Tiffenau Index Research Articles

BLOCK OF THE ANGIOTENSIN PATHWAYS EFFECTS FLOW-VOLUME SPIROMETRY IN PATIENTS WITH SARS-COV-2 INFECTION

Objective: Angiotensin Converting Enzyme 2 (ACE2) pathways inhibitors have been first evaluated in COVID-19 patients for the risk of poor prognosis. Pulmonary function tests (PFTs) are the main diagnostic tools for most respiratory diseases. Few data are present in follow-up PFTs according to hypertension or treatment. We evaluated patients that are hypertensives and not and the role of ACE2i/ARB through flow-volume spirometry in follow-up after infection recovery. Design and method: We evaluated 112 Caucasian patients 3-6 months after Covid-19 disease, i.e. after the date of negative molecular/antigenic nasopharyngeal swab. The series of patients showed a great variability due to a wide spectrum of age, the severity of disease manifestations, hospitalization, invasive/non-invasive ventilation, comorbidities, the presence/absence of a previous pneumological diagnosis, and the variants of the virus. Patients were divided into those who were hypertensives (Group1, 18 females and 30 males, aged 63.47±14.24), and who were not (Group2, 32 females and 32 males, aged 53.03±16.66). Group1 was further analysed according to treatment: patients in ACEi/ARB treatment (Group1A, 23 females and 12 males, aged 63.63±10.40) and those who not (Group1B, 6 females and 7 males, aged 53.03±16.66). Distal airflow obstruction (DAO) was evaluate as forced expiratory flow (FEF) at 25%, 50% and 75% of total flow. PFTs values were related to age, sex and BMI before comparison. Results: Group1 presented lower peripheral oxygen saturation percentage (SpO2) vs Group2 (p<0.05). Spirometry data were worst in Group1: Forced expiratory volume at first minute (FEV1) (p<0.05), Forced vital capacity (FVC) (p<0.05), and Tiffenau Index (p<0.05). There was a DAO in Group1. In Group 1, we found also a reduction in FEF 25 (p<0.05), FEF 50 (p<0.05), and FEF 25-75 (p<0.05), and in FEF 75 (p<0.05). There was no difference in those parameters comparing Group1A vs Group1B. Conclusions: In hypertensives the indexes of respiratory function were shifted towards the lower limits (albeit within normal limits). These parameters were significantly reduced compared to controls. Treatment with ACEi/ARB didn’t affect PFTs at follow-up evaluation after recovery. Thus, COVID-19 is not only a pulmonary, but also a vascular disease worsening when a previous CV comorbidity.

Block of the Angiotensin Pathways Affects Flow-Volume Spirometry in Patients with SARS-CoV-2 Infection.

Angiotensin Converting Enzyme 2 (ACE2) is an endothelial cell receptor used by SARS-CoV- 2 virus to enter cells. Pulmonary function tests (PFTs), mainly spirometry, are the main diagnostic tools for most respiratory diseases. PFTs are mandatory for assessing the response to therapy. We evaluated patients after the SARS-CoV-2 infection through flow-volume spirometry that evaluates the role of drugs inhibiting the ACE2 pathway. We evaluated 112 Caucasian patients 3-6months after COVID-19 disease, i.e. after the date of negative molecular or antigenic nasopharyngeal swab. The series of patients showed a great variability due to a wide spectrum of age, the severity of disease manifestations, hospitalization, invasive/non-invasive ventilation, comorbidities, the presence/absence of a previous pneumological diagnosis and the variants of the virus. Patients were divided into those who were being treated with angiotensin receptor blocker (ARB) or ACE2 inhibitors (ACEi) (ARB/ACEi, group 1, 23 females and 12 males, aged 63.63±10.40), and those who were not treated with these drugs (group 2, 38 females and 37 males, aged 55.12±16.51). Distal airflow obstruction (DAO) was evaluate as forced expiratory flow (FEF) at 25%, 50% and 75% of total flow. Group 1 presented lower peripheral oxygen saturation percentage vs group 2 (96.54±3.06 vs 97.30±1.19%, p<0.05). Spirometry data were worst in group1: Forced expiratory volume at first minute (FEV1) (91.20±17.09 vs 97.56±16.40%, p<0.05), Forced vital capacity (94.06±17.48 vs 99.13±17.71%, p<0.05), and Tiffenau Index (0.78±0.12 vs 0.84±0.10, p<0.05). There was a DAO in group1. In group 1, we found also a reduction in FEF 25 (73.97±27.28 vs 86.89±22.44%, p<0.05), FEF 50 (74.69±33.01 vs 85.67±23.74%, p<0.05), and FEF 25-75 (74.14±35.03 vs 83.92±25.38%, p<0.05) but not in FEF 75 (73.06±39.37 vs 82.27±43.33%, p<0.05). In patients treated with ARB/ACEi the indexes of respiratory function were shifted towards the lower limits (albeit within normal limits). These parameters were significantly reduced compared to patients not treated with these drugs. This indicates that the COVID-19 disease is not only a pulmonary disease, but also a vascular one.

