Ventilatory Dysfunction Research Articles

A rare case of Interstitial lung disease complicated by overlapping syndrome with obstructive ventilatory dysfunction as the first symptom

Interstitial lung disease is often a serious complication of connective tissue disease（CTD）, representing the first cause of death in CTD. However, there are few reports of SSc-RA overlap-associated interstitial pneumonia. Respiratory dysfunction as the first clinical manifestation is even rarely reported. We herein described a case of a male patient who developed significant respiratory dysfunction as the principal clinical sign for the past 6 months, plus newly developed skin thickening in bilateral upper limbs and pain and swelling of multiple joints for the past 6 weeks. Extensive immunological screening showed high titer of antinuclear antibodies(ANA), rheumatoid factor(RF), anti-cyclic peptide containing citrulline (anti-CCP)，and positive anti-Scl-70 antibody. Chest high resolution computed tomography(HRCT) was performed and hence ILD was confirmed. Pulmonary function test (PFT) revealed obstructive ventilatory dysfunction rather than restrictive ventilatory dysfunction. So bronchodilation test was performed and asthma was considered. Finally, after a multidisciplinary team (MDT) discussion, the diagnosis of asthma and ILD associated with SSc-RA overlap was established. It is important to note that CTD associated pulmonary interstitial fibrosis must be considered as the differential diagnosis of any newly diagnosed interstitial pulmonary disease. In addition, if patient with dyspnea is highly suspicious of pulmonary interstitial fibrosis, bronchodilation test is still needed to exclude asthma in order to avoid misdiagnosis.

Comparative Evaluation of Lung Functions between Ac and Non Ac users among Student Population

Background: Usage of air conditioners (AC) has been highly increased in this modern era. In addition to the cooling of the environment, it has a major impact on human health. Rapid influx of cold dry air increases the risk of bronchoconstriction in asthma patients due to the dehydration of the air pathway. So, the present study planned to comparatively evaluate the lung functional status in air conditioner and non air conditioner users.
 Materials and Methods: The pulmonary functional capacity was assessed using FVC, FEV1 and FEV1/FVC ratio, Peak expiratory flow rate (PEFR) and FEF 25-75% in a Helios 702 spirometer.
 Results: The lung functional capacities among the AC users showed a statistically significant decline in PEFR and FEF25-75% indicating the risk of airway obstruction.
 Conclusion: The study concluded an innovative finding that AC users are developing ventilatory dysfunction and are at more risk of respiratory dysfunction. The coldness of the aerosol of the AC unit or other factors responsible may be allergens, infections and humidity level. Thus technical and hygienic features of air intake must be ensured to maintain a good indoor air quality.

Is There a Correlation Between Cobb Angle and Pulmonary Function Tests at 2-year Follow-up in Patients With Severe Spinal Deformity Treated by Posterior Vertebral Column Resection?

Study design:A retrospective study.Objective:The aim was to evaluate the relationships of Cobb angle and pulmonary function tests (PFTs) changes in severe spinal deformity and underwent posterior vertebral column resection (PVCR).Summary of Background Data:No previous study focused on the correlation of deformity correction and PFTs changes in patients with cobb angle >90 degrees.Methods:PFTs values [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and percent-predicted values FVC%, FEV1%] were evaluated preoperative and at 2 years after PVCR. FVC% <80% were defined as restrictive ventilation dysfunction (RVD), the severity of RVD were divided into mild (FEV1% ≥70%), moderate (70% > FEV1% ≥50%) and severe (FEV1% <50%). The relationships among PFTs values improvements and all possible impact factors (mainly correction cobb angle) collected in this study were analyzed. PFTs data were compared among the 3 RVD subgroups (mild vs. moderate vs. severe) and between residual >30 versus <30 degrees.Results:A total of 53 cases (28 male/25 female, mean ages 18.9 Y) underwent PVCR in one center from 2004 to 2016 were enrolled cobb angle. When 2 years after PVCR, average PFTs values showed significant improvements. PFTs values changes showed no correlation with correction rate and correction angle. The only significant impact factor in this study for FVC, FVC%, FEV1 improvements was preoperative FVC% and the only impact factor for FEV1% improvement was preoperative FEV1%, the relationships were negative. In accordance with the regression analysis, PFTs values improvements among the 3 RVD subgroups from high to low was severe>moderate>mild. However, patients with residual cobb angle <30 degrees had less PFTs values improvements than patients with residual cobb angle >30 degrees.Conclusions:Two years after PVCR, PFTs values were significantly improved. There is no linear correlation between cobb angle change and PFTs values improvements. Lower preoperative FVC% and FEV1% indicate more PFTs values improvements at 2 years post-PVCR.Level of Evidence:Level III.

