Spirometric Data Research Articles

RELATION OF MID-EXPIRATORY FLOW RATES TO BRONCHIAL HYPERRESPONSIVENESS DURING EXERCISE-INDUCED BRONCHOCONSTRICTION TEST

SESSION TITLE: Monday Electronic Posters 5 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Exercise-induced asthma is commonly encountered in clinical practice. An exercise-induced bronchoconstriction (EIB) test is an important diagnostic tool for exercise-induced asthma, especially in patients in whom routine spirometry is normal. Limited information exists in medical literature on flow rates during EIB, including small airway function parameters such as the mid expiratory flow rate during 25-75% of FVC(MEFR) and its relation to bronchial hyperresponsiveness. The objective of this study was to determine (i) the correlation between change in MEFR to change in FEV1 during EIB; (ii) the correlation between the decline in MEFR during EIB to decline in FEV1 in patients with a positive EIB. METHODS: We retrospectively analyzed EIB tests performed on 79 patients in our institution from 2008-2018. Parameters reviewed included age, gender, spirometric data including FVC, FEV1, FEV1/FVC ratio, MEFR25-75%, and the relative changes from baseline for FEV1 and MEFR25-75% during the EIB. Number of patients with positive and negative tests was abstracted. Per current guidelines, a positive EIB was defined as >10% decrease in FEV1, within 30 minutes post-exercise. Decline in MEFR post-exercise was also noted. Values are expressed as means+ SD. Co-relation analysis was performed to assess correlation between studied parameters and BrHR. p< 0.05 was deemed statistically significant. RESULTS: Mean age: 41+ 12.9 years; 67 % were female. Mean FEV1 was 110+17%predicted, with FEV1/FVC ratio of 80+6.2%. Fourteen percent had a positive test. Mean change in FEV1 during the test was -1+10.4% pred. Pre-test MEFR: 88+26 %predicted. Post-test MEFR: 89+30 L/sec. Change in MEFR during test was 2.25+22% predicted. Using Pearson’s correlation analysis, correlation between change in FEV1 versus (i) pre-test MEFR (r= -0.002, p< 0.98). (ii) post-test MEFR (r=0.433, p < 0.001). (ii) aggregate MEFR during test (r=0.433, p < 0.001). (iv) change in MEFR (r=0.78, p=0.005) In patients with a positive EIB, no significant correlation was noted between change in FEV1 versus pre-test MEFR or aggregate MEFR during test. However, a significant correlation was noted with post-test MEFR (r=0.72, p=0.01). CONCLUSIONS: Change in MEFRs corelates with bronchial hyperresponsiveness in EIB. CLINICAL IMPLICATIONS: Further studies are needed to determine if change in MEFR can be used as an adjunct parameter for diagnosing bronchial hyperresponsiveness. DISCLOSURES: No relevant relationships by Debapriya Datta, source=Web Response No relevant relationships by Gaurav Manek, source=Web Response No relevant relationships by Nihar Shah, source=Web Response No relevant relationships by Katherine Stettmeier, source=Web Response

Borderline pulmonary hypertension is associated with exercise intolerance and increased risk for acute exacerbation in patients with interstitial lung disease

BackgroundPulmonary hypertension (PH) is traditionally defined as a resting mean pulmonary artery pressure (mPAP) of ≥25 mmHg, while mPAP in the range of 21 to 24 mmHg is recognized as “borderline PH.” Interstitial lung disease (ILD) is complicated by the development of PH, which is known to be linked with exercise intolerance and a poor prognosis. Even though it has recently been recommended that PH is redefined as a mPAP of > 20 mmHg, little is known about the clinical significance of borderline PH in ILD. We evaluated whether borderline PH has an impact on the exercise capacity, risk of acute exacerbation (AE), and mortality in patients with ILD.MethodsA total of 80 patients with ILD who underwent right heart catheterization (RHC) between November 2013 and October 2016 were included. The patients were divided into 3 groups according to the mPAP values: mPAP ≤20 mmHg (No-PH group; n = 56), 20 < mPAP < 25 mmHg (Bo-PH group; n = 18), and mPAP ≥25 mmHg (PH group; n = 6). The demographic, hemodynamic, spirometric, and 6-min walk test (6MWT) data of the patients were collected. In addition, the 1-year incidence of AEs and 1-year survival of the patients after the initial RHC were also evaluated.ResultsThere were no significant differences among the 3 groups in the mean age, pulmonary function parameters or the PaO2, however, 6-min walk distance was significantly lower in both the Bo-PH and PH groups (p < 0.001 for both) as compared to the No-PH group. The results of the Kaplan-Meier analysis revealed that while there was no significant difference in the 1-year survival rate among the three groups, the 1-year incidence of AEs was significantly higher in both the Bo-PH and PH groups (p < 0.001, p = 0.023, respectively) as compared to the No-PH group.ConclusionsThe current study suggested that borderline PH may be associated with poorer exercise tolerance and an increased risk of AEs in patients with ILD. Therefore, the physicians should pay close attention to the presence of even mild elevation of the mPAP at the initial evaluation in patients with ILD.

