Alterations in Antioxidant Vitamins in Bronchial Asthma and Its Correlation with Spirometry

Bronchial asthma may result in oxidant/antioxidant imbalance. Antioxidant vitamins E and C concentrations were estimated in plasma of asthmatics that were also simultaneously subjected to spirometry and matched with healthy controls showing significant changes in both the vitamin concentrations. Vitamin C showed strong correlation whereas vitamin E was not correlated with spirometry.

Evaluation of Spirometry for Medical Clearance in Occupations Requiring Respirator Usage

Medical certification of workers for respirator use is an important activity of occupational medicine health professionals. Spirometry is a diagnostic tool to evaluate respiratory distress/insufficiency that may affect respirator use. The pulmonary function data of 337 subjects from different occupations that required medical evaluation to wear a respirator were analyzed to determine the effect of using various spirometric equations on respirator fitness outcomes. Of 337 subjects who were cleared for respiratory use by medical questionnaires for respirator compliance, 14 (4.15%) failed to pass respirator compliance by NFPA criteria and 5 (1.48%) failed to pass respirator compliance measures by ATS criteria. We compared the use of different spirometric equations to evaluate these measures, and it was determined that the Crapo equation cleared more workers for respirator use as compared to the Knudson and NHANES III equations. As some workers were able to qualify for respirator use based on questionnaire alone but failed respirator clearance after pulmonary function testing, it is recommended that spirometry is used to evaluate clearance for all workers who will use a respirator in the workplace. As well, using different spirometric equations can affect the outcome on passing or failing clearance for respirator use, and this should be considered in a respiratory medical certification program.

Pitfalls in spirometry: Clinical relevance

Spirometry is one of the functional tests most used in respiratory medicine to assess lung function in health and disease conditions.Its success is grounded on solid principles of lung mechanics that state that maximal flow on expiration is limited by the physical properties of airways and lung parenchyma.In contrast,on inspiration,flow depends on the force generated by the inspiratory muscles.Reduced expiratory forced flow and volumes usually reflect a deviation from health conditions.Yet due to a complex interplay of different obstructive and restrictive lung diseases within the multiple structural dimensions of the respiratory system,flows and volumes do not always perfectly reflect the impact of the disease on lung function.The present review is intended to shed light on a series of artefacts and biological phenomena that may confound the clinical interpretation of the main spirometric measurements.Among them is thoracic gas compression volume,the volume and time history of the inspiratory manoeuvre that precedes the forced expiration,the effects of heterogeneous distribution of the disease across the respiratory system,and the changes in lung elastic recoil.

Pulmonary Function by Spirometry in Children with Perinatal HIV Infection

Background: In an age of antiretroviral therapy, the life expectancy of children perinatally infected with Human Immunodeficiency Virus (HIV) has significantly increased. At the same time, however, pulmonary pathologies secondary to opportunistic infections have decreased thanks to increased diagnostics and access to antiretroviral therapy (ART). Despite this, in these children an immune dysregulation is maintained due to chronic infection. There is evidence that these patients have increased probability of presenting with abnormalities in pulmonary function, mainly with chronic obstructive clinical pictures (25% - 40% of perinatally infected adolescents display some anomaly in the spirometry), which predisposes them to increased risk of chronic pulmonary disease. Since lung development occurs mainly during infancy, patients perinatally infected with HIV may suffer consequences. This can be secondary to opportunistic infections, chronic inflammation due to the virus, and immunologic effects of ART, mainly in non-industrialized countries, where late diagnosis is frequent. Methodology: An analytical, observational, cross-sectional study was conducted at Roosevelt Hospital Pediatric infectious disease clinic, from January to December 2019. A sample of 76 patients was obtained, out of a population of 362 patients. A total of 62 subjects, who met the criterion of reproducibility in the spirometry, were analyzed. Results were analyzed with percentages and the association of variables using the chi-squared test (χ2). Results: A decrease in pulmonary function was found in 34% of patients, mild obstructive pattern (16%) predominating. Significant association between basal viral load greater than 100,000 cp/ml and a decrease in Forced expiratory flow 25 - 75 (FEF 25-75) (p 0.046) and in relationship between forced expiratory volume and forced vital capacity (FEV1/ FVC p = 0.024) was observed, as well as a non-statistically significant relationship between advanced clinical stage at diagnosis and decreased pulmonary function. Conclusions: The prevalence of decreased pulmonary function related to advanced clinical stage and elevated basal viral load (>100,000 cps/ml) is higher than that reported in other studies (25%) and has an influence in the long-term decrease in pulmonary function.

