Spirometry Testing Research Articles

Effectiveness of paediatric asthma hubs: a clinical pilot study

BackgroundChildren and young people (CYP) with asthma in the UK are at higher risk of poor outcomes compared with other high-income European countries due to factors including poor access to high-quality asthma reviews, diagnostic testing and inconsistent postattack reviews. The Leicester Integrated Care Board funded the first UK pilot asthma hub for CYP, to investigate the feasibility and effectiveness of hubs, in providing postattack reviews along with providing asthma education, the opportunity to carry out diagnostic lung function tests and optimise treatment.MethodsClinical pilot study including CYP aged 4–17 years referred to the hub with uncontrolled asthma or postattack from November 2021 to April 2022. CYP received a structured clinical assessment including National Institute for Health and Care Excellence (NICE) first-line diagnostic investigations for asthma including spirometry, bronchodilator reversibility (BDR) and fraction of exhaled nitric oxide (FeNO).ResultsOf 312 CYP referred (mean age 8.6±3.2 years; 42% women), 266 (85.3%) attended their appointment. Median time from referral to review was 2 days (IQR 1–3). Three CYP (1.1%) were severely unwell at review and required further hospital treatment. In the 231 CYP who completed first-line tests, asthma was confirmed for 73 (31.6%) based on NICE diagnostic criteria for CYP. Twenty-two per cent of children with normal baseline spirometry had ≥12% BDR.ConclusionPaediatric asthma hubs are a feasible model of care to deliver CYP postasthma attack reviews and identify high-risk patients requiring further treatment. Spirometry, BDR and FeNO testing allowed diagnostic confirmation in a significant proportion of CYP.

Stability of severe asthma phenotypes

Introduction. Severe asthma (SA) is a heterogeneous disease with several phenotypes. There are lack of data about its stability.Aim. To assess stability of SA phenotypes in adult patients during 5 years follow-up.Materials and methods. Prospective study included 117 adult outpatients with allergic SA, 51 severe asthmatics with aspirin-induced disease, 59 patient with persistent airflow limitation (PAL) and 35 patients with SA and concomitant COPD, 65 steroid-dependent severe asthmatics and 89 patients with SA and frequent (≥2 per year) exacerbations. Spirometry and bronchodilator reversibility testing were carried out; fractional exhaled nitric oxide (FeNO) was measured; hypersensitivity to common inhalant allergens (skin prick and blood specific IgE testing) and peripheral blood eosinophil counts were estimated. Asthma control and asthma-related quality of life were assessed by using ACQ-5 and SGRQ questionnaire.Results. During 5-year prospective study stability of aspirin-induced SA and SA with COPD was 100%. Allergic phenotype was stable in 81% of SA cases and in patients with changed atopic status we revealed worsening of symptoms and accelerated lung function decline. Stability of SA phenotype with PAL without COPD was 86% and steroid-dependent SA was stable in 55% of cases. After 5 years of treatment frequent exacerbations remained in 28% of severe asthmatics.Conclusion. The most stable phenotypes of SA were aspirin-induced and asthma with concomitant COPD. Less stable were allergic SA, steroid-dependent SA and phenotype with persistent airflow limitation. The least stable was SA phenotype with frequent exacerbations.

Severe asthma phenotypes and endotypes

Introduction. Severe asthma is a heterogeneous disease with several phenotypes and endotypes. However, little is known about frequency of severe asthma phenotypes and endotypes in Russia.Aim. To assess frequency of severe asthma phenotypes and endotypes compared with mild/moderate asthma.Materials and methods. Cross-sectional single center study included 643 adult outpatients with mild/moderate asthma and 314 patients with severe asthma (SA) aged 18–90 years. Spirometry and bronchodilator reversibility testing were carried out. Fractional exhaled nitric oxide (FeNO) was measured by a chemiluminescent analyzer (logan 4100, UK). Hypersensitivity to common inhalant allergen was assessed by skin prick and blood specific IgE level. Peripheral blood eosinophil counts were measured by automatic analyzer. Asthma control and asthma-related quality of life were assessed by using ACQ-5 and SGRQ.Results. Allergic phenotype was more frequent in patients with mild/moderate asthma than in those with SA, but aspirin-induced asthma, steroid-dependent asthma, asthma with persistent airflow limitation and concomitant COPD, asthma with late onset and obesity were more frequent in SA. The majority of patients with SA had several phenotypes (mean 3 phenotypes) and at least one marker of T2-high endotype.Conclusion. The most frequent phenotypes of SA were allergic, with persistent airflow limitation, with concomitant obesity and COPD. Occurrence of asthma phenotypes differed between patients with SA and mild/moderate asthma. The majority of SA patients have T2-endotype.