Effects of smoking and physical exercise on respiratory function test results in students of university: A cross-sectional study.

We explored the effects of smoking and exercise on pulmonary function (PF) in young adults.This was a 2-year, prospective cross-sectional study on university students. We recorded age, gender, weight, height, pulmonary symptoms, smoking status, and sports habits. Spirometry was used to evaluate lung function; we recorded the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), and the FEV1/FVC ratio.A total of 1014 (552 female, 464 male) subjects were included. Smokers reported significantly more wheezing and sputum production than nonsmokers, but exhibited better FVC and FEV1 values. Those who smoked less than half a pack/d had significantly poorer FVC and FEV1 levels than nonsmokers. Smokers exhibited significantly lower FEV1/FVC ratios than nonsmokers. Overall, those who exercised exhibited better FEV1 and FVC levels, but this was attributable entirely to females.The spirometric percentile data were adjusted for gender, age, and height, and used as indicators of health status (good: >90: average: 25–90, poor <25). ln males, PF was associated with regular exercise (good: 7.8, average: 6.5, poor: 14.2, P = .02). The smoking rate was higher in the “good” group (males: good: 31.3, average: 30, poor: 17.9, P = .02/females: good: 22.4, average: 17.9, poor: 10.4, P = .02).On multivariate regression analysis, above-average PF test results were associated with age (1.32 [1.04–1.69]) and exercising at least once per week (4.06 [1.16–14.20]) in males. In females, above-average results were associated with irregular exercise (2.88 [1.36–6.09]), age (1.85 [1.44–2.37]), and exercising until palpitations developed (0.18 [0.04–0.88]).Smoking improves lung function in young adults; these are “healthy smokers.” Physical activity did not improve lung function, but the absence of physical activity significantly worsened lung function.

The impact of indoor air quality on respiratory health of older people living in nursing homes: spirometric and exhaled breath condensate assessments

In the Portuguese Geriatric Study of the Health Effects of Indoor Air Quality in Senior Nursing Homes, we aimed to evaluate the impact of indoor air contaminants on the respiratory symptoms and biomarkers in a sample of elderly living in nursing homes.A total of 269 elderly answered a health questionnaire, performed a spirometry and 150 out of these collected an exhaled breath condensate sample for pH and nitrites analysis. The study included the evaluation of indoor chemical and microbiological contaminants.The median age of the participants was 84 (78–87) years and 70.6% were women. The spirometric data indicated the presence of airway obstruction in 14.5% of the sample. Median concentrations of air pollutants did not exceed the existing standards, although increased peak values were observed. In the multivariable analysis, each increment of 100 µg/m3 of total volatile organic compounds was associated with the odds of respiratory infection in the previous three months (=1.05; 95% CI: 1.00–1.09). PM2.5 concentrations were inversely associated with pH values (= −0.04, 95%: −0.06 to −0.01, for each increment of 10 µg/m3). Additionally, a direct and an inverse association were found between total bacteria and FEV1/FVC and FVC, respectively.

