Spirometric Pattern Research Articles

#5129 CLINICAL-FUNCTIONAL KIDNEY-LUNG LINK IN A POPULATION OF HEMODIALYZED PATIENTS

Abstract Background and Aims We know that lung and kidney are intimately related from a functional standpoint, both in physiological conditions and in diseases. The close relationship between lung and kidney (kidney-lung link) is evidence of a homeostatic connection between all organs and systems in an attempt to maintain the body system balance. In a recent review [1] we emphasized the importance to search for the clinical signs of a disease not only in the primary affected organ but also in organ functionally related. Method For this purpose we examined 81 hemodialyzed patients, with a mean age of 66.6 ± 13 years (28 f and 53 M), undergoing hemodialysis treatment (mean dialysis: 96 ± 34 months), with regard to smoking habits (47 non-smokers and 34 smokers with an average of 19.8 cigarettes per day: pack / years: 33.4 ± 2.9). Pulmonary function test (PFT) and clinical signs were evaluated. we excluded 6 patients (4 males and 2 females) in the smoking group with obstructive spirometric pattern (detected by a FEV1.0/FVC ratio lower than 70 absolute value), so that the final non-smoking group consisted of 47 patients and the smoking-group by 28 smokers: both groups matched for anthropomorphic data. Results The mean values of PFT were globally no different between smokers with normal PFT and non smokers are summarized in Table 1: Although the never-smoking group was nearly twice as large as the smokers, and PFT were similar and normal, respiratory symptoms were predominant: daily cough (49 yes; 26 no); chronic phlegm (51 yes; 24 no). Conclusion in dialysis patients, cough and phlegm are common symptoms, regardless of smoking and spirometric values. Probably these results are the consequence of synergistic effects between lungs and kidneys, as recently demonstrated [2]. Hence the need to evaluate dialysis patients from the clinical-functional point of view of both, kidneys and lungs, in order to evaluate the appropriate, personalized, therapeutic strategy according to the last evidences of the literature [3].

Race-neutral equations for assessment of lung function in children with thalassemia.

The aim of this study was to assess pulmonary dysfunction in children with transfusion-dependent thalassemia (TDT) using the Global Lung Function Initiative (GLI) 2022 race-neutral spirometric reference equations and to determine the main predicting factors. The spirometric results of 68 children with TDT were compared to the results of 68 healthy control subjects using both GLI-2012 reference equations for Caucasians and GLI-2022 global equations. Associations between the spirometric data and various anthropometric, clinical, and laboratory parameters were analyzed to detect predictors of pulmonary dysfunction in this group of patients. Children with TDT showed significantly lower values of FVC and FEV1 with a predominance of the restrictive pattern (23.53%). Thalassemic children with the restrictive pattern were significantly older, had a longer duration of regular blood transfusion, lower height, weight, and BMI z-scores, higher average serum ferritin, and higher frequency of having a serum ferritin level >2500 ng/mL. The strongest predictor for having a restrictive spirometric pattern was high serum ferritin. Our analysis shows that the transition from GLI-2012 spirometric reference equations for Caucasians to the GLI-2022 global equations has led to a reduction in the prevalence rate of restrictive pulmonary dysfunction in children with TDT, which should not affect the patient outcome in the long term. Asymptomatic children with TDT exhibited a restrictive spirometric pattern in a significant proportion. The most important predictor was high serum ferritin. We encourage the inclusion of pulmonary function testing in the routine monitoring of patients with TDT, especially in older patients and those with iron overload.

Trajectories of Spirometric Patterns, Obstructive and PRISm, in a Population-Based Cohort in Latin America.

