Lung Function Testing: Selectionof reference Values and Interpretative Strategies: Reply

A new autosomal dominant eye and lung syndrome linked to mutations in TIMP3 gene

Article

Full-text available

Sep 2016

To revisit the autosomal dominant Sorsby fundus dystrophy (SFD) as a syndromic condition including late-onset pulmonary disease. We report clinical and imaging data of ten affected individuals from 2 unrelated families with SFD and carrying heterozygous TIMP3 mutations (c.572A > G, p.Y191C, exon 5, in family 1 and c.113C > G, p.S38C, exon 1, in family 2). In family 1, all SFD patients older than 50 (two generations) had also a severe emphysema, despite no history of smoking or asthma. In the preceding generation, the mother died of pulmonary emphysema and she was blind after the age of 50. Her two great-grandsons (<20 years), had abnormal Bruch Membrane thickness, a sign of eye disease. In family 2, eye and lung diseases were also associated in two generations, both occurred later, and lung disease was moderate (bronchiectasis). This is the first report of a syndromic SFD in line with the mouse model uncovering the role of TIMP3 in human lung morphogenesis and functions. The TIMP3 gene should be screened in familial pulmonary diseases with bronchiectasis, associated with a medical history of visual loss. In addition, SFD patients should be advised to avoid tobacco consumption, to practice sports, and to undergo regular pulmonary examinations.

Spirometric measurements in Arab, Kurd and Turkoman ethnic groups in Kirkuk

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Full-text available

Aug 2022

Spirometric measurements including forced vital capacity (FVC), forced expiratory volume in first second (FEV1) and forced expiratory volume ratio (FEV%) were done for 193 males and 212 females in Kirkuk City to the northeast of Iraq. Their ages ranged from 16 to 68 years (males 39.01 ± 13.54 years and females 39.95 ± 15.44 years). Their mean height was 172.65 ± 3.85 cm (males 176.22 ± 2.94 cm and females 168.34 ± 3.36 cm) who were divided into three ethnic groups: Arab, Kurd and Turkoman. There were no significant differences in age, height and FEV% neither among the three ethnic groups nor between males and females. But FVC and FEV1 were significantly higher in Kurd and Turkoman groups than in Arab group (p<0.001) while there were no significant differences between Kurd and Turkoman groups which indicates that lung functions in Kurd and Turkoman were higher than in Arab. It is concluded that Iraqi ethnic groups must be studied separately when to assess their lung function status rather than studying them collectively as one harmonic population.

Normal Predicted Reference Values for Spirometry in Korean Children and Adolescents

Article

Full-text available

Aug 2020

Pulmonary function tests are useful to evaluate airway obstructions and bronchial responsiveness. We aimed to determine the reference values applicable to Korean children and adolescents. In total, 5590 (2607 males, 2983 females) healthy children aged 4 to 17 years old were recruited from three regions in Korea. Simple and multiple regression analyses were applied using age, height, and weight as variables to predict the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum mid-expiratory flow (MMEF) and the peak expiratory flow rate (PEFR). There were significant correlations between the variables and parameters (P < 0.001). The coefficient of determination (R2) values of polynomial equations with two variables were lower than those with two variables but higher than those of monomial equations based on height. The prediction equations by height were obtained, and the R2 value of the FEV1 was the highest. The predicted spirometric values for males were higher than those for females except for the MMEF. The R2 values for the FEV1 and FVC were higher than previous studies except for the R2 value of the FVC for males in European data. This study provided updated regression equations of normal predicted values for spirometry applicable to Korean children and adolescents.

Abnormal Gas Diffusing Capacity and Portosystemic Shunt in Patients With Chronic Liver Disease

Article

Full-text available

Oct 2012

Park

Background Pulmonary dysfunctions including the hepatopulmonary syndrome and portosystemic shunt are important complications of hepatic cirrhosis. To investigate the severity and nature of abnormal gas diffusing capacity and its correlation to portosystemic shunt in patients with chronic liver disease. Methods Forty-four patients with chronic liver disease (15 chronic active hepatitis (CAH), 16 Child-Pugh class A, and 13 Child-Pugh class B) without other diseases history were enrolled in the study. Evaluation of liver function tests, arterial blood gases analysis, ultrasonography, pulmonary function test including lung diffusing capacity of carbon monoxide (DLco), forced vital capacity(FVC), forced expiratory volume 1 seconds(FEV1), total lung capacity(TLC), DLco/AV(alveolar volume) and thallium-201 per rectum scintigraphy were performed. We were analyzed correlations between pulmonary function abnormalities and heart/liver (H/L) ratio in patients with chronic liver diseases. Results In CAH, percentage of patients with DLco and DLco/VA (< 80%) was 22.2 % but it was significantly increased to 47.2-54.5% in Child-Pugh class A and B patients. The means of DLco and DLco/VA were significantly (P < 0.05) decreased in Child-Pugh class. The mean H/L ratio in Child-Pugh class B increased markedly (P < 0.01) than those with CAH and Child-Pugh class A. The frequency of specific pulmonary function abnormality in patients with Child-Pugh class B was significantly (P < 0.01) greater than those with Child-Pugh class A and CAH. There was a inverse linear correlation between H/L ratio and DLco (r = -0.339, P < 0.05) and DLco/VA (r = -0.480, P < 0.01). Conclusion A total of 62% of patients with advanced liver disease have abnormal pulmonary diffusion capacity with a reduced DLco or DLco/VA and abnormal portosystemic shunt (increased H/L ratio) is common hemodynamic abnormality. Therefore, inverse linear correlation between DLco or DLco/VA and H/L ratio may be an important factor in predicting pulmonary complication and meaningful diagnostic and prognostic parameters in patients with advanced chronic liver disease.

Severe tracheal and bronchial collapse in adults with type II mucopolysaccharidosis

Article

Full-text available

Dec 2016
ORPHANET J RARE DIS

Background Mucopolysaccharidosis type II (MPSII) patients frequently suffer from dyspnoea caused by restrictive airway disease due to skeletal abnormalities as well as glycosaminoglycans (GAG) accumulation at different levels of the airway, including the trachea. In this study we describe the extent of the tracheal and bronchial narrowing, the changes in airway diameter during respiration and the effects of these obstructions on respiratory function in adult MPSII patients. Methods Five adult MPSII patients (mean age 40 years) were included. Pulmonary function tests and in- and expiratory chest CT scans were obtained. Cross-sectional areas of trachea and main bronchi were measured at end-inspiration and -expiration and percentage collapse was calculated. ResultsThere was diffuse narrowing of the entire intra-thoracic trachea and main bronchi and severe expiratory collapse of the trachea in all patients. At 1 cm above the aortic arch the median % collapse of the trachea was 68 (range 60 to 77 %), at the level of the aortic arch 64 (range 21–93 %), for the main bronchi this was 58 (range 26–66 %) on the left and 44 (range 9–76 %) on the right side. The pulmonary function tests showed that this airway collapse results in obstructive airway disease in all patients, which was severe (forced expiratory volume <50 % of predicted) in four out of five patients. Conclusion In adult MPS II patients, central airways diameters are strikingly reduced and upon expiration there is extensive collapse of the trachea and main bronchi. This central airways obstruction explains the severe respiratory symptoms in MPSII patients.

Does COPD risk vary by ethnicity? A retrospective cross-sectional study

Article

Full-text available

Apr 2016

Background Lower risk of COPD has been reported in black and Asian people, raising questions of poorer recognition or reduced susceptibility. We assessed prevalence and severity of COPD in ethnic groups, controlling for smoking. Method A retrospective cross-sectional study using routinely collected primary care data in London. COPD prevalence, severity (% predicted forced expiratory volume in 1 second [FEV1]), smoking status, and treatment were compared between ethnic groups, adjusting for age, sex, smoking, deprivation, and practice clustering. Results Among 358,614 patients in 47 general practices, 47.6% were white, 20% black, and 5% Asian. Prevalence of COPD was 1.01% overall, 1.55% in whites, 0.58% in blacks, and 0.78% in Asians. COPD was less likely in blacks (adjusted odds ratio [OR], 0.44; 95% confidence interval [CI] 0.39–0.51) and Asians (0.82; CI, 0.68–0.98) than whites. Black COPD patients were less likely to be current smokers (OR, 0.56; CI, 0.44–0.71) and more likely to be never-smokers (OR, 4.9; CI, 3.4–7.1). Treatment of patients with similar disease severity was similar irrespective of ethnic origin, except that long-acting muscarinic antagonists were prescribed less in black COPD patients (OR, 0.53; CI, 0.42–0.68). Black ethnicity was a predictor of poorer lung function (% predicted FEV1: B coefficient, −7.6; P<0.0001), an effect not seen when ethnic-specific predicted FEV1 values were used. Conclusion Black people in London were half as likely as whites to have COPD after adjusting for lower smoking rates in blacks. It seems likely that the differences observed were due either to ethnic differences in the way cigarettes were smoked or to ethnic differences in susceptibility to COPD.

