Significant Differences In FEV1 Research Articles

Effect of high-dose N-acetylcysteine on exacerbations and lung function in patients with mild-to-moderate COPD: a double-blind, parallel group, multicentre randomised clinical trial.

Evidence for the treatment of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) is limited. The efficacy of N-acetylcysteine (an antioxidant and mucolytic agent) for patients with mild-to-moderate COPD is uncertain. In this multicentre, randomised, double-blind, placebo-controlled trial, we randomly assigned 968 patients with mild-to-moderate COPD to treatment with N-acetylcysteine (600 mg, twice daily) or matched placebo for two years. Eligible participants were 40-80 years of age and had mild-to-moderate COPD (forced expiratory volume in 1 second [FEV1] to forced vital capacity ratio <0.70 and an FEV1 ≥ 50% predicted value after bronchodilator use). The coprimary outcomes were the annual rate of total exacerbations and the between-group difference in the change from baseline to 24 months in FEV1 before bronchodilator use. COPD exacerbation was defined as the appearance or worsening of at least two major symptoms (cough, expectoration, purulent sputum, wheezing, or dyspnoea) persisting for at least 48 hours. Assessment of exacerbations was conducted every three months, and lung function was performed annually after enrolment. The difference between the N-acetylcysteine group and the placebo group in the annual rate of total exacerbation were not significant (0.65 vs. 0.72 per patient-year; relative risk [RR], 0.90; 95% confidence interval [CI], 0.80-1.02; P = 0.10). There was no significant difference in FEV1 before bronchodilator use at 24 months. Long-term treatment with high-dose N-acetylcysteine neither significantly reduced the annual rate of total exacerbations nor improved lung function in patients with mild-to-moderate COPD. Chinese Clinical Trial Registration: ChiCTR-IIR-17012604.

Efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease and obstructive sleep apnea; a randomized controlled trial.

To evaluate the efficacy of pulmonary rehabilitation in the outcomes of patients with chronic obstructive pulmonary disease-obstructive sleep apnoea overlap syndrome patients who used positive airway pressure. Prospective randomized controlled single- blind trial. A total of 79 patients with chronic obstructive pulmonary disease-obstructive sleep apnoea overlap syndrome were randomly assigned to either the intervention group (n = 40) or control group (n = 39). All patients consistently adhered to positive airway pressure therapy every night from enrolment in the study, while intervention group patients received additional moderate-intensity aerobic exercise for 20 weeks. Pre- and post-intervention measurements included the 6-Minute Walk Test, Barthel Index, body mass index, fat mass, free fat mass, forced expiratory volume in 1 s (FEV1), FEV1%predicted, modified Medical Research Council, and polysomnography parameters. After 20 weeks, the intervention group exhibited statistically significant improvements in 6MWD, Barthel Index, body mass index, fat mass, and modified Medical Research Council compared with control group (all p < 0.01). In addition, the intervention group showed a significantly lower percentage of total sleep time with oxygen saturation < 90% (p = 0.013) and higher lowest nocturnal oxygen saturation (p = 0.008) than the control group. However, there was no significant difference in FEV1 %predicted between the 2 groups. Pulmonary rehabilitation incorporating moderate-intensity aerobic exercise could improve physical endurance and motor abilities in individuals with chronic obstructive pulmonary disease-obstructive sleep apnoea overlap syndrome, while also improving anamnestic dyspnoea, body composition, and sleep-disordered breathing.

Lung function and symptom recovery in chronic obstructive pulmonary disease with pneumonic and non-pneumonic exacerbations

RATIONALE Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) accelerate decline in lung function and are associated with hospitalization. Patients with COPD are at risk for community acquired pneumonia (CAP). There may be a benefit to distinguish between these entities. OBJECTIVES The objectives of this research were to assess differences in initial presentation and short-term lung function and symptom recovery in patients with COPD hospitalized for AECOPD or CAP. METHODS A single center, non-interventional, prospective cohort study of patients with COPD hospitalized with AECOPD or CAP was used. Baseline characteristics were collected. Spirometry was obtained on admission, at discharge, and 6-wk post-discharge. The primary outcome was change in forced expiratory volume in the first second (FEV1%) predicted over time. COPD Assessment Test (CAT) was used to assess symptom burden on admission and 6-wk post-discharge. MAIN RESULTS A total of 54 patients were recruited, all with at least moderate airflow obstruction. On admission, there were higher levels of CRP in COPD with CAP compared to AECOPD (86.4 [SD 81.9] vs 33.5 [35.4]). There was a statistically significant difference in FEV1% predicted (p = 0.0038) and CAT score (p = 0.0005) over time, after adjusting for presence of CAP. However, there was no difference in FEV1% predicted (p = 0.7184) or CAT score (p = 0.441), between those with an AECOPD and COPD with CAP, after adjusting for time. Average length of stay in hospital was longer in COPD with CAP than for AECOPD (11.0 [10.2] versus 6.9 [4.5] days). CONCLUSIONS Time is the principal factor in short term lung function and symptom recovery in patients with COPD hospitalized for acute respiratory decompensation.