The association between preserved ratio impaired spirometry (PRISm) and cognitive function among American older adults: the mediating role of systolic blood pressure

BackgroundRecent studies have drawn attention to the association between preserved ratio impaired spirometry (PRISm) and cognitive function decline. High systolic blood pressure (SBP) is a known risk factor for both PRISm and dementia. This study aimed to investigate whether elevated SBP may mediate the relationship between PRISm and cognitive function in older adults.MethodsThis study analyzed 732 participants aged ≥ 60 years who had completed spirometry and cognitive function tests in the National Health and Nutrition Examination Survey (NHANES) 2011–2012. Multivariable linear regression was employed to assess the relationship between PRISm and cognitive function, as measured through the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word Learning sub-test, the Animal Fluency test (AFT), the Digit Symbol Substitution test (DSST), and global cognition tests. All cognitive tests were modeled as z-scores, and global cognition was calculated as the sum of the z-scores of the CERAD, AFT, and DSST. Mediation analyses were conducted to test the mediating effect of SBP on the association between PRISm and cognitive function.ResultsParticipants with PRISm had lower AFT (β = -0.300; 95% confidence interval [CI] = -0.479 to -0.122; p = 0.001), DSST (β = -0.157; 95% CI = -0.309 to -0.004; p = 0.044), and global cognition scores (β = -0.211; 95% CI = -0.369 to -0.053; p = 0.009) than those with normal spirometry, after adjusting for all potential confounders. SBP was considerably associated with AFT (β = -0.084; 95% CI = -0.162 to -0.005; p = 0.038) and DSST (β = -0.132; 95% CI = -0.207 to -0.057; p < 0.001), mediating 7.9% and 18.0% of the association of PRISm with cognitive function, respectively. Furthermore, SBP mediated 17.1% of the association of PRISm with global cognition.ConclusionsThe findings suggested the potential role of SBP as a mediator of associations between PRISm and cognitive decline in older adults.

Determining the respiratory functions and isometric strength differences among recreational athletes and non-athletes: a cross-sectional analysis

Understanding the differences in respiratory functions and isometric strength between recreational athletes and non-athletes has a significant importance in the fields of Sports science, exercise physiology, and performance enhancement. The purpose of this study was to determine the respiratory functions and isometric strength differences among recreational athletes and non-athletes. A cross-sectional design was selected for this research with 16 recreational athletes and 16 non-athletes. Respiratory functions were assessed using spirometry tests, measuring parameters such as forced vital capacity (FVC), peak expiratory flow rate (PEFR), and forced expiratory volume in one second (FEV1). Isometric strength was measured by a handheld dynamometer for dominant and non-dominant hands. The results of the study showed a significant difference between recreational athletes and non-athletes for respiratory function parameters (FVC = t-3.00, p-.006 &amp; FEV1= t-2.221, p-.011), whereas PEFR is insignificant (t-218, p-.219). The isometric strength is also significant between recreational athletes and non-athletes (Dominant arm = t—3.039, p-.005 &amp; non-dominant arm= t-.255, p-.001). The study findings revealed significant differences in respiratory functions and isometric strength between recreational athletes and non-athletes, and there was a significant relationship between parameters. Athletes typically exhibit remarkable isometric strength due to their consistent engagement in activities designed to enhance muscle function. Future research should give priority to conducting long term studies that directly compare the effects of different sports disciplines on respiratory functions and isometric strength. Keywords: Isometric Strength, Pulmonary Functions, Forced Vital Capacity, Peak Expiratory Flow Rate, FEV1, Recreational Athletes.

