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Background/Objectives: This systematic review evaluated the impact of nusinersen therapy on respiratory health and function in individuals with spinal muscular atrophy (SMA) and determined whether nusinersen improves pulmonary function, focusing on differences based on patient age and the timing of treatment initiation. Methods: A systematic search of PubMed, Ovid Medline, ScienceDirect, and Web of Science databases was conducted up to January 2024 in accordance with the PRISMA guidelines. Thirteen studies were included, comprising clinical trials, observational studies, and case series that focused on respiratory outcomes in SMA patients treated with nusinersen. The data on study design, participant characteristics, nusinersen intervention, respiratory outcomes, and adverse events were extracted. The Joanna Briggs Institute Critical Appraisal Tool was used to assess study quality. A narrative synthesis was conducted to address the heterogeneity of the studies. Results: This review found a general trend of improvement in pulmonary function, specifically in forced vital capacity (FVC), although the extent and duration of improvement varied across the studies. Peak cough flow (PCF) and peak expiratory flow (PEF) showed positive trends in some studies, although the results were not consistently significant. Respiratory function improvements were frequently observed, particularly in younger patients and those treated earlier. Conclusions: Nusinersen appears to enhance respiratory function and improve motor outcomes in SMA patients, especially with early treatment. However, further research is needed to fully understand its mechanisms and long-term effects on respiratory health in SMA. [ABSTRACT FROM AUTHOR]

Background and Objective Methods Results Conclusion Chronic obstructive pulmonary disease (COPD) exhibits diverse patterns of disease progression, due to underlying disease activity. We hypothesized that changes in static hyperinflation or KCO % predicted would reveal subgroups with disease progression unidentified by preestablished markers (FEV1, SGRQ, exacerbation history) and associated with unique baseline biomarker profiles. We explored 18‐month measures of disease progression associated with 18–54‐month mortality, including changes in hyperinflation parameters and transfer factor, in a large German COPD cohort.Analysing data of 1364 patients from the German observational COSYCONET‐cohort, disease progression and improvement patterns were assessed for their impact on mortality via Cox hazard regression models. Association of biomarkers and COPD Assessment test items with phenotypes of disease progression or improvement were evaluated using logistic regression and random forest models.Increased risk of 18–54‐month mortality was linked to decrease in KCO % predicted (7.5% increments) and FEV1 (20 mL increments), increase in RV/TLC (2% increments) and SGRQ (≥6 points), and an exacerbation grade of 2 at 18 months. Decrease in KCO % predicted ≥7.5% and an increase of RV/TLC ≥2% were the most frequent measures of 18‐month disease progression occurring in ~52% and ~46% of patients, respectively. IL‐6 and CRP thresholds exhibited significant associations with medium‐ and long‐term disease measures.In a multicentric cohort of COPD, new markers of current disease activity predicted mid‐term mortality and could not be anticipated by baseline biomarkers. [ABSTRACT FROM AUTHOR]

Summary: Sleep‐disordered breathing is highly prevalent in individuals with high‐level spinal cord injury. In addition, chest mechanics are known to be altered, leading to paradoxical breathing. Here we investigated the interaction between paradoxical breathing and sleep quality in these patients, and its association with measurements of respiratory function, hypercapnic ventilatory response and peak exercise ventilation. Home‐based polysomnography was performed in 13 patients with spinal cord injury (C4 to T4) untreated for sleep‐disordered breathing. We defined paradoxical breathing as counterphase between thoracic and abdominal movements during slow‐wave and rapid eye movement sleep. Sleep quality, pulmonary function, hypercapnic ventilatory responses and peak exercise ventilation were compared between those with and without paradoxical breathing. Half of individuals presented with nocturnal paradoxical breathing. Despite similar age, body mass index, injury level, time since injury, and respiratory function, those with paradoxical breathing had higher apnea–hypopnea index (13 ± 8 versus 5 ± 3 events per hr) and average sleep heart rate (67 ± 12 versus 54 ± 4 bpm; p < 0.05). Moreover, paradoxical breathing was associated with lower hypercapnic ventilatory response (slope: 0.35 ± 0.17 versus 0.96 ± 0.38) and lower peak exercise ventilation (33 ± 4 versus 48 ± 12 L min−1; p < 0.05). Nocturnal respiratory muscle desynchronization could play a role in the pathophysiology of sleep apnea, and could relate to low ventilatory responses to both hypercapnia and exercise in high‐level spinal cord injury. Polysomnography may be an important diagnostic tool for these patients for whom therapeutic approaches should be considered to treat this abnormality. [ABSTRACT FROM AUTHOR]

Objective To investigate the characteristics of pulmonary function changes in older children with pertussis. Methods Clinical data and pulmonary function date of older children diagnosed with pertussis in outpatient clinics from April 2021 to December 2023 were collected. The clinical data of the case group were collected. A group of healthy older children were included as the control group. Pulmonary function parameters included peak expiratory flow (PEF), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, expiratory flow at 50% of vital capacity (FEF50), maximum mid-expiratory flow (MMEF) and expiratory flow rate with 75% vigorous exhalation (FEF75). Results Seventy children (36 boys and 34 girls) with pertussis were recruited in the case group, including 54 children with pertussis only and 16 children with pertussis and asthma together. The incidence of paroxysmal cough was 40.0% (28/70) and inspiratory croup 8.5% (6/70) in the case group. Sixty healthy children (28 boys and 32 girls) were included in the control group. There were no significant differences in gender, age, height and body weight between children with pertussis alone group and the control group (P＞0.05). The pulmonary function parameters were significantly lower in the children with pertussis alone group than those in the control group, and PEF had the most obvious decline: PEF%pred [80.5 (62.6, 85.9) vs. 109.8 (103.2, 118.7)]. Compared with the pertussis alone group, pulmonary function was not decrease further in the pertussis combined with asthma group. After the improvement of clinical symptoms of children in the pertussis alone group, the level of pulmonary function (PEF and FEF50) increased significantly, but they were still lower than those of the control group. Conclusion The pulmonary function declines slightly in loder children with pertussis. The decreased PEF is most significant. [ABSTRACT FROM AUTHOR]

Objective：To investigate the effect of comprehensive pulmonary rehabilitation therapy on pulmonary and motor function in children after pneumonia. Method：Children with improved acute symptoms of community-acquired pneumonia who were hospitalized in PKUFH-Ningxia Women and Children's Hospital from September 2020 to January 2021 were selected and divided into experimental group (n=30) and control group (n=30) according to the treatment intention of patients and parents. Comprehensive pulmonary rehabilitation therapy was provided to the patients in the experimental group. The pulmonary function and motor function of the two groups were assessed prior to intervention and 3 months after intervention. The forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), Borg scores and 6min walking test (6MWT) results were recorded and statistically analyzed. Result：After intervention, FEV1/FVC in experimental group was significantly higher than control group (P＜ 0.05); the FVC, FEV1 and 6MWT of the experimental group were significantly higher than those before intervention (P＜0.05). There were significant differences in FVC, FEV1, Borg scores and 6MWT between the experimental group and the control group before and after intervention (P＜0.05). Conclusion：Comprehensive pulmonary rehabilitation therapy is helpful to the recovery of pulmonary and motor function in children after community-acquired pneumonia. [ABSTRACT FROM AUTHOR]

Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease that affects exocrine glands, mainly the salivary and lacrimal glands, leading to the development of sicca symptoms. Patients with pSS may also present with extraglandular manifestations, including lung involvement, estimated to occur in 9–24% of cases. Shrinking lung syndrome (SLS) is an uncommon respiratory complication primarily associated with systemic lupus erythematosus, with a prevalence of approximately 1% in these patients. It typically manifests as dyspnea, pleuritic chest pain, lung volume reduction, and a restrictive pattern on respiratory function tests. Cases reporting SLS with other connective tissue diseases, including pSS, are even rarer. Herein, we describe a case of a 57-year-old woman with a 10-year history of pSS who presented with dyspnea and pleuritic chest pain. After evaluation, the patient was diagnosed with SLS based on clinical, radiologic, laboratorial, and electrophysiologic characteristics. In addition, we identified and analyzed previously published cases of SLS in pSS. Treatment includes corticosteroids, immunosuppressants, and respiratory muscle training. This study highlights the importance of considering SLS in the differential diagnosis of patients with pSS and respiratory symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Cancer is amongst the leading causes of death worldwide. A total of 19.3 million new cases were diagnosed in 2020. Cardiovascular impairment is the second leading cause of death in patients undergoing cancer treatment. By measuring the maximum rate of oxygen consumption (VO2max) in cancer patients, it is possible to estimate their cardiorespiratory health. This study aims to show how participants’ VO2max increases with a therapeutic physical exercise programme. Methods: Four databases were used for the literature search. Twenty-eight studies were analysed using the inclusion and exclusion criteria. The quality of these studies was analysed with the PEDRO scale. The structural characteristics of the articles and the study variable (VO2max) were studied. Results: The VO2max of the 2558 patients studied presents some variations by gender, intervention and moment of measurement. For male-associated cancer, the increased VO2max ranged between 1.5 and 4.2% after the intervention. The increase in the maximum VO2max in female-associated cancer was between 0.3 and 53%. Different types of cancer for both genders presented an oscillation between 0.5 and 3.47%. Conclusions: Therapeutic physical exercise is an efficient intervention to improve the VO2max in oncology patients. The results show that a therapeutic physical exercise intervention lasting 12 weeks, 3 days per week with a moderate-vigorous intensity, increases the VO2max in oncology patients. [ABSTRACT FROM AUTHOR]