Clinical features and prognostic factors of systemic sclerosis in Guangxi, China: Retrospective, single‐center study of long‐term survival in 470 patients

Systemic sclerosis (SSc) is an autoimmune disease the prevalence of which varies among populations. We analyzed SSc patients from Guangxi to improve the clinical understanding of this disease. Data of 470 SSc patients admitted to our institution from October 1,2012 to January 1,2019 were examined. The characteristics of these patients were analyzed using Kaplan-Meier survival analysis. Cox proportional-hazard regression was used to identify prognostic factors. The average age was 50.44±12.31years, 285 patients (60.6%) were women, 2.1% had pneumoconiosis, 58.2% had pulmonary interstitial disease (ILD), 18.7% had pulmonary hypertension (PH), and 3.6% had renal crisis. These patients had diffuse cutaneous systemic sclerosis (dcSSc, 70.2%) or limited cutaneous systemic sclerosis (29.7%), and PH and renal crisis were more common in the dcSSc group. Patients 50years old or more had greater prevalences of ILD, PH, and musculoskeletal damage, greater positivity of laboratory biomarkers, and increased mortality (all P<.05). Seventy-four patients (15.7%) died. The non-survivors were older, had longer disease duration, had higher prevalences of ILD, restrictive ventilation dysfunction, PH, and renal crisis, and had higher levels of creatine kinase myocardial band (CK-MB), C-reactive protein, and immunoglobin A (all P<.05). Renal crisis, PH, and high CK-MB were independent risk factors for death. Pneumoconiosis was more common in SSc patients than the general population from this region. Our patients had a 10-year cumulative survival rate of 74.9%, higher than reported for patients from the US. Renal crisis, PH, and high CK-MB level were independent risk factors for death.

Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure

Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with an inexorably progressive course which leads to a progressive neuromuscular weakness. Weight loss is one of the major bad prognostic factors in ALS. The placement of percutaneous endoscopic gastrostomy (PEG) is of paramount importance in patients with dysphagia to improve the disease outcomes, although some fear exists regarding the possible ventilatory complications during the procedure. The aim of this study was to evaluate the safety and effectiveness of PEG tube insertion under non-invasive ventilation (NIV) in patients with ALS and severe ventilatory impairment. Methods: A retrospective study of all consecutive PEGs placed in our department from May 2011 to January 2018 in patients with ALS was performed. The procedure was performed under non-invasive positive-pressure ventilation for ventilatory support. Results: We included 59 patients with ALS with severe ventilatory impairment, 58% were female, with a mean age of 67.2 ± 10.1 years and a median follow-up of 6 [2–15] months. The main indication for PEG placement was dysphagia (98%). The median time for PEG tube insertion since the established diagnosis of ALS was 12 [6–25] months and 4 [2–18] months since the beginning of bulbar symptoms. The majority of the patients had placed a 20-Fr PEG (63%) and under mild sedation with midazolam (80%), all under NIV. There were no immediate complications during and after the procedure (no episodes of aspiration or orotracheal intubation) and mortality. Conclusion: The placement of PEG is a very important procedure in patients with ALS and severe ventilatory impairment. The interdisciplinary department collaboration permitted the placement of PEG under NIV, in a safe and effective procedure in this special population.