Device for Performing Spirometry in Total Laryngectomized Patients.

Patients who have undergone total laryngectomy (TL) are, in most cases, affected by lung disease due to smoking habits. Therefore, as part of the follow-up protocol for these patients, a spirometry test should be performed to adequately assess lung function. Current spirometers do not allow for spirometry tests in patients who breathe through a tracheostomy, as the patient cannot perform respiratory acts from the spirometer mouthpiece, which is designed to be used by mouth. We have, therefore, designed a device that allows the test to be performed through the tracheostoma. The device is made of biocompatible polymeric material, modeled using a 3-dimensional printer, reusable, and hermetically connected to the spirometer distally and to the tracheostoma proximally. The device was used on 5 patients who underwent TL and was found to be comfortable, safe, and valid for diagnostic purposes.

32 - Research on the correlation between emphysema severity measured by CT COPD AI software on CT scan and spirometry test

32 - Research on the correlation between emphysema severity measured by CT COPD AI software on CT scan and spirometry test

Simultaneous effects of high-speed circuit training (HSCT) and high-speed interval training (HSIT) on physical fitness and lung volumes of males after coronavirus disease

BackgroundPeople who are quarantined after coronavirus disease experience immobility, obesity and changes in the cardiopulmonary system. We hypothesized that the concurrent use of high-speed circuit training (HSCT) and high-speed interval training (HSIT) can be used to improve physical fitness and respiratory functions. MethodologyPhysical education students (n = 65, 18–22 yrs. Old) who recovered from a previous coronavirus infection were randomly divided into either an experimental (n = 38) or control (n = 27) group. Physical fitness tests such as heart rate (HR), Cooper's test, maximum oxygen consumption (VO2max), speed of 30 m, flexibility, balance of right and left legs, agility 4 × 9 m, barfix, sit-up, Sargent jump, push-up, and spirometry tests were conducted before and after the training protocols (HSCT and HSIT for 12 weeks). The control group only took regular university classes. ResultsThe simultaneous implementation of HSCT and HSIT had a positive significant effect on physical fitness indicators (VO2max, flexibility, sit-ups, push-ups, vertical jump, barfix, balance legs, agility 4 × 9, 30 m sprint, and Cooper test) and respiratory indicators (FVC, FEV1, PEF, MVV and FEV1/FVC). While it did not affect other variables. ConclusionThe simultaneous implementation of HSCT and HSIT can have a positive significant effect on physical fitness indicators and respiratory indicators of male university students. Therefore, students have more aerobic capacity for physical activities.

Abnormal spirometry is a predictor of exercise capacity in patients with tetralogy of Fallot

&lt;p&gt;We investigated the association between cardiac factors, spirometry, and exercise testing in patients with tetralogy of Fallot (TOF). Clinical data from patients with TOF performing a cardiopulmonary exercise test (CPET) was collected retrospectively over a 10-year period. 122 patients with TOF were identified, 52 excluded for incomplete exercise, spirometry, or cardiac data for 70 total patients included in the study. There was a male predominance 39 (56%), a mean age of 25 ± 12 years, with 28 (40%) &amp;lt; 18 years of age. The mean number of cardiac surgeries was 2.1 ± 1.2. Most, 46 (69%) had moderate to severe pulmonary valve insufficiency (PI) and 34 (51%) had moderate to severe right ventricular (RV) dilation. Mean forced vital capacity (FVC) was low at 81.8% predicted, and 32 (46%) with low FVC (&amp;lt; 80% predicted). Overall peak VO&lt;sub&gt;2&lt;/sub&gt;/kg was low with a mean of 58.2 ± 13.2 % predicted. Using multiple regression analysis, a higher number of cardiac surgeries was an independent predictor of lower FVC (&lt;em&gt;p&lt;/em&gt; = 0.01). Lower FVC was itself an independent predictor of lower peak VO&lt;sub&gt;2&lt;/sub&gt;/kg and O&lt;sub&gt;2&lt;/sub&gt; pulse (&lt;em&gt;p&lt;/em&gt; &amp;lt; 0.05). Moderate or severe RV systolic dysfunction was an independent predictor of stroke volume response (&lt;em&gt;p&lt;/em&gt; = 0.03).&lt;strong&gt; &lt;/strong&gt;Higher body mass index (BMI) was an independent predictor of all exercise measures being worse (&lt;em&gt;p&lt;/em&gt; &amp;lt; 0.05). Low FVC and reduced exercise capacity were common in our population of TOF patients. Low FVC was predictive of low exercise capacity while, of the cardiac measures only RV systolic dysfunction was significant and predictive of stroke volume response. Spirometry may be a valuable screening tool in evaluation of TOF patients.&lt;/p&gt;