EIT monitors valid and robust regional ventilation distribution in pathologic ventilation states in porcine study using differential DualEnergy-CT (\u0394DECT)

It is crucial to precisely monitor ventilation and correctly diagnose ventilation-related pathological states for averting lung collapse and lung failure in Intensive Care Unit (ICU) patients. Although Electrical Impedance Tomography (EIT) may deliver this information continuously and non-invasively at bedside, to date there are no studies that systematically compare EIT and Dual Energy CT (DECT) during inspiration and expiration (ΔDECT) regarding varying physiological and ICU-typical pathological conditions such as atelectasis. This study aims to prove the accuracy of EIT through quantitative identification and monitoring of pathological ventilation conditions on a four-quadrant basis using ΔDECT. In a cohort of 13 pigs, this study investigated systematic changes in tidal volume (TV) and positive end-expiratory pressure (PEEP) under physiological ventilation conditions. Pathological ventilation conditions were established experimentally by single-lung ventilation and pulmonary saline lavage. Spirometric data were compared to voxel-based entire lung ΔDECT, and EIT intensities were compared to ΔDECT of a 12-cm slab of the lung around the EIT belt, the so called ΔDECTBelt. To validate ΔDECT data with spirometry, a Pearson’s correlation coefficient of 0.92 was found for 234 ventilation conditions. Comparing EIT intensity with ΔDECT(Belt), the correlation r = 0.84 was found. Normalized cross-correlation function (NCCF) between scaled global impedance (EIT) waveforms and global volume ventilator curves was r = 0.99 ± 0.003. The EIT technique correctly identified the ventilated lung in all cases of single-lung ventilation. In the four-quadrant based evaluation, which assesses the difference between end-expiratory lung volume (ΔEELV) and the corresponding parameter in EIT, i.e. the end-expiratory lung impedance (ΔEELI), the Pearson’s correlation coefficient of 0.94 was found. The respective Pearson’s correlation coefficients implies good to excellent concurrence between global and regional EIT ventilation data validated by ventilator spirometry and DECT imaging. By providing real-time images of the lung, EIT is a promising, EIT is a promising, clinically robust tool for bedside assessment of regional ventilation distribution and changes of end-expiratory lung volume.

Sulphurous thermal water inhalation impacts respiratory metabolic parameters in heavy smokers.

Sulphurous thermal water inhalations have been traditionally used in the treatment of airway diseases. In vivo and in vitro studies reported that they ameliorate mucus rheology, mucociliary clearance and reduce inflammation. Cigarette smoking induces an inflammatory damage, with consequent remodeling of respiratory airways, which in turn affect pulmonary functions. Despite the anti-inflammatory effects of H2S are clinically documented in several airway inflammatory diseases, data on the effects of sulphurous thermal water treatment on pulmonary function and biomarkers of airways inflammation in smokers are still scant. Therefore, we investigated whether a conventional cycle of sulphurous thermal water inhalation produced changes in markers of respiratory inflammation and function. A cohort of 504 heavy current and former smokers underwent 10-day cycles of sulphurous thermal water inhalation. Pulmonary function and metabolic analyses on exhaled breath condensate were then performed at day 0 and after the 10-day treatment. Spirometric data did not change after spa therapy, while exhaled breath condensate analysis revealed that a single 10-day cycle of sulphurous water inhalation was sufficient to induce a statistically significant increase of citrulline levels along with a decrease in ornithine levels, thus shifting arginine metabolism towards a reduced nitric oxide production, i.e. an anti-inflammatory profile. Overall, sulphurous thermal water inhalation impacts on arginine catatabolic intermediates of airways cells, shifting their metabolic balance towards a reduction of the inflammatory activity, with potential benefits for smokers.

Design, optimization, characterization, and in vivo evaluation of sterosomes as a carrier of metformin for treatment of lung cancer

