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Background: Limited research has investigated the relationship between small airway dysfunction (SAD) and static lung hyperinflation (SLH) in patients with post-acute sequelae of COVID-19 (PASC) especially dyspnea and fatigue., Methods: 64 patients with PASC were enrolled between July 2020 and December 2022 in a prospective observational cohort. Pulmonary function tests, impulse oscillometry (IOS), and symptom questionnaires were performed two, five and eight months after acute infection. Multivariable logistic regression models were used to test the association between SLH and patient-reported outcomes., Results: SLH prevalence was 53.1% (34/64), irrespective of COVID-19 severity. IOS parameters and circulating CD4/CD8 T-cell ratio were significantly correlated with residual volume to total lung capacity ratio (RV/TLC). Serum CD8 + T cell count was negatively correlated with forced expiratory volume in the first second (FEV 1 ) and forced vital capacity (FVC) with statistical significance. Of the patients who had SLH at baseline, 57% continued to have persistent SLH after eight months of recovery, with these patients tending to be older and having dyspnea and fatigue. Post-COVID dyspnea was significantly associated with SLH and IOS parameters R5-R20, and AX with adjusted odds ratios 12.4, 12.8 and 7.6 respectively. SLH was also significantly associated with fatigue., Conclusion: SAD and a decreased serum CD4/CD8 ratio were associated with SLH in patients with PASC. SLH may persist after recovery from infection in a substantial proportion of patients. SAD and dysregulated T-cell immune response correlated with SLH may contribute to the development of dyspnea and fatigue in patients with PASC., (© 2024. The Author(s).)

Rationale: Subjects with preserved ratio impaired spirometry (PRISm) experience increased respiratory symptoms, although they present heterogeneous characteristics. However, the longitudinal changes in these symptoms and respiratory function are not well known. Objectives: To investigate PRISm from the viewpoint of respiratory symptoms in a longitudinal, large-scale general population study. Methods: The Nagahama study included 9,789 inhabitants, and a follow-up evaluation was conducted after 5 years. Spirometry and self-administered questionnaires regarding respiratory symptoms, including prolonged cough, sputum and dyspnea, and comorbidities were conducted. Results: In total, 9,760 subjects were analyzed, and 438 subjects had PRISm. Among the subjects with PRISm, 53% presented with respiratory symptoms; dyspnea was independently associated with PRISm. Follow-up assessment revealed that 73% of the subjects with PRISm with respiratory symptoms were consistently symptomatic, whereas 39% of the asymptomatic subjects with PRISm developed respiratory symptoms within 5 years. In addition, among subjects with respiratory symptoms without airflow limitation at baseline, PRISm was a risk factor for the development of airflow limitation independent of smoking history and comorbidities. Conclusions: This study demonstrated that 53% of the subjects with PRISm had respiratory symptoms; dyspnea was a distinct characteristic of PRISm. Approximately three-fourths of the symptomatic subjects with PRISm consistently complained of respiratory symptoms within 5 years. Together with our result that PRISm itself is an independent risk factor for the development of chronic obstructive pulmonary disease among subjects with respiratory symptoms, the clinical course of subjects with PRISm with symptoms requires careful monitoring.

Background: Spirometry reference values differ by race/ethnicity, which is controversial. We evaluated the effect of race-specific references on prevalence of lung function impairment and its relation to breathlessness and mortality in the US population., Methods: Population-based analysis of the National Health and Nutrition Examination Survey (NHANES) 2007-2012. Race/ethnicity was analyzed as black, white, or other. Reference values for forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC) were calculated for each person using the Global Lung Initiative (GLI)-2012 equations for (1) white; (2) black; and (3) other/mixed people. Outcomes were prevalence of lung function impairment (< lower limit of normal [LLN]), moderate/severe impairment (< 50%pred); exertional breathlessness; and mortality until 31 December, 2015., Results: We studied 14,123 people (50% female). Compared to those for white, black reference values identified markedly fewer cases of lung function impairment (FEV 1 ) both in black people (9.3% vs. 36.9%) and other non-white (1.5% vs. 9.5%); and prevalence of moderate/severe impairment was approximately halved. Outcomes by impairment differed by reference used: white (best), other/mixed (intermediate), and black (worst outcomes). Black people with FEV 1  ≥ LLN black but < LLN white had 48% increased rate of breathlessness and almost doubled mortality, compared to blacks ≥ LLN white . White references identified people with good outcomes similarly in black and white people. Findings were similar for FEV 1 and FVC., Conclusion: Compared to using a common reference (for white) across the population, race-specific spirometry references did not improve prediction of breathlessness and prognosis, and may misclassify lung function as normal despite worse outcomes in black people., (© 2022. The Author(s).)

Objective: Exposures at hairdressers' work have been reported to lead to an increased risk of several health outcomes. The present study aimed to investigate the relations between occupational exposures and respiratory symptoms and lung function among hairdressers in Iran., Methods: We conducted a cross-sectional study to compare potential respiratory effects among 140 women working as hairdressers to such effects among 140 women working as office workers (administrative personnel). Both groups worked in Shiraz, Iran. Respiratory symptoms were assessed by a standard respiratory questionnaire. The questionnaire also inquired about substances used and workspace conditions, including ventilation type. Lung function levels were measured by spirometry., Results: Respiratory symptoms, including cough, wheezing, shortness of breath, and chest tightness were significantly more frequent in hairdressers compared to the reference group (p < 0.05). After controlling for potential confounders, hairdressers had a prevalence ratio (PR) of 2.18 (95% CI 1.26-3.77) for cough, 9.59 (95% CI 1.004-91.73) for wheezing, 2.06 (95% CI 1.25-3.39) for shortness of breath, and 3.31 (95% CI 1.84-5.97) for chest tightness compared to the reference group. Lung function parameters (including VC, FVC, and FEV1) were significantly reduced in hairdressers (p < 0.001). Absence of air conditioning predicted greater reduction in lung function (p < 0.05) in the exposed. Decrease in FVC with normal FEV1/FVC in the exposed group suggested existence of restrictive lung function., Conclusions: This study provides evidence of increased prevalence of respiratory symptoms and restrictive lung function impairment among hairdressers in Iran.

Objective: Cancers have been reported to worsen the clinical course of coronavirus disease 2019 (COVID-19) infection. We aimed to demonstrate the real-life data on health outcomes in COVID-19-infected cancer patients., Materials and Methods: We analyzed the data of 43 COVID-19-infected cancer patients in our COVID-19 clinics between March 25, 2020, and May 9, 2020, retrospectively., Results: We determined that 1051 patients were followed up with COVID-19 infection and 43 (4%) of them were cancer patients. The mean age of the patients was 64.3 ± 12.3 years. Lung cancer is the most common cancer type among the patients (23.2%). Dyspnea (51.2%) was the most common symptom in the first admission. Typical ground-glass consolidation or patchy appearance with peribronchial thickening resembling bronchopneumonia on high-resolution computed tomography (HRCT) was present in 29 (67.4%) patients. COVID-19 was diagnosed in 14 (32.5%) patients based on reverse transcriptase-polymerase chain reaction analysis of nose-throat swab samples without any sign of lung involvement on HRCT. Total mortality of the COVID-19 infection was 46.5% (n = 20). Presence of heart disease (hazard ratio [HR]: 3.5; 95% confidence interval [CI]: 1.29-9.4), previous surgeries to the respiratory system (HR: 6.95; 95% CI: 1.29-27.7), and presence of dyspnea at admission (HR: 4; 95% CI: 1.31-12.3) were statistically significantly associated with death (P = 0.01, 0.02, and 0.01, respectively)., Conclusion: Our practices supported that cancer patients were more affected by COVID-19 disease than the normal population. However, our findings can not be generalized due to being retrospective and single centered study, Also, we did not compare the findings with noncancer patients with COVID19 disease., Competing Interests: None

Purpose of Review: Activity-related breathlessness is a key determinant of poor quality of life in patients with advanced cardiorespiratory disease. Accordingly, palliative care has assumed a prominent role in their care. The severity of breathlessness depends on a complex combination of negative cardiopulmonary interactions and increased afferent stimulation from systemic sources. We review recent data exposing the seeds and consequences of these abnormalities in combined heart failure and chronic obstructive pulmonary disease (COPD)., Recent Findings: The drive to breathe increases ('excessive breathing') secondary to an enlarged dead space and hypoxemia (largely COPD-related) and heightened afferent stimuli, for example, sympathetic overexcitation, muscle ergorreceptor activation, and anaerobic metabolism (largely heart failure-related). Increased ventilatory drive might not be fully translated into the expected lung-chest wall displacement because of the mechanical derangements brought by COPD ('inappropriate breathing'). The latter abnormalities, in turn, negatively affect the central hemodynamics which are already compromised by heart failure. Physical activity then decreases, worsening muscle atrophy and dysfunction., Summary: Beyond the imperative of optimal pharmacological treatment of each disease, strategies to lessen ventilation (e.g., walking aids, oxygen, opiates and anxiolytics, and cardiopulmonary rehabilitation) and improve mechanics (heliox, noninvasive ventilation, and inspiratory muscle training) might mitigate the burden of this devastating symptom in advanced heart failure-COPD.

