Spirometric Tests Research Articles

Spirometric reference equations and lung function testing in adults from Southwestern Tanzania.

The increasing relevance of lung function testing in diagnosing and treating pulmonary diseases globally requires adequate spirometric reference equations. However, locally derived reference standards from African countries are widely missing. This cross-sectional study was conducted in Southwestern Tanzania. Participants underwent a socio-demographic interview, anthropometric measurements and standardised spirometric lung function testing. Regression modelling was used to generate Tanzanian prediction equations for spirometry parameters forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1) and the FEV1/FVC ratio. Out of 400 recruited participants, 343 had usable spirometry results with respect to the American Thoracic Society (ATS)/European Respiratory Society (ERS) reproducibility and acceptability criteria. The mean age of participants was 32.65 years (SD 12.11), and 44,9% were females. Spirometric parameters increased with height but decreased with older age. The coefficients of our new prediction equations for spirometry parameters differed substantially from those of existing reference standards. This study provides prediction equations for spirometric lung function in a non-smoking Tanzanian population. The differences in existing equations underline the heterogeneity of locally derived reference equations in Africa and contribute insights and data to discussing global respiratory health care reference standards.

Ribs with Anterior Protrusion (Winged Ribs) Treated Using Percutaneous Chondroplasty.

Thoracic features play a significant role in determining various plastic surgery techniques. Particularly, the thorax has potential for excessive anterior projection, commonly referred to as winged ribs. This study aimed to describe a treatment method for addressing winged ribs for aesthetic purposes using percutaneous chondral management. Thirty-two female patients underwent FrontXribs from February to March 2023. Two angular measurements were obtained: (1) the angle formed by lines intersecting tangentially to the shoulder and the lower gluteal border; and (2) the angle formed by a line tangential to the greatest anterior projection, intersected by a vertical line on the standing axis. Length measurements were obtained using a tape measure at the position of the greatest thoracic projection. Pulmonary function studies were conducted. All variables were measured before surgery and 6 months postoperatively. On average, patients were 25 years old. The average operative time was 51.1 minutes, and all patients underwent general anesthesia. The average increase for angular measurement 1 was 26.1 degrees, whereas that for angular measurement 2 was 3.43 degrees. The average decrease in anterior chest length during the postoperative period was 9.66 cm (P < 0.001). Spirometric tests showed no significant changes 6 months postoperatively. The FrontXribs technique for treating winged ribs effectively reduces anterior costal protrusion, as evidenced by the angular variation of projections and the reduction in thoracic length at this level. No adverse effects on respiratory function were observed 6 months postoperatively.

Duration and Frequency of Spirometry Needed to Accurately Reflect Annualized Change of FEV1 in COPD.

The slope of FEV1 decline is commonly used to reflect the rate of disease progression for descriptive studies and therapeutic trials in COPD. Frequency and duration of spirometric testing needed to report the true slope is unknown. To define the minimum frequency and follow-up duration needed to accurately describe the annualized rate of FEV1 change among patients with moderate-to-very severe COPD. We performed a post-hoc analysis of the annualized rate of FEV1 change among 4412 subjects previously enrolled in the four-year UPLIFT trial of tiotropium versus placebo. Slope estimates were modeled for different iterations of semiannual or annual testing over a variable duration up to four years. All models were compared to a reference of semiannual spirometry for four years. The overall rate of post-bronchodilator FEV1 decline measured semi-annually for four years (44.6 ml; 95% CI:42.5-46.6) did not differ significantly from annual spirometry over the same period (43.7 ml; 95% CI:41.3-46.1) or semiannual spirometry over the first two years (44.3 ml; 95% CI:41.1-47.5). Agreement was consistent for two follow-up values as far as 24 months apart (43.3ml; 95% CI:39.9-46.8). Models based on less than two follow-up values or duration less than 18 months were characterized by relative underestimation of the slope. In a large cohort of patients with moderate-to-very severe COPD, the annualized rate of change in FEV1 was accurately represented by a minimum of two follow-up measurements over 18 months compared to semiannual testing over four years.