15 THE HEAVY BURDEN OF SARS-COV-2 RELATED PNEUMONIA REQUIRING HIGH-OXYGEN FLOW

Abstract Aim there is evidence of significant clinical sequelae of COVID-19 that may impair both life length and its quality. Aim of this study was to assess the long-term consequences of moderate to severe SARS-CoV-2-related pneumonia in patients requiring high-flow oxygen treatment. Methods This prospective follow-up study included 45 patients with confirmed COVID-19 admitted to a medical ward at the Montichiari Hospital, Brescia, Italy from November 2020 to April 2021 Patients had COVID-19 related pneumonia with respiratory failure and needed at least treatment with an inspired fraction of oxygen of 40% (of them, 59% were treated with Venturi mask and 41% needed non-invasive ventilation). Patients underwent a clinical assessment with standard laboratory testing, chest CT scan, lung function tests with DLCO, and evaluation of vital parameters after a mean of 382 days after hospital discharge. A quality-of-life questionnaire was administered to each willing patient. Results See table for details. While standard laboratory testing showed a substantial normalization, we found persistence of radiological alterations (i.e. ground-glass opacities, irregular linear/reticular opacities) in 61% of patients; mean Tiffenau index (FEV1/FVC) was reduced, although not clearly pathologic (79%) and 38% of patients showed a mild to moderate reduction in CO lung diffusion (DLCO). Interestingly, 54% of subjects showed concomitant presence of radiologic alterations AND persistence of dyspnea OR reduction in CO lung diffusion, while 21% had all three concomitant conditions, compatible with the diagnosis of lung fibrosis. Overall, a total of 75% patients had some degree of functional or structural alteration of respiratory apparatus. We also evaluated quality of life thorough a structured questionnaire: after more than one year 62% of the patients still lamented fatigue, 62% effort dyspnea, 12% anorexia, 29% dysgeusia or anosmia, 31% insomnia and 43% anxiety. Conclusions these data seem to demonstrate that SARS-CoV-2-related pneumonia requiring high flow oxygen has a heavy long-term burden, both in terms of persistence of functional and structural pulmonary damage (which may be progressive and evolve to a more severe degree) and of burden on overall quality daily life.

Lung-protective ventilation during Trendelenburg pneumoperitoneum surgery: A randomized clinical trial