Background: Dyspnea is a subjective symptom of asthma whose perception is characterized by an interindividual variability. Poor dyspnea perception is usually associated with increased risk of exacerbation and may lead to inappropriate asthma management and under-treatment. We sought to identify factors associated with discrepancies between poor dyspnea perception and abnormal lung function in patients with moderate persistent asthma., Methodology: 65 patients, who attended their scheduled follow-up pulmonology consultation at Ibn Sina Hospital (Rabat - Morocco), underwent interrogation including modified Medical Research Council (mMRC) scale for dyspnea, physical examination and spirometry. Two groups, those with mMRC < 2 (poor dyspnea perceivers) and those with mMRC scale ≥ 2 were compared., Results: Poor dyspnea perception was found in 21 patients (32.3%). Associated factors were male sex (p : 0.03), low socio-economic income (p : 0.01), an onset of symptoms greater than 10 years (p : 0.01), BMI ≥ 25 Kg/m2 (p : 0.04) and depression (p : 0.04)., Conclusion: The results revealed factors significantly associated with poor dyspnea perception despite an obstructive ventilatory disorder. These factors could usefully be considered to successfully manage asthma as well as the regular prescription of an objective test like spirometry., (© 2020 Jniene A et al.)

Background: Prediction of future lung function will enable the identification of individuals at high risk of developing COPD, but the trajectory of lung function decline varies greatly among individuals. This study involved the development and validation of an individualized prediction model of lung function trajectory and risk of airflow limitation in the general population., Methods: Data were obtained from the Framingham Offspring Cohort, which included 4,167 participants ≥ 20 years of age and who had ≥ 2 valid spirometry assessments. The primary outcome was prebronchodilator FEV 1 ; the secondary outcome was the risk of airflow limitation (defined as FEV 1 /FVC less than the lower limit of normal). Mixed effects regression models were developed for individualized prediction, and a machine learning algorithm was used to determine essential predictors. The model was validated in two large, independent multicenter cohorts (N = 2,075 and 12,913, respectively)., Results: With 20 common predictors, the model explained 79% of the variation in FEV 1 decline in the derivation cohort. In two validation datasets, the model had low error in predicting FEV 1 decline (root mean square error range, 0.18-0.22 L) and high discriminative power in predicting risk of airflow limitation (C-statistic range, 0.86-0.87). This model was implemented in a freely accessible website-based application, which allows prediction based on flexible sets of predictors (http://resp.core.ubc.ca/ipress/FraminghamFEV1)., Conclusions: The individualized predictor is an accurate tool to predict long-term lung function trajectories and risk of airflow limitation in the general population. This model enables identifying individuals at higher risk of COPD, who can then be targeted for preventive therapies., (Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Purpose: Many older adults with a history of smoking and asthma develop clinical features of both asthma and COPD, an entity sometimes called asthma-COPD overlap (ACO). Patients with ACO may be at higher risk of poor health outcomes than those with asthma or COPD alone. However, understanding of ACO is limited in the primary care setting and more information is needed to better inform patient management. We aimed to compare the characteristics of patients with ACO or COPD in Australian general practices., Patients and Methods: Data were from the RADICALS (Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers) trial, an intervention study of an interdisciplinary community-based model of care. Baseline demographic and clinical characteristics, pre- and post-bronchodilator spirometry, dyspnoea and St. George's Respiratory Questionnaire scores were compared between 60 ACO patients and 212 with COPD alone., Results: Pre-bronchodilator Forced Expiratory Volume in 1 second (mean±SD 58.4±14.3 vs 67.5±20.1% predicted) and Forced Vital Capacity (mean 82.1±16.9 v 91.9±17.2% predicted) were significantly lower in the ACO group (p<0.001), but no difference was found in post-bronchodilator spirometry. Demographic and clinical characteristics, dyspnoea, quality of life, comorbidities and treatment prescribed did not differ significantly between groups., Conclusion: This is the first study describing the clinical characteristics of ACO patients in Australian general practices. Our finding of lower pre-bronchodilator lung function in the ACO group compared to those with COPD reinforces the importance of spirometry in primary care to inform management., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684., Competing Interests: Michael J Abramson holds an investigator-initiated grant from Pfizer for unrelated research. He has also conducted an unrelated consultancy for Sanofi and reports grants from Boehringer-Ingelheim, during the conduct of the study. Johnson George has held investigator-initiated grants from Pfizer for unrelated research and has received cash and in-kind contributions from Boehringer Ingelheim (BI) Pty Ltd for an unrelated project. He has received an honorarium from GSK for consultancy. He also received non-financial support from the Lung Foundation Australia, grants from the National Health and Medical Research Council, non-financial support from the Inner East Melbourne Primary Health Network, during the conduct of the study and grants and personal fees from GSK and grants from Pfizer, outside the submitted work. Professor Anne E Holland reports grants from the National Health and Medical Research Council, grants from Boehringer Ingelheim, non-financial support from Lung Foundation Australia, and non-financial support from Eastern Melbourne PHN, during the conduct of the study. Ms Jenifer Liang reports grants and non-financial support from Boehringer Ingelheim, non-financial support from the Lung Foundation Australia, non-financial support from Eastern Melbourne PHN, and grants from National Health and Medical Research Council (Australia), during the conduct of the study. The authors report no other conflicts of interest in this work., (© 2019 Izbicki et al.)

