Spirometric Tests Research Articles

Pulmonary Function Changes Before and After Mitral Valve Surgery in Severe Mitral Stenosis

Abstract Objective This study was undertaken to assess the pulmonary functions in the patients with predominant severe mitral stenosis before corrective mitral valve surgery, then to reassess the same 6 months after surgery and compare them. Patients and Methods Fifty consecutive patients with predominant severe mitral stenosis undergoing mitral valve replacement surgery were included in this prospective observational study. This study was conducted from July 2016 till January 2018 after obtaining approval from the institute's ethics committee and written consent from all the participants. All the patients were evaluated clinically and divided according to New York Heart Association (NYHA) class symptomatology. Computed spirometric pulmonary function tests (PFTs) such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, forced expiratory flow (FEF) 25–75%, peak expiratory flow rate (PEFR), and maximum voluntary ventilation (MVV) were performed on each patient 1 day before and 6 months after surgery. Results Fifty study patients were analyzed, mean age was 38.4 ± 10.76 years (15–56 years), and male-to-female ratio was 1:1.38 (21 males and 29 females). NYHA class symptoms improved significantly in most of our patients after surgery (p < 0.01). PFTs such as FVC, FEV1, FEV1/FVC ratio, FEF 25–75%, and MVV showed significant improvement 6 months after surgery (p < 0.01). Though PEFR also improved compared with preoperative values, it was not significant statistically (p < 0.07). Conclusion This study showed that the lung functions are impaired in patients with severe mitral stenosis and improved significantly 6 months after surgery, which does not correlate well with the betterment of NYHA class.

Long-term safety and tolerability of nintedanib in patients with idiopathic pulmonary fibrosis: results from the open-label extension study, INPULSIS-ON

The efficacy and safety of nintedanib, an intracellular tyrosine kinase inhibitor, in patients with idiopathic pulmonary fibrosis were assessed in two phase 3, placebo-controlled INPULSIS trials. Patients who completed the 52-week treatment period in an INPULSIS trial could receive open-label nintedanib in the extension trial, INPULSIS-ON. We aimed to assess the long-term efficacy and safety of nintedanib in INPULSIS-ON. Patients who completed the 52-week treatment period of INPULSIS, and the follow-up visit 4 weeks later, were eligible for INPULSIS-ON. The off-treatment period between INPULSIS and INPULSIS-ON could be 4-12 weeks. Patients receiving nintedanib 150 mg twice daily or placebo at the end of an INPULSIS trial received nintedanib 150 mg twice daily in INPULSIS-ON. Patients receiving nintedanib 100 mg twice daily or placebo at the end of an INPULSIS trial could receive nintedanib 100 mg twice daily or 150 mg twice daily in INPULSIS-ON. Spirometric tests were done at baseline, at weeks 2, 4, 6, 12, 24, 36, 48, and then every 16 weeks. The primary outcome of INPULSIS-ON was to characterise the long-term safety and tolerability of nintedanib in patients with idiopathic pulmonary fibrosis, and this was analysed in patients who received at least one dose of nintedanib in INPULSIS-ON. This study is registered with ClinicalTrials.gov, number NCT01619085, and with EudraCT, number 2011-002766-21. The first patient was enrolled into INPULSIS-ON in July 2, 2012. Of 807 patients who completed the INPULSIS trials, 734 (91%) were treated in INPULSIS-ON. 430 (59%) patients had received nintedanib in INPULSIS and continued nintedanib in INPULSIS-ON, and 304 (41%) had received placebo in INPULSIS and initiated nintedanib in INPULSIS-ON. Median exposure time for patients treated with nintedanib in both the INPULSIS and INPULSIS-ON trials was 44·7 months (range 11·9-68·3). The safety profile of nintedanib in INPULSIS-ON was consistent with that observed in INPULSIS. Diarrhoea was the most frequent adverse event in INPULSIS-ON (60·1 events per 100 patient exposure-years in patients who continued nintedanib, 71·2 events per 100 patient exposure-years in patients who initiated nintedanib). 20 (5%) of 430 patients who continued nintedanib and 31 (10%) of 304 patients who initiated nintedanib permanently discontinued nintedanib because of diarrhoea. The adverse event that most frequently led to permanent discontinuation of nintedanib was progression of idiopathic pulmonary fibrosis (51 [12%] patients continuing nintedanib and 43 [14%] patients initiating nintedanib). The event rate of bleeding was 8·4 events per 100 patient exposure-years in patients who continued nintedanib and 6·7 events per 100 patient exposure-years in patients who initiated nintedanib. The event rate of major adverse cardiovascular events was 3·6 events per 100 patient exposure-years in patients who continued nintedanib and 2·4 events per 100 patient exposure-years in patients who initiated nintedanib. The event rate of myocardial infarction using the broad scope (ie, all possible cases) was 1·3 events per 100 patient exposure-years in patients who continued nintedanib and 0·7 events per 100 patient exposure-years in patients who initiated nintedanib. These findings suggest that nintedanib has a manageable safety and tolerability profile over long-term use, with no new safety signals. Patients with idiopathic pulmonary fibrosis could use nintedanib over the long-term to slow disease progression. Boehringer Ingelheim.