AI-Based Model Design for Prediction of COPD Grade from Chest X-Ray Images: A Model Proposal (COPD-GradeNet)

Chronic Obstructive Pulmonary Disease (COPD) ranks high among the leading causes of death, particularly in middle- and low-income countries. Early diagnosis of COPD is challenging, with limited diagnostic methods currently available. In this study, a artificial intelligence model named COPD-GradeNet is proposed to predict COPD grades from radiographic images. However, the model has not yet been tested on a dataset. Obtaining a dataset including spirometric test results and chest X-ray images for COPD is a challenging process. Once the proposed model is tested on an appropriate dataset, its ability to predict COPD grades can be evaluated and implemented. This study may guide future research and clinical applications, emphasizing the potential of artificial intelligence-based approaches in the diagnosis of COPD.

Symptoms of COPD in the absence of airflow obstruction are more indicative of pre-COPD than overdiagnosis.

Dysfunction of the small airways is a precursor of COPD but is not detectable on standard spirometric testing until significant destruction has occurred. A proportion of COPD patients have a forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.7 which is greater than the lower limit of normal (LLN), when adjusted for their age and sex. It is not understood whether this group of patients, known as "discordant COPD", are representative of "early COPD" or overdiagnosis. We sought to characterise discordant COPD (disCOPD) using radiology, lung function, serum biomarkers, activity monitoring and quality-of-life scores, comparing with COPD patients with an FEV1/FVC <0.7 and <LLN and healthy, age-matched controls. Six out of eight serum biomarkers were significantly different in the disCOPD group versus healthy controls, as were the scores of all four quality-of-life questionnaires. Activity monitoring revealed similar levels of sedentary time between the disCOPD group and concordant COPD (conCOPD). Computed tomography analysis showed less involvement of small airway dysfunction and emphysema in the disCOPD group versus conCOPD. Collectively, our findings support the hypothesis that disCOPD is a clinically relevant phenomenon that represents a pre-COPD state. Identification of such patients is important for early intervention and management before progression to fully established COPD.

Cost-effectiveness of population-based screening for chronic obstructive pulmonary disease in China: a simulation modeling study

China has the highest disease burden of chronic obstructive pulmonary disease (COPD) in the world; however, the diagnosis rate remains low. Screening for COPD in the population may improve early diagnosis and long-term health outcomes for patients with COPD. In this study, we aimed to evaluate the cost-effectiveness of population-based COPD screening policies in China. We developed a microsimulation model that simulated incidence, natural history, and clinical management of COPD over a lifetime horizon among the general population aged 35-80 years in China. We evaluated population-based screening policies with different screening methods (one-step with COPD Screening Questionnaire or two-step with additional portable spirometer test) and frequencies (one-time or every 1-10 years). We calculated the incremental cost-effectiveness ratio (ICER) of the screening policies compared with the status quo (without screening) and identified the most cost-effective screening policy. Scenario and sensitivity analyses were performed to assess the impact of key parameters and the robustness of model results. Compared with the status quo, all population-based COPD screening policies were cost-effective with estimated ICERs ranging between $8034 and $13,209 per quality-adjusted-life-year (QALY), all under the willingness-to-pay value of $38,441/QALY (three times China's gross domestic product per capita). A total of 0.39%-8.10% of COPD-related deaths and 0.58%-2.70% of COPD exacerbations were projected to be averted by COPD screening. Among all screening policies, annual two-step screening was the most cost-effective. Improving the linkage from screening to diagnosis and treatment could further increase population health benefits and the cost-effectiveness of COPD screening. Population-based screening for COPD could be cost-effective in China. Offering public programs for COPD screening similar to existing preventive health services for other chronic diseases could be a promising strategy to improve population health outcomes and mitigate the disease burden of COPD in China. Alexander von Humboldt Foundation, National Natural Science Foundation of China, CAMS Innovation Fund for Medical Science, Chinese Academy of Engineering project, and Horizon Europe.

A novel motivation tool to encourage smoking cessation in Iraq

Introduction: Smoking is one of the most important causes of diseases and affects the health of the body in general and the health of the lungs in particular. There is a significant increase in smoking rates among Iraqi adults after 2003 until now. The term lung age is a term that can be inferred from it about the extent to which the lungs are affected by causes of diseases such as smoking. Objective: To create knowledge about the importance of using lung age concept in order to encourage smoking cessation. Methodology: A comprehensive search was conducted for many studies on several sites including Google Scholar, Scopus and PubMed in order to find out whether using the concept lung age can encourage smoking cessation or not. Results: Studies have shown that using lung age concept can contribute to motivating smokers to quit smoking twice compared with non-motivated smokers. Conclusion: Smokers knowing their lung age can motivate them to quit smoking and it is important to use this term in developing countries after conducting a spirometer test

Insights from Overviewing Selective International Guidelines for Pediatric Asthma.

