Pulmonary Function Test Variables Research Articles

Deteriorating Pulmonary Functions in Patients with Rheumatoid Arthritis- A Pilot Study from South India

Background and Objective: Pulmonary involvement is a common extra-articular manifestation of rheumatoid arthritis (RA). The present study attempts to highlight the extent of involvement by assessing lung function using pulmonary function tests (PFTs) in patients with RA. Methods: This pilot study involved 30 patients with RA and an equal number of age- and sexmatched healthy controls. All the study participants were subjected to spirometry and in RA patients, the test was repeated after 30 minutes of administering 400 mcg of salbutamol. PFT values of the controls and the pre and post-values of cases like forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), Percentage of forced expiratory volume in the first second (FEV1%), forced expiratory flow at 25% to 75% of the lung volume (FEF25-75%) and peak expiratory flow rate (PEFR) were recorded. Independent sample t-test or Mann-Whitney U test were used for comparisons. The pre- and post-values of PFT were compared using paired t-test, Welsch’s test, or Wilcoxon tests. (p ≤ 0.05 implied statistical significance). Results: PFT variables were significantly lower among patients with RA compared with controls (p<0.05). A significant negative correlation of FEF25%-75% and PEFR with BMI in obese patients (BMI >23) and FVC, FEV1, and PEFR significantly lower in post-menopausal women (p < 0.05) was seen. Conclusion: Based on the pilot study findings, patients in south India with RA could manifest decreased pulmonary functions. Obese patients and post-menopausal females with RA could be at a higher risk, and the administration of nebulized salbutamol could improve pulmonary functions.

Assessment of therapeutic benefit obtained on administering nintedanib with respect to pulmonary function parameters in COVID-induced pulmonary fibrosis – A prospective study

Background: The COVID-19 infection has not only affected the patients in the acute phase but also has left several long-term sequels which are becoming clinically evident in the long run. The development of pulmonary fibrosis following recovery from COVID-19 is presently a cause of concern worldwide. Fibrosis of the lungs is a long-term ongoing inflammatory disorder which causes functional impairment and chronic pulmonary insufficiency. It is observed that the profibrotic mechanisms responsible for causing post-COVID lung fibrosis have some resemblance with that of autoimmune interstitial lung disease (ILD). Nintedanib, a tyrosine kinase inhibitor, is reported to block the profibrotic cytokine receptors. It is thus being administered widely for disease modification in idiopathic pulmonary fibrosis, a progressive and fatal form of ILD. Aims and Objectives: The present study tries to establish that nintedanib has a therapeutic role to prevent lung function impairment in the post-recovery pulmonary fibrosis patients of COVID-19 disease. Materials and Methods: 50 adult patients having fibrotic changes in the computed tomography scan of the chest, following recovery from coronavirus disease, were chosen. They were divided into two categories. Both the categories were given the treatment of lung fibrosis as per the standard regimen. In addition, only one of the categories received the recommended dose of nintedanib. A pulmonary function test (PFT) was performed on the patients of both categories on day 1 and day 90. A comparison of the PFT variables was done by statistical analysis. Results: The PFT parameters of both groups were similar on day 1. On day 90, most of the spirometry variables of the patients administered with nintedanib along with the standard treatment regimen showed statistically significant improvement with respect to the values on day 1. The lung function test variables of the group receiving nintedanib were also significantly better than those not receiving it, as observed on day 90. Conclusion: As the spirometry variables of the patients following recovery of coronavirus disease with confirmed fibrosis of the lungs showed significant improvement after receiving nintedanib, it can be concluded that nintedanib may be useful in treating such cases.

Application of impulse oscillometry to detect interstitial lung disease and airway disease in adults with rheumatoid arthritis

BackgroundWe conducted a retrospective observational study to explore the potential application of impulse oscillometry (IOS) as an alternative to high-resolution computed tomography (HRCT) for detecting pulmonary involvement in patients with rheumatoid arthritis (RA) because clinically evident interstitial lung disease (ILD) and airway involvement are common in this population.MethodsWe enrolled 72 patients with RA who underwent pulmonary function tests (PFTs) and IOS between September 2021 and September 2022. We aimed to identify the PFT and IOS variables associated with lung diseases shown on HRCT images.ResultsIn our cohort of 72 patients, 48 underwent HRCT; of these, 35 had airway disease or ILD and 13 showed no obvious abnormalities on HRCT. Abnormal IOS and PFT parameters were observed in 34 and 23 patients, respectively, with abnormal HRCT images. The predicted percentages for forced vital capacity, the ratio of forced expiratory volume in the first one second to forced vital capacity, and forced mid-expiratory flow value were significantly lower in patients with abnormal HRCT. Lung resistance at 5 Hz, difference in resistance between 5 and 20 Hz, resonant frequency (Fres), and reactance area were higher in these patients and reactance at 5 Hz was lower. Compared to other parameters, Fres > 14.14 was significantly associated with alterations in HRCT and may be used as an indicator for monitoring disease.ConclusionFres > 14.14 is significantly associated with lung involvement in RA patients. Performance of spirometry with IOS is more beneficial than spirometry alone for evaluating lung involvement in RA patients.

