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Spirometric evaluation of pulmonary function tests in clinically diagnosed patients of bronchial asthma
Abstract
The present study was undertaken to assess the difference between the normal predicted value and observed value of pulmonary function test (PFT) amongst the asthmatic patients and also to compare the aforesaid observed values between male and female asthmatic patients. Clinically diagnosed cases (male 62, female 75) of bronchial asthma attending medical out patient department of Nepal Medical College Teaching Hospital were assessed. All the pulmonary parameters showed significantly less observed values than the normal predicted values except PEFR in female and FVC in male asthmatic patients. Hence, PEFR in female and FVC in male asthmatic patients might not be considered as a valid parameter to indicate bronchial asthma. Present study also revealed that all the pulmonary variables were significantly higher in males than in females.
... Clotet, Gómez-Arbonés, Ciria and Albalad (2004); Kotz, Wesseling, Aveyard and van Schayck (2011) reported that spirometric screening of smokers can identify those most susceptible to developing COPD while the disease is in an early phase. Early detection of functional impairment and its appropriate treatment will help to reduce morbidity and mortality due to these diseases (Prajapati et al., 2010). ...
... Pulmonary function test (PFT), is a relatively simple, non invasive test, used to detect air flow limitation and/or lung volume restriction (Prajapati et al., 2010). Spirometry is the most widely used pulmonary function test that measures the volume of air expelled from fully inflated lungs as a function of time. ...
... Clotet, Gómez-Arbonés, Ciria and Albalad (2004); Kotz, Wesseling, Aveyard and van Schayck (2011) reported that spirometric screening of smokers can identify those most susceptible to developing COPD while the disease is in an early phase. Early detection of functional impairment and its appropriate treatment will help to reduce morbidity and mortality due to these diseases (Prajapati et al., 2010). ...
... Pulmonary function test (PFT), is a relatively simple, non invasive test, used to detect air flow limitation and/or lung volume restriction (Prajapati et al., 2010). Spirometry is the most widely used pulmonary function test that measures the volume of air expelled from fully inflated lungs as a function of time. ...
Tobacco smoking has multidimensional motives which might lead to compulsive or problematic nicotine use. Pulmonary diseases associated with tobacco smoking are a complex group of disorders the early diagnosis of which as well as identification of motives behind smoking would allow effective management. Therefore, the aim of the present study was to assess motives that influence smokerstextquoteright decision to use tobacco, the impact on pulmonary function and possible associations among those outcomes as well as with related background characteristics of study participants. METHODS: Participants in this descriptive correlational study comprised of 96 smokers. Majority was students, with average age of 22.01textpm5.87 years. Age, weight, height, BMI and pack-years were recorded, smoking dependence motives were assessed and spirometry was performed. RESULTS: Smoking dependence motives revealed equivocal mean ranged between (2.5 textendash 2.8) with increasing mean value of nicotine dependence motives. Mean tobacco consumption was 9.80 textpm 10.82 pack-years. Study participants exhibited mild airflow limitation, mean percentage of predicted values for FEV1 was 83% textpm 0.9, mean FVC was 4.6 textpm 1.3, and FEV1/FVC ratio was as low as 45% textpm 1.2. Psychological motives had shown weak correlations with FEV1, FVC and PEF. Certain motives however, showed significant differences with number of cigarettes smoked per day. Age at start of smoking as well as intensity of smoking showed significant relation with FEV1 decline. CONCLUSIONS: Smokers had shown mild airflow limitation. Various smoking motives affected study participants equally. The implementation of a coordinated tobacco control program is therefore required.
... There has been few study on effect of sports, occupational dust, bronchial asthma on pulmonary function however study on pulmonary function of medical students and their anthropometric relation seems to be scanty. [5][6][7] Moreover there was a study done on assessment of pulmonary function test of students of age group 5-25 years. However, this group only look at PEFR, which on itself does not carry any diagnostic significance these days. ...