The present study aimed to formulate and evaluate metformin sterosomes. Sterosomes were prepared by incorporating stearylamine and cholesterol in different ratios. Sterosomes were characterized using size, zeta potential, entrapment efficiency (EE%) and in vitro release. Aerosol generated by nebulization was evaluated by a cooled Andersen cascade impactor (ACI) at 15 L/min. In vitro cytotoxicity of free and metformin-containing sterosomes was tested against human cancer cell lines. A comparative pharmacokinetic study between sterosomal formulation and free drug solution (750 mg) was performed. Spirometry was performed before and at time intervals after inhalation. The mean hydrodynamic diameter of the formulated vesicles was in the range of 288.7–578 nm. The EE% varied from 71 ± 1.4% to 89 ± 5.2%, with an optimum EE% of 89 ± 5.2at a lipid ratio of 2/1 stearylamine/cholesterol. Metformin sterosomes displayed an inhibitory effect on A549 lung cancer cell lines which significantly (p < 0.05) increased depending on dose and prolonged exposure time. Spirometric data were minimally changed before and after inhalation without a statistically significant difference in the forced expiratory volume in one second (FEV1), forced vital capacity (FVC) or FEV1/FVC ratio (p > 0.05). Metformin-loaded sterosomes resulted in a significant increase in biological half-life (t1/2) with a mean value of 7.31 ± 1.04 h compared to 3.99 ± 0.17 h of the solution form. However, the peak plasma concentration of metformin sterosomes was lower than that achieved by metformin-free solution aerosol, and the difference was statistically significant (p < 0.05).The eligibility of sterosomes for aerosol delivery by nebulization would provide a novel strategy for delivery of metformin by inhalation as a potentially effective inhalation treatment of lung cancer.

Factors Associated With Mortality and Response to Extracorporeal Photopheresis in Lung Allograft Recipients With Bronchiolitis Obliterans Syndrome.

This study was designed to identify factors associated with clinical response to extracorporeal photopheresis (ECP) and mortality after ECP in lung allograft recipients with bronchiolitis obliterans. Forced expiratory volume in 1 second (FEV1) values obtained 6 months before (baseline) and 6 months after initiation of ECP were used to plot the linear relationship between FEV1 versus time before and after ECP. Response to ECP was assigned when a positive integer was derived after subtracting the baseline rate of decline from the rate of decline 6 months after ECP. Univariate and multivariate logistic regression analyses were used to identify demographic, treatment-related factors or spirometric parameters that may be associated with response to ECP or mortality at either 6 or 16 months after initiation of ECP. Forced expiratory volume in 1 second just before ECP was associated with mortality (P = 0.007) at 16 months after ECP initiation. An FEV1 of 1.50 L or less had a sensitivity of 87% and specificity of 60% to identify patients who died within 16 months after ECP initiation. Patients whose FEV1 decline exceeded 40 mL/month were 12 times more likely to have a response to ECP (P = 0.0001). Patients whose decline in FEV1 before ECP was statistically significant (P < 0.05) were nearly 10 times (P = 0.008) more likely to respond to ECP. Forced expiratory volume in 1 second is an important predictor of mortality, and the response to ECP is influenced by both the extent (>40 mL/mo) and statistical significance of the relationship between FEV1 versus time before ECP initiation. Therefore, earlier bronchiolitis obliterans detection and more timely implementation of ECP (ie, when FEV1 values >1.5 L) should be considered especially in patients with a more aggressive rate of decline of lung function.

Chronic pesticide mixture exposure including paraquat and respiratory outcomes among Colombian farmers.

This study explored the potential association between chronic exposure to pesticide mixtures including paraquat and respiratory outcomes among Colombian farmers. Sociodemographic and occupational data, respiratory symptoms and spirometric data were collected. Paraquat in spot urine samples were quantified with solid-phase extraction high-performance liquid chromatography. Multiple Poisson regressions with robust variance were used to determine factors associated with respiratory outcomes. Profiles of pesticide mixtures used were identified among 217 farmworkers, but profenofos and methamidophos-based mixtures were more frequent. Chronic paraquat exposure was slightly associated with self-reported asthma (PR: 1.06; 95% CI 1.00 to 1.13). Different pesticide mixtures were associated with flu, thoracic pain, allergic rhinitis, and obstructive pattern in spirometry. Although acute exposure to paraquat is low among Colombian farmers participating in the study, associations between respiratory outcomes and chronic pesticide mixtures exposure including profenofos, methamidophos or glyphosate require further specific studies.

Reference Equations for the ADL-Glittre Test in Pediatric Subjects.