Preoperative and Postoperative Spirometry in Patients Undergoing Lobectomy for Sequelae of Pulmonary Tuberculosis

Objective: To assess preoperative and postoperative spirometry values in patients undergoing lobectomy for sequelae of pulmonary tuberculosis. Method: A total of 20 patients (10 males) with history of treatment for tuberculosis and presenting with symptomatic sequelae (repeat infection or hemoptysis) who sought assistance at the chest surgery outpatient clinic between 11.09.07 and 04.02.10, were selected for the study. Only patients that met theeligibility criteria (symptomatic, submitted to tuberculosis treatment) were included in the study. The age of patients ranged from 15 to 56 years (mean: 35.75 years). The average treatment time for tuberculosis was 6 months and onset of symptoms occurred between 01 and 32 years after treatment. To assess the impact of surgery on the variables VC, FVC, FEV1, FEV1/FVC, FEF and PEF preoperative values were compared with postoperative values at 1st, 3rd, 6th and 12th month using the paired t test. The level of significance (α) applied for all tests was 5% where a value of p 0.05 was considered significant. Results: 11 patients were treated because of recurrent infections and 9 because of haemoptysis. The most common lobectomy was right upper lobectomy (7 patients), followed by left upper lobectomy (6 patients), left lower lobectomy (6 patients), and right middle lobectomy (1 patient). There were no postoperative complications. There was no postoperative mortality. Conclusion: Based on the results of the present study, it can be concluded that, at the 12th postoperative month, spirometric parameters of patients with tuberculosis sequelae submitted to lobectomy had returned to preoperative levels.

Overview of Spirometry and the Use of Its Parameters for Asthma Monitoring in Children

Asthma is the most common chronic pulmonary disease in the world,affecting more than three hundred million people from different races and age groups.Childhood asthma is considered one of the main causes of increased healthcare expenditures,particularly in developing countries.Spirometry is the most essential and commonly used lung function test.It is used mainly for the evaluation of lung function to obtain reliable data used for the detection of lung diseases,such as asthma,as well as for monitoring lung health.The two spirometry parameters,peak expiratory flow rate(PEFR)and forced expiratory volume in one second(FEV1),are effective in the diagnosis and management of patients with asthma.However,FEV1 is preferred as it is a more accurate parameter compared to PEFR for the evaluation and recognition of bronchoconstriction.In children with asthma,the most commonly used lung function parameter for asthma monitoring is FEV1.It was discovered that a decrease in FEV1 is associated with an increase in asthma severity.

The Beneficial Effect of 3-Month-Induction Therapy with Corticosteroids and Mycophenolate Mofetil Followed by Maintenance Therapy with Yearly Rituximab Infusions as Sole Maintenance Therapy in Cryptogenic Chronic Hypersensitivity Pneumonitis

Background: The available data on cryptogenic chronic hypersensitivity pneumonitis (ccHP) indicate an inherited predisposition to disease with triggering autoimmune phenomena. Hence, we evaluated prospectively the role of a new autoimmune regimen in treatment of its severe and progressive disease. Patients and Methods: A total of 9 patients were included in the study. They had criteria for ccHP viz. 1) clinical features of cryptogenic progressive restrictive lung disease, 2) high-resolution computed tomographic pulmonary abnormalities, and 3) bronchoalveolar lavage lymphocytosis (>30%). The regimen consisted of an initial induction phase of 3-month Solumedrol 1 g IV daily for 3 days followed by 1 month of Prednisone (P) 60 mg/day to tapered down to discontinuation by 3rd month. They also had received Mycophenolate mofetil (MMF) 1 g twice daily for 3 months. This stage was followed by a maintenance phase of yearly Rituximab infusions (1 g followed by 1 g 2 weeks later). Results: compared to their previous 6 months deterioration;all patients showed significant improvement in their forced vital volume, diffusion capacity for carbon monoxide, 6-minutes-walk after the induction phase (at 3 months) which improved further at 15 months with Rituximab therapy. Conclusion: After 3-month induction therapy with P and MMF;yearly R treatment is a safe, practical and effective long-term therapy for ccHP.