Respiratory Symptoms and Pulmonary Function among Workers in a Rubber Wood Sawmill Factory in Thailand

Objectives: 1) To determine the prevalence of respiratory symptoms and abnormal pulmonary function among workers exposed to different levels of rubber wood dust (RWD) and 2) to determine the factors which may be associated with the respiratory effects. Methods: The study population was 340 workers working in a rubberwood sawmill factory in Nakhon Si Thammarat province, Southern Thailand. Respiratory health questionnaires and spirometric testing according to the ATS 1994 criteria were performed. Workers were classified into three groups by the RWD levels; low RWD ( 1.9 mg/m3); moderate RWD (2.0-4.9 mg/m3); and high RWD (≥ 5.0 mg/m3). Results: A total of 279 workers (59 male and 220 female) were participated in the study. Their average age and work duration were 36.7 years (SD=8.5) and 6.2 years (SD=4.1), respectively. The prevalence rate of upper and lower respiratory symptoms were 67.0% and 63.1% respectively. The prevalence of abnormal spirometric testing result was 20.6 % (obstructive type 4.4 %, restrictive type 10.5 %, and small airway disease 5.7 %). These prevalence rates were not significantly different according to the RWD level. However, the factors which were significantly associated with the upper respiratory symptoms were being female [OR 2.03 (95%CI 1.10, 3.78)] and being atopy [OR 3.63 (95%CI 1.88, 7.0)]. The factor which was significantly associated with lower respiratory symptoms was a family of asthma [OR 3.95 (95%CI 1.32, 11.7)]. Conclusion: Exposure to rubber wood dust is associated with a high prevalence of respiratory illnesses and being atopic person takes a high risk of work related respiratory illnesses.

Determining the optimal approach to identifying individuals with chronic obstructive pulmonary disease: The DOC study.

Early identification of chronic obstructive pulmonary disease (COPD) results in patients receiving appropriate management for their condition at an earlier stage in their disease. The determining the optimal approach to identifying individuals with chronic obstructive pulmonary disease (DOC) study was a case-finding study to enhance early identification of COPD in primary care, which evaluated the diagnostic accuracy of a series of simple lung function tests and symptom-based case-finding questionnaires. Current smokers aged 35 or more were invited to undertake a series of case-finding tools, which comprised lung function tests (specifically, spirometry, microspirometry, peak flow meter, and WheezoMeter) and several case-finding questionnaires. The effectiveness of these tests, individually or in combination, to identify small airways obstruction was evaluated against the gold standard of spirometry, with the quality of spirometry tests assessed by independent overreaders. The study was conducted with general practices in the Yorkshire and Humberside area, in the UK. Six hundred eighty-one individuals met the inclusion criteria, with 444 participants completing their study appointments. A total of 216 (49%) with good-quality spirometry readings were included in the analysis. The most effective case-finding tools were found to be the peak flow meter alone, the peak flow meter plus WheezoMeter, and microspirometry alone. In addition to the main analysis, where the severity of airflow obstruction was based on fixed ratios and percent of predicted values, sensitivity analyses were conducted by using lower limit of normal values. This research informs the choice of test for COPD identification; case-finding by use of the peak flow meter or microspirometer could be used routinely in primary care for suspected COPD patients. Only those testing positive to these tests would move on to full spirometry, thereby reducing unnecessary spirometric testing.

