Static Lung Function Research Articles

The effect of body compartments on lung function in childhood and adolescence

BackgroundThere is an association between body composition and lung function, assessed by spirometry, but the effects of body compartments on static lung volumes and its changes during lung growth remain to be explored. We aimed to investigate the association of appendicular lean mass, reflecting skeletal muscle mass, and fat mass on forced and static lung function measures in childhood and adolescence. MethodsIn total, 1489 children and adolescents (6-18 years) of the observational, longitudinal (first and second visit within 4 years), general population-based LEAD study have been investigated. The association of appendicular lean mass and fat mass indices (ALMI and FMI; assessed by dual-energy X-ray absorptiometry) on lung function by spirometry (FEV1, FVC) and body plethysmography (TLC, RV, FRC) was investigated cross-sectionally. Longitudinal associations between lung function and body compartment changes between the two visits were analysed. FindingsThe ALMI is positively associated with FEV1, FVC, and TLC. Contrary, FMI is inversely associated with lung function measures including FRC and RV. During the phase of lung growth, higher gain in muscle mass is associated with higher increases of FVC and TLC. InterpretationThis study demonstrates the different effects of muscle and fat mass on forced expiratory and static lung volumes. Achieving and maintaining muscle mass in childhood and adolescence might become an important preventive strategy for lung health in adulthood.

Characterization of Obesity in Severe Asthma in the German Asthma Net

Asthma is increasingly recognized as heterogeneous, characterized by different endotypes, with obesity not only a distinct phenotype but a risk factor for severe asthma. We sought to understand the associations of obesity with relevant parameters of severe asthma, including asthma control, disease burden, and lung function. The German Asthma Net registry is a multicenter international real-life registry capturing long-term follow-up data. This analysis included 2213 patients (52 ± 16 years, 58% female, 29% with obesity [body mass index ≥30 kg/m2], 4.2 ± 4.3 exacerbations/year). The primary analysis assessed relationships between BMI and variables through univariate tests, followed by a multiple regression model. Secondary outcomes regarded clinically relevant variables in relation to weight groups. Patients with obesity were more frequently female, more likely to have depression and gastroesophageal reflux, and suffered from worse asthma control, lower quality of life, reduced static lung volumes, more pronounced hypoxemia, and higher blood neutrophil counts, all statistically significant. Blood eosinophils, exhaled nitric oxide, and total IgE were independent of obesity. In the multiple regression analysis, obesity was significantly associated with more frequent reflux and depression, reduced static lung function values, older age, poor asthma control, and long-acting muscarinic antagonist therapy, and inversely associated with bronchiectasis and nonsmoking status. In this large, well-characterized cohort, we identified the association of obesity with a significantly higher disease burden and a similar portfolio of inflammation type 2 markers in patients with and without obesity; therefore, patients with obesity seem similarly eligible for the treatment with biologics targeting these disease endotypes.

Using electrical impedance tomography to characterize lung impairment of children with primary ciliary dyskinesia: A pilot cross-sectional study.

In children with primary ciliary dyskinesia (PCD), measures more sensitive than spirometry are needed to characterize underlying pulmonary impairment. Electrical impedance tomography (EIT) is a promising noninvasive method for monitoring the distribution of lung ventilation, and it does not require patient collaboration. We aimed to provide an assessment of the feasibility and clinical usefulness of EIT in characterizing lung impairment in children with PCD, compared to spirometry and multiple breath nitrogen washout (MBWN2 ) test. Children and adolescents with PCD underwent MBWN2 test as first respiratory assessment, followed by EIT monitoring and spirometry during outpatient follow-up. We included 12 out of 16 individuals regularly followed at our clinic. A total of 41.7% (5/12) showed abnormalforced expiratory volume in 1 s (FEV1 ), whereas 11/12 (91.7%) had abnormal ventilation inhomogeneity measured with MBWN2 test. Using EIT, the global inhomogeneity (GITOT ) index showed moderate to strong correlation with FEV1 (ρ = -0.55, 95% confidence interval [CI]: -0.87 to 0.02) and ranged from 37 to 44, with the highest inhomogeneity detected in the dorsal right quadrant. GITOT was moderately correlated with RV/TLC %predicted (ρ = 0.38, 95%CI: -0.17 to 0.74), while we detected a weak correlation between GITOT and lung clearance index(ρ = 0.29, 95%CI: -0.45 to 0.82). EIT appears promising as a noninvasive technique to characterize ventilation distribution in children with PCD, thus providing a complementary assessment to static and dynamic lung function measures of PCD disease.