MRI and Pulmonary Function Tests' Results as Ventilation Inhomogeneity Markers in Children and Adolescents with Cystic Fibrosis.

Magnetic resonance imaging (MRI) of the chest is becoming more available in the detection and monitoring of early changes in lung function and structure in patients with cystic fibrosis (CF). The aim of this study was to assess the relationship between pulmonary function tests (PFT) and perfusion deficits in CF children measured by MRI. We performed a retrospective analysis of the perfusion lung MRI scans and the results of spirometry, oscillometry, body plethysmography, single-breath carbon monoxide uptake, and multiple-breath washout technique (MBW). There were statistically significant correlations between the MRI perfusion scores and MBW parameters (2.5% LCI, M1/M0, M2/M0), spirometry parameters (FEV1, FVC, FEF25/75), reactance indices in impulse oscillometry (X5Hz, X10Hz), total lung capacity (TLC) measured in single breath carbon monoxide uptake, markers of air-trapping in body plethysmography (RV, RV/TLC), and the diffusing capacity of the lungs for carbon monoxide. We also observed significant differences in the aforementioned PFT variables between the patient groups divided based on perfusion scores. We noted a correlation between markers of functional lung deficits measured by the MRI and PFTs in CF children. MRI perfusion abnormalities were reflected sooner in the course of the disease than PFT abnormalities.

Perceived stress and its effect on cardio-respiratory system in first year medical students.

Objectives: To determine the correlation of perceived stress with blood pressure and pulmonary function tests in normal, healthy first-year medical students. Study Design: Cross Sectional study. Setting: Department of Physiology, Al-Tibri Medical College, Isra University Karachi Campus. Period: August 2021 to February 2022. Material & Methods: From all the students enrolled in the first year MBBS during academic year 2021-22, data from 72 students were evaluated who met the inclusion criteria. The sphygmomanometer was used to measure the blood pressure parameters, and the Biopac ® data acquisition system was used to measure the pulmonary function test variables. A ten-item classic stress assessment questionnaire was used to evaluate the perceived stress scale, and the observed values were then correlated with the variables of blood pressure and pulmonary function tests. Results: The majority of the study cohort (69.44%) is in a moderate level of stress with female predominance (p= 0.001), while diastolic blood pressure (p=0.008), mean arterial blood pressure (p=0.006), vital capacity (p=0.000), forced vital capacity (p=0.006), forced expiratory volume in the first second (p=0.003) all negatively correlated with perceived stress scale in the participants. Conclusion: The findings of the present study point toward possible delirious effects of stress on cardio-pulmonary health. The timely detection and address budding stress issues in the early years of medical schools by establishing counseling and preventive mental health services centers will prevent future morbidity and produce healthy doctors.

The Efficacy of Pulmonary Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis

Background: This study evaluated the efficacy and safety of pulmonary rehabilitation (PR) on functional performance, exercise-related oxygen saturation, and health-related quality of life among patients with idiopathic pulmonary fibrosis (IPF). Methods: A total of 25 patients with IPF (13 in the PR group and 12 in the non-PR group) were enrolled between August 2019 and October 2021 at Haeundae-Paik Hospital in the Republic of Korea. A cardiopulmonary exercise test (CPET), six-minute walk test (6MWT), pulmonary function test (PFT), Saint George's Respiratory Questionnaire (SGRQ), muscle strength test, and bioelectrical impedance analysis were performed in each group at baseline and after eight weeks of PR. Results: The mean age was 68 years of age and most subjects were male. Baseline characteristics were similar between the two groups. The distance during 6MWT after PR was significantly improved in the PR group (inter-group p-value = 0.002). VO2max and VE/VCO2 slopes showed a significant difference after eight weeks only in the PR group, but the rate of change did not differ significantly from the non-PR group. Total skeletal muscle mass, PFT variables, and SGRQ scores did not differ significantly between the groups. Conclusions: PR improved exercise capacity, as measured using CPET and 6 MWT. Further studies in larger samples are needed to evaluate the long-term efficacy of PR in IPF patients.

Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic

BackgroundService member exposure to explosive blast overpressure waves is common with considerable attention to traumatic brain injury (TBI) and neuropsychological sequalae. Less is known about the impacts on the respiratory system, particularly long-term effects, despite vulnerability to overpressure. Using a national registry, we previously observed an independent relationship between self-reported blast exposure and respiratory symptoms; however, the impact on objective measures of pulmonary function is poorly understood.Methods307 Veterans referred to our national specialty center for post-deployment health concerns underwent a comprehensive multi-day evaluation that included complete pulmonary function testing (PFT), occupational and environmental medicine history, neuropsychological or psychological evaluation. We developed an a priori chart abstraction process and template to classify Veterans into blast exposure groups: (1) none, (2) single-mild, or (3) multiple-mild. This template focused primarily on clinician documented notes of blast related TBI that were used as proxy for blast overpressure injury to thorax. PFT variables characterizing flow (FEV1%; %∆FEV1), volume (TLC%), diffusion (DLCO%) and respiratory mechanics (forced oscillometry) were selected for analysis.ResultsVeterans (40.5 ± 9.7 years; 16.3% female) were referred 8.6 ± 3.6 years after their last deployment and presented with considerable comorbid conditions and health problems (e.g., 62% post-traumatic stress, 55% dyspnea). After chart abstraction, Veterans were assigned to none (n = 208), single mild (n = 52) and multiple mild (n = 47) blast exposure groups. Among the blast exposed, clinicians documented 73.7% were < 50 m from the blast and 40.4% were physically moved by blast. PFT outcome measures were similar across all groups (p value range: 0.10–0.99).ConclusionsIn this referred sample of deployed Veterans, PFT measures of flow, volume, diffusion, and respiratory mechanics were not associated with clinician documented blast exposure per the retrospective chart abstraction methodology applied. Yet, these clinical findings suggest future research should determine and assess distinction between Veteran recollections of perceived blast experiences versus overpressure wave exposure to the respiratory system.

Impact of Pre-Heart Transplant Pulmonary Function Tests on Post-Transplant Pulmonary Outcomes

<h3>Purpose</h3> Pulmonary function tests (PFT) are a component of heart transplant (HT) evaluation. In cardiac surgery, abnormal PFTs, especially reduced DLCO, are associated with poor outcomes. We sought to evaluate the impact of pre-HT PFTs on post-HT pulmonary outcomes. <h3>Methods</h3> We retrospectively reviewed 235 consecutive HT recipients and collected pre-HT data including PFTs. PFT patterns were classified according to ATS/ERS standards (Severe restrictive ventilatory defect (RVD): [FEV1/FVC≥70%, FVC<80% & FEV1<50%], Severe obstructive ventilatory defect (OVD): [FEV1/FVC<70% & FEV1<80%]). The combined endpoint included reintubation, prolonged intubation (greater than 5 days), tracheostomy, or post-HT treated pneumonia. <h3>Results</h3> 151 patients had pre-HT PFT data. The mean age was 55±12 years, 75% were male, 59% were bridged with a LVAD, and 52% were former smokers. 28 patients (18%) had normal PFTs, 81 (53%) had RVD (10 severe), and 42 (29%) had OVD (10 severe). Among 136 patients with DLCO data, 30 (22%) had a severely reduced DLCO (<40% predicted). Overall, 37 patients (24.5%) experienced an adverse pulmonary event. Among those with severely reduced DLCO, 40% met the combined endpoint (vs 23.6% with mild-moderate DLCO reduction, P=0.07). Among the 10 patients with severe OVD, 6 (60%) experienced the combined endpoint (vs. 31.3% of those with mild-moderate OVD p=0.14). 40% with severe RVD experienced the combined endpoint (vs. 22% with mild-moderate RVD, p=0.20). Those with severe lung disease (OVD, RVD, DLCO) had a 3.1 fold increased odds of post-HT pulmonary complications (95% CI 1.2-8.0, p=0.03). Similarly, post-HT ICU length of stay was significantly longer 16.2±19.9 vs. 7.3±8.6 days (p=0.03) and 90 day survival was significantly reduced 66.7% vs. 94.7, p=0.002 (Figure). <h3>Conclusion</h3> Severe abnormalities of pre-HT PFTs are associated with increased odds of post-HT pulmonary complications, ICU length of stay, and 90 day mortality. Severely reduced DLCO seems to be the strongest predictor among PFT variables.

Effects of COPD on Left Ventricular and Left Atrial Deformation in Patients with Acute Myocardial Infarction: Strain Analysis Using Speckle-Tracking Echocardiography.

