No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Lung volumes and forced ventilatory flows: Report working party standardization of lung function tests
... Adult patients with NMDs and a respiratory involvement defined as VC values lower than 80% of predicted (Quanjer et al., 1993) were solicited during their routine follow-up visits at the unit. Patients with tracheostomy and/or pulmonary disease contraindicating hyperinsufflation and the use of a MI-E device were excluded. ...
... At this time, spirometry variables, lung volumes, Maximal static inspiratory (MIP) and expiratory (MEP) pressures were measured using a Vmax 229 SensorMedics System (Yorba Linda, CA, USA) according to standard guidelines (Quanjer et al., 1993) using a flanged mouthpiece and a noseclip. MIP and MEP were measured at FRC and TLC, respectively. ...
... After these measures, three slow unassisted VC maneuvers were performed (baseline maneuvers). If values differed by more than 5% from the best value, further maneuvers were performed (Quanjer et al., 1993). ...
Respiratory muscle weakness and chest wall abnormalities in neuromuscular diseases (NMD) may lead to decreased pulmonary volumes. We assessed the reversibility of vital capacity (VC) reduction with mechanical In-Exsufflation (MI-E).
We evaluated the effects of positive inspiratory and negative expiratory pressures on spirometric variables under passive (without patients’ participation) and active (with active participation) application in 47 NMD patients. VC, inspiratory capacity (IC), expiratory reserve volume (ERV) were measured during maneuvers without and with MI-E assistance, delivering inspiratory assistance (+40 cmH2O), expiratory assistance (-40cmH2O) and both (+/−40 cmH2O).
Passive and active assistance improved significantly VC and IC compared to baseline (P < 0.0001 for both). ERV improved only with active assistance which normalized VC in 10, IC in 18 and ERV in 6 patients, mainly in patients with late-onset NMD. MI-E assistance produced greater increases in IC than in ERV, resulting in a VC increase enhanced by patients’ active participation.
This type of evaluation may help to evaluate the potential reversibility of restrictive ventilatory pattern in NMDs.
... The values of slow vital capacity (VC), forced expiratory volume in one second (FEV1), and the FEV1/VC% ratio, were used as markers of airway patency. VC and FEV1 were expressed either as absolute values or as percent of the predicted value [27]. Reversibility of airway obstruction was established if FEV1 increased by 12% from baseline or by 200 mL following inhalation of albuterol 400 μg [25]. ...
... The values of slow vital capacity (VC), forced expiratory volume in one second (FEV 1 ), and the FEV 1 /VC% ratio, were used as markers of airway patency. VC and FEV 1 were expressed either as absolute values or as percent of the predicted value [27]. Reversibility of airway obstruction was established if FEV 1 increased by 12% from baseline or by 200 mL following inhalation of albuterol 400 µg [25]. ...
Background:
Intervention studies with vitamin D in asthma are inconclusive for several reasons, such as inadequate dosing or duration of supplementation or uncontrolled baseline vitamin D status. Our aim was to evaluate the benefit of long term vitamin D add-on in asthmatic patients with actual vitamin D deficiency, that is a serum 25-hydroxy vitamin D (25-OHD ) below 20 ng/mL.
Methods:
Serum 25-OHD, asthma exacerbations, spirometry and inhaled corticosteroids (CS) dose were evaluated in a cohort of 119 asthmatic patients. Patients with deficiency were evaluated again after one year vitamin supplementation.
Results:
25-OHD was low in 111 patients and was negatively related to exacerbations (p < 0.001), inhaled CS dose (p = 0.008) and asthma severity (p = 0.001). Deficiency was found in 90 patients, 55 of whom took the supplement regularly for one year, while 24 discontinued the study and 11 were not adherent. Patients with vitamin D deficiency after 12 months supplementation showed significant decrease of exacerbations (from 2.6 ± 1.2 to 1.6 ± 1.1, p < 0.001), circulating eosinophils (from 395 ± 330 to 272 ± 212 10⁶/L, p < 0.001), and need of oral CS courses (from 35 to 20, p = 0.007) and improvement of airway obstruction.
Conclusions:
Asthma exacerbations are favored by vitamin D deficiency and decrease after long-term vitamin D replacement. Patients who are vitamin D deficient benefit from vitamin D supplementation.
... The European Community for Steel and Coal issued the first European standardisation document in 1983, which was updated in 1993 as the official statement of the European Respiratory Society (ERS). There are generally only minor differences between the two most recent ATS (American ThoracicSociety, 1987;1995) and ERS statements (Quanjer & Tammeling, 1983;Quanjer et al., 1993), except that the ERS statement includes absolute lung volumes and the ATS does not (Miller et al., 2005). Spirometry can be done by means of many different types of equipment, it requires cooperation between the participant and the examiner, and the results depend on both technical and human factors. ...
... Such a procedure provides not only absolute reference values but also the percent values of the ventilation pulmonary function variables. This is compulsory given the fact that this procedure allows the use of absolute values only when there are no significant differences in the anthropometric variables, small results variability, and large participants sample (Pavlov, 2003;Quanjer et al., 1993;Wrangler, 1992). In this study, comparison between actual athletes and their reference results was not feasible, because karatekas BM and BMI variation coefficients (CV) were higher than 10% (Cohen, 1988), results' CVs far exceeded such value, and participants sample was not large (Altman, 1991). ...
Spirometry can be considered a method for measuring lung capacity and speed of air-flow through the airways. Due to its simple application, it is commonly used in sport diagnostics. Aims of this research were to determine the values of ventilation function variables in karatekas competing in kumite discipline and their relationship to result. The sample included 51 junior karate athletes (with defined subgroups of more successful [n=31] and less successful [n=20]), competing in kumite discipline, from nine European countries. Their values of some ventilation function variables were measured. Measurement procedures were chosen and used according to acknowledged literature. By univariate analysis of differences, significant differences between more successful and less successful competitors were determined in the following variables: forced vital capacity (more successful 5.24±0.56 l; less successful 4.27±0.61 l; p=0.00), forced expiratory volume in 1 second (more successful 4.13±0.68 l; less successful 3.69±0.57 l; p=0.02), ratio of forced expiratory volume in 1 second/forced vital capacity (more successful 78.98±10.29%; less successful 86.64±8.37%; p=0.01) and maximal voluntary ventilation (more successful 150.46±31.14 l/min; less successful 125.50±29.49 l/min; p=0.01). More successful contestants showed higher values in some relevant variables compared to less successful ones supporting a relationship to result.
... 16 Criteria to define subjects as normal or healthy have been discussed in previous ATS and European Respiratory Society (ERS) statements. 17,18,19 Criteria for Assessing the Severity of Abnormalities on PFT. 19 ...
... In our study we did not have any patient with RPT more than 10 mm. (See Table No. 9,17,18 and Graph No.7,11,12,and 13) Studies by Estenne et al 26 have found that thoracocentesis resulted in only small changes in pulmonary mechanics. These changes were inconsistent and could not explain the immediate and remarkable relief of dyspnoea noted by the patients. ...
... We performed spirometry according to the guidelines of the American Thoracic Society/European Respiratory Society (ATS/ERS) [8]. The equation developed by Quanjer et al. [9] was used for determining the predicted values. A minimum of three and maximum of eight spirometric maneuvers were conducted for each participant to evaluate the acceptability and repeatability of each spirogram, as per the criteria of ATS/ERS [8]. ...
... It is reported that COPD patients are likely to remain at a high risk of developing metabolic syndrome due to high levels of nonesterified fatty acid released into circulation, and as the skeletal muscles are prone to have affinity toward triglycerides and free fatty acid, patients with dyslipidemia or uncontrolled circulating lipid level may be at potential risk [17]. Our findings of an inverse relationship between triglyceride and BMI and FRC indicate a negative influence of lipid metabolites on the biophysical properties of the lungs by reducing the expiratory reserve volume (since the RV does not change much in obesity) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Cirillo et al. [21], in an analysis of 18,162 participants from the third National Health and Nutritional Examination Survey, found that total cholesterol and LDL had no significant influence on the decline of FEV 1 , which was also observed in our study. ...
Background: Although dietary patterns are known to modulate disease severity in chronic obstructive pulmonary disease (COPD), the interplay between circulating lipid profile and lung function in COPD has not been studied extensively.