When caring for patients with respiratory diseases, always think of the heart! This is especially important for COPD patients, but also for a variety of other disorders of the respiratory system. At the workshop "Luftschlösser", held once more at Wiesbaden, Germany in February 2019 the many and important interactions of the lungs and the heart as well as the therapeutic implications were discussed. Based on pathophysiology, the psycho-social consequences of dyspnea, the leading symptom in patients with lung and heart disease became apparent. A particularly demanding diagnostic and therapeutic situation occurs in patients suffering simultaneously of lung and heart disease. It has been shown how frequently the diagnosis myocardial infarction is missed in COPD patients - and vice versa. Surprisingly, this is also the case in asthmatics with coronary heart disease or heart failure, a fact not readily known in clinical practice. In patients with emphysema and no apparent heart disease, hyperinflation leads to significantly restricted heart function. Reducing hyperinflation by inhaling broncholytics thus improves heart function. Biomarkers are increasingly being used for diagnostic purposes. Their role is being investigated in the large German COPD cohort COSYCONET. Lung patients suffering from more severe heart diseases pose a challenge for therapy in intensive care, especially when ventilated, and weaning from the ventilator is prolonged. Lung vessel diseases are "classic" examples of the intimate interaction of the lungs and the heart. In pulmonary arterial hypertension as well as in chronic thrombo-embolic pulmonary hypertension the lag time between the first symptoms and the definite diagnosis is often unacceptably long. For both diseases of the lung vessels therapeutic options have improved significantly over the last years. Pulmonologists should take care of this increasingly important patient group. Sleep-related breathing disorders and heart function are closely intertwined. Both conditions need special attention after the results of the SERVE-HF trial have been published. But there is no doubt that obstructive sleep apnea represents an independent and important risk factor for cardiovascular disease and needs to be treated according to existing guidelines.This workshop demonstrated impressively the multiple interactions of the respiratory system with cardiac function, resulting diagnostic and therapeutic problems, and means to overcome these problems. Guidelines for respiratory diseases should appropriately address cardiac comorbidity., Competing Interests: B. Jany erhielt Vortragshonorare und Reisekostenerstattung von Boehringer Ingelheim.R. Bals erhielt Forschungsmittel oder persönliche Bezüge von AstraZeneca, CSL Behring, Boehringer Ingelheim, Novartis, German Federal Ministry of Education and Research (BMBF), Competence Network Asthma and COPD (ASCONET), persönliche Bezüge von GlaxoSmithKline, Grifols. Weitere Förderung außerhalb dieser Publikation erfolgte durch die Wilhelm-Sander Stiftung, die Schwiete Stiftung, die Deutsche Krebshilfe und den Mukoviszidose e. V. M. Dreher erhielt Vortragshonorare von Actelion, Astra Zeneca, Bayer, Berlin Chemie, Boehringer, Chiesi, Hamilton, Heinen und Löwenstein, Intermune, Linde, Novartis, Pfizer, Philips Respironics, ResMed, Roche und Weinmann, Beraterhonorare von Almirall, Boehringer, Hamilton, Linde, Novartis, Pfizer, Philips Respironics, ResMed und Roche, Forschungsmittel von Linde, Philips Respironics und ResMed.M. Held gibt an Vortrags- und Beraterhonorare von folgenden Firmen erhalten zu haben: Actelion, Astra Zeneca, Bayer Healthcare, BMS, Boehringer Ingelheim, Berlin Chemie, Daichii Sanyo, MSD, OMT, Pfizer und Forschungsbeihilfen von der Firma Actelion.R. Koczulla hat Honorare von Grifols, CSL, Novartis, Roche, GSK, Boehringer, Astra Zeneca, Berlin Chemie, TEVA, Sanofi, Mundipharma, GSK, Chiesi erhalten.W. Randerath erhielt Vortragshonorare und Reisekosten der Firmen Boehringer Ingelheim, Berlin Chemie, Bayer, Novartis und Roche.H. Watz erhielt Honorare für Vortrags- und Beratungstätigkeit sowie die Durchführung von klinischen Studien und Reisekostenerstattungen von den Firmen AstraZeneca, Bayer, Boehringer Ingelheim, BerlinChemie, Chiesi, Novartis, GlaxoSmithKline, Takeda und SanofiAventis.H. Wilkens erhielt Honorare für Vorträge und/oder Beratertätigkeiten von Actelion, Bayer Health Care, Boehringer Ingelheim, MSD, Pfizer und Roche.G. Steinkamp erhielt Honorare für Medizinisch-wissenschaftliches Publizieren von Boehringer Ingelheim, Gilead Sciences, InfectoPharm, Novartis, Pari GmbH und Alpha1 Deutschland e. V. L. Jany und M. Pfeifer geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Breathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) >30 kg/m 2 ) is rapidly increasing globally and its impact on breathlessness is unclear., Methods: This population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score ≥1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex., Results: We included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m 2 ; and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; p<0.001) was related to their lower FVC. Irrespective of current BMI and confounders, individuals who had increased in BMI since age 20 had more breathlessness., Conclusion: Breathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes., Competing Interests: Competing interests: SS reports being an advisory board member and receiving speakers honoraria from Actelion, Bayer, MSD, outside the submitted work. Dr Olin reports having a patent WO2009045163 (Collection and measurement of exhaled particles) and being a chairholder and board member of PExA AB, outside the submitted work. JS reports advisory board work for Itrim, outside the submitted work., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: A seven-item prescreening questionnaire (gender, age, pack-years smoking, dyspnea, sputum, cough, previous spirometry data) was developed for COPD detection in the primary care setting (PUMA Study) of four Latin America countries., Objectives: To validate the PUMA prescreening COPD questionnaire externally in two different populations (primary care and general)., Methods: The PUMA prescreening COPD questionnaire score was applied to subjects from the Hospital Maciel, Montevideo (primary care), case-finding program and the PLATINO population (general) using PUMA study inclusion criteria. Post-bronchodilator FEV 1 /FVC <0.70 and lower limit of normal (LLN) criteria were used to define COPD. Area under the received operator curve (ROC AUC ), sensitivity, specificity, predictive positive and negative values (PNV), number needed to treat (NNT), and best cut-points of the score were calculated., Results: 974 individuals from Hospital Maciel and 2512 from the PLATINO population were eligible, using post-bronchodilator FEV 1 /FVC <0.70, 45.1% and 18.7% had COPD, respectively, and using LLN 38.4% and 15.4% had COPD, respectively. From Hospital Maciel (post-bronchodilator FEV 1 /FVC <0.70), the best cut-point of ≥6 had moderate discriminatory power (ROC AUC 0.70), sensitivity 69.9%, specificity 62.1%, PNV 70.9%, and NNT of 3. The discriminatory power was 0.73 (ROC AUC ) in the PLATINO population with three potential cut-points (Youden's index): ≥3 (sensitivity 85.4%, specificity 46.9%), ≥4 (sensitivity 66.7%, specificity 66.5%), and ≥5 (sensitivity 51.5%, specificity 81.6%); the PNV at each cut-point was 93.3%, 89.9%, and 88.0%, respectively. The NNT was 5 for scores ≥3 and ≥4, and 4 for ≥5. The mean accuracy using the LLN for Hospital Maciel and PLATINO was 0.67 and 0.70, respectively., Conclusion: External validation of the PUMA prescreening questionnaire in two Latin American populations (general and primary care) suggests moderate accuracy, similar to the original study in which the questionnaire was developed., Competing Interests: Larissa Ramirez is a full-time employee of AstraZeneca Latin America. Ana Menezes has been paid for her work as a statistician for the study. The Hospital Maciel, Montevideo, data of this paper were presented at the European Respiratory Society 2017 Congress as a poster presentation with interim findings. The poster’s abstract was published in the European Respiratory Journal 2017; 50 (Suppl 61): PA1198. DOI: 10.1183/1393003. The authors report no other conflicts of interest in this work., (© 2019 Lopez Varela et al.)

Purpose: The aim of this study was to examine the changing influence over time of comorbid heart disease on symptoms and health status in patients with COPD., Patients and Methods: This is a prospective cohort study of 495 COPD patients with a baseline in 2005 and follow-up in 2012. The study population was divided into three groups: patients without heart disease (no-HD), those diagnosed with heart disease during the study period (new-HD) and those with heart disease at baseline (HD). Symptoms were measured using the mMRC. Health status was measured using the Clinical COPD Questionnaire (CCQ) and the COPD Assessment Test (CAT; only available in 2012). Logistic regression with mMRC ≥2 and linear regression with CCQ and CAT scores in 2012 as dependent variables were performed unadjusted, adjusted for potential confounders, and additionally adjusted for baseline mMRC, respectively, CCQ scores., Results: Mean mMRC worsened from 2005 to 2012 as follows: for the no-HD group from 1.8 (±1.3) to 2.0 (±1.4), ( P =0.003), for new-HD from 2.2 (±1.3) to 2.4 (±1.4), ( P =0.16), and for HD from 2.2 (±1.3) to 2.5 (±1.4), ( P =0.03). In logistic regression adjusted for potential confounding factors, HD (OR 1.71; 95% CI: 1.03-2.86) was associated with mMRC ≥2. Health status worsened from mean CCQ as follows: for no-HD from 1.9 (±1.2) to 2.1 (±1.3) with ( P =0.01), for new-HD from 2.3 (±1.5) to 2.6 (±1.6) with ( P =0.07), and for HD from 2.4 (±1.1) to 2.5 (±1.2) with ( P =0.57). In linear regression adjusted for potential confounders, HD (regression coefficient 0.12; 95% CI: 0.04-5.91) and new-HD (0.15; 0.89-5.92) were associated with higher CAT scores. In CCQ functional state domain, new-HD (0.14; 0.18-1.16) and HD (0.12; 0.04-0.92) were associated with higher scores. After additional correction for baseline mMRC and CCQ, no statistically significant associations were found., Conclusion: Heart disease contributes to lower health status and higher symptom burden in COPD but does not accelerate the worsening over time., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objectives: The present cross-sectional study aimed to estimate the prevalence of chronic respiratory symptoms in primary Sjögren's syndrome (pSS) and define the clinical, functional and imaging characteristics of symptomatic pulmonary disease in pSS., Methods: Four hundred and fourteen consecutive pSS patients were interviewed for the presence of chronic respiratory complaints (cough and/or dyspnea). Symptomatic pSS patients without respiratory or other comorbidities underwent further investigation with clinical evaluation and assessment with pulmonary functional testing (PFTs) and chest high resolution CT (hrCT) on inspiratory and expiratory phase. Comparison of clinical and laboratory features between symptomatic and asymptomatic pSS patients was also performed., Results: Prevalence of chronic respiratory symptoms in pSS was estimated at 21.5% (89/414). Symptoms were attributed to underlying comorbidities in approximately one third of cases (30/89). Thirty nine of the remaining 59 patients were finally assessed with PFTs and hrCT. Small airway disease was diagnosed in 20 individuals with an obstructive pattern in PFTs and/or compatible radiological signs. Seven patients were diagnosed with interstitial lung disease, while in the remaining 12 pSS patients, with normal PFTs and hrCT, symptoms were attributed to xerotrachea. Raynaud's phenomenon occurred more frequently in symptomatic than asymptomatic patients (p=0.024)., Conclusions: Approximately one fifth of a large cohort of pSS patients presented chronic respiratory symptoms. Small airway disease was the most commonly recognized pulmonary disorder among symptomatic pSS patients, followed by xerotrachea and interstitial lung disease.