Background: Open heart surgery, involving median sternotomy, may cause diminished chest wall motion and restrictive pulmonary function in the early postoperative period. Thoracic and upper extremity range of motion (ROM) exercises are often recommended after surgery but have not been evaluated regarding effect on lung volumes and oxygenation. The objective of this study was to evaluate the immediate effect of upper limb elevations, with or without simultaneous deep breathing, on lung function after cardiac surgery. Methods: In a randomized 2 × 2 crossover trial, 22 adult patients (> 18 years old) were assessed during one of the first days after surgery in the spring of 2022 at Örebro University Hospital, Sweden. Exercises involving five bilateral upper limb elevations, performed either with simultaneous deep breathing (ROM-DB) or without (ROM), while sitting in an upright position at the edge of the bed, were evaluated. Peripheral oxygen saturation (Rad-5v; Masimo, Irvine, USA) was the primary outcome. Tidal volume and respiratory rate were recorded continuously during the exercises (Spiropalm; Cosmed, Rome, Italy). Heart rate, pain, exertion and dyspnoea were evaluated before and after the exercises. Results: Both ROM-DB and ROM momentarily increased peripheral oxygen saturation (+ 1% ± 1, p = 0.004 and + 1% ± 1, p < 0.001, respectively), with no significant differences between these exercises (p = 0.525). ROM-DB significantly increased the VT compared with ROM (798 ± 316 vs. 602 mL ± 176, p = 0.004). However, ROM-DB induced more pronounced pain (p = 0.012), exertion (p = 0.035) and dyspnoea (p = 0.013) than ROM. Conclusions: Upper limb elevations improved oxygenation momentarily, both performed with and without simultaneous deep breathing, with no significant differences between these exercises. The additive deep breathing improved tidal volume compared with upper limb elevations alone, but induced more pain, exertion and dyspnoea during the performance of exercise. Trial registration: ClinicalTrials.gov (NCT05278819). [ABSTRACT FROM AUTHOR]

Background The effect of COVID-19 infection on pulmonary function is unknown. Objective This study aimed to evaluate pulmonary function tests (PFTs) of patients hospitalized with the diagnosis of COVID-19 pneumonia at 3 and 6 months post-discharge. Methods Patients aged 18 years and over who had positive COVID-19 PCR test results and were hospitalized in the pandemic service between 1 May 2020 and 31 October 2020, were included in the study. All patients were evaluated with PFTs FVC, FEV1, FEV1/FVC, and FEF25–75 at 3 and 6 months after discharge. Results The mean age of 34 patients included in the study was 47.7 ± 12.7 years. The FVC, FEV1, FEV1/FVC, and FEF25–75 measurements at 3 and 6 months post-discharge showed no significant difference (P = 0.765, P = 0.907, P = 0.707, and P = 0.674, respectively). There was no significant difference in any PFT measurements at the third month follow-up, regardless of the pharmacological treatment protocols applied during hospitalization (P > 0.05). However, FEV1/FVC and FEF25–75 levels were 83.1 [3.4]% and 91.0 [10.0]%, respectively, in those who received systemic steroid treatment, and 78.3 ± 8.5% and 72.5 ± 25.7% in those who did not (P = 0.019 and P = 0.048, respectively). In addition, FVC and FEV1 levels increased significantly from the third to the sixth month follow-up in patients who received systemic steroid therapy (P = 0.035 and P = 0.018, respectively). Conclusion Although there is no significant difference in PFT measurements from 3 to 6 months in COVID-19 patients, systemic steroid therapy may have a beneficial effect on respiratory function in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: The Conventional thoracic radiotherapy planning ignores regional pulmonary function changes. This study aimed to evaluate the beneficial effect of a new hybrid three-dimensional conformal radiation therapy (3DCRT)/intensitymodulated radiation therapy (IMRT) technique. Materials and Methods: Thirty patients with non-small cell lung cancer were included in this study. Four protocols were designed for each patient: anatomical IMRT (A-IMRT, based on the total lung), functional IMRT (F-IMRT), pure IMRT (O-IMRT) plan, and hybrid 3DCRT/IMRT plan (H-3DCRT/IMRT), which were based on the functional lung. The opposing pair of fields in the O-IMRT and H-3DCRT/IMRT protocols provide 2/9 and 1/2 of radiation dose, respectively. The planning target volume coverage, dose in both total and functional lungs, maximum spinal cord dose, mean esophagus dose, mean heart dose, homogeneity index (HI), conformity index (CI), and treatment monitor units (MUs) were compared in this study. Results: The V5, V20, and mean dose (Dmean) of the both total and functional lungs in the H-3DCRT/IMRT protocol were the lowest among the four treatment regimes. For D2, D98, HI, and CI, the A-IMRT protocol was superior to the H-3DCRT/IMRT protocol. Compared with the A-IMRT protocol, the F-IMRT protocol achieved significantly lower V5, V20, and Dmean for functional lungs, but showed worse HI, CI, and maximum dose of spinal cord. The H-3DCRT/IMAT protocol significantly reduced the maximum spinal cord dose and MUs. Conclusions: The H-3DCRT/IMAT plan based on functional lung images appeared to be better than conventional F-IMRT in preserving functional lung without compromising on HI and CI in NSCLC patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effect of breathing pressurized air in two consecutive hyperbaric sessions on lung function in hyperbaric chamber inside attendants (HCIAs). Materials and Methods: The study included 29 HCIAs working in the hospital's hyperbaric oxygen (HBO2) therapy unit. HCIAs re-entered the HBO2 therapy session multiple times after the break given to the internal assisted sessions due to the Coronavirus Disease 2019 (COVID-19) pandemic. We assessed the pulmonary function tests (PFTs) measurements from the first two sessions to understand whether any changes in lung function that might develop in participants at the first session were permanent and what the effect would be at the second session. Results: There was a decrease in mean forced vital capacity (FVC) of 4.77% (p=0.003) in the first session and 4.20% (p=0.006) in the second session. Mean forced expiratory volume in one second (FEV1) decreased by 5.33% (p=0.003) in the first session and by 4.73% (p=0.001) in the second session. There was a decrease in mean peak expiratory flow (PEF) of 10.27% (p=0.001) in the second session. There was a decrease in mean forced expiratory flow (FEF) 25-75% of 9.64% (p=0.008) in the second session. No significant difference was found for any PFT parameters when comparing the pre-session values of the first and second sessions. Conclusion: Pulmonary function in HCIAs is affected by HBO2 therapy. There was a decrease in FEV1 and FVC in one session and all PFT parameters in the following session. This finding is important because it shows that PFT may be more affected in repeated HBO2 therapy sessions. [ABSTRACT FROM AUTHOR]