Methods: 43 COPD patients with a history of smoking and 39 patients with biomass fuel exposure were recruited in this study along with 43 age-matched healthy controls. All participants underwent complete lung function profiling and their glucose and lipid profiles were measured. Association between metabolic profile and lung function was assessed using the Spearman’s rank-order correlation coefficient.
Results: 52.4% of the COPD patients were smokers in compared to the healthy group (46.5%). We found an inverse correlation between triglyceride and functional residual capacity (ρ=-0.21, p=0.05) and a positive association between serum cholesterol and overall airway resistance (R5) (ρ=0.24, p=0.04) and central airway resistance (R20) (ρ=0.32, p=0.004). Low-density lipoprotein (LDL), cholesterol and high density lipoprotein (HDL) ratio and LDL/HDL ratio were also found to correlate with R5 (ρ=0.25, 0.23 and 0.22, respectively) and R20 (ρ=0.31, 0.24 and 0.24, respectively). No significant association was observed between other metabolites and either spirometric or plethysmographic lung function indices.
Conclusion: High serum triglyceride and cholesterol may increase the resistance in the airways, which may lead to increased airway obstruction in future. Therefore, monitoring of lipid profile should be taken into account in the diagnosis and management of COPD.
... The MEF was obtained by a forced expiratory manoeuver commencing with a maximum inhalation (equal to that as in spirometry). Following the suggestions of Quanjer et al. (1993), the measurement was taken while the individual was standing without flexing the neck. Prior to the measurement, the students were informed about the use of the device. ...
Background
The norms for evaluating the maximum expiratory flow (MEF) usually are developed according to chronological age and height. However, to date, little research has been conducted using reference values that take into account the temporal changes of biological maturation. The objectives of this study were to (a) compare the MEF with those of other international studies, (b) align the MEF values with chronological and biological age, and (c) propose reference standards for children and adolescents.
Methods
The sample studied consisted of 3,566 students of both sexes (1,933 males and 1,633 females) ranging in age from 5.0 to 17.9 years old. Weight, standing height, and sitting height were measured. Body mass index was calculated. Biological maturation was predicted by using age of peak height velocity growth (APHV). MEF (L/min) was obtained by using a forced expiratory manoeuvre. Percentiles were calculated using the LMS method.
Results and Discussion
Predicted APHV was at age 14.77 ± 0.78 years for males and for females at age 12.74 ± 1.0 years. Biological age was more useful than chronological age for assessing MEF in both sexes. Based on these findings, regional percentiles were created to diagnose and monitor the risk of asthma and the general expiratory status of paediatric populations.
... It is important to stress that the first lung function tests were carried out less than a month before surgery and that the patient regained weight after the surgical intervention. Another aspect to be mentioned is that our laboratory uses the ERS Quanjer 1993 lung function reference values 8 which were validated to patients with a minimum height of 154 cm tall. Since our patient height is only 141 cm tall, her measured values as percent of predicted are globally overestimated and we should focus on the absolute volumes. ...
... We tested 42 healthy individuals who self-reported the absence of history of respiratory disease, breathing difficulties during simple physical activities (e.g., climbing stairs), acute respi- ratory symptoms (e.g., cough, flu) within 2 weeks prior to testing, neurological/cardiac/internal diseases, psychological disorders, use of psychotropic medications, pregnancy, metallic implants, and large tattoos. Normal lung function (forced expiratory volume in 1 s in percent predicted > 80%) was confirmed by standard spirometry on the day of the experiment ( Miller et al., 2005), based on established norma- tive reference values ( Quanjer et al., 1993). Written informed consent was obtained prior to the study. ...
Breathlessness is an aversive symptom in many prevalent somatic and psychiatric diseases and is usually experienced as highly threatening. It is strongly associated with negative affect, but the underlying neural processes remain poorly understood. Therefore, using fMRI, the present study examined the effects of breathlessness on the neural processing of affective visual stimuli within candidate brain areas including the amygdala, insula, and anterior cingulate cortex (ACC). During scanning, 42 healthy volunteers, mean (SD) age: 29.0 (6.0) years, 14 female, were presented with affective picture series of negative, neutral, and positive valence while experiencing either no breathlessness (baseline conditions) or resistive‐load induced breathlessness (breathlessness conditions). Respiratory measures and self‐reports suggested successful induction of breathlessness and affective experiences. Self‐reports of breathlessness intensity and unpleasantness were significantly higher during breathlessness conditions, mean (SD): 45.0 (16.6) and 32.3 (19.8), as compared to baseline conditions, mean (SD): 1.9 (3.0) and 2.9 (5.5). Compared to baseline conditions, stronger amygdala activations were observed during breathlessness conditions for both negative and positive affective picture series relative to neutral picture series, while no such effects were observed in insula and ACC. The present findings demonstrate that breathlessness amplifies amygdala responses during affective processing, suggesting an important role of the amygdala for mediating the interactions between breathlessness and affective states.
... Respiratory function tests were performed under medically stable conditions. At the time NIV was indicated, spirometry was performed using a pneumotachometer (MS 2000; C. Schatzman, Madrid, Spain) in accordance with the European Respiratory Society guidelines and suggested values [12]. Maximum inspiratory pressure and maximal expiratory pressure were measured (Electrometer 78.905A; Hewlett-Packard, Andover, MA, USA) in accordance with the BLACK and HYATT [13] technique. ...
There is general agreement that noninvasive ventilation (NIV) prolongs survival in amyotrophic lateral sclerosis (ALS) and that the main cause of NIV failure is the severity of bulbar dysfunction. However, there is no evidence that bulbar impairment is a contraindication for NIV. The aim of this study was to determine the effect of bulbar impairment on survival in ALS patients with NIV.
ALS patients for whom NIV was indicated were included. Those patients who refused NIV were taken as the control group.
120 patients who underwent NIV and 20 who refused NIV were included. The NIV group presented longer survival (median 18.50 months, 95% CI 12.62–24.38 months) than the no-NIV group (3.00 months, 95% CI 0.82–5.18 months) (p<0.001) and also in those patients with severe bulbar dysfunction (13.00 months (95% CI 9.49–16.50 months) versus 3.00 months (95% CI 0.85–5.15 months), p<0.001). Prognostic factors for ALS using NIV, adjusted for NIV failure, were severity of bulbar dysfunction (hazard ratio (HR) 0.5, 95% CI 0.92–0.97; p=0.001) and time spent with oxygen saturation measured by pulse oximetry <90% (%sleepSpO2<90) using NIV (HR 1.12, 95% CI 1.01–1.24; p=0.02).
Severe bulbar impairment in ALS does not always prevent NIV from being used, but the severity of bulbar dysfunction at NIV initiation and %sleepSpO2<90 while using NIV appear to be the main prognostic factors of NIV failure in ALS.
... The phenotyping protocol included more than 200 clinical parameters covering all organ manifestations. To harmonise pulmonary function data, the ERS-modified European Community for Steel and Coal reference values were applied to the entire cohort [19,20]. Chest radiographs were grouped according to SCADDING [21] at the corresponding study centre. ...
Sarcoidosis is a highly variable, systemic granulomatous disease of hitherto unknown aetiology. The GenPhenReSa (Genotype–Phenotype Relationship in Sarcoidosis) project represents a European multicentre study to investigate the influence of genotype on disease phenotypes in sarcoidosis.
The baseline phenotype module of GenPhenReSa comprised 2163 Caucasian patients with sarcoidosis who were phenotyped at 31 study centres according to a standardised protocol.
From this module, we found that patients with acute onset were mainly female, young and of Scadding type I or II. Female patients showed a significantly higher frequency of eye and skin involvement, and complained more of fatigue. Based on multidimensional correspondence analysis and subsequent cluster analysis, patients could be clearly stratified into five distinct, yet undescribed, subgroups according to predominant organ involvement: 1) abdominal organ involvement, 2) ocular–cardiac–cutaneous–central nervous system disease involvement, 3) musculoskeletal–cutaneous involvement, 4) pulmonary and intrathoracic lymph node involvement, and 5) extrapulmonary involvement.
These five new clinical phenotypes will be useful to recruit homogenous cohorts in future biomedical studies.