The ADL-Glittre test (TGlittre) was initially proposed to evaluate the activities of daily life (ADL) of adults with COPD that involve activities with the upper limbs in addition to walking. Recently, the test has been adapted for children (TGlittre-P), but no reference values have been proposed for its use in this population. The main objective of this study was to develop reference equations for the pediatric adaptation of the TGlittre. A cross-sectional study carried out over a period of 19 months. Children 6-14 y old participated in the study. The study was rigorously controlled based on the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and on normal spirometry. Study subjects were evaluated for their biometric data (ie, weight, height, body mass index, body surface area, and length of the lower limbs) and spirometric data. Subjects then performed 2 TGlittre-P tests with an interval of 30 min between them. Statistical analysis included a Pearson correlation test to verify a correlation between time spent on the TGlittre-P and biometric variables such as gender and age. Subsequently, a multiple regression analysis was conducted for those variables. The level of signficance was set at a P of 0.05. Eighty-seven children (44 girls) participated in the study. Age was the predictive variable with the greatest influence on the time spent on the TGlittre-P (male: adjusted R2 = 39.6%; female: adjusted R2 = 25.2%). The following equations were established: time spent on the TGlittre-P = 3.781 - 0.083 × age (female), and time spent on the TGlittre-P = 4.025 - 0.123 × age (male). TGlittre-P reference equations were developed for females and males, with age being the most influential predictive variable in the test performed by children.

Strategies for recruitment and retention of underrepresented populations with chronic obstructive pulmonary disease for a clinical trial

BackgroundRecruitment and retention are two significant barriers in research, particularly for historically underrepresented groups, including racial and ethnic minorities, patients who are low-income, or people with substance use or mental health issues. Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and disproportionately affects many underrepresented groups. The lack of representation of these groups in research limits the generalizability and applicability of clinical research and results. In this paper we describe our experience and rates of recruitment and retention of underrepresented groups for the Aides in Respiration (AIR) COPD Health Coaching Study.MethodsA priori design strategies included minimizing exclusion criteria, including patients in the study process, establishing partnerships with the community clinics, and ensuring that the health coaching intervention was flexible enough to accommodate patient needs.ResultsChallenges to recruitment included lack of spirometric data in patient records, space constraints at the clinic sites, barriers to patient access to clinic sites, lack of current patient contact information and poor patient health. Of 282 patients identified as eligible, 192 (68%) were enrolled in the study and 158 (82%) completed the study. Race, gender, educational attainment, severity of disease, health literacy, and clinic site were not associated with recruitment or retention. However, older patients were less likely to enroll in the study and patients who used home oxygen or had more than one hospitalization during the study period were less likely to complete the study. Three key strategies to maximize recruitment and retention were identified during the study: incorporating the patient perspective, partnering with the community clinics, and building patient rapport.ConclusionsWhile the AIR study included design features to maximize the recruitment and retention of patients from underrepresented groups, additional challenges were encountered and responded to during the study. We also identified three key strategies recommended for future studies of COPD and similar conditions. Incorporating the approaches described into future studies may increase participation rates from underrepresented groups, providing results that can be more accurately applied to patients who carry a disparate burden of disease.Trial registrationThis trial was registered at ClinicalTrial.gov at identifier NCT02234284 on August 12, 2014.Descriptor number: 2.9 Racial, ethnic, or social disparities in lung disease and treatment.

STUDY TO FIND OUT THE EFFICACY OF 6 MINUTE WALK TEST IN ASSESSING RESPONSE TO MEDICAL INTERVENTION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

Background: Chronic obstructive pulmonary disease (COPD) is a lung condition which is a result of long term inflammation of the lung tissues, especially the airways. COPD manifests with respiratory symptoms like breathlessness, effort intolerance, cough with expectoration and in severe cases respiratory arrest, respiratory failure or heart failure.&#x0D; Methods: We included 50 patients with stable COPD attending the outpatient department in the stipulated study period and diagnosis of COPD was established by clinical symptoms and spirometric data of ratio of FEV 1 and forced vital capacity (FVC) ≤ 0.7. &#x0D; Results: The 6 minute walk distance (6MWD) of the patients were assessed once the health status of the patients have been stabilized. This was done under strict monitoring, just before discharge of the patient from the hospital. Participants aged less than 60 years had a 6MWD of 342 m while those aged above 60 years clocked 291 m. With regards to gender, males had significantly higher 6 MWD when compared to females.&#x0D; Conclusions: 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.&#x0D; Key words: Chronic obstructive pulmonary disease, six-minute walk test, spirometric indices, severity