Background: Spirometry is vital in screening, diagnosing and monitoring of patients in clinical respiratory medicine. The interpretations of these results depend on comparison with reference values derived from a pool of normal healthy population, which are age, weight, height, gender and ethnicity dependant. Objectives: To establish normative data of lung function indices (FVC, FEV1, FEV1/FVC, PEFR and MVV) of healthy adult persons and to find correlation of these data, if any, with age, height, weight and BMI. Methods: Participants (n=174, mean age 19.60±1.177 yrs, height 161.87±8.572 cm, weight 58.65±11.190 kg and BMI 22.28±3.159 kg/m2) were recruited from KIST medical college. Spriometry was performed and data were grouped according to age, height, weight, BMI and gender. Results: The mean FVC, FEV1, PEFR and MVV of males (3.58 ±0.7241 L, 3.34±0.61L, 8.41±1.20L/sec and 141.45±18.54L/min respectively) were significantly higher than that of females (2.52±0.50L, 2.44±0.44L, 6.72±0.82L/sec and 106.93±12.49L/min respectively). However, FEV1/FVC ratio was statistically similar in males and females. FVC and FEV1 were positively correlated with height and weight in females. PEFR showed correlation with weight and BMI and MVV showed correlation with weight in females. In males, FVC showed positive correlation with height, weight and BMI. FEV1 and MVV showed maximum correlation with height of male students. Conclusions: Significant increased in PFT parameters were observed in male as compare to female. PFT parameters were mainly influenced by body height and weight in both sexes, so on this basis, a prediction equation was established for Nepalese population. Asian Journal of Medical Science, Volume-5(3) 2014: 82-86 http://dx.doi.org/10.3126/ajms.v5i3.9352
... where a higher proportion of study participants (57.7%) were of female gender. In adults, the incidence of asthma is greater among women and it is one of the major risk factors for early adulthood asthma [10] . A wide range of clinical factors predisposes asthma risk in females during adulthood, such as higher estrogen levels, single nucleotide polymorphisms in the cyclooxygenase-2 gene, socioeconomic factors and differential access to resources such as poor nutrition and air quality [11] . ...
... where a higher proportion of study participants (57.7%) was of female gender. In adults, the incidence of asthma is greater among women and it is one of the major risk factors for early adulthood asthma [18]. A wide range of clinical factors predisposes asthma risk in females during adulthood, such as higher estrogen levels, single nucleotide polymorphisms in the cyclooxygenase-2 gene, socioeconomic factors, and differential access to resources such as poor nutrition and air quality [13]. ...
Background and aims: Asthma is a chronic airway inflammatory disorder that imposes substantial morbidity and mortality. Spirometry is a significant tool for the objective measurement of obstruction among asthmatics. The present study was conducted to assess the pulmonary function test parameters among asthmatics and compare the observed and predicted values.
Materials and methods: This cross-sectional research was performed on 120 asthmatic patients who attended a tertiary care healthcare center and underwent spirometry evaluation. The spirometry indices such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, peak expiratory flow rate (PEFR), and maximal voluntary ventilation (MVV) were recorded. Further, a gender-wise comparison of spirometry indices was also done.
Results: There was a substantial decrease in FVC (2.05 ± 0.12 vs. 2.75 ± 0.24 L/sec; p = 0.02), FEV1 (1.78 ± 0.16 vs. 2.38 ± 0.32 L/sec; p = 0.01), FEV1/FVC ratio (74 ± 4.38 vs. 83 ± 5.76 %; p = 0.01), PEFR (4.76 ± 0.42 vs. 5.82 ± 0.65 L/sec; p = 0.03), and MVV (78.65 ± 28.45 vs. 115.87 ± 32.15 L/min; p = 0.001) for observed and predicted values. Female asthmatic patients displayed a substantial decline in FVC (p = 0.001), FEV1 (p = 0.006), FEV1/FVC (p = 0.001), and MVV (p = 0.01) when compared to males.
Conclusion: This study suggests that asthmatic individuals had impaired lung function upon initial assessment. Female asthmatic patients studied are at increased risk of asthma severity when compared to males.