Introduction: A cohort of Gulf War I veterans who sustained exposure to depleted uranium undergoes biennial surveillance for potential uranium-related health effects. We performed impulse oscillometry and hypothesized that veterans with higher uranium body burdens would have more obstructive abnormalities than those with lower burdens., Methods: We compared pulmonary function of veterans in high versus low urine uranium groups by evaluating spirometry and oscillometry values., Results: Overall mean spirometry and oscillometry resistance values fell within the normal ranges. There were no significant differences between the high and low uranium groups for any parameters. However, more veterans were classified as having obstruction by oscillometry (42%) than spirometry (8%)., Conclusions: While oscillometry identified more veterans as obstructed, obstruction was not uranium-related. However, the added sensitivity of this method implies a benefit in wider surveillance of exposed cohorts and holds promise in identifying abnormalities in areas of the lung historically described as silent., (© 2018 Wiley Periodicals, Inc.)

Objectives: To compare characteristics of patients readmitted after discharge by chronic obstructive pulmonary disease (COPD) exacerbation with those who were not readmitted and to identify factors associated with readmission risk., Patients and Methods: We randomly selected a group of 40 COPD patients with high frequency of readmissions (HFR), who had ≥ 2 admissions by COPD exacerbation within 30 days after the last admission in 2015, and another group of 40 COPD patients with low frequency of readmissions (LFR), with 0-1 admissions in that period., Results: Patients of the HFR group, compared to those in LFR group, were more frequently males (p = 0.009), older (p = 0.022), had a higher degree of dyspnea (p = 0.044), worse lung function (p = 0.049), belonged more frequently to exacerbator emphysema phenotype (p < 0.001), and had a higher frequency of diabetes (p = 0.049). The variables independently associated with increased risk of HFR were sex (OR 0.06, 95% CI 0.01-0.63, in women in relation to males), exacerbator emphysema phenotype (OR 28.61, 95% CI 3.59 compared to non-exacerbator phenotype), complications during hospitalization (OR 0.09, 95% CI 0.01-0.62, compared with those without complications), destabilized heart failure (OR 5.25, 95% CI 1.11-24.75, compared to those who did not), and length of hospital stay (OR 0.79, 95% CI 0.65-0.95, per day)., Conclusions: Chronic obstructive pulmonary disease patients with HFR are more frequently male, older, have worse dyspnea, lower lung function, belong more frequent to exacerbator emphysema phenotype, and more frequently diabetics. The variables that continued to be independent predictors of HFR in the multivariate analysis were sex, phenotype, occurrence of complications during admission, destabilized heart failure, and length of hospital stay.

Background: Pulmonary tuberculosis (PTB) is a risk factor for COPD, but the clinical characteristics and the chest imaging features (emphysema and bronchiectasis) of COPD with previous PTB have not been studied well., Methods: The presence, distribution, and severity of emphysema and bronchiectasis in COPD patients with and without previous PTB were evaluated by high-resolution computed tomography (HRCT) and compared. Demographic data, respiratory symptoms, lung function, and sputum culture of Pseudomonas aeruginosa were also compared between patients with and without previous PTB., Results: A total of 231 COPD patients (82.2% ex- or current smokers, 67.5% male) were consecutively enrolled. Patients with previous PTB (45.0%) had more severe ( p =0.045) and longer history ( p =0.008) of dyspnea, more exacerbations in the previous year ( p =0.011), and more positive culture of P. aeruginosa ( p =0.001), compared with those without PTB. Patients with previous PTB showed a higher prevalence of bronchiectasis ( p <0.001), which was more significant in lungs with tuberculosis (TB) lesions, and a higher percentage of more severe bronchiectasis (Bhalla score ≥2, p =0.031), compared with those without previous PTB. The overall prevalence of emphysema was not different between patients with and without previous PTB, but in those with previous PTB, a higher number of subjects with middle ( p =0.001) and lower ( p =0.019) lobe emphysema, higher severity score ( p =0.028), higher prevalence of panlobular emphysema ( p =0.013), and more extensive centrilobular emphysema ( p =0.039) were observed. Notably, in patients with TB lesions localized in a single lung, no difference was found in the occurrence and severity of emphysema between the 2 lungs., Conclusion: COPD patients with previous PTB had unique features of bronchiectasis and emphysema on HRCT, which were associated with significant dyspnea and higher frequency of severe exacerbations. While PTB may have a local effect on bronchiectasis, its involvement in airspace damage in COPD may be extensive, probably through interactions with cigarette smoke., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Dyspnea is a common angina equivalent that adversely affects quality of life, but its prevalence in patients with chronic total occlusions (CTOs) and predictors of its improvement after CTO percutaneous coronary intervention (PCI) are unknown. We examined the prevalence of dyspnea and predictors of its improvement among patients selected for CTO PCI., Methods and Results: In the OPEN CTO registry (Outcomes, Patient health status, and Efficiency iN Chronic Total Occlusion) of 12 US experienced centers, 987 patients undergoing CTO PCI (procedure success 82%) were assessed for dyspnea with the Rose Dyspnea Scale at baseline and 1 month after CTO PCI. Rose Dyspnea Scale scores range from 0 to 4 with higher scores indicating more dyspnea with common activities. A total of 800 (81%) reported some dyspnea at baseline with a mean (±SD) Rose Dyspnea Scale of 2.8±1.2. Dyspnea improvement was defined as a ≥1 point decrease in Rose Dyspnea Scale from baseline to 1 month. Predictors of dyspnea improvement were examined with a modified Poisson regression model. Patients with dyspnea were more likely to be female, obese, smokers, and to have more comorbidities and angina. Among patients with baseline dyspnea, 70% reported less dyspnea at 1 month after CTO PCI. Successful CTO PCI was associated with more frequent dyspnea improvement than failure, even after adjustment for other clinical variables. Anemia, depression, and lung disease were associated with less dyspnea improvement after PCI., Conclusions: Dyspnea is a common symptom among patients undergoing CTO PCI and improves significantly with successful PCI. Patients with other potentially noncardiac causes of dyspnea reported less dyspnea improvement after CTO PCI., (© 2017 American Heart Association, Inc.)