Preserved ratio impaired spirometry (PRISm) has been associated with adverse outcomes and increased transition to other spirometric categories over time. We aimed to examine its prevalence, trajectories over time, and outcomes in a population-based sample from Latin America. Data were obtained from two population-based surveys of adults from three cities in Latin America (PLATINO study), conducted on the same individuals 5-9 years after their baseline examination. We estimated the frequency of PRISm defined by FEV1/FVC≥0.70 with FEV1 <80%, describing their clinical characteristics, longitudinal transition trajectories over time, factors associated with the transition. At baseline, 2942 participants completed post-bronchodilator spirometry, and 2026 at both evaluations. The prevalence of normal spirometry was 78%, GOLD-stage 1 10.6%, GOLD 2-4 6.5%, and PRISm was: 5.0% (95% CI 4.2-5.8). PRISm was associated with less schooling, more reports of physician-diagnosis of COPD, wheezing, dyspnea, missing days at work, having ≥2 exacerbations in the previous year but without accelerated lung function decline. Mortality risk was significantly higher in PRISm (HR 1.97, 95% CI 1.2-3.3) and COPD GOLD 1-4 categories (HR 1.79, 95% CI 1.3-2.4) compared with normal spirometry. PRISm at baseline most frequently transitioned to another category at follow-up (46.5%); 26.7% to normal spirometry and 19.8% to COPD. The best predictors of transition to COPD were closeness of FEV1/FVC to 0.70, older age, current smoking, and a longer FET in the second assessment. PRISm, is a heterogeneous and unstable condition prone to adverse outcomes that require adequate follow-up.

The effect of diuretics on spirometric parameters in patients with ischemic heart failure

Heart failure is the failure of the cardiac pump under physiological loading conditions to impart sufficient hydraulic energy output in order to maintain a physiological circulation. A cohort study extended over a period of 14 months from the first of august 2010 to the first of November 2011. The patient was diagnosed as having heart failure according to the recommendation of the European Society of Cardiology, depending on the result of history, examination and echocardiographic conformation. Spirometric data were collected in accordance with American Thoracic Society standards. All the patients had a restrictive spirometric defect before treatment with diuretics, but after treatment all show normal spirometric pattern. The present study recommend the followings: - The use of a cheap office spirometer in rural area by general practitioner (GP) doctors and nursing staff could be useful for follow up patients with ischemic heart failure to detect early deterioration by objective mean to refer the patient for specialized care. Also, the office spirometer needs no special skills and the nursing staff can master the procedure with a 2 weeks training course.

Prevalence of restrictive lung function in children and adults in the general population

BackgroundRestrictive lung function (RLF) is characterized by a reduced lung expansion and size. In the absence of lung volume measurements, restriction can be indirectly assessed with restrictive spirometric patterns (RSP) by spirometry. Prevalence data on RLF by the golden standard body plethysmography in the general population are scarce. Therefore, we aimed to evaluate the prevalence of RLF and RSP in the general population by body plethysmography and to determine factors influencing RLF and RSP. MethodsPre-bronchodilation lung function data of 8891 subjects (48.0% male, age 6–82 years) have been collected in the LEAD Study, a single-centered, longitudinal, population-based study from Vienna, Austria. The cohort was categorized in the following groups based on the Global Lung Initiative reference equations: normal subjects, RLF (TLC < lower limit of normal (LLN)), RSP (FEV1/FVC ≥ LLN and a FVC < LLN), RSP only (RSP with TLC ≥ LLN). Normal subjects were considered those with FEV1, FVC, FEV1/FVC and TLC between LLN and ULN (upper limit of normal). ResultsThe prevalence of RLF and RSP in the Austrian general population is 1.1% and 4.4%. Spirometry has a positive and negative predictive value of 18.0% and 99.6% to predict a restrictive lung function. Central obesity was associated with RLF. RSP was related to smoking and underweight. ConclusionsThe prevalence of true restrictive lung function and RSP in the Austrian general population is lower than previously estimated. Our data confirm the need for direct lung volume measurement to diagnose true restrictive lung function.

Effect of Altitude on Respiratory Functional Status in COVID-19 Survivors: Results from a Latin American Cohort-FIRCOV.