Myocardial strain analysis, which describes myocardial deformation (shortening or lengthening), provides more detailed information about left ventricular (LV) and atrial (LA) functions than conventional echocardiography and delivers prognostic information. To analyze the effects of COPD on left heart function upon acute myocardial infarction (AMI), consecutive AMI patients were retrospectively screened, and patients were included if a post-AMI echocardiography and results of recent pulmonary function tests (PFTs) were available. Strain analysis was performed by a cardiologist who was blinded to clinical information. Overall, 109 AMI patients were included (STEMI: 38%, non-STEMI: 62%). COPD patients (41%) had significantly more impaired LV “global-longitudinal-strain” (LV-GLS) compared to non-COPD patients (−15 ± 4% vs. −18 ± 4%; p < 0.001, respectively), even after adjusting for LV-ejection-fraction (LVEF) and age (mean estimated difference: 1.7%, p = 0.009). Furthermore, COPD patients had more impaired LA strain (LAS) than non-COPD patients in all cardiac cycle phases (estimated mean differences after adjusting for LVEF and age: during reservoir phase: −7.5% (p < 0.001); conduit phase: 5.5% (p < 0.001); contraction phase: 1.9% (p = 0.034)). There were no correlations between PFT variables and strain values. In conclusion, the presence of COPD was associated with more impaired LV and LA functions after AMI, as detected by strain analysis, which was independent of age, LVEF, and PFT variables.

Sleep features in Lymphangioleiomyomatosis and their relationship with disease severity: a pilot study

Lymphangioleiomyomatosis (LAM) is a rare pulmonary disease characterized by progressive airflow limitation. We conducted a pilot trial to investigate the incidence of sleep disorders, sleep quality and their relationship with disease severity.We performed pulmonary function tests, blood gas analysis, overnight 12-channels polysomnography and clinical assessments in 15 consecutive LAM patients. For statistics, p values < 0.05 were considered significant.Sleep efficiency (SE) was inversely correlated with RV/TLC (p = 0.035) and positively with daytime SpO2 (p = 0.010) and PaO2 (p = 0.011). Three cases had obstructive sleep apnea (OSA); seven patients (46.7%) showed a REMOSA. AHIREM was correlated with FEV1% (r = 0.75, p = 0.003), TLC% (r = 0.57, p = 0.026), RV% (r = 0.8, p=<0.0001) and RV/TLC (r = 0.77, p = 0.001). No correlations were observed between anxiety/depression and SE, CAP rate, pulmonary function test variables and AHIREM (p > 0.05). four subjects had nocturnal hypoxia (T90 ≥ 1% of TST) showing lower values of DLCO%, daytime SpO2%, PaO2, FEV1% and a higher value of VR/TLC comparing with the subgroup with normal T90 (p < 0.05).This pilot study shows that sleep alterations could be frequent in LAM and associated to disease severity. Nocturnal hypoxemia and SE were related to lung function impairment. A dysregulation of sleep seems to involve exclusively REM phase, while NREM appears to be preserved. This phenomenon might be linked to the pathophysiology of disease: our study, even with the limits of the small sample size, showed that the presence of REMOSA is related to the disease severity, in particular to the degree of airflow limitation and hyperinflation. More studies are needed to assess this topic.

Posttraumatic Stress Disorder Is Associated With a Decrease in Anaerobic Threshold, Oxygen Pulse, and Maximal Oxygen Uptake

Posttraumatic stress disorder (PTSD) has been linked to respiratory symptoms and functional limitations, but the mechanisms leading to this association are poorly defined. What is the relationship between PTSD, lung function, and the cardiopulmonary response to exercise in combat veterans presenting with chronic respiratory symptoms? This study prospectively enrolled military service members with respiratory symptoms following deployment to southwest Asia. All participants underwent a comprehensive evaluation that included pulmonary function testing and cardiopulmonary exercise testing. Pulmonary function test variables and cardiopulmonary response to exercise were compared in subjects with and without PTSD by using multivariable linear regression to adjust for confounders. A total of 303 participants were included (PTSD, n= 70; non-PTSD, n= 233). Those with PTSD had a greater frequency of current respiratory symptoms. There were no differences in measures for airway disease or lung volumes, but patients with PTSD had a reduction in diffusing capacity that was eliminated following adjustment for differences in hemoglobin levels. Participants with PTSD had a lower anaerobic threshold (23.9 vs26.4 cc/kg per minute; P= .004), peak oxygen pulse (19.7 vs18.5 cc/beat; P= .03), and peak oxygen uptake (34.5 vs38.8 cc/kg per minute; P< .001). No significant difference was observed in gas exchange, respiratory reserve, or effort at peak exercise between participants with and without PTSD. A diagnosis of PTSD was associated with a reduced anaerobic threshold, oxygen pulse, and peak oxygen uptake. This objective reduction in cardiopulmonary work is independent of baseline lung function, was not associated with abnormalities in gas exchange or respiratory reserve, and may be related to deconditioning.