Canadian Prediction Equations of Spirometric Lung Function for Caucasian Adults 20 to 90 Years of Age: Results from the Canadian Obstructive Lung Disease (COLD) Study and the Lung Health Canadian Environment (LHCE) Study

Article

Full-text available

Jan 2011

Currently, no reference or normative values for spirometry based on a randomly selected Canadian population exist. OBJECTIVE: The aim of the present analysis was to construct spirometric reference values for Canadian adults 20 to 90 years of age by combining data collected from healthy lifelong nonsmokers in two population-based studies. METHOD: Both studies similarly used random population sampling, conducted using validated epidemiological protocols in the Canadian Obstructive Lung Disease study, and the Lung Health Canadian Environment study. Spirometric lung function data were available from 3042 subjects in the COLD study, which was completed in 2009, and from 2571 subjects in the LHCE study completed in 1995. A total of 844 subjects 40 to 90 years of age, and 812 subjects 20 to 44 years of age, were identified as healthy, asymptomatic, lifelong nonsmokers, and provided normative reference values for spirometry. Multiple regression models were constructed separately for Caucasian men and women for the following spirometric parameters: forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC) and FEV 1 /FVC ratio, with covariates of height, sex and age. Comparison with published regression equations showed that the best agreement was obtained from data derived from random populations. RESULTS: The best-fitting regression models for healthy, never-smoking, asymptomatic European-Canadian men and women 20 to 90 years of age were constructed. When age- and height-corrected FEV 1 , FVC and FEV 1 /FVC ratio were compared with other spirometry reference studies, mean values were similar, with the closest being derived from population-based studies. CONCLUSION: These spirometry reference equations, derived from randomly selected population-based cohorts with stringently monitored lung function measurements, provide data currently lacking in Canada.

Effect of inhaled budesonide on seasonal changes in sensitivity and maximal response to methacholine in pollen-sensitive asthmatic subjects

Article

Full-text available

Oct 1994

The aim of this study was to investigate the effect of inhaled budesonide on modifications of the provocative concentration of agonist causing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) and maximal response plateau to inhaled methacholine during the pollen season in pollen-sensitive subjects with mild asthma. The effects of inhaled budesonide (800 micrograms.day-1) on the threshold value (PC20) and maximal response plateau to inhaled methacholine were studied in 28 pollen-sensitive subjects with mild asthma during a pollen season in a randomized, double-blind, placebo-controlled parallel fashion. They were challenged with methacholine (up to 200 mg.ml-1) in February (preseasonal assessment) and during the middle of the pollen season (in May and again in June). Subjects treated with budesonide (n = 13) were protected from the decrease in PC20 seen in the placebo (n = 15) group (geometric mean PC20 placebo group: preseasonal = 8.51, May = 2.19 and June = 1.78 mg.ml-1; budesonide group: preseasonal = 3.71, May = 3.23 and June = 2.40 mg.ml-1; intergroup differences in doubling concentrations, p < 0.05). Among 10 subjects in the placebo group who reached plateau during the preseasonal assessment, seven lost the plateau in May and six in June. In the budesonide group, among seven subjects who reached plateau during the preseasonal assessment, three lost the plateau in May and four in June. Between-group differences were not significant. We conclude that in pollen-sensitive subjects with mild asthma, inhaled budesonide blocks the effects of natural allergen exposure on the methacholine threshold value.(ABSTRACT TRUNCATED AT 250 WORDS)

Spirometric measurements in Iraqi children 6-14 years old in Najaf Governorate

Article

Full-text available

Aug 2006

Basim Zwain

Spirometric measurements including forced vital capacity (FVC), forced expiratory volume in first second (FEV1), forced expiratory volume ratio (FEV%) and peak expiratory flow rate (PEFR) were done for a total number of 580 healthy children (258 males and 322 females) randomly selected from the general population of Najaf governorate. Their ages ranged from 6 to 14 years (males 12.36 ± 1.36 years and females 12.69 ± 1.37 years). Their heights ranged from 130 to 166 cm (males 146.86 ± 9.11 cm and females 146.14 ± 8.42 cm). Height was shown to be significantly correlated with age, FVC, FEV1 and PEFR in males (r = 0.66, 0.73, 0.74 and 0.58 respectively (p<0.001)) and with FVC, FEV1 and PEFR in females (r = 0.79, 0.75 and 0.98 respectively (p<0.001)) and there were significantly higher FVC, FEV1 and PEFR in males than in females (p<0.001). Equations of regression lines of spirometric parameters on height in either sex were constructed and regression lines were drawn and shown to be quite different from those predicted regression lines of previous foreign research. It is concluded that spirometric outcomes in Iraqi children must not be compared with foreign reference values and, instead, a larger size comprehensive Iraqi study is mandatory to construct local reference spirometric values for Iraqi children as those in many other countries.

SPIROMETRIC MEASUREMENTS IN RESIDENTS AROUND ANCIENT BRICK FACTORIES NEAR KEFEL TOWN

Article

Full-text available

Aug 2008

Basim Zwain

Spirometric measurements including forced vital capacity (FVC) and forced expiratory volume in first one second (FEV1) were done for a total number of 134 subjects (79 males and 55 females) residing around ancient brick factories near Kefel town. Their ages ranged from 16 to 72 years (average 41.32 ± 12.77 years) and their heights average 169.57 ± 7.11 cm. It is found that FVC in males was 2.72 ± 0.69 liters and in females was 2.5 ± 0.53 liters, and that FEV1 in males was 2.18 ± 0.68 liters and in females was 1.58 ± 0.52 liters. On comparison with the documented predicted values, it is found that all the measured averages were significantly lower than their predicted values (p<0.001) which leads to conclude that deterioration of lung function of the present research participants may be an inevitable outcome of their residence near the ancient brick factories and so, it is suggested to construct modern less pollutant factories away from the city centers and to motivate citizens not to reside near the already established factories.

Effects of and barriers to hospital-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Article

Full-text available

Jun 2020

Objective: The purpose of this study was to assess the effect of hospital-based pulmonary rehabilitation (PR) on exercise capacity and quality of life as well as barriers to participation in persons with chronic obstructive pulmonary disease (COPD) in South Korea. Design: One-group pretest-posttest design. Methods: A total of 14 patients were enrolled in this study in an 8-week PR program with two 60-minute sessions per week. The program included: flexibility exercises, breathing techniques, strengthening exercises, and aerobic exercises. The outcomes were defined as changes in the variables before and after the PR program. A change in the 6-minute walk distance (6MWD) was defined as the primary outcome, and changes in pulmonary function test, respiratory and grip strength, and the St. George’s Respiratory Questionnaire (SGRQ) about quality-of-life results were secondary outcomes. A dropout was defined as missing >3 of the 16 sessions. Results: Patients who completed the program showed a significant improvement of 43.57±39.43 m in the 6MWD (p<0.05), but no significant differences were noted for the other function tests. The SGRQ showed a significant improvement in the activity and total score (p<0.05). The total dropout rate was 53.3%. Newly developed symptoms, exacerbation of COPD, transport problems, and lack of motivation were major barriers to PR. Conclusions: Our study showed that an 8-week hospital-based PR program improved exercise capacity and quality of life but had a high dropout rate in individuals with COPD. Since comprehensive PR has only recently been established in South Korea, patient motivation and education are critical. Keywords : Exercise, Lung Diseases, Obstructive, Quality of life, Rehabilitation