Evaluation of efficacy and utility of spirometry data in elderly (&gt;65years) individuals with or without lung diseases

Background: Spirometry is an important diagnostic monitoring tool for various lung disorders. Ventilatory function can be assessed by spirometry. Also, we can find whether it is obstructive or restrictive disease. An appropriate technique is essential to ensure accurate results. Spirometry requires proper understanding and cooperation of the patient while doing the test. The objective was to evaluate the efficacy and utility of spirometry data in elderly (&gt;65years) individuals with or without lung diseases.Methods: A hospital based cross sectional study was carried out among 199 subjects who were then divided into 100 controls and 99 cases. Spirometry was carried out among all subjects. The values of spirometry were compared among cases and controls as well as across age and sex groups. Student’s t-test was applied.Results: After studying the spirometric data in elderly population with or without lung disease, there was significant difference between cases and controls as far as pack years of smoking was concerned. There was significant difference in FEV1, FVC and FEV1/FVC between the cases and controls. As the age increased the spirometric values decreased. The spirometry was normal in controls in majority compared to none in cases.Conclusions: Spirometry should be used by all primary care and specialist physicians even in elderly population.

Does Ramadan Fasting Affect Spirometric Data of Healthy Adolescents?

Purpose:Several studies raised the effects of Ramadan fasting on healthy adults spirometric data, but none was performed in children. The aim of this study was to compare the spirometric data of a group of faster adolescents (n = 26) with an age-matched non-faster one (n = 10).Methods:This comparative quasi-experimental study, including 36 healthy males aged 12 to 15 years, was conducted during the summer 2015 (Ramadan: June 18 to July 16). Three sessions (Before-Ramadan [Before-R], Mid-Ramadan [Mid-R], After-Ramadan [After-R]) were selected for spirometry measurements. Spirometry was performed around 5.5 to 3.5 h before sunset and the spirometric data were expressed as percentages of local spirometric norms.Results:The two groups of fasters and non-fasters had similar ages and weights (13.35 ± 0.79 vs 12.96 ± 0.45 years, 46.8 ± 9.2 vs 41.7 ± 12.6 kg, respectively). There was no effect of Ramadan fasting on forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow, and maximal mid-expiratory flow. For example, during the Before-R, Mid-R, and After-R sessions, there was no significant difference between the fasters and non-fasters mean FVC (101 ± 11 vs 99 ± 14, 101 ± 12 vs 102 ± 14, 103 ± 11 vs 104 ± 13, respectively) or FEV1 (101 ± 13 vs 96 ± 16, 98 ± 11 vs 97 ± 16, 101 ± 10 vs 98 ± 16, respectively).Conclusions:Ramadan fasting had no interaction effect with the spirometric data of Tunisian healthy male adolescents.

Joint Indian Chest Society-National College of Chest Physicians (India) guidelines for spirometry.

Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India.

Applicability of Biomarker Analysis in Primary Prevention (through awareness) for Street Runners

INTRODUCTION: Street runner is a health-friendly and low-cost practice, which makes it currently biased worldwide. However, this prophylaxis unaccompanied by qualified professionals culminates in a higher incidence of lesions. OBJECTIVES: The aim this study was to evaluate the efficacy of intervention at the primary level (awareness of habits and behaviors that modulate the physiological and biochemistry responses) given by qualified professionals through the analysis of biochemical and physiological parameters, in order to promote health. MATERIALS AND METHODS: The sample had 28 runners (both sexes) with mean age of 32.8 ± 7.2, subdivided into control group (without intervention) and test group (submitted to intervention/orientation on modifiable aspects before and after training, for example: feeding/hydration, metabolic/hormonal control, breathing, and posture). Two evaluations were performed, with a 45-day interval in both groups. In each evaluation, the participants were submitted to a 10 minute exercise test (mean intensity), and before and after the test the following parameters were measured: blood glucose and lactate, and spirometry. DISCUSSION AND RESULTS: Spirometric data demonstrated that the airway functionality increased significantly (p= 0.005) through the Tiffeneau index only in the test group, which in fact is directly related to the change in the metabolic profile. For the glycemic and lacthemic findings, the test group showed only tendency to maintain and decrease these parameters, respectively. However, even if based, these results demonstrate that there was a beneficial modification of the parameters analyzed after primary intervention. These results reinforce the applicability of the analysis and awareness on biochemical and physiological biomarkers for the promotion of health extrapolating the laboratory and clinical environment. CONCLUSION: Thus, the potential applicability of the intervention by educational processes of awareness is shown here, using basic parameters of biochemistry and physiology as a tool, aiming at the promotion of health at the primary level.