Long-Term Follow-Up after Laser-Assisted Pulmonary Metastasectomy Shows Complete Lung Function Recovery.

Preserving maximum lung function is a fundamental goal of parenchymal-sparing pulmonary laser surgery. Long-term studies for follow-up of lung function after pulmonary laser metastasectomy are lacking. However, a sufficient postoperative lung function is essential for quality of life and reduces potential postoperative complications. In this study, we investigate the extent of loss in lung function following pulmonary laser resection after three, six, and twelve months. We conducted a retrospective analysis using a prospective database of 4595 patients, focusing on 126 patients who underwent unilateral pulmonary laser resection for lung metastases from 1996 to 2022 using a 1318 nm Nd:YAG laser or a high-power pure diode laser. Results show that from these patients, a median of three pulmonary nodules were removed, with 75% presenting central lung lesions and 25% peripheral lesions. The median preoperative FEV1 was 98% of the predicted value, decreasing to 71% postoperatively but improving to 90% after three months, 93% after six months, and 96% after twelve months. Statistical analysis using the Friedman test indicated no significant difference in FEV1 between preoperative levels and those at six and twelve months post-surgery. The findings confirm that pulmonary laser surgery effectively preserves lung function over time, with patients generally regaining their preoperative lung function within a year, regardless of the metastases' location.

Association of pulmonary function test abnormalities and quality-of-life measures after COVID-19 infection

BackgroundLong-COVID is a multisystem disease that can lead to significant impairments in health-related quality of life (HRQoL). Following COVID-19 infection, abnormalities on pulmonary function tests (PFT) are common. The primary aim of this study is to evaluate for any correlation between PFT abnormalities and impairment in HRQoL scores following COVID-19 infection. MethodsThis is an analysis of a prospective cohort of patients in Louisville, KY who were infected with COVID-19. Data collected included demographics, past medical history, laboratory tests, PFTs, and several HRQoL questionnaires such as the EuroQol 5 Dimension HRQoL questionnaire (EQ-5D-5 L), Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire (PHQ-9), and Posttraumatic stress disorder checklist for DSM-5 (PCL-5). Descriptive statistics were performed, comparing PFTs (normal vs abnormal) and time since COVID-19 infection (3- vs 6- vs ≥ 12 months). ResultsThere were no significant differences in FEV1, FVC, or the percentage of patients with abnormal PFTs over time after COVID-19 infection. Following COVID-19, patients with normal PFTs had worse impairment in mobility HRQoL scores and change in GAD-7 scores over time. There were no differences over time in any of the HRQoL scores among patients with abnormal PFTs. ConclusionsAmong patients with an abnormal PFT, there was no temporal association with HRQoL scores as measured by EQ-5D-5 L, GAD-7, PHQ-9, and PCL-5. Among patients with a normal PFT, mobility impairment and anxiety may be associated with COVID-19 infection. Following COVID-19 infection, impairment in HRQoL scores is not completely explained by the presence of abnormalities on spirometry.

Meta-analysis of peripheral blood eosinophils in clinical testing of chronic obstructive pulmonary disease patients.

Meta-analysis was used to investigate the relationship between peripheral blood eosinophil (EOS) levels, clinical characteristics, and prognosis in chronic obstructive pulmonary disease (COPD)patients in previous literature. To analyse the correlation between peripheral blood EOS levels and clinical characteristics and prognosis of patients with COPD using meta-analysis. In databases such as PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wan Fang Data, literature related to the clinical characteristics or prognosis of COPD patients with high-level EOS published before July 2023 was searched for meta-analysis. Through computer search and screening, 29 articles were ultimately included. The meta-analysis results showed that compared to conventional EOS levels, COPD patients with high EOS levels had a lower proportion of GOLD III-IV grade patients (OR = 00.78, 95% CI (0.68, 0.88), p < 0.001), lower CAT scores (OR = -1.01, 95% CI (-1.75, -0.28), p = 0.007), shorter hospital stay (OR = -1.33, 95% CI (-1.52, -1.14), p < 0.001), and lower mortality rate (OR = 0.53, 95% CI (0.42, 0.66), p < 0.001). The readmission rate was low (OR = 0.40, 95% CI (0.33, 0.48), p < 0.001), and there was no statistically significant difference in FEV1%pred (OR = -0.55, 95% CI (-1.33, 0.23), p = 0.17), higher FEV1/FVC values (OR = -0.45, 95% CI (-1.08, 0.18), p = 0.160), and mechanical ventilation usage rate (OR = 0.89, 95% CI (0.65, 1.21), p = 0.450) among COPD patients with different EOS levels. The levels of peripheral blood EOS in COPD patients are related to lung function, respiratory symptoms, etc.; Moreover, COPD patients with high-level EOS have shorter hospital stays, lower mortality and readmission rates. Therefore, ESO can be used as an auxiliary indicator for clinical symptom diagnosis of COPD patients and as an auxiliary indicator for predicting prognosis.