The prolonged consequences of SARS‐CoV‐2 on young elite athletes recovering from primary and reinfection are unclear. This study aimed to assess inspiratory/expiratory muscle strength and respiratory function at the time of spontaneous recovery at 3, 6, and 9 months after SARS‐CoV‐2 primary and reinfection in elite athletes. The study enrolled 25 elite male judoists, including 11 primary infection cases, five reinfection cases, and nine controls from the Türkiye Olympic Preparation Center. Inspiratory/expiratory muscle strength and respiratory function were measured, including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) before and up to 9 months after SARS‐CoV‐2 infection in the early pre‐competition preparation phases. The most common symptoms reported by reinfection cases were fatigue (80%), dyspnea (60%), and muscle/joint pain (60%), while primary infection cases reported fatigue (73%), muscle/joint pain (45%), and headache (45%). MIP decreased by −14% and MEP decreased by −13% following the SARS‐CoV‐2 infection in reinfection cases. Likewise, FEV1 and FVC decreased by −5% and −8%, respectively; consequently, FEV1/FVC increased by 3%. Inspiratory/expiratory muscle strength and respiratory function improved rapidly after 9 months of SARS‐CoV‐2 infection in primary cases, whereas dysfunction persisted in reinfection cases. PEF was unaffected throughout the 9‐month follow‐up period. Reinfection may lead to further alterations in respiratory system relative to the primary infection, with a suspected restrictive pattern that remains dysfunctional in the third month; however, it improves significantly during a 9‐month follow‐up period. Highlights: In elite judo athletes, reinfection with SARS‐CoV‐2 cause more severe respiratory dysfunction compared to primary infection, with notable impairments in maximal inspiratory pressure (MIP) and MEP by −14% and −13%, respectively, at 3 months.FEV1 and FVC decreased by −5% and −8%, respectively, at 3 months post‐infection. Although respiratory function gradually improved over 9 months, some reinfected athletes have the potential to exhibit a suspected restrictive abnormality (FVC <80% of predicted) characterized by a greater decrease in FVC compared to FEV1, leading to an increased FEV1/FVC ratio.Reinfected athletes who have recovered from SARS‐CoV‐2 infection may require a longer recovery period before returning to training and competition. It seems warranted that they should be followed carefully in terms of clinical rehabilitation needs after a repeated infection and directed to specific care pathways aimed at reducing long‐term adverse effects. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this meta-analysis was to determine the effects of respiratory muscle training (RMT) on functional ability, pain-related outcomes, and respiratory function in individuals with sub-acute and chronic low back pain (LBP). Methods: The study selection was as follows: (participants) adult individuals with >4 weeks of LBP; (intervention) RMT; (comparison) any comparison RMT (inspiratory or expiratory or mixed) versus control; (outcomes) postural control, lumbar disability, pain-related outcomes, pain-related fear-avoidance beliefs, respiratory muscle function, and pulmonary function; and (study design) randomized controlled trials. Results: 11 studies were included in the meta-analysis showing that RMT produces a statistically significant increase in postural control (mean difference (MD) = 21.71 [12.22; 31.21]; decrease in lumbar disability (standardized mean difference (SMD) = 0.55 [0.001; 1.09]); decrease in lumbar pain intensity (SMD = 0.77 [0.15; 1.38]; increase in expiratory muscle strength (MD = 8.05 [5.34; 10.76]); and increase in forced vital capacity (FVC) (MD = 0.30 [0.03; 0.58]) compared with a control group. However, RMT does not produce an increase in inspiratory muscle strength (MD = 18.36 [−1.61; 38.34]) and in forced expiratory volume at the first second (FEV1) (MD = 0.36 [−0.02; 0.75]; and in the FEV1/FVC ratio (MD = 1.55 [−5.87; 8.96]) compared with the control group. Conclusions: RMT could improve expiratory muscle strength and FVC, with a moderate quality of evidence, whereas a low quality of evidence suggests that RMT could improve postural control, lumbar disability, and pain intensity in individuals with sub-acute and chronic LBP. However, more studies of high methodological quality are needed to strengthen the results of this meta-analysis. [ABSTRACT FROM AUTHOR]

Patients with neuromuscular diseases are particularly vulnerable in the perioperative period to the development of pulmonary and cardiac complications, or medication side effects. These risks could include hypoventilation, aspiration pneumonia, exacerbation of underlying cardiomyopathy, arrhythmias, adrenal insufficiency, prolonged neuromuscular blockade, issues related to thermoregulation, rhabdomyolysis, malignant hyperthermia, or prolonged mechanical ventilation. Interventions at each of the perioperative stages can be implemented to mitigate these risks. A careful pre-operative evaluation may help identify risk factors so that appropriate interventions are initiated, including cardiology consultation, pulmonary function tests, initiation of noninvasive ventilation, or implementation of preventive measures. Important intraoperative issues include positioning, airway and anesthetic management, and adequate ventilation. The postoperative period may require correction of electrolyte abnormalities, control of secretions with medications, manual or mechanical cough assistance, avoiding the risk of reintubation, judicious pain control, and appropriate medication management. The aim of this review is to increase awareness of the particular surgical challenges in this vulnerable population, and guide the clinician on the various evaluations and interventions that may result in a favorable surgical outcome. [ABSTRACT FROM AUTHOR]

• The impact of using GLI race neutral reference equations on ppFEV1 will vary by race. • Individuals who identify as Black, Native American or Alaska Native, Hawaiian or Pacific Islander, or other race with CF will have lower ppFEV1 compared to those calculated from the GLI 2012 race specific equations. • White and Asian individuals with CF will have higher ppFEV1 when using the new equations. • Individuals with higher ppFEV1 values based upon GLI 2012 equations will see larger changes (in either direction) when using the new equations compared to people with lower ppFEV1 values. The American Thoracic Society recommended switching to race-neutral spirometry reference equations, as race is a social construct and to avoid normalizing disparities in lung function due to structural racism. Understanding the impact of the race-neutral equations on percent predicted forced expiratory volume in one second (ppFEV 1) in people with cystic fibrosis (PwCF) will help prepare patients and providers to interpret pulmonary function test results. To quantify the impact of switching from Global Lung Initiative (GLI) 2012 race-specific to GLI 2022 Global race-neutral reference equations on the distribution of ppFEV 1 among PwCF of different races. Cross-sectional analysis of FEV 1 among PwCF ages ≥6 years in the 2021 U.S. Cystic Fibrosis Foundation Patient Registry. We describe the absolute difference in ppFEV 1 between the two reference equations by reported race and the effect of age and height on this difference. With the switch to GLI Global, ppFEV 1 will increase for White (median increase 4.7, (IQR: 3.1; 6.4)) and Asian (2.6 (IQR: 1.6; 3.7)) individuals and decrease for Black individuals (-7.7, (IQR: -10.9; -5.2)). Other race categories will see minimal changes in median ppFEV 1. Individuals with higher baseline ppFEV 1 and younger age will see a greater change in ppFEV 1 (i.e., a greater improvement among White and Asian individuals and a greater decline among Black individuals). Switching from GLI 2012 race-specific reference equations to GLI 2022 Global race-neutral equations will result in larger reductions in ppFEV 1 among Black individuals with CF than increases among White and Asian people with CF. [ABSTRACT FROM AUTHOR]

Background and Objective: When multiple complex air pollutants are combined in real‐world settings, the reliability of estimating the effect of a single pollutant is questionable. This study aimed to investigate the combined effects of changes in air pollutants on small airway dysfunction (SAD). Methods: We analysed Korea National Health and Nutrition Examination Survey (KNHANES) V–VIII database from 2010 to 2018 to elucidate the associations between annual changes in air pollutants over a previous 5‐year period and small airway function. We estimated the annual concentrations of five air pollutants: NO2, O3, PM2.5, SO2 and CO. Forced expiratory flow between 25% and 75% of vital capacity (FEF25%–75%) <65% was defined as SAD. Using the quantile generalized‐Computation (g‐Computation) model, the combined effect of the annual changes in different air pollutants was estimated. Results: A total of 29,115 individuals were included. We found significant associations between SAD and the quartiles of annual changes in NO2 (OR = 1.10, 95% CI = 1.08–1.12), O3 (OR = 1.03, 95% CI = 1.00–1.05), PM2.5 (OR = 1.03, 95% CI = 1.00–1.05), SO2 (OR = 1.04, 95% CI = 1.02–1.08) and CO (OR = 1.16, 95% CI = 1.12–1.19). The combined effect of the air pollutant changes was significantly associated with SAD independent of smoking (OR = 1.31, 95% CI = 1.26–1.35, p‐value <0.001), and this trend was consistently observed across the entire study population and various subgroup populations. As the estimated risk of SAD, determined by individual‐specific combined effect models, increased and the log odds for SAD increased linearly. Conclusion: The combined effect of annual changes in multiple air pollutant concentrations were associated with an increased risk of SAD. [ABSTRACT FROM AUTHOR]