Serum Folate in Asthma: Does it Correlate to Severity? A Single Center Experience

Background: Bronchial asthma is the most common chronic childhood illness. It is characterized by airway inflammation and episodic airflow obstruction. Low serum folate has been inconsistently reported as a risk factor for bronchial asthma severity. Other studies reported an increased risk of asthma in children whose mothers received prenatal folic acid supplementation. Aim of the work: To compare serum folate level in asthmatic patients to non-asthmatic healthy controls, and to demonstrate whether folate level correlates to severity &/or frequency of asthma exacerbations and pulmonary function parameters. Methods: Forty-five asthmatic Egyptian children and an equal number of healthy controls were included. Serum folate level was measured in both groups and spirometry was performed for the asthmatic children. Results: Serum folate levels were significantly lower among patients (7.83ng/ml ± 2.47) versus controls (9.84ng/ml ± 3.47), (p value 0.002). Serum folate levels also had an inverse correlation with severity of asthma exacerbations (r = – 0.482), (p = 0.001) and their frequency (r = – 0.418), (p= 0.004). Serum folate levels inversely correlated as well with severity of asthma as a chronic illness (r = – 0.315), (p = 0.035). The cutoff point of serum folate level that was found to increase the severity of asthma exacerbations was calculated at ≤ 8.84ng/ml. Only 7 patients fell below the current normal reference range for serum folate. On the other hand, serum folate level did not significantly correlate with any of the pulmonary function test variables measured. Conclusions: Serum folate levels were lower in asthmatic children when compared to healthy controls, and it negatively correlated with asthma severity and exacerbations, but not to pulmonary function parameters. The cutoff serum folate level for increased severity of asthma exacerbations fell within the normal folate range for children. Further research is recommended to assess any possible beneficial effects for folate supplementation in asthma.

Derivation and Validation of a Diagnostic Prediction Tool for Interstitial Lung Disease

Interstitial lung disease (ILD) results in high morbidity and health-care utilization. Diagnostic delays remain common and often occur in nonpulmonology settings. Screening for ILD in these settings has the potential to reduce diagnostic delays and improve patient outcomes. This study sought to determine whether a pulmonary function test (PFT)-derived diagnostic prediction tool (ILD-Screen) could accurately identify incident ILD cases in patients undergoing PFT in nonpulmonology settings. Clinical and physiologic PFT variables predictive of ILD were identified by using iterative multivariable logistic regression models. ILD status was determined by using a multi-reader approach. An ILD-Screen score was generated by using final regression model coefficients, with a score≥ 8 considered positive. ILD-Screen test performance was validated in an independent external cohort and applied prospectively to PFTs over 1 year to identify incident ILD cases at our institution. Variables comprising the ILD-Screen were age, height, total lung capacity, FEV1, diffusion capacity, and PFT indication. The ILD-Screen showed consistent test performance across cohorts, with a sensitivity of 0.79 and a specificity of 0.83 when applied prospectively. A positive ILD-Screen strongly predicted ILD (OR, 18.6; 95%CI, 9.4-36.9) and outperformed common ILD clinical features, including cough, dyspnea, lung crackles, and restrictive lung physiology. Prospective ILD-Screen application resulted in a higher proportion of patients undergoing chest CT imaging compared with a historical control cohort (74%vs56%, respectively; P= .003), with a significantly shorter median time to chest CT imaging (5.6 vs21.1months; P< .001). The ILD-Screen showed good test performance in predicting ILD across diverse geographic settings and when applied prospectively. Systematic ILD-Screen application has the potential to reduce diagnostic delays and facilitate earlier intervention in patients with ILD.

Are We Neglecting Long Term Effects of Vertebral Shortening on Pulmonary Function in Spinal Tuberculosis?

Background: In developing part of world, it is common to see near complete destruction of vertebral bodies in TB due to contiguous involvement of multiple vertebrae. This leads to frequent occurrence of spinal deformities including kyphosis. Resultant loss of vertebral column height & its effects on pulmonary function haven't been studied previously. Our study aims to assess effect of spinal TB with vertebral shortening on pulmonary function. Methods: 50 cases consisted of both operative & non operatively managed cases of spinal TB who presented to tertiary care institute between the years 2011 to 2016 were assessed. Vertebral height loss was assessed by SDI. All patients underwent pulmonary function testing and various spirometry variables were considered. Arm span was used as a surrogate marker for height. Findings: Study group consisted of 14 males & 36 females with mean age of 27.9 years. 11 patients with mean SDI of 2.72 ± 1.1 showed normal lung function. 36 patients showed a restrictive pattern of which 12 showed mild, 14 moderate and 10 showed severe pattern. Only 3 cases showed an Obstructive pattern. 36 patients had Thoracic affection, 13 patients had a thoracolumbar affection while 1 patient had a purely Lumbar affection. As the apex of the curve shifted proximally, the FVC% reduced and the decrement was statistically significant. Increase in the SDI value was associated with a fall in the vital capacity and FEV1. Increase in the kyphotic angle was associated with a deleterious effect on PFT results. SDI showed significant difference between Normal & restrictive pattern groups. Interpretations: Careful preservation of pulmonary function along with restoration of neurological function should be the aim of management of TB spine. Usually shortening procedures are better tolerated by spinal cord as compared to distraction. However, pulmonary dysfunction resulting from vertebral body height loss due to kyphosis is neglected. This risk stratification will further emphasize the need for early detection of this disease before the deformity sets in & need for long term observation for possible deterioration in lung function. Funding Statement: The authors hereby declare that they have not received any funding for this manuscript. Declaration of Interests: Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Ethics Approval Statement: Approval from the IRB was taken prior to commencement.