Laura Gochicoa-Rangel, Santiago C. Arce, Carlos Aguirre-Franco, Wilmer Madrid-Mejía, Mónica Gutiérrez-Clavería, Lorena Noriega-Aguirre, Patricia Schonffeldt-Guerrero, Agustín Acuña-Izcaray, Arturo Cortés-Telles, Luisa Martínez-Valdeavellano, Federico Isaac Hernández-Rocha, Omar Ceballos-Zúñiga, Rodrigo Del Rio Hidalgo, Sonia Sánchez, Erika Meneses-Tamayo, and Iván Chérrez-Ojeda; and on Behalf of the Respiratory Physiology Project in COVID-19 (FIRCOV). Effect of altitude on respiratory functional status in COVID-19 survivors: results from a Latin American Cohort-FIRCOV. High Alt Med Biol 24:37-48, 2023. Persistent symptoms and lung function abnormalities are common in COVID-19 survivors. Objectives: To determine the effect of altitude and other independent variables on respiratory function in COVID-19 survivors. Methods: Analytical, observational, cross-sectional cohort study done at 13 medical centers in Latin America located at different altitudes above sea level. COVID-19 survivors were invited to perform pulmonary function tests at least 3 weeks after diagnosis. Results: 1,368 participants (59% male) had mild (20%), moderate (59%), and severe (21%) disease. Restriction by spirometry was noted in 32%; diffusing capacity of the lung for carbon monoxide (DLCO) was low in 43.7%; and 22.2% walked less meters during the 6-minute walk test (6-MWT). In multiple linear regression models, higher altitude was associated with better spirometry, DLCO and 6-MWT, but lower oxygen saturation at rest and during exercise. Men were 3 times more likely to have restriction and 5.7 times more likely to have a low DLCO. Those who had required mechanical ventilation had lower DLCO and walked less during the 6-MWT. Conclusions: Men were more likely to have lower lung function than women, even after correcting for disease severity and other factors. Patients living at a higher altitude were more likely to have better spirometric patterns and walked farther but had lower DLCO and oxygen saturation.

BRONQUIECTASIAS NÃO FIBROCÍSTICAS: UM PERFIL EPIDEMIOLÓGICO EM HOSPITAL PEDIÁTRICO

Objectives: to describe the epidemiological profile of patients with non-cystic fibrosis bronchiectasis in a pediatric hospital and to expand the knowledge of this comorbidity in the pediatric population. Methods: Chest CT scans performed from January 2016 to January 2020 in a pediatric care service were selected. The reports were consulted, verifying those with compatible criteria currently accepted for the diagnosis of bronchiectasis. The medical records of those selected underwent a review process in search of the variables analyzed. Patients diagnosed with cystic fibrosis and with outdated medical records were excluded. Results: Of the 2319 reports studied, 42 patients were identified. Among these, 59.5% were female, 66.7% were followed up at a pneumopediatrics outpatient clinic, and the mean age at the time of imaging diagnosis was 9.3 years (±4.9). At follow-up, 57.1% of patients underwent spirometry and 35.7% underwent sputum culture. The most observed bacterial growth was that of Pseudomonas aeruginosa (33.4%) and the most frequent spirometric pattern was restrictive (29.2%). Of the presumptive etiologies, the most prevalent was recurrent pneumonia (21.4%), followed by bronchiolitis obliterans (14.3%) and collagen diseases (14.3%). Conclusions: The results found in this study allowed a better characterization of this subgroup of patients. In addition, the importance of diagnosing non-cystic fibrosis bronchiectasis is reinforced, as its therapy requires specific and individualized management.

Markers of Bronchiolitis Obliterans Syndrome after Lung Transplant: Between Old Knowledge and Future Perspective.

Bronchiolitis obliterans syndrome (BOS) is the most common form of CLAD and is characterized by airflow limitation and an obstructive spirometric pattern without high-resolution computed tomography (HRCT) evidence of parenchymal opacities. Computed tomography and microCT analysis show abundant small airway obstruction, starting from the fifth generation of airway branching and affecting up to 40-70% of airways. The pathogenesis of BOS remains unclear. It is a multifactorial syndrome that leads to pathological tissue changes and clinical manifestations. Because BOS is associated with the worst long-term survival in LTx patients, many studies are focused on the early identification of BOS. Markers may be useful for diagnosis and for understanding the molecular and immunological mechanisms involved in the onset of BOS. Diagnostic and predictive markers of BOS have also been investigated in various biological materials, such as blood, BAL, lung tissue and extracellular vesicles. The aim of this review was to evaluate the scientific literature on markers of BOS after lung transplant. We performed a systematic review to find all available data on potential prognostic and diagnostic markers of BOS.