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

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

Effect of long-term exposure to fine particulate matter on lung function decline and risk of chronic obstructive pulmonary disease in Taiwan: a longitudinal, cohort study

Information on the effects of long-term exposure to fine particulate matter with an aerodynamic diameter of 2·5 μm or less (PM2·5) on lung health is scarce. We aimed to investigate the associations between long-term exposure to PM2·5, lung function, and chronic obstructive pulmonary disease (COPD) in a large-scale longitudinal cohort. We included 285 046 participants aged 20 years or older from the Taiwan MJ Health Management Institution cohort, who were recruited between 2001 and 2014 and had spirometric tests during the medical examination visit. We used a satellite-based spatiotemporal model to estimate the 2-year average ground concentration of PM2·5 (for the calendar year of each participant's medical examination and for the previous year) at each participant's address. We used the generalised linear mixed model to examine the associations between PM2·5 concentrations and lung function and the Cox proportional hazard regression model with time-dependent covariates to investigate the PM2·5 effects on COPD development. Every 5 μg/m3 increment in PM2·5 was associated with a decrease of 1·18% for forced vital capacity (FVC), 1·46% for forced expiratory volume in 1 s (FEV1), 1·65% for maximum mid-expiratory flow (MMEF), and 0·21% for FEV1:FVC ratio. The decrease accelerated over time. Additional annual declines were observed for FVC (0·14%), FEV1 (0·24%), MMEF (0·44%), and FEV1:FVC ratio (0·09%). Compared with the participants exposed to the first quartile of PM2·5, participants exposed to the fourth, third, and second quartiles of PM2·5 had a hazard ratio of 1·23 (95% CI 1·09-1·39), 1·30 (1·16-1·46), and 1·39 (1·24-1·56) for COPD development, respectively. Long-term exposure to ambient PM2·5 is associated with reduced, and faster declines in, lung function. Long-term exposure to ambient PM2·5 is also associated with an increased risk of the incidence of COPD. This study reinforces the urgency of global strategies to mitigate air pollution for improvement of pulmonary health and prevention of COPD. Environmental Health Research Fund of the Chinese University of Hong Kong and PhD Studentship of the Chinese University of Hong Kong.

Asthma Does Not Explain A Decline In Post Bronchodilator Lung Function In Early Adult Life

Using the Isle of Wight Birth Cohort (IOWBC), we investigated lung function deficits in young adults with asthma to identify whether airways obstruction in that group accounted for a decline in post-bronchodilator lung function within the overall population seen by 26-years. The IOWBC is a population based cohort (n=1456), recruited in 1989- 90 and assessed at birth, 1, 2, 4, 10, 18 and 26 years for asthma, allergic diseases and environmental exposures. Spirometric lung function tests were carried out using standardized methodology at 18 (n=839) and 26 years (n=555) before and after inhaled bronchodilator (salbutamol 400mcg). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio and mid-expiratory flows (FEF25-75) at 26 years plus changes in these indices between 18 and 26 were assessed. Asthma was defined as physician diagnosis plus current wheeze and/or on treatment. Pre-bronchodilator FEV1, FEV1/FVC, and FEF25-75 were all significantly reduced (P<0.001) in those with asthma (3.52L, 0.73 and 3.11L) compared to those without asthma (3.90L, 0.73, and 3.89L). However, there was no significant difference in post-bronchodilator FEV1, FEV1/FVC, and FEF25-75 between the two groups. Airways obstruction at 26 years of age is usually fully reversible in most people with asthma. An observed decline in postbronchodilator FEV1, FEV1/FVC, and FEF25-75 from 18 to 26 years in this cohort therefore does not appear to be accounted for by the influence of asthma.

Spirometric Assessment of Impact of Complete Dentures on Respiratory Performance: An in vitro Study