Study objectiveTo assess the effects of a protective ventilation strategy during Trendelenburg pneumoperitoneum surgery on postoperative oxygenation. DesignsParallel-group, randomized trial. SettingOperating room of a university hospital, Italy. PatientsMorbidly obese patients undergoing Trendelenburg pneumoperitoneum gynaecological surgery. InterventionsParticipants were randomized to standard (SV: tidal volume = 10 ml/kg of predicted body weight, PEEP = 5 cmH2O) or protective (PV: tidal volume = 6 ml/kg of predicted body weight, PEEP = 10 cmH2O, recruitment maneuvers) ventilation during anesthesia. MeasurementsPrimary outcome was PaO2/FiO2 one hour after extubation. Secondary outcomes included day-1 PaO2/FiO2, day-2 respiratory function and intraoperative respiratory/lung mechanics, assessed through esophageal manometry, end-expiratory lung volume (EELV) measurement and pressure-volume curves. Main resultsSixty patients were analyzed (31 in SV group, 29 in PV group). Median [IqR] tidal volume was 350 ml [300–360] in PV group and 525 [500–575] in SV group. Median PaO2/FiO2 one hour after extubation was 280 mmHg [246–364] in PV group vs. 298 [250–343] in SV group (p = 0.64). Day-1 PaO2/FiO2, day-2 forced vital capacity, FEV-1 and Tiffenau Index were not different between groups (all p > 0.10). Intraoperatively, 59% of patients showed complete airway closure during pneumoperitoneum, without difference between groups: median airway opening pressure was 17 cmH2O. In PV group, airway and transpulmonary driving pressure were lower (12 ± 5 cmH2O vs. 17 ± 7, p < 0.001; 9 ± 4 vs. 13 ± 7, p < 0.001), PaCO2 and respiratory rate were higher (48 ± 8 mmHg vs. 42 ± 12, p < 0.001; 23 ± 5 breaths/min vs. 16 ± 4, p < 0.001). Intraoperative EELV was similar between PV and SV group (1193 ± 258 ml vs. 1207 ± 368, p = 0.80); ratio of tidal volume to EELV was lower in PV group (0.45 ± 0.12 vs. 0.32 ± 0.09, p < 0.001). ConclusionsIn obese patients undergoing Trendelenburg pneumoperitoneum surgery, PV did not improve postoperative oxygenation nor day-2 respiratory function. PV was associated with intraoperative respiratory mechanics indicating less injurious ventilation. The high prevalence of complete airway closure may have affected study results. Trial registrationProspectively registered on http://clinicaltrials.govNCT03157479 on May 17th, 2017.

COVID-19 Lockdown Impacts Among Patients with Cystic Fibrosis: An Italian Regional Reference Centre Experience

Coronavirus pandemic has influenced our society with social distancing and management of chronic disease such as cystic fibrosis (CF). During the Italian lockdown from March to May 2020, CF patients reduced the number of outpatient visits, limited social interactions and spent more time at home. The aim of this study is to evaluate the impact of the lockdown on body mass index (BMI) and lung function tests on CF patients. We retrospectively reviewed clinical data about 111 CF patients followed in our Regional Cystic Fibrosis Reference Centre (Policlinico Umberto I, Rome) according to two periods: pre-lockdown (from October 2019-March 2020) and post-lockdown (from May 2020-October 2020). We collected data on nutritional (BMI and body weight) and lung function status; we chose the best values of the 'pre-lockdown' and 'post-lockdown' period for each patient. Patients were divided into 3 groups according to FEV1 value (Forced Expiratory Volume in the 1st second): group 1 (FEV1 <40%), group 2 (FEV1 40-70%), group 3 (FEV1 >70%). All patients received a telephone interview asking for the number of hours per week devoted to physical activity, number of pulmonary acute exacerbations and subjective evaluation of adherence to medical therapy, respiratory physiotherapy and diet, during the two periods. Comparing weight, BMI and respiratory function between pre and post lockdown periods, we noticed an increase in weight during among overall patients. Male patients improved weight, BMI, FEF 25-75% (Forced Expiratory flow between 25% and 75% of vital capacity) and Tiffenau index more than female patients. The most severely compromised patients (group 1), showed a significant loss of both weight and BMI. Instead, patients with moderate respiratory function (group 2) showed a significant increase of both weight and BMI and a slightly reduced CVF (Forced Vital capacity). We found no differences among patients with good respiratory function (group 3). Comparing each clinical sub-groups, we noticed a significative improvement of weight (p = 0.018) and BMI (p = 0.030) among patients with moderate respiratory function compared to patients with compromised respiratory function. During lockdown, patients reported less physical activity, no variation in food amount and composition, more adherence to therapy (43%) and more consistent daily respiratory physiotherapy (47.6%). Lockdown period had benefit among CF patients in terms of weight in particular in male patient. The greatest benefit on nutritional state was observed in patients with moderate reduction of respiratory function. In addition, we noted a stabilization and sometimes a slight improvement of lung function, instead of a continuous and steady decline that is normally observed in CF patients. These beneficial effects are slight but significative, bearing in mind the general worsening that CF patients experience annually.