Assessment of lung function by spirometry in transfusion-dependent thalassemia patients in a tertiary care center in Sultanate of Oman

Introductionβ-thalassemia’s are hereditary chronic hemolytic diseases, the mainstay of treatment of thalassemia major is regular blood transfusion and iron chelation. They cause many complications, one of the recognized complications related to respiratory system is pulmonary hypertension. Respiratory functions in those patients are not well studied in most of the world. The studies done to assess respiratory function are inconsistent, some found a predominantly restrictive pattern, others found obstructive pattern, and few found normal spirometry. The aim of this study was to assess the spirometric patterns in asymptomatic Omani patients with transfusion-dependent thalassemia using spirometry studies. MethodsTransfusion-dependent thalassemia patients who are registered at Sultan Qaboos University Hospital who are > 15 years old and able to perform spirometry test were selected for the study after they signed the informed consent. All the patients were free of any respiratory disease. Spirometry was performed in all patients in the sitting position and FVC, FEV1, FEV1/FVC were obtained. ResultsTotal number of thalassemia patients enrolled in the study was 37. 32 patients are suffering from thalassemia major and 5 are suffering from thalassemia intermedia. The mean age of our patients was 29.95 years. We found that 37.8 % of the patients showed normal spirometry. Most patients had abnormal spirometry (62.1 %). Of these, 35.1 % showed a restrictive pattern while 27 % showed obstructive pattern. ConclusionSpirometry assessment of the lung function in thalassemia patients who are receiving regular transfusion showed that majority had abnormal spirometry results despite being asymptomatic from a respiratory point of view.

The impact of driving pressure on postoperative pulmonary complication in patients with different respiratory spirometry

Risk factors for postoperative pulmonary complication (PPC) have not been determined according to preoperative respiratory spirometry. Thus, we aimed to find contributors for PPC in patients with restrictive or normal spirometric pattern. We analyzed 654 patients (379 with normal and 275 with restrictive spirometric pattern). PPCs comprised respiratory failure, pleural effusion, atelectasis, respiratory infection, and bronchospasm. We analyzed the association between perioperative factors and PPC using binary logistic regression. In particular, we conducted subgroup analysis on the patients stratified according to preoperative spirometry. Of 654 patients, 27/379 patients (7.1%) with normal spirometric pattern and 33/275 patients (12.0%) with restrictive spirometric pattern developed PPCs. Multivariable analysis demonstrated that high driving pressure was the only intraoperative modifiable factor increasing PPC risk (OR = 1.13 [1.02–1.25], p = 0.025). In the subgroup of patients with restrictive spirometric pattern, intraoperative driving pressure was significantly associated with PPC (OR = 1.21 [1.05–1.39], p = 0.009), whereas driving pressure was not associated with PPC in patients with normal spirometric pattern (OR = 1.04 [0.89–1.21], p = 0.639). In patients with restrictive spirometric pattern, greater intraoperative driving pressure is significantly associated with increased PPC risk. In contrast, intraoperative driving pressure is not associated with PPC in patients with normal spirometric pattern.

Diagnostic Performance of Forced Expiratory Volume in Six Seconds for the Detection of Obstructive and Restrictive Pulmonary Diseases in a Population of Young Adults in South of Iran

Background: Forced expiratory volume in 6 seconds (FEV6) is a reliable substitute for forced vital capacity (FVC) to identify pulmonary diseases. This study aimed to determine the diagnostic performance of FEV6 in the detection of obstructive and restrictive spirometric patterns. Methods: In this cross-sectional study, spirometry was performed on patients referred to the occupational medicine clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, 2018. Spirometric parameters, including FEV1, FVC, and FEV6, were recorded for those tests meeting the American Thoracic Society (ATS) standards. Taken as the reference, the FEV1/FVC ratio&lt;70% indicated airway obstruction, and the restrictive pattern was defined as FVC&lt;80%. Results: In general, 1100 spirometries were included after meeting the ATS standards. The optimal cut-off of FEV1/FEV6 for the prediction of airway obstruction was 71.45% with a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 97.22%, 98.22%, 89.17%, 99.57%, and 98.09%, respectively. The best cut-off of FEV6 for the prediction of the restrictive pattern was 79.23% with the corresponding diagnostic indices of 97.29%, 99.05%, 94.11%, 99.57%, and 98.81%, respectively. Based on the FEV1/FEV6 cut-off, the frequency of obstruction was 14.27% (157/1100) compared to 13.09% based on FEV1/FVC. The frequency of restriction was 13.90% (153/1100) according to the FEV6 cut-off compared to 13.45% with respect to FVC. Conclusion: Overall, our results indicated the applicability of FEV1/FEV6 as an accepted surrogate for FEV1/FVC to diagnose airway obstruction, particularly to screen for chronic obstructive pulmonary disease (COPD) among high-risk patients. In addition, FEV6 is potentially an appropriate substitute for FVC to detect a restrictive pattern.