Breathing patterns during sleep and their relationship with FEV1 in pediatric patients with cystic fibrosis residing at high altitude.

Sleep-disordered breathing (SDB) and gas exchange disorders are common in patients with cystic fibrosis (CF). Currently, the impact of the disease on sleep patterns in patients living at high altitude and the relationship of these patterns to lung function are largely unknown. The aim of this study was to determine the frequency of SDB in children with CF aged 6-18 years and the relationship between SDB and lung function (FEV1). This is an analytical cross-sectional study of children aged 6-18 years diagnosed with CF. Spirometry before and after bronchodilators and polysomnography with capnography were performed. Descriptive analysis of qualitative and continuous variables was performed. Spearman's correlation coefficient was used to determine the correlation between polysomnogram and lung function (FEV1). Twenty-four patients with CF were included. The mean age was 10.5 ± 3.1 years and 62.5% were male. Nine children had bronchiectasis on chest CT. The median absolute baseline FEV1 was 1,880 (1,355-2,325) ml and 98% (83%-110%) of predicted value. No significant difference in FEV1% was observed between subjects with obstructive sleep apnea (OSA) and those without OSA (P = 0.56). The prevalence of OSA was 66.7% in children younger than 13 years and 40% in children older than 13 years. The Spearman correlation coefficient between FEV1 and percentage of total sleep time with saturation less than 90% (T90) was rho -0.52 (p-value = 0.018), and between FEV1 and percentage of total sleep time with saturation less than 85% (T85) was statistically significant with rho -0.45 (p-value = 0.041). A positive correlation was observed between FEV1 and SpO2 during sleep with rho 0.53 and a statistically significant p-value (0.014). A high prevalence of sleep apnea was found in children with CF living at high altitude, with a negative correlation between FEV1 and T90 and T85 oxygenation indices, and a positive correlation between FEV1 and SpO2 during sleep.

Online-merge-offline (OMO)-based music therapy for asthmatic children during the COVID-19 pandemic in China.

The purpose of this study is to evaluate online-merge-offline (OMO)-based music therapy (MT) as a complementary option for asthma management in pediatric patients. A total of 86 children diagnosed with mild asthma were enrolled and treated with the same drug therapy. They were assigned into three groups: Music I group (standard medical care plus a single individualized MT session along with singing training and breathing exercise), Music II group (similar as Music I as well as further wind instrument playing), and Control group (standard medical care). Primary endpoints included pulmonary function tests FEV1, FVC, FEV1/FVC, MMEF 75/25, and PEF, c-ACT, PAQLQ, and PACQLQ. After 6months of continuous intervention of MT, significant differences in FEV1, FVC, MMEF75/25, PEF, c-ACT score, PAQLQ, PACQLQ (p < 0.001), and FEV1/FVC (p < 0.05) were observed among Music I, Music II, and Control groups. Besides, FEV1, FVC, FEV1/FVC, MMEF75/25, and PEF showed positive trends in Music I and Music II groups compared to those in Control group (p < 0.05). The c-ACT score of children was significantly increased in Music I (p < 0.001) and II (p < 0.001) groups in contrast with Control group. Children in Music I and II groups had better quality of life than those in Control group (PAQLQ, p < 0.001), and the parents in Music I and II groups also showed better quality of life than those in Control group (PACQLQ, p < 0.001). Conclusion: As a child-friendly, low-risk, and convenient intervention, the OMO-based MT has a positive impact on pediatric asthma management during the COVID-19 pandemic. What is Known: • A few findings proved the positive effect of MT on pediatric asthma. What is New: • Our study further proving the validation and effectiveness of MT with OMO-based model on pediatric asthma, wind instrument playing has a greater impact on pediatric asthma control via small airways and might be recommended to mix to singing and breathing to improve effectiveness of MT for asthmatic children.