Masa muscular y valores espirométricos en el equipo de atletismo de fondo de la BUAP

Introducción. La espirometría es una prueba para valorar la función respiratoria y su evaluación en atletas resulta útil, ya que las capacidades físicas son esenciales para un buen desempeño deportivo. La masa muscular (MM) pueden ser factor determinante que explicaría la variabilidad de los resultados de la espirometría en atletas. Por estas razones el objetivo del estudio es asociar la MM y su distribución con valores espirométricos en el equipo de Atletismo de fondo de la BUAP.&#x0D; Materiales y Métodos. Muestra: 25 deportistas del equipo masculino de atletismo de fondo de la BUAP. Evaluación antropométrica: a través de Impedancia Bioeléctrica para obtener MM, del tronco (MMtr) y de las extremidades inferiores (MMei). Valoración de la función pulmonar: a través de espirometría forzada obteniendo: capacidad vital forzada (CVF), volumen espiratorio forzado al primer segundo (VEF1), pico flujo e Índice de Tiffenau.&#x0D; Resultados. Se encontró correlación positiva entre todas las variables espirométricas y las de la MM, siendo la MMei la que mayor correlación presento, siendo las correlaciones más fuertes con PEF y VEF1 respecto a la MMei (0.664 y 0.865 respectivamente).&#x0D; Conclusiones. La distribución de la MM tiene influencia significativa en la función respiratoria de los atletas y es la MMei la que tiene mayor asociación con valores espirométricos (VEF1 y el PEF).

Short term effects of rapid maxillary expansion on breathing function assessed with spirometry: A case-control study

BackgroundThe aim of this work is to evaluate changes following rapid maxillary expansion (RME) on breathing function in two groups of patients: mouth breathers and nasal breathers. Materials and methodsTwenty-five oral breather patients (12 male, 13 female, mean age 15.2 ± 1.3), and 25 nasal breather patients (14 male, 11 female, mean age 15.3 ± 1.6) were treated with RME. Breathing function was evaluated by computerized spirometry. Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), Tiffenau index (FEV1/ FVC ratio, IT%), forced expiratory flow at 25–75% of vital capacity (FEF 25–75%), and Tidal volume (TV) were assessed. Breathing function analysis was performed before RME and 6 and 12 months after RME during follow-up appointments. The Shapiro–Wilk test was used to assess whether data were normally distributed. As data were not normally distributed, Mann–Whitney U and Friedman tests were used to perform comparisons between treatment groups and within group comparisons, respectively. ResultsOral breathers and nasal breathers showed statistically significant differences in FVC, FEF 25–75%, and TV at T0. They did not present any statistically significant difference in FEV1 and IT% at the same time point.Statistically significant differences were noticed for all indices in the oral breather group after maxillary expansion, while the nasal breather group showed statistically significant differences only in FCV, FEF 25–75%, and TV after treatment.There were no statistically significant differences in all indices 12 months after maxillary expansion between the oral breather and nasal breather groups. ConclusionsRME appeared to improve breathing function in both groups. Forced vital capacity (FVC), forced expiratory flow at 25–75% of vital capacity (FEF 25–75), and Tidal volume (TV) reached similar values in both groups after treatment with RME.

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.

Respiratory Health in Waste Collection and Disposal Workers.

Waste management, namely, collection, transport, sorting and processing, and disposal, is an issue of social concern owing to its environmental impact and effects on public health. In fact, waste management activities are carried out according to procedures that can have various negative effects on the environment and, potentially, on human health. The aim of our study was to assess the potential effects on respiratory health of this exposure in workers in the waste management and disposal field, as compared with a group of workers with no occupational exposure to outdoor pollutants. The sample consisted of a total of 124 subjects, 63 waste collectors, and 61 office clerks. Informed consent was obtained from all subjects before inclusion in the study. The entire study population underwent pulmonary function assessments with spirometry and completed two validated questionnaires for the diagnosis of rhinitis and chronic bronchitis. Statistical analyses were performed using STATA 13. Spirometry showed a statistically significant reduction in the mean Tiffenau Index values in the exposed workers, as compared with the controls, after adjusting for the confounding factors of age, BMI, and smoking habit. Similarly, the mean FEV1 values were lower in the exposed workers than in the controls, this difference being again statistically significant. The FVC differences measured in the two groups were not found to be statistically significant. We ran a cross-sectional study to investigate the respiratory health of a group of workers in the solid waste collection and disposal field as compared with a group of office workers. In agreement with most of the data in the literature, our findings support the existence of a prevalence of respiratory deficits in waste disposal workers. Our data suggest the importance of adopting preventive measures, such as wearing specific individual protection devices, to protect this particular category of workers from adverse effects on respiratory health.