Ventilatory Disorders in Elite Athletes: Comparative Study between High-Level Athletes and Sedentary Subjects in a Sub-Saharan African Country

Background/Objective: Very intense and repeated exercise, particularly when performed over many years, could cause respiratory health problems. The combination of a sustained high ventilation and provocative training environments may impact the susceptibility of athletes to ventilatory disorders. Previous studies suggest that impaired ventilatory function in elite athletes can be detected in the absence of respiratory symptoms even after cessation of sports activity. The purpose of this study was to evaluate the ventilatory function of elite athletes compared to sedentary subjects. Material and Methods: This study included sedentary subjects and elite athletes, all male, aged 16 to 23 years. The athletes played regularly in the Senegalese league 1 championships (football and basketball) for at least two seasons with more than 10 hours of training per week during two years. For all participants, an interrogation was submitted and we conducted a clinic examination was performed following by a basic and post-bronchodilator spirometry. Results: The mean age of athletes (n = 66) and sedentary subjects (n = 61) was respectively 19.16 ± 2 years and 19.54 ± 2.12 years. The elite athletes presented significantly higher spirometry values (p Conclusion: This study found a high prevalence (72.73%) of ventilatory disorders (VD) in Senegalese elite athletes. Many previously undiagnosed elite athletes had significant ventilatory problems. To prevent the respiratory risk, athletes should be encouraged to avoid certain environmental factors and to adapt the period of their training.

Carbon Monoxide and Respiratory Disorders in Professional Female Fish Smokers at 2 Artisanal Sites in Benin

Introduction: The use of biomass for cooking is a very common practice in Africa and Benin, and is associated with exposure to organic pollutants. The aim of this study was to assess carbon monoxide exposure and respiratory disorders in women at artisanal fish-smoking sites. Methods: This was a cross-sectional study of women fish smokers at two artisanal fish-smoking sites in Benin. Recruitment was exhaustive. An interview using a respiratory questionnaire inspired by the Union questionnaire, spirometry and carbon monoxide (CO) measurement were carried out. Descriptive analysis and comparison of means using Student’s t-test with a threshold of p = 0.05 were performed. Results: The median age of the 81 people surveyed was 40, with an interquartile range (IQT) of [25 to 75]. The median duration of daily exposure to smoke was 6 h IQT [4, 7]. Of those surveyed, 64 (79.01%) were illiterate and 39 (48.24%) had been working for 20 years. CO levels at the start of activity varied from 89 to 145 ppm in one case and from 40 to 89 ppm in the other. Respiratory symptoms were present in 19 (23.46%);18 (22.22%) had mild airway impairment on spirometry. There was a statistically significant decrease between the mean values of peak expiratory flow (PEF), mean expiratory volume in seconds (FEV1) and forced vital capacity (FVC) before and after exposure to smoke. Conclusion: CO levels are high on fish smoking sites and respiratory problems are common. Improved working conditions are important for these women.

Heart failure and chronic obstructive pulmonary disease: Two for tea or tea for two?

A combination of chronic obstructive pulmonary disease (COPD) and heart failure (HF) is common yet it is inadequately and rarely recognized. Because of the similar clinical manifestations, comorbidity is frequently not considered and appropriate diagnostic tests are not performed. It is very important that a combination of COPD and HF is recognized as these patients have a worse prognosis than patients with an individual disease. When present, COPD should not prevent the use of life-saving therapy in patients with HF, particularly β-blockers. Despite clear evidence of the safety and tolerability of cardioselective β-blockers in COPD patients, these drugs remain grossly underprescribed and underdosed. Routine spirometry and echocardiography in HF and COPD patients, respectively, is therefore warranted to improve current clinical practice.