Purpose: Chronic obstructive pulmonary disease (COPD), characterized by irreversible airflow obstruction, is a major cause of morbidity and mortality worldwide. However, geographic differences in the clinical characteristics of severe COPD patients have not been widely studied., Methods: We recruited a total of 828 severe COPD cases from three continents. Subjects in Poland were enrolled by the Institute of Tuberculosis and Lung Diseases in Warsaw; subjects in Korea participated at several university hospitals in Korea; and subjects in USA were enrolled at two clinics affiliated with academic medical centers. All subjects were over the age of 30 with at least 10 pack-years of cigarette smoking history. Cases manifested severe to very severe airflow obstruction with post-bronchodilator forced expiratory volume in 1 second (FEV 1 ) <50% predicted and FEV 1 /forced vital capacity <0.7. All subjects completed a detailed questionnaire and underwent standardized pre-bronchodilator and post-bronchodilator spirometry. Subjects with known tuberculosis (TB)-associated lung parenchymal destruction were excluded. Univariate and multivariate assessments of the impact of the country of origin on respiratory symptoms and respiratory illness were performed., Results: In both univariate and multivariate analyses, a history of TB (38.7%) and physician-diagnosed asthma (43.9%) were significantly more common in subjects with severe COPD from Korea than USA or Poland, while attacks of bronchitis (64.2%) were more common in subjects with severe COPD from Poland. COPD subjects from Poland had more severe dyspnea (modified Medical Research Council 3.3±1.0) and more frequently reported symptoms of chronic bronchitis (52.2%). A history of TB was also more common in Poland (10.8%) than in USA (0.3%) severe COPD patients., Conclusion: Respiratory symptoms and other respiratory illnesses associated with severe COPD differed widely among three continents., Competing Interests: Disclosure In the past 3 years, Edwin K Silverman received honoraria and consulting fees from Merck, grant support and consulting fees from GlaxoSmithKline, and honoraria and travel support from Novartis. The other authors report no conflicts of interest in this work.

Background: Patients with chronic obstructive pulmonary disease (COPD) often have poor health-related quality of life (HRQoL) that is disproportionate to their degree of airflow limitation. This study evaluated the association between St George's Respiratory Questionnaire for COPD (SGRQ-C) score and forced expiratory volume in one second and investigated the factors responsible for high SGRQ-C score according to severity of airflow limitation., Methods: Data from 1,264 COPD patients were obtained from the Korean COPD Subgroup Study (KOCOSS) cohort. Patients were categorized into two groups according to severity of airflow limitation: mild-to-moderate and severe-to-very severe COPD groups. We evaluated the clinical factors associated with high SGRQ-C score (≥25) in each COPD patient group., Results: Of the 1,264 COPD patients, 902 (71.4%) had mild-to-moderate airflow limitation and 362 (28.6%) had severe-to-very severe airflow limitation. Of the mild-to-moderate COPD patients, 59.2% (534/902) had high SGRQ-C score, while 80.4% (291/362) of the severe-to-very severe COPD patients had high SGRQ-C score. The association between SGRQ-C score and post-bronchodilator forced expiratory volume in one second (% predicted) was very weak in the mild-to-moderate COPD patients ( r =-0.103, p =0.002) and weak in the severe-to-very severe COPD patients ( r =-0.219, p <0.001). Multiple logistic regression analysis revealed that age, being an ex- or current smoker, lower level of education, cough, dyspnea, and number of comorbidities with congestive heart failure, hyperlipidemia, and depression were significantly associated with high SGRQ-C score in mild-to-moderate COPD patients. In comparison, being an ex-smoker and having respiratory symptoms including sputum and dyspnea were significant factors associated with high SGRQ-C score in severe-to-very severe COPD patients., Conclusions: In addition to the respiratory symptoms of dyspnea and cough, high SGRQ-C score was associated with extra-pulmonary comorbidities in mild-to-moderate COPD patients. However, only respiratory symptoms such as sputum and dyspnea were significantly associated with high SGRQ-C score in severe-to-very severe COPD patients. This indicates the need for an improved management strategy for relieving respiratory symptoms in COPD patients with poor HRQoL. In addition, attention should be paid to extra-pulmonary comorbidities, especially in mild-to-moderate COPD patients with poor HRQoL., Competing Interests: Disclosure Hye Yun Park received lecture fees from AstraZeneca, Novartis, and Boehringer-Ingelheim. The authors report no other conflicts of interest in this work.

Discriminating between causes of dyspnea may be difficult, particularly in the elderly. The aim of this retrospective study of 83 inpatients with acute dyspnea was to assess the influence of age, multimorbidity and cognitive or motor impairment on the diagnostic accuracy of lung ultrasound (LUS) in discriminating acute heart failure (AHF) from noncardiogenic dyspnea (NCD). Univariate analysis indicates that LUS misdiagnosis was associated with the following parameters: history of stroke (p = 0.037), lower activity of daily living (p = 0.039), higher modified-Rankin scale (mRS) (p = 0.027) and need of two operators to complete LUS because of reduced patient compliance (p = 0.030). Regression analysis identified only history of stroke (p = 0.048) as an independent predictor of LUS misdiagnosis. This study supports LUS usefulness to differentiate AHF from NCD. Our data suggest that diagnostic accuracy of LUS is affected by history of stroke as a proxy for severe motor impairment but not by age, cognitive impairment and multimorbidity., (Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Purpose: Smoking can affect both the phenotypic expression of COPD and factors such as disease severity, quality of life, and comorbidities. Our objective was to evaluate if the impact of active smoking on these factors varies according to the disease phenotype., Patients and Methods: This was a Spanish, observational, cross-sectional, multicenter study of patients with a diagnosis of COPD. Smoking rates were described among four different phenotypes (non-exacerbators, asthma-COPD overlap syndrome [ACOS], exacerbators with emphysema, and exacerbators with chronic bronchitis), and correlated with disease severity (body mass index, obstruction, dyspnea and exacerbations [BODEx] index and dyspnea grade), quality of life according to the COPD assessment test (CAT), and presence of comorbidities, according to phenotypic expression., Results: In total, 1,610 patients were recruited, of whom 46.70% were classified as non-exacerbators, 14.53% as ACOS, 16.37% as exacerbators with emphysema, and 22.40% as exacerbators with chronic bronchitis. Smokers were predominant in the latter 2 groups (58.91% and 57.67%, respectively, P =0.03). Active smoking was significantly associated with better quality of life and a higher dyspnea grade, although differences were observed depending on clinical phenotype., Conclusion: Active smoking is more common among exacerbator phenotypes and appears to affect quality of life and dyspnea grade differently, depending on the clinical expression of the disease., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Opioids adversely influence respiration in five distinct ways. Opioids reduce the respiratory rate, tidal volume, amplitude, reflex responses to hypercapnia and hypoxia, and arousability related necessary for respiratory adaptive responses. Opioids cause impairment of upper pharyngeal dilator muscles leading to obstructive apnea. Opioids cause complex sleep disordered breathing (SDB) consisting of central sleep apnea and obstructive sleep apnea. Clinically opioids worsen pre-existing SDB. Recent studies have shown increased morbidity and mortality in patients receiving opioids for chronic noncancer pain and chronic obstructive pulmonary disease, which appear to be related to cardiovascular events, not overdose. Both patient populations are at risk for sleep disordered breathing and increased risk for adverse cardiovascular events on opioids for dyspnea or pain. This review discusses the influence of opioids on respiration and SDB and will review the adverse respiratory and cardiovascular effects of opioid use in at risk populations. Recommendations regarding management will follow as a summary.

Objective: Dyspnea is a defining symptom in the classification and treatment of chronic obstructive pulmonary disease (COPD). However, the degree of variation in burden among symptomatic COPD patients and the possible correlates of burden remain unclear. This study was conducted to characterize patients in Europe currently being treated for COPD according to the level of dyspnea in terms of sociodemographics, health-related quality of life, work productivity impairment, and health care resource use assessed by patient reports., Methods: Data were derived from the 5-EU 2013 National Health and Wellness Survey (N=62,000). Respondents aged ≥40 years who reported currently using a prescription for COPD were grouped according to their level of dyspnea as per the Global Initiative for Chronic Obstructive Lung Disease guidelines and compared on health status (revised Short Form 36 [SF-36]v2), work impairment (Work Productivity and Activity Impairment questionnaire), and number of health care visits in the past 6 months using generalized linear models with appropriate distributions and link functions., Results: Of the 768 respondents who met the inclusion criteria, 245 (32%) were considered to have higher dyspnea (equivalent to modified Medical Research Council score ≥2). Higher dyspnea was associated with decrements ranging from 3.9 to 8.2 points in all eight domains of the SF-36 health profile after adjustment for sociodemographics, general health characteristics, and length of COPD diagnosis; mental component summary scores and Short Form-6D health utility scores were lower by 3.5 and 0.06 points, respectively. Adjusted mean activity impairment (55% vs 37%, P <0.001) and number of emergency room visits (0.61 vs 0.40, P =0.030) were higher in patients with greater dyspnea., Conclusion: Many European patients with COPD continue to experience dyspnea despite treatment and at levels associated with notable impairments in the patients' ability to function across a multitude of domains. These patients may benefit from more intense treatment of their symptoms., Competing Interests: Disclosure Novartis paid fees to Kantar Health for access to survey data, analysis, and reporting. Jean-Bernard Gruenberger and Dorothy Keininger are employees of Novartis. Jeffrey Vietri is an employee of Kantar Health. Donald A Mahler has received consulting fees for advisory boards from Boehringer Ingelheim, GlaxoSmithKline (GSK), Novartis, Sunovion, and Theravance and is on Speaker’s Bureaus of Boehringer Ingelheim, GSK, and Sunovion. The authors report no other conflicts of interest in this work.