Asthma is a chronic atopic and inflammatory bronchial disease characterized by recurring symptoms and, episodic reversible bronchial obstruction and easily triggered bronchospasms. Asthma often begins in childhood. International guidelines are widely accepted and implemented; however, there are similarities and differences in the management approaches. There is no national guideline in many cities in Asia. This review aims to provide a practical perspective on current recommendations in the management of childhood asthma, specifically in the following aspects: diagnosis, classification of severity, treatment options, and asthma control, and to provide physicians with up-to-date information for the management of asthma. We used the PubMed function of Clinical Queries and searched keywords of "Asthma", "Pediatric," AND "Guidelines" as the search engine. "Clinical Prediction Guides", "Etiology", "Diagnosis", "Therapy," "Prognosis," and "Narrow" scope were used as filters. The search was conducted in November 2022. The information retrieved from this search was used in compiling the present article. Diagnosis is clinically based on symptom pattern, response to therapy with bronchodilators and inhaled corticosteroids, and spirometric pulmonary function testing (PFT). Asthma is classified in accordance with symptom frequency, peak expiratory flow rate (PEFR), forced expiratory volume in one second (FEV1), atopic versus nonatopic etiology, where atopy means a predisposition toward a type 1 hypersensitivity reaction. Asthma is also classified as intermittent or persistent (mild to severe). Unfortunately, there is no disease cure for asthma. However, symptoms can be prevented by trigger avoidance and suppressed with inhaled corticosteroids. Antileukotriene agents or long-acting beta-agonists (LABA) may be used together with inhaled corticosteroids if symptoms of asthma are not controlled. Rapidly worsening symptoms are usually treated with an inhaled short-acting beta-2 agonist (SABA, e.g., salbutamol) and oral corticosteroids. Intravenous corticosteroids and hospitalization are required in severe cases of asthma attacks. Some guidelines also provide recommendations on the use of biologics and immunotherapy. Asthma is diagnosed clinically, with supporting laboratory testing. Treatment is based on severity classification, from intermittent to persistent. Inhaled bronchodilator and steroid anti-inflammatory form the main stay of management.

Relationship between Laryngeal Disorders and Respiratory Function in Professional Road Cyclists

Objective: Engaging in outdoor cycling, particularly within cold and arid environments, frequently precipitates dryness in the laryngeal mucosa and induces various supraglottic disorders. Such conditions hold the potential to detrimentally impact respiratory system efficiency. This study principally sought to elucidate the influence of supraglottic and upper airway disorders on the respiratory capacities of road cyclist. Methods and Materials: This investigation encompassed seventy-two professional and elite road cyclists, comprising 22 females and 50 males, with an average age of 22 years and a Body Mass Index (BMI) of 21.95(±0.02) kg/m². Utilizing stroboscopic examinations, supraglottic conditions including Sicca, Tension, Edema, and Gastroesophageal Reflux Disease were assessed. Concurrently, respiratory capacity was evaluated through spirometric tests, encompassing Forced Vital Capacity [FVC], Forced Expiratory Volume in the first second [FEV1], Tidal Volume [VT], Maximum Vital Capacity [VC MAX], Mean Mid-Expiratory Flow [MMEF (FEF25-75)], Peak Expiratory Flow [PEF], and Controlled Mechanical Volume Ventilation [cMVV]. Analysis of Variance (ANOVA) was employed to analyze the relationship between stroboscopic and spirometric findings, additionally exploring correlations between the two. A backward method in regression analysis was used, with Edema (ED), Gastroesophageal Reflux Disease (GERD), Dry Laryngeal Mucosa (Sicca), and Tension (TE) serving as predictor variables against spirometric outcomes. Results: Predominantly, participants exhibited low levels of ED, GERD, Sicca, and TE. No substantial correlation emerged between ED, GERD, TE, and any spirometric indices (p-value &gt; 0.05). However, a notable relationship was observed between Sicca and the MMEF index (p-value &lt; 0.05). Regression analysis revealed significant outcomes for independent variables impacting VT and MEF25, with GERD negatively influencing VT in a statistically significant manner. Likewise, GERD's effect on the MEF25 variable was both negative and significant. Conclusion: This research offers critical insights into the impact of adverse training conditions and laryngeal disorders on respiratory function in cyclists. Addressing these concerns could facilitate considerable enhancements in their performance during training and competitive events.