Pulmonary Function Testing and Outcomes after Left Ventricular Assist Device Implantation.

Pulmonary function testing (PFT) is often done during workup prior to left ventricular assist devices (LVAD), but its utility for predicting outcomes and changes in pulmonary function post-LVAD is not well established. We assessed the association of baseline PFT metrics with outcomes after LVAD, and quantified the changes in PFTs post-LVAD. A retrospective study of 178 patients receiving continuous flow LVADs was conducted. A total of 129 subjects had baseline PFT data and 54 of these had repeat tests after LVAD. We collected PFT data (FEV1, FVC, FEV1/FVC ratios, and DLCO) at baseline and post-LVAD, and tested the association with survival, right heart failure, quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]) and functional capacity (six-minute walking distance [6MWD]). Proportional hazards and linear regressions determined relationships between baseline PFT data and survival time and functional outcomes, respectively. Paired t-tests compared pre- and post- LVAD PFT variables. There was no association of baseline PFT parameters with survival time post-LVAD (all P > .2), nor the incidence of perioperative RV failure (all P > .15). There were no significant associations of the baseline PFT metrics with the change in KCCQ or 6MWD. There were statistically significant declines in FEV1, FEV1/FVC ratio, and DLCO after LVAD (P < .05). In this single center study, there was no relationship between baseline PFTs and post-LVAD outcomes, and PFT parameters often worsened after LVAD. Further studies are needed to determine whether PFTs are useful in this setting, and what, if any, impact LVAD therapy has on pulmonary function.

Bariatric surgery in patients with interstitial lung disease

Perioperative pulmonary complications are frequent in patients with interstitial lung diseases (ILD). Limited literature exists regarding the safety of bariatric procedures in patients with ILD. This study aims to assess the safety, feasibility, and outcomes of patients with ILD who underwent bariatric surgery at our institution. After IRB approval, all patients with preoperative diagnosis of ILD who had bariatric surgery at an academic center between 2004 and 2014 were retrospectively reviewed. A total of 25 patients with ILD underwent bariatric surgery: Roux-en-Y gastric bypass (n = 17, 68%), sleeve gastrectomy (n = 7, 28%), and adjustable gastric banding (n = 1, 4%). Twenty-one patients (84%) were females. The median age and preoperative body mass index (BMI) were 53 (IQR 42-58) years and 39 (IQR 37-44)kg/m2, respectively. The median operative time and length of stay was 137 (IQR 110-187)min and 3 (IQR 2-5)days, respectively. The 30-day complications were reported in four patients (16%) but there was no pulmonary complication or unplanned admission to theintensive care unit. At 1-year follow-up (85%), the median BMI and excess weight loss were 30 (IQR 25-36)kg/m2 and 67% (IQR 45-100), respectively. Compared to preoperative values, there was significant improvement in the pulmonary function test (PFT) variables at 1year with respect to forced vital capacity (62% vs 74%; n = 13, p = 0.003), and diffusing capacity of the lungs for carbon monoxide (53% vs 66%; n = 10, p = 0.003). Six out of the seven potential lung transplant candidates became eligible for transplantation after weight loss, and one of them had successful lung transplant at 88months after bariatric surgery. In our experience, bariatric patients with ILD achieved significant weight loss and improvement in PFT. Bariatric surgery in these higher risk ILD patients appears relatively safe with acceptable perioperative morbidity and improved candidacy for lung transplantation.