Objectives: Chest wall deformities are a series of abnormalities that extend from the sternum to the vertebral column and often cause aesthetic and psychological problems. Most chest wall deformities are caused by cartilaginous malformations such as pectus excavatum and pectus carinatum. The aim of this study was to provide a detailed description of chest wall abnormalities in young male athletes with no existing complaints. Methods: A comprehensive health assessment was performed on 1600 young men at the Erzincan Police Vocational Training Centre in March 2023. The evaluation included chest radiographs, pulmonary function tests, electrocardiography, transthoracic echocardiography, haemogram, biochemical test findings and comorbidities. Haller index scale was used to grade the severity of pectus deformity in individuals with pectus excavatum. Results: Pectus excavatum deformity was detected in 16 individuals (1%). Pectus carinatum was detected in only one individual (0.06%). Only one of the patients with chest wall deformity had an abnormal pulmonary function test, especially in the form of a minor obstructive pattern. In addition, 11 individuals in this group had associated electrocardiographic abnormalities. These abnormalities did not cause significant clinical findings. Conclusion: Our study showed that the prevalence of chest wall deformities in physically active young men is comparable to the prevalence of chest wall deformities reported for the general population in the available literature. Furthermore, this study demonstrated a higher prevalence of electrocardiographic abnormalities in subjects with chest wall deformities. [ABSTRACT FROM AUTHOR]

Introduction: Computed tomography (CT) is routinely employed on the evaluation of dyspnea, yet limited data exist on its assessment of diaphragmatic muscle. This study aimed to determine the capability of CT in identifying structural changes in the diaphragm among patients with ultrasound-confirmed diaphragmatic dysfunction. Methods: Diaphragmatic ultrasounds conducted between 2018 and 2021 at our center in Marseille, France, were retrospectively collected. Diaphragmatic pillars were measured on CT scans at the L1 level and the celiac artery. Additionally, the difference in height between the two diaphragmatic domes in both diaphragmatic dysfunction cases and controls was measured and compared. Results: A total of 65 patients were included, comprising 24 with diaphragmatic paralysis, 13 with diaphragmatic weakness, and 28 controls. In the case group (paralysis and weakness) with left dysfunctions (n = 24), the CT thickness of the pillars at the level of L1 and the celiac artery was significantly thinner compared with controls (2.0 mm vs. 7.4 mm and 1.8 mm vs. 3.1 mm, p < 0.001 respectively). Significantly different values were observed for paralysis (but not weakness) in the right dysfunction subgroup (n = 15) (2.6 mm vs. 7.4 mm and 2.2 mm vs. 3.8 mm, p < 0.001 respectively, for paralysis vs. controls). Regardless of the side of dysfunction, a significant difference in diaphragmatic height was observed between cases and controls (7.70 cm vs. 1.16 cm and 5.51 cm vs. 1.16 cm, p < 0.001 for right and left dysfunctions, respectively). Threshold values determined through ROC curve analyses for height differences between the two diaphragmatic domes, indicative of paralysis or weakness in the right dysfunctions, were 4.44 cm and 3.51 cm, respectively. Similarly for left dysfunctions, the thresholds were 2.70 cm and 2.48 cm, respectively, demonstrating good performance (aera under the curve of 1.00, 1.00, 0.98, and 0.79, respectively). Conclusion: In cases of left diaphragmatic dysfunction, as well as in paralysis associated with right diaphragmatic dysfunction, CT revealed thinner pillars. Additionally, a notable increase in the difference in diaphragmatic height demonstrated a strong potential to identify diaphragmatic dysfunction, with specific threshold values. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) commonly coexists with lung disease. However, the association between OSA components and lung function remains unclear. This study estimated STOP-BANG scores according to lung function using nationwide Korean data. Materials and Methods: Three thousand and two hundred eighty adults with available STOP-BANG scores and spirometry data were analyzed. Multivariate regression models were applied to estimate STOP-BANG scores according to lung function. Results: Approximately 28% of participants had abnormal lung function, and the characteristics were diverse. The significant factors associated with abnormal lung function included the STOP-BANG score. In multivariate regression analyses, individuals with abnormal lung function had significantly higher STOP-BANG scores than those with normal lung function (odds ratio: 1.19; 95% confidence interval: 1.10-1.29; P < 0.001), and this difference was remarkable in men. Conclusion: Our results suggest that screening and management of OSA components are warranted to prevent impaired lung function. [ABSTRACT FROM AUTHOR]

Background: Epidemic thunderstorm asthma is an observed increase in cases of acute bronchospasm following thunderstorms. This study aimed to compare the frequency of obstructive airway disease or bronchial hyperresponsiveness in subjects with thunderstorm-associated respiratory symptoms with subjects with similar symptoms presented at other times. Methods: A cross-sectional study from June to November of 2013 was conducted on subjects with thunderstorm-associated respiratory symptoms living in Ahvaz City, Iran. Thunderstorm-associated subjects were presented with asthmatic symptoms in thunderstorms, and other patients presented with similar symptoms at other times. Baseline spirometry was performed on patients to examine the presence of obstructive airway disease. In all patients with normal spirometry, a provocation test was applied. A comparison of qualitative and quantitative variables was made using the Chi-square and independent t test, respectively. All analyses were carried out using SPSS Statistics Version 22. A P value less than 0.05 was considered statistically significant. Results: Out of 584 subjects, 300 and 284 participants were in thunderstorm-associated and non-thunderstorm-associated groups, respectively. After the final analysis, 87 (30.6%) and 89 (33.3%) of the thunderstorm-associated subjects and non-thunderstorm-associated group, respectively, had pieces of evidence of airflow limitation (P=0.27). Among the patients with normal spirometry, 161 (81.72%) of the thunderstorm-associated patients and 100 (56.17%) patients of the non-thunderstorm-associated symptoms group had a positive methacholine challenge test result (P<0.001). Conclusion: Most of the patients with thunderstorm-associated respiratory symptoms had no obvious evidence of airflow limitation in spirometry. [ABSTRACT FROM AUTHOR]

Background: Muscle dysfunction may cause disability and reduce the quality of life of patients with systemic sclerosis (SSc) when compared to healthy individuals. However, the literature on the topic is scarce and uses several criteria for assessing muscle dysfunction in this population. Objectives: To compare diaphragm and quadriceps muscle thickness, diaphragm mobility, and handgrip strength between patients with SSc and healthy individuals. Method: This cross-sectional study included 16 patients with SSc and 16 self-reported healthy individuals matched for age. We assessed quadriceps and diaphragm thickness and diaphragmatic mobility (ultrasound), handgrip strength (hand-held dynamometer), and respiratory muscle strength (manovacuometer). Patients also responded to the Health Assessment Questionnaire Disability Index and the International Physical Activity Questionnaire. Results: Patients with SSc presented lower quadriceps thickness (p < 0.0001), diaphragmatic mobility (p = 0.01), handgrip (p < 0.0001), and respiratory muscle strength (p < 0.0001) than healthy individuals. A moderate positive correlation was observed between handgrip strength and quadriceps thickness in patients with SSc (rho = 0.576; p = 0.02). Conclusions: Patients with SSc presented reduced quadriceps thickness, diaphragmatic mobility, handgrip, and respiratory muscle strength when compared to healthy individuals Also, handgrip strength was correlated with quadriceps thickness in patients with SSc, suggesting that loss of muscle mass accompanies loss of peripheral muscle strength group of patients. Key Points • SSc patients presented reduced quadriceps thickness and diaphragmatic mobility • SSc patients have reduced handgrip and respiratory muscle strength • Lower handgrip muscle strength correlated with lower quadriceps thickness. [ABSTRACT FROM AUTHOR]

Background: The quality of the spirometry is estimated with criteria of acceptability and repeatability. The repeatability criteria accepted by consensus is < 0.150 L. Objective: To know the repeatability in quality A spirometry. Material and methods: Analytical cross-sectional design. The demographic variables and the 3 best spirometry curves with normal, suggestive of restriction and bronchial obstruction profiles were obtained from consecutive subjects of both genders from 18 to 80 years of age. The repeatability was analyzed with the mean difference (bias) and the intraclass correlation coefficient. Results: 630 curves from 210 subjects were accepted. Group age 60 ± 15 years. Female predominance 113 (53.8%), occupation: domestic services 61 (29%), and diagnosed with chronic obstructive pulmonary disease: 70 (33.4%). The differences in the curves were < 0.150 L. The mean difference (bias) and the intraclass correlation coefficient (95% confidence interval, 95% CI) of the forced expiratory volume in the first second were 1 vs. 2 maneuver: -0.01 (0.13, -0.14), 0.997 (95% CI 0.996, 0.998); 2 vs. 3 maneuver: 0.00 (0.13, -0.13), 0.997 (95% CI 0.996, 0.998), and maneuver 1 vs. 3: -0.00 (0.16, -0.17), 0.995 (95% CI 0.994, 0.996). Forced vital capacity: 1 vs. 2 maneuver: -0.01 (0.17, -0.18), 0.996 (95% CI 0.995, 0.997); 2 vs. 3 maneuver: 0.01 (0.17, -0.16), 0.997 (95% CI 0.0.996, 0.998), and maneuver 1 vs. 3: -0.00 (0.18, -0.19), 0.996 (95% CI 0.995, 0.997). Conclusion: The repeatability obtained in spirometry with quality A validates the use of the repeatability criterion of 0.150 L. [ABSTRACT FROM AUTHOR]