Effect of Simultaneous Multiplane Surgery on Cardiopulmonary Function in Patients with Moderate to Severe Obstructive Sleep Apnea-Hypopnea Syndrome and Its Curative Effect.

Objective To investigate the changes in cardiopulmonary function in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) by one-stage multiplane surgery. Methods 70 patients with moderate and severe OSAHS underwent nasal in our hospital from July 2017 to February 2021, palatopharyngeal, and/or tongue operations simultaneously and were followed up for 6 months. The Epworth Sleeping Scale (ESS) scores of patients before and after surgery were compared to observe the surgical efficacy, and the changes in the cardiopulmonary function of patients before and after surgery were detected. The static and dynamic indexes of cardiopulmonary function, respiratory disturbance index (AHI), and blood oxygen saturation (SaO2) were compared before and after the operation. Results After surgery, all patients' indexes of static lung function were improved compared with that before surgery. After surgery, the percentage of maximal oxygen uptake peak to the predicted value, percentage of oxygen pulse to the predicted value, the ratio of oxygen uptake power, anaerobic threshold, and maximum ventilatory capacity per minute/maximum exercise volume were increased compared with that before surgery, and AHI and SaO2 were improved compared with that before surgery. Conclusion This study suggests that it is feasible for patients with OSAHS who are unable to tolerate or unwilling to undergo noninvasive assisted ventilation to undergo simultaneous surgery for multiplane stenosis. It can reduce clinical symptoms and improve cardiopulmonary function.

Upper airway symptoms and Small Airways Disease in Chronic Obstructive Pulmonary Disease, COPD

BackgroundSmall Airways Disease (SAD) is a recognised part of the pathology in Chronic Obstructive Pulmonary Disease (COPD) and contributes to the symptom burden in the disease. Upper airway symptoms in COPD is an emerging field of study, and in this study, we sought to examine the co-existence of SAD and upper airways symptoms in a cohort of COPD patients MethodsWe investigated a cohort of patients with COPD for the presence of SAD with three different modalities. We performed High-Resolution CT (HRCT) with Parametric Response Mapping (PRM) analysis and recorded distribution of emphysema (PRMEmph) and functional Small Airways Disease (PRMfSAD). We measured central and peripheral lung resistance using Impulse Oscillometry (IOS) and recorded R5Hz, R20Hz, R5-R20Hz, X5, Fres and Ax. Static lung function parameters were obtained using Body Plethysmography.Data on upper and lower airway symptoms were evaluated using the Upper Airway subdomain of the 22 items Sino Nasal Outcome Test (SNOT22nasal) and the COPD Assessment Test (CAT), respectively. FindingsWe recruited a total of 112 patients. (female sex: 58%, Age 68 (±8) years, FEV1%predicted: 53% (±16%), GOLD stage: A: 23%, B: 55%, C:1% D: 21%). Forty-five (40%) were classified as having high upper airway symptoms (UAS), defined as SNOT22nasal ≥6. Eighty-seven per cent showed signs of SAD using IOS (R5-R20Hz > 0.07 kPa/L/s). No significant differences were found between UAS groups in IOS, PRM or Body Plethysmography parameters. ConclusionIn patients with COPD, the prevalence of small airways disease was very high, but no association between upper airway symptoms and small airways disease was demonstrated.