Effect of CArbocisteine in Prevention of exaceRbation of chronic obstructive pulmonary disease (CAPRI study): An observational study

BackgroundChronic Obstructive Pulmonary Disease (COPD) is a chronic and progressive lung disease characterized by irreversible airflow obstruction, airway inflammation, oxidative stress and, often, mucus hypersecretion. The aim of this study is to determine if carbocisteine, a mucolytic and antioxidant agent, administered daily for 12 months, can reduce exacerbation frequency in COPD patients. MethodsThis observational study was conducted in Naples (population approximately 1000,000), Italy. It included 85 out-patients (mean age of 67.8 ± 8.6 years) followed by Clinic of Respiratory Diseases of the University Federico II. Every patient underwent spirometry demonstrating airflow obstruction not fully reversible according to ERS/ATS criteria for COPD diagnosis (Tiffenau index less than 70% after administration of salbutamol, a beta2 agonist drug). Patients enrolled had diagnosed COPD since 2 years and suffered at least one exacerbation in the previous year. None of the patients had been treated with carbocisteine or other mucolytic agent for a longer period of time than 7 days and no more than 4 times in the previous year to the enrollment. All of them assumed daily 2.7 g of carbocisteine lysine salt for a year in addition to their basic therapy. ResultsThe comparison of exacerbation frequency between the previous year (T0) and the end of study treatment (T12), documents a statistically significant reduction of exacerbations(number of exacerbations at T0: 2 [1,3] vs number of exacerbations at T12: 1 [1,2]; p < 0.001).Quality of life was also reported and showed a statistically significant improvement at the end of the study (p < 0.001).We did not find correlation between reducing exacerbation frequency and exposure to cigarette smoking, passive smoking exposure in childhood, the use of inhaled steroids, the level of education of our patients and the GOLD stadium. InterpretationDaily administration of a mucolytic drug such as carbocisteine for prolonged periods in addition to the bronchodilator therapy can be considered a good strategy for reducing exacerbation frequency in COPD.

Portugues

Introdução: a doença pulmonar obstrutiva crônica (DPOC) é caracterizada pela destruição da árvore traqueobrônquica a qual acarreta prejuízos na musculatura pulmonar e periférica, onde o treinamento físico desses pacientes é geralmente voltado para a melhora no condicionamento aeróbico o qual proporciona melhora nas atividades de vida diária e diminuição da sensação de dispnéia. Objetivo: analisar através da espirometria a função respiratória dos pacientes hospitalizados portadores de doença pulmonar obstrutiva crônica antes e após a realização de um protocolo de exercícios aeróbicos em musculatura respiratória e periférica. Métodos: trata-se do ensaio clinico não controlado composto por uma amostra de 6 pacientes hospitalizados submetidos a um protocolo de reabilitação fisioterapêutica sendo avaliados dados hemodinâmicos (Pressão arterial sistólica e diastólica, frequência cardíaca, frequência respiratória, escala subjetiva de Borg, distancia/tempo no cicloergômetro e saturação periférica de oxigênio) e as variáveis espirométricas ( capacidade vital forçada-CVF, pico de fluxo expiratório – PFE, volume expiratório forçado no primeiro segundo- VEF1 e o índice Tiffenau com a relação VEF1/CVF. Resultados: após a aplicação do protocolo e tabulação de dados, pode-se comprovar uma melhora nos valores hemodinâmicos e espirométricos, porêm não foi encontrado alterações estatisticamente significativas. Conclusão: Conclui-se portanto que a realização apesar de não apresentar significância estatística o protocolo resultou em melhora dos dados na população estudada.

Respiratory function, physical activity and body composition in adult rural population.

The aim of this study was to evaluate functioning of the respiratory system and to estimate the correlation between the function parameters of the respiratory system and the level of physical activity and body composition in the adult rural population. The study involved a group of 116 people from rural population aged 35-60 years, staying on 3-week rehabilitation camps. They were divided into two groups: men (29) and women (87). The somatic features: body height, body weight, Body Mass Index (BMI) and body copmposition were analysed, on the status of smoking and declared level of physical activity (PA) was checked. For the evaluation of the functional parameters of the respiratory system the pattern of flow volume curve was used. The following parameters were determined: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), MEF50 (maximum expiratory flow at 50% of VC) and Tiffenau index. Hand grip and maximum torque of the knee join flexor and extensor muscles was measured. As expected, men had significantly higher levels of respiratory parameters. In analyzing the status of smoking cigarettes, it can be stated that the majority of subjects are smokers. The values of functional parameters of the respiratory system were suitable for the age they were within the norm and did not show lung ventilation disorder. Most subjects of the study declared low physical activity which may be due to manual work on the farm. Smoking cigarettes significantly lowered the value of such parameters as FEV1, PEF and MEF50 only in the male group but the values did not indicate ventilatory disorder. Parameters of the respiratory system show the highest correlations with the parameters of muscle strength. Significant correlations with body compositions parameters (FFM, water) have been noticed too.