Analysis of the pulmonary function characteristics and associated factors in silicosis patients with progressive massive fibrosis

Objective: To investigate the characteristics of and associated risk factors for pulmonary dysfunction in silicosis patients with progressive massive fibrosis (PMF) . Methods: In-patients with PMF treated in the Department of Occupational Medicine and Toxicology in Beijing Chao-Yang Hospital, Capital Medical University from June 2014 to October 2020 were enrolled in this study. Based on their pulmonary ventilation function, the patients were divided into normal ventilation group, obstructive ventilation dysfunction group, restrictive ventilation dysfunction group, and mixed ventilation dysfunction group. The location and area of the large opacity and the grade of emphysema were evaluated by high-resolution CT (HRCT) of the chest. Based on the location, the large opacity was classified into central type, peripheral type, and mixed type. Results: A total of 115 silicosis patients with PMF were enrolled, with 85 (73.91%) having different types of pulmonary dysfunction, including 36 cases (31.30%) in the obstructive ventilation dysfunction group, 9 cases (7.83%) in the restrictive ventilation dysfunction group and 40 cases (34.78%) in the mixed ventilation dysfunction group. As for the location of the large opacity, 41 cases (35.65%) were central type, 52 cases (45.22%) were peripheral type, and 22 cases (19.13%) were mixed type. Logistic regression analysis showed that the central large opacity and grade 3-4 emphysema were risk factors for obstructive ventilation dysfunction (OR=52.179, 5.500, P<0.05) , class C large opacity was the risk factor for restrictive ventilation dysfunction (OR=33.146, P<0.05) , class B, class C large opacity and central large opacity were the risk factors for mixed ventilation dysfunction (OR=6.414, 11.561, 19.600, P<0.05) . Conclusion: In silicosis patients with PMF, the incidence rate of pulmonary ventilation dysfunction is higher, mainly obstructive and mixed ventilation dysfunction. The area and location of large opacity are associated with the incidence and types of pulmonary ventilation dysfunction.

Respiratory symptoms as initial manifestations of interstitial lung disease in clinically amyopathic juvenile dermatomyositis: a case report with literature review

BackgroundClinically amyopathic juvenile dermatomyositis (CAJDM) is a clinical subgroup of juvenile dermatomyositis (JDM), characterized by JDM rashes with little or no clinically evident muscle weakness. Interstitial lung disease (ILD) is an uncommon but potentially fatal complication of juvenile dermatomyositis (JDM). While adults with dermatomyositis-associated ILD usually present respiratory symptoms before or at the same time as skin muscle manifestations, only a few studies have covered the onset of respiratory symptoms of ILD in JDM patients, especially CAJDM. There is currently no clear effective treatment regime or any prognostic factors for CAJDM-associated ILD.Case presentationHere, we report the first case of a CAJDM patient who presented with respiratory symptoms as the initial manifestation. A 10-year-old male patient presented to the hospital with a complaint of progressive cough and chest pain. Violaceous macule and papules appeared a few days later and he was positive for anti-Ro-52 antibodies. Imaging showed diffuse interstitial infiltration in both lungs and lung function tests showed restrictive and obstructive ventilatory dysfunction. Muscular abnormalities were excluded by thigh magnetic resonance imaging (MRI) and electromyography. Skin biopsy showed pathognomonic findings consistent with DM. Lung biopsy indicated chronic inflammation of the mucosa. This patient was finally diagnosed with CAJDM complicated by ILD and prescribed methylprednisolone, immunoglobulin, prednisolone and mycophenolate mofetil (MMF) for treatment. The patient’s cutaneous and respiratory manifestations were largely improved. We retrospectively reviewed this and another six cases with CAJDM-associated ILD reported previously to better understand its clinical characteristics and effective management.ConclusionsInitial respiratory symptoms with rapid progression in patients presenting Gottron papules should be considered manifestations of CAJDM-associated ILD. We also found a combination of corticosteroids, IVIG and MMF to be an effective method of arresting the progress of CAJDM-associated ILD and improving the prognosis of the patients.

Ventilation in patients with stage IIIB or above lung cancer.