Phenotyping emphysema and airways disease: Clinical value of quantitative radiological techniques

The pathophysiology of chronic obstructive pulmonary disease(COPD) and Alpha one antitrypsin deficiency is increasingly recognised as complex such that lung function alone is insufficient for early detection, clinical categorisation and dictating management. Quantitative imaging techniques can detect disease earlier and more accurately, and provide an objective tool to help phenotype patients into predominant airways disease or emphysema. Computed tomography provides detailed information relating to structural and anatomical changes seen in COPD, and magnetic resonance imaging/nuclear imaging gives functional and regional information with regards to ventilation and perfusion. It is likely imaging will become part of routine clinical practice, and an understanding of the implications of the data is essential. This review discusses technical and clinical aspects of quantitative imaging in obstructive airways disease.

Is obesity related to the lung function of non-asthmatic children?

Overweight and obesity are highly prevalent in developed and developing countries among children and adolescents. During the last two decades, it became evident that excess weight is adversely related to respiratory health in childhood and adolescence mainly in terms of asthma occurrence. Additionally, there is a mounting body of evidence that overweight/obesity may also affect lung function in non-asthmatic subjects. The aim of this review was to present and discuss the studies that investigated this issue in non-asthmatic children and adolescents. Only a few studies have evaluated the impact of excess weight on static volumes and their results point towards an inverse relationship between overweight/obesity and functional residual capacity. More studies have been conducted on the impact of excess weight on dynamic lung volumes with inconsistent, however, results. Nevertheless, a relatively consistent finding was that the ratio of forced expiratory volume in 1 s/forced vital capacity was significantly lower among overweight/obese children compared to their counterparts with normal weight. The underlying mechanisms of these observations have not been adequately elucidated but it is believed to result from complex interaction of mechanical, developmental, and metabolic causes. There is a need for more welldesigned studies in order to clarify the impact of excess weight on lung function in non-asthmatic subjects, as well as to explore the contribution of factors such as duration and degree of obesity, and fat distribution. Despite the absence of conclusive data, there are stillconvincing evidence to be communicated to the children and their families as part of the arguments to encourage them to adopt a healthier lifestyle.

Altered Pulmonary Function among the Transport Workers in Dhaka City

Motor vehicular exhaust is threatening to human health in Dhaka city. To find out the extent of respiratory problem among a particular cadre of transport workers, the human hauler helpers (HHH) of Dhaka city, we conducted a cross sectional study from March 2006 to June 2006. We enrolled 108 HHH from Mirpur to Mohakhali and Gabtoli to Mohakhali routes and collected data using a pre tested questionnaire including interview and physical examination. The pulmonary functions of the participants were measured with electronic spirometer. Among the participants with current respiratory problems 69% complained of gradual increase in respiratory problems and 38% gave history of feeling better on weekly holidays. Occurrence of hoarseness of voice (90%) and wheeze (71%) was extremely high among the helpers followed by cough (50%) and nasal irritation (50%). Spirometry showed 41.7% had obstructive and 4.6% had combined features of pulmonary impairment. Logistic regression analysis showed that respondents who worked 24 months or more were 6.9 times more likely to develop respiratory problem than the less exposed group (OR 6.9;95% CI 3.42, 8.41). This study provides new information on respiratory health of a specific group of transport workers in Dhaka city which warrants further evaluation with a representing sample covering other areas of Dhaka city among all transport workers.

Evaluation of Nasal Functions While Wearing N95 Respirator and Surgical Facemask

There is a lack of reported studies on how the long duration wearing of N95 respirators or surgical facemasks will affect the upper airway functions. Considering the frequency of mask wearing especially in hospitals and during an outbreak of influenza, it is essential to have such data documented. Therefore, the current study is to establish the effect of long duration wearing of N95 and surgical facemasks on upper airway functions. 47 staffs of National University Hospital Singapore in 2013 were recruited. Each of the volunteers wore both N95 respirator and surgical facemask for 3 hours on two different days. During the period of mask wearing, relative airflow rates were recorded. Smell function test was carried out before and after mask wearing. The results show that no significant change of smell test score was found after removal of both the two types of masks. With N95 respirator, more air was breathed into the upper airways compared to surgical facemask.