Pectus Excavatum and Pectus Carinatum in dogs

Background: Deformities of the anterior thoracic wall are called pectus: pectus excavatum and pectus carinatum. Pectus excavatum is characterised by dorsal deviation of the caudal region of the sternum while pectus carinatum consists of protrusion of the sternum and/or adjacent cartilage. Both defects may remain symptom-free, but respiratory and cardiac abnormalities have been reported. Another deformity observed in dogs is the swimming dog syndrome, which consists of the lateral opening of the thoracic and pelvic limbs, associated with the pedalling movement. These disorders are frequently reported in medical practice, are considered rare among canines. This report aims to describe a case of pectus excavatum associated with the swimming dog syndrome (Case 1) and another case of pectus carinatum (Case 2).Case: In Case 1, an approximately 45-day-old male American Pitbull canine had difficulty standing. Physical examination revealed hyperextension of the thoracic and pelvic limb joints and flattening of the thorax. After radiographic examination, pectus excavatum and the swimming dog syndrome were confirmed. The conservative treatment with splinting and hydrotherapy was chosen. At the 3-month follow-up, slight improvement in the limbs and irregular and unsatisfactory growth of the thorax leading to episodes of dyspnoea were observed. In Case 2, a female Pug, approximately 2 months old, had a thorax deformity. Physical examination revealed thorax protrusion, confirmed on radiography as pectus carinatum. Conservative therapy was provided using compressive bandage. One month later, the tutor reported improvement in the condition and absence of respiratory changes.Discussion: Pectus deformities has low incidence, and cases to pectus carinatum, there is a sexual predisposition, that is, males are more predisposed, differing from Case 2, a female dog. In the cases of pectus excavatum, no genetic alteration was directly related to its occurrence, although familial occurrence is reported in humans, as in Case 1, in which the patient was the only one of this litter to present this deformity. Though the possibility is lower, the acquired aetiology has been described in other cases. In pectus carinatum, there is the possibility of an acquired aetiology, which corroborates Case 2, considering that the canine had no history of inbreeding, nor family history. However, it is important consider racial predisposition, where there is an increasing number of cases of pectus carinatum in brachycephalic canines. Respiratory symptoms are frequently reported in cases of pectus excavatum, which the evolution of the condition occurred in Case 1, that can be explained by the displacement of organs or the restriction to ventilation. Humans have shown that pectus excavatum reduces static lung function. Case 2 showed no clinical signs, despite this presented dextrocardia, which in the future may confer cardiac dysfunctions. The diagnosis for pectus is considered simple. Performed only by radiography, it can be complemented by echocardiography. In both cases, conservative treatment was the choice. However, in Case 1 there was no success due to the degree of patient involvement, unlike Case 2, which had a better development of the thoracic wall, ensuring better quality of life for the patient. Thus, it is possible to conclude that some differences were found in these two reported cases when compared to others described in the literature. The radiographic diagnosis is confirmatory, and the therapy must be adequate to the degree of thoracic wall deformity. In addition, the prognosis is more reserved for pectus excavatum than pectus carinatum.

Predictive Value of Combining Inflammatory Biomarkers and Rapid Decline of FEV1 for COPD in Chinese Population: A Prospective Cohort Study.

BackgroundIn China, the high prevalence and mortality rate of Chronic Obstructive Pulmonary Disease (COPD) and the poor intervention effect makes it into a heavy social burden. The main reason is that the current diagnosis of COPD mainly based on the static lung function, which is difficult for early intervention. Through matching a predictive model for high-risk groups of COPD that rewards FEV1 rapid decline as the core, we will establish the early warning model and prove its validity and socio-economic value.MethodsThis is a multi-center, prospective, cohort study. A total of 10,000 people aged 40∼75 without lung disease will be recruited and followed for 3 years. Some questionnaires such as St George’s Respiratory Questionnaire (SGRQ), income class, educational level, comorbidity, smoking habit, and biomass smoke exposure history will be collected. The baseline level of Interleukin 6 (IL-6), high-sensitivity C-reactive Protein (hs-CRP), microRNAs-23a (miR-23a) in peripheral blood and pH value in exhaled breath condensate (EBC) will be measured, lung spirometry will be tested in the first, second, and fourth years. Primary outcome is the incidence of COPD, multivariate regression analysis will be used to establish the predictive model for COPD in China.DiscussionWith the rapid decline of lung function as the core and the baseline inflammatory biomarkers in peripheral blood and pH of the exhaled breath condensate as affecting factors, a predictive model to achieve early detection of high-risk COPD groups will be established and promoted.Trial registrationThis study has been registered at www.ClinicalTrials.gov (registration identifier: NCT03532893) on 21 May 2018, https://register.clinicaltrials.gov.