FVC and FEV Reference Values for Beninese Individuals Aged 17 - 20 Years

Article

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Jan 2019

Assessment of functional lung impairment in patients with thyroid disorders

Article

Full-text available

Nov 2016

EmanR Ali

Abstract Background and objective Many thyroid diseases can lead to pulmonary problems. Hypothyroidism reduces respiratory drive and can cause obstructive sleep apnea, pleural effusion, skeletal muscle myopathy, and decreased carbon monoxide diffusing capacity, whereas hyperthyroidism increases respiratory drive and can cause dyspnea on exertion. Thus, the aim of this study was to evaluate and compare the frequency of clinical presentations, the extent of lung functional endurance (spirometric and diffusion lung capacity), and arterial blood gases affection between patients with hypothyroidism and hyperthyroidism when compared with normal euthyroid volunteers and find out who could compromise the respiratory system more. Patients and methods This study included 90 participants (30 patients with hyperthyroidism, 30 patients with hypothyroidism, and the remaining 30 were normal healthy volunteers as control) referred from the Endocrinology and Internal Medicine Departments in Ain Shams University Hospitals and Misr University for Science and Technology according to their serum free thyroid hormone 3, free thyroid hormone 4, and thyroid-stimulating hormone values. Spirometric function tests and diffusing capacity of the lung for carbon monoxide evaluation were performed for all participants. Results Respiratory symptoms were more frequent in hypothyroid than in hyperthyroid patients, especially cough, sputum production, and chest wheezes. All spirometric functional parameters and respiratory muscle function were decreased (whether or not significant) among patients with hypothyroidism and hyperthyroidism compared with normal euthyroid controls. More statistically significant respiratory functional impairment was noticed among patients with hypothyroidism than among those with hyperthyroidism. Diffusion was more affected in the hypothyroidism group than in the hyperthyroid group, but it was statistically nonsignificant. A statistically significant increase in partial carbon dioxide pressure was observed among patients with hypothyroidism than in patients in hyperthyroidism (However, there was a statistically significant decrease in partial oxygen pressure and pH in patients with hypothyroidism than in those with hyperthyroidism.). Although oxygen saturation was lower in hypothyroidism, it was statistically nonsignificant. Conclusion Hypothyroidism causes greater respiratory system endurance compared with hyperthyroidism. Early diagnosis and hormonal replacement may be of value.

Sahaja yoga meditation as a tool to enhance aging pulmonary functions

Article

Full-text available

Jan 2017

Background: Aging is of recent origin. It is not a disease. Most of the age-related functional changes in the respiratory system result from three physiologic events-progressive decreases in the compliance of the chest wall, in the static elastic recoil of the lung, and in the strength of respiratory muscles. Meditation by the Sahaja yoga technique is, according to tradition, an innately therapeutic process, which is beneficial for all chronic diseases, mental or physical, including asthma. Aims and Objectives: To evaluate and compare the effect of Sahaja yoga meditation on pulmonary functions in subjects aged older than 40 years before and after the practice of Sahaja yoga meditation and to correlate pulmonary function test (PFT) parameters with age. Materials and Methods: The study included 100 subjects (50 male and 50 female subjects) aged older than 40 years who were selected from Jawaharlal Nehru Medical College campus and Wardha city. PFTs were carried out on all subjects, and Sahaja yoga meditation training was given, and all of them were advised to practice Sahaja yoga for 6 months. Statistical analysis was done using Wilcoxon signed-rank test and Pearson’s correlation coefficient. Results: The mean FEV1% predicted increased from 65.55% ± 26.76% to 82.30% ± 29.81%. The forced vital capacity (FVC) % predicted increased from 75.76% ± 30.78% to 85.90% ± 30.49% at the posttest. The mean FEV1/FVC ratio was 0.93 ± 0.40 and 0.94 ± 0.11 at the pre- and posttest, respectively. All the parameters except peak expiratory flow rate were significantly negatively correlated with age. All the PFT parameters significantly increased at the posttest. Conclusion: Sahaja yoga meditation aims to promote the experience of “thoughtless awareness.” Age-related decline in respiratory functions can be modified by the daily practice of Sahaja yoga meditation, which is specifically convenient in elderly individuals to prevent the risk of pulmonary diseases related to age.

A Study on Pulmonary Function of Adolescent Bengalee Trainee Bharatnatyam Dancers

Article

Jan 2014

Abstract Dance, a type of art that generally refers to the rhythmic body movement, is performed in many different cultures. It provides an energetic, non-competitive form of exercise which has potential positive impacts on physical health and may enhance fitness level. On the other hand, pulmonary function test is a non invasive and simple technique used for the assessing lung function status. Practicing dancing as a physical activity may have some impact on lung function variables. In this backdrop a study was conducted to assess the effect of dancing exercise on the pulmonary function indices in terms of VC, FEV1, FEV1%, PEFR in the 31 adolescent Bengalee females receiving training in Bharatnatyam dancing. It has been found that individuals receiving dancing training have significant (P <0.05) favorable impact on pulmonary status compared to control group consisting of 39 individuals of same age and socio economic status.

Comparative study of Ventilatory Functions of Cotton Mill Workers, Mumbai, India

Article

Full-text available

Nov 2016

Background & objectives: The present observational study was carried out in cotton mill workers of Mumbai to compare the pulmonary functions with those of apparently healthy population and to find out the effect of duration of exposure to the working environment. Materials & Methods: The study group comprised of 150 cotton mill workers and 150 workers of hospital staff, all males, in age group of 25-60 years. Socio-demographic characteristics and occupational history was noted in predesigned questionnaire performa for both groups. Respiratory functions namely FEV1, FVC, FEV1/FVC & PEFR were recorded by using portable and electronic instrument pneumotachometer, results were analysed by using difference of means. Results: The pulmonary functions were found to be significantly lower in cotton mill workers as compared to hospital staff and pulmonary functions were correlated negatively with duration of exposure to the cotton dust. Conclusion: In spite of modernization and recent technical evolution the working conditions and occupational environment has still a long way to go as per as the safety of cotton mill workers of Mumbai city is concerned.

Effects of Judo Strength-Velocity Training during Precompetition on Cardiorespiratory Responses in Congolese Judoists Aged 15 - 17 Years Old

Article

Full-text available

Jan 2016

Restrictive spirometric pattern in the general adult population: Methods of defining the condition and consequences on prevalence

Article

Full-text available

Oct 2016
RESP MED

Background: Attempts have been made to use dynamic spirometry to define restrictive lung function, but the definition of a restrictive spirometric pattern (RSP) varies between studies such as BOLD and NHANES. The aim of this study was to estimate the prevalence and risk factors of RSP among adults in northern Sweden based on different definitions. Methods: In 2008-2009 a general population sample aged 21-86y within the obstructive lung disease in northern Sweden (OLIN) studies was examined by structured interview and spirometry, and 726 subjects participated (71% of invited). The prevalence of RSP was calculated according to three different definitions based on pre-as well as post-bronchodilator spirometry: 1) FVC < 80% & FEV1/FVC > 0.7 2) FVC < 80% & FEV1/FVC > LLN 3) FVC < LLN & FEV1/FVC > LLN RESULTS: The three definitions yielded RSP prevalence estimates of 10.5%, 11.2% and 9.4% respectively, when based on pre-bronchodilator values. The prevalence was lower when based on post-bronchodilator values, i.e. 7.3%, 7.9% and 6.6%. According to definition 1 and 2, the RSP prevalence increased by age, but not according to definition 3. The overlap between the definitions was substantial. When corrected for confounding factors, manual work in industry and diabetes with obesity were independently associated with an increased risk for RSP regardless of definition. Conclusions: The prevalence of RSP was 7-11%. The prevalence estimates differed more depending on the choice of pre- compared to post-bronchodilator values than on the choice of RSP definition. RSP was, regardless of definition, independently associated with manual work in industry and diabetes with obesity.

Antipanic drugs and pulmonary function in panic disorder patients

Article

Full-text available

Jan 2009

BACKGROUND: Studies suggest an association between panic disorder (PD) and impairment of lung function. OBJECTIVES: To evaluate lung function in 11 asymptomatic PD patients and to investigate antipanic drug effects on respiratory function. METHOD: Lung function was evaluated on two different occasions (with antipanic drugs and after drug washout). It was comprised of a spirometric evaluation and a bronchodilation test (salbutamol inhalation). Subjective Units of Disturbance Scale (SUDS) was applied before and after each spirometric assessment. RESULTS: One patient showed mild obstructive airway impairment. Before bronchodilation test forced expiratory volume in 1 sec (FEV1) and forced expiratory flow between 25% and 75% of the forced vital capacity (FEF25-75) were significantly higher in patients on antipanic drugs than in those in the washout period. After salbutamol inhalation, only FEV1 was significantly higher in patients with antipanic drugs in comparison to the other group, whereas a significant increase in FEV1 and FEF25-75 after salbutamol inhalation was detected in patients without antipanic drugs. The subjective anxiety level was not different among PD patients in both test days. DISCUSSION: These results suggest a possible beneficial effect of the antipanic drug on lung function in PD patients.