This systematic review aimed to assess the available body of published peer-reviewed articles related to the effects of Olympic combat sports (OCS) on cardiorespiratory fitness (CRF) in the non-athlete population. The methodological quality and certainty of evidence were evaluated using PRISMA, TESTEX, RoB, and GRADE scales. The protocol was registered in PROSPERO (code: CRD42023391433). From 4133 records, six randomized controlled trials were included, involving 855 non-athletes (mean age = 27.2 years old). The TESTEX scale reported all studies with a ≥ 60% (moderate-high quality) score. The GRADE scale indicated moderate to low certainty of evidence. It was only possible to perform a meta-analysis on direct methods to maximum oxygen consumption (VO2max). The main results indicated significant differences in favor of OCS compared to active/passive controls in VO2max (SMD = 4.61; 95%CI = 1.46 to 7.76; I2 = 99%; p = 0.004), while the individual results of the studies reported significant improvements in favor of the OCS on the indirect methods of the CRF. OCS improved CRF in a healthy non-athlete population of different ages, specifically showing a significant improvement in VO2max with direct tests, such as cardiopulmonary tests. However, moderate to low certainty of evidence is reported, so no definitive recommendations can be established. [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the impact of scoliosis on pregnancy and gestational outcome. Material and Methods: We retrospectively evaluated gestational outcomes of pregnant women with scoliosis at Hacettepe University Hospital between 2008 and 2018. Cases were grouped according to the presence of previous scoliosis surgery and compared in terms of gestational week at birth, birthweight, rate of neonatal intensive care unit admission, hospitalization during pregnancy, route of delivery, type of anesthesia at labor and postpartum intensive care unit admission rate. Ejection fraction (EF), functional vital capacity (FVC), forced expiratory volume (FEV1) and FEV1/FVC ratio values were also recorded. Results: A total of 23 women were included, of whom 12 (52.2%) had a prior scoliosis surgery. One of the 23 (4.3%) cases was terminated due to respiratory problems, while the remaining 22 cases resulted in deliveries. The median gestational week at birth was 38.2 and the median birth weight was 3150 g. Median (range) maternal height was 143 (80-160) cm while median (range) maternal weight was 51 (35-86) kg. Three (13.6%) were diagnosed with restrictive lung disease. No significant difference was found between operated and non-operated groups in terms of respiratory function test results, cardiac EF and other related demographic and clinical features. Overall cesarean delivery rate was 63.6% (14/22) and cesarean section rate was significantly higher in the operated group (83.3% versus 40%) (p=0.04). Conclusion: Cesarean section rate was increased in this cohort of pregnancies in women with scoliosis and who had previous scoliosis surgery. [ABSTRACT FROM AUTHOR]

The article focuses on the interpretation of pulmonary function tests in children, addressing key topics such as respiratory diseases in pediatrics, spirometry, and the significance of lung function testing in various conditions. It delves into the complexities of pediatric lung function assessment, highlighting essential techniques and guidelines for accurate interpretation in clinical practice.

Introduction: The diaphragm function assessed by ultrasound has been well-studied in COPD, asthma, and intensive care. However, there are only a few studies on diffuse interstitial lung disease, while dyspnea and quality of life are major issues in the management that may depend on the diaphragm. Methods: We retrospectively included idiopathic pulmonary fibrosis (IPF) patients followed in our center (Marseille, France) between January 2020 and February 2023 who underwent diaphragmatic ultrasound. Our objectives were to describe the diaphragmatic function of IPFs compared to healthy controls and to correlate with clinical, functional, and lung density on CT-scan. Results: 24 IPF patients and 157 controls were included. The diaphragmatic amplitude in IPF was increased at rest (median of 2.20 cm vs 1.88 cm on the right, p < 0.007, and 2.30 cm vs 1.91 cm on the left, p < 0.03, in IPF and controls respectively) and decreased in deep breathing (median of 4.85 cm vs 5.45 cm on the right, p < 0.009, and 5.10 cm vs 5.65 cm on the left, p < 0.046, in IPF and controls respectively). Diaphragmatic thickness was significantly reduced at rest on the right side (median of 1.75 mm vs 2.00 mm, p < 0.02, in IPF and controls respectively) and in deep breathing on both sides compared to controls (mean of 3.82 mm vs 4.15 mm on the right, p < 0.02, and 3.53 mm vs 3.94 mm, on the left, p < 0.009, in IPF and controls respectively). Diaphragmatic amplitude in deep breathing was moderate to strongly correlated with FVC, DLCO, and 6MWT and negatively correlated with the dyspnea and lung density on CT scan. Conclusion: The diaphragmatic amplitude and thickness were impaired in IPF compared to controls. Diaphragmatic amplitude is the parameter best correlated with clinical, functional, and lung density criteria. Further studies are needed to determine if diaphragmatic amplitude can be a prognostic factor in IPF. [ABSTRACT FROM AUTHOR]

Although hepatitis B virus (HBV) and hepatitis C virus (HCV) are hepatotrophic viruses, they may affect pulmonary diseases. The purpose of this study was to assess whether chronic viral hepatitis (CVH) infection was associated with a rapid decline in lung function. Repeated measurements of lung function were obtained from a well-curated health check-up database. A case was defined as an individual positive for HBsAg or anti-HCV antibody. A control was randomly selected (from the same dataset) after 1:1 matching in terms of age, sex, height, the body mass index, and smoking status. Separate analyses of non-smokers and smokers were performed. A total of 701 cases were enrolled (586 with HBV and 115 with HCV). In cross-sectional analysis, both forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) decreased significantly only in smokers (smoking cases vs. smoking controls) (adjusted p = 6.6 × 10−5 and adjusted p = 2.2 × 10−3, respectively). In longitudinal analysis, smoking cases showed significantly greater FEV1 and FVC decline rates than did smoking controls (adjusted p = 8.5 × 10−3 and adjusted p = 1.2 × 10−5, respectively). Such associations were particularly high in smoking cases at intermediate-to-high risk of hepatic fibrosis, as evaluated by the non-invasive Fibrosis-4 index. In summary, CVH was associated with both decreased lung function and accelerated lung function decline in smokers. A non-invasive measurement of hepatic fibrosis may be useful in predicting rapid lung function decline in smokers with CVH. [ABSTRACT FROM AUTHOR]

Background and Objective: Little is known about the association between ambient air pollution and idiopathic pulmonary fibrosis (IPF) in areas with lower levels of exposure. We aimed to investigate the impact of air pollution on lung function and rapid progression of IPF in Australia. Methods: Participants were recruited from the Australian IPF Registry (n = 570). The impact of air pollution on changes in lung function was assessed using linear mixed models and Cox regression was used to investigate the association with rapid progression. Results: Median (25th–75th percentiles) annual fine particulate matter (<2.5 μm, PM2.5) and nitrogen dioxide (NO2) were 6.8 (5.7, 7.9) μg/m3 and 6.7 (4.9, 8.2) ppb, respectively. Compared to living more than 100 m from a major road, living within 100 m was associated with a 1.3% predicted/year (95% confidence interval [CI] −2.4 to −0.3) faster annual decline in diffusing capacity of the lungs for carbon monoxide (DLco). Each interquartile range (IQR) of 2.2 μg/m3 increase in PM2.5 was associated with a 0.9% predicted/year (95% CI −1.6 to −0.3) faster annual decline in DLco, while there was no association observed with NO2. There was also no association between air pollution and rapid progression of IPF. Conclusion: Living near a major road and increased PM2.5 were both associated with an increased rate of annual decline in DLco. This study adds to the evidence supporting the negative effects of air pollution on lung function decline in people with IPF living at low‐level concentrations of exposure. [ABSTRACT FROM AUTHOR]