Saber-sheath trachea as a marker of severe airflow obstruction in chronic obstructive pulmonary disease

Saber-sheath trachea is a specific radiographic parameter for chronic obstructive pulmonary disease (COPD), which consists of marked coronal narrowing associated with sagittal widening (tracheal index<2/3-0.67). The aim of this study was to investigate the correlation between saber-sheath trachea and clinical-radiological findings in a group of patients with COPD of varying severity. We evaluated the chest radiographs of 71 patients with COPD distributed as follows: GOLD class I, 8/71 (11.3%); class II, 34/71 (47.9%); class III, 16/71(22.5%); class IV, 13/71 (18.3%). In 52/71 (73.2%) patients we also evaluated chest computed tomography (CT) scans. We analyzed the prevalence of saber-sheath trachea and its correlation with the Tiffenau index, GOLD stage and radiological signs of COPD. Moreover, we evaluated the sensitivity, specificity and accuracy of chest radiography as compared to CT taken as the gold standard, and the correlation between the radiographic and CT tracheal index. Saber-sheath trachea was found in 18/71 (25.4%) patients, with a greater prevalence in patients with lower Tiffenau Index (p=0.02), GOLD stages III-IV and visual severity score 3 (severe) on chest CT. Saber-sheath trachea was not found to be related to other radiological signs of COPD. The sensitivity, specificity and accuracy values of radiography were 72.2, 97.0 and 88.5%, with perfect concordance between the radiographic and CT tracheal index (p<0.00001). Saber-sheath trachea is linked to the functional severity of airway obstruction, but not to other radiological signs of COPD. Thus, evaluation of the trachea at chest radiography is strongly recommended.

A first-year dornase alfa treatment impact on clinical parameters of patients with cystic fibrosis: the Brazilian cystic fibrosis multicenter study

OBJECTIVE: To describe the clinical impact of the first year treatment with dornase alfa, according to age groups, in a cohort of Brazilian Cystic Fibrosis (CF) patients. METHODS: The data on 152 eligible patients, from 16 CF reference centers, that answered the medical questionnaires and performed laboratory tests at baseline (T0), and at six (T2) and 12 (T4) months after dornase alfa initiation, were analyzed. Three age groups were assessed: six to 11, 12 to 13, and >14 years. Pulmonary tests, airway microbiology, emergency room visits, hospitalizations, emergency and routine treatments were evaluated. Student's t-test, chi-square test and analysis of variance were used when appropriated. RESULTS: Routine treatments were based on respiratory physical therapy, regular exercises, pancreatic enzymes, vitamins, bronchodilators, corticosteroids, and antibiotics. In the six months prior the study (T0 phase), hospitalizations for pulmonary exacerbations occurred in 38.0, 10.0 and 61.4% in the three age groups, respectively. After one year of intervention, there was a significant reduction in the number of emergency room visits in the six to 11 years group. There were no significant changes in forced expiratory volume in one second (VEF1), in forced vital capacity (FVC), in oxygen saturation (SpO2), and in Tiffenau index for all age groups. A significant improvement in Shwachman-Kulczychi score was observed in the older group. In the last six months of therapy, chronic or intermittent colonization by P. aeruginosa was detected in 75.0, 71.4 and 62.5% of the studied groups, respectively, while S. aureus colonization was identified in 68.6, 66.6 and 41.9% of the cases. CONCLUSIONS: The treatment with dornase alfa promoted the maintenance of pulmonary function parameters and was associated with a significant reduction of emergency room visits due to pulmonary exacerbations in the six to 11 years age group, with better clinical scores in the >14 age group, one year after the intervention.