Vacuna contra el virus de la influenza y exacerbaciones de EPOC, un estudio transversal

Background: Influenza (flu) is one of the most frequent infections associated with acute exacerbations of Chronic ObstructivePulmonary Disease (COPD). Objective: To determine the association between flu vaccine use and acute exacerbation ofCOPD and the cost of COPD exacerbations. Methods: Cross-sectional, multicenter study at two hospitals and three clinics inLima and Callao, Peru. All subjects had a COPD diagnosis based on The Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (e.g., age 3 40 years old, smoker or ex-smoker, spirometry test). Sociodemographic, clinical, and COPD-relatedvariables were collected using questionnaires and medical records. Multivariate analysis using multiple logistic regression wasperformed to measure the association between the use of the flu vaccine and acute exacerbations of COPD. Results: Onehundred twelve patients were included, with a median age of 70 years (interquartile range: 63.5-75.0 years). Of these, 37.5%were vaccinated against flu, and 51.79% had at least one COPD exacerbation. In the adjusted analysis, being vaccinated theprevious year with the flu vaccine was not significatively associated with fewer exacerbations (OR=0.49, 95% CI 0.15-1.57;p=0.230), whereas being vaccinated three consecutive previous years was associated with significative fewer exacerbations(OR=0.13, 95% CI 0.02-0.91; p=0.040). The mean cost of an inpatient COPD exacerbation was USD 7,150.70. Conclusions:This study did not show a statistically significant relationship between having flu vaccination the previous year and fewerCOPD exacerbations in Peruvian patients, which was the primary study objective; however, this shows a statistically significantrelationship between the use of three consecutive flu vaccines and fewer exacerbations.

Risk factors associated with the incidence of asthma among adolescents in Ukraine

Background. Asthma is a common disease among children and adolescents. The purpose of this study was to describe the detailed characteristics of adolescents with asthma, identify risk factors associated with the development of asthma and to evaluate medical care for patients with asthma. Materials and methods. Asthma patients (n = 80) aged 12 to 18 years from the Allergology Department of the Kyiv City Children’s Clinical Hospital 2, the clinical base of the Department of Pediatrics 2 of the Bogomolets National Medical University, were included in the study. The control group consisted of 120 children without asthma. In the group of interviewed children, asthma was diagnosed based on clinical data and objective measurement of lung function. All children underwent spirometry and skin prick test with aeroallergens. During the clinical examination, weight and height were measured, and body mass index was calculated. The survey was conducted by a research doctor using a Google form. Results. Parents of 80 children with asthma were involved in our survey between September 2023 and May 2024. Asthma occurred more often in boys than in girls: odds ratio (OR) = 7.3 (95% confidence interval (CI) 3.84–14.16, P &lt; 0.0001). 31.25 % respondents reported a history of atopic dermatitis, 26.25 % had atopic dermatitis at the time of the study. Food allergy was detected in 25 % children. 48.75 % children had concomitant allergic rhinitis, of which 33.75 % had seasonal, 15 % had perennial. We found that children living in the city had asthma more often: OR = 7.3 (95% CI 3.26–16.62, P &lt; 0.0001). Having an older sibling was associated with a lower risk of asthma: OR = 3.6 (95% CI 1.86–6.92, P &lt; 0.0001). Also, we found that cat owners were significantly more likely not to have asthma: OR = 7.7 (95% CI 3.96–14.99, P &lt; 0.0001). Such data are most likely related to the refusal to own a cat due to the prevalence of cat allergy among children with asthma or at risk of cat allergy. We have not found a statistically significant difference in the group of children with asthma and in the control group in relation to the exposure to tobacco smoke in the atmosphere (passive smoking): OR = 1.4 (95% CI 0.79–2.59, P &gt; 0.05). Conclusions. Treatment of allergies and atopic conditions should be considered an important component of asthma treatment, which may affect the frequency and severity of the disease. In adolescents and adults, smoking cessation, in particular, as a factor in the impact of passive smoking on a sick child can also significantly reduce the number of hospitalizations. Confirming the diagnosis of asthma, demonstrating good inhaler technique, and emphasizing adherence to preventive therapies such as inhaled glucocorticosteroids can improve asthma control and reduce overreliance on short-acting bronchodilators.