LEFT HEART DIASTOLIC DYSFUNCTION PARAMETERS IN ASSOCIATION WITH PULMONARY FUNCTION VARIABLES IN COPD

SESSION TITLE: Obstructive Lung Diseases 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: COPD is a leading cause for morbidity and mortality worldwide. Though it is primarily a pulmonary disease, COPD affects other body systems including the cardiovascular system. Few studies have found an association between COPD and left heart diastolic dysfunction. The aim of this study is to look for an association between parameters of diastolic dysfunction, and parameters of pulmonary function test (PFT) among patients with COPD. METHODS: This is a cross-sectional analysis performed in a community-based teaching hospital. Patients with working diagnosis of COPD, who underwent PFT during the years 2016 and 2017, were initially-screened. A total of 182 individuals were identified. We then included the patients who had; 1) forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio < 70%, and 2) an echocardiography performed not more than two years from the most recent PFT. Patients were excluded if any one of the following was identified; 1) age < 18 years old, 2) mitral stenosis, repair, or replacement, 3) moderate annular mitral valve calcification or worse, 4) moderately severe mitral regurgitation or worse, 5) left ventricular assistant device, 6) left bundle branch block, 7) ventricular-paced rhythm, 8) ejection fraction (EF) < 50%. We included the following cardiac variables; EF, tricuspid regurgitation (TR) velocity, average e/e’, septal e’, and lateral e’. PFT variables (as percentage predicted) were; post-bronchodilator FEV1, post-bronchodilator FVC, total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC). Correlation between each cardiac parameter and each PFT variable was estimated using Pearson correlation coefficient. Two-tailed t-test was used to calculate p-values. RESULTS: From the 182 initially-screened individuals, a total of 24 were identified. 66.7% (n=16) were females, and with mean age of 66.2 ± 8.2 years. After performing statistical analysis, there was a significant association between FRC and TR velocity with correlation coefficient of 0.44 (p =0.033). Moreover, there was a trend, but not a significant association, between RV and TR velocity with correlation coefficient of 0.38 (p = 0.067). CONCLUSIONS: Among patients with COPD, FRC and RV, parameters for air-trapping, are associated with TR velocity, a parameter for diastolic dysfunction. CLINICAL IMPLICATIONS: One of the theories which attempts to explain left heart diastolic dysfunction in patients with COPD is that auto-PEEP effect due to air-trapping would cause reduction in preload, which then stresses the left ventricle, leading to tachycardia with subsequent diastolic dysfunction. In our study, the association between FRC and TR velocity, along with the trend between RV and TR velocity would support this theory. This could help in predicting patients with COPD who might have unidentified left heart diastolic dysfunction. DISCLOSURES: No relevant relationships by Ali Alkhayat, source=Web Response No relevant relationships by Faeq Kukhon, source=Web Response No relevant relationships by Taro Minami, source=Web Response No relevant relationships by Ahmed Mohamed, source=Web Response No relevant relationships by Fatima Zeba, source=Web Response

A COMPARISON OF FVC, FVC/DLCO AND TLC/DLCO AS AN INDICATOR FOR INTERSTITIAL LUNG DISEASE IN PATIENTS WITH SCLERODERMA

SESSION TITLE: Characteristics of Interstitial Lung Disease SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2018 02:30 pm - 03:30 pm PURPOSE: Pulmonary function tests (PFTs) have been reported to be unreliable for the identification of interstitial lung disease (ILD) in Scleroderma patients. A normal Forced Vital Capacity [FVC], was reported in 62.5% of these Scleroderma patients with significant ILD on high resolution CT (HRCT) of chest. The correlation of FVC/DLC and TLC/DLCO to pulmonary fibrosis in Scleroderma patients has not been studied. The objective of this study was to compare the correlation between FVC, Total Lung capacity [TLC] / Diffusion Capacity [DLCO]) ratio and FVC/DLCO ratio, respectively, with the extent of ILD measured by a fibrosis score on HRCT of chest in patients with Scleroderma. METHODS: The records of 40 patients with Scleroderma without Pulmonary Arterial Hypertension followed at the rheumatology clinic our institution were reviewed. Patient demographics and PFT parameters (FVC, TLC, and DLCO) were noted. FVC/DLCO and TLC/DLCO was calculated for each patient. Patients’ chest HRCT scans were graded by a radiologist for ILD by a HRCT Fibrosis Score, calculated by estimating the percentage of parenchymal involvement in three zones (upper, middle, lower) of each lung, with a score of 100 representing normal and a score of 400 representing severe fibrosis. PFT variables were recorded as percent predicted (%) and expressed as mean + SD. Pearson’s test for linear correlation was used to determine correlation of Fibrosis Score with respectively-FVC, FVC/DLCO and TLC/ DLCO. RESULTS: Mean age was 58.8 +/- 12.9 years; 76% were females; 74% had limited disease. Mean FVC: 87.80 +/- 23.52 %; mean TLC: 94 +/-15.9 %; mean DLCO :72.8 +/- 21%; mean FVC/DLC: 0.20 +/- 0.5; mean TLC/DLCO: 0.33 +/- 0.08. Normal FVC was seen in 70%; normal TLC in 85%.; normal DLCO in 32.5%. Mean fibrosis score was:105.2 +/- 11.3 (Range: 100-280). Using Pearson’s correlation analysis, correlation between fibrosis-score and respectively FVC, FVC/DLC and TLC/DLCO was as follows: FVC vs. Fibrosis Score: r= -0.313; p=0.04; FVC/DLCO vs. Fibrosis Score: r= -0.119; p=0.46; TLC/DLCO vs. Fibrosis Score: r=0.06; p =0.69. CONCLUSIONS: ILD in Scleroderma, estimated by the Fibrosis score, correlates significantly with FVC but not with FVC/DLCO and TLC/ DLCO. CLINICAL IMPLICATIONS: Despite prior studies reporting FVC as an unreliable indicator of ILD in Scleroderma, our study shows that FVC has a strong correlation with pulmonary fibrosis in Scleroderma. Further studies are needed to re-evaluate this. DISCLOSURES: No relevant relationships by Debapriya Datta, source=Web Response No relevant relationships by Carol Halasan, source=Web Response No relevant relationships by Sophie Korzan, source=Web Response