BackgroundTo investigate the distribution of lung function and ventilation dysfunction in patients with locally advanced and advanced lung cancer, and the correlation with clinical factors.MethodsA retrospective study was conducted on patients who were discharged from the respiratory department of our hospital and diagnosed with locally advanced (IIIB, IIIC) or advanced (IVA, IVB) lung cancer from October 2013 to October 2020. Demographic information, clinical data, and lung function assessments were recorded, and the proportion and type of ventilation dysfunction and the correlations between them and clinical factors were statistically analyzed.ResultsA total of 130 patients were included. Han nationality accounted for 99.2%, and males accounted for 79.2% of patients. The average age was 68.48±10.77 years old. In terms of the stage of lung cancer, the proportion of locally advanced IIIB/IIIC was 34.6%, and the proportion of advanced IVA/IVB was 65.4%. The lung function results were as follows: forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) was 72.27% (62.35%, 79.60%), FEV1/vital capacity (VC) was 71.35% (61.78%, 79.20%), FEV1 was 1.72±0.64 L, VC was 2.44±0.70 L, and total lung volume (TLC) was 4.41±0.97 L. Obstructive, restrictive, and mixed ventilation dysfunction accounted for 23.1%, 26.9%, 27.7%, respectively, and 93.1% had not received lung function screening or treatment before. A total of 42 cases (32.3%) had moderate or above obstruction or mixed (mainly obstruction) ventilation dysfunction. The most common symptoms were cough (88.1%), expectoration (71.4%), and dyspnea (40.5%). The chi-square test showed that male, ≥70 years old, smoking history, smoking index ≥800 years, accompanied by airway diseases [chronic obstructive pulmonary disease (COPD)/asthma/chronic bronchitis], and computed tomography (CT) with atelectasis accounted for a higher proportion (P<0.05). Logistic regression showed that age (P=0.003), smoking history (P=0.04), atelectasis (P=0.004), and associated airway diseases (P=0.001) were significant related factors.ConclusionsSome patients with locally advanced or advanced lung cancer have ventilation dysfunction, especially moderate or above obstruction or mixed (mainly obstruction) ventilation dysfunction. For vulnerable populations such as males, the elderly, long-term heavy smokers, patients with airway diseases, or patients with atelectasis on CT, lung function assessment and intervention should be improved to further manage the symptom control and quality of life of patients with this type of lung cancer.

A Prediction Model for Postoperative Pulmonary Complication in Pulmonary Function-Impaired Patients Following Lung Resection

PurposeMost patients with lung cancer have impaired pulmonary function. Single pulmonary function parameters have been suggested as good indices for predicting postoperative pulmonary complications (PPC). The purpose of this retrospective study was to construct a prediction model, including more than one pulmonary function parameter, for better prediction of PPC in patients with lung cancer and impaired pulmonary function.Patients and MethodsOur database of patients who underwent lung resection for non-small cell lung cancer was reviewed and those with impaired pulmonary function were enrolled. Clinical data, including PPC, were recorded. Univariate and logistic regression analyses were applied to explore potential predictors and a prediction model constructed based on the results of logistic regression.ResultsPatients with impaired pulmonary function (n = 124) were enrolled. Most patients were male, current smokers, >60 years old, and had adenocarcinoma and mild ventilatory dysfunction or diffusion dysfunction. In univariate analysis, we identified six pulmonary function parameters that differed significantly between the PPC and non-PPC groups. Receiver operating characteristic curves were used to determine the best cutoff values. In logistic regression, only forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC%), peak expiratory flow (PEF%), and post predictive operation (ppo)-FEV1% remained significant. Based on these results, we constructed a prediction model for PPC including FEV1/FVC%, PEF%, and ppo-FEV1%, which had an good diagnostic performance of, with 76.7% sensitivity and 67.6% specificity.ConclusionOur prediction model, including the pulmonary function parameters, FEV1/FVC%, PEF%, and ppo-FEV1%, shows excellent performance for predicting PPC in patients with lung cancer and impaired pulmonary function following resection, and has potential for wide application in clinical practice.