Impact of lobectomy for non-small-cell lung cancer on respiratory function in octogenarian patients with mild to moderate chronic obstructive pulmonary disease☆

To assess the long-term impact of standard lobectomy on respiratory function in octogenarian patients with mild/moderate chronic obstructive pulmonary disease (COPD). We reviewed all octogenarians (n=38), who underwent lobectomy for stage I-II non-small-cell lung cancer (NSCLC) from 2000 to 2006. Inclusion criteria were: Tiffenau index<0.7, no adjuvant therapies, smoking cessation after surgery, spirometric data available after 12±3 months from surgery in the absence of relapsing disease. After excluding 14 patients (three died perioperatively), 24 fulfilled the inclusion criteria. The median preoperative forced expiratory volume in 1s (FEV1) was 80% (range 56.7-100%). The mean change in FEV1 after lobectomy resulted in a loss of 11% (range -32% to +7%, p=0.004). Considering two groups on the basis of median FEV1 (group 1: FEV1≤80%, group 2: FEV1>80%), mean FEV1 loss after surgery was 7.9% in group 1 and 14.9% in group 2, respectively (p=0.17). No statistical differences were found between the two groups in changes after surgery of forced vital capacity (FVC), arterial oxygen and carbon-dioxide tension. Diffusion capacity of the lung for carbon monoxide (DLCO)% loss was significantly higher in group 2 compared with group 1 (-22.5% vs +1.5%, p=0.001). Six patients showed an improvement of postoperative FEV1: all had a preoperative FEV1 less than 60%, an upper or homogeneous pattern of emphysema, and received an upper lobectomy. In group 2, the FEV1 loss was not affected by the type of lobectomy whereas in group 1, the resection of lower lobe was associated to a major FEV1 loss (-14.5% vs +5.3%, p=0.05). Octogenarians with lower preoperative FEV1% have a better late preservation of pulmonary function after lobectomy. Upper lobectomy seems to produce a lung-volume reduction effect, leading to an improvement in the expiratory volume in patients with higher airflow obstruction.

Chromosome 12q24.3 controls sensitization to cat allergen in patients with asthma from Siberia, Russia

In Russian population of Siberia asthma is usually concomitant with high sensitization to indoor allergens (cat, dog and house dust mites), overproduction of total immunoglobulin E (IgE) and airway hyperreactivity. Definition of genes that predispose to development of various sub-components of the asthma phenotype is important for understanding of etiology of this disease. To map genes predisposing to asthma, we tested 21 microsatellite markers from candidate chromosomal regions in 136 Russian nuclear families with asthma from Siberia. We performed non-parametric analysis for linkage with asthma, total IgE, specific IgE to cat, dog, and dust mites, and spirometric indices (FEV1 (%) – percentage of predicted forced expiratory volume in 1 s, FVC (%) – percentage of predicted forced vital capacity, and FEV1/FVC (%) – Tiffenau index). The most significant linkage was to the candidate region on chromosome 12. Locus controlling cat-specific IgE, which is the most abundant in asthma patients from Siberian population, mapped within the interval between 136 and 140 cM on chromosome 12q24.3, with the suggestive linkage at the marker D12S1611 (LOD = 2.23, P = 0.0007). Total IgE was also linked to this region (D12S1611 – LOD = 1.12, P = 0.012). FEV1 (%) exceeded LOD > 1 threshold for significance with the same locus 12q24.3, but with the peak at a more proximal region at 111.87 cM (D12S338 – LOD = 1.21, P = 0.009). Some evidence of linkage (LOD > 1.0) was also detected for asthma at 6p21.31 (D6S291) and total IgE at 13q14.2 (D13S165). These data indicate that the locus 12q24.3 is the most promising candidate for identification of asthma genes in Russian population of Siberia.

External respiration function of young male residents of northern Europe during the annual cycle

In young men (19.0 ± 0.9 years of age), the following parameters were studied during the annual cycle: the tidal and minute lung volumes, vital and forced vital capacities of the lungs, expiratory and inspiratory reserve volumes, 0.5-and 1-s forced expiratory volumes, and Tiffenau index. Young men working under the conditions of the North (62°N) proved to have deeper breathing; the minute volume and vital capacity of their lungs were increased. Analysis of the lung volume during the annual cycle demonstrated changes in most parameters studied (except the expiratory reserve volume and Tiffenau index). The maximum values of the lung volumes were recorded in the cold time of the year (from November to April), whereas the minimum values were observed in the warm time (from May to September).