Research of the diagnostic utility of impulse oscillometry in patients with bronchiectasis

Background: Bronchiectasis is a chronic respiratory condition in which infection, inflammation, and damage of the airways all play a role. Intense airway inflammation is precipitated by pathogenic insults, resulting in chronic airway damage. Impulse oscillometry (IOS) is a noninvasive approach that might offer worldwide information on airway resistance by researching the mechanical waves superimposed upon breathing movements. It has been observed that IOS may differentiate peripheral airways abnormalities in chronic obstructive pulmonary disease (COPD), asthma, interstitial pulmonary disease (ILD) and pulmonary fibrosis (CF) with high degree of precision. Methods: This research was carried out on 40 cases with bronchiectasis diagnosed by HRCT. Such cases were classified into two groups, according to Bronchiectasis Severity Index (BSI)(108): group I: Included 20 cases with mild to moderate bronchiectasis and group II: Included 20 cases with severe bronchiectasis. Cases included in the research were subjected to full history taking and complete physical examination. This includes: Complete blood count (CBC), sputum culture, chest x-ray to exclude cases with other lung diseases, High-Resolution Computerized Tomography (HRCT), that were interpreted for the presence, pattern and distribution of bronchiectasis, arterial blood gases, echocardiography, measuring systolic pulmonary artery pressure, pulmonary function tests (PFT), Impulse Oscillometry and reactance area (AX) were measured. Results: Regarding disease duration, no significant differences was found between both groups while a statistically significant difference was observed between groups regarding the used medications. Regarding laboratory investigations, no significant difference was observed among the groups for any of the measured measurements. Regarding functional assessment data, A statistically evident difference was found between groups in the following: MEF 50%, FEV1% predicted, FEV1/FVC% and FVC% with no significant differences in FEV1. Regarding IOS measurements, A statistically evident difference was found between both groups in R5% predicted while no difference was observed regarding R5 actual, R20, AX, or X5. Positive correlation was very high in between HRCT score and each of FEV1% predicted, FVC (%) AX, R5% predicted, R5 actual, R20 and X5 but negative correlation was very high in between HRCT score and MEF 75%, FEV1/FVC% Conclusions: IOS measurements are markedly increased in cases with bronchiectasis and they are correlated with spirometric measurements and HRCT scores.

Cystic fibrosis exacerbations treated with medical therapy with and without concurrent sinus surgery

ObjectiveThis analysis investigates any potential differences in pulmonary function test (PFT) outcomes among pediatric patients with cystic fibrosis (CF) receiving both medical management (MM) and functional endoscopic sinus surgery (FESS) versus MM alone for CF exacerbation. Study designProspective cohort. SettingPediatric tertiary care facility. MethodsThe data was prospectively collected from July 2011 to March 2020. Diagnosis of CF and age ≤ to 18 were required. All patients were hospitalized and treated for CF exacerbations with both FESS with MM and MM alone at variable time intervals, although the order of initial treatment received differed. Two-way ANOVA with repeated measures were used to determine the effect of receiving FESS with MM versus MM alone on PFT outcomes over time (during admission, at discharge, at 3 months, at 6 months, and at 12 months). Results13 pediatric patients, 7 of which had FESS with MM initially and 6 who had MM alone initially, and 20 events of both FESS and MM were included for analysis. For PFT outcomes, there was no statistically significant two-way interaction between treatment type and time following treatment, p = 0.492. The main effect of treatment did not show a statistically significant difference in FEV1 between treatment types, p = 0.737. There was no statistically significant association between treatment type and time between hospital readmission in months, p = 0.111. ConclusionThere was no significant difference between PFT outcomes in pediatric patients hospitalized for CF exacerbation treated with MM with or without FESS at any time interval.

COPD sleep phenotypes: Genesis of respiratory failure in COPD.

The chronic obstructive pulmonary disease (COPD) patients could have respiratory failure during sleep without daytime overt arterial blood gas (ABG) abnormality. We undertook a study first of its kind to attempt in distinguishing the underlying pathophysiological mechanisms. It was a prospective observational study in stable COPD patients. The inclusion criterion was presence of day time PaO2>60 mmHg and PaCO2<45 mmHg. Twenty five out of 110 patients were excluded because of the ABG abnormality. The remaining 85 patients were subjected to overnight pulse oximetry and end-tidal (ET)-CO2 monitoring. The nocturnal oxygen desaturation was defined as per Fletcher's criteria. The nocturnal hypoventilation was defined as per American academy of sleep medicine (AASM) guidelines. Patients having saw-tooth pattern on pulse oximetry and/or snoring were subjected to polysomnography. 38/85(44.8%) patients had nocturnal gas exchange abnormality in absence of daytime respiratory failure and were identified into 3 different phenotypes: obstructive sleep apnoea (OSA), nocturnal hypoventilation and nocturnal oxygen desaturation. The isolated abnormality was seen in 24 patients: 10 patients had OSA, 9 had nocturnal hypoventilation and 5 had nocturnal oxygen desaturation. Overlap of two or more phenotypes was seen in 14 patients. As compared to the nocturnal hypoventilation and desaturation phenotypes, the OSA phenotype had a significantly higher BMI & FEV1. The nocturnal hypoventilation and the desaturation phenotypes did not have significant difference in FEV1 and BMI, but the daytime SpO2 and PaO2 differed significantly. Such parameters could help in identifying the three distinct COPD-sleep phenotypes (OSA, nocturnal hypoventilation and nocturnal oxygen desaturation). A phenotype based nocturnal management may help in delaying the process of overt respiratory failure in COPD.