Evaluation of pulmonary function and respiratory symptoms in pyrochlore mine workers

Article

Full-text available

Aug 2016

Objective To identify respiratory symptoms and evaluate lung function in mine workers. Methods This was a cross-sectional observational study involving production sector workers of a pyrochlore mining company. The subjects completed the British Medical Research Council questionnaire, which is designed to evaluate respiratory symptoms, occupational exposure factors, and smoking status. In addition, they underwent pulmonary function tests with a portable spirometer. Results The study involved 147 workers (all male). The mean age was 41.37 ± 8.71 years, and the mean duration of occupational exposure was 12.26 ± 7.09 years. We found that 33 (22.44%) of the workers had respiratory symptoms and that 26 (17.69%) showed abnormalities in the spirometry results. However, we found that the spirometry results did not correlate significantly with the presence of respiratory symptoms or with the duration of occupational exposure. Conclusions The frequencies of respiratory symptoms and spirometric changes were low when compared with those reported in other studies involving occupational exposure to dust. No significant associations were observed between respiratory symptoms and spirometry results.

Diabetes Mellitus and Airway Obstruction: Is there an Association?

Article

Full-text available

Jun 2016

Abstract Background: The incidence of Diabetes mellitus is increasing rapidly, with type 2 diabetes making up to 90% of the cases. Whether diabetes interferes with lung function is unknown. Aim of this study is to evaluate lung function of diabetic patients. Materials and Methodology: A cohort of diabetic patients was randomly selected. History and type of diabetes, glycemic control, comorbidities, smoking history was recorded; clinical examination and spirometry was performed. Results: 62 individuals with type 2 diabetes were enrolled (36 men), aged 64.5 (10.7 Standard Deviation (sd)), Body Mass index 30.1 (6.4 sd), 9.2 years of disease (9.4 sd), HbA1c 7.02% (1.25 sd, 53 mmol/mol, 5.2 sd). 67.7% had arterial hypertension, 14.5% Coronary Heart disease, 54.8% hyperlipidaimia and 16.1% had history of asthmatic symptomatology without any respiratory follow up. 48.3% had smoking history (46.2 pack years) and 20.9% were current smokers. 19.3% had normal spirometry, 30.6% COPD (73.4% mild disease), 6.4% restrictive disorder, 3.2% combined disorder and 40.2% small airway disease (FEF25-75%<60% predicted). In total 74% had obstructive disorder (p<0.001). There was no correlation between sex, smoking, years of diabetes, glycemic control, antidiabetic medications or other comorbidities and obstructive pattern in the spirometry. No patient had evaluated lung function before. Conclusion: These results prompt to the need of a large cohort study to evaluate the state and evolution of respiratory function in patients with diabetes. The existence of obstructive disorder in the majority of our patients may suggest an endothelial inflammatory process that leads to airway obstruction as a complication of type II diabetes

Residual Volume and Total Lung Capacity to Assess Reversibility in Obstructive Lung Disease

Article

Aug 2016
RESP CARE

Background: Reversibility of obstructive lung disease is traditionally defined by changes in FEV1 or FVC in response to bronchodilators. These may not fully reflect changes due to a reduction in hyperinflation or air-trapping, which have important clinical implications. To date, only a handful of studies have examined bronchodilators' effect on lung volumes. The authors sought to better characterize the response of residual volume and total lung capacity to bronchodilators. Methods: Responsiveness of residual volume and total lung capacity to bronchodilators was assessed with a retrospective analysis of pulmonary function tests of 965 subjects with obstructive lung disease as defined by the lower limit of normal based on National Health and Nutritional Examination Survey III prediction equations. Results: A statistically significant number of subjects demonstrated response to bronchodilators in their residual volume independent of response defined by FEV1 or FVC, the American Thoracic Society and European Respiratory Society criteria. Reduced residual volume weakly correlated with response to FEV1 and to FVC. No statistically significant correlation was found between total lung capacity and either FEV1 or FVC. Conclusions: A significant number of subjects classified as being nonresponsive based on spirometry have reversible residual volumes. Subjects whose residual volumes improve in response to bronchodilators represent an important subgroup of those with obstructive lung disease. The identification of this subgroup better characterizes the heterogeneity of obstructive lung disease. The clinical importance of these findings is unclear but warrants further study.

Prediction equations for diffusing capacity (transfer factor) of lung for North Indians

Article

Full-text available

Sep 2016

Background: Prediction equations for diffusing capacity of lung for carbon monoxide (DLCO), alveolar volume (VA), and DLCO/VA using the current standardization guidelines are not available for Indian population. The present study was carried out to develop equations for these parameters for North Indian adults and examine the ethnic diversity in predictions. Materials and Methods: DLCO was measured by single-breath technique and VA by single-breath helium dilution using standardized methodology in 357 (258 males, 99 females) normal nonsmoker adult North Indians and DLCO/VA was computed. The subjects were randomized into training and test datasets for development of prediction equations by multiple linear regressions and for validation, respectively. Results: For males, the following equations were developed: DLCO, −7.813 + 0.318 × ht −0.624 × age + 0.00552 × age²; VA, −8.152 + 0.087 × ht −0.019 × wt; DLCO/VA, 7.315 − 0.037 × age. For females, the equations were: DLCO, −44.15 + 0.449 × ht −0.099 × age; VA, −6.893 + 0.068 × ht. A statistically acceptable prediction equation was not obtained for DLCO/VA in females. It was therefore computed from predicted DLCO and predicted VA. All equations were internally valid. Predictions of DLCO by Indian equations were lower than most Caucasian predictions in both males and females and greater than the Chinese predictions for males. Conclusion: This study has developed validated prediction equations for DLCO, VA, and DLCO/VA in North Indians. Substantial ethnic diversity exists in predictions for DLCO and VA with Caucasian equations generally yielding higher values than the Indian or Chinese equations. However, DLCO/VA predicted by the Indian equations is slightly higher than that by other equations.

What is the impact of different spirometric criteria on the prevalence of spirometrically defined COPD and its comorbidities? Results from the population-based KORA study

Article

Full-text available

Aug 2016

Background There is an ongoing debate about the appropriate spirometric criterion for airway obstruction to detect COPD. Furthermore, the association of different criteria with comorbidity prevalence and inflammatory biomarkers in advanced age is unclear. Materials and methods Spirometry was performed in a population-based study (n=2,256) covering an age range of 41–90 years. COPD was spirometrically determined either by a fixed ratio (FR) of <0.7 for forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) or by FEV1/FVC below the lower limit of normal (LLN). Comorbidity prevalences and circulating biomarker levels (C-reactive protein [CRP], interleukin [IL]-6) were compared between subjects with or without COPD by the two criteria using logistic and multiple regression models, adjusting for sex and age. Results The prevalence of spirometrically defined COPD by FR increased with age from 10% in subjects aged <65 years to 26% in subjects aged ≥75 years. For LLN-defined COPD, it remained below 10% for all age groups. Overall, COPD diagnosis was not associated with specific comorbidities, except for a lower prevalence of obesity in both FR- and LLN-defined cases. Both CRP and IL-6 tended to be higher in cases by both criteria. Conclusion In a population-based cohort of adults up to the age of 90 years, the prevalence of spirometrically defined COPD was higher for the FR criterion than for the LLN criterion. This difference increased with age. Neither prevalences of common comorbidities nor levels of the biomarkers, CRP or IL-6, were conclusively associated with the selection of the COPD criterion. Results have to be considered in light of the predominantly mild cases of airway obstruction in the examined study population.

Comparing the 2007 and 2011 GOLD Classifications as Predictors of all-Cause Mortality and Morbidity in COPD

Article

Jul 2016

To better classify patients with chronic obstructive pulmonary disease (COPD) for prognostic purposes and to tailor treatment, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007 classification was revised in 2011. The primary aim of the current data analyses was to evaluate the accuracy of the GOLD 2007 and 2011 GOLD classifications to predict all-cause mortality and morbidity in a well-described COPD cohort. The prognostic values of both GOLD classifications, expressed as the C-statistic, were assessed in the Cohort of Mortality and Inflammation in COPD (COMIC) study of 795 COPD patients, with a follow-up of 3 years. Outcomes were all-cause mortality and morbidity. Morbidity was defined as time until first COPD-related hospitalisation and time until first community-acquired pneumonia (CAP). The prognostic value of the GOLD 2011 classification was compared between symptom classification based on the modified Medical Research Council (mMRC) score and the Clinical COPD Questionnaire (CCQ) scores with two different thresholds. Although the GOLD 2011 CCQ classification had the highest accuracy to predict mortality and morbidity in our study, the C-statistics differed only numerically. Furthermore, our study showed that the instrument used to determine the level of symptoms in the GOLD 2011 classification has not only important consequences on the mortality prognosis, but also affects the morbidity prognosis in COPD. Therefore, patients' estimated prognosis could alter when different types of tools are used to evaluate the prognosis.