Long-term morbidity of respiratory viral infections during chemotherapy in children with leukaemia.

BackgroundRespiratory viruses are a common cause of infection in immunosuppressed children undergoing cancer therapy. Pulmonary sequelae have been documented following respiratory viral infections (RVIs) in hematopoietic stem cell transplant (HSCT) recipients; however potential late effects in children undergoing nonmyeloablative chemotherapy have not been investigated.AimTo evaluate the long‐term pulmonary morbidity of respiratory viral infections during chemotherapy in children with acute lymphoblastic leukemia (ALL).MethodsChildhood ALL survivors, aged 7 to 18 years, greater than 6 months posttreatment were recruited. Exclusion criteria included HSCT or proven bacterial/fungal respiratory infection during treatment. Subjects were classified into “viral” or “control” groups according to retrospective medical records that documented the presence of laboratory‐proven RVIs during chemotherapy. Symptom questionnaires (Liverpool, ISAAC) and lung function testing (spirometry, plethysmography, diffusing capacity, forced oscillation technique to ATS/ERS standards) were then performed cross‐sectionally at the time of recruitment.ResultsFifty‐four patients (31 viral, 23 control) were recruited: median (range) age 11.2 (7.2‐18.1) years, and at 4.9 (0.5‐13) years posttherapy. Abnormalities were detected in 17 (31%) individuals (8 viral, 9 control), with the most common being DLCO impairment (3 viral, 4 control) and reduced respiratory reactance at 5 Hz (5 viral, 6 control). Children with RVIs during chemotherapy reported more current respiratory symptoms, particularly wheeze (odds ratio [OR], 3.0; 95% confidence interval [CI]: 0.9‐10.0; P = .09) and cough (OR, 2.7; 95% CI: 0.8‐9.5; P = .11). No differences in lung function tests were observed between the two groups.ConclusionsOur study found children with RVIs during chemotherapy developed more long‐term respiratory symptoms than controls; however, differences did not reach statistical significance. No differences in static lung function were found between the two groups. Overall, pulmonary abnormalities and/or significant ongoing respiratory symptoms were detected in nearly a third of ALL survivors treated without HSCT. Larger, prospective studies are warranted to evaluate the etiology and clinical significance of these findings.

DOZ047.28: Clinical utility of cardiopulmonary exercise testing in children with esophageal atresia

Abstract Background Respiratory morbidity in children with esophageal atresia/tracheoesophageal fistula (OA/TOF), due to impaired mucociliary clearance, recurrent infections, and aspiration, may impair pulmonary function during childhood and this may persist into adult life. Early recognition of reduced lung function could optimize respiratory management and improve long-term outcomes. However, static lung function assessments, using spirometry and body plethysmography, may not sensitively identify impaired lung function. Cardiopulmonary exercise testing (CPET), which involves a dynamic assessment of respiratory function and determines aerobic capacity, degree of fitness, and ventilatory (breathing) reserve during maximal exertion, may detect poor lung function earlier. Aim This study determines the clinical utility of cardiopulmonary exercise testing in children with OA/TOF. Methods Retrospective chart review of children attending a multidisciplinary OA/TOF clinic who underwent spirometry, plethysmography, and a maximal CPET (Bruce Treadmill Protocol). Plethysmography and CPET were performed on the same day in 16 children; 4 children within 2 days and 6 within 2 months. Studies exceeding 2 months were not analyzed (n = 2). Results Thirty-nine children, aged ≥ 7 years, underwent CPET when clinically well. Thirty-two children, 7–18 years, achieved a maximal CPET (82.1%). There was no significant exercise-induced drop in PPFEV1 in any child. One child experienced a reduction in oxygen saturation to 92%. Exercise capacity (VO2MAX, peak oxygen consumption) was normal in 30 children (93.8%). However reduced ventilatory or breathing reserve (BR), defined as <20% predicted, was identified in 18 children (56.3%). Four of these children had no ventilatory reserve (BR = 0). In contrast, spirometry was normal in 20 children (62.5%). Nine (28%) had a mild obstructive or restrictive pattern. One child had moderate restriction and 2 had a mixed pattern. Plethysmography (n = 26) revealed mild restrictive lung disease in 9 (34.6%). An additional 3 children had air-trapping. Conclusion Children with OA/TOF have significant lung function impairment. Spirometry and plethysmography revealed normal or mildly abnormal airway function/lung volumes in the majority of children. CPET identified significant ventilation limitation in over half of all children. CPET assessment is a feasible and sensitive assessment of cardiorespiratory function in children with OA/TOF. Further evaluation of risk factors and longitudinal CPET assessments may inform future management guidelines.