Pulmonary function assessment after COVID-19 in vaccinated healthcare workers

COVID-19 typically presents with flu-like symptoms due to the viral infection itself. The most severe cases are characterised by lung damage, an important factor in fatal outcome due to alveolar damage. In some cases, patients develop a long COVID with persistent symptoms of chest pain and fatigue. Causes, including organ damage or inflammation, are being investigated. Clinical outcomes are variable and permanent lung damage is not fully understood, while vaccination is effective against severe infection but its effect on respiratory function in mild cases remains uncertain. This retrospective study aims to analyse changes in lung function in HCWs who had COVID-19 between 2020 and 2022, comparing their spirometric test results before and after the pandemic and taking into account their vaccination status. 321 HCWs were included in the study. The study examined spirometric parameters both before and after the pandemic, and all measured outcomes except the FEV1/FVC ratio showed a significant decrease during the study period. We then assessed the association between SARS-CoV-2 infection and changes in lung function parameters, analysing infections in 2020, 2021 and 2022 separately. We found a statistically significant difference in Forced vital capacity (FVC) between infected and non-infected subjects in 2020 and 2021, but not in 2022. To evaluate the protective effect of SARS-CoV-2 vaccination on respiratory function, a linear regression analysis was performed using changes in FVC, Forced expiratory volume in 1 s (FEV1), FVC/FEV1 ratio and Peak expiratory flow (PEF) as dependent variables. The analysis showed that the decline in FVC was significantly lower in subjects who had been vaccinated prior to infection. The study concludes that subclinical SARS-CoV-2 infections in 2020 and 2021 worsened respiratory parameters (FVC and FEV1), but vaccination protected against these effects. Even healthy individuals with previous infections showed respiratory changes, with vaccination providing protection, especially for FVC decline. This highlights the importance of vaccinating healthcare workers against COVID-19.

Assessment of Work Ability of Patients with COPD in Relation to the Workplace.

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic lung diseases and is an important cause of mortality and morbidity in the world. Chronic obstructive pulmonary disease is a heterogeneous and multisystemic disease. Aims of the study was to assess workability of patients with COPD in relation to the workplace. Prospective study. The study was conducted on 150 patients with COPD. Each patient was examined by an occupational medicine specialist and a standardized COPD Questionnaire was completed. A physical examination was performed with special emphasis on auscultatory findings on the lungs. Spirometric testing was performed. Using the statistical methods, the results of the parameters of temporary (number of lost working days) and permanent incapacity (exercised right to some kind of disability) of the examined group were analyzed. Descriptive statistics. SPSS 10.0. Results of the study showed that out of 150 patients, 48.67% had preserved working capacity for jobs. There are mostly jobs without special working conditions. Out of 150 patients, 51.33% had reduced working capacity for jobs. These are mostly workplaces with special working conditions, where respondents are exposed to the harmfulness of the workplace. Reduced working capacity was found in 51.33% of examined simple.

Determining factors affecting the acceptability of spirometry: A survey study in a tertiary chest diseases center.

Unlike other laboratory tests, spirometry requires the participant’s full compliance with the maneuvers in the test for an acceptable test result. In this study, we aimed to determine the suitability of spirometric tests regarding acceptability and the factors associated with acceptability. Before the test, our 15-scale questionnaire, prepared by us in the respiratory function laboratory, was applied to the participants who requested spirometric examination in our hospital. Afterwards, patients were subjected to spirometric analysis. Spirogram results of the participants were evaluated by four clinicians who were experts in the field based on the acceptability criteria in the American Thoracic Society and European Respiratory Society Spirometry Standardization Guidelines. Participants were divided into two groups as those who met the acceptability criteria and those who did not. Both groups were compared regarding demographic data, comorbidities, education levels, and questions in the questionnaire. The acceptability spirometry rate was 71.2%. The most common error among those who could not perform an acceptable test was the inability to complete the expiratory time to the time that would create a plateau, with 37.3%. Education level and acceptability of spirometry were not related (p= 0.228). Asthma was statistically significantly higher in the group that performed acceptable spirometry (p= 0.049). Acceptable spirometry rate was statistically significantly higher in the participants who had previously performed spirometric tests compared to the other group (p< 0.001). The test success of the participants who did not have success anxiety about the test was significantly higher than the other group (p= 0.033). Reduction of participants’ anxiety and repetitive testing increases test acceptability. For this reason, in our clinical practice, we recommend that people who want a spirometry test relieve their anxiety about the test and repeat the test in unacceptable tests.