Constant Vt Ventilation and Surfactant Dysfunction: An Overlooked Cause of Ventilator-induced Lung Injury.

Ventilator-induced lung injury (VILI) is currently ascribed to volutrauma and/or atelectrauma, but the effect of constant Vt ventilation (CVtV) has received little attention. This Perspective summarizes the literature documenting that CVtV causes VILI and reviews the mechanisms by which it occurs. Surfactant is continuously inactivated, depleted, displaced, or desorbed as a function of the duration of ventilation, the Vt, the level of positive end-expiratory pressure (PEEP), and possibly the respiratory rate. Accordingly, surfactant must be continuously replenished, and secretion primarily depends on intermittent delivery of large ventilatory excursions. The surfactant abnormalities resulting from CVtV result in atelectasis and VILI. Although surfactant secretion is reduced by the absence of intermittent deep breaths, continuous administration of large Vts depletes surfactant and impairs subsequent secretion. Low or normal lung volumes result in desorption of surfactant. PEEP can be protective by reducing surface film collapse and subsequent film rupture on reexpansion, and/or by reducing surfactant displacement into the airways, but PEEP can also downregulate surfactant release. The effect of CVtV on surfactant is complex. If attention is not paid to facilitating surfactant secretion and limiting its inactivation, depletion, desorption, or displacement, surface tension will increase and atelectasis and VILI will occur.

Analysis of the Effect of Emergency Ventilators on the Treatment of Critical Illness Based on Smart Medical Big Data.

Respiratory failure refers to pulmonary ventilation and ventilatory dysfunction caused by various reasons, which makes the patient unable to maintain the gas exchange required for stillness and causes a series of pathophysiological changes and corresponding clinical manifestations. In order to solve the problem of respiratory failure in critically ill patients, it is of great significance to analyze the role of microprocessor-based emergency ventilator in the treatment of critically ill patients. This article aims to study the role of microprocessor-based emergency ventilator in the treatment of critically ill patients. This paper presents the key technology based on the ARM11 processor. A breathing motion model is detected and established through a ventilator. The research objects are mainly divided into group A and group B. By comparing the two groups of emergency ventilator ventilation, it can effectively prevent the increase in respiratory muscle fatigue, reduce oxygen consumption, improve the patient's ventilation function and oxygen balance, quickly correct hypoxia and carbon dioxide storage, cooperate with drug treatment, and quickly take out the ventilator after relief. Good treatment results were achieved. The results show that the emergency ventilator controlled by a microcomputer is effective. The total effective rate of the control group was 71.11%, which was significantly lower than that of the observation group (86.67%).

Pulmonary rehabilitation in patients with obstructive ventilatory dysfunction and COVID-19

Pulmonary rehabilitation in patients with obstructive ventilatory dysfunction and COVID-19

Pulmonary rehabilitation in patients with obstructive ventilatory dysfunction and COVID-19

Pulmonary rehabilitation in patients with obstructive ventilatory dysfunction and COVID-19

Two case reports: chronic obstructive pulmonary disease developed in long term survived patients after acute paraquat poisoning

Patients with acute paraquat poisoning mostly die of respiratory failure, and the surviving ones may live with pulmonary fibrosis, but the long-term changes in lung function are still un-clear. Two patients with acute paraquat poisoning survived for more than 7 years were followed up in Northern Jiangsu People's Hospital to evaluate the imaging and spirometric changes. Eight years after poisoning, 1 patient's chest computerized tomography (CT) revealed interstitial pneumonia, chronic bronchitis, emphysema, accompanied by bronchiectasis. Spirometric test showed very severe obstructive ventilatory dysfunction [percentage of vital capacity (VC) to predicted values was 63.7%, percentage of forced expiratory volume in one second (FEV1) to predicted values was 33.2%, percentage of forced vital capacity (FVC) to predicted values was 64.7%, forced expiratory volume in one second to forced vital capacity (FEV1/FVC) was 52.5%, percentage of maximal mid-expiratory flow (MMEF) to predicted values was 9.9%, percentage of diffusion capacity for carbon monoxide in single breath (DLCO-SB) to predicted values was 49.3%]. The radiography of the other patient who survived over 7 years after poisoning also discovered chronic bronchitis, emphysema and bullae, along with pleural effusion. Spirometry identified severe mixed ventilatory dysfunction, mainly obstructive ventilatory disorder (percentage of VC to predicted values was 47.8%, percentage of FEV1 to predicted values was 35.6%, percentage of FVC to predicted values was 49.3%, FEV1/FVC was 74.1%, percentage of MMEF to predicted values was 17.1%, percentage of DLCO-SB to predicted values was 21.8%). These 2 cases indicate that acute paraquat poisoning had long-term effects on lung structure and pulmonary function, which may be manifested as chronic obstructive pulmonary disease.