Effect of Buyang Huanwu Decoction Foot Bath on Pulmonary Rehabilitation of Patients with Chronic Obstructive Pulmonary Disease at Stable Phase

<bold>Objective:</bold> To observe the effect of Buyang Huanwu decoction foot bath on pulmonary function and quality of life of patients with chronic obstructive pulmonary disease (COPD) at stable phase, improving the clinical treatment plan for COPD patients and providing clinical evidence to promote pulmonary rehabilitation. <sec><title>Methods</title> A retrospective analysis of 60 patients with COPD at stable phase who were admitted to the Affiliated Peoples Hospital of Fujian University of Traditional Chinese Medicine from June 2020 to February 2021 and met the inclusion criteria of this study were divided into treatment group and control group using the SPSS 26.0, with thirty cases in each group. The control group was given routine drug treatment, nursing therapy, guided exercise, and health education. The treatment group received the Buyang Huanwu decoction foot bath in addition to the treatment of the control group. To be specific, the prepared Buyang Huanwu decoction was immersed in 5,000 mL water for twenty minutes. After boiling, the decoction was changed to simmer for ten minutes. After discarding the residue, the decoction was placed in a bucket, and foot bath was conducted when the temperature dropped to about 40 ℃. Foot bath required the water surface to be 10 cm above the ankle joint, twenty minutes per time, and once per day before going to bed, seven times per week, continuous treatment for two weeks. At both the before treatment and after treatment for two weeks, the percentage of forced expiratory volume in 1 second to predicted value (FEV1%pred) and forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) were used to evaluate the changes of pulmonary function in COPD patients at stable phase; the change of locomotor ability was observed by 6-minute walk distance (6MWD); the changes in the degree of dyspnea were assessed using the dyspnea scale of modified British Medical Research Council (mMRC); the chronic obstructive pulmonary disease assessment test (CAT) was used to observe the changes of patients quality of life; the anxiety inventory for respiratory disease (AIR) was used to evaluate the change of anxiety. To evaluate the safety of the Buyang Huanwu decoction foot bath in treating COPD patients at stable phase, the vital signs were recorded before and after the intervention, and recording the adverse reactions during the intervention, such as palpitations, and breathing difficulties. </sec><sec><title>Results</title> 1) Before treatment, there was no significant difference in FEV1%pred, FEV1/FVC value, 6MWD, mMRC score, CAT score, and AIR score between the two groups (<italic>P</italic>>0.05). 2) Compared with the situation before treatment, the FEV1%pred, FEV1/FVC value, and 6MWD of the two groups all increased (<italic>P</italic><0.05), but the mMRC score, CAT score, and AIR score all decreased (<italic>P</italic><0.05). After 2 weeks of treatment, the FEV1%pred, FEV1/FVC value, and 6MWD of the treatment group were all higher than those of the control group (<italic>P</italic><0.05); the mMRC score, CAT score, and AIR score of the treatment group were all lower than those of the control group (<italic>P</italic><0.05). 3) Safety results showed that no adverse events occurred during the clinical treatment, suggesting that the Buyang Huanwu decoction foot bath was safe and reliable. </sec><sec><title>Conclusion</title> The Buyang Huanwu decoction foot bath could improve pulmonary function, athletic ability, dyspnea, anxiety level, and quality of life of COPD patients at stable phase. The clinical effect is good and can be promoted clinically. </sec>

A randomized trial comparing inspiratory training and positive pressure training in immediate lung recovery after minor pleuro-pulmonary surgery.