Clinical effects of accreditation in general practice: a pragmatic randomized controlled study.

Accreditation has been implemented in general practice in many countries as a tool for quality improvement. Evidence of the effects of accreditation is, however, lacking. To investigate the clinical effects of accreditation in general practice. A mandatory national accreditation programme in Danish general practice was rolled out from 2016 to 2018. General practices were randomized to year of accreditation at the municipality level. We conducted a pragmatic randomized controlled study with general practices randomized to accreditation in 2016 (intervention group) and 2018 (control group). Data on patients enlisted with these practices were collected at baseline in 2014 (before randomization) and at follow-up in 2017. We use linear and logistic regression models to compare differences in changes in outcomes from baseline to follow-up between the intervention and control groups. The primary outcome was the number of redeemed medications. Secondary outcomes were polypharmacy, nonsteroidal anti-inflammatory drugs (NSAIDs)without proton pump inhibitors, sleeping medicine, preventive home visits, annual controls, spirometry tests, and mortality. We found statistically significant effects of accreditation on the primary outcome, the number of redeemed medications, and the secondary outcome, polypharmacy. No other effects were detected. In this first randomized study exploring the effects of accreditation in a primary care context, accreditation was found to reduce the number of redeemed medications and polypharmacy. We conclude that accreditation can be effective in changing behaviour, but the identified effects are small and limited to certain outcomes. Evaluations on the cost-effectiveness of accreditation are therefore warranted.

Level of Compliance with Spanish Guideline Recommendations in the Management of Asthma.

To describe the clinical management of asthmatic patients and the level of compliance with the Guía Española para el Manejo del Asma (GEMA, Spanish Guidelines for Asthma Management) in the influential al area of Virgen de la Victoria University Hospital, Málaga (Spain). Descriptive, cross-sectional study in asthma patients from the Virgen de la Victoria University Hospital influential area, Málaga (Spain). Asthma Control Test (ACT) results, demographic and clinical characteristics, and GEMA indicators of quality asthma care were obtained from each participating patient. Two hundred and eighty-eight patients (64.2% woman, mean age 48.6 years) were included in the study. The evaluation of the level of compliance with the GEMA quality indicators showed that in 20.8% of the patients the diagnosis of asthma was confirmed by spirometry and bronchodilator test, and 52.5% of the patients with suspicion of allergic asthma performed a sensitization test. Among the smoker patients, 76.3% were recommended to stop smoking; 14.2% of the patients received a paper-based educational plan. Regarding asthma treatment, 92.3% of patients with persistent asthma received inhaled glucocorticoids (IGC). IGC and LABA were the most common treatments for asthma, used in combination (ICG + LABA) in 139 (48.3%) patients; 32.6% discontinued SABA treatment during the study period. Asthma was well controlled in 54.9% of the patients (ACT score ≥20), and 13.9% of the patients registered exacerbations during the previous year with a mean (SD) of 1.38 (0.74) events. Most of the GEMA quality indicators of asthma care are not followed in real-world clinical practice. Specialists select the best option among the available treatments but there is an unmet need for training plans in other relevant aspects, such as diagnosis and/or disease monitoring.