Analysis of a large cohort of cystic fibrosis patients with severe liver disease indicates lung function decline does not significantly differ from that of the general cystic fibrosis population.

Previous reports of lung function in cystic fibrosis (CF) patients with liver disease have shown worse, similar, or even better forced expiratory volume in 1 second (FEV1), compared to CF patients without liver disease. Varying definitions of CF liver disease likely contribute to these inconsistent relationships reported between CF lung function and liver disease. We retrospectively evaluated spirometric data in 179 subjects (62% male; 58% Phe508del homozygous) with severe CF liver disease (CFLD; defined by presence of portal hypertension due to cirrhosis). FEV1 values were referenced to both a normal population (FEV1% predicted) and CF population (CF-specific FEV1 percentile). We utilized a linear mixed model with repeated measures to assess changes in lung function (before and after diagnosis of CFLD), relative to both the normal and CF populations. At diagnosis of CFLD, the mean FEV1 was 81% predicted, or at the 53rd percentile referenced to CF patients without CFLD. There was a significant difference in post-CFLD slope compared to pre-CFLD slope (post–pre) using FEV1% predicted (-1.94, p-value < 0.0001). However, there was insignificant evidence of this difference using the CF-specific FEV1 percentile measure (-0.99, p-value = 0.1268). Although FEV1% predicted values declined in patients following CFLD diagnosis, there was not significant evidence of lung function decline in CF-specific FEV1 percentiles. Thus, the observed study cohort indicates diagnosis of severe CFLD was not associated with worsened CF lung disease when compared to a large CF reference population.

Clinical significance of interleukin-18 and interleukin-10 in patients with chronic obstructive pulmonary disease combined with hypertension

The problem of chronic obstructive pulmonary disease (COPD) in combination with hypertension (HT) is becoming more relevant because of the growth of its prevalence and adverse consequences in the world as well as in Ukraine.Aim: To assess the level of interleukin-18 (IL-18) and IL-10 in patients with COPD in combination with HT.Materials and methods. We examined 87 patients with occupational COPD GOLD 2–3, groups B, C, D. The main group included 67 patients with COPD in combination with HT stage II, the comparison group – 20 patients with COPD. Patients were divided into phenotypes: emphysematous, chronic bronchitic, frequent exacerbator and asthma-COPD overlap syndrome (ACOS) based on the analysis of clinical and anamnestic, anthropometric, spirometric data and chest X-ray examination. The examination was carried out in remission which is characterized by stable clinical symptoms and spirometry indices. General clinical and laboratory examinations, pulse oximetry, pulmonary function test, electrocardiographic, echocardiographic and chest X-ray examinations were performed in all patients. IL-18 and IL-10 in peripheral blood were determined by ELISA using a test system “Bender MedSystems, GmbH” (Austria). The control group included 20 practically healthy age- and gender-matched persons. Statistical analysis of the data was performed using nonparametric statistical methods. The probability of differences in independent groups was estimated using the Mann-Whitney U-criterion. All statistical tests were bilateral, differences were considered significant for P &lt; 0.05.Results. Analysis of IL-18 levels in patients of the main group, comparison group and control group showed statistically significant differences. The most significant increase in IL-18 level was observed in patients of the main group that was associated with more severe systemic inflammation in COPD combined with HT. The level of IL-10 was significantly increased only in the main group. Patients with COPD GOLD 3, groups C, D and COPD GOLD 2, group B did not significantly differ in IL-18 and IL-10 levels, but there was a tendency to decrease in IL-18 and increase in IL-10 levels in patients with COPD GOLD 3, groups C, D due to initial manifestations of IL-18-mediated proinflammatory response exhaustion. Significant differences between levels of IL-18 and IL-10 in patients with COPD with different phenotypes were revealed. IL-18 levels were elevated in all studied patients, but the degree of increase was quite different. Frequent exacerbators demonstrated blunted IL-18-mediated proinflammatory and excessive anti-inflammatory response.Conclusions. Cytokine imbalance in patients with COPD in combination with HT determines the course of disease and may be a prognostically significant criterion for consequences of the disease.