Prevalence of Bronchial Asthma among School Children (Under 12 Years of Age) In Nedumangadu Municipality Area

Article

Jul 2016

P S Sreejith

Background. Bronchial asthma is the chronic airway obstruction and increased airway hyperresponsiveness. The prevalence of bronchial asthma increased steadily over the latter part of the last century, first in the developed and then in the developing world. Objective To find out the prevalence of bronchial asthma among school children under 12 years and to find out the association between bronchial asthma and its risk factors. Methodology A Cross sectional study was conducted in Nedumangad area during the period May-August 2014. 200 children under age of 12 were interviewed using questionnaire and examined. Data was analysed using SPSS Version 16. Results: Out of 200 study population, 18.5%, ie, 37 persons were found to be asthmatic. Of these 81% are males,93% had positive family history,73% are passive smokers,86.6% had history of other allergy,80% are exposed to allergens. There is association between gender and bronchial asthma. (chi square=11.61)Odds ratio = 3.65. p value=0.056. There is association between family history and bronchial asthma. Odds ratio = 2.52. p value = 0.022. Conclusion. Of the total study population 18.5% are asthmatic. There is significant statistical association

Does the incremental shuttle walk test require maximal effort in young obese women?

Article

Full-text available

Jul 2016

Obesity is a chronic disease with a multifaceted treatment approach that includes nutritional counseling, structured exercise training, and increased daily physical activity. Increased body mass elicits higher cardiovascular, ventilatory and metabolic demands to varying degrees during exercise. With functional capacity assessment, this variability can be evaluated so individualized guidance for exercise training and daily physical activity can be provided. The aim of the present study was to compare cardiovascular, ventilatory and metabolic responses obtained during a symptom-limited cardiopulmonary exercise test (CPX) on a treadmill to responses obtained by the incremental shuttle walk test (ISWT) in obese women and to propose a peak oxygen consumption (VO2) prediction equation through variables obtained during the ISWT. Forty obese women (BMI ≥30 kg/m2) performed one treadmill CPX and two ISWTs. Heart rate (HR), arterial blood pressure (ABP) and perceived exertion by the Borg scale were measured at rest, during each stage of the exercise protocol, and throughout the recovery period. The predicted maximal heart rate (HRmax) was calculated (210 - age in years) (16) and compared to the HR response during the CPX. Peak VO2 obtained during CPX correlated significantly (P<0.05) with ISWT peak VO2 (r=0.79) as well as ISWT distance (r=0.65). The predictive model for CPX peak VO2, using age and ISWT distance explained 67% of the variability. The current study indicates the ISWT may be used to predict aerobic capacity in obese women when CPX is not a viable option.

Pulmonary effects of active smoking and secondhand smoke exposure among adolescent students in Juárez, Mexico

Article

Full-text available

Jun 2016

Background: Youth smoking trends among Latin American countries, including Mexico, are on the rise. Notably, although the high prevalence of smoking in teens has been well documented in the literature, few studies have evaluated the impact of smoking and secondhand smoke (SHS) exposure on their respiratory system. Objective: To investigate the effects of smoking and SHS exposure on the respiratory health and lung function among eighth-grade students in Juárez, Mexico. Methods: A cross-sectional study was undertaken on a sample of convenience. The study outcomes centered on evaluating 300 students' lung function by spirometry (forced expiratory volume in 1 second [FEV1], forced expiratory volume in 1 second/forced vital capacity ratio [FEV1/FVC], and forced mid-expiratory flow rate [FEF25%-75%]) and their respiratory health (smoking behavior and SHS exposure) by their self-reported responses to a standardized respiratory questionnaire. The study outcomes were compared among three distinct groups: 1) nonsmokers/nonexposed to SHS; 2) nonsmokers/exposed to SHS; and 3) smokers. Results: The majority of the study participants were 14 years old (85%), females (54%), who attended eighth grade in a public school setting (56%). Approximately, half reported being of low socioeconomic status (49%) and nonsmokers/exposed to SHS (49%). The lung function parameters of smokers were found to be lower (FEV1 =62.88±10.25; FEV1/FVC =83.50±14.15; and FEF25%-75% =66.35±12.55) than those recorded for the nonsmokers/exposed to SHS (FEV1 =69.41±11.35; FEV1/FVC =88.75±15.75; and FEF25%-75% =78.90±14.65) and significantly reduced when compared to the nonsmokers/nonexposed to SHS (FEV1 =79.14±13.61; FEV1/FVC =94.88±21.88; and FEF25%-75% =87.36±17.02) (P<0.001). Similarly, respiratory complaints were more prevalent among smokers and those exposed to SHS when compared to nonsmokers/nonexposed to SHS. Conclusion: Our findings suggest that initiation of cigarette smoking and, to a lesser extent, exposure to SHS in adolescence leads to increased respiratory symptoms and reduction of pulmonary function test values. Public health initiatives that aim to prevent smoking initiation, assist in cessation, and lessen SHS exposure of adolescents need to be school-based and employed as early as middle school.

Critical review of the equations predicting 6-minute walking distance in obese subjects

Article

Full-text available

Jun 2016

The correlation between the 6-minute walking distance and obesity has been only partially explored. Results obtained from the existing predictive equations are influenced by a variety of factors (health status, severity of obesity, reduced muscle strength and mobility, decreased aerobic capacity, presence of comorbidities). The aim of our study was to verify, compare and discuss the 6MWD predictive capacity of the equations currently available in the literature in a sample of obese subjects. Despite similar study design, the considered articles varied with regard to the number of individuals included and to age range. None of the equations available in the literature was able to accurately predict the six-minute walked distance performed by the obese subjects involved in our study. The six-minute walked distance performed by obese subjects seems to be influenced by other factors than the variables included in the equations from the literature, suggesting that they may not thoroughly capture the complexity of disability in obese people. Future research should be designed in order to validate population-specific equations, by including variables related to clinical, functional, and psychological areas, which are usually impaired in obese individuals.

Tipo de tratamiento farmacológico y deterioro de la función pulmonar en pacientes con diabetes tipo 2: un estudio de corte transversal

Article

Full-text available

May 2016
BIOMEDICA

Introducción. La relación de la diabetes mellitus de tipo 2 con el deterioro de la función pulmonar no es clara, como tampoco si el tipo de tratamiento modifica los parámetros espirométricos e inflamatorios. Objetivo. Comparar la función pulmonar de pacientes con diabetes mellitus de tipo 2 tratados con un agente de sensibilización a la insulina (metformina) y de los tratados con secretagogos, así como de estos combinados con insulinas, y evaluar las diferencias en los biomarcadores de inflamación de los grupos. Materiales y métodos. Se hizo un estudio analítico de corte transversal en 196 pacientes con diabetes mellitus de tipo 2. Se midieron las variables espirométricas y la concentración sanguínea de biomarcadores de inflamación (ferritina, fibrinógeno, proteína C reactiva, interleucina 6 y factor de necrosis tumoral alfa). Se analizaron los valores residuales (valores observados menos valores predichos) para la capacidad vital forzada y el volumen espiratorio forzado en los diferentes tipos de tratamiento. También, se compararon las diferencias en las medianas de las concentraciones de los biomarcadores, según los tipos de tratamiento. Resultados. Después de ajustar según los factores determinantes de la función pulmonar y el control y la duración de la diabetes mellitus de tipo 2, los valores esperados de la capacidad vital forzada de los pacientes tratados con agentes de sensibilización a la insulina fue menor que los de aquellos tratados con secretagogos (-212,1 ml Vs. -270,2 ml; p=0,039), y lo mismo se registró en el volumen espiratorio forzado durante el primer segundo (-133,2 ml Vs. -174,8 ml; p>0,05), aunque dichas diferencias no fueron estadísticamente significativas. En el grupo de pacientes tratados con agentes de sensibilización a la insulina, las concentraciones de ferritina y del factor de necrosis tumoral alfa fueron menores (p

Immediate effect of manual therapy on respiratory functions and inspiratory muscle strength in patients with COPD

Article

Full-text available

Jun 2016

Objective: The objective of this study was to investigate the immediate effect of manual therapy (MT) on respiratory functions and inspiratory muscle strength in patients with COPD. Participants and methods: Thirty patients with severe COPD (eight females and 22 males; mean age 62.4±6.8 years) referred to pulmonary physiotherapy were included in this study. The patients participated in a single session of MT to measure the short-term effects. The lung function was measured using a portable spirometer. An electronic pressure transducer was used to measure respiratory muscle strength. Heart rate, breathing frequency, and oxygen saturation were measured with a pulse oximeter. For fatigue and dyspnea perception, the modified Borg rating of perceived exertion scale was used. All measurements were taken before and immediately after the first MT session. The ease-of-breathing visual analog scale was used for rating patients' symptoms subjectively during the MT session. Results: There was a significant improvement in the forced expiratory volume in the first second, forced vital capacity, and vital capacity values (P<0.05). The maximal inspiratory pressure and maximal expiratory pressure values increased significantly after MT, compared to the pre-MT session (P<0.05). There was a significant decrease in heart rate, respiratory rate (P<0.05), and dyspnea and fatigue perception (P<0.05). Conclusion: A single MT session immediately improved pulmonary function, inspiratory muscle strength, and oxygen saturation and reduced dyspnea, fatigue, and heart and respiratory rates in patients with severe COPD. MT should be added to pulmonary rehabilitation treatment as a new alternative that is fast acting and motivating in patients with COPD.