Edentulism is one of the debilitating states affecting a significant portion of the geriatric population. It is often considered as the ultimate marker for predicting the pressure and burden on oral health. Respiration is also a routine vital function running continuously through the human body and most commonly assessed by a spirometer. Hence, we planned the present study to assess the impact of complete dentures on the functioning of the respiratory system. In the present study, a spirometric assessment of the effect of complete dentures on respiratory performance was done. A total of 100 subjects were included, and diagnostic spirometer was used for carrying out the spiro-metric test at different stages of each subject. The spirometric test was carried out at four different stages: In the absence of both the denture (AODs), with both the dentures (maxillary and mandibular) inserted in the patient's mouth (BDs), with only maxillary denture inserted in the oral cavity (UDs), and finally, by inserting only the mandibular dentures in the oral cavity (LDs). Forced vital capacity (FVC), peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), and forced expiratory flow between 25 and 75% (FEF25-75) were evaluated. All the results were compiled and assessed using Statistical Package for the Social Sciences (SPSS) software. Of the total 100 subjects included in the study, 42 were males and 58 were females. The mean FVC values of AOD, BD, LD, and UD group were 3.10, 3.02, 2.90, and 2.93 respectively. The mean PEF values of AOD, BD, LD, and UD group were 5.79, 5.60, 5.40, and 5.48 respectively; 2.39, 2.35, 2.33, and 2.32 were the mean FEV1 values observed in AOD, BD, LD, and UD group respectively. Statistically significant results were obtained while comparing AOD-FVC and BD-FVC and other oral conditions. Spirometric values of respiratory functional tests in edentulous patients might be unfavorably affected by wearing complete dentures. Since subjects without complete dentures exhibited a maximum value of respiratory functional test, respiratory exercise protocols should also be carried in denture-wearing edentulous patients for increasing the performance of the respiratory system.

Comparison of spirometric results obtained from the sitting and standing position in children participating in an epidemiological study.

IntroductionIt is recommended that spirometric testing in children be completed while sitting. Our experience indicates that children prefer standing during spirometry.AimWe sought to compare spirometric results obtained from the sitting (SIP) and standing (STP) positions.Material and methodsTwo testing sessions were performed in random order (SIP vs. STP: 30–45 min apart) in 118 children (7–13 years), attending one, randomly selected, primary school (response rate: 92%).ResultsAcceptable quality was found in 77.9% of STP and 77.1% of SIP maneuvers. Higher values of spirometric variables on STP, compared to SIP, were obtained for forced vital capacity (FVC) (2.12 ±0.41 l vs. 2.11 ±0.39 l) and forced expiratory volume in 1 s (FEV1) (1.78 ±0.36 l vs. 1.77 ±0.35 l) but the differences were not statistically significant. Relative between-position differences (RBPD) ≤ 5% were found with the following frequencies: FVC: 56.4%, FEV1: 69.2%, PEF: 21.7%, and FEF25–75: 24.3%. Similar patterns were found for FEF25, FEF50, and FEF75. Relative between-position differences were related to age in the case of FEV1 (p = 0.005), FEF25 (p = 0.02), and FEF25–75 (p = 0.01) where older children had smaller RBPD. Forced vital capacity RBPD was lower (p = 0.01) in subjects with current wheeze; PEF RBPD were lower (p = 0.02) in children with asthma.ConclusionsIn epidemiological studies, the position of spirometric testing does not affect the results of lung function assessment.

Respiratory Function in Wind Instrument Players.

Introduction:Wind instrumentalists require a sophisticated functioning of their respiratory system.Aim:The purpose of this research is to examine the function of the respiratory system of wind instrumentalists.Material and methods:Thirty-two adult professional musicians from two philharmonic bands (Piraeus and Zografou Municipality) participated in the survey. Each participant, after completing a questionnaire given, went through two spirometric tests, one before and one after the rehearsal. The rehearsal lasted one hour and a half and included low-mid and high frequency notes. Respiratory volumes measured and analyzed were, vital capacity (VC), maximum expiratory volume of air in 1st second (FEV1), forced vital capacity (FVC), forced expiratory flow (FEF), and Tiffenau index (FEV1/FV%).Results:The results showed that: 1) Participants did not show any noticeable change in their respiratory volumes before and after rehearsal. 2) Wind instrument players do not have a VC greater than their predicted age, height, weight and gender. 3) There is no statistically significant difference between the first and second assessment of respiratory indicators for smokers and non-smokers. 4) Regarding the type of instrument: a) Those who played wooden instruments improved the FEV1/FVC% indicator to a remarkable percentage between the first and second spirometry and b) individuals playing wooden instruments had a lower FVC, FEV1 and VC score than those playing bronze.Conclusion:There is no significant strain sign in respiratory system even in smokers after exercising in wind instrument. There is an improvement in Tiffenau index in those who played wooden instruments between the two rehearsals. Undoubtedly, new research is needed to combine a respiratory disease scenario with a respiratory treatment program that involves practicing a wind instrument.