Impact of Dyspnea on Adults With Respiratory Symptoms Without a Defined Diagnosis

BackgroundWe investigated dyspnea, its associated risk factors, and its impact on healthcare utilization, quality of life, and work productivity in adults with undiagnosed respiratory symptoms. Research QuestionWhat is the impact of dyspnea in adults with undiagnosed respiratory symptoms? Study Design and MethodsThis population-based study included 2857 adults who were experiencing respiratory symptoms. These individuals had not been previously diagnosed with any lung conditions and were recruited from 17 Canadian centers using random digit-dialing. Each participant underwent spirometry testing both before and after using a bronchodilator to determine if they met the diagnostic criteria for COPD, asthma, Preserved Ratio Impaired Spirometry (PRISm), or if their spirometry results were normal. An age-matched control group (n= 231) was similarly recruited using random-digit dialing. A dyspnea impact assessment score from 0 to 100 was produced using questions from the COPD Assessment Test and St. George’s Respiratory Questionnaire. ResultsIndividuals with PRISm (n=172) reported more impactful dyspnea (mean score 63.0, 95% CI: 59.5- 66.4) than those with undiagnosed asthma (n=265, mean score 56.6, 95% CI: 53.9-59.3) or undiagnosed COPD (n=330, mean score 57.5, 95% CI: 55.1-59.9). All groups reported significantly more impactful dyspnea compared to controls (mean score 13.8, 95% CI:11.8-15.7). Subject-specific risk factors including age, sex, BMI, smoking, and comorbidities explained 20.6% of the variation in dyspnea. An additional 12.4% of the variation was explained by disease classification and another 1.7% by the severity of lung function impairment assessed with spirometry. After adjusting for age, sex, and BMI, greater dyspnea impact was associated with increased healthcare utilization, lower quality of life, and reduced work productivity. InterpretationIn community-based adults with undiagnosed respiratory symptoms, those identified with PRISm experienced the greatest impact of dyspnea. Dyspnea imposes burdens on the healthcare system and is associated with impaired quality of life and work productivity.

Managing Exercise-Induced Bronchoconstriction: A Comprehensive Review of Strategies for Athletes to Maintain Fitness and Health

Exercise-induced bronchoconstriction (EIB) significantly impacts athletes by impairing their performance and overall health. Characterized by airway narrowing during or after physical activity, EIB affects the quality of training and competition. This study employs a qualitative descriptive research model based on a comprehensive literature review to evaluate EIB management strategies in athletes. We systematically collected data from trusted scientific databases—Scopus, Science Direct, and Google Scholar—using keywords such as "Exercise-Induced Asthma," "Athlete," and "Sport." Relevant articles were identified, and key terms related to EIB management were reviewed. The data, including study designs, research objectives, sample sizes, and findings, were compiled and analyzed to determine effective management approaches. Key findings indicate that accurate diagnosis using spirometry and bronchial provocation tests is essential. Pharmacological management primarily involves inhaled corticosteroids (ICS) to reduce inflammation and control EIB, while short-acting beta agonists (SABAs) offer only temporary relief. Non-pharmacological strategies include avoiding triggers, implementing proper warm-up routines, and using breathing techniques. Supervised aerobic exercise programs were shown to improve cardiovascular fitness without worsening EIB symptoms. The study also reviewed the impact of environmental factors, such as air pollution and post-COVID-19 conditions, on EIB. Recommendations include personalized asthma action plans, training for coaches on environmental triggers, and exercising in controlled conditions. This study highlights the need for a holistic approach combining pharmacological and non-pharmacological methods to manage EIB effectively and maintain athletic performance. Further research is warranted to develop tailored strategies for athletes with EIB.

PM2.5 exposure and household income are associated with lung function abnormalities in children with sickle cell disease.