BackgroundTwo respiratory physiotherapy modalities were compared in a randomized controlled trial on patients undergoing minor pleuro-pulmonary surgery.MethodsForty-five patients were randomly allocated into positive expiratory pressure (PEP) therapy (n=23) and inspiratory muscle training (IMT) groups (n=22). Individualized group specific physiotherapeutic guidance was administered preoperatively, and once a day postoperatively. Patients also performed independent exercises and kept a logbook. Pain was assessed on a numerical reference scale (NRS). Volumetric pulmonary function values and walking distance were recorded preoperatively, and on first (POD1) and second postoperative days (POD2). Pre- and postoperative values were compared using two-way repeated measures analysis of variance.ResultsPatient characteristics and pleuro-pulmonary interventions were similar between the groups. Thoracotomy was performed in 14/45 and video assisted surgery (VATS) in 31/45 of cases. Preoperative volumetric pulmonary functions were normal or slightly decreased in 29/45, and fell significantly (P<0.001) on the first postoperative day (POD1) and improved but remained significantly lower on the second postoperative day. The recovery of mean FEV1, FIV1 and FIVC values was greater in the IMT than in the PEP group between POD1 and POD2, but without significant difference. The corresponding relative to preoperative values were higher in the IMT group, with a significant difference in FEV1 (P=0.045). Also relative PEF and FIV1 values seemed to be slightly higher in the IMT compared to the PEP group, but not significantly. Average NRS values for pain were lower in the IMT group (P=0.010) but only on POD1. Air leak was noted in 4/45 patients, two in each group, on POD1, and two in PEP groups and one in IMT group on POD2. Mean measured walking distances between groups did not differ. Mean hospital stay was 4 days in the PEP group and 3 days in the IMT group. There was no hospital mortality.ConclusionsPulmonary function values decreased significantly after minor lung resections, supporting rehabilitative respiratory physiotherapy to avoid postoperative pulmonary complications (PPCs). Both PEP and IMT training were well tolerated and equally efficient when comparing spirometry values at three time points. IMT appeared advantageous regarding relative FEV1 recovery and immediate postoperative pain.

The effect of Acapella trainer on respiratory function of patients after thoracoscopic lung cancer surgery

AbstractObjectiveTo investigate the effect of Acapella training on respiratory function in patients undergoing video‐assisted thoracic surgery (VATS).MethodsA total of 60 patients undergoing VATS surgery for lung cancer in the department of thoracic Surgery of our hospital from August 2018 to February 2019 were selected as study subjects, and were divided into observation group (n = 30) and control group (n = 30) according to the random number table method. The control group received routine pulmonary rehabilitation exercise after surgery, and the patients in the observation group received postoperative respiratory function exercise with Acapella therapeutic apparatus on the basis of the control group. Respiratory function, including forced vital capacity (FVC), forced expiratory capacity in the first second (FEV1), peak expiratory flow (PEF), and length of hospital stay, were observed and compared between the two groups before and after using Acapell trainer.ResultsThere was no significant difference in FEV1, FVC, and PEF between the two groups before treatment with Acapella (P &gt;.05), the difference between the above indicators after treatment and before treatment was statistically significant (P &lt;.05); After Acapella treatment, FEV1, FVC, and PEF were significantly different between the two groups (P = .04, P = .047, P = .047).The postoperative hospital stay in the experimental group was shorter than that in the control group, and the difference was statistically significant (P = .028).ConclusionAcapella trainer can improve patients' respiratory function and shorten postoperative hospital stay.

Effectiveness and safety of mycophenolate mofetil in connective tissue disorder associated interstitial lung disease: A real-life experience from India

Aim: To study the effectiveness and safety of mycophenolate mofetil (MMF) in patients with connective tissue disease (CTD) associated interstitial lung disease (ILD). Methods: The retrospective observational study was carried out from Jan 2015 to Feb 2019. Symptomatic CTD-LD patients with (HRCT chest) documented ILD and abnormal pulmonary function test (forced vital capacity, FVC&lt; 70%), who were treated with MMF were included. The treatment response was assessed clinically by pulmonary function test and radiology. Clinical assessment and PFT were done at baseline, 6, 12 and 24 months. HRCT chest was done at baseline and 24 months. Results and analysis: Out of 33 patients, 13 had MCTD, 12 had RA, and remaining 8 belonged to the systemic sclerosis (SSc)-predominant groups (3: diffuse cutaneous SSc, 2: SSc/myositis overlap, and 1 each with Sjogren’s syndrome, SLE/Sjogren’s overlap and interstitial pneumonia with autoimmune features). Increased female predominance was noted (90.9%). The mean FVC at baseline noted in MCTD, RA and SSc-predominant groups were 62±6.17, 64±4.17 and 59±6 respectively. Improvement was reported in 4 patients, each in MCTD and RA groups. Eight patients in the MCTD group and 7 each in RA and SSc- predominant groups had a stable lung disease. One patient each in all the groups reported worsening of the disease. There was a positive trend in FEV1 and FVC with treatment. No significant difference in FEV1 and FVC values with treatment was noted across the three groups. Numerical differences in the mean values of FEV1 and FVC between two groups (NSIP and UIP) were noted, but was not statistically significant. All the subjects completed 24 months of follow-up. They were on 2 g/day of MMF for the first 12 months, followed by a maintenance of 1.5- 2 g/day for the next 12 months. None of the subjects discontinued treatment due to intolerance or adverse effects.