При коморбидной кардиореспираторной патологии инициальное назначение β2-агонистов снижает риск бронхоспазма, вызванного β1-адреноблокаторами

In the treatment of patients with cardiorespiratory pathology, it is often necessary to simultaneously administer drugs that affect β-adrenergic receptors: β1-adrenoblockers and β2-agonists. β1-blockers can trigger a bronchospasm in patients with bronchoobstructive diseases, therefore, practitioners often decide not to prescribe them. This work aimed to evaluate functional parameters of patients with cardiovascular and bronchoobstructive diseases in the context of different sequences of administration of selective β1-blockers (bisoprolol) and long-acting β2-agonists (formoterol). This prospective, single-center 2-week pilot study involved 30 individuals suffering the aforementioned diseases. Using the envelopes method, we divided the patients into two groups of 15 people each. First group started therapy with a long-acting β2-agonist, second group — with a selective β1-adrenoblocker. While taking the β1-adrenoblocker, patients underwent a four-hour spirometric test enabling assessment of the external respiration function parameters. The tests and assessments have shown that the value of FEV1 went down in 33.3% of those who started therapy with a selective β1-adrenoblocker (bisoprolol 2.5 mg), and in the group that first took a long-acting β2-agonist for a week and then added bisoprolol 2.5 mg to the regimen the said value dropped in 7% of patients only. Thus, preceding long-acting β2-agonists, formoterol in particular, reduced the risk of bronchospastic incidents triggered by selective β1-adrenoblocker (bisoprolol) in patients with cardiorespiratory pathology.

Sex modifies the risk of HIV-associated obstructive lung disease in Ugandans postpneumonia.

Spirometric abnormalities are frequent, and obstructive lung disease (OLD) is a common comorbidity among people with HIV (PWH). HIV increases the risk of many comorbidities to a greater degree in women than in men. Few studies have evaluated whether sex modifies the HIV-associated risk of OLD. To evaluate the associations between sex and HIV with abnormal lung function, women and men with and without HIV underwent spirometric testing after completing therapy for pneumonia, including tuberculosis (TB), in Kampala, Uganda. OLD was defined as a postbronchodilator forced expiratory volume in the first second to forced vital capacity (FEV 1 /FVC) ratio less than 0.70. Associations between sex, HIV, and lung function were evaluated using multivariable regression models including sex-by-HIV interaction terms after adjusting for age, BMI, smoking status, and TB status. Among 348 participants, 147 (42%) were women and 135 (39%) were HIV-positive. Sixteen (11%) women and 23 men (11%) had OLD. The HIV-sex interaction was significant for obstructive lung disease ( P = 0.04). In the adjusted stratified analysis, women with HIV had 3.44 (95% CI 1.11-12.0; P = 0.04) increased odds of having OLD compared with men with HIV. Women without HIV did not have increased odds of having OLD compared with men without HIV. HIV appears to increase the risk of OLD to a greater degree in women than in men in an urban Ugandan setting. The mechanistic explanation for this interaction by sex remains unclear and warrants further study.

The Potential of Fractional Exhaled Nitric Oxide as a Biomarker in Predicting and Optimizing Use of Treatment in Asthma

Asthma affects the respiratory system and causes airway inflammation. The indication of asthma includes a triad of airway inflammation, hyperresponsiveness, and obstruction. Nitric Oxide (NO) is a gas that is exhaled and is a sign of airway inflammation. NO levels in the exhaled breath of patients with type 2 asthma are elevated, and fractional exhaled nitric oxide (FeNO) is an objective biomarker of airway inflammation. Measurements of FeNO are noninvasive, require minimal patient effort, and are easy to collect in clinical settings. The current review is a systematic review performed using PubMed, Science Direct, and Google Scholar according to The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) guidelines. This review discusses the entanglement of understanding FeNO measurement and supplementing existing diagnostic and assessment tools for inflammatory lung diseases. Monitoring FeNO can also help identify different asthma phenotypes within the asthma syndrome and suggest the optimal administration of inhaled corticosteroids (ICS) as elevated FeNO levels indicate ICS response. Non-adherence to ICS is a significant contributor to the failure of asthma treatment. A FeNO suppression test can be done to determine non-adherence. FeNO levels should be used with a careful history, conventional spirometric testing with bronchodilator reversibility, measures of bronchial hyperreactivity using methacholine, and other measures of eosinophilic inflammation, such as a peripheral blood eosinophil cell count. FeNO is more sensitive and specific when paired with other lung function tests.