Effects of SARS-CoV-2 Infection on Pulmonary Function Tests and Exercise Tolerance.

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to cause long-term pulmonary sequelae. Objects: The aim of this study was to evaluate the consequences of the SARS-CoV-2 infection on pulmonary function and on the 6-min walk test related to the severity of the disease. Methods: A cross-sectional study was conducted at the “Policlinico Tor Vergata” Academic Hospital (Rome, Italy), including 75 patients evaluated in post-COVID clinics at the Respiratory Units between November 2020 and September 2021. Complete pulmonary function tests, 6-min walk tests and persistence of symptoms were performed. Results: Of the 75 subjects, 23 had mild, 16 moderate, 26 severe and 10 very severe COVID-19, classified according to WHO. Very severe patients had a lower FVC (100 ± 10%pr) compared to the other groups (116 ± 16%pr, 116 ± 13%pr, 122 ± 20%pr from mild to severe; p < 0.05) and a lower TLC (94 ± 13%pr) compared to the others (102 ± 10%pr, 108 ± 15%pr, 108 ± 12%pr from mild to severe; p < 0.05). DLco and DLco/VA were similar among groups. At the 6MWT, distance, rest and nadir SpO2 were similar among groups, but all groups presented a significant decrease in SpO2 from rest to nadir (Rest SpO2: 97.0 ± 1.0% vs. Nadir SpO2: 93.6 ± 2.7%, p < 0.01). A positive correlation was found between desaturation and delta SpO2 (rest—nadir) (R: 0.29, p < 0.05) and the Distance Desaturation Product (R: 0.39, p < 0.01). Conclusions: These results showed that, although the PFTs are within the normal range, there is still a mild restrictive spirometric pattern after six months in very severe subjects. Moreover, the only persistent pathological sequalae of SARS-CoV-2 infection were a mild desaturation at 6MWT, despite the severity of the infection.

Decrements in lung function and respiratory abnormalities associated with exposure to diacetyl and 2,3-pentanedione in coffee production workers.

Coffee production workers are exposed to complex mixtures of gases, dust, and vapors, including the known respiratory toxins, diacetyl, and 2,3-pentanedione, which occur naturally during coffee roasting and are also present in flavorings used to flavor coffee. This study evaluated the associations of these two α-diketones with lung function measures in coffee production workers. Workers completed questionnaires, and their lung function was assessed by spirometry and impulse oscillometry (IOS). Personal exposures to diacetyl, 2,3-pentanedione, and their sum (SumDA+PD) were assigned to participants, and metrics of the highest 95th percentile (P95), cumulative, and average exposure were calculated. Linear and logistic regression models for continuous and binary/polytomous outcomes, respectively, were used to explore exposure-response relationships adjusting for age, body mass index, tenure, height, sex, smoking status, race, or allergic status. Decrements in percent predicted forced expiratory volume in 1 second (ppFEV1) and forced vital capacity (ppFVC) were associated with the highest-P95 exposures to 2,3-pentanedione and SumDA+PD. Among flavoring workers, larger decrements in ppFEV1 and ppFVC were associated with highest-P95 exposures to diacetyl, 2,3-pentanedione, and SumDA+PD. Abnormal FEV1, FVC, and restrictive spirometric patterns were associated with the highest-P95, cumulative, and average exposures for all α-diketone metrics; some of these associations were also present among flavoring and non-flavoring workers. The combined category of small and peripheral airways plus small and large airways abnormalities on IOS had elevated odds for highest-P95 exposure to α-diketones. These results may be affected by the small sample size, few cases of abnormal spirometry, and the healthy worker effect. Associations between lung function abnormalities and exposure to α-diketones suggest it may be prudent to consider exposure controls in both flavoring and non-flavoring settings.