Background: Obesity is a chronic disease that occurs when the amount of energy taken into the body from food exceeds the energy spent. Asthma is a disease characterized by recurrent airway obstruction that can cause deterioration in patients' quality of life and mental status. In recent studies, asthma has been frequently associated with obesity. One of the reasons given for this association is the parallel increase in the prevalence of both diseases. The aim of this study is to evaluate the effect of obesity on respiratory function tests in asthma patients. Materials and Methods: The study included 80 asthma patients over the age of 18 years. The patients included in our study were divided into two groups, normal weight and overweight, according to their body mass index, FEV1, FVC, PEF, FEV1/FVC, FEF25-75 values in pulmonary function tests were analyzed. Results: Of the 80 patients included in the study, 30 were in normal weight and 50 were in overweight group according to body mass index. When a comparison was made between both groups, FVC, FEV1, PEF, FEF25-75, FEV1/FVC values w ere f ound t o be l ower i n t he overweight g roup c ompared t o t he n ormal weight group, but no statistically significant difference was found (p<0.05). Conclusions: It was observed that most of the patients included in our study were overweight and the majority were female. In our study, it was found that the values in pulmonary function tests were similar between normal weight and overweight patients with asthma. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of inspiratory muscle training (IMT) in glucose control and respiratory muscle function in patients with diabetes. It was a randomized clinical trial conducted at the Physiopathology Laboratory of the Hospital de Clínicas de Porto Alegre. Patients with Type 2 diabetes were randomly assigned to IMT or placebo-IMT (P-IMT), performed at 30% and 2% of maximal inspiratory pressure, respectively, every day for 12 weeks. The main outcome measures were HbA1c, glycemia, and respiratory muscle function. Thirty patients were included: 73.3% women, 59.6 ± 10.7 years old, HbA1c 8.7 ± 0.9% (71.6 ± 9.8 mmol/mol), and glycemia 181.8 ± 57.8 mg/dl (10.5 ± 3.2 mmol/L). At the end of the training, HbA1c was 8.2 ±0.3% (66.1 ± 3.3 mmol/mol) and 8.7 ± 0.3% (71.6 ± 3.3 mmol/mol) for the IMT and P-IMT groups, respectively (p =.8). Fasting glycemia decreased in both groups with no difference after training although it was lower in IMT at 8 weeks: 170.0 ± 11.4 mg/dl(9.4 ± 0.6 mmol/L) and 184.4 ± 15.0 mg/dl (10.2 ± 0.8 mmol/L) for IMT and P-IMT, respectively (p <.05). Respiratory endurance time improved in the IMT group (baseline = 325.9 ± 51.1 s and 305.0 ± 37.8 s; after 12 weeks = 441.1 ± 61.7 s and 250.7 ± 39.0 s for the IMT and P-IMT groups, respectively; p <.05). Considering that glucose control did not improve, IMT should not be used as an alternative to other types of exercise in diabetes. Higher exercise intensities or longer training periods might produce better results. The clinical trials identifier is NCT 03191435. [ABSTRACT FROM AUTHOR]

This article, titled "Letter from Belgium," provides an account of the COVID-19 crisis from the perspective of a non-medical respiratory research scientist in Belgium in 2024. The author highlights the interruption of research projects involving human testing during the crisis and the development of low-cost ventilators in response. The article also discusses collaborative efforts in the diagnostic toolbox, including the use of AI for detecting abnormalities on CT images. Additionally, the article addresses challenges in measuring lung function in COVID-affected patients, particularly in relation to ethnicity and interpretation of lung capacity measurements. Finally, the article mentions a citizen science project on air pollution in Brussels and the positive effects of working from home and increased bicycle use. [Extracted from the article]

See relatedarticle [ABSTRACT FROM AUTHOR]

This document is a quarterly editorial from the journal Respirology, highlighting three published articles that are of ongoing educational value. The first article discusses supranormal lung function, which is associated with a reduced risk for chronic lung diseases. The second article explores racial and ethnic disparities in antifibrotic therapy for idiopathic pulmonary fibrosis. The third article compares the outcomes of two treatments for severe asthma. These articles provide valuable insights into lung health and the impact of disparities in respiratory diseases. Further research is needed to confirm these findings and address the identified disparities. [Extracted from the article]

Objective To explore the value of serum miR-134-5p and miR-320a combined with pulmonary function indexes in the early clinical diagnosis of pneumoconiosis. Methods Forty cases of coal workers' pneumoconiosis (CWP), 40 cases of coal mine dust exposed physical examination population and 40 cases of healthy physical examination population in the same period were included in this study. Expression levels of serum miR-134-5p and miR-320a were detected by qRT-PCR assay. Lung function indexes were detected in three groups, including maximum ventilation volume (MVV), forced vital capacity (FVC), forced expiratory volume 1 (FEV1), forced expiratory volume 3 (FEV3), FEV1/FVC, FEV3/FVC, maximum mid-expiratory flow (MMEF), peak expiratory flow (PEF), 75 % maximal expiratory flow (MEF75), 50% maximal expiratory flow (MEF50), 25% maximal expiratory flow (MEF25), residual volume (RV), RV/total lung capacity (TLC), functional residual capacity (FRC) and alveolar ventilation (VA). Logistic regression was used to analyze risk factors of CWP in coal mine dust-related operations. Receiver operating characteristic (ROC) curve was used to analyze the early diagnostic value of miRNA combined with pulmonary function index in patients with CWP. Results The expression levels of serum miR-134-5p, miR-320a, MVV, FEV1, FEV1/FVC, MMEF, MEF50, FRC and VA were decreased gradually in the control group, the dust exposure group and the CWP group (P＜0.05). Multiple Logistic regression analysis showed that the decrease of FRC was an independent risk factor for CWP in coal mine dust exposure population (P＜0.05). miR-134-5p and miR320a combined with lung function index FRC showed high diagnostic efficacy in predicting CWP disease in coal mine dust-related operations, with an AUC of 0.975 (95%CI: 0.948-1.000). Conclusion The combination of serum miR-134-5p, miR-320a and lung function index FRC has important reference value for the clinical diagnosis in patients with early CWP. [ABSTRACT FROM AUTHOR]

Reticular basement membrane (RBM) thickening may occur in children with allergic bronchial asthma (BA), cystic fibrosis (CF), and primary ciliary dyskinesia (PCD). Its functional consequences remain unknown. We investigated the relationship between baseline RBM thickness and subsequent spirometry. In our cohort follow-up study, patients aged 3-18 yr with BA, CF, and PCD and controls underwent baseline lung clearance index (LCI) measurement, spirometry, and endobronchial biopsy sampling. Total RBM and collagen IV-positive layer thickness were measured. Trends in forced vital capacity (FVC), forced expired volume in 1 s (FEV1), and FEV1/FVC were analyzed during follow-up, and their relationship to baseline characteristics was studied using univariate analysis and multiple regression models. Complete baseline data were available in 19 patients with BA, 30 patients with CF, 25 patients with PCD, and 19 controls. The RBM was thicker in patients with BA (6.33 ±1.22 µm), CF (5.60 ±1.39 µm), and PCD (6.50 ±1.87 µm) than in controls (3.29 ±0.55 µm) (all P < 0.001). The LCI was higher in patients with CF (15.32 ±4.58, P < 0.001) and PCD (10.97±2.46, P = 0.002) than in controls (7.44±0.43). The median follow-up times were 3.6, 4.8, 5.7, and 1.9 years in patients with BA, CF, PCD, and controls, respectively. The z-scores of FEV1 and FEV1/FVC deteriorated significantly in all groups except in controls. In patients with CF and PCD, trends in FEV1 z-scores correlated with baseline LCI and RBM; in BA, it correlated with collagen IV. In multiple regression models, RBM morphology and ventilation inhomogeneity could predict up to 84.4% of variability in spirometry trends. In conclusion, baseline LCI value and RBM morphology may predict trends in subsequent spirometry. [ABSTRACT FROM AUTHOR]