... Multiple data suggest reduced resistance of the conducting airways in IPF. Among 55 IPF patients with a mean age of 71 years, the mean ratio of the forced expiratory volume in 1 s (FEV1) to FVC (FEV1/FVC) was 0.83 [56], which is higher than expected (0.74 for males, 0.75 for females according to European Respiratory Society reference equations) [83]. The ratio of the forced expiratory flow at 25-75% of FVC (FEF25-75%) to FVC (FEF25-75%/FVC) correlates positively with HRCT indices of IPF [39], suggesting that airway dilation occurs as part of the disease process. ...
The clinical expression of idiopathic pulmonary fibrosis (IPF) is directly related to multiple alterations in lung function. These alterations derive from a complex disease process affecting all compartments of the lower respiratory system, from the conducting airways to the lung vasculature. In this article we review the profound alterations in lung mechanics (reduced lung compliance and lung volumes), pulmonary gas exchange (reduced diffusing capacity, increased dead space ventilation, chronic arterial hypoxaemia) and airway physiology (increased cough reflex and increased airway volume), as well as pulmonary haemodynamics related to IPF. The relative contribution of these alterations to exertional limitation and dyspnoea in IPF is discussed.
... It is important to stress that the first lung function tests were carried out less than a month before surgery and that the patient regained weight after the surgical intervention. Another aspect to be mentioned is that our laboratory uses the ERS Quanjer 1993 lung function reference values 8 which were validated to patients with a minimum height of 154 cm tall. Since our patient height is only 141 cm tall, her measured values as percent of predicted are globally overestimated and we should focus on the absolute volumes. ...
... Forced inspiratory vital capacity is defined as the maximal volume of gas that can be inhaled during a forced and complete inspiration from a position of full expiration. It is closely associated with FEV 1 , the volume of air inhaled in one second during the performance of the forced inspiratory vital capacity[19]. In this context, the amount of inhaled volume of air may lead to longer exhalation times during spirometry. ...
Purpose: Humans have two types of breathing pattern, abdominal and thoracic, which show physiological differences. The primary goal of the present study is to assess the spirometric variability of breathing patterns in individuals, and secondary goal is to elucidate the influence of age and gender differences on breathing types.
Methods: Patients aged between 18 and 40 years were asked to participate in the study, and spirometry using the Spirodoc® (MIR-Medical International Research-Srl, Roma, Italy) was preoperatively performed on subjects. Age, gender, weight, height, body-mass index, the American Society of Anesthesiologists score, the observed breathing pattern (thoracic or abdominal) while standing, and the spirometric measurements were recorded into a standardized data sheet.
Results: A total of 126 subjects were included in the study. The mean age of the patients was 29.90 ± 6.76, and the mean body-mass index value was 26.20 ± 5.84. Sixty-seven subjects were female and 59 were male. The forced expiratory time value of spirometry was found to be significantly higher in patients with abdominal breathing (5.94 ± 1.01) compared to thoracic (4.47 ± 1.32; p=0.007). The Forced inspiratory vital capacity measurement in patients with abdominal breathing pattern (4.26 ± 1.01) was higher than in thoracic (3.61 ± 1.04; p=0.063). The thoracic breathing pattern was observed at a rate of 84.7% (n=50) among subjects of the 18-29-year age group, and 73.8% (n=45) in subjects of the 30-40-year age group (p=0.139).
Conclusion: The present study revealed that abdominal breathing is superior in some aspects of spirometric measurements compared to thoracic breathing.
... Dynamic PFTs [forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ), diffusion capacity (DLCO) and maximal oxygen uptake (VO 2 max)] was measured by the single-breath method or by spirometry was performed after bronchodilator administration. DLCO, FVC, FEV 1 and FEV 1 /FVC ratio were obtained and expressed as percentage of predicted for age, sex, and height according to the European Community for Steel and Coal prediction equations (16,17). ...
Background:
Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use.
Methods:
A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed.
Results:
One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% vs. 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05).
Conclusions:
The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.
... In addition, at each visit, participants' symptoms were evaluated according to the modified British medical Research Council (mMRC) dyspnea scale[17]and COPD assessment test (CAT)[18]. Besides, at visit 1, 3 and 4, spirometry was performed[19]. ...
Background
The systemic inflammation is associated with clinical outcome and mortality in chronic obstructive pulmonary disease (COPD) patients. To investigate the effects of tiotropium (Tio) and/or budesonide/formoterol (Bud/Form) on systemic inflammation biomarkers in stable COPD patients of group D, a randomized, open-label clinical trial was conducted.
Methods
Eligible participants (n = 324) were randomized and received either Tio 18ug once daily (group I), Bud/Form 160/4.5ug twice daily (group II), Bud/Form 320/9ug twice daily (group III), or Tio 18ug once daily with Bud/Form 160/4.5ug twice daily (group IV) for 6 months. Systemic inflammation biomarkers were measured before randomization and during the treatment, including C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), serum amyloid A (SAA), tumor necrosis factor-α (TNF-α), fibrinogen (Fib), and white blood cell (WBC).
Results
After 6-month treatment, CRP levels in group II, group III and group IV changed by a median (interquartile range) of -1.25 (-3.29, 1.18) mg/L, -1.13 (-2.55, 0.77) mg/L, and -1.56 (-4.64, 0.22) mg/L respectively, all of which with statistical differences compared with group I. In addition, there were no treatment differences in terms of IL-8, SAA, TNF-α, Fib and WBC levels.
Conclusions
A long-term treatment with Bud/Form alone or together with Tio can attenuate circulating CRP levels in COPD patients of group D, compared with Tio alone.
... Written informed consent was obtained from each participant prior to testing. Post-bronchodilator lung function (forced expiratory volume in 1 s, FEV 1 ; forced vital capacity, FVC) was measured using standard spirometry (Miller et al., 2005), based on established reference values (Quanjer et al., 1993). All control subjects had normal lung function (FEV 1 %pred > 80%; FEV1/FVC > 0.7) and no history of respiratory disease. ...
Background: Dyspnea is the impairing cardinal symptom in COPD, but the underlying brain mechanisms and their relationships to clinical patient characteristics are widely unknown. This study compared neural responses to the perception and anticipation of dyspnea between patients with stable moderate-to-severe COPD and healthy controls. Moreover, associations between COPD-specific brain activation and clinical patient characteristics were examined.
Methods: During functional magnetic resonance imaging, dyspnea was induced in patients with stable moderate-to-severe COPD (n = 17) and healthy control subjects (n = 21) by resistive-loaded breathing. Blocks of severe and mild dyspnea were alternating, with each block being preceded by visually cued anticipation phases.
Results: During the perception of increased dyspnea, both patients and controls showed comparable brain activation in common dyspnea-relevant sensorimotor and cortico-limbic brain regions. During the anticipation of increased dyspnea, patients showed higher activation in hippocampus and amygdala than controls which was significantly correlated with reduced exercise capacity, reduced health-related quality of life, and higher levels of dyspnea and anxiety.
Conclusions: This study suggests that patients with stable moderate-to-severe COPD show higher activation in emotion-related brain areas than healthy controls during the anticipation, but not during the actual perception of experimentally induced dyspnea. These brain activations were related to important clinical characteristics and might contribute to an unfavorable course of the disease via maladaptive psychological and behavioral mechanisms.
... This was similar to the study group of patients of Hyatt et al. [5] The above recording may be because the patients are unable to exhale completely to empty their lungs to RV. [2] Early airway closure and gas trapping due to airflow limitation results in incomplete emptying of the lungs along with hyperinflation. [6] In these patients the lung volumes would be misinterpreted as restrictive disease although the pathology is obstructive. ...
Introduction: Obstructive airway disease is characterized by reversibility on bronchodilator therapy
measured by pulmonary function tests; however this is not often seen is restrictive diseases. We
studied the clinical significance of bronchodilator reversibility in patients of restrictive pattern of
spirometry. Materials and Methods: 30 patients with restrictive spirometry having significant
bronchodilators response, were included in our study. Restiction was defined as decreased FVC and
FEV1, with normal FEVI/FVC and a bronchodilator response as improvement of 12% and 200ml in
FEV1 and FVC. Patients demographics, clinical history, treatment history, X-Ray characteristics,
spirometry, diffusing lung capacity, and lung volumes measurements on Body Plethysmography
were recorded. Results: The mean age was 48.60 + 14.06 years, majority of the patients were male
70 % and 22.23 + 3 .59 was females BMI slightly higher than males .40% were smokers, with
shortness of breath the most common symptom, followed by cough, wheeze and chest pain..Asthma
was the most common diagnosed medical condition and most of them were on bronchodialtors. The
mean post bronchodilator FEV1% and FVC% was 66.88 + 24.28 and 70.95 + 24.99, with a
reversibility of 12.91%.The FEV1/FVC% was 96.80+16.95. The mean TLC was normal whereas
the RV, TLC, RV/TLC was increased. Conclusions: It can be concluded that post bronchodilator
reversibility in patients of restrictive spirometry may be because of decrease elastic recoil resulting
in early airway closure leading to air trapping and low FVC. Even though the numbers of such
patients are low if symptomatic they would be benefited with bronchodilator therapy.