Effect of Tai Chi on Cardiac and Static Pulmonary Function in Older Community-Dwelling Adults at Risk of Ischemic Stroke: A Randomized Controlled Trial.

To evaluate the effect of tai chi exercise on cardiac and static lung function for older community-dwelling adults at risk of ischemic stroke. A total of 170 older community-dwelling adults (aged 55-75 years old) at risk of ischemic stroke were allocated to either tai chi training group (85 cases, five 60-min sessions of tai chi training per week for 12 weeks) or control group (85 cases, usual pbysical activity for 12 weeks) using a computer-generated randomization. The echocardiographic parameters of cardiac structure, cardiac function and static lung function were measured at baseline, after 12 weeks of intervention and additional 12-week follow-up period by a blinded professional staffmember using a color Doppler ultrasound imaging device or a cardiopulmonary function instrument. The t test and linear mixed model based on the intentionto-treat analysis principle was used to calculate the effect. The adverse effect was observed. Most of echocardiographic parameters on the cardiac structure, cardiac function and static lung function between the tai chi group and control group did not have a significant difference either post 12-week intervention or additional 12-week follow-up period. Only three parameters involving in right ventricular diameter (P=0.024), main pulmonary artery diameter (P=0.002) and vital capacity maximum (P=0.036) were beneficial to be improved in the tai chi group compared to the control group by the analysis of mixed linear model. No adverse effects were found during the intervention period. The 12-week tai chi exercise did not have an obvious beneficial effect on cardiac structure, cardiac function and static lung function in older community-dwelling adults at risk of ischemic stroke. The study with a longer duration of intervention should be necessary. (Trial registration No. ChiCTR-TRC-13003601).

Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery.

BackgroundPulmonary function is severely reduced in the early period after cardiac surgery, and impairments have been described up to 4–6 months after surgery. Evaluation of pulmonary function in a longer perspective is lacking. In this prospective study pulmonary function and health-related quality of life were investigated 1 year after cardiac surgery.MethodsPulmonary function measurements, health-related quality of life (SF-36), dyspnoea, subjective breathing and coughing ability and pain were evaluated before and 1 year after surgery in 150 patients undergoing coronary artery bypass grafting, valve surgery or combined surgery.ResultsOne year after surgery the forced vital capacity and forced expiratory volume in 1 s were significantly decreased (by 4–5 %) compared to preoperative values (p < 0.05). Saturation of peripheral oxygen was unchanged 1 year postoperatively compared to baseline. A significantly improved health-related quality of life was found 1 year after surgery, with improvements in all eight aspects of SF-36 (p < 0.001). Sternotomy-related pain was low 1 year postoperatively at rest (median 0 [min-max; 0–7]), while taking a deep breath (0 [0–4]) and while coughing (0 [0–8]). A more pronounced decrease in pulmonary function was associated with dyspnoea limitations and impaired subjective breathing and coughing ability.ConclusionsOne year after cardiac surgery static and dynamic lung function measurements were slightly decreased, while health-related quality of life was improved in comparison to preoperative values. Measured levels of pain were low and saturation of peripheral oxygen was same as preoperatively.