Impact of adenotonsillectomy in pediatric respiratory function

IntroductionAdenotonsillar hypertrophy (ATH) is an important health condition that leads to upper airway obstruction and constitutes the main cause of obstructive sleep disordered breathing (OSDB) in children. The aim of this study was to analyze the effect of surgical intervention on spirometrical parameters of children with ATH/OSDB and upper airway recurrent infections (URTIs). Material and methodsThe study covered children treated surgically in a Pediatric Ambulatory Unit in a tertiary hospital. Spirometric tests were performed before and three months after surgery and results were compared. ResultsA total of 78 children were enrolled with a mean age of 6.95 ± 2,81 years. There was a significant improvement in forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF) and forced expiratory flow rate at 25% (F25) values after surgery in children suffering from OSDB (FVC pre: 1.52 ± 0.47 L vs FVC post: 1.85 ± 0.63 L, p < 0.001; FEV1 pre: 1.24 ± 0.38 L vs FEV1 post: 1.39 ± 0.40 L, p = 0.014; PEF pre: 2.04 ± 0.85 L/s vs PEF post: 2.33 ± 0.76 L/s, p = 0.014; F25 pre: 1.77 ± 0.77 L/s vs F25 post: 2.02 ± 0.73 L/s, p = 0.030). On a multivariate analysis model, preoperative tonsil size and performing tonsillectomy were the most significant determinants of improvement in spirometric values (p < 0.05). Children with isolated adenoid hypertrophy without tonsillar obstruction and those with URTIs alone did not show relevant differences in spirometric values after surgery (p > 0.05). No significant differences were found concerning pre-operative and post-operative forced expiratory flow rate at 75% (F75) and forced expiratory flow between 25 and 75% of the pulmonary volume (FEF25–75%) in any group (p > 0.05). ConclusionsSurgery seems effective in ameliorating spirometry values in patients with OSDB and ATH, namely FVC, FEV1, PEF and F25. Spirometry may give a clue on the importance of adequate surgical resolution of pediatric lymphoid hypertrophy obstruction. No significant differences exist on spirometric parameters of children with isolated adenoid hypertrophy and URTIs without ATH. Further studies are needed in order to evaluate the potential benefit of spirometry utilization in the daily clinical setting.

Comparison of physiological characteristics and physical performance measures among athletes from random intermittent dynamic type sports

Background and Study Aim. The physiological [Maximum oxygen uptake (VO2max), Peak Inspiratory Flow (PIF), Peak Expiratory Flow (PEF), Force Vital Capacity (FVC)] and physical performance measures [power, dynamic balance, flexibility, agility, and speed] are the key determinants in random intermittent dynamic type sports which enable the players to address decisive situations. Therefore, the purpose of this study was to determine the physiological and physical measures among athletes from random intermittent dynamic type sports. Material and Methods. A comparative cross-sectional study with 56 male athletes, 14 in each sport (Rugby, Soccer, Volleyball, Futsal) was conducted. The mean age was 23.59±4.27 years, body mass 71.96±10.10 kg, body height 174.71±6.82 cm, and BMI 23.51±2.38 kg/m2. Physiological characteristics and physical performance measures were measured by using dry spirometer and functional tests respectively. A one-way analysis of variance test was performed to determine differences between athletes for physiological and physical performance measures. Results. There were significant differences for physiological characteristics (VO2max, PIF, PEF, and FVC) and physical performance measures (power, dynamic balance, flexibility, agility and speed) in athletes from random intermittent dynamic type sports. Conclusions. These findings showed significant differences for physiological and physical performance characteristics among athletes from random intermittent dynamic type sports. These measures are responsible for improving physiological and physical performance to achieve top athletic achievements. While constructing the training program, morphological and functional factors should be considered based on the game’s nature.

Relationships Between Systemic Inflammatory Markers and 18F-FDG PET/CT Imaging and Clinical Findings in Pulmonary Sarcoidosis.