... According to ATS/ERS guidelines all patients underwent post-bronchodilator pulmonary function testing (V max 229 and Autobox 6200, Sensormedics) including spirometry measurements (9). COPD patients inhaled 400 µg salbutamol 20 minutes before testing. ...
Background:
Functional condition is crucial for operability of patients with lung cancer and/or chronic respiratory diseases. The aim of the study was to measure changes of functional and quality of life parameters in terms of the effectiveness of perioperative pulmonary rehabilitation (PR).
Methods:
A total of 208 COPD patients (age: 63±9 years, man/woman: 114/94, FEV1: 62±14%pred) participated in a perioperative PR program. The indication was primary lung cancer in 72% of the patients. The 68 patients participated in preoperative (PRE) rehabilitation, 72 in a pre- and postoperative rehabilitation (PPO) and 68 patients only in postoperative rehabilitation (POS). PR program included respiratory training techniques, individualized training and smoking cessation. Lung function tests, 6 minutes walking distance (6MWD) were measured before and after the rehabilitation. Quality of life tests [COPD Assessment Test (CAT) and Modified Medical Research Council Dyspnoea Scale (mMRC)] were evaluated as well.
Results:
There was a significant improvement in FEV1 (PRE: 64±16 vs. 67±16%pred; PPO: 60±13 vs. 66±13%pred before the operation, 48±13 vs. 52±13%pred after the operation; POS: 56±16 vs. 61±14%pred, P<0.05) and 6MWD (PRE: 403±87 vs. 452±86 m; PPO: 388±86 vs. 439±83 m before, 337±111 vs. 397±105 m after the operation; POS: 362±89 vs. 434±94 m, P<0 0001). Significant improvement was detected in FVC, grip strength, mMRC and CAT questionnaires as an effectiveness of PR, also. Average intensive care duration was 3.8±5.2 days with vs. 3.1±3.6 without preoperative PR.
Conclusions:
Improvements in exercise capacity and quality of life were seen following PR both before and after thoracic surgery.
... Lung function assessment will include spirometry before and after the administration of 400 μg albuterol, static lung volumes, and single-breath diffusion capacity of the lung for carbon monoxide (DLCO). All lung function tests will be performed according to international guidelines [22][23][24] and standardized as percentages of predicted values [25][26][27]. ...
... PFTs were performed according to the ERS guidelines. 24 For all SSc patients spirometry and gas transfer studies were available, and for two thirds of the controls these studies were recovered from old archives. The results are expressed as a percentage of the predicted value (%pred). ...
Purpose:
The aim was to evaluate computed tomography (CT)-measured pulmonary artery diameter (PAD) and lung density as predictors of pulmonary hypertension (PH) in subjects with systemic sclerosis (SSc). We compared these PAD values with normal values and between SSc subgroups with PH and/or interstitial lung disease (ILD). We investigated whether PAD predicts PH and whether lung densitometry, by using the 85th percentile density value (Perc85) as a measure for ILD, can predict PH.
Materials and methods:
PAD and Perc85 were measured in axial CT scans and compared between 54 SSc and 76 control subjects. Four SSc subgroups were defined on the basis of PH (systolic PA pressure ≥35 mm Hg) and/or ILD (fibrosis score ≥7): PH-/ILD-, PH-/ILD+, PH+/ILD-, and PH+/ILD+. The association of PAD with age, body mass index, Perc85, lung function, and hemodynamic measures was investigated using univariate correlation along with the predictive value of these measures with respect to PH.
Results:
PAD in SSc was larger than that in controls (30.1±4.9 vs. 26.9±2.7 mm, P<0.001). PH+ patients showed increased PAD compared with PH- patients (34.2±4.2 vs. 28.6±4.3 mm, P<0.001), where PH+/ILD+ subjects showed the widest diameter (34.6±4.1 mm). In SSc patients, hemodynamic measures, age, body mass index, Perc85, and lung function correlated with PAD. PAD was best explained by Perc85, together with age (R=0.358). PAD best predicted PH (AUC, 0.877; P<0.001), and PAD≥30.7 mm showed 80% sensitivity and 87% specificity. Perc85 also predicted PH (AUC, 0.733; P=0.024).
Conclusions:
In subjects with SSc, lung density and PAD are CT markers, each with predictive value for PH.
Background
More than half the cobalt needed for vehicle electrification originates from the southern part of the Democratic Republic of the Congo (DRC), with a substantial part being extracted by artisanal miners.
Aims
To investigate oxygen saturation during underground work among cobalt artisanal miners.
Methods
In a field survey, we measured oxygen saturation (SpO2) and heart rate by pulse oximetry in 86 miners from two underground mines and 24 miners from a surface mine at four different time points: before descent into the mine (T1), at 50 minutes in the mine (T2), upon leaving the shaft (T3), and 10 minutes after having left the mine (T4).
Results
Miners working underground (–36 to –112 meters) were somewhat older (34.8 ± 6.7 years) than those working in the surface mine (32.0 ± 6.5 years), and they worked more hours daily (12.6 ± 1.2 hours) than controls (9.0 ± 0.0 hours). All participants had SpO2 >95% at T1 and T4. At T2, SpO2 dropped below 93% and 80% in 35% and 10% underground miners, respectively; SpO2 was still <93% at T3 in 13%. SpO2 remained stable among surface miners. Later, we showed that underground ambient oxygen levels decreased well below 21% in several pits.
Conclusions
Pulse oximetry revealed relevant hypoxaemia during underground work in a substantial proportion of artisanal miners. Such hypoxaemia without evidence of underlying cardiovascular disease is indicative of low ambient oxygen, due to insufficient mine ventilation. This may cause deaths from asphyxia. The hazards of low ambient oxygen in artisanal mines must be prevented by appropriate technical measures ensuring the supply of sufficient fresh air.
Patients with end-stage chronic kidney disease show higher systemic oxidative stress and exhale more hydrogen peroxide (H2O2) than healthy controls. Kidney transplantation reduces oxidative stress and H2O2 production by blood polymorphonuclear leukocytes (PMNs). Kidney transplant recipients (KTRs) may be predisposed to an impairment of lung diffusing capacity due to chronic inflammation. Lung function and H2O2 concentration in the exhaled breath condensate (EBC) were compared in 20 KTRs with stable allograft function to 20 healthy matched controls. Serum interleukin eight (IL-8) and C-reactive protein (CRP), blood cell counts, and spirometry parameters did not differ between groups. However, KTRs showed lower total lung diffusing capacity for carbon monoxide, corrected for hemoglobin concentration (TLCOc), in comparison to healthy controls (92.1 ± 11.5% vs. 102.3 ± 11.9% of predicted, p = 0.009), but similar EBC H2O2 concentration (1.63 ± 0.52 vs. 1.77 ± 0.50 µmol/L, p = 0.30). The modality of pre-transplant renal replacement therapy had no effect on TLCOc and EBC H2O2. TLCOc did not correlate with time after transplantation. In this study, TLCOc was less reduced in KTRs in comparison to previous reports. We suggest this fact and the non-elevated H2O2 exhalation exhibited by KTRs, may result perhaps from the evolution of the immunosuppressive therapy.
BackgroundSARS-CoV-2 infection can impair diaphragm function at the acute phase but the frequency of diaphragm dysfunction after recovery from COVID-19 remains unknown.Materials and methodsThis study was carried out on patients reporting persistent respiratory symptoms 3–4 months after severe COVID-19 pneumonia. The included patients were selected from a medical consultation designed to screen for recovery after acute infection. Respiratory function was assessed by a pulmonary function test, and diaphragm function was studied by ultrasonography.ResultsIn total, 132 patients (85M, 47W) were recruited from the medical consultation. During the acute phase of the infection, the severity of the clinical status led to ICU admission for 58 patients (44%). Diaphragm dysfunction (DD) was detected by ultrasonography in 13 patients, two of whom suffered from hemidiaphragm paralysis. Patients with DD had more frequently muscle pain complaints and had a higher frequency of prior cardiothoracic or upper abdominal surgery than patients with normal diaphragm function. Pulmonary function testing revealed a significant decrease in lung volumes and DLCO and the dyspnea scores (mMRC and Borg10 scores) were significantly increased in patients with DD. Improvement in respiratory function was recorded in seven out of nine patients assessed 6 months after the first ultrasound examination.Conclusion
Assessment of diaphragm function by ultrasonography after severe COVID-19 pneumonia revealed signs of dysfunction in 10% of our population. In some cases, ultrasound examination probably discovered an un-recognized pre-existing DD. COVID-19 nonetheless contributed to impairment of diaphragm function. Prolonged respiratory physiotherapy led to improvement in respiratory function in most patients.Clinical trial registration[www.cnil.fr], identifier [#PADS20-207].
Background
To understand the accuracy of volume calibration syringes used in China and compare the difference between new and old volume calibration syringes, technical testing was performed on volume calibration syringes in clinical lung function instruments.
Materials and methods
A standard validator device (Model 1180, Hans Rudolph, USA) was used to perform leak testing and volume accuracy testing for calibration syringes. Sixteen volume calibration syringes from 8 brands (CareFusion in Germany, Vyaire in Germany, Yaeger in Germany, Vitalograph in the United Kingdom, MGC Diagnostics in the United States, U-Breath in Zhejiang, China, Wendi in Ningbo, Zhejiang, and Boya in Ningbo, China) were tested.
Results
A total of 75% (12/16) of the volume calibration syringes passed the pressure decay leak test, 69% (11/16) of the volume calibration syringes passed the volume accuracy and repeatability test, and 56% (9/16) passed both tests; there was no significant difference in the total passing of the new and old volume calibration syringe quality tests ( P > 0.05).
Conclusions
A standard validator device should be used for both leakage tests and volume accuracy and repeatability tests to ensure the reliability of volume calibration syringes. It is suggested that the quality verification of volume calibration syringes should be regularly conducted to ensure the accuracy of the pulmonary function tests.
In patients with chronic obstructive pulmonary disease (COPD), emphysema, airway disease, and extrapulmonary comorbidities may cause various symptoms and impair physical activity. To investigate the relative associations of pulmonary and extrapulmonary manifestations with physical activity in symptomatic patients, this study enrolled 193 patients with COPD who underwent chest inspiratory/expiratory CT and completed COPD assessment test (CAT) and the Life-Space Assessment (LSA) questionnaires to evaluate symptom and physical activity. In symptomatic patients (CAT ≥ 10, n = 100), emphysema on inspiratory CT and air-trapping on expiratory CT were more severe and height-adjusted cross-sectional areas of pectoralis muscles (PM index) and adjacent subcutaneous adipose tissue (SAT index) on inspiratory CT were smaller in those with impaired physical activity (LSA < 60) than those without. In contrast, these findings were not observed in less symptomatic patients (CAT < 10). In multivariable analyses of the symptomatic patients, severe air-trapping and lower PM index and SAT index, but not CT-measured thoracic vertebrae bone density and coronary artery calcification, were associated with impaired physical activity. These suggest that increased air-trapping and decreased skeletal muscle and subcutaneous adipose tissue quantity are independently associated with impaired physical activity in symptomatic patients with COPD.
Rationale
The characteristics of patients with respiratory complaints and/or lung radiologic abnormalities after hospitalisation for COVID-19 are unknown. The objectives were to determine their characteristics and the relationships between dyspnoea, radiologic abnormalities and functional impairment.
Methods
In the COMEBAC cohort study, 478 hospital survivors were evaluated by telephone 4 months after hospital discharge, and 177 who had been hospitalised in an intensive care unit (ICU) or presented relevant symptoms underwent an ambulatory evaluation. New-onset dyspnoea and cough were evaluated, and the results of pulmonary function tests, high-resolution computed tomography of the chest were collected.
Results
Among the 478 patients, 78 (16.3%) reported new-onset dyspnoea, and 23 (4.8%) new-onset cough. The patients with new-onset dyspnoea were younger (56.1±12.3 versus 61.9±16.6 years), had more severe COVID-19 (ICU admission 56.4% versus 24.5%) and more frequent pulmonary embolism (18.0% versus 6.8%) (all p≤0.001) than patients without dyspnoea. Among the patients reassessed at the ambulatory care visit, the prevalence of fibrotic lung lesions was 19.3%, with extent <25% in 97% of the patients. The patients with fibrotic lesions were older (61±11 versus 56±14 years, p=0.03), more frequently managed in ICU (87.9 versus 47.4%, p<0.001), had lower total lung capacity (74.1±13.7 versus 84.9±14.8%pred, p<0.001) and diffusing lung capacity for carbon monoxide (DLCO) (73.3±17.9 versus 89.7±22.8%pred, p<0.001). The combination of new-onset dyspnoea, fibrotic lesions and DLCO <70%pred was observed in 8/478 patients.
Conclusions
New-onset dyspnoea and mild fibrotic lesions were frequent at 4 months, but the association of new-onset dyspnoea, fibrotic lesions and low DLCO was rare.
Background:
Limited evidence exists regarding adverse modifications affecting cardiovascular and pulmonary function in physical active adults affected by COVID-19, especially in athletic populations. We aimed to describe the clinical presentation of COVID-19 in a cohort of competitive athletes, as well as spirometry and echocardiography findings and cardio-respiratory performance during exercise.
Methods:
Twenty-four competitive athletes with COVID-19 were recruited for this study after ending self-isolation and confirmation of negative laboratory results. All athletes underwent clinical evaluation, spirometry, echocardiography and cardiopulmonary exercise testing (CPET). These data were compared to a group of healthy control athletes.
Results:
Anosmia was the most frequent symptom present in 70.83% patients, followed by myalgia, fatigue and ageusia. The most frequent persisting symptoms were anosmia 11 (45.83%) and ageusia 8 (33.33%). Compared to controls, COVID-19 patients presented lower FEV1%: 97.5 (91.5-108) vs. 109 (106-116) p = 0.007. Peak Oxygen Uptake (VO2) in COVID-19 patients was 50.1 (47.7-51.65) vs. 49 (44.2-52.6) in controls (p = 0.618).
Conclusions:
Reduced exercise capacity was not identified and pulmonary and cardiovascular function are not impaired during early recovery phase in a population of physical active adults except FEV1 reduction.
Treatment with Dextromethorphan/Quinidine (DM/Q) has demonstrated benefit on pseudobulbar affect and bulbar function in amyotrophic lateral sclerosis (ALS). The aim of this study was to assess whether DM/Q could provide long-term improvement in bulbar function and thereby prolong noninvasive respiratory management in ALS.
Materials and methods
This prospective, case-cohort study, recruited ALS patients with bulbar dysfunction. Subjects included were compared with cross-matched historical controls. Cases received DM/Q (20/10 mg twice daily) during one-year follow-up; bulbar dysfunction was evaluated with the Norris scale bulbar subscore (NBS) and bulbar subscale of AlSFRS-R (ALSFRSb).
Results
In total, 21 cases and 20 controls were enrolled, of whom noninvasive respiratory muscle assistance failed in 6 (28.5%) patients in the DM/Q group, compared with 4 patients (20.0%) in the control group (p=0.645). Time from study onset to failure of respiratory muscle aids was 5.50+1.31 months in the DM/Q group and 5.20+1.15 months in the control group (p=0.663). The adjusted OR for the effect of treatment on failure of noninvasive respiratory muscle aids was 2.12 (95%CI 0.23-33.79, p=0.592). In the DM/Q group an impairment in scores was found in NBS (F=19.26, p=0.000) and ALSFRS-Rb (F=12.71, p=0.001) across different months of the study.
Conclusion
Treatment with DM/Q in ALS is unable to prolong noninvasive respiratory management, and moreover, has no effect on long-term deterioration of bulbar function. Notwithstanding the results on bulbar function, DM/Q was found to improve pseudobulbar affect during one-year follow-up.
Objective:
The study aimed to evaluate whether high-flow oxygen therapy (HFOT) during training was more effective than oxygen in improving exercise capacity in hypoxemic chronic obstructive pulmonary disease (COPD).
Methods:
A total of 171 patients with COPD and chronic hypoxemia were consecutively recruited in 8 rehabilitation hospitals in a randomized controlled trial. Cycle-ergometer exercise training was used in 20 supervised sessions at iso inspiratory oxygen fraction in both groups. Pre- and post-training endurance time (Tlim), 6-minute walking distance (6MWD), respiratory and limb muscle strength, arterial blood gases, Barthel Index, Barthel Dyspnea Index, COPD Assessment Test, Maugeri Respiratory Failure questionnaire, and patient satisfaction were evaluated.
Results:
Due to 15.4% and 24.1% dropout rates, 71 and 66 patients were analyzed in HFOT and Venturi mask (V-mask) groups, respectively. Exercise capacity significantly improved after training in both groups with similar patient satisfaction. Between-group difference in post-training improvement in 6MWD (mean: 17.14 m; 95% CI = 0.87 to 33.43 m) but not in Tlim (mean: 141.85 seconds; 95% CI = -18.72 to 302.42 seconds) was significantly higher in HFOT. The minimal clinically important difference of Tlim was reached by 47% of patients in the V-mask group and 56% of patients in the HFOT group, whereas the minimal clinically important difference of 6MWD was reached by 51% of patients in the V-mask group and 69% of patients in the HFOT group, respectively.
Conclusion:
In patients with hypoxemic COPD, exercise training is effective in improving exercise capacity.
Impact statement:
The addition of HFOT during exercise training is not more effective than oxygen through V-mask in improving endurance time, the primary outcome, whereas it is more effective in improving walking distance.
Background and objective:
The Body mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index is a well-known metric for chronic obstructive pulmonary disease (COPD), but it is inadequate for predicting mortality. This study proposed a new index that combines inspiratory muscle training with the BODE index and verified its ability to predict mortality in patients with COPD.
Methods:
Cox regression identified predictors of mortality, which were then included in the new index. The receiver operating characteristic (ROC) curve verified the ability of the new index to predict mortality. The Kaplan-Meier curves compared the survival rates of patients with different scores on the new index.
Results:
Among the 326 patients, 48 died during follow-up (1-59 months). Cox regression showed that the fat-free mass index (FFMI), forced expiratory volume in one second/the predicted value (FEV1%), modified Medical Research Council (mMRC) score, six-minute-walk test (6MWT) distance, and maximal inspiratory pressure were predictors of mortality (P<0.05); these variables were included in the FODEP index. The AUC of the FODEP index (0.860, 95% CI: 95% CI: 0.817-0.896) was greater than that of the BODE index (0.778, 95% CI: 0.729-0.822). The Kaplan-Meier curves suggested that as the FODEP score increased, so did the risk of morality in patients with COPD. The cumulative survival in the group with the highest FODEP-value was significantly lower than that in the other groups (P<0.01).
Conclusion:
The FODEP index was more effective than the BODE index at predicting the risk of mortality in patients with COPD.
Study Objectives
Low lung volumes are thought to contribute to obstructive sleep apnea (OSA). OSA is worse in the supine versus lateral body position, men versus women, obese versus normal-weight (NW) individuals and REM versus NREM sleep. All of these conditions may be associated with low lung volumes. The aim was to measure FRC during wake, NREM, and REM in NW and overweight (OW) men and women while in the supine and lateral body positions.
Methods
Eighty-one healthy adults were instrumented for polysomnography, but with nasal pressure replaced with a sealed, non-vented mask connected to an N2 washout system. During wakefulness and sleep, repeated measurements of FRC were made in both supine and right lateral positions.
Results
Two hundred eighty-five FRC measures were obtained during sleep in 29 NW (body mass index [BMI] = 22 ± 0.3 kg/m2) and 29 OW (BMI = 29 ± 0.7 kg/m2) individuals. During wakefulness, FRC differed between BMI groups and positions (supine: OW = 58 ± 3 and NW = 68 ± 3% predicted; lateral OW = 71 ± 3, NW = 81 ± 3% predicted). FRC fell from wake to NREM sleep in all participants and in both positions by a similar amount. As a result, during NREM sleep FRC was lower in OW than NW individuals (supine 46 ± 3 and 56 ± 3% predicted, respectively). FRC during REM was similar to NREM and no sex differences were observed in any position or sleep stage.
Conclusions
Reductions in FRC while supine and with increased body weight may contribute to worsened OSA in these conditions, but low lung volumes appear unlikely to explain the worsening of OSA in REM and in men versus women.
Background
M‐mode ultrasonography might be useful for detecting hemidiaphragm paralysis. The objective of the present study was to describe the motion recorded by M‐mode ultrasonography of both diaphragmatic leaves in patients with a pre‐established diagnosis of hemidiaphragm paralysis.
Methods
A study was conducted in 26 patients (18 men, 8 women) with unilateral diaphragmatic paralysis. They were referred to two different rehabilitation centres after thoracic surgery in 23 cases and cardiac interventional procedures in three cases. The pulmonary function tests and the study of the diaphragmatic motion using M‐mode ultrasonography were recorded.
Results
The pulmonary function tests showed a restrictive pattern. The M‐mode ultrasonography reported either the absence of motion or a weak paradoxical (cranial) displacement (less than 0·5 cm) of the paralysed hemidiaphragm during quiet breathing. A paradoxical motion was recorded in all patients during voluntary sniffing, reaching around −1 cm. During deep breathing, a paradoxical motion at the beginning of the inspiration was observed. Thereafter, a re‐establishment of the motion in the craniocaudal direction was recorded. The excursions measured on the healthy side, during quiet breathing and voluntary sniffing, were increased in patients suffering from contralateral hemidiaphragm paralysis, when compared with 170 healthy volunteers.
Conclusions
To detect diaphragmatic dysfunction in patients at risk, it would be useful to study diaphragmatic motion by M‐mode ultrasonography during quiet breathing, voluntary sniffing and deep breathing.
Pulmonary function testing has a rich and diverse history. Since the time of ancient Greece, we have endeavored to understand the processes that regulate our breathing in health and disease. To augment this understanding, there are many extensive published histories of pulmonary function and physiology, and the reader is advised to seek out further details as listed in the Selected References. Within the confines of the present book, this chapter will focus on selected highlights relevant to clinical pulmonary function testing, through which we hope that the reader can gain a deeper understanding of the different tests as each is done today.
Background and objective
Poor lung function is a predictor of future all‐cause mortality. In Australia, respiratory diseases are particularly prevalent among the Indigenous population, especially in remote communities. However, there are little published pulmonary function tests (PFT) data of remote‐based adult Indigenous patients. We aimed to evaluate the severity of airflow obstruction and other PFT abnormalities of adults referred to specialist respiratory clinics in remote Indigenous communities.
Methods
Retrospective analysis of PFTs [pre‐ and post‐bronchodilator spirometry, total lung capacity (TLC) and diffusing capacity to carbon monoxide (DLCO)] of Indigenous patients collected during specialist respiratory clinics in remote Northern Territory (NT) Indigenous communities (Australia) between 2013‐2015. The National Health and Nutrition Examination Survey (NHANES) III without ethnic correction was used as the reference.
Results
Of the 357 patients, 150 had acceptable spirometry and 71 had acceptable DLCO and TLC studies. Despite the relatively young age (mean=49 years, SD=12.9) their lung function was generally low; mean % predicted values were FEV1=55%(SD=20.5%), FVC=61%(SD=15.6%), DLCO=64.0%(SD=19.7%), TLC=70.1%(SD=18.2%). Mean FEV1/FVC ratio was preserved (0.71, SD=0.16). Post‐bronchodilator airflow obstruction (FEV1/FVC<0.7) was found in 37% of patients, where a large proportion (67%) demonstrated at least severe airflow obstruction with a mean FEV1 of 41% predicted.
Conclusion
In this first study of PFT findings of Indigenous adults from a remote‐based clinical service, we found a high rate of at least moderate airflow limitation and low FVC along with preserved FEV1/FVC ratio. Increased awareness and screening for reduced lung function needs to be considered in this population.
This article is protected by copyright. All rights reserved.
La bronchopneumopathie chronique obstructive (BPCO) est une maladie fréquente et sera la 3ème cause de mortalité en France en 2020. La réhabilitation respiratoire est une étape clé de la thérapeutique. Il s'agit d'une prise en charge globale et pluridisciplinaire dont le réentraînement à l'effort constitue la pierre angulaire. Nous avons étudié de façon rétrospective les résultats d'un programme de réhabilitation respiratoire selon la façon de le mettre en œuvre : à domicile ou en hôpital de jour. Les deux principaux paramètres analysés étaient l'évolution de la distance parcourue au test de marche de 6 minutes (TDM6) et la qualité de vie liée à la santé après réhabilitation respiratoire (questionnaire du St George's Hospital). 56 BPCO (38H, 18F) ont été inclus dans un programme qui se déroulait au domicile (n 27, 3 à 5 séances par semaine, 1 séance supervisée) ou en centre (n = 29, 3 séances de 2 heures par semaine). Le groupe ville et le groupe hôpital étaient identiques pour le sexe, l'âge (61,7 ± 8,7 vs 62,1 ± 10)4 ans), l'IMC (26,4 ± 6,3 vs 28,4 ± 7,5 kg/m2), la fonction respiratoire (VEMS 1,2 ± 0,5 vs 1,3 ± 0,5 Vs, soit 43,8 ± 12,6 vs 46,9 ± 18,0%), la tolérance de l'effort initiale (VO2pic 13,4 ± 4,4 vs 13,2 ± 3,6 ml/min/kg; TDM6 430 ± 132 vs 434 ± 116 m). L'augmentation du TDM6 était faible dans le groupe ville et le groupe hôpital ( ± 12 ± 46 vs ± 13 ± 34 m, ns), comme le nombre de sujets ayant gagné 35 m ou plus (6/27 vs 8/29, ns) ou 10% ou plus (5/27 vs 5/29, ns). La qualité de vie dans les domaines "Activité" (- 8,6 ± 6,4 vs - 0,7 ± 17,7, p< 0,05), "Impact" (- 8,4 ± 6,5 vs 1,6 ± 11,7, p < 0,001) et au score "Total" (- 8,2 ± 4,0 vs 0,0 ± 8,8, p <0,001) était significativement améliorée dans le groupe domicile. Le domaine "Symptômes" était inchangé. La réhabilitation respiratoire en ville apparaît équivalente à celle effectuée à l'hôpital concernant l'évolution de la tolérance à l'effort et elle est plus performante concernant la qualité de vie. Elle permet une prise en charge pluridisciplinaire et globale dont le médecin généraliste doit être le véritable chef d'orchestre. Le rôle du médecin traitant est crucial afin de pérenniser les résultats de la réhabilitation respiratoire.
The correlations between acoustic characteristics and lung function parameters measured by body plethysmography were revealed when analyzing the sample of 230 subjects consisting of subgroups of healthy subjects, subjects with risk factors, and patients with obstructive lung diseases. Multidirectional character of the correlations between acoustic characteristics of forced expiratory tracheal sounds and parameters measured by body plethysmography/spirometry was established in subgroups of healthy subjects, asthma patients with spirometrically confirmed and unconfirmed obstructive changes, and patients with chronic pulmonary disease.
Respiratory deficits are common following curative intent lung cancer surgery and may reduce the patient's ability to be physically active. We evaluated the influence of surgery on pulmonary function, respiratory muscle strength and physical performance after lung resection.
Pulmonary function, respiratory muscle strength (maximal inspiratory/expiratory pressure) and 6-min walk test (6MWT) were assessed pre-operatively, 2 weeks post-operatively and 6 months post-operatively in 80 patients (age 68±9 years).
Video-assisted thoracoscopic surgery was performed in 58% of cases. Two weeks post-operatively, we found a significant decline in pulmonary function (forced vital capacity −0.6±0.6 L and forced expiratory volume in 1 s −0.43±0.4 L; both p<0.0001), 6MWT (−37.6±74.8 m; p<0.0001) and oxygenation (−2.9±4.7 units; p<0.001), while maximal inspiratory and maximal expiratory pressure were unaffected. At 6 months post-operatively, pulmonary function and oxygenation remained significantly decreased (p<0.001), whereas 6MWT was recovered.
We conclude that lung resection has a significant short- and long-term impact on pulmonary function and oxygenation, but not on respiratory muscle strength. Future research should focus on mechanisms negatively influencing post-operative pulmonary function other than impaired respiratory muscle strength.
Die pneumologische Funktionsdiagnostik ist neben bildgebenden Verfahren in der Lage, Hinweise auf die zugrunde liegende Störung zu liefern, beispielsweise in Bezug auf Asthma, chronisch-obstruktive Lungenerkrankung (COPD) oder Lungenfibrose. Wichtig ist aber auch die Beurteilung des Schweregrads der Erkrankungen und die Einschätzung des Verlaufs unter einer Therapie. Die Spirometrie als erste Basisuntersuchung, die Ganzkörperplethysmographie in der erweiterten Diagnostik, die Blutgasanalyse und Bestimmung des Transferfaktors sowie die Spiroergometrie, Echokardiographie und Rechtsherzkatheteruntersuchung in der funktionellen Beurteilung besonders von pulmonalvaskulären Erkrankungen werden dargestellt. Funktionsstörungen des respiratorischen Systems sind auch die schlafbezogenen Atmungsstörungen und die chronische respiratorische Insuffizienz. Auch deren Diagnostik ist integraler Bestandteil der pneumologischen Funktionsanalyse.
Particulate matter levels and physiological parameters of 150 school going children were monitored continually for 3 years (2013–2016) at three agriculturally active sites. Percent changes in physiological parameters like forced vital capacity, peak expiratory flow, etc. were estimated using mixed effect model with adjustment of covariates such as BMI. Results show that the increase in fine PM levels were much more in rice seasons than in wheat seasons. During the burning episodes, severe adverse effects on physiological parameters of the selected subjects were observed due to enhanced PM2.5 levels. Significant changes were observed in FVC (− 5.27 to − 7.53%) and PEF (− 4.89 to − 7.12%) in comparison to FEV1 and FEF25–75%. Respiratory health in terms of FVC and PEF corresponded very well with the body mass indices of the human subjects for different PM levels in the ambient air. The subjects having lower BMI level were affected more than those with normal and high BMI on exposure to same level of fine particulate matter. It has been concluded that the trends of fall in respiratory parameters were alarming especially for the subjects with lower and higher BMI during crop residue burning episodes.
Purpose:
Purpose of this study was to analyze the impact of a pulmonary rehabilitation (PR) program on the measured inspiratory capacity (IC) in patients with chronic obstructive pulmonary disease (COPD) while performing a 6-min walk test (6MWT).
Methods:
Before and after PR, IC was measured by spirometry both at the beginning and at the end of the 6MWT for 15 patients with COPD in the PR group (PRG) and compared with a similar calisthenics training group (CTG; n = 15). In addition, the COPD Assessment Test (CAT), St George's Respiratory Questionnaire (SGRQ), and other lung function tests were recorded and compared.
Results:
Both groups were not significantly different at baseline. Compared with the CTG, the PRG achieved a significant increase in the delta of IC measured during the 6MWT (0.5 ± 0.2 L [PRG] vs -0.2 + 0.2 L [CTG], P = .001). Significant differences were found for the 6MWT walking distance (PRG: 99 ± 36 m vs CTG: 5 ± 25 m, P = .001). No significant increase in dyspnea while performing the 6MWT was found in either group. The differences in the CAT score and the SGRQ Global score were significant only for the PRG in intragroup comparisons, whereas the intergroup comparison showed no significant differences. Except for residual volume, no significant changes in all parameters of the static lung function tests were observed in either group.
Conclusion:
Participation in a PR may lead to a significant and clinically relevant increase in IC and the walking distance. Additional research is necessary to define the effects of this increase in IC on exercise capacity.
Objective:
To longitudinally evaluate effects of smoking cessation on quantitative CT in a lung cancer screening cohort of heavy smokers over 4 years.
Methods:
After 4 years, low-dose chest CT was available for 314 long-term ex-smokers (ES), 404 continuous smokers (CS) and 39 recent quitters (RQ) who quitted smoking within 2 years after baseline CT. CT acquired at baseline and after 3 and 4 years was subjected to well-evaluated densitometry software, computing mean lung density (MLD) and 15th percentile of the lung density histogram (15TH).
Results:
At baseline, active smokers showed significantly higher MLD and 15TH (-822±35 and -936±25 HU, respectively) compared to ES (-831±31 and -947±22 HU, p<0.01-0.001). After 3 years, CS again had significantly higher MLD and 15TH (-801±29 and -896±23 HU) than ES (-808±27 and -906±20 HU, p<0.01-0.001) but also RQ (-813±20 and -909±15 HU, p<0.05-0.001). Quantitative CT parameters did not change significantly after 4 years. Importantly, smoking status independently predicted MLD at baseline and year 3 (p<0.001) in multivariate analysis.
Conclusion:
On quantitative CT, lung density is higher in active smokers than ex-smokers, and sustainably decreases after smoking cessation, reflecting smoking-induced inflammation. Interpretations of quantitative CT data within clinical trials should consider smoking status.
Key points:
• Lung density is higher in active smokers than ex-smokers. • Lung density sustainably decreases after smoking cessation. • Impact of smoking cessation on lung density is independent of potentially confounding factors. • Smoke-induced pulmonary inflammation and particle deposition influence lung density on CT.
The six-minute walk test (6MWT) has been used to evaluate functional exercise capacity, for assessment of the response to medical interventions, as a predictor of morbidity and mortality in patients with chronic heart or lung diseases. The aim of the study was to evaluate functional exercise capacity and the relationships between 6MWT and lung function, health-related quality of life in patients with tuberculosis sequelae. A secondary aim was to determine factors affecting functional exercise capacity. Seventy patients, aged 25-82 years (forty one men and twenty nine women) were assessed including measures of health status, 6MWT, dyspnea and pulmonary function. The six-minute walk distance was 520±107 м. 6MWT had good correlation with quality of life and pulmonary function tests. The main factor affecting the six-minute distance was impaired pulmonary function
Introduction: The determination of residual lung volume are technically challenging and can involve rather elaborate techniques. However, due to the complex nature of measurement protocols , a number of studies have attempted to use alternative estimation techniques, including application of regression equations following spirometry measurement, panting manoeuvres and general predictive equations. With such extensive measures, it is difficult to reach a consensus where all residual lung volume measures are in agreement, hence the aim of this meth-odological investigation. Methods: Twenty two participants (n=10 male and n=12 female) were recruited from the University of Gloucestershire, undergraduate programmes. All participants were over 18 years of age and all were free from disease, illness or injury (͞ χ±s; age=20.5±1.7 years, body mass=68.7±1.5 kg and stretched stature=172.0±8.3 cm). Three estimations of residual lung volume were carried out by participants, a 'spirometry' method (via forced vital capacity), a 'pant-ing' method (via the air displacement plethysmograph (BOD POD ®)) and a general 'prediction' method (based on age, gender, ethnicity and stature predictive equation to estimate whole body density (D b)). Data analysis was conducted to establish the linear relationship and agreement between the three estimation methods by constructing scatter plots showing deviation from the line of identity and by applying the 95% limits of agreement (LoA) method to quantify the bias, random variation and heteroscedasticity. Results: Results indicated that linear relationships were evident from the scatter plots, but this was expected given they were measuring the same variable. Further analysis with limits of agreement indicated that there was a bias of 0.13, 0.17 and 0.04 l for the panting, spirometry and prediction estimation techniques and limits of agreement of 0.47 to-0.21, 0.45 to-0.11 and 0.23 to-0.15 L respectively. Conclusion: The spirometry technique demonstrated a more accurate estimation of residual lung volume when compared to panting and prediction techniques, in addition, as spirometry uses standard (and the simplest) techniques to determine lung volumes, and is the most widely used method within research determining D b from hydrostatic weighing, it was concluded that the spirometry method would be the measurement approach of choice for determination of residual lung volume.
Background:
An increased ventilatory response to exertional metabolic demand (high ventilation (⩒E)-carbon dioxide output (⩒CO2) relationship) is a common finding in patients with coexistent COPD-heart failure. We aimed to determine the mechanisms underlying high ⩒E-⩒CO2 and its impact on operating lung volumes, dyspnea and exercise tolerance in these patients.
Methods:
Twenty-two ex-smokers with combined COPD and heart failure with reduced left ventricular ejection fraction (LVEF) undertook, after careful treatment optimization, a progressive cycle exercise test with capillary (c) blood gas collection.
Results:
Regardless the chosen metric (increased ⩒ E-⩒CO2 slope, ⩒E/⩒CO2 nadir or end-exercise ⩒E/⩒CO2), ventilatory inefficiency was closely related to PcCO2 (r values from -0.80 to -0.84; p<0.001) but not dead space /tidal volume ratio. Ten patients consistently maintained exercise PcCO2 ≤35 mmHg (hypocapnia). These patients had particularly poor ventilatory efficiency than non-hypocapnic patients. (p<0.05). Despite the lack of between-group differences in spirometry, resting lung volumes and LVEF, hypocapnic patients had lower resting PaCO2 and lung diffusing capacity (p<0.01). Excessive ventilatory response in this group was associated with higher exertional PcO2. The hypocapnic group, however, had worse mechanical inspiratory constraints and higher dyspnea scores for a given work rate leading to poorer exercise tolerance compared to their counterparts (p<0.05).
Conclusion:
Heightened neural drive promoting a ventilatory response beyond that required to overcome an increased "wasted" ventilation led to hypocapnia and poor exercise ventilatory efficiency in COPD-heart failure overlap. Excessive ventilation led to better arterial oxygenation but at the expense of earlier critical mechanical constraints and intolerable dyspnea.
Objectives/hypothesis:
Patients with empty nose syndrome (ENS) following turbinate surgery often complain about breathing difficulties. We set out to determine if dyspnea in patients with ENS was associated with hyperventilation syndrome (HVS). We hypothesized that lower airway symptoms in ENS could be explained by HVS.
Study design:
Observational prospective study.
Methods:
All consecutive patients referred to our center for ENS over 1 year were invited to participate. Patients completed the Nijmegen score and underwent a hyperventilation provocation test (HVPT) and arterial blood gas and cardiopulmonary tests. HVS was defined by a delayed return of the end-tidal partial pressure of carbon dioxide in the expired gas to baseline during HVPT. Patients with HVS were asked to complete the Sinonasal Outcome Test (SNOT)-16 questionnaire before and after a specific eight-session respiratory rehabilitation program.
Results:
Twenty-two of the 29 patients referred for ENS during the study period were eligible for inclusion and underwent a complete workup. HVS was diagnosed in 17 of these patients (77.3%). In the five patients who completed the SNOT-16, the score was significantly lower after rehabilitation.
Conclusions:
This study suggests that HVS is frequent in patients with ENS, and that symptoms can be improved by respiratory rehabilitation. Pathophysiological links between ENS and HVS deserve to be further explored.
Level of evidence:
2b Laryngoscope, 2017.
The aim of the investigation was to study the impact of prematurity and severe infections of lower respiratory tract suffered in early childhood on the occurrence of chronic bronchopulmonary pathology in young adults. Materials and methods. 25 men took part in the study: 16 adult patients born prematurely (n=10) or suffered infections of lower respiratory tract in early childhood (n=6), and 9 healthy volunteers as a control group. All patients filled in British Medical Research Council (mMRC scale) questionnaires of breathlessness rating, underwent spirometry with bronchodilatation test, 6-minute walk test with determination of blood oxygen saturation level, body plethysmography and examination of lung diffusion capacity. Results. Post-bronchodilator reversible obstruction of the peripheral airways (p<0.05), signs of static hyperinflation (p<0.05), and fibrous changes in the lung parenchyma (p<0.05) were revealed in all participants with bronchopulmonary pathology. Though no statistically significant differences in the influence of prematurity and infections of lower respiratory tract on the function of the respiratory system have been established, structural and functional alterations in the peripheral airways were more marked in the group of prematurely born patients. Statistically significant positive correlations (p<0.05) were revealed between gestation age and body mass at birth and parameters characterizing the function of the peripheral airways, as well as between the indices of static hyperinflation and the intensity of changes in the bronchi. Conclusion. The processes affecting the growth and development of the lungs, such as prematurity and severe infection of the lower respiratory tract suffered in early childhood, result in formation of structural and functional changes of the respiratory system, which promote the development of chronic obstructive pulmonary disease. © 2017, Nizhny Novgorod State Medical Academy. All rights reserved.
ResearchGate has not been able to resolve any references for this publication.