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M140 Effect Of Beta-blockade On Lung Function In A Population With Arterial Vascular Disease With And Without Copd

Introduction Patients are frequently prescribed β-blockers for heart failure, ischaemic heart disease and peri-operatively, especially for vascular surgery. However, β-blockers remain under prescribed in patients with COPD despite epidemiological evidence indicating little negative impact. This reluctance to use β-blockers is due to concerns about increased airway hyper-responsiveness and bronchoconstriction. As part of a study of peri-operative β-blockade in patients with abdominal aortic aneurysm (AAA) we examined the effect of β-blockers on lung function. Methods We prospectively recruited 55 AAA patients with no selection bias for COPD or β-blocker use. Thirty eight patients successfully completed detailed lung function testing (PFT) measured by body plethysmography both on and off β-blockers. Subjects already taking β-blockers continued usual treatment while others were prescribed weight adjusted bisoprolol for 48 h. Results Mean age was 70 (5) years and 33 (77%) subjects were male. 16/38 (42%) were already taking beta-blockers and 5 people (15%) were diagnosed with COPD although 15 (39%) had COPD based on spirometry. Ten (26%) were current smokers and 19 (50%) ex-smokers. The lung function results are shown in the table. Beta-blockade had no significant impact on most lung function measures in both COPD and non-COPD subjects. Specific airways resistance (sRaw) was significantly higher when subjects were taking β-blockers but this effect did not differ between COPD and non-COPD subjects (Δ sRaw: whole group p = 0.004, COPD p = 0.025, non-COPD p = 0.031). Discussion β-blockers had little effect on static lung function including FEV1 and specific conductance. The small change in resistance was seen in subjects with and without COPD. In this population there appears to be no reason for not using a cardio-selective β-blocker both in this peri-operative setting and for cardiac indications.

Validation of Rules of Two™ as a Paradigm for Assessing Asthma Control

Assessing asthma control at each patient encounter is an essential task to determine pharmacologic requirements. Rules of Two (Ro2) was created from the original 1991 National Asthma Education Program guidelines to determine the need for controller therapy. This study determined the degree of agreement between Ro2 and the Expert Panel Report (EPR-3) definition of “in control” asthma and compared that value with the Asthma Control Test (ACT) in a group of asthmatics for the purpose of validating this tool. Patients with documented asthma were randomized to complete Ro2 or ACT prior to being assessed for asthma control by certified asthma educators using an EPR-3 template. Assessments occurred in either a specialty asthma clinic or at a local health fair. Patients were also queried for their personal assessment of asthma control. The primary statistical methodology employed was the degree of agreement (kappa) between each survey tool and the EPR-3 template. Of 150 patients, 72% did not have their asthma in control, based on the EPR-3 template. Ro2 identified 58% of patients not in control of their asthma, whereas ACT identified 36%, with kappa scores of 0.41 for Ro2 and 0.37 for ACT compared with the EPR-3 template. These were not significantly different. Of the 150 patients, 75% considered their asthma in control based on self-assessments, with a kappa of 0.23. In 14 of 73 ACT questionnaires, scores were not added or were misadded. Eliminating evaluation of static lung function significantly improved both kappa scores of Ro2 and ACT. In conclusion, Ro2 identifies patients with uncontrolled asthma as well as ACT and may be useful to the primary assessing clinician in determining asthma control.

Diet‐induced weight loss in obese children with asthma: a randomized controlled trial