Introduction: Past research has suggested significant relationships between symptoms and health outcomes among patients with COPD. However, these studies have generally focused on a broad COPD sample and may have included those not receiving proper treatment. As a result, the aim of this study was to document the burden of COPD symptoms among those who are currently treated with the standard-of-care (SOC) medications in both the US and Western Europe., Methods: Data from the 2013 US (N=75,000) and 2011 (N=57,512)/2013 (N=62,000) European (France, Germany, Italy, Spain, and UK; 5EU) National Health and Wellness Survey (NHWS) were used. The NHWS is a health survey administered to a demographically representative sample of the adult population in each country. A total of 1,666 and 2,006 patients with self-reported physician diagnosis of COPD in the 5EU and US, respectively, were being treated with the appropriate SOC (based on self-reported medication use) and were included in the analyses. Symptoms (eg, dyspnea, coughing, wheezing) were reported descriptively and summed to create a symptom score (with higher score indicating more frequent symptoms). The relationships between the symptom score and patient outcomes (eg, health status using the Short Form-36 version 2 [SF-36v2], work productivity and activity impairment [WPAI], and self-reported health care resource use) were explored using regression modeling., Results: Nearly all patients (99.7% and 99.8% in the 5EU and US, respectively) reported experiencing symptoms and >80% reported experiencing at least one symptom "often". Increasing symptom scores were associated with poorer health status (unstandardized beta [ b ] =-0.87 and -0.78 for mental component summary and physical component summary, respectively, in the US and b =-0.67 and -0.79 in the 5EU, respectively; all P <0.05). Increasing symptom scores were also associated with greater work impairment ( b =0.09 and 0.06 for the US and 5EU, respectively), activity impairment ( b =0.05 and 0.06, respectively), and health care resource utilization (eg, hospitalizations: b =0.05 and 0.06, respectively) (all P <0.05). Approximately 70% of patients reported some level of non-adherence. Greater non-adherence was significantly associated with more frequent symptoms, poorer health status, and greater work impairment and health care resource use (all P <0.05)., Conclusion: Patients with COPD who are using the appropriate SOC still experience symptoms, which have a significant effect on both humanistic and economic outcomes., Competing Interests: Disclosure BD, NK, GB, and UH are full-time employees of AstraZeneca. During the conduct of the study, MD was a full-time employee of Kantar Health, the organization that received funding from AstraZeneca. The authors report no other conflicts of interest in this work.

Objective: To determine the prevalence, change in breathlessness status over time, and risk factors for disabling and persistent disabling breathlessness in relation to treatments in chronic obstructive pulmonary disease (COPD)., Materials and Methods: Longitudinal analysis of data from the Swedish National Register of COPD with breathlessness measured using modified Medical Research Council (mMRC) scores at two subsequent visits. Prevalence of disabling breathlessness (mMRC ≥2 at baseline) and persistent disabling breathlessness (disabling breathlessness at baseline and follow-up) was investigated in relation to COPD treatment. Risk factors for disabling breathlessness, change from non-disabling to disabling breathlessness, and persistent disabling breathlessness were analyzed using multiple logistic regression., Results: A total of 1,689 patients were included in the study with a median follow-up of 12 months (interquartile range: 4 months). Prevalence of disabling breathlessness was 54% at baseline. Persistent disabling breathlessness was present in 43% of patients despite treatment and in 74% of patients despite combined inhaled triple therapy and physiotherapy. Risk factors for disabling breathlessness or change to disabling breathlessness were higher age, lower lung function, frequent exacerbations, obesity, heart failure, depression, and hypoxic respiratory failure (all P <0.05). Persistent disabling breathlessness was associated with lower lung function and ischemic heart disease (all P <0.05)., Conclusion: Disabling breathlessness is common in COPD despite treatment, which calls for improved symptomatic treatments and consideration of factors influencing disabling breathlessness. Factors influencing disabling breathlessness should be considered for COPD management., Competing Interests: The authors report no conflicts of interest in this work.

Purpose: The purpose of this study was to define the prevalence of undiagnosed airflow obstruction (AO) among subjects with a history of smoking but no previous diagnosis of chronic lung disease. The finding of AO likely represents diagnosis of chronic obstructive pulmonary disease., Patients: People aged ≥30 years with a history of smoking who attended public outpatient clinics for primary care services were included in this study., Methods: A cross-sectional survey in five clinics in Hong Kong using the Breathlessness, Cough, and Sputum Scale, the Lung Function Questionnaire, and office spirometry was conducted., Results: In total, 731 subjects (response rate =97.9%) completed the questionnaires and spirometry tests. Most of the subjects were men (92.5%) in the older age group (mean age =62.2 years; standard deviation =11.7). Of the 731 subjects, 107 had AO, giving a prevalence of 14.6% (95% confidence interval =12.1-17.2); 45 subjects with AO underwent a postbronchodilator test. By classifying the severity of chronic obstructive pulmonary disease using the Global Initiative for Chronic Obstructive Lung Disease, 27 (60%) were considered to be in mild category and 18 (40%) in moderate category. None of them belonged to the severe or very severe category. The total score of Lung Function Questionnaire showed that majority of the subjects with AO also had chronic cough, wheezing attack, or breathlessness, although most did not show any acute respiratory symptoms in accordance with the Breathlessness, Cough, and Sputum Scale. Diagnosis of AO was positively associated with the number of years of smoking (odds ratio =1.044, P =0.035) and being normal or underweight (odds ratio =1.605, P =0.046). It was negatively associated with a history of hypertension (odds ratio =0.491, P =0.003)., Conclusion: One-seventh of smokers have undiagnosed AO. Spirometry screening of smokers should be considered in order to diagnose AO at an early stage, with an emphasis on smoking cessation.

Purpose: This study aimed to investigate whether the prevalence of postoperative pulmonary complications (PPCs) in patients with non-small-cell lung cancer (NSCLC) is even higher in the early stages of COPD than in such patients with normal lung function and to verify the usefulness of symptom- or quality of life (QoL)-based scores in predicting risk for PPCs., Patients and Methods: Patients undergoing pulmonary resection for NSCLC between July 2012 and October 2014 were prospectively enrolled. Preoperative measurements of lung function, dyspnea, and QoL, operative characteristics, PPCs, duration of postoperative hospitalization, and in-hospital mortality were assessed., Results: Among 351 consecutive patients with NSCLC, 343 patients with forced expiratory volume in 1 second (FEV1) ≥70% of predicted value were enrolled. At least one PPC occurred in 57 (16.6%) patients. Prevalence of PPC was higher in patients with COPD (30.1%) than in those with normal spirometry (10.0%; P<0.001). However, in patients with COPD, the prevalence of PPC was not different in patients with FEV1 ≥70% compared to those with FEV1 <70% and between group A (low risk and less symptoms) and group B (low risk and more symptoms) patients with COPD, based on the new Global initiative for chronic Obstructive Lung Disease 2011 guidelines. In patients with COPD, body mass index (odds ratio [OR]: 0.80, P=0.007), carbon monoxide diffusing capacity of the lung (DLCO), % predicted value (OR: 0.97, P=0.024), and operation time (OR: 1.01, P=0.003), but not COPD assessment test or St George Respiratory Questionnaire scores, were significantly associated with PPCs., Conclusion: Even in patients with early-stage COPD, the prevalence of PPCs is higher than in patients with NSCLC with normal spirometry. However, this rate is not different between group A and group B patients with COPD. In accordance with this, scores based on symptoms or QoL are not predictors of risk of PPCs in patients with early-stage COPD.