To determine the differences in respiratory muscle strength and pulmonary function between patients with chronic neck pain (CNP) and asymptomatic individuals. Databases were MEDLINE, CINAHL, Scopus, Web of Science and EMBASE up to the end of September 2021. Studies with cross-sectional and longitudinal design were selected, with adult patients with CNP and asymptomatic individuals with reports respiratory function. 11 studies met the inclusion criteria and 10 were included in the meta-analysis showing a statistically significant reduction in inspiratory/expiratory muscle strength (MIP/MEP) in the patients with CNP compared with the asymptomatic individuals (mean difference (MD) for MIP, −11.67 [–14.57 to −8.77]; MD for MEP, −11.80 [–14.99 to −8.60]) and pulmonary function: vital capacity (standardized mean difference (SMD), −0.31 [−0.56 to −0.06]); maximum voluntary ventilation (SMD, −0.36 [−0.59 to −0.14]); forced vital capacity (SMD, −0.53 [−0.99 to −0.06]); peak expiratory flow (SMD, −0.58 [−1.03 to −0.12]); and forced expiratory volume in the first second (SMD, −0.28 [−0.51 to −0.05]). Patients with CNP have reduced respiratory muscle strength and pulmonary function compared with asymptomatic individuals, and this difference could be clinically meaningful. However, more studies of high methodological quality and longitudinal studies are needed to strengthen the results of this meta-analysis. Respiratory dysfunction has been observed in patients with chronic neck pain. Patients with chronic neck pain present a decrease in respiratory muscle strength and pulmonary function compared with asymptomatic individuals. Respiratory pattern disorders should be considered in the clinical context of chronic neck pain. Interventions focused on respiratory muscle training could be helpful for this population. [ABSTRACT FROM AUTHOR]

Idiopathic inflammatory myopathy (IIM)-associated interstitial lung disease (ILD) is often rapidly progressive with a poor prognosis; however, no standard therapeutic regimen has been identified. This study aimed to investigate the efficacy and safety of rituximab in IIM-ILD patients. Five patients who had been administered rituximab for IIM-ILD at least once between August 2016 and November 2021 were included. Lung function decline was compared one year before and after rituximab. Disease progression, defined as a greater than 10% relative decline in forced vital capacity (FVC) compared to the baseline, was also compared before and after treatment. Adverse events were recorded for safety analysis. Five IIM-ILD patients received eight cycles. FVC-predicted values significantly decreased from 6 months before rituximab administration to those at the baseline (54.1% predicted (pre-6 months) vs. 48.5% predicted (baseline), p = 0.043); however, the FVC decline stabilized after rituximab. The rate of disease progression before rituximab showed a tendency to decrease after rituximab (75% (before) vs. 12.5% (6 months after, p = 0.059) vs. 14.3% (12 months after, p = 0.102)). Three adverse events developed, but none resulted in death. Rituximab can stabilize lung function decline with tolerable safety in Korean IIM patients with refractory ILD. [ABSTRACT FROM AUTHOR]

Effects of chronic stroke on pulmonary function are largely unknown. To compare lung volumes in people with chronic stroke with a control group of healthy people matched by age and sex, as well as to investigate the relationship between the lung volumes and functional capacity. A cross-sectional study involving people with chronic stroke. Cases were matched to a control group of healthy people. Lung function and the distance walked during the Six-Minute Walk Test (6MWD) were the main outcomes. Independent t-tests were used to compare pulmonary function between groups and the Pearson correlation coefficient was used to assess any relationship between lung volumes and the 6MWD in the stroke group. Sixty-six participants (24 males in each group; 56.5 ± 15.5 years) were included. People with stroke presented significantly lower lung volumes when compared to the control group. The median of forced vital capacity (FVC) was 79% and peak expiratory flow was 64% of the reference value. The 6MWD was found to be weakly correlated with inspiratory reserve volume (r = 0.39, p =.03) and peak inspiratory flow (r = 0.35, p =.05). People with chronic stroke show decreased lung volumes when compared with healthy people and this likely impacts on their functional capacity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the number of new cases of coronavirus 2019 (COVID-19) has been drastically reduced worldwide, patients who demonstrate long-term symptoms need more attention from health systems, as these symptoms can negatively affect functionality and quality of life. OBJECTIVE: To evaluate muscle function and quality of life at 3, 6, 9 and 12 months in patients with post-acute COVID-19 syndrome and to assess their associations with general fatigue and lung function. METHODS: This observational and longitudinal study evaluated patients with post-acute COVID-19 syndrome. Participants were subjected to the following evaluations: Short Form-36; handgrip strength; Functional Assessment of Chronic Illness Therapy-Fatigue scale; and spirometry. RESULTS: Among the 350 participants who were evaluated in the third month, 74.6%, 61.4% and 45.4% reported general fatigue, dyspnoea and cough, respectively. In the comparisons between the third month and the sixth month, there were significant increases in Functional Assessment of Chronic Illness Therapy-Fatigue scale, pulmonary function and several Short Form-36 domains. In the comparisons between the sixth month and the ninth month, there was a significant increase only in the social functioning domain of the Short Form-36. In the comparisons between the ninth month and the twelfth month, there was an increase only in some Short Form-36 domains. Significant correlations were observed between the Short Form-36 domains with Functional Assessment of Chronic Illness Therapy-Fatigue scale, handgrip strength and pulmonary function. CONCLUSION: In patients with post-acute COVID-19 syndrome, there was a progressive improvement in quality of life, general fatigue and pulmonary function during the 12 months of follow-up, with this improvement being more pronounced in the first 6 months. There was a relationship between functionality and quality of life in these patients. [ABSTRACT FROM AUTHOR]

Objectives: In many countries, workers who developed asbestosis due to their occupation are eligible for government support. Based on the results of clinical examination, a team of pulmonologists determine the eligibility of patients to these programs. In this Dutch cohort study, we aim to demonstrate the potential role of an artificial intelligence (AI)-based system for automated, standardized, and cost-effective evaluation of applications for asbestosis patients. Methods: A dataset of n = 523 suspected asbestosis cases/applications from across the Netherlands was retrospectively collected. Each case/application was reviewed, and based on the criteria, a panel of three pulmonologists would determine eligibility for government support. An AI system is proposed, which uses thoracic CT images as input, and predicts the assessment of the clinical panel. Alongside imaging, we evaluated the added value of lung function parameters. Results: The proposed AI algorithm reached an AUC of 0.87 (p < 0.001) in the prediction of accepted versus rejected applications. Diffusion capacity (DLCO) also showed comparable predictive value (AUC = 0.85, p < 0.001), with little correlation between the two parameters (r-squared = 0.22, p < 0.001). The combination of the imaging AI score and DLCO achieved superior performance (AUC = 0.95, p < 0.001). Interobserver variability between pulmonologists on the panel was estimated at alpha = 0.65 (Krippendorff's alpha). Conclusion: We developed an AI system to support the clinical decision-making process for the application to the government support for asbestosis. A multicenter prospective validation study is currently ongoing to examine the added value and reliability of this system alongside the clinic panel. Key Points: • Artificial intelligence can detect imaging patterns of asbestosis in CT scans in a cohort of patients applying for state aid. • Combining the AI prediction with the diffusing lung function parameter reaches the highest diagnostic performance. • Specific cases with fibrosis but no asbestosis were correctly classified, suggesting robustness of the AI system, which is currently under prospective validation. [ABSTRACT FROM AUTHOR]

To investigate the effect of mobilization with movement (MWM) on pulmonary functions in subjects with thoracic hyperkyphosis. This randomized single-blinded controlled trial included a sample of 50 subjects (age 18 − 25 years old) with thoracic hyperkyphosis. Subjects were randomly allocated into two groups; the Real MWM group (n = 25) which received thoracic MWM plus standard postural correction exercises, and the Sham MWM group (n = 25) which received sham MWM plus standard postural correction exercises. Digital X-ray and handheld spirometer were used to measure selected pulmonary function tests (FVC, FEV1/FVC ratio, MVV) respectively. Within-group comparisons demonstrated a statistically significant improvement in all outcome measures in both groups. The between-group comparisons demonstrated significant improvement in the MWM compared to the Sham group regarding the value of FVC, FEV1/FVC ratio, and MVV (P <.05). In young adults with thoracic hyperkyphosis, MWM plus postural exercise produces better improvements in FVC, FEV1, FEV1/FVC, and MVV compared to sham MWM plus postural exercise. [ABSTRACT FROM AUTHOR]