Obesity is highly prevalent in asthmatic children and associated with worse clinical outcomes. Energy restriction to induce weight loss in asthmatic children has not been investigated in a randomized controlled trial (RCT). To assess if (1) weight loss can be achieved in obese asthmatic children using a dietary intervention; and (2) changes in asthma outcomes occur following diet-induced weight loss. In a 10-week pilot RCT, obese asthmatic children, aged 8-17years, were randomized to a wait-list control (WLC) (n=15) or dietary-intervention group (DIG) (n=13). Lung function, Asthma Control Questionnaire (ACQ) score, and sputum and systemic inflammation were assessed at baseline and post-intervention. (Australian New Zealand Clinical Trials Registry: ACTRN12610000955011). Body mass index (BMI) z-score reduced significantly in the DIG vs. the WLC (-0.2 [-0.4, -0.1] vs. 0.0 [-0.1, 0.0], P=0.014). Expiratory reserve volume (ERV) increased significantly within the DIG, but not compared to the WLC (0.7 [0.0, 1.0]L vs. 0.3 [0.0, 0.8]L, P=0.355). ACQ improved significantly in the DIG, compared to the WLC (-0.4 [-0.7, 0.0] vs. 0.1 [0.0, 0.6], P=0.004). Airway and systemic inflammation did not change within the DIG. In comparison, C-Reactive Protein (CRP) increased significantly in the WLC (-0.4 [-0.5, 0.4] vs. 0.7 [-0.1, 1.9], P=0.037). Change (∆) in BMI z-score correlated with ∆CRP (r=0.47, P=0.012) and ∆exhaled nitric oxide (eNO) (r=0.46, P=0.034), and ∆ACQ was associated with ∆CRP (r=0.43, P=0.029). Dietary intervention can induce acute weight loss in obese asthmatic children with subsequent improvements in static lung function and asthma control. Systemic and airway inflammation did not change following weight loss. However, changes in BMI z-score were associated with changes in airway and systemic inflammation and this requires further investigation in a larger RCT. This is the first weight loss RCT conducted in obese asthmatic children. Diet-induced weight loss can achieve significant improvements in clinical outcomes for obese children with asthma.

Multifactorial intervention for children with asthma and overweight (Mikado): study design of a randomised controlled trial

BackgroundIn children, the prevalence’s of both obesity and asthma are disconcertingly high. Asthmatic children with obesity are characterised by less asthma control and a high need for asthma medication. As the obese asthmatic child is becoming more common in the clinical setting and the disease burden of the asthma-obesity phenotype is high, there is an increasing need for effective treatment in these children. In adults, weight reduction resulted in improved lung function, better asthma control and less need for asthma medication. In children this is hardly studied. The Mikado study aims to evaluate the effectiveness of a long term multifactorial weight reduction intervention, on asthma characteristics in children with asthma and a high body weight.Methods/designThe Mikado study is a two-armed, randomised controlled trial. In total, 104 participants will be recruited via online questionnaires, pulmonary paediatricians, the youth department of the Municipal Health Services and cohorts of existing studies. All participants will be aged 6–16 years, will have current asthma, a Body Mass Index in the overweight or obesity range, and no serious comorbidities (such as diabetes, heart diseases). Participants in the intervention arm will receive a multifactorial intervention of 18 months consisting of sessions concerning sports, parental involvement, individual counselling and lifestyle advices including dietary advices and cognitive behavioural therapy. The control group will receive usual care. The primary outcome variables will include Forced Expiratory Volume in one second and Body Mass Index - Standard Deviation Score. Secondary outcomes will include other lung function parameters (including dynamic and static lung function parameters), asthma control, asthma-specific quality of life, use of asthma medication and markers of systemic inflammation and airway inflammation.DiscussionIn this randomised controlled trial we will study the potential of a multifactorial weight reduction intervention to improve asthma-related outcome measures in asthmatic children with overweight. Moreover, it will provide information about the underlying mechanisms in the relationship between asthma and a high body weight in children. These findings can contribute to optimal management programs and better clinical guidelines for children with asthma and overweight.Trial registrationClinicaltrial.gov NCT00998413

A Comparison of Pattern of Breathing during Incremental Exercise in Patients with Pulmonary Fibrosis and Primary Pulmonary Hypertension

It has previously been proposed that the pattern of breathing during exercise, and particularly maximum tidal volume, can be used to distinguish between interstitial lung disease and pulmonary vascular disease; however this has never been formally investigated. This study looks at the impact of incremental exercise on a bicycle ergometer and the impact that such exercise has on breathing pattern, specifically maximum tidal volume. Method: We retrospectively reviewed the incremental exercise tests of 10 patients with pulmonary fibrosis (PF) and 9 with primary pulmonary hypertension (PPH). Patients were exercised using a bicycle ergometer, seated, and breathing into a mouthpiece. Results: The VE/VCO2 relationship was linear in all patients, but PPH patients had higher VE/VCO2 slopes (0.058±0.03) mean ±SD than PF patients (0.039±0.01, P<0.04). The respiratory rate/VE slopes were also higher in PPH patients (0.48±0.17) than in PF patients (0.30±0.14, P<0.02). There was no correlation between the VTmax/IC at the end of exercise and the IC %predicted in either group. However, VTmax as % of IC at the end of exercise in PPH patients (59.1±7.6) was lower than in PF patients (87.0±14.5%, P<0.001). Conclusion: The pattern of breathing during exercise, specifically maximum tidal volume, is different in patients with primary pulmonary hypertension compared with pulmonary fibrosis patients. These changes in the breathing pattern are unrelated to underlying static and dynamic lung function. Thus, the conclusion is that patients who have lung diseases which restrict their breathing often compensate, likely in an effort to avoid dyspnea, by modifying their natural breathing into a more tightly constrained pattern.