Clinical characteristics, radiological features, and disease severity of bronchiectasis according to the spirometric pattern

Bronchiectasis show various ventilatory disorders in pulmonary function. The characteristics and severity of patients with bronchiectasis according to these pulmonary dysfunctions are still very limited. This study aimed to evaluate the clinical, radiologic feature and the disease severity of patients with bronchiectasis according to spirometric patterns. We retrospectively evaluated 506 patients with bronchiectasis who underwent pulmonary lung function test (PFT) at a referral hospital between 2014 to 2021. The results showed that cylindrical type was the most common (70.8%) type of bronchiectasis on chest Computed tomography (CT), and 70% of patients had bilateral lung involvement. On the other hand, obstructive ventilatory disorder was the most common (51.6%), followed by normal ventilation (30%) and restrictive ventilatory disorder (18.4%). The modified Medical Research Council (mMRC) was highest in patients with obstructive ventilatory disorders, Modified Reiff score [median (interquartile range)] [6 (3–10), P < 0.001], FACED (FEV1, Age, Chronic colonization, Extension, and Dyspnea) score [3 (1–4), P < 0.001], and Bronchiectasis Severity (BSI) score [8 (5–11), P < 0.001] showed significantly highest values of obstructive ventilatory disorder rather than restrictive ventilatory disorder and normal ventilation. More than half of patients with bronchiectasis had obstructive ventilatory disorder. Bronchiectasis with obstructive ventilatory disorders has more dyspnea symptom, more disease severity and more radiologic severity. There was no significant association between spirometric pattern and radiologic type, but the more severe the radiologic severity, the more severe the lung function impairment.

Clinical predictors of lung function in patients recovering from mild COVID-19

BackgroundFew studies have assessed lung function in Hispanic subjects recovering from mild COVID-19. Therefore, we examined the prevalence of impaired pulmonary diffusing capacity for carbon monoxide (DLCO) as defined by values below the lower limit of normal (< LLN, < 5th percentile) or less than 80% of predicted in Hispanics recovering from mild COVID-19. We also examined the prevalence of a restrictive spirometric pattern as defined by the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) being ≥ LLN with the FVC being < LLN. Finally, we evaluated previous studies to find factors correlated to impaired DLCO post-COVID-19.MethodsIn this observational study, adult patients (n = 146) with mild COVID-19 were recruited from a long-term follow-up COVID-19 clinic in Yucatan, Mexico, between March and August 2021. Spirometry, DLCO, and self-reported signs/symptoms were recorded 34 ± 4 days after diagnosis.ResultsAt post-evaluation, 20% and 30% of patients recovering from COVID-19 were classified as having a restrictive spirometric pattern and impaired DLCO, respectively; 13% had both. The most prevalent reported symptoms were fatigue (73%), a persistent cough (43%), shortness of breath (42%) and a blocked/runny nose (36%). Increased age and a restrictive spirometric pattern increased the probability of having an impaired DLCO while having a blocked nose and excessive sweating decreased the likelihood. The proportion of patients with previous mild COVID-19 and impaired DLCO increased by 13% when the definition of impaired DLCO was < 80% predicted instead of below the LLN. When comparing previous studies, having severe COVID-19 increased the proportion of those with impaired DLCO by 21% compared to those with mild COVID-19.ConclusionsOne-third of patients with mild COVID-19 have impaired DLCO thirty-four days post-diagnosis. The criteria that define impaired DLCO and the severity of COVID-19 disease affects the proportion of those with impaired DLCO at follow-up. One-fifth of patients have a restrictive spirometric pattern.