Postoperative Pulmonary Function in Open versus Laparoscopic Cholecystectomy: A Meta-Analysis of the Tiffenau Index

Background: Available scientific literature about open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) does not show univocal results in terms of postoperative pulmonary function. A meta-analysis was carried out to evaluate the postoperative pulmonary function after OC and LC focusing on the Tiffenau index. Methods: Electronic databases were consulted (Cochrane Library, Embase and Pubmed). Standardized mean difference (SMD) with 95% CI was calculated for the Tiffenau Index. The kappa test was performed to evaluate agreement between the reviewers regarding the quality of the selected studies. A sensitivity analysis was carried out to assess the robustness of our study. Heterogeneity among studies was tested by using a χ² test at 0.05 significance level. A random effects model meta-analysis was performed. Results: Meta-analysis of the 13 articles included, resulted in a SMD of 53% (95% CI 0.04, 1.02) for the Tiffenau Index in favor of laparoscopic cholecystectomy. The χ² test analysis showed the presence of heterogeneity among studies (Tiffenau index χ² = 99.97, p = 0.03). The sensitivity analysis confirms the validity of our results. Conclusions: Postoperative pulmonary function is better preserved after laparoscopic cholecystectomy than open cholecystectomy.

Pulmonary Function in Patients With Type 1 Diabetes Before and After Simultaneous Pancreas and Kidney Transplantation

Pulmonary function is impaired in type 1 diabetes mellitus and is associated with the quality of metabolic control. Correction of chronic hyperglycemia by pancreas transplantation may ameliorate pulmonary function. Lung volume and diffusing capacity were measured in 75 uremic patients with type 1 diabetes and a long diabetes duration waiting for a simultaneous kidney and pancreas transplantation (SPK). In addition 85 patients after SPK and 20 patients after kidney transplantation alone (KA) were investigated. In a subgroup of 30 patients, data before and after SPK were available for prospective analysis. Reduced lung volume and diffusing capacity were found in type 1 diabetic patients before transplantation. Nearly all parameters of pulmonary function improved after SPK and KA. A significant change was found for forced expiratory volume at 1 sec (FEV1) and FEV1/forced vital capacity (FVC) (Tiffenau index). A significant amelioration of diffusing capacity was only found in the SPK group but not in the KA group. The prospective investigation revealed significant improvements of pulmonary function after SPK: FEV1 (P=0.001), FVC, (P=0,006), Tiffenau index (P=0.03), and Hb-corrected diffusing capacity (carbon monoxide transfer factor, TCO), P=0.03; transfer coefficient (KCO=TCO corrected for alveolar volume), P=0.01. Simultaneous pancreas and kidney transplantation is able to attain long-term normoglycemia and to improve pulmonary function in uremic type 1 diabetic patients.

Polymorphisms of the GSTM1 and GSTT1 genes in patients with allergic diseases in the Czech population

Allergic diseases belong to the most common chronic disorders affecting mankind and their prevalence in population is increasing. Several studies have indicated that oxidative stress impairs pulmonary function and makes existing asthma worse. Members of the glutathione-S-transferase (GST) superfamily of genes are important in protection of cells from reactive oxygen species. Relationships among allergic diseases including asthma and variations in the GST mu (GSTM1) and GST theta (GSTT1) genes were investigated in 1,006 Caucasian subjects. The multiplex polymerase chain reaction protocol was used for simultaneous amplification of both genes for molecular analysis. Genotype frequencies among patients and controls were assessed and the associations of the genotypes with intermediary phenotypes of allergy were statistically determined. The frequencies of GST null genotypes did not differ significantly between patients with allergic diseases (or asthma alone) and healthy controls. However, when compared with patients homozygous or heterozygous for GSTM1 functional allele, asthmatics carrying both GSTM1 null alleles displayed significantly worse lung function, assessed by forced expiratory volume in 1 s/forced vital capacity (FEV(1)/FVC) ratio (Tiffenau index), (P < 0.01). Genetic polymorphisms of the GSTM1 and GSTT1 genes, both individually and in combination, were not associated with the development of allergic diseases including asthma in the Czech population, the GSTM1 gene variability, however, may influence lung functions in our asthmatics.