Pneumoconiosis and emphysema in construction workers: results of HRCT and lung function findings

ObjectivesTo evaluate the prevalence of HRCT findings in construction workers previously surveyed by chest radiographs classified according to ILO guidelines. To examine the association between HRCT findings and exposure to...

Structural lung changes, lung function, and non‐invasive inflammatory markers in cystic fibrosis

Cystic fibrosis (CF) lung disease is characterized by chronic airway inflammation and recurrent infections, resulting in (ir)reversible structural lung changes and a progressive decline in lung function. The objective of this study was to investigate the relationship between non-invasive inflammatory markers (IM) in exhaled breath condensate (EBC), lung function indices and structural lung changes, visualized by high resolution computed tomography (HRCT) scans in CF. In 34 CF patients, lung function indices (forced expiratory volume in 1 s, forced vital capacity [FVC], residual volume, and total lung capacity [TLC]) and non-invasive IM (exhaled nitric oxide, and condensate acidity, nitrate, nitrite, 8-isoprostane, hydrogen peroxide, interferon-gamma) were assessed. HRCT scans were scored in a standardized and validated way, a composite score and component scores were calculated. In general, the correlations between non-invasive IM and structural lung changes, and between IM and lung function were low (correlation coefficients <0.40). Patients with positive sputum Pseudomonas cultures had higher EBC nitrite levels and higher parenchymal HRCT subscores than patients with Pseudomonas-negative cultures (p < 0.05). Multiple linear regression models demonstrated that FVC was significantly predicted by hydrogen peroxide in EBC, and the scores of bronchiectasis and mosaic perfusion (Pearson correlation coefficient R = 0.78, p < 0.001). TLC was significantly predicted by 8-isoprostane, nitrate, hydrogen peroxide in EBC, and the mucous plugging subscore (R = 0.92, p < 0.01). Static and dynamic lung function indices in this CF group were predicted by the combination of non-invasive IM in EBC and structural lung changes on HRCT imaging. Future longitudinal studies should reveal whether non-invasive monitoring of airway inflammation in CF adds to better follow-up of patients.

Studies of Gamma-Glutamyl Transferase in Alpha-1 Antitrypsin Deficiency

ABSTRACTGamma-glutamyl transferase (GGT) is a clinical marker of biliary disease, but is also of importance in anti-oxidant metabolic pathways and, consequently, is a potential biomarker of oxidative stress in COPD. Serum GGT is increased in alpha-1 antitrypsin deficiency (AATD) but this could reflect a hepatic, systemic or pulmonary origin. We aimed to investigate the relationship between serum GGT, lung disease, liver disease and mortality in subjects with AATD. Serum GGT was measured at the baseline assessment in 334 PiZ subjects from the UK AATD registry, and related to static lung function, chronic bronchitis, sputum purulence, history of acute exacerbations, smoking status, mortality, alcohol consumption, cirrhosis and serum markers of liver disease. GGT correlated with airflow obstruction and was associated with chronic bronchitis. GGT levels were higher in current smokers compared with ex-smokers and never smokers, and in non-survivors compared with survivors. Although GGT related to alcohol consumption and established liver disease, it was independently related to FEV1, mortality, smoking history and male gender. In conclusion, although serum GGT reflects the presence of liver disease it is independently associated with airflow obstruction and mortality. Further studies are needed to establish the role of GGT in oxidative lung injury, and its use as a potential biomarker in chronic inflammatory lung disease.