AN ASSESSMENT OF PLEUROPULMONARY POST-TUBERCULOSIS PATIENTS IN A TEACHING HOSPITAL IN EAST INDIA

Objectives: Quality of life of a patient may be impaired seriously in the aftermath of pleuropulmonary tuberculosis (TB) even after being cured or taking adequate treatment. Proper evaluation of post-TB sequelae is of extreme clinical importance. The study objective was to assess demographic, clinical, radiological, and spirometric pattern of pleuropulmonary post-TB patients in a teaching hospital. Methods: An observational cross-sectional study was carried out in a teaching hospital in India over a period of 14 months. A total of 300 patients of more than 12 years of age from both genders were included in the study. Detailed history, clinical, radiological, microbiological, and spirometric evaluation were being carried out. Results: It was a male predominant study with male: female ratio of 2.29:1 and mean age of patient was 52.97 ± 0.51 (mean±standard error of mean) years. History of pleural and pulmonary TB was present in 11% and 89% of cases, respectively. Cough was present in all patients. Shortness of breath (86.33%) and hemoptysis (58.33%) were among other common presenting symptoms. In majority of cases, pulmonary involvement was unilateral (57%). Pleural fibrosis/thickening was seen in 11% of cases, lung parenchymal fibrosis 38.67%, bronchiectasis in 12.67%, and aspergilloma found in 7% of cases. Bacteriological positivity was detected in 14.33% of cases. Spirometric evaluation revealed restrictive pattern (50.20%) in most of the cases followed by obstructive pattern in 38.13% of cases. Conclusion: Respiratory symptoms, radiological, and spirometric abnormalities can present among pleuropulmonary post-TB patients as a sequelae. It may be considered as an important cause of chronic lung disease, particularly in high TB burden countries.

Spirometric Patterns in Patients with Sleep-Related Breathing Disorders: Some Points to Highlight.

Spirometric Patterns in Patients with Sleep-Related Breathing Disorders: Some Points to Highlight.

The role of growth and nutrition in the early origins of spirometric restriction in adult life: a longitudinal, multicohort, population-based study

Spirometric restriction, defined as a reduced forced vital capacity (FVC) with a preserved FEV1/FVC ratio, is associated with increased respiratory and non-respiratory comorbidities and all-cause mortality in adulthood. Little is known about the early origins of this condition. We sought to identify early-life risk factors for spirometric restriction in adult life. In this longitudinal, multicohort, population-based study, we used data from the Tucson Children's Respiratory Study (TCRS), which recruited 1246 healthy infants at birth between April 1980, and October 1984, in Tucson, AZ, USA. Questionnaires were answered by the primary caregiver at enrolment, immediately after the child's birth, and multiple follow-up questionnaires were completed through childhood and adulthood. At the age of 22, 26, 32, and 36 years, lung function was measured with spirometry. At each survey, three mutually exclusive spirometric patterns were defined: (1) normal (FEV1/FVC ≥10th percentile and FVC ≥10th percentile); (2) restrictive (FEV1/FVC ≥10th percentile and FVC <10th percentile); and (3) obstructive (FEV1/FVC <10th percentile, independent of FVC). Data on demographic features and parental health factors were collected from questionnaires; pregnancy and perinatal data (including nutritional problems) and birth measurements were obtained from medical records; and weight, height, and body-mass index (BMI) during childhood (age 6-16 years) were measured by study nurses. The associations between early-life risk factors and spirometric patterns were assessed by multivariate multinomial logistic regression analysis, adjusted for survey year, sex, and race-ethnicity. Significant risk factors were further tested for replication in the Swedish Child (Barn), Allergy, Milieu, Stockholm, Epidemiological (BAMSE; n=1817; spirometry surveys were done at age 24 years) survey and the UK Manchester Asthma and Allergy Study (MAAS; n=411; spirometry surveys were done at age 18 years) birth cohorts, and fixed-effect meta-analyses of relative risk ratios (RRRs) from multinomial logistic regression models were done to generate a pooled estimate of the effect across the three cohorts. Measurements of body composition (MAAS; n=365) and total lung capacity (TCRS; n=173 and MAAS; n=407) were also available for a subset of participants. Of 1246 healthy infants included in TCRS, for the present study we included data for 652 participants who had at least one set of spirometry data, contributing up to 1668 observations. In the TCRS cohort, results from the multivariate models showed that maternal nutritional problems during pregnancy (RRR 2·48 [95% CI 1·30-4·76]; p=0·0062), being born small for gestational age (birthweight <10th percentile; 3·26 [1·34-7·93]; p=0·0093), and being underweight in childhood (BMI-for-age <5th percentile; 3·54 [1·35-9·26]; p=0·010) were independent predictors of spirometric restriction in adult life. Associations between being small for gestational age (p=0·0028) and underweight in childhood (p<0·0001) with adult spirometric restriction were supported by the results of meta-analysis of data from all three cohorts. In the MAAS cohort, having a low lean BMI (ie, <10th percentile) at age 11 years predicted adult (age 18 years) spirometric restriction (RRR 3·66 [1·48-9·02]; p=0·0048). These associations of spirometric restriction with small for gestational age, childhood underweight, and low lean BMI in childhood were verified in participants with spirometric restriction who had diminished total lung capacity, indicating that these factors specifically increase the risk of lung restriction. Poor growth and nutritional deficits in utero and throughout childhood precede and predict the development of spirometric restriction in adult life. Strategies to improve prenatal and childhood growth trajectories could help to prevent spirometric restriction and its associated morbidity and mortality burden. National Institutes of Health.

