology of Nontuberculous Mycobacteria in a German CF Center and Clinical Course of NTM Positive Patients

Goal of this study was to analyse the clinical course of cystic fibrosis (CF) patients with nontuberculous mycobacteria (NTM) in their respiratory secretions and to investigate the molecular epidemiology of the most prevalent NTM species by multilocus sequence analysis (MLSA). The respiratory specimen and the clinical parameters forced expiratory volume in one second (FEV1), body-mass-index (BMI), erythrocyte sedimentation rate (ESR) 1 h and immunoglobulin G (IgG) of 357 CF patients, 0 - 52.4 years, mean FEV1 2009 81.5% pred were analysed between 1998 and 2010. In 13 patients NTM were detected. 12 of 13 patients carried M. abscessus, for one patient the NTM species was not characterized. 4 patients carried a second NTM species (M. avium, M. chelonae (2x), M. intracellulare). 6 patients exhibited a significant decline in FEV1, however changes in BMI, IgG and ESR were discordant. Molecular genotyping of M. abscessus isolates revealed a unique MLSA pattern in 6 patients. 2 patients harboured identical strains, and one patient a closely related strain. Whether the presence of identical strains is attributed to the acquisition of NTM clones from common environmental sources or to patient-to-patient transmission cannot be definitely clarified. Although cross-in- fection of the three patients with identical/closely related strains in the present cohort is highly unlikely, we recommend strict hygiene measures for all CF patients harbouring NTM.