Exercise testing and spirometry as predictors of mortality in congenital heart disease: Contrasting Fontan physiology with repaired tetralogy of Fallot.

Risk prediction using cardiopulmonary exercise testing (CPET) in complex congenital heart disease tends to either focus on single diagnoses or complete cohorts. We aimed to evaluate patients with two distinct anatomies cared for at a single institution over the same time period to determine CPET variables associated with mortality. All Fontan and tetralogy of Fallot (TOF) subjects with CPET between November 1, 2002 and December 31, 2014 and subsequently died were identified (cases). Cases were matched 1:3 to controls with similar age, underlying anatomy and timing of exercise test. Of the 42 cases, 27 had a Fontan circulation and 15 with TOF. All Fontan patients had a low peak VO2 but there was no significant difference between cases and controls (52.5±14.7 v. 57.4%±13.5% predicted, P=.11). Spirometry values were significantly lower in Fontan cases than controls (eg, FVC 67.4±19.1 v 77.6%±14.9% predicted, P=.007). Spirometry values were also lower in TOF cases than controls (% predicted FVC 62.8±16.7 v 75±14, P=.006). In contrast to the Fontan analysis, both %peak predicted VO2 and VE/VCO2 slope were worse in TOF cases than controls (50.1±13.5 v. 68.5%±15.0% predicted VO2 , P=.0004; 33.9±12.9 v 26.6±4.4, P=.002). Multivariable analysis also identified different predictors of mortality among the anatomic subgroups. Spirometric data (FVC) correlated most strongly with mortality in Fontan patients while the VE/VCO2 slope was most associated with outcome in TOF patients. Variables most predictive of mortality in Fontan and TOF patients diverge but spirometry was abnormal and associated with mortality in both groups. When compared with age-matched controls, reduced FEV1 and FVC correlated most strongly with mortality in Fontan patients while VE/VCO2 slope correlated with mortality for TOF patients. These findings further support the importance of lung health in patients with complex congenital heart disease.

The multi-ethnic global lung initiative 2012 (GLI-2012) norms reflect contemporary adult's Algerian spirometry.

BackgroundThe validation of the multi-ethnic GLI-2012 spirometric norms has been debated in several countries. However, its applicability in Algeria has not been verified.AimTo ascertain how well the GLI-2012 norms fit contemporary adult Algerian spirometric data.MethodsThis was a cross-sectional study of a convenience sample of 300 healthy non-smoker adults (50% men, age range: 18–85 years) recruited from the Algiers region general population. All participants underwent a clinical examination and a plethysmography measurement. Z-scores for some spirometric data [FEV1, FVC, FEV1/FVC and forced expiratory flow at 25–75% of FVC (FEF25-75%)] were calculated. If the average Z-score deviated by “< ± 0.5” from the overall mean, the GLI-2012 norms would be considered as reflective of contemporary Algerian spirometry.ResultsThe means±SDs of age, height, weight, FVC, FEV1, FEV1/FVC and FEF25-75% of the participants were, respectively, 48±17 years, 1.65±0.10 m, 73±14 kg, 4.04±1.04 L, 3.18±0.82 L, 0.79±0.05 and 4.09±1.09 L/s. Almost the quarter of participants were obese. The total sample means±SDs Z-scores were 0.22±0.87 for FVC, 0.04±0.88 for FEV1, -0.34±0.67 for FEV1/FVC and 0.93±0.79 for FEF25-75%. For men and women, only the means±SDs of the FEF25-75% Z-scores exceeded the threshold of “± 0.5”, respectively, 1.13±0.77 and 0.73±0.76.ConclusionResults of the present study, performed in an Algerian population of healthy non-smoking adults, supported the applicability of the GLI-2012 norms to interpret FEV1, FVC and FEV1/FVC but not the FEF25-75%.