Clinical and pulmonary functions profiling of patients with chronic obstructive pulmonary disease experiencing frequent acute exacerbations

Purpose:The present study aimed at clinical and pulmonary functions profiling of patients with chronic obstructive pulmonary disease (COPD) to anticipate future exacerbations.Methods:The study included 80 COPD patients; 40 patients had ≥2 acute exacerbations during preceding 1 year (frequent exacerbation [FECOPD] group) and 40 patients had <2 acute exacerbations during preceding 1 year (infrequent exacerbation [I-FECOPD] group). Clinical profile, sputum microbiology, blood gas analysis, spirometric indices, and diffusion capacity (transfer test) variables were assessed. Groups’ comparison was performed using an independent t-test for numeric scale parameters and Chi-square test for nominal parameters. Pearson's and Spearman's correlation coefficients were derived for numeric scale parameters and numeric nominal parameters, respectively. Multinomial logistic regression analysis was done using SPSS software.Results:FECOPD group contained younger patients than in I-FECOPD group although the difference was not statistically significant. There was no significant difference between two groups regarding smoking pack-years and duration of illness. FECOPD group had significantly more expectoration score and Modified Medical Research Council dyspnea scores. Cough score and wheeze score did not differ significantly between two groups. More patients in FECOPD group (12/40 vs. 4/40) had lower airway bacterial colonization. Arterial blood gas parameters were more deranged in FECOPD group. Spirometric indices (forced expiratory volume during 1st s) as well as transfer test (both diffusing capacity for carbon monoxide and transfer coefficient of the lung values) were significantly reduced in FECOPD group.Conclusions:The patients in FECOPD group had clinical, spirometric, and transfer test profiling suggestive of a severe COPD phenotype, the recognition will help in predicting future exacerbations and a better management.

The Prevalence of Smoking among Sample of Kuwait Asthmatics and Its Impact on the Response of the Treatment

Background: Bronchial asthma is one of the most common diseases in Kuwait. Smoking also is on the rise in Kuwait. We therefore conducted this study to at prevalence of smoking among sample of Kuwaiti patients and the impact on asthma control. Methods: Descriptive study of 50 outpatients who were prospectively assessed from single center (Al-Jahra Hospital) that diagnosed recently as bronchial asthma using American Thoracic Society/European Respiratory Society (ATS/ERS) criteria definitions of asthma between the period of 1st of April and 20th may 2013. Patients were divided into two groups: Group A smokers and Group B non-smokers. Pulmonary function test using spirometer and asthma control test (ACT) was done for every patient at the time of visit and after 4 weeks to determine the effect of smoking on asthma control as a primary outcome using GINA guidelines definition for Asthma control and treatment. Results: At study entry 30% of sample size were smoker asthmatics. Smokers showed worse symptoms of wheezing, cough, and shortness of breath compared to non-smokers asthmatics whereas non-smokers asthmatics were more likely to have seasonal symptoms and use salbutamol MDI. Both groups showed similar spirometry findings at study entry. At 4 weeks from the first visit there was a significant difference in symptoms and signs of bronchial asthma between the 2 groups. Both measures of asthma control test and spirometer results favoured non-smokers. Smokers asthmatics were more likely to use rescue salbutamol MDI and non-compliant. No hospital admissions or acute exacerbations during the period of the study. Conclusion: Smoking was associated with worse asthma control and poor compliance among asthmatics.

A Correlational Study on Spirometric Lung Function test with Pack Years among Smokers in a Selected Therapeutic Clinic at Bangalore

A Correlational Study on Spirometric Lung Function test with Pack Years among Smokers in a Selected Therapeutic Clinic at Bangalore

Age and mini-mental state examination score can predict poor-quality spirometry in the elderly: a cross-sectional study

OBJECTIVES:The goal was to identify predictors of poor-quality spirometry in community-dwelling older adults and their respective cutoffs.METHODS:This was a cross-sectional population-based study involving 245 elderly subjects (age≥60 years). The spirometric data were categorized as good or poor quality, and cognitive status was assessed using an adapted version (scaled to have a maximum of 19 points) of the Mini-Mental State Examination. Multivariate analysis was used to assess the association between poor-quality spirometry and sociodemographic, behavioral and health characteristics. The best cutoff points for predicting poor-quality spirometry were evaluated by the receiver operating characteristic curve.RESULTS:In this population, 61 (24.9%) subjects with poor-quality spirometry were identified. After multiple logistic regression analysis, only age and Mini-Mental State Examination score were still associated with poor-quality spirometry (p≤0.05). The cutoff for the Mini-Mental State Examination score was 15 points, with an area under the receiver operating characteristic curve of 0.628 (p=0.0017), sensitivity of 74.5% and specificity of 49.5%; for age, the cutoff was 78 years, with an area under the receiver operating characteristic curve of 0.718 (p=0.0001), sensitivity of 57.4% and specificity of 79.9%.CONCLUSION:Age and Mini-Mental State Examination score together are good predictors of poor-quality spirometry and can contribute to the screening of community-dwelling older adults unable to meet the minimum quality criteria for a spirometric test.