Effects of left ventricular assist device on pulmonary functions and pulmonary hemodynamics:A meta-analysis

BACKGROUND Given current evidence,the effect of left ventricular assist device(LVAD)implantation on pulmonary function tests remains controversial.AIM To better understand the factors contributing to the changes seen on pulmonary function testing and the correlation with pulmonary hemodynamics after LVAD implantation.METHODS Electronic databases were queried to identify relevant articles.The summary effect size was estimated as a difference of overall means and standard deviation on a random-effects model.RESULTS A total of four studies comprising 219 patients were included.The overall mean forced expiratory volume in one second(FEV1),forced vital capacity(FVC)and diffusion lung capacity of carbon monoxide(DLCO)after LVAD implantation were significantly lower by 0.23 L(95%CI:0.11-0.34,P=00002),0.18 L(95%CI:0.03-0.34,P=0.02),and 3.16 mmol/min(95%CI:2.17-4.14,P<0.00001),respectively.The net post-LVAD mean value of the cardiac index was significantly higher by 0.49 L/min/m2(95%CI:0.31-0.66,P<0.00001)compared to pre-LVAD value.The pulmonary capillary wedge pressure and pulmonary vascular resistance were significantly reduced after LVAD implantation by 8.56 mmHg(95%CI:3.78-13.35,P=0.0004),and 0.83 Woods U(95%CI:0.11-1.55,P=0.02),respectively.There was no significant difference observed in the right atrial pressure after LVAD implantation(0.61 mmHg,95%CI:-2.00 to 3.32,P=0.65).Overall findings appear to be driven by studies using HeartMateII devices.CONCLUSION LVAD implantation might be associated with a significant reduction of the spirometric measures,including FEV1,FVC,and DLCO,and an overall improvement of pulmonary hemodynamics.

Effect of Impaired Lung Function on the Development and Progression of Endobronchial Premalignant Lesions

Background: Chronic obstructive pulmonary disease (COPD) and presence of endobronchial premalignant lesions (EPL) are individual risk factors for lung cancer (LC). However, effect of impaired lung function (ILF) on the natural history of EPL has not been explored. Patients and Methods: This study included 217 high-risk participants from a hospital-based LC surveillance cohort who underwent pulmonary function testing followed by bronchoscopy with endobronchial biopsies. Baseline histopathology diagnoses included 91 cases (41.9%) with squamous metaplasia (SM), 25 (11.5%) with squamous dysplasia (SD), 1 (0.5%) with in-situ carcinoma and 5 (2.3%) with invasive LC. Follow-up biopsies were obtained for 69 patients, and 16 (23.2%) patients demonstrated progression to a higher grade lesion. Regression models were used to evaluate the relationship between ILF and EPL. All the models were adjusted for age, gender and tobacco smoking. Results: Patients with FEV1% of <50% had 4.5 times greater risk of being diagnosed with an EPL [95% confidence interval: 1.93-10.80] and 8-fold greater risk of SD, compared to patients with FEV1% ≥80. COPD was associated with 2.7 and 4.8 times greater risk of SM and SD, respectively. The mean time to progression to a higher-grade lesion was shorter in COPD patients compared to patients without COPD (27 versus 50 months, p = 0.02). Conclusion: Our results indicate that ILF may be a predictor of prevalence and progression of EPLs among patients at high risk of LC. Therefore, spirometry can be a complementary pre-screening tool for identifying patients with EPL who need more intense LC surveillance.

Barriers to Placement of Spirometers in Clinics Affiliated with an Academic Medical Center

United States physician office visits for asthma have increased since 1989, and most of these visits are to primary care physicians. The National Institutes of Health has published guidelines for asthma diagnosis and management, implementation of which is expected to result in improved care and reduced costs. Compliance with asthma guidelines has been suboptimal, especially with spirometry recommendations, and more so in primary care clinics than in specialist clinics. Noncompliance has largely been attributed to physician and patient factors. This paper describes an experience with navigation of health system barriers to implementation of spirometry encountered at three primary care clinics affiliated with an internal medicine residency program. Included are perspectives and priorities of key individuals, systems issues related to institutions, and technical issues pertaining to spirometers. Navigation of ACGME core competencies is discussed.