Development of the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT®) questionnaire: A new patient-reported outcome instrument for PAH

Article

Full-text available

Jun 2016
RESP RES

Background Regulators and clinical experts increasingly recognize the importance of incorporating patient-reported outcomes (PROs) in clinical studies of therapies for pulmonary arterial hypertension (PAH). No PAH-specific instruments have been developed to date in accordance with the 2009 FDA guidance for the development of PROs as endpoints in clinical trials. A qualitative research study was conducted to develop a new instrument assessing PAH symptoms and their impacts following the FDA PRO guidance. MethodsA cross-sectional study was conducted at 5 centers in the US in symptomatic PAH patients aged 18–80 years. Concept elicitation was based on 5 focus group discussions, after which saturation of emergent concepts was reached. A PRO instrument for PAH symptoms and their impacts was drafted. To assess the appropriateness of items, instructions, response options, and recall periods, 2 rounds of one-on-one cognitive interviews were conducted, with instrument revisions following each round. Additional interviews tested the usability of an electronic version (ePRO). PRO development considered input from an international Steering Committee, and translatability and lexibility assessments. ResultsFocus groups comprised 25 patients (5 per group); 20 additional patients participated in cognitive interviews (10 per round); and 10 participated in usability interviews. Participants had a mean ± SD age of 53.1 ± 15.8 years, were predominantly female (93 %), and were diverse in race/ethnicity, WHO functional class (FC I/II: 56 %, III/IV: 44 %), and PAH etiology (idiopathic: 56 %, familial: 2 %, associated: 42 %). The draft PRO instrument (PAH-SYMPACT®) was found to be clear, comprehensive, and relevant to PAH patients in cognitive interviews. Items were organized in a draft conceptual framework with 16 symptom items in 4 domains (respiratory symptoms, tiredness, cardiovascular symptoms, other symptoms) and 25 impact items in 5 domains (physical activities, daily activities, social impact, cognition, emotional impact). The recall period is the past 24 h for symptoms, and the past 7 days for impacts. Conclusions The PAH-SYMPACT® was shown to capture symptoms and their impacts relevant to PAH patients, demonstrating content saturation, concept validity, and ePRO usability. Final content and psychometric validation of the instrument will be based on the results of an ongoing Phase IIIb clinical trial in PAH patients.

Role of HIF1A, VEGFA and VEGFR2 SNPs in the susceptibility and progression of COPD in a Spanish population

Article

Full-text available

May 2016
PLOS ONE

Hypoxia is involved in the development of chronic inflammatory processes. Under hypoxic conditions HIF1A, VEGF and VEGFR2 are expressed and mediate the course of the resultant disease. The aim of the present study was to define the associations between tSNPs in these genes and COPD susceptibility and progression in a Spanish cohort. The T alleles in rs3025020 and rs833070 SNPs (VEGFA gene) were less frequent in the group of COPD cases and were associated with a lower risk of developing the disease (OR = 0.60; 95% CI = 0. 39-0.93; p = 0.023 and OR = 0.60; 95% CI = 0.38-0.96; p = 0.034, respectively) under a dominant model of inheritance. The haplotype in which both SNPs presented the T allele confirmed the association found (OR = 0.02; 95% CI = 0.00 to 0.66; p = 0.03). Moreover, patients with COPD carrying the T allele in homozygosis in rs3025020 SNP showed higher lung function values and this association remained constant during 3 years of follow-up. In conclusion, T allele in rs833070 and rs3025020 may confer a protective effect to COPD susceptibility in a Spanish population and the association of the SNP rs3025020 with lung function may be suggesting a role for VEGF in the progression of the disease.

Cough in Children: Clinical Approach

Article

Full-text available

Dec 2015

Cough is an important reflex defense mechanism and it cleans the airways with the various stimuli. Children are more sensitive than adults to these environmental stimuli. Full mechanism of the cough reflex have not been completely analyzed. Causes of chronic cough in children are different from adults. Even cough is normal for most children, the presence of cough may be indicative of serious disorders and should be considered important because cough affects the child’s quality of life. All children with chronic cough should be evaluated for diagnosis. Cough in children should be treated based on etiology. There is no evidence of the affect of symptomatic treatment for cough in children.

Frequency of circulating topoisomerase-I-specific CD4 T cells predicts presence and progression of interstitial lung disease in scleroderma

Article

Full-text available

May 2016
ARTHRITIS RES THER

Background Scleroderma is an antigen-driven T cell-mediated autoimmune disease. Presence of anti-topoisomerase-I antibodies is associated with pulmonary fibrosis and predicts increased mortality. Characterization of autoreactive T lymphocytes may shed light on disease pathogenesis and serve as a biomarker for disease activity. Here, we aimed to quantify and functionally characterize circulating topoisomerase I (topo-I)-specific CD4+ T cells and to define their association with presence and progression of interstitial lung disease (ILD) in patients with scleroderma. Methods Using flow cytometry, circulating topo-I-reactive CD4+ T cells were identified by the expression of specific activation markers (CD154 and CD69) upon stimulation with purified topo-I and quantified in 27 SSc patients and 4 healthy donors (HD). Polarization of autoreactive T cells (Th1, Th2, Th17, Th1–17) was defined using surface expression of specific chemokine receptors. Presence and progression of ILD were determined using high-resolution chest CT and pulmonary function tests. ResultsTopo-I-reactive CD4+ T cells were found in all topo-I-positive patients compared to one topo-I-negative subject and no HD. Topo-I-specific CD4+ T cells exhibited a distinct Th17 polarized phenotype. Autoreactive T cells were significantly increased in subjects with evidence of ILD and were quantitatively associated with the decline of lung volumes. Conclusions Topo-I-specific T cells can be reliably quantified in the peripheral blood of patients with scleroderma, exhibit a pro-inflammatory Th17 phenotype, and predict progression of ILD.

Physiological Profile and Limitations in Exercise in Idiopathic Pulmonary Fibrosis

Article

Full-text available

Apr 2016

Purpose: This study aimed to describe the physiological profile and limiting factors during exercise among patients with idiopathic pulmonary fibrosis. Methods: A descriptive study involving 34 patients with idiopathic pulmonary fibrosis (22 men) aged 68 ± 8 years was conducted. All patients completed a pulmonary function test, cardiopulmonary exercise test, Doppler echocardiography, 6-minute walk test, and modified Medical Research Council dyspnea evaluation. Results: Approximately 38% of patients (range, 15%-71%) presented with coexisting comorbidities including pulmonary hypertension and emphysema. Modified Medical Research Council grades 0-2 and 3-4 were assigned to 68% and 32% of patients, respectively. Median values for forced vital capacity and diffusion capacity for carbon monoxide percent (%) predicted were 68 (95% CI, 63-76) and 51 (95% CI, 46-55), respectively. Left ventricular systolic function was normal. Aerobic capacity (VO2peak = 13.4 mL/kg/min [95% CI, 12.6-14.9]; 62% predicted [95% CI, 56-67]) was moderately reduced with the presence of abnormalities in pulmonary gas exchange and desaturation, circulatory impairments, inefficient ventilation, and skeletal muscle dysfunction. Functional capacity was normal (6-minute walk test distance = 505 m [95% CI, 435-522]; 99% predicted [95% CI, 91-108]). Conclusions: The physiological profile demonstrated the presence of comorbidities in approximately 38% of patients with idiopathic pulmonary fibrosis and a moderate level of dyspnea. Resting cardiopulmonary function showed moderate pulmonary restriction and severe impairments in diffusion capacity with normal left ventricular systolic function. Multifactorial limitations for a moderately diminished aerobic capacity were revealed during the cardiopulmonary exercise test, although functional capacity was normal. These results emphasize the significance of a meticulous evaluation, including the cardiopulmonary exercise test for an accurate exercise tolerance evaluation, to aid in the diagnosis and prognosis and for developing effective targeted treatments.