Background and aim Sarcoidosis is a multisystem inflammatory disease of unknown aetiology. This study aimed to evaluate the relationship between systemic inflammatory parameters, the systemic immune-inflammation index (SII) and the lymphocyte-to-monocyte ratio (LMR), and disease stage, clinical findings, and 18F-fluoro-2-deoxy-D-glucose (18F-FDG) tomography/computed tomography (PET/CT) uptake. Materials and methods Our study included 73 patients. The general characteristics, radiological features, spirometric tests, PET/CT findings, and laboratory parameters of the patients were recorded. Results Relapse and parenchymal fibrosis were not associated with metabolic parameters, such as LMR and SII. Serum angiotensin-converting enzyme (ACE) levels were lower in the relapsed group than in the non-relapse group. However, the patients' PET/CT images indicated that 18F-FDG parenchym maximum standard uptake value (SUV max), lymph node SUV max, lymph node short axis dimension, SII, and LMR were similar between all patients, relapsed or not. Conclusion Although found to be significant in other inflammatory diseases, we found that SII and LMR alone did not indicate disease prognosis in sarcoidosis due to the small number of patients and the lack of homogeneity between the groups in our study. The usefulness of these markers for clinical use should be investigated by studies that include those with extrapulmonary sarcoidosis, and that calculate these markers at the time of disease diagnosis and during the post-treatment period.

Isolated abnormal FEF75% detects unsuspected bronchiolar obstruction in CF children.

Physiologic detection of bronchiolar obstruction in children with cystic fibrosis (CF) may be clinically unsuspected because of normal routine spirometry despite bronchiectasis on lung CT. Children from two accredited CF facilities had spirometry obtained every 3 months when clinically stable. Pre-bronchodilator maximum expiratory flow volume curves were retrospectively analyzed over 16 years to detect an isolated abnormal FEF75%, despite normal routine spirometry. At Miller Children's and Women's Hospital (MCWH), an abnormal FEF75% was initially detected in 26 CF children at age 7.5 ± 4 (SD) years despite normal routine spirometry initially. FEF75% remained an isolated abnormality for 2.5 ± 1.5 years after it was initially detected in these 26 CF children. At Cohen Children's Medical Center (CCMC), despite normal routine spirometry initially, abnormal FEF75% occurred in 13 children at age 11.7 ± 4.5 years, and abnormal FEF25-75% in 10 children at age 11.8 ± 5.3 years. FEF75% was most sensitive spirometric test for diagnosing both early and isolated progressive bronchiolar obstruction. Data from CCMC in older children demonstrated the simultaneous detection of abnormal FEF75% and FEF25-75% values consistent with greater bronchiolar obstruction when serial spirometry was initiated at an older age. There is very little published spirometric data regarding diagnosis of isolated small airways obstruction in CF children. FEF75% can easily detect unsuspected small airways obstruction in CF children with normal routine spirometry and bronchiectasis on lung CT and optimize targeted modulatory therapies.

Deep Transfer Learning for Chronic Obstructive Pulmonary Disease Detection Utilizing Electrocardiogram Signals

The primary objective and contribution of this research is the development and design of an artificial intelligence system that will diagnose Chronic Obstructive Pulmonary Disease (COPD) utilizing only the heart signal (ECG) of the patient. In contrast to the traditional way of diagnosing COPD, which requires spirometer tests and a laborious workup in a hospital setting, the proposed system uses the classification capabilities of deep transfer learning and the patient’s heart signal, which provides COPD signs in itself and can be received from any modern smart device. The motivation of this research is that it introduces the first research on automated COPD diagnosis using deep learning and utilizes the first annotated dataset in this field. Since the disease progresses slowly and conceals itself until the final stage, hospital visits for diagnosis are uncommon. Hence, the medical goal of this research is to detect COPD using a simple heart signal before it becomes incurable. Deep transfer learning frameworks, which were previously trained on a general image data set, are transferred to carry out an automatic diagnosis of COPD by classifying patients’ electrocardiogram (ECG) signal equivalents, which are produced by signal-to-image transform techniques. Xception, VGG-19, InceptionResNetV2, DenseNet-121, and "trained-from-scratch" convolutional neural network architectures have been investigated for the detection of COPD, and it is demonstrated that they are able to obtain high performance rates in classifying nearly 33.000 instances using diverse training strategies. The highest classification rate was obtained by the Xception model at 99%. This research shows that the newly introduced COPD detection approach is effective, easily applicable, and eliminates the burden of considerable effort in a hospital. It could also be put into practice and serve as a diagnostic aid for chest disease experts by providing a deeper and faster interpretation of ECG signals. Using the knowledge gained while identifying COPD from ECG signals may aid in the early diagnosis of future diseases for which little data is currently available.