... Increased muscle ability caused by changes in the form hypertrophy, increasing number of mitochondria, oxidative enzymes and myoglobin. Lung physiology increased apart from movement as well caused by previous sufferers not never gymnastics (13) . Research conducted by Huldani (2016) states that aerobic exercise will stimulate muscle damage caused by local inflammation so that the muscles degenerate and regenerate around the connective tissue. ...
Asthma is a chronic inflammation of the airways that involves many cells and their elements. Non-pharmacological treatment of Asthma, one of them is Asthma Gymnastics. The purpose of this study was to determine the effect of asthma exercises on levels of Tumor Necrosis Factor Alpha (TNF-α) in asthma patients. This study used a quasi-experiment method of pre and post-test with control. The sample size of the intervention group was 8 people and the control group was 7 people. The results of hypothesis testing with the Wilcoxon Test found that there was an influence of asthma gymnastic intervention on the levels of Tumor Necrosis Factor Alpha (TNF-α) with a p-value of 0.046. The result of this study showed the effect of asthma exercises on levels of Tumor Necrosis Factor Alpha (TNF-α) in asthma patients. For further research, it is expected to research by increasing the number of treatments in the intervention group and controlling the drugs taken so that it is more optimal in its effect on respondents. Keywords: asthma; Tumor Necrosis Factor alpha (TNF-α); asthma gymnastics
Ergonomics is one of the emerging fields of interest for the researchers of the twenty-first century but is being incorporated into unusual traits of human life from the period of prehistoric Greek civilization. On the former, it has been tried to present how Greeks have used ergonomics in the manufacture of various products. Later on, during the twentieth century, there have been many changes in the application of ergonomics in different aspects of the product design. In this paper, an attempt has been made to represent how ergonomics in product design has changed its face from the prehistoric Greek civilization to the present age and what are the future trends of ergonomic developments in product design.
Assessment of respiratory functions is of considerable importance in both the physiologic and diagnostic purposes. The peak expiratory flow rate (PEFR), an effective measure of effort dependent air flow, is one of the important indicators of the lung functions. It can easily and efficiently evaluate any kind of airflow obstructions and several broncho-constrictions. In this backdrop, a study was carried out on 39 male individuals (24 - 35 years) engaged in automobile works to assess their pulmonary function status and to find out and/or validate the linkage, if any, existing between select anthropometric measures and the lung function indicator. Stature (cm), body weight (kg), arm span (cm), sitting height (cm), trunk length (cm), and chest circumference (cm) were measured, and PEFR was measured. Stature, arm span, trunk length and sitting height were significantly (P<0.05) correlated with the indicator of the lung function.
Keywords: lung performance, airways obstruction, occupation, body morphology, mathematical model
Assessment of pulmonary function, a non invasive test, used to detect air flow limitation and/or lung volume restriction, remains an important parameter in pre employment and periodic medical examinations in many occupations. For various constrain, it has been made a statutory compulsion in only few industrial activities in India. But it is no less important in other avocations, even that of sedentary nature, particularly in view of the fact that many human resources of sedentary occupations are nowadays required to spend a major part of their daily working time in poorly ventilated very small, partitioned cubicles. The situation aggravates further when the partitioning is done with chemically treated insect resistant ply boards. In this backdrop a study was conducted on young sedentary females to assess the status of pulmonary function and to find out and/or validate relationship, if any, existing between pulmonary function as manifest in lung function tests in terms of FVC, FEV 1 and anthropometric variables particularly leg height, trunk height, shoulder height, and arm span. Body height (cm) and body weight (kg) along with the anthropometric parameters leg height, trunk height, shoulder height, arm span were measured. Pulmonary function test procedures were carried out on 39 females volunteers (age range 24-30 year) using Jaeger Flowscreen Pro in morning hours, following the recommendation of American Thorasic Society (ATS). Arm span and body height were found to have significant (P<0.05) positive correlation with FVC and FEV 1. Shoulder height and trunk height were also significantly (P<0.05) correlated with FVC and FEV 1 .