Differences in the clinical characteristics of chronic pulmonary aspergillosis according to spirometric impairment.

The clinical features by declining lung function remain uncharacterized in chronic pulmonary aspergillosis (CPA) patients. We investigated the clinical characteristics of CPA patients based on spirometric impairments (restrictive spirometric pattern [RSP] and obstructive spirometric pattern [OSP]) and their severity. We retrospectively analyzed medical records of CPA patients who underwent pulmonary function tests from March 2017 to February 2020. We used Global Lung Initiative 2012 equations with lower limit of normal. The clinical characteristics of patients with RSP were compared to those with OSP. Additionally, RSP patients’ characteristics were analyzed according to forced vital capacity (FVC) tertile, and OSP patients’ characteristics were analyzed according to forced expiratory volume in 1 second (FEV1) tertile. Among the 112 patients with CPA (52 [46%] with RSP and 60 [54%] with OSP), body mass index (BMI) was significantly lower in patients with RSP than in those with OSP (17.6 kg/m2 versus 20.3 kg/m2; P = 0.003), and non-tuberculous mycobacterial disease was more frequently observed in patients with RSP than in those with OSP (28.8% versus 11.7%; P = 0.004). Additionally, for patients with RSP, younger age and bilateral pulmonary lesions were more frequently observed in the first tertile group than in the other groups (P for trend: 0.025 and 0.001, respectively). For patients with OSP, low BMI, paracavitary infiltrates, and elevated WBC count were more frequently observed in the first tertile group than in the other groups (P for trend: < 0.001, 0.011, and 0.041, respectively). Differences in the clinical features of CPA patients were identified according to heterogeneous spirometric patterns and their severity. Further studies are needed to investigate the clinical significance of these findings.

Relationship Between Rheumatoid Arthritis and Pulmonary Function Measures on Spirometry in the UK Biobank.

To investigate the independent relationship of rheumatoid arthritis (RA) to the type and severity of pulmonary patterns on spirometry compared to the pulmonary patterns in general population controls. In this cross-sectional study, we investigated the association of RA with pulmonary function measures on spirometry among subjects in the UK Biobank who underwent spirometry for research purposes. RA cases were identified based on self-report and current disease-modifying antirheumatic drug/glucocorticoid use. Controls were subjects without RA from the general population. Outcome measures included continuous forced expiratory volume in 1 second percent predicted (FEV1 %) and forced vital capacity percent predicted (FVC%), type of spirometric pattern (restrictive or obstructive), and severity of the restrictive or obstructive pattern. We used multivariable regression to estimate the effects in RA cases compared to the effects in controls, adjusting for age, sex, body mass index, and smoking status/pack-years. Among 350,776 analyzed subjects who underwent spirometry (mean age 56.3 years; 55.8% female; 45.5% ever smokers), we identified 2,008 cases of treated RA. In multivariable analyses, RA was associated with lower FEV1 % (β = -2.93 [95% confidence interval (95% CI) -3.63, -2.24]), FVC% (β = -2.08 [95% CI -2.72, -1.45]), and FEV1 /FVC (β = -0.008 [95% CI -0.010, -0.005]) compared to controls. RA was additionally associated with restrictive patterns (odds ratio [OR] 1.36 [95% CI 1.21, 1.52]) and obstructive patterns (OR 1.21 [95% CI 1.07, 1.37]) independent of confounders, and was most strongly associated with severe restrictive and obstructive patterns. RA is associated with increased odds of restrictive and obstructive patterns, and this relationship is not explained by confounders, including smoking status. In addition to restrictive lung disease, clinicians should also be aware that airway obstruction may be a pulmonary manifestation of RA.