Spirometric Reference Equations for Semi-Urban and Urban Bantu Cameroonians

Background: Spirometric reference values vary substantially across ethnic groups, and remain largely poorly characterized among Africans. We derived spirometric reference equations for adult Cameroonians and compared their performance with those derived from other ethnic groups. Methods: Spirometric variables according to the American Thoracic Society/European Respiratory Society 2005 guidelines were acquired in voluntary healthy non-smoker subjects in Yaounde (Capital City) and Foumbot (semi-urban area in West Region), in Cameroon during November 2011 to January 2012 (Yaounde) and August 2012 (Foumbot). Reference equations were derived separately for men and women from multiple linear regressions. Results: A total of 411 subjects (206 men) met the inclusion criteria. The mean age was 39.5 ± 16.1 years (min - max: 18 - 85 years) for men and 39.2 ± 14.1 years (18 - 90 years) for women. Age and height were the only variables significantly associated with spirometric values in the final linear regression models. Derived reference values were lower than those derived from Global Lung Initiative 2012 equations for different ethnic groups, except for the forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC ratio). The mean FEV1/FVC ratio was 0.88 ± 0.07 for Cameroonian men and 0.89 ± 0.07 for Cameroonian women. Variations in the performance of derived models in bootstrap internal validation were marginal. Conclusion: This study highlights the importance of deriving specific predictive equations for each ethnic group. The use of adjustment factors applied to Caucasian equations when compared with the values derived in our study leads to an overestimation of the values for FEV1 and FVC.

Results of the Evaluation of the Respiratory Condition of Permanent Workers in an Oil Mill in Benin

Introduction: The process of extracting oil from cotton seeds can create dusty work atmospheres that can cause respiratory problems. The main objective of this study was to determine the prevalence of respiratory problems among permanent workers in an oil mill in Benin. Methods: This cross-sectional study of 52 workers in an oil mill took place in January 2017 as part of the annual medical check-ups of workers. A questionnaire was administered and spirometry using Spirobank II and chest radiography were performed. The spirometry results were interpreted by an occupational physician and a pulmonologist. Data were entered and analyzed using Epidata software. Results: The mean age was 42.7 ± 6.4 years, and 43 of the 52 workers were men. Of these, 58% were in technical production positions and 42% in administrative positions. Most of them had more than 10 years of seniority. The prevalence of respiratory symptoms among production workers was 4 (13%) versus 2 (9%) among administrative workers. A total of 8 (15.4%) abnormal spirometry was identified with 4 obstructive syndrome, 3 restrictive syndrome, 1 a mixed pattern. There were 5 (16.6%) workers in production versus 3 (13.6%) in administration who had abnormal spirometry. The means 25/75 forced expiratory flow (FEF) value of production workers was significantly lower than that of administration workers. Abnormal chest radiographs were 5 (17%) in production workers compared to 3 (14%) in administration workers. Conclusion: Oil mill workers had few respiratory symptoms. However, production workers had more ventilatory disorders than administrative workers. A spirometric follow-up of this group of workers is therefore necessary.

Evaluation of Pulmonary Function in Adults with Grade Ⅲ Obesity

Pulmonary function studies in obese individuals have alerted the pathophysiological changes due to weight gain. However, these changes are not fully explained yet. Objective: To evaluate and analyze the pulmonary function of obese adults in the city of Manaus (AM, Brazil) and to correlate the parameters of spirometry with weight and BMI. Method: A descriptive cross-sectional study, in which pulmonary function of 22 adults with grade III obesity was evaluated pre and post bronchodilator administration, performed at the Adriano Jorge Hospital Foundation—FHAJ. Results: Of the 22 patients evaluated, 6 were male and 16 were female;mean age was 37.1 ± 7.4 years, with a weight of 134.2 ± 28.6 kg and a BMI of 51.1 ± 9.4 kg/m2, corresponding to grade III obesity. Spirometry showed a reduction in values obtained from Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1) and Peak Expiratory Flow (PEF) in relation to those predicted, with 23% of restrictive disorders. There were negative correlations between BMI and PEF, weight and FVC, weight and PEF. The P value for correlation of weight and FEV1 is not statistically significant. Conclusion: Restrictive and obstructive disorders are prevalent in the population with grade III obesity. Correlations between pulmonary function and BMI/weight were negative for this specific population.