Spirometry evaluation of ventilatory functions plays a critical role in the diagnosis, differentiation and management of respiratory illness such as asthma, chronic obstructive pulmonary disease and restrictive lung disorders. It appears to be underutilized especially by most primary care physicians.
This study was aimed at determining the indications for spirometry at a tertiary health institution in Nigeria and to determine the source of referral of the patients.
Clinical and anthropometric data of all subjects who underwent spirometry at the University of Nigeria Teaching Hospital, Enugu, Nigeria over a three year period were retrieved from the records book and analyzed to determine the sex distribution, age distribution, indication for the procedure, and source of referral.
A total of fifty two patients had the procedure over a three year period (Jan 2004-Dec 2006). The male to female ratio was 1: 1.08. Their ages ranged from 5 to 85 years of age with a mean age of 42.3 +/- 20.50 years. The commonest indication for spirometry during the study period was Bronchial asthma followed by Chronic Obstructive Pulmonary disease (COPD). Most of the patients were referred by the respiratory unit performing the procedure followed by the surgical units and no referral came from the neighbouring peripheral hospitals.
Bronchial Asthma is the commonest indication for the use of spirometry. There is poor referral from the peripheral primary care centers. Primary care general physicians and surgeons should be encouraged to use of spirometry.
Global Initiative Strategy for Asthma Management (GINA) is poorly applied in undeveloped and developing countries. The current study examined the effects of applying GINA guidelines on treatment efficacy in asthmatic patients in Iran.
Twenty four asthmatic patients (usual care group) were treated as usual and 26 patients (intervention group) according to the GINA for 2 months. Asthma symptom score, asthma severity, frequency of symptoms/week and wheezing were recorded at the beginning (first visit), one month after treatment (second visit), and at the end of the study (third visit). Pulmonary function tests (PFTs) were performed by spirometry, and the patients' use of asthma drugs and their symptoms were evaluated, at each visit.
Asthma symptoms, frequency of symptoms/week, chest wheezing, and PFT values were significantly improved in the intervention group at the second and third visits compared to first visit (p < 0.001 for all measures). In addition, exercise induced cough and wheeze were significant improved in the third visit compared to the second visit in this group (p < 0.01 for both measures). In the second and third visits all symptoms were significantly lower, and PFT values higher, in the intervention group compared to the usual care group (p < 0.005 to p < 0.001). In the usual care group, there were only small improvements in some parameters in just the second visit (p < 0.01 for all measures). The use of asthma drugs was unchanged in the usual care group and significantly reduced in the intervention group (p < 0.01) by the end of the study.
Adoption of GINA guidelines improves asthma symptoms and pulmonary function in asthmatic patients in Iran.
When asthma is diagnosed, eosinophilic inflammation and airway remodeling are established in the bronchial airways and can no longer be separated as cause and effect because both processes contribute to persistence and progression of disease, despite anti-inflammatory therapy. Th2 cells are continually active in the airways, even when disease is quiescent. IL-13 is the key effector cytokine in asthma and stimulates airway fibrosis through the action of matrix metalloproteinases on TGF-beta and promotes epithelial damage, mucus production, and eosinophilia. The production of IL-13 and other Th2 cytokines by non-T cells augments the inflammatory response. Inflammation is amplified by local responses of the epithelium, smooth muscle, and fibroblasts through the production of chemokines, cytokines, and proteases. Injured cells produce adenosine that enhances IL-13 production. We review human and animal data detailing the cellular and molecular interactions in established allergic asthma that promote persistent disease, amplify inflammation, and, in turn, cause disease progression.
At the population level, asthma has been associated with chronic systemic inflammation as well as adverse cardiovascular outcomes.
The aim of this study was to investigate peripheral vascular hemodynamic variables of arterial stiffness (AS) and their relationship to pulmonary function tests in asthmatic patients.
Young asthmatic patients from the tertiary center for pulmonary diseases at the Barzilai Medical Center underwent pulmonary function evaluation and non-invasive radial artery hemodynamic profiling, pre- and post-exercise. Results were compared to age matched, non-asthmatic controls.