Therapeutic challenges in a case of sarcoidosis

Abstract Sarcoidosis is a chronic systemic inflammatory disease with unknown etiology, whose diagnosis is based on suggestive symptoms/imaging, histopathological examination with non-caseous granuloma, and exclusion of other etiologies. Corticosteroid therapy is the treatment of choice for moderate/severe forms, but medication intolerance or unfavorable evolution may require immunomodulatory therapy. A 40-year-old patient known with poly-allergy was hospitalized for resting dyspnoea, dry cough, night sweats, and itching. Objective examination identifies roughened breathing, wheezing and SpO2 = 98%. Spirometry shows a medium mixed ventilatory dysfunction. Computed tomography (CT) describes multiple mediastinal lymphadenopathies and inhomogeneous hepatomegaly. Osteomedullary biopsy refutes the suspicion of lymphoma. Bronchoscopy detects bronchial hypervascularization. Due to the suggestive imaging context, a transbronchial biopsy was performed (EBUS-TBNA) from the mediastinal lymphadenopathy. Histopathological examination suggested sarcoidosis: granulomas with epithelioid histiocytes, without caseous necrosis, associated with Langerhans cells and lymphocytes. We initiated corticosteroid therapy, but the patient had an allergic reaction that required the interruption of treatment and administration of methotrexate. After eight months, the clinical and imaging aspect worsened, and we replaced the treatment with cyclophosphamide. However, side effects occurred after a few months, it was replaced with azathioprine. The patient’s condition deteriorates significantly with desaturation. We requested a consultation with the ‘Sarcoidosis Center’ in Rotterdam, which recommended treatment with anti-TNF-α or human immunoglobulin. The patient shows a slightly favorable evolution under human immunoglobulin. The poly-allergy and drug intolerance, including corticosteroid therapy, led to the initiation of immunomodulatory therapy for a young patient with moderate/severe sarcoidosis. The choice of medication was difficult due to the side effects.

Thoracic Morphology and Bronchial Narrowing Are Related to Pulmonary Function in Adolescent Idiopathic Scoliosis.

In adolescent idiopathic scoliosis (AIS), lung function impairment is not necessarily related to the coronal spinal deformity. Recently, right-sided bronchial narrowing has been reported in thoracic AIS. The aim of this study was to describe the relation of chest and spinal deformity parameters, bronchial narrowing, and lung volumes with pulmonary function in preoperative AIS. Spinal radiographs, low-dose computed tomographic (CT) scans of the spine including the chest, and pulmonary function tests were retrospectively collected for 85 preoperative patients with thoracic AIS in 2 centers and were compared with 14 matched controls. Three-dimensional lung and airway reconstructions were acquired. Correlation analysis was performed in which radiographic spinal parameters, CT-based thoracic deformity parameters (rib-hump index [RHi], spinal penetration index, endothoracic hump ratio, hemithoracic-width ratio), lung volume asymmetry, and bronchial cross-sectional area were compared with percent-of-predicted spirometry results. Forty-one patients (48%) had a percent-of-predicted forced expiratory volume in 1 second (FEV1%) or percent-of-predicted forced vital capacity (FVC%) of <65%, and 17 patients (20%) had obstructive lung disease. All thoracic deformity parameters correlated significantly with FEV1% and FVC%; RHi was found to be the best correlate (rs = -0.52 for FEV1% and -0.54 for FVC%). Patients with AIS with impaired pulmonary function had hypokyphosis, a larger rib hump, increased spinal and thoracic rotation, a narrower right hemithorax, and increased intrusion of the spine into the chest. Spinal intrusion correlated with right-sided bronchial narrowing, relative right lung volume loss, and decreased FEV1% and FVC%. Multivariate regression including spinal and thoracic deformity parameters, lung volume asymmetry, and airway parameters could explain 57% of the variance in FEV1% and 54% of the variance in FVC%. Chest intrusion by the endothoracic hump is related to right-sided bronchial narrowing and lung function loss in preoperative AIS. The findings support the theory that ventilatory dysfunction in thoracic AIS is not only restrictive but frequently has an obstructive component, especially in patients with hypokyphosis. RHi is the most predictive chest parameter for lung function loss. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Analysis of spirometer data of 5272 coal dust-exposed miners