A randomized prospective study to compare the efficacy and safety of budesonide plus formoterol and tiotropium plus formoterol in patients having mild to moderate chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a leading respiratory illness affecting the quality of lives around the world. The present study aims to compare the efficacy and safety of combination of inhaled corticosteroid (ICS) and long acting β2 agonist (LABA) with long acting β2 agonist and long acting muscarinic antagonist (LAMA) in treatment of mild to moderate COPD in a tertiary care hospital.Methods: Total 132 patients with COPD were recruited on the basis of inclusion and exclusion criteria for 8 weeks study from outpatient clinic. A complete pulmonary examination including spirometry examination was done to rule out severe and very severe forms of COPD. Spirometry was performed at the time of recruitment for evaluation of forced expiratory volume in one second (FEV1) and measurement of SpO2 at the time of recruitment at 2 weeks and 8 weeks. Appropriate statistical methods were used to compare the qualitative and quantitative primary and secondary efficacy end points, p value &lt;0.05 was considered significant.Results: On analysis, there was a significant difference (p&lt;0.05) was observed in FEV1 and SpO2 from baseline in ICS plus LABA group (n=66). A similarly significant difference (p&lt;0.05) was observed in LABA and LAMA group (n=66). On comparison between ICS plus LABA and LABA plus LAMA no significant difference in FEV1 and SpO2 was observed between the two groups. More adverse drug reactions were observed in ICS plus LABA group than LAMA plus LABA group.Conclusions: Combination of ICS and LABA combination is as effective as combination of LABA and LAMA in patients having mild to moderate COPD. However, LABA and LAMA combination is preferable because it is associated with fewer side effects.

ВПЛИВ КОМБІНАЦІЇ ТІОТРОПІЮ/ОЛОДАТЕРОЛУ НА ФУНКЦІЮ ЗОВНІШНЬОГО ДИХАННЯ У ХВОРИХ НА ХОЗЛ В РЕАЛЬНІЙ КЛІНІЧНІЙ ПРАКТИЦІ

EFFECT OF COMBINATION OF TIOTROPIUM/OLODATEROL ON PULMONARY FUNCTION IN PATIENTS WITH COPD IN THE REAL CLINICAL PRACTICE Y. M. Mostovoy, K. D. Dmytriiev, N. S. Slepchenko Abstract Aim — to evaluate the effect of combination therapy with tiotropium/olodaterol on pulmonary function in real clinical practice. Materials and methods. 100 patients with the diagnosis of COPD were included into the study (mean age was 64,09±1,94 years, 66 men and 34 women). Smokers — 68 %, mean smoking duration (24,44 ± 4,84) packyears. Average COPD duration was 9,35±2,42 years. All patients underwent spirometry at screening, 4-6 weeks and at 1 year after inclusion. FEV1, FVC, FEV1/FVC, FEF25, FEF50, FEF75, PEF, MMEF75/85, FEF75/85 were calculated. Results. There was statistically significant improvement in FEV1 and FVC values between visits 1 and 3 (p &lt; 0,05). At visit 3 there was a statistically significant difference in FEV1 and FVC values when compared with same values at visit 1 after the inhalation of salbutamol, demonstrating better bronchodilation effect of tiotropium/olodaterol. Absolute increase of FEV1 between visits 1 and 3 was 221,31±34,9 ml; FVC — 411,01±66,08 ml. There was statistically significant increase of FEF75, MMEF75/25, FEF75/85 between visits 1 and 3 (p &lt; 0,05). There was statistically significant increase of FEF75 at visits 2 and 3 in comparison with postBD FEF75 at visit, confirming better bronchodilation effect of tiotropium/olodaterol combination of at the level of small bronchi when compared with salbutamol (p &lt; 0,05). Conclusions. Tiotropium/olodaterol combination showed good effect on pulmonary function in patients with COPD in real clinical settings. This combination demonstrated better bronchodilation than salbutamol, especially at the level of small bronchi. Key words: COPD, tiotropium/olodaterol, spirometry. Ukr. Pulmonol. J. 2020;29(3):28–30.

Comparison of clinical outcomes of inhaled formoterol or fluticasone versus formoterol or mometasone in the patients of bronchial asthma