23 young asthmatics and 41 controls, completed all evaluation points. Pulmonary flow parameters were significantly reduced in the asthma group at all points. There were no differences between groups in BMI, blood pressure, pulse rate or measurements of AS at baseline or after bronchodilation. The % predicted forced expiratory volume in the first second at baseline (FEV1%) in asthmatics was positively correlated with the small arteries elasticity index (SAEI) and negatively correlated with the systemic vascular resistance (SVR) in these patients. These correlations were not observed in non-asthmatic controls. In multifactorial regression FEV1 remained the major factor associated with measurements of AS in asthmatic patients, while gender was the only significant factor in non-asthmatic controls.
Significant correlations between measurements of AS and FEV1 in young asthmatics, suggest the presence of a common systemic, most likely inflammatory pathway involving both the cardiovascular and respiratory systems.
National guidelines advice self measurement of peak flow variability as a diagnostic tool for asthma. However, its actual value for this purpose remains controversial.
219 persons were recruited by 14 general practitioners after they presented themselves for the first time with symptoms suspicious of obstructive airway disease. They were asked to measure and record peak expiratory flow (PEF) three times daily for two weeks. PEF variability was calculated with three different indices and compared to the post bronchodilator FEV (1) response or methacholine inhalation challenge.
132 (60.3 %) patients completed the peak flow diary. 60 (45.5 %) of them were found to have asthma. But the sensitivity, specificity and predictive values of PEF variability were low. The number of daily measurements did not enhance diagnostic accuracy. Variation of the cut-off value (PEF variability > 25 %) increased the probability for asthma to 77.8 %. However, only one out of six had PEF variability > 25 %. None of the three methods sufficed to rule out asthma.
The diagnostic accuracy of PEF variability was low. Thus, in case of inconclusive spirometric results in general practice bronchial provocation remains an essential tool for diagnosing asthma. Diagnostic algorithms, as recommended by national guidelines, should be reconsidered in relation to the diagnostic value of peak flow variability.
To determine whether lung function alters asthma severity based on symptom history in asthmatic adolescents.
Data on asthma symptoms and lung function were collected from adolescents randomly selected from the general population.
Five schools from the central Wellington, New Zealand, area during 2003 to 2005.
Two hundred twenty-four secondary school students aged 13 to 17 years (asthmatic, 118; nonasthmatic, 106).
Asthma questionnaire and lung function testing.
Distribution of asthmatic adolescents in each severity class based on symptoms, lung function, or a combination of both.
Median values for all spirometric parameters for asthmatic adolescents, apart from forced expiratory volume in the first second of expiration (FEV(1))/forced vital capacity (FVC), were in the normal range. Distribution of severity (based on symptoms and beta(2)-agonist use with adjustment for regular inhaled corticosteroid use) was 48.3%, mild; 28.8%, moderate; and 22.9%, severe asthma. For severity based on percentages of predicted FEV(1) and predicted forced expiratory flow, midexpiratory phase (FEF(25%-75%)) and FEV(1)/FVC, the percentages were 89.8%, 86.4%, and 63.5%, mild; 9.3%, 10.2%, and 18.6%, moderate; and 0.9%, 3.4%, and 17.8%, severe asthma, respectively. When percentages of predicted FEV(1) or predicted FEF(25%-75%) or FEV(1)/FVC were added to symptom severity, 6.8%, 5.1%, and 16.9% of asthmatic adolescents were reclassified into another severity group, respectively.
The majority of asthmatic adolescents have normal lung function despite experiencing significant asthma symptoms. Adding FEV(1)/FVC to symptom history changes the distribution of severity; however, both percentages of predicted FEV(1) and FEF(25%-75%) have little added effect in assessing asthma severity in adolescents.