Objective: To analyze the spirometer data of coal mine workers, explore the impact of coal dust on the lung function of coal mine workers. Methods: From June to December 2018, 5272 male coal mine dust-exposed workers who underwent occupational health examinations at the Xinjiang Uygur Autonomous Region Occupational Disease Prevention and Treatment Hospital were selected as the research subjects. The basic information and spirometer data of the workers were collected and analyzed for different ages, years of service and the degree of lung function injury of workers exposed to dust and its influencing factors. Results: The total detection rate of lung function injury among dust-exposed workers was 33.9% (1785/5272) . The type of injury was mainly restrictive ventilatory dysfunction (66.7%, 1190/1785) , followed by mixed ventilatory dysfunction (31.4%, 561/1785) , obstructive ventilatory dysfunction (1.9%, 34/1785) . The detection rate of mild lung function impairment was 21.0% (1105/5272) , The detected rate of moderate or higher lung injury was 12.9% (680/5272) . The abnormal detection rate of chest radiography was 3.4% (179/5272) . The logistic regression analysis of the factors affecting lung function damage showed that employees aged 40-<50 were more likely to detect overall lung function injury and the moderate or higher lung injury (P<0.05) , and that they had been working for 35 to 45 years and excavators were more likely to detect overall function injury and different degree of lung injury (P<0.05) . Conclusion: The lung function injury of coal mine dust-exposed workers is related to their age, dust-exposed working years and type of work, mainly with mild injury and restrictive ventilation dysfunction.

Influences of Thoracic Spinal Deformity on Exercise Performance and Pulmonary Function: A Prospective Study of 168 Patients with Adolescent Idiopathic Scoliosis.

A prospective study. The aim of this study was to investigate the factors associated with cardiopulmonary exercise testing (CPET) measurements in patients with adolescent idiopathic scoliosis (AIS). Patients with AIS display restrictive pulmonary dysfunction on pulmonary function testing (PFT). It remains unknown whether thoracic spinal deformity affects exercise performance. One hundred and sixty-eight patients with AIS from January 2014 to December 2019 were included. They underwent preoperative spinal radiological assessment, PFT, and CPET. The effects of the thoracic curve magnitude, body mass index, physical activity level and history of bracing on pulmonary function and exercise performance were analyzed. The Student t test and two-tailed Pearson test were used in data analysis. We found significantly reduced forced expiratory volume in 1second (FEV1) in patients with a larger magnitude of the proximal thoracic curve (P < 0.001) and the main thoracic curve (P < 0.001). There was a negative correlation between forced vital capacity (FVC) and the magnitude of the main thoracic curve (P < 0.001) and thoracic hypokyphosis (P < 0.001). In CPET, exercise capacity indicators such as the work rate, peak oxygen intake, and heart rate were not affected by the thoracic curve magnitude. Patients with moderate or severe pulmonary dysfunction had decreased tidal volume (P = 0.01) and ventilatory reserve (P < 0.001), as well as increased respiratory frequency at maximal exercise (P = 0.01). Patients with a moderate or high physical activity level had better exercise capacity, which was reflected by a higher work rate (P = 0.009) and oxygen intake (P < 0.001). There was no significant correlation between radiographic parameters and exercise capacity indicators. When the thoracic curve increased, patients had restrictive ventilatory dysfunction, which led to a tachypneic breathing pattern and reduction of ventilatory reserve during exercise. A physiological change of improved peak oxygen intake was demonstrated in patients with a moderate or high physical activity level.Level of Evidence: 3.