Pulmonary siderosis cases diagnosed with minimally invasive surgical technique: A retrospective analysis of 7 cases.

OBJECTIVE:The aim of the present study was to report our patients with pulmonary siderosis (PS) who were exposed to iron oxide and diagnosed with the minimally invasive surgical technique (video-assisted thoracic surgery [VATS]), and to provide a discussion of the relevant literature.METHODS:Hospital records of seven patients who were diagnosed with PS by VATS between 2008 and 2016 were retrospectively reviewed. VATS was performed for seven patients for whom no definitive diagnosis could be made with other diagnostic techniques.RESULTS:All 7 patients included in our study were male, and their mean age was 54 years. As for the profession, two patients were founders, two were grinders, and three were welders. All patients were operated with VATS. The patients were followed with chest radiograms and spirometric tests for an average of 24 (15–36) months. At the follow-up, the patients were not only free of progression but also they even showed regression.CONCLUSION:VATS is currently an established technique used for many diagnostic and therapeutic procedures, notably in chest surgery practice. We also advocate that VATS technique is an ideal method for making the pathological diagnosis of pneumoconioses when other methods fail to do so.

Restrictive pulmonary dysfunction is associated with vertebral fractures and bone loss in elderly postmenopausal women.

Association between bone metabolism and pulmonary function in the general population is controversial. The aim of this study was to investigate relationship between lung and bone parameters in elderly postmenopausal women. One hundred and six postmenopausal women (75.6 ± 8.0years old) who underwent spirometric tests were examined for prevalent vertebral fractures, bone mineral density (BMD), bone metabolic markers, and other metabolic indices such as urinary pentosidine. Multivariable logistic regression analyses revealed that forced vital capacity (FVC) (OR = 0.063, 95% CI: 0.011-0.352, p = 0.002) and urinary pentosidine (OR = 1.067, 95% CI: 1.020-1.117, p = 0.005) were associated with the presence of vertebral fractures after adjustment for height loss, age, and BMD at femoral neck. Moreover, vital capacity (VC) or FVC as well as body mass index and age was among independent determinants of BMD after adjustment for height loss and the number and grade of vertebral fractures in forced multiple linear regression analysis (VC: β = 0.212, p = 0.021, FVC: β = 0.217, p = 0.031). Urinary pentosidine was negatively correlated with pulmonary function parameters such as FVC and forced expiratory volume in 1s (FEV1.0), although these correlations appeared dependent on age. Diminished FVC was associated with prevalent vertebral fractures and decreased BMD in Japanese postmenopausal women without apparent pulmonary diseases. Mechanism of such association between pulmonary function and bone status remains to be determined.

Validation of Global Lung Function Initiative and All Ages Reference Equations for Forced Spirometry in Healthy Spanish Preschoolers

IntroductionRecent publication of multi-ethnic spirometry reference equations for subjects aged from 3 to 95 years aim to avoid age-related discontinuities and provide a worldwide standard for interpreting spirometric test results. ObjectivesTo assess the agreement of the Global Lung Function Initiative (GLI-2012) and All ages (FEV0.5) reference equations with the Spanish preschool lung function data. To verify the appropriateness of these reference values for clinical use in Spanish preschool children. MethodsSpirometric measurements were obtained from children aged 3–6 years attending 10 randomly selected schools in Barcelona (Spain). Stanojevic's quality control criteria were applied. z-Scores were calculated for the spirometry outcomes based on the GLI equations. If the z-score (mean) of each parameter was close to 0, with a maximum difference of ±0.5 from the mean and a standard deviation of 1, the GLI-2012 equations would be applicable in our population. ResultsOf 543 children recruited, 405 (74.6%) were ‘healthy’, and of these, 380 were Caucasians. Of these 380, 81.6% (169 females, 141 males) performed technically acceptable and reproducible maneuvers to assess FEVt, and 69.5% achieved a clear end-expiratory plateau. z-Scores for FVC, FEV1, FEV1/FVC, FEV0.75, FEV0.75/FVC, FEV0.5, FEF75 and FEF25–75 all fell within ±0.5, except for FEV1/FVC (0.53 z-scores). ConclusionsGLI equations are appropriate for Spanish preschool children. These data provide further evidence to support widespread application of the GLI reference equations.