Extracorporeal Photopheresis Improves Survival in Hematopoietic Cell Transplant Patients with Bronchiolitis Obliterans Syndrome without Significantly Impacting Measured Pulmonary Functions

We carried out the first matched retrospective cohort study aimed at studying the safety and efficacy of extracorporeal photopheresis (ECP) for bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (HCT). Medical records of 1325 consecutive adult patients who underwent HCT between 2005 and 2015 were reviewed. Seventy-four patients (median age, 51 years) with a diagnosis of BOS were included in the study. After propensity-score matching for BOS severity, 26 patients who underwent ≥3 months of ECP were matched to 26 non–ECP-treated patients, who were assigned an index date corresponding to the ECP start date for their matched pairs. The rate of decline in FEV1 percentage predicted (FEV1PP) decreased after ECP initiation (and after index date in the non-ECP group), with no significant difference between the 2 groups (P = .33). On a multivariable analysis that included baseline transplant and pulmonary function test variables, matched related donor HCT (HR, .1; 95% CI, .03 to .5; P = .002), ECP (HR, .1; 95% CI, .01 to .3; P = .001), and slower rate of decline in FEV1PP before the ECP/index date (HR, .7; 95% CI, .6 to .8; P = .001) were associated with a better overall survival. At last follow-up, non–ECP-treated patients were more likely to be on >5 mg daily dose of prednisone (54% versus 23%; P = .04) and had a greater decline in their Karnofsky performance score (mean difference, −9.5 versus −1.6; P = .06) compared with ECP-treated-patients. In conclusion, compared with other BOS-directed therapies, ECP was found to improve survival in HCT patients with BOS, without significantly impacting measured pulmonary functions. These findings need prospective validation in a larger patient cohort.

Predictive value of pulmonary function testing in the evaluation of pulmonary hypertension in sarcoidosis.

Background: In sarcoidosis patients, pulmonary hypertension (PH) is associated with significant morbidity and mortality. Early identification of sarcoidosis-associated pulmonary hypertension (SAPH) has substantial clinical implications. While a number of pulmonary function testing (PFT) variables have been associated with SAPH, the optimal use of PFT’s in screening for SAPH is unknown. Objectives: To examine the predictive value of PFT’s for echocardiographic PH in a cohort of sarcoidosis patients. Methods: We conducted a retrospective cohort study of patients with sarcoidosis from a single center over a period of five years. All consecutive adult patients with a diagnosis of biopsy-proven sarcoidosis (determined by review of the medical chart) who underwent PFT and echocardiographic testing were included. Echocardiographic risk of PH (either intermediate or high) was determined by the presence of echocardiographic PH signs and tricuspid regurgitant jet velocity. Data analysis was performed using multivariate logistic regression analysis with least absolute shrinkage and selection operator. Results: Of the 156 patients included in the study, 42 (27%) met the criteria for echocardiographic PH. Roughly equal proportions met the criteria for intermediate risk (45%) as did for high risk of PH (55%). The percent predicted of diffusion capacity for carbon monoxide (%DLCO) and forced vital capacity (%FVC) were predictive of echocardiographic PH. No other PFT variables outperformed these two markers, and the incorporation of additional PFT variables failed to significantly enhance the model. Conclusions: The %FVC and %DLCO emerged as being predictive of echocardiographic PH in this cohort of biopsy-proven sarcoidosis patients. Potentially reflecting the multifactorial pathogenesis of PH in sarcoidosis, incorporation of other PFT variables failed to enhance screening for PH in this population. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 308-316)