A Study of Pulmonary Functions of Spray Painters Working In Automobile Garage

Article

Full-text available

Apr 2016

Isocyanates are used in various industries including paints. Isocyante induced asthma and extrinsic allergic alveolitis (Hypersensitivity pneumonitis) are known occupational hazards. Hypersensitivity pneumonitis is characterized by both restrictive (acute/subacute) and obstructive (chronic) pattern. Isocyanates are potent agents known to provoke immunological responses leading to a Hypersensitivity pneumonitis. This is a cross sectional study to observe the incidence of obstructive as well as restrictive pattern of disease. FVC, FEV 1, FEV 1 /FVC, FEF 25-75, FEF 0.2-1.2 and PEFR were evaluated in 50 male spray painters, aged 20 to 50 years exposed to spray paints for atleast a year. FVC (p = 0.0009) and FEV 1 (p = 0.0006) were found to be significantly reduced in spray painters, but FEV 1 /FVC ratio was statistically insignificant (p = 0.99) showing a restrictive pattern of disease. The changes in ventilatory pattern may be due to diffuse, predominantly mononuclear inflammation of the lung parenchyma, particularly the terminal bronchioles, interstitium and alveoli.

CXC chemokine superfamily induced by Interferon-γ in asthma: a cross-sectional observational study

Article

Full-text available

Dec 2016

Background Asthma is a disease encompassing a variety of contributing factors. Phenotyping of asthma based on the profile of accumulated granulocytes in the airways has been performed to explore the mediators involved in allergic bronchial inflammation. The aim of this study was to clarify the characteristics of the CXC chemokine superfamily induced by IFN-γ, namely CXCR3 ligands, in the airways of patients with asthma stratified by the differential proportion of granulocytes in sputum. Methods Sputum was induced in 39 adult patients with asthma and 12 healthy subjects. Sputum samples were analyzed for total cell counts and differentials, and concentrations of IFN-γ–inducible protein 10 kDa (IP-10, CXCL10), monokine induced by IFN-γ (Mig, CXCL9), IFN-inducible T cell a chemoattractant (I-TAC, CXCL11), and IL-8 in the supernatants were assayed by ELISA. Results Sputum concentrations of IP-10, Mig, and IL-8 were significantly higher in asthma than in healthy subjects. IP-10, Mig, and IL-8 were significantly higher in the mixed granulocyte subtype (eosinophils ≥ 2 % and neutrophils ≥ 40 % in sputum) than in healthy subjects. Additionally, IP-1 0 was significantly higher in the mixed granulocyte subtype than in eosinophil-predominant or neutrophil-predominant subtype (eosinophil percentage ≥ 2 % or neutrophil percentage ≥ 40 %). Mig and IL-8 were significantly higher in the mixed granulocyte subtype than in the paucigranulocyte subtype (eosinophils < 2 % and neutrophils < 40 % in sputum). I-TAC was not different between healthy subjects and asthmatics or granulocyte subtypes. All CXCR3 ligands were significantly associated with the composite of the eosinophil and neutrophil ratio in patients with asthma. Only Mig was significantly correlated with the total eosinophil and neutrophil ratio in patients with asthma on adjusted partial correlation analysis. Mig and IL-8 were significantly negatively correlated with forced expiratory volume in 1 s % predicted (% FEV1) in patients with asthma. Conclusions CXCR3 ligands may serve as potent promoters in eosinophilic and neutrophilic airway inflammation in asthma. Electronic supplementary material The online version of this article (doi:10.1186/s40733-016-0021-y) contains supplementary material, which is available to authorized users.

150 Years of Blowing: Since John Hutchinson

Article

Full-text available

Jan 1997

Three recent advances in assessment of routine lung function are reviewed. In both normal subjects and patients with obstructive lung disease, the flows during the forced vital capacity (FVC) manoeuvre depend significantly on the pattern of the preceding inspiratory manoeuvre. Accordingly, the latter should be standardized in clinical and epidemiological studies. Although the nature of this phenomenon is not fully understood, stress relaxation of lung tissues probably plays the primary role. The negative expiratory pressure technique provides a simple and reliable tool for detecting expiratory flow limitation both at rest and during exercise. The method does not require body plethysmography or the patient’s cooperation and coordination, and can be applied in any desired body posture. A simple method for monitoring FVC performance has been developed. It allows detection of flow limitation during the FVC manoeuvre.

Article

Full-text available

Jan 1997

Byssinosis, a chronic lung disease of cotton mill workers, is characterized by repeated episodes of reversible airway obstruction, which can lead to permanent alterations of lung function. When this occurs in Quebec the worker must be removed from further exposure in accordance with the provincial compensation rules. The current Quebec Occupational Safety and Health Regulation has a permissible exposure limit of 500 μg/m 3 , resulting in a prevalence rate of byssinosis of 2% to 5% in cotton workers. In this study the incidence of new respiratory disorders in persons employed in Quebec cotton mills from 1980 to 1995 was assessed and factors that identified byssinosis cases were analyzed. Incidence of the disease was assessed on the basis of cases referred to the Commission de Santé & Sécurité au travail du Québec (Quebec Workers’ Compensation Board) from all Quebec textile plants. Analyses of age, years of employment, job description, smoking history, bronchial reactivity and lung function before and at work were used for diagnostic purposes. Incidence of new byssinosis cases from 1990 to 1995 was 2.8 cases per year per 5000 workers, slightly above the incidence from 1980 to 1989, at 1.7 cases per year. The incidence of chronic cases was stable at 1.5 cases per year, whereas that of early cases increased from 0.3 cases per year (1980 to 1989) to 1.25 cases per year (1990 to 1995). In comparison with chronic byssinosis cases, the average time of work before symptom appearance was 17±4 versus 32±1 years, P

The comparison of sensitization to animal allergens in children and adult-onset patients with asthma

Article

Full-text available

Jan 2015

Background: With higher exposure to animal during the life, the risk of sensitization to animals may get more. The purpose of this study was the comparison of sensitization to animal allergens in children with asthma from those with adult‑onset asthma. Materials and Methods: This cross‑sectional study included 100 children and 100 adults with asthma as well as 100 healthy individuals with no history of asthma and atopy. Skin tests were performed in patients and controls to allergens using a panel of 15 animal allergens. Results: The rate of sensitization to animal allergens was 33% in children with asthma and 39% in patients with adult‑onset asthmatics compared to 10% in the control group. Children with asthma were most commonly sensitized to dog (10%), hamster (8%), and cat (7%). Among patients with adult‑onset asthma, the most common sensitizations were to dog (19%), canary (14%), and cat and goat (each 7%). The frequency of sensitization to animal allergens was not significantly different between children and adult‑onset patients with asthma. Conclusions: We observed that sensitization to dog and canary was higher in adult‑onset than children with asthma. Efforts to improve conditions at the public buildings to reduce the load of airborne allergens are also potentially helpful.

Comparative Study between the Effect of Short Term and Long Term Exposure to Cotton Dust on Pulmonary Function Tests in Cotton Mill Workers

Article

Nov 2019

Kadam Charulata

Background Byssinosis is the most common disease affecting the cotton textile workers; symptom complexes like mill fever, weaver's cough, mattress-maker‘s cough, also occur in textile workers. 1Cotton workers are at risk for occupational lung disease, including byssinosis and chronic bronchitis3. The present study was done to compare the effect of short term exposure and long term exposure to cotton dust in cotton mill workers and suggest precautions them to prevent this. Objective To compare the effect of short term and long term exposure to cotton dust on pulmonary function tests in cotton mill workers. Method In this study, one group of fifty workers exposed for short term duration and other sixty four, for long term duration exposure were examined for PFTs of age 25–50 years. PFTs were carried out using spirometer. Results or observations The present study found that there is statistically significant difference in PFTs between the short term exposed group and long term exposure group of 25–50 years age. Discussion & conclusion The results of the present study helped us to understand and compare the shortterm and long term exposure group better and suggest workers to take precautions to avoid more subtle effects that can occur.