A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study.

The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD) patients. Prospective study in tertiary-level care center. Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. The patients' average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94%) and hypoalbuminemia (72%) were common. Diabetes mellitus (68%), hypertension (34%) and coronary artery disease (18%) were major comorbidities. Forty-five patients (90%) had been on hemodialysis for six months to three years. The patients' pre-dialysis mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P < 0.01). The increase in mean FEV1/FVC, from 97.8 ± 20.8% to 99.3 ± 20.1% of predicted, was not significant (P > 0.05). The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05). The mean peak expiratory flow was below normal (43.8 ± 30.7%) and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05). Males and females showed similar directions of change after hemodialysis. Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.

Effect of 16 weeks diving practice at two different times of day on the pulmonary function, spirometry measurements and 6-minute walk test data of healthy professional Tunisian scuba divers

The aim of this study was to investigate the effect of time of the day (TOD) and 16 weeks diving practice (16WDP) on the spirometric parameters and 6-min walk test data (6MWT) on professional Tunisian scuba divers. In randomized order, 36 health males divided into 3 groups [morning practice group) (MPG): n = 12; evening practice group (EPG): n = 12; control group (CG) n = 12] participated voluntary in this study. They performed spirometry measurements and 6MWT during two periods: [before-season (June 05–10), and after-season (October 05–10)]. Our results revealed that assessment sessions comprised the following: FVC, FEV1, FEV1/FVC and PEF. Results were analyzed by applying repeated measures analysis of variance ANOVA. The spirometric parameters were similar upon two times of day on both EPG and MPG before the season (i.e. FEV1, FVC). Likewise, our finding revealed a significant decrease in lung functions following the 16 weeks practice of scuba diving upon two times of day. Thus, this period of hyperbaric scuba diving practice lead a significant alteration of lung function parameters with decrease of percent of variation in EPG vs. CEG compared to MPG vs. CMG: (i.e. FEV1, FVC, and PEF). In conclusion, 16 weeks of hyperbaric scuba diving lead a significant change in the spirometric and 6MWT values and respiratory problem with damage on lung function in healthy adult divers older than 40 years. Professional divers are recommended to have practice diving in the morning.

Thoracic complications of upper gastrointestinal endoscopy in Zagazig University Hospitals. A cross-sectional single center study

Upper Gastro Intestinal Endoscopy (UGIE) is a commonly performed diagnostic and/or therapeutic procedure for evaluation of patients with various abdominal complaints. UGIE complications vary including; pneumonia, mediastinitis, oesophago-pleural fistula. The reported complications of UGIE are diverse and vary from one center to another. AimThe study aimed to report the thoracic complications in patients underwent UGIE during the period between July and December 2016. Patients and methodsOne hundred and twenty patients, candidates for UGIE were included in the study. All patients were subjected to: thorough medical history, complete general and local chest and abdominal examination, routine laboratory investigations, chest X-ray and chest computed tomography (CT) if needed, spirometric pulmonary function tests (PFT), arterial blood gases (ABGs), pre and post UGIE. ResultsPatients were 84 males and 36 female, age ranged from 25 to 70years old, hematemesis and/or melena was the most common presentation (65%). Oesophageal varices was the most common endoscopic finding (50% of cases). Chest pain, cough and bronchitis were more common among Oesophageal Varices Sclerotherapy (OVS) patients. Pneumonia, atelectasis, pleural effusion and mediastinitis were reported after OVS. There was significant difference regarding spirometric parameters before, 2days and 3weeks after the procedure in patients underwent OVS and Gastric Varices Sclerotherapy (GVS), while no significant difference was reported in patients underwent Oesophageal Varices (OV) band ligation and peptic ulcer diagnosis before, 2days and 3weeks after the procedure. ConclusionsThoracic complications were more common in OVS and GVS than in OV band ligation.