Is the allergic reaction to Aspergillus a contraindication for biological therapy in severe asthma?

Abstract Introduction: According to the available speciality data, a study from the Netherlands has proven that 24% of patients are in Stage 4–5 of the Global Initiative for Asthma guide (GINA) treatment. Among them, 17% have difficult-to-treat asthma and only 3.7% have severe asthma. Patients with severe asthma have a poor prognosis, with numerous exacerbations that are usually severe. Therefore, add-on biological treatments used for eligible patients may change the outcome. Case report: A 56-year-old female patient, diagnosed 10 years ago with asthma, without professional exposure, treated at home with maximal inhalation treatment, with multiple exacerbations and therefore multiple admissions to the hospital, one of which in the intensive care unit where she received endotracheal intubation and mechanical ventilation, is admitted to the hospital for persistent dyspnoea at rest, wheezing and chest tightness. Investigations revealed obstructive ventilatory dysfunction with a decreased value of forced expiratory volume (FEV1) by 37.57% and a reversibility ratio of 156%. Radiography results indicated absence of acute pleuropulmonary lesions; white blood cells (WBC) at 13,550 and eosinophils at 5566/µL; and 4.107% confirmed immunoglobulin E (IgE)-mediated allergy. The score for asthma control test (ACT) taken on 26 April 2018 was −8 and total IgE was 513 UI/L. Allergology evaluation results did not indicate allergies at prick test. Specific IgE was done for allergy for cat epithelium, guinea pig, rabbit, Penicillium notatum, Cladosporium herbarum and Aspergillus fumigates. Negative fungal test after bronchoscopy was performed to exclude pulmonary Aspergillosis. Omalizumab at 900 mg/month treatment was started. The outcome after 1 year showed no exacerbations, no admissions and no systemic corticotherapy usage. Discussion: Allergic reaction to Aspergillus does not overlap with the diagnosis of pulmonary Aspergillosis; the condition is rather associated with immunosuppression and with a poor outcome. Severe asthma with prolonged progression and multiple risk factors must be treated with maximal therapy.

Risk factors analysis and intervention of lung dysfunction in children with obstructive sleep apnea: A retrospective case series study

ObjectivesTo establish an optimized airway management process to improve preoperative lung dysfunction in obstructive sleep apnea (OSA). MethodsThe study included 483 children (319 males and 164 females; 6y to14y years) with OSA who underwent an adenotonsillectomy from November 2017 to December 2018. Children with OSA and who had abnormal airway function were identified by lung function test, and the risk factors for abnormal lung function were assessed. Next, the children received individualized atomization intervention based on the severity of their abnormal lung function, and the improvement in lung function was evaluated. ResultsLung function tests revealed that 45 patients had obstructive ventilation dysfunction, and histories of chronic cough or asthma were identified as risk factors for perioperative abnormal lung function. The FEV1% pre exceeded 80% after 2 days of atomization intervention in 27 of 28 mild cases, 4 of 13 moderate cases, but in none of the 4 moderate-severe cases. After 4 days of atomization intervention, the FEV1%pre of the remaining 14 patients in the three groups all increased up to 80%. Other indicators of lung function (e.g., FEV1/FVC% pre, MEF50% pre, MEF25% pre, and MMEF% pre) were also greatly improved following the improvement of FEV1% pre. No perioperative airway complications occurred. ConclusionsPrior to performing surgery on children with OSA and who have risk factors associated with abnormal lung function, it is potentially beneficial to establish an optimized airway management process to improve lung function before adenotonsillectomy.