Background: This study was undertaken because of paucity of literature regarding outcomes of inhaled formeterol/fluticasone versus formoterol/mometasone in asthmatic patients.Methods: Fifty newly (male/female) recruited cases of bronchial asthma were diagnosed on the basis of spirometry. The patients were allocated to two groups viz group A and B. Group-A received mometasone furoate/formoterol (200/10 μg OD) and Group-B received fluticasone/formoterol (200/10 μg OD) respectively. The drugs were administered through metered-dose inhaler (MDI).Results: The mean FEV1/FVC ratio recorded (64.40±9.01) before starting the treatment has significantly changed to (68.92±8.58) after starting the treatment. Mean forced expiratory volume (47.56±14.73%) noted before the use of bronchodilator also changed to mean FEV1 63.98±15.17. Mean forced expiratory volume recorded before treatment (55.02±5.01) in a group who were treated with formoterol/mometasone combination changed to (72.06±5.86) after treatment. However, the mean forced expiratory volume recorded before treatment 54.92±4.47 in a group who were treated with formoterol/fluticasone combination changed to 75.48±5.03 after the treatment. While comparing the two treatment regimens, it is evident from the results that there is no significant difference in FEV1 between the groups. However, the post bronchodilator FEV1 was significantly (p&lt;0.001) higher among the patient group which were treated with fluticasone/formoterol combination than the group who were treated with mometasone/formoterol combination. No significant adverse effect of either of two regimens was observed thus showing that both the combinations are comparatively safe for use.Conclusions: This study reveals that both the treatment regimens showed a significant improvement in lung functions without any significant adverse event.

Efficacy of early structured pulmonary rehabilitation program in pulmonary function, exercise capacity, and health-related quality of life for patients with post-tubercular sequelae: A pilot study

BackgroundResidual structural changes in the lung along with pulmonary impairment remain in a large number of patients of tuberculosis after microbiological cure. The aim of this study was to determine whether 12 weeks of a structured pulmonary rehabilitation program (PRP) administered along with antitubercular treatment improved the baseline measurement of pulmonary function, exercise capacity, and health-related quality of life (HRQOL). MethodsA pilot study with single blind randomized control design was carried out in a tertiary care chest center. Spirometry, exercise capacity by 6-minute walk distance (6MWD), and HRQOL using St George respiratory questionnaire (SGRQ) score were evaluated in 62 patients, divided into 2 groups: intervention group (IG) (n = 31) and control group (CG) (n = 31) patients at baseline and at end of 12 weeks. IG completed 12 weeks of PRP. ResultsSignificant difference in forced expiratory volume in 1st second (FEV1) (2.94 L at baseline vs 3.18 L at end of 12 weeks of PRP, diff 0.239 L, p-0.001), forced vital capacity (FVC) (3.43 L vs 3.75L, p −0.00), 6MWD (440.6 m vs 574.6 m, p = 0.00), and SGRQ score of at baseline (24.5 m vs 11.1m, p = 0.00) was seen in the IG. At end of 12 weeks, there was statistically significant difference in FEV1(L) (p = 0.01, 95% CI −0.317 to −0.046), FVC(L) (p = 0.00, 95% CI −0.359 to −0.139),6MWD(m) (p = 0.00; 95% CI −101.6 to −49.57) between CG and IG. There was no statistically significant difference in SGRQ scores between the 2 groups (p = 0.231). ConclusionPRP administered along with treatment is beneficial in reducing residual pulmonary impairment.

Short-term responses to high-dose inhaled corticosteroid treatment in patients with chronic obstructive pulmonary disease with a fractional nitric oxide concentration over 35 parts per billion: A single-centre pre–post study

Introduction: There is currently no strategy for identifying chronic obstructive pulmonary disease (COPD) patients whose pulmonary function could benefit from inhaled corticosteroids. We investigated whether a 28-day regime of inhaled corticosteroids improved pulmonary function test results among COPD patients with a fractional exhaled nitric oxide concentration &gt; 35 parts per billion. Methods: This single-centre one-arm pre–post trial included COPD patients with a fractional exhaled nitric oxide concentration &gt; 35 parts per billion treated at our institution from September 2018 to August 2019. Patients were administered budesonide (200 μg, 8 puffs daily) for 28 days. The primary outcome measure was the difference between the forced expiratory volume in 1 s (FEV1) at baseline and after 28 days of inhaled corticosteroid treatment. Secondary outcomes included differences in COPD Assessment Test scores, %FEV1, and that between the percent forced vital capacity (%FVC) at baseline and after 28 days of treatment. Results: Twenty patients completed the 28-day inhaled corticosteroid regime. The mean difference in FEV1 between day 1 and day 28 was 340 mL (95% confidence interval: −100 to 770 mL; p = 0.122). The mean differences in secondary outcomes were: %FVC, −0.16% (95% confidence interval [CI]: −2.84 to 2.53%; p = 0.905); %FEV1, 1.63% (95%CI: −4.56 to 7.81%; p = 0.589); COPD Assessment Test score, −2.50 (95%CI: −5.72 to 0.72; p = 0.121). Conclusion: The 28-day course of inhaled corticosteroids yielded no significant difference in FEV1 for COPD patients with a fractional exhaled nitric oxide concentration &gt; 35 parts per billion. Trial registration: University Hospital Medical Information Network Center, UMIN000034005. Registered 3 September 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000038557