Background: While respiratory bronchiolitis (RB) is a frequent histopathological finding in smoker's lungs, RB-associated interstitial lung disease (RB-ILD) remains a rare disease., Objectives: We analyzed how the histological finding of RB was associated with clinical information in a series of 684 consecutive surgical lung biopsies., Methods: Retrospective analysis with delineation of clinical manifestations, smoking habits, pulmonary function test, and blood gas analysis in patients with RB in surgical lung biopsy. In 240 of these biopsies, RB was diagnosed, and in 146 of these cases a full clinical dataset was available., Results: The final diagnosis of these 146 patients was consistent with RB-ILD (n = 18), pulmonary Langerhans cell histiocytosis (n = 7), various ILD (n = 9), spontaneous pneumothorax (n = 43), traumatic pneumothorax (n = 5), lung cancer (n = 41), various benign lung tumors (n = 8), and chronic pulmonary effusion (n = 15). Smoking history was positive in 93% of patients, 72% revealed centrilobular emphysema in their biopsy, and 58% described dyspnea as the main symptom. Amongst these diagnoses there were significant differences in age and smoking habits, but only small distinctions in pulmonary function test and blood gas analysis. Out of the patients with RB-ILD, 17% developed lung cancer in the later course., Conclusion: RB is strongly related to smoking, emphysema, and dyspnea and frequently associated with lung cancer. RB-ILD is a rare disease that may represent a considerable risk for lung cancer. Pulmonary function testing and blood gas analysis do not differ between RB-associated diseases. The finding of RB should prompt further diagnostic workup, and in case of RB-ILD, entail regular screening for lung cancer., (© 2015 S. Karger AG, Basel.)

Background: Assessment of dyspnea in COPD patients relies in clinical practice on the modified Medical Research Council (mMRC) scale, whereas the Baseline Dyspnea Index (BDI) is mainly used in clinical trials. Little is known on the correspondence between the two methods., Methods: Cross-sectional analysis was carried out on data from the French COPD cohort Initiatives BPCO. Dyspnea was assessed by the mMRC scale and the BDI. Spirometry, plethysmography, Hospital Anxiety-Depression Scale, St George's Respiratory Questionnaire, exacerbation rates, and physician-diagnosed comorbidities were obtained. Correlations between mMRC and BDI scores were assessed using Spearman's correlation coefficient. An ordinal response model was used to examine the contribution of clinical data and lung function parameters to mMRC and BDI scores., Results: Data are given as median (interquartile ranges, [IQR]). Two-hundred thirty-nine COPD subjects were analyzed (men 78%, age 65.0 years [57.0; 73.0], forced expiratory volume in 1 second [FEV1] 48% predicted [34; 67]). The mMRC grade and BDI score were, respectively, 1 [1-3] and 6 [4-8]. Both BDI and mMRC scores were significantly correlated at the group level (rho =-0.67; P<0.0001), but analysis of individual data revealed a large scatter of BDI scores for any given mMRC grade. In multivariate analysis, both mMRC grade and BDI score were independently associated with lower FEV1% pred, higher exacerbation rate, obesity, depression, heart failure, and hyperinflation, as assessed by the inspiratory capacity/total lung capacity ratio. The mMRC dyspnea grade was also associated with the thromboembolic history and low body mass index., Conclusion: Dyspnea is a complex symptom with multiple determinants in COPD patients. Although related to similar factors (including hyperinflation, depression, and heart failure), BDI and mMRC scores likely explore differently the dyspnea intensity in COPD patients and are clearly not interchangeable.

Background and Objective: According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, either a modified Medical Research Council (mMRC) dyspnea score of ≥2 or a chronic obstructive pulmonary disease (COPD) assessment test (CAT) score of ≥10 is considered to represent COPD patients who are more symptomatic. We aimed to identify the ideal CAT score that exhibits minimal discrepancy with the mMRC score., Methods: A receiver operating characteristic curve of the CAT score was generated for an mMRC scores of 1 and 2. A concordance analysis was applied to quantify the association between the frequencies of patients categorized into GOLD groups A-D using symptom cutoff points. A κ-coefficient was calculated., Results: For an mMRC score of 2, a CAT score of 15 showed the maximum value of Youden's index with a sensitivity and specificity of 0.70 and 0.66, respectively (area under the receiver operating characteristic curve [AUC] 0.74; 95% confidence interval [CI], 0.70-0.77). For an mMRC score of 1, a CAT score of 10 showed the maximum value of Youden's index with a sensitivity and specificity of 0.77 and 0.65, respectively (AUC 0.77; 95% CI, 0.72-0.83). The κ value for concordance was highest between an mMRC score of 1 and a CAT score of 10 (0.66), followed by an mMRC score of 2 and a CAT score of 15 (0.56), an mMRC score of 2 and a CAT score of 10 (0.47), and an mMRC score of 1 and a CAT score of 15 (0.43)., Conclusion: A CAT score of 10 was most concordant with an mMRC score of 1 when classifying patients with COPD into GOLD groups A-D. However, a discrepancy remains between the CAT and mMRC scoring systems.

Background: The purpose of this study was to assess the relationship of smoking duration with respiratory symptoms and history of chronic obstructive pulmonary disease (COPD) in the South Carolina Behavioral Risk Factor Surveillance System survey in 2012., Methods: Data from 4,135 adults aged ≥45 years with a smoking history were analyzed using multivariable logistic regression that accounted for sex, age, race/ethnicity, education, and current smoking status, as well as the complex sampling design., Results: The distribution of smoking duration ranged from 19.2% (1-9 years) to 36.2% (≥30 years). Among 1,454 respondents who had smoked for ≥30 years, 58.3% were current smokers, 25.0% had frequent productive cough, 11.2% had frequent shortness of breath, 16.7% strongly agreed that shortness of breath affected physical activity, and 25.6% had been diagnosed with COPD. Prevalence of COPD and each respiratory symptom was lower among former smokers who quit ≥10 years earlier compared with current smokers. Smoking duration had a linear relationship with COPD (P<0.001) and all three respiratory symptoms (P<0.001) after adjusting for smoking status and other covariates. While COPD prevalence increased with prolonged smoking duration in both men and women, women had a higher age-adjusted prevalence of COPD in the 1-9 years, 20-29 years, and ≥30 years duration periods., Conclusion: These state population data confirm that prolonged tobacco use is associated with respiratory symptoms and COPD after controlling for current smoking behavior.

Background: The COPD Assessment Test (CAT) has been recently developed to quantify COPD impact in routine practice. However, no relationship with other measures in the Global Initiative for Obstructive Lung Disease (GOLD) strategy has been evaluated. The present study aimed to evaluate the relationship of the CAT with other GOLD multidimensional axes, patient types, and the number of comorbidities., Methods: This was a cross-sectional analysis of the Clinical presentation, diagnosis, and course of chronic obstructive pulmonary disease (On-Sint) study. The CAT score was administered to all participants at the inclusion visit. A GOLD 2011 strategy consisting of modified Medical Research Council scale (MRC) scores was devised to study the relationship between the CAT, and GOLD 2011 axes and patient types. The relationship with comorbidities was assessed using the Charlson comorbidity index, grouped as zero, one to two, and three or more., Results: The CAT questionnaire was completed by 1,212 patients with COPD. The CAT maintained a relationship with all the three axes, with a ceiling effect for dyspnea and no distinction between mild and moderate functional impairment. The CAT score increased across GOLD 2011 patient types A-D, with similar scores for types B and C. Within each GOLD 2011 patient type, there was a considerably wide distribution of CAT values., Conclusion: Our study indicates a correlation between CAT and the GOLD 2011 classification axes as well as the number of comorbidities. The CAT score can help clinicians, as a complementary tool to evaluate patients with COPD within the different GOLD patient types.