Depression is a severe and common mental disorder. The association between depressive symptoms and lung function remains unclear. To determine whether depressive symptoms are associated with lung function in U.S. adults without pulmonary diseases. A cross-sectional study of National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2012 were used to estimate the relationship between depressive symptoms and lung function. Depressive symptoms were determined by a participant's score on the Patient Health Questionnaire-9. Forced Expiratory Volume 1st Second (FEV1) Forced Vital Capacity (FVC) were determined by the spirometry. Weighted multivariate linear regression was used to analyze this relationship and subgroup analyses were performed. Of 8027 participants, 576 (7.18 %) participants with depression. Depression group had significant lower FEV1 and FVC than non-depression group. After adjustment for all covariates, there was a significant negative association between depressive symptoms and FVC (β −4.84, 95 % CI −9.10 to −0.57), especially in non-Hispanic White people (β −9.03, 95 % CI −14.38 to −3.69). There was no independent association between depressive symptoms and FEV1 in all participants, whereas the association was significant in non-Hispanic White people (β −4.91, 95 % CI −9.50 to −0.32). High depressive symptoms were independently associated with decline of FVC among U.S. adults without pulmonary diseases, especially in non-Hispanic White people. In addition, although it was not independently associated with FEV1 in all participants, depressive symptom score was also negatively associated with FEV1 in non-Hispanic White people. • High depressive symptoms were independently associated with decline of FVC among U.S. adults without pulmonary diseases. • High depressive symptoms were more obvious associated with decline of FVC in non-Hispanic White people. • High depressive symptoms were also independently associated with decline of FEV1 in non-Hispanic White people. [ABSTRACT FROM AUTHOR]

Background and Objective: The effect of serial incremental concentrations of methacholine is only slightly cumulative when assessed by spirometry. This limited cumulative effect may be attributed to the bronchodilator effect of deep inspirations that are required between concentrations to measure lung function. Using oscillometry, the response to methacholine can be measured without deep inspirations. Conveniently, oscillometry can also dissociate the contribution of large versus small airways. Herein, oscillometry was used to assess the cumulative effect of methacholine in the absence of deep inspirations on large and small airways. Methods: Healthy and asthmatic volunteers underwent a multiple‐concentration methacholine challenge on visit 1 and a single‐concentration challenge on visit 2 using the highest concentration of visit 1. The maximal response was compared between visits to assess the cumulative effect of methacholine. The lung volume was also measured after the final concentration to assess hyperinflation. Results: In both healthy and asthmatic subjects, increases in resistance at 19 Hz (Rrs19), reflecting large airway narrowing, did not differ between the multiple‐ and the single‐concentration challenge. However, increases in resistance at 5 Hz (Rrs5) minus Rrs19, reflecting small airway narrowing, were 117 and 270% greater in the multiple‐ than the single‐concentration challenge in healthy (p = 0.006) and asthmatic (p < 0.0001) subjects, respectively. Hyperinflation occurred with both challenges and was greater in the multiple‐ than the single‐concentration challenge in both groups. Conclusion: Without deep inspirations, the effect of methacholine is cumulative on small airways but not on large airways. Lung hyperinflation and derecruitment may partially explain these different responses. [ABSTRACT FROM AUTHOR]

Laura Gochicoa-Rangel, Santiago C. Arce, Carlos Aguirre-Franco, Wilmer Madrid-Mejía, Mónica Gutiérrez-Clavería, Lorena Noriega-Aguirre, Patricia Schonffeldt-Guerrero, Agustín Acuña-Izcaray, Arturo Cortés-Telles, Luisa Martínez-Valdeavellano, Federico Isaac Hernández-Rocha, Omar Ceballos-Zúñiga, Rodrigo Del Rio Hidalgo, Sonia Sánchez, Erika Meneses-Tamayo, and Iván Chérrez-Ojeda; and on Behalf of the Respiratory Physiology Project in COVID-19 (FIRCOV). Effect of altitude on respiratory functional status in COVID-19 survivors: results from a Latin American Cohort—FIRCOV. High Alt Med Biol 24:37–48, 2023. Persistent symptoms and lung function abnormalities are common in COVID-19 survivors. Objectives: To determine the effect of altitude and other independent variables on respiratory function in COVID-19 survivors. Methods: Analytical, observational, cross-sectional cohort study done at 13 medical centers in Latin America located at different altitudes above sea level. COVID-19 survivors were invited to perform pulmonary function tests at least 3 weeks after diagnosis. Results: 1,368 participants (59% male) had mild (20%), moderate (59%), and severe (21%) disease. Restriction by spirometry was noted in 32%; diffusing capacity of the lung for carbon monoxide (DLCO) was low in 43.7%; and 22.2% walked less meters during the 6-minute walk test (6-MWT). In multiple linear regression models, higher altitude was associated with better spirometry, DLCO and 6-MWT, but lower oxygen saturation at rest and during exercise. Men were 3 times more likely to have restriction and 5.7 times more likely to have a low DLCO. Those who had required mechanical ventilation had lower DLCO and walked less during the 6-MWT. Conclusions: Men were more likely to have lower lung function than women, even after correcting for disease severity and other factors. Patients living at a higher altitude were more likely to have better spirometric patterns and walked farther but had lower DLCO and oxygen saturation. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Obstructive Pulmonary Disease (COPD), a prevalent respiratory condition, can be prevented and treated. Among various triggers, infections are a leading cause of COPD exacerbations. Assessing aerobic capacity is essential in COPD management, as it serves as a fundamental indicator of both quality of life and mortality. However, determining this target value necessitates the estimation of a gender-specific predictive aerobic capacity value for each individual. Need of the Study: The newly developed gender-based reference equation for aerobic capacity may have the potential to accurately calculate predicted values that assess the individual patient and aerobic capacity. Aim: To develop a gender-based prediction equation to assess aerobic capacity in COPD patients with infection. Materials and Methods: A cross-sectional study will be conducted at a tertiary care super specialty hospital, analysing various parameters including anthropometric data and pulmonary function tests to identify factors related to aerobic capacity. The Forced Expiration Volume in 1 second/Forced Vital Capacity (FEV1/FVC) ratio will be documented using the post-bronchodilator Pulmonary Function Test (PFT) report, while aerobic capacity will be evaluated through the Six-Minute Walk Test (6MWT). The sample size will be calculated with G*Power 3.1.9.7 software. Data will be analysed using IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Demographics and outcomes will be checked for normality using the Shapiro–Wilk test. Depending on data type, Chi-square, Spearman’s or Pearson’s tests will be used to assess the correlations between FEV1/ FVC and 6MWT. Multivariate linear regression with a step-wise approach will create a predictive equation for aerobic capacity. Subsequently, a standardised equation for aerobic capacity will be derived. [ABSTRACT FROM AUTHOR]

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Introduction: There are no published studies assessing the evolution of combined determination of the lung diffusing capacity for both nitric oxide and carbon monoxide (DLNO and DLCO) 12 months after the discharge of patients with COVID-19 pneumonia. Methods: Prospective cohort study which included patients who were assessed both 3 and 12 months after an episode of SARS-CoV-2 pneumonia. Their clinical status, health condition, lung function testings (LFTs) results (spirometry, DLNO-DLCO analysis, and six-minute walk test), and chest X-ray/computed tomography scan images were compared. Results: 194 patients, age 62 years (P25–75, 51.5–71), 59% men, completed the study. 17% required admission to the intensive care unit. An improvement in the patients' exercise tolerance, the extent of the areas of ground-glass opacity, and the LFTs between 3 and 12 months following their hospital discharge were found, but without a decrease in their degree of dyspnea or their self-perceived health condition. DLNO was the most significantly altered parameter at 12 months (19.3%). The improvement in DLNO-DLCO mainly occurred at the expense of the recovery of alveolar units and their vascular component, with the membrane factor only improving in patients with more severe infections. Conclusions: The combined measurement of DLNO-DLCO is the most sensitive LFT for the detection of the long-term sequelae of COVID-19 pneumonia and it explain better their pathophysiology. [ABSTRACT FROM AUTHOR]

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The aim of this study was to investigate mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength and pulmonary function in surgical cancer patients admitted to an intensive care unit (ICU). We conducted a prospective cohort study with 85 patients. Mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength, and pulmonary function were assessed using the following tests: ICU Mobility Scale (IMS); Chelsea Critical Care Physical Assessment (CPAx); handgrip strength and Medical Research Council Sum-Score (MRC-SS); maximal inspiratory pressure (MIP) and S-Index; and peak inspiratory flow, respectively. The assessments were undertaken at ICU admission and discharge. The data were analyzed using the Shapiro–Wilk and Wilcoxon tests and Spearman’s correlation coefficient. Significant differences in inspiratory muscle strength, CPAx, grip strength, MRC-SS, MIP, S-Index, and peak inspiratory flow scores were observed between ICU admission and discharge. Grip strength showed a moderate correlation with MIP at admission and discharge. The findings also show a moderate correlation between S-Index scores and both MIP and peak inspiratory flow scores at admission and a strong correlation at discharge. Patients showed a gradual improvement in mobility, physical functioning, peripheral and inspiratory muscle strength, and inspiratory flow during their stay in the ICU. [ABSTRACT FROM AUTHOR]