Cardiopulmonary dysfunction is a major contributor to mortality among persons with sickle cell disease (pwSCD). Despite this, little is known regarding environmental drivers of lung function decline. We hypothesized that environmental and socioeconomic variables have a significant effect on lung function in pwSCD that can be detected by spirometry. We retrospectively analyzed all spirometry results from pwSCD followed in the Pediatric Pulmonology clinic at the Children's Hospital of Philadelphia since 1 January 2016. The study included 349 spirometry tests from 128 patients, primarily "Black or African American" (88%) and male (61%). More frequent exposure to PM2.5 above 25 μg/m3 was associated with higher odds of obstruction. Specifically, when compared to incidence of exposure to PM2.5 above 25 μg/m3 <25th percentile, both pwSCD exposed to 25th-75th percentile and pwSCD >75th percentile had higher odds of obstruction on spirometry (25th-75th: odds ratio [OR]: 9.6, p = .017; >75th:OR: 31.85, p = .002) despite correction for potential confounders. Similarly, median household income below the mean was associated with higher odds of restriction (OR: 4.37; p = .009). We report higher odds of obstruction in pwSCD frequently exposed to PM2.5 concentrations above 25 μg/m3 and higher odds of restriction in pwSCD with lower household income. Our findings link spirometry patterns to modifiable risk factors indicating that there may opportunities for early intervention in pwSCD that have been referred to a pulmonology clinic. Further research is needed to assess if these findings can be generalized to the wider population of pwSCD.

Exercise-Induced Bronchoconstriction in Children: State of the Art from Diagnosis to Treatment.

Exercise-induced bronchoconstriction (EIB) is a common clinical entity in people with asthma. EIB is characterized by postexercise airway obstruction that results in symptoms such as coughing, dyspnea, wheezing, chest tightness, and increased fatigue. The underlying mechanism of EIB is not completely understood. "Osmotic theory" and "thermal or vascular theory" have been proposed. Initial assessment must include a specific work-up to exclude alternative diagnoses like exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history and clinical examination must be followed by basal spirometry and exercise challenge test. The standardized treadmill running (TR) test, a controlled and standardized method to assess bronchial response to exercise, is the most adopted exercise challenge test for children aged at least 8 years. In the TR test, the goal is to reach the target heart rate in a short period and maintain it for at least 6 min. The test is then followed by spirometry at specific time points (5, 10, 15, and 30 min after exercise). In addition, bronchoprovocation tests like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) can be considered when the diagnosis is uncertain. Treatment options include both pharmacological and behavioral approaches. Considering medications, the use of short-acting beta-agonists (SABA) just before exercise is the commonest option strategy, but daily inhaled corticosteroids (ICS) can also be considered, especially when EIB is not controlled with SABA only or when the patients practice physical activity very often. Among the behavioral approaches, warm-up before exercise, breathing through the nose or face mask, and avoiding polluted environments are all recommended strategies to reduce EIB risk. This review summarizes the latest evidence published over the last 10 years on the pathogenesis, diagnosis using spirometry and indirect bronchoprovocation tests, and treatment strategies, including SABA and ICS, of EIB. A specific focus has been placed on EIB management in young athletes, since this condition can not only prevent them from practicing regular physical activity but also competitive sports.

The Nonlinear Relationship Between High-Density Lipoprotein and Changes in Pulmonary Structure Function and Pulmonary Function in COPD Patients in China.

The previous findings on the correlation between spirometry and high-density lipoprotein (HDL) cholesterol are intriguing yet conflicting. The aim of this research is to evaluate the relationship between HDL levels and spirometry as well as imaging parameters in patients with chronic obstructive pulmonary disease (COPD) in China. This study encompasses a total of 907 COPD patients. Participants with complete data from questionnaire interviews, lipid profile examinations, spirometry testing, and computed tomography (CT) scans were included in the analysis. A generalized additive model was employed to identify the non-linear relationship between HDL levels and both spirometry and imaging parameters. In the presence of non-linear correlations, segmented linear regression model was applied to ascertain threshold effects. After adjusting for various factors, we found a non-linear correlation between HDL levels and spirometry/imaging parameters, with an inflection point at 4.2 (66 mg/dL). When Ln (HDL) was below 4.2, each unit increase correlated significantly with reduced post-bronchodilator FEV1 (0.32L, 95% CI: 0.09-0.55), decreased predicted FEV1% (11.0%, 95% CI: 2.7-19.3), and lowered FEV1/FVC (8.0%, 95% CI: 4.0-12.0), along with notable increases in Ln (LAA-950) by 1.20 (95% CI: 0.60-1.79) and Ln (LAA-856) by 0.77 (95% CI: 0.37-1.17). However, no significant associations were observed when Ln (HDL) was greater than or equal to 4.2. A non-linear correlation existed between HDL levels with lung function and CT imaging in COPD patients. Prior to reaching 66 mg/dL, an elevation in HDL was significantly associated with impaired lung function, more severe gas trapping and emphysema.