Objectives: In 2013, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) updated the management strategy on COPD based on severity using a combined assessment of symptoms, degree of airflow limitation, and number of exacerbations. This study quantified prevalence and incidence of COPD in the United Kingdom and estimated disease severity by GOLD 2013 categories A/B (low risk) and C/D (high risk)., Methods: The Clinical Practice Research Datalink was used to identify COPD patients ≥40 years. Patient characteristics were described, and prevalence was calculated on December 31, 2013. Five-year incidence (2009-2013) was estimated, with rates standardized using 2011 UK population age and sex. To classify patients by GOLD categories, spirometry results, the modified British Medical Research Council grade, and history of exacerbations were used., Results: The prevalent cohort comprised 49,286 patients with COPD with mean age 70 years; 51.0% were male. Overall prevalence was 33.3 per 1,000 persons (95% confidence interval [CI]: 33.1-33.6); 66.4% were classified as GOLD A/B and 33.6% as C/D. The standardized prevalence of GOLD A/B was 21.9 per 1,000 persons (95% CI: 21.7-22.1) and of C/D was 11.1 (95% CI: 10.9-11.2). A total of 27,224 newly diagnosed COPD patients were identified with mean age 67 years at diagnosis; 53.0% were male. Incidence was 2.2 per 1,000 person-years (95% CI: 2.2-2.3); 68.7% were classified in categories A/B and 31.3% in C/D, of which 17.2% did not receive COPD maintenance medication., Conclusion: A third of COPD patients in the UK are considered high risk (GOLD 2013 categories C/D), and a third of patients are diagnosed for the first time at these severe stages. Given the progressive nature of the disease, results suggest that closer attention to respiratory symptoms for early detection, diagnosis, and appropriate treatment of COPD in the UK is warranted.

Background: Some patients with chronic obstructive pulmonary disease (COPD) show increased airway inflammation and bacterial colonization during stable phase. The aim of this study was to follow COPD patients and investigate chronic colonization with pathogenic bacteria during stable disease phase, and relate these findings to clinical parameters, inflammatory pattern, lung function, and exacerbations., Methods: Forty-three patients with COPD were included while in a stable state and followed up monthly until exacerbation or for a maximum of 6 months. The patients completed the Clinical COPD Questionnaire and Medical Research Council dyspnea scale questionnaires, and exhaled breath condensate was collected, followed by spirometry, impulse oscillometry, and sputum induction., Results: Ten patients were chronically colonized (ie, colonized at all visits) with Haemophilus influenzae during stable phase. These patients had higher sputum levels of leukotriene B4 (P<0.001), 8-isoprostane (P=0.002), myeloperoxidase activity (P=0.028), and interleukin-8 (P=0.02) during stable phase when compared with other patients. In addition, they had lower forced vital capacity (P=0.035) and reactance at 5 Hz (P=0.034), but there was no difference in forced expiratory volume in 1 second (FEV1), FEV1 % predicted, forced vital capacity % predicted, exhaled breath condensate biomarkers, C-reactive protein, or Clinical COPD Questionnaire and Medical Research Council dyspnea scale results. Three patients had intermittent colonization (colonized at only some visits) of H. influenzae during stable phase, and had lower levels of inflammatory biomarkers in sputum when compared with the chronically colonized patients. The difference in airway inflammation seen during stable phase in patients chronically colonized with H. influenzae was not observed during exacerbations., Conclusion: Some COPD patients who were chronically colonized with H. influenzae during stable phase showed increased airway inflammation and reduced lung volumes when compared with non-chronically colonized patients.

Background: The 21st century Influenza A (H1N1) pandemic arrived during spring of 2009 and has posed a serious public health challenge world-wide. We describe the clinic-radiological profile and outcome of patients who were found H1N1 positive in Jawahar Lal Nehru Hospital, Ajmer of Rajasthan from 5th August 2009 to 31st May 2014., Aims and Objectives: Primary objective was to study clinical and radiological profile of the patients admitted with confirmed H1N1 infection. Secondary objective was to observe the risk factors and associated comorbid conditions with complications and need of mechanical ventilation and / or death among H1N1-infected patients, Materials and Methods: Hospitalized patient with laboratory-confirmed H1N1 flu by reverse transcriptase PCR during August 2009 to May 2014 in JLN Hospital, Ajmer, were included in this retrospective study. Data was collected from hospital isolation ward admission register. Statistical analysis was done by SPSS, version 16. Binary logistic regression was used to find out independent risk factors for morbidity., Results: A total of 94 PCR-confirmed H1N1-infected patients were included in the study, of them 32 (34%) males and 62 (66%) females. Median age was 35 years and median duration of symptoms before hospitalization was 5 days. Common presenting symptoms include fever 83 (88%), cough 79 (84%), breathlessness 67 (71%), rhinnorrhoea/ common cold 25 (26.5%), throat pain 13 (13.8%), chest pain 5 (5.3%) and haemoptysis 4 (4.2%). Bilateral crepitations were audible in 86 (91.4%) and tachypnoea in 73 (78%) cases. Co-morbidities were seen in 75 (79.7%) patients. Ventilatory support was required in 57 (60.6%) patients. On presentation, chest x-ray showed pulmonary opacities in 72 (76.5%) patients. We observed no significant side effects of oseltamivir 150 mg twice day dose for 5-7 days. Forty-one (43.6%) patients were cured and discharged from hospital, 53 (56.3%) patients died. Development of ARDS, involvement of bilateral lower zones of lungs in chest skiagram, requirement of mechanical ventilator and associated pregnancy (third trimester) were independent predictors of mortality., Conclusion: During evaluation period from 2009 to 2014, H1N1 influenza caused severe illness requiring hospitalization, including pneumonia, acute respiratory distress and complications involving renal, liver and cardiac dysfunction. Maximum patients were between age group of 20-40 year. Fever and cough were most common presenting symptoms. Common comorbidities were pregnancy, diabetes, hypertension, and obesity. Mortality rate was high in H1N1-infected patients with development of ARDS, associated pregnancy and patients who required ventilatory support.

Background: Few studies have investigated the 24-hour symptom profile in patients with COPD or how symptoms during the 24-hour day are inter-related. This observational study assessed the prevalence, severity and relationship between night-time, early morning and daytime COPD symptoms and explored the relationship between 24-hour symptoms and other patient-reported outcomes., Methods: The study enrolled patients with stable COPD in clinical practice. Baseline night-time, early morning and daytime symptoms (symptom questionnaire), severity of airflow obstruction (FEV1), dyspnoea (modified Medical Research Council Dyspnoea Scale), health status (COPD Assessment Test), anxiety and depression levels (Hospital Anxiety and Depression Scale), sleep quality (COPD and Asthma Sleep Impact Scale) and physical activity level (sedentary, moderately active or active) were recorded., Results: The full analysis set included 727 patients: 65.8% male, mean ± standard deviation age 67.2 ± 8.8 years, % predicted FEV1 52.8 ± 20.5%. In each part of the 24-hour day, >60% of patients reported experiencing ≥1 symptom in the week before baseline. Symptoms were more common in the early morning and daytime versus night-time (81.4%, 82.7% and 63.0%, respectively). Symptom severity was comparable for each period assessed. Overall, in the week before baseline, 56.7% of patients had symptoms throughout the whole 24-hour day (3 parts of the day); 79.9% had symptoms in ≥2 parts of the 24-hour day. Symptoms during each part of the day were inter-related, irrespective of disease severity (all p < 0.001). Early morning and daytime symptoms were associated with the severity of airflow obstruction (p < 0.05 for both). Night-time, early morning and daytime symptoms were all associated with worse dyspnoea, health status and sleep quality, and higher anxiety and depression levels (all p < 0.001 versus patients without symptoms in each corresponding period). In each part of the 24-hour day, there was also an association between symptoms and a patient's physical activity level (p < 0.05 for each period)., Conclusions: More than half of patients experienced COPD symptoms throughout the whole 24-hour day. There was a significant relationship between night-time, early morning and daytime symptoms. In each period, symptoms were associated with worse patient-reported outcomes, suggesting that improving 24-hour symptoms should be an important consideration in the management of COPD.

Breathlessness is a common symptom in the general population and a frequent reason for presentation in all healthcare settings. It causes serious functional limitations, distress for both patient and carer, and predicts poor clinical outcomes. Traditionally, clinical care focuses on investigation, diagnosis and treatment of the conditions causing breathlessness. Breathlessness itself is often not seen as a target for therapeutic interventions by either clinician or patient, and so breathlessness which persists despite optimum treatment of the condition is self-managed by the patient without medical help. There are evidence based interventions which benefit breathlessness, irrespective of its cause; systematic assessment should lead to individually tailored management plans. A simple measure of severity (intensity) and assessment of bother