Comparative Study between the Effect of Short Term and Long Term Exposure to Cotton Dust on Pulmonary Function Tests in Cotton Mill Workers

Article

Jan 2019

Asbestos Concentrations and Lung Restrictive Patterns

Article

Full-text available

Mar 2011

Asbestos applications were limited during past two decades in developed nations due to its debilitating health problems, while in developing countries it's various usages continues. The main goals of present study were evaluation of asbestos concentrations in ambient outdoor and indoor air and occupational exposure, as well as exposure effects on pulmonary function. Sampling procedure was carried out during May and June 2010 at four outdoor and seven indoor air sampling stations. Ten persons were selected based on their exposure limits including high, moderate and low exposure. Also to assess pulmonary function of workers, 42 spirometry cases were tested. Samples were analyzed by SEM with EDXA. Obtained results revealed that average concentrations of asbestos fibers were 1.885×10-5 f/mL and 0.065 f/mL in outdoor and indoor air, respectively. Occupational exposure contents were between 1.5 ×10-5 – 0.2 f/mL (based on exposure limits). Spirometry tests showed that 28% of workers had impaired lung functions. Lung restrictive pattern in workers were 2% severe, 12% moderate and 14%. Results showed pattern of fibrous particles as actinolite> termolite> chrysotile in indoor air. Generally, it is clear that there is positive meaningful relationship between more than ten occupational ages and malfunction of lungs in studied workers due to asbestos effects.

Sarcopenia correlates with systemic inflammation in COPD

Article

Full-text available

Feb 2017

Background Muscle wasting and chronic inflammation are predominant features of patients with COPD. Systemic inflammation is associated with an accelerated decline in lung function. In this study, the prevalence of sarcopenia and the relationships between sarcopenia and systemic inflammations in patients with stable COPD were investigated. Materials and methods In a cross-sectional design, muscle strength and muscle mass were measured by handgrip strength (HGS) and bioelectrical impedance analysis in 80 patients with stable COPD. Patients (≥40 years old) diagnosed with COPD were recruited from outpatient clinics, and then COPD stages were classified. Sarcopenia was defined as the presence of both low muscle strength (by HGS) and low muscle mass (skeletal muscle mass index [SMMI]). Levels of circulating inflammatory biomarkers (IL-6 and high-sensitivity TNFα [hsTNFα]) were measured. Results Sarcopenia was prevalent in 20 (25%) patients. Patients with sarcopenia were older, had lower body mass index, and a higher percentage of cardiovascular diseases. In addition, they had significantly higher modified Medical Research Council scores and lower 6-minute walk distance than those without sarcopenia. HGS was significantly correlated with age, modified Medical Research Council score, and COPD Assessment Test scores. Both HGS and SMMI had associations with IL-6 and hsTNFα (HGS, r=−0.35, P=0.002; SMMI, r=−0.246, P=0.044) level. In multivariate analysis, old age, lower body mass index, presence of cardiovascular comorbidities, and higher hsTNFα levels were significant determinants for sarcopenia in patients with stable COPD. Conclusion Sarcopenia is very common in patients with stable COPD, and is associated with more severe dyspnea-scale scores and lower exercise tolerance. Systemic inflammation could be an important contributor to sarcopenia in the stable COPD population.

Prevalence, risk factors, and clinical outcomes of atopic and nonatopic asthma among rural children

Article

Jan 2017

Background: Because of time and cost constraints, objective classification of atopic and nonatopic asthma has been limited in large epidemiologic studies. However, as we try to better understand exposure-outcome associations and ensure appropriate treatment of asthma, it is important to focus on phenotype-defined asthma classification. Objective: To compare atopic and nonatopic asthma in rural children with regard to risk factors and clinical outcomes. Methods: We conducted a cross-sectional study in rural Saskatchewan, Canada, in 2011. Parents of 6- to 14-year-old children completed a health and exposure survey. Skin prick tests were completed in a subsample of 529 children. Asthma was based physician diagnosis. Asthma status was defined as no asthma, nonatopic asthma, and atopic asthma. Results: Asthma prevalence was 14.7% of which 32.1% of cases were atopic. After adjustment, early respiratory illness and a family history of asthma were predictors of childhood asthma, regardless of atopic status (P < .05). Being overweight and having a dog in the home were associated with an increased risk of nonatopic asthma (P < .05). A mother with a history of smoking increased the risk of atopic asthma (P = .01). Compared with those with nonatopic asthma, in the past 12 months, children with atopic asthma were more likely to report a sneezy, runny, or blocked nose or have shortness of breath (odds ratio >2), whereas those with nonatopic asthma were more likely to have parents who missed work (odd ratio >3). Those with nonatopic asthma had significantly lower forced expiratory volume in 1 second compared w2ith those with atopic asthma. Conclusion: Exposures may contribute differentially to atopic and nonatopic asthma and result in differential clinical presentation or burden. The study of these characteristics is important for etiologic understanding and management decisions.

Pulmonary Function in Young Bengalee Females of Sedentary Occupations: Influence of Select Anthropometric Variables on It

Chapter

Full-text available

Jan 2015

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 .

Different Spirometry Pattern in Patient Attending Respiratory Medicine OPD for Diagnostic Evaluation

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Oct 2016

The relationship between the severity of asthma and comorbidites with anxiety and depressive disorders

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Sep 2006

OBJECTIVE: There is evidence that asthma is associated with increased frequency of psychiatric symptoms and mental disorders. Our aim was to assess the frequency of anxiety and depressive disorders in a sample of asthmatic outpatients and observe if there is any relationship between this comorbidity and the severity of asthma. METHOD: Sixty-two consecutive patients of two outpatient asthma clinics located in university hospitals were evaluated. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview 4.4 Version. RESULTS: Twenty-seven patients (43.5%) met criteria for at least one psychiatric diagnosis. The most frequent diagnoses were major depression (24%), generalized anxiety disorder (20.9%) and panic disorder/agoraphobia spectrum disorders (17.7%). We found no significant differences in the prevalence of anxiety disorders and depression between the groups with mild/moderate and severe asthma. Despite the high frequency of depression and anxiety disorders, only 4 (6.5%) patients were under psychiatric treatment and 13 (20.9%) patients were taking benzodiazepines. Twelve of 15 (80%) patients who reported present use of psychotropic medication were not under psychiatric treatment at the moment of the study. CONCLUSIONS: Our results support the high morbidity of anxiety and depressive disorders in asthmatic patients, independent of the severity of asthma.OBJETIVO: Existem evidências de que a asma está associada a um aumento da presença de sintomas psiquiátricos e de transtornos mentais. O objetivo do presente estudo é o de averiguar a freqüência de transtornos de ansiedade e depressão em uma amostra de pacientes asmáticos ambulatoriais e observar se há relação deste tipo de comorbidade com a gravidade da asma. MÉTODO: Sessenta e dois pacientes consecutivos de dois ambulatórios universitários especializados em asma foram examinados. Os diagnósticos psiquiátricos foram obtidos em entrevista com a utilização do Mini-International Neuropsychiatric Interview 4.4 Version. RESULTADOS: Vinte e sete (43,5%) pacientes preencheram os critérios para ao menos um diagnóstico psiquiátrico. Os diagnósticos mais freqüentes foram depressão maior (24,0%), transtorno de ansiedade generalizada (20,9%) e transtornos do espectro pânico/agorafobia (17,7%). Não encontramos diferenças significativas na prevalência de transtornos de ansiedade e depressão entre os grupos com asma leve/moderada e com asma grave. Apesar da alta freqüência de depressão e transtornos de ansiedade, apenas 4 (6,5%) pacientes estavam em tratamento psiquiátrico e 13 (20,9%) estavam usando benzodiazepínicos. Doze dos 15 (80,0%) pacientes em uso de medicação psicotrópica não estavam em tratamento psiquiátrico no momento do estudo. CONCLUSÃO: Nossos resultados demonstram a elevada comorbidade de transtornos de ansiedade e depressão em pacientes asmáticos, independente da gravidade da asma.

Canadian Asthma Consensus Conference Summary of Recommendations

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Jan 1996

The Asthma Committee of the Canadian Thoracic Society invited a group of Canadian physicians with a particular interest in asthma to meet in Montebello, Quebec, March 9-12, 1995 to arrive at a consensus statement on the optimal approach to the management of asthma in the pediatric and adult ambulatory care settings. The societies and associations represented are listed in the appendix with the names of the contributors to this document. The objectives of the Montebello conference were: 1. To review the current ambulatory care management of asthma in Canada; 2. To develop guidelines with the participation of family physicians and specialists; 3. To develop guidelines which are evidence-based; 4. In creating evidence-based guidelines to focus attention on aspects of asthma management that are currently not supported by randomized controlled trials; 5. To develop strategies that allow for the implementation of rational guidelines at a local level. Recommendations were based on a critical review of the scientific literature by small groups prior to the meeting and are categorized according to the strength of the scientific evidence supporting each recommendation (Table 1).

Lung Function Testing: Selectionof reference Values and Interpretative Strategies: Reply

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