Comparing the Pulmonary-Spirometry In Laboratory Workers Who Wear Acchadana® and KN95® Masks

BACKGROUND : The upper respiratory tract is susceptible to inflammation caused by exposure to airborne contaminants, particularly chemical irritants. Inhaled irritant gases can lead to various symptoms and adverse reactions in the respiratory tract. Laboratory workers are at a high risk of respiratory tract inflammation due to exposure to volatile chemicals. The use of personal protective equipment (PPE), such as masks, is essential to prevent inflammation and protect the respiratory tract. Lung function tests using spirometry, including Forced Vital Capacity (FVC), Forced Expiratory Volume in One Second (FEV1.0), and Peak Expiratory Flow (PEF), can help identify abnormalities in lung function. AIMS : The primary objective of this investigation is to juxtapose the pulmonary conditions of laboratory workers before and after the utilization of KN95® masks and Acchadana® masks. METHOD : The study design was a Randomized Control Trial, and the subjects were divided into two groups: the control group wearing KN95 masks and the treatment group wearing Acchadana® herbal masks. Spirometry measurements were taken before and after using the masks, and statistical analysis was conducted to compare the results. RESULT : The results showed that both mask groups experienced improvements in lung function parameters after using the masks. However, the KN95 mask group showed better lung conditions compared to the Acchadana® mask group. CONCLUSION : Spirometry tests conducted on lab workers revealed improved lung function metrics (including FVC, FEV1.0, and PEF) following the usage of KN95 masks and Acchadana® herbal masks. The KN95 mask users exhibited superior respiratory health compared to the other group in this investigation.

Evaluation of PHR160 Spray Effect on Improvement of Lung Function, Asthma Severity and Exacerbation in Severe Asthmatic Patients

Pinen Hydronoplacton Ribonucleic acid (PHR160) medicine contains compounds that can be useful in the recovery of respiratory patients. The aim of this study was to determine the effect of PHR spray on improving lung function, severity and asthma attacks in patients with severe asthma. This study is a pioneering interventional study (pilot study) conducted during the years 2021-2022 on patients with severe asthma resistant to treatment who referred to the lung clinic of Imam Khomeini, Golestan Hospitals and the private practice of lung specialists of this academic center. The study includes two groups of patients with asthma, both groups were given the usual treatment according to the stage of the disease, in addition, the intervention group was given two puffs of PHR spray every eight hours, and the control group was given a placebo spray with the same dose. Before and after the intervention, GSK 2002 questionnaire, six-minute walk distance (6MWD) and spirometry tests were completed. Among of 60 patients, 27 (45%) were male. The mean age of the patients was 44.33±6.94 years. Based on findings, the forced vital capacity (FVC) and forced expiratory flow between 25% and 75% (FEF 25-75%) were significantly better in the intervention group than the control group (P&lt;0.001 and P=0.019, respectively), but there was a statistically remarkable difference between the two groups in terms of forced expiratory volume (FEV1) and FEV1/FVC (P=0.505, P=0.575, respectively). In addition, the GSK questionnaire score in the intervention group was higher than the control group (P&lt;0.001), however there is no significant difference between the two intervention groups in terms of the 6MWD test and the number of exacerbation (P=0.114 and P=0.09, respectively). It is generally concluded that PHR160 spray can lead to improvement of spirometry parameters and severity of disease in severe asthma patients by affecting small airways.