We compared the ratio of maximal voluntary ventilation/forced expiratory volume in one second (MVV/FEV1) in normal individuals and asthmatic subjects. Our hypothesis was that MVV/FEV1 would be lower in asthmatic subjects. We also compared MVV/FEV1 results with the effects of deep inspiration (DI) on bronchomotor tone and with methacholine responsiveness. In normal subjects, MVV/FEV1 was higher than that in asthmatic subjects. Specific conductance (SGaw) increased after a single DI or an MVV maneuver in normal individuals. An MVV maneuver caused SGaw to decrease in asthmatic subjects. In asthmatic subjects, there was a significant correlation between MVV/FEV1 ratio and magnitude of decrease in SGaw after an MVV maneuver. Results of methacholine testing indicated that asthmatic subjects with low MVV/FEV1 ratios were more responsive to methacholine than those whose MVV/FEV1 ratios were within normal range. We conclude that MVV/FEV1 ratios are abnormally low in many asthmatic subjects and that low MVV/FEV1 ratios may indicate increased bronchial responsiveness to methacholine.
Knowing the effect body habitus can have on pulmonary function is important when there is a concern of an underlying respiratory impairment. The pattern of PFT abnormaLities can help distinguish an underlying ventilatory defect as deriving from the body habitus or from a second process. There are limitations, however. Individuals who are obese and have the same weight will likely have different degrees of impairment, for instance. It then becomes difficult to predict the effect body habitus will have in each patient. It therefore is vitally important to evaluate these patients using other clinical data to decide whether the ventilatory defect can be explained by body habitus alone. It also should be noted that some of the more subtle physiologic changes that occur in these conditions are still not fully understood. Hopefully, further insight into these changes can be obtained with further investigation. Certainly, better predictors of the impact of the patient's weight, abdominal girth, and other anthropomorphic data on PFT results would be extremely helpful in the evaluation of these individuals.
The aim of this study was to evaluate the effects of body mass index (BMI) changes over an 8-yr follow-up, on longitudinal changes of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ), and carbon monoxide diffusing capacity of the lung ( D L,CO ) indices in a general population sample of North Italy.
To avoid including weight changes possibly related to physical growth, only the 1,426 adults (>24 yrs, 46% males) with complete follow-up were selected. Median linear regression models were applied to estimate the medians of change (computed as follow-up minus baseline values) of VC, FVC, FEV 1 and D L,CO indices, as functions of changes of BMI over the follow-up period, separately by sex, after considering several potential confounders and effect modifiers.
The extent of lung function loss tended to be higher among those who, at baseline, reported greater BMI values. Males experienced larger losses than females (20 and 16 mL FEV 1 median reduction for a BMI unit increase in males and females, respectively). Conversely, longitudinal changes of BMI caused a slight and nonsignificant increase in D L,CO values in both sexes.
Over an 8-yr follow-up, the detrimental effect of gaining weight might be reversible for many adults as most of those who reduced their body mass index values also increased their lung function. Overweight patients with ventilatory impairment should be routinely encouraged to lose weight for improving their lung function.
Studies in the vital capacity of Bombay medical students
- Dm Telang
- Bhagwat
Telang DM, Bhagwat GA. Studies in the vital capacity of Bombay medical students. Indian J Med Res 1941; 29: 723-9
Indian norms for Pulmonary Function
- Sr Kamat
- Sarma
- Raju
Kamat SR, Sarma BS, Raju VR et al. Indian norms for Pulmonary Function. J Assoc Phys India 1977; 25: 531-40
Critical Care (Manual of ICU and CCU of TU Teaching Hospital) Published by Japan International Cooperation Agency (JICA). 1 st edition
- A Sayami
- Br Shrestha
Sayami A, Shrestha BR. Critical Care (Manual of ICU and
CCU of TU Teaching Hospital). Published by Japan
International Cooperation Agency (JICA). 1 st edition.
1995:102.
Practical Assessment of Pulmonary performance in Pulmonary Diseases and Disorders
- Ap Fishman
Fishman AP. Practical Assessment of Pulmonary performance
in Pulmonary Diseases and Disorders. 2 nd edition 1988; 3:
2469-71.
- H Christopher
- Fanta
Christopher H. Fanta. Asthma. New Engl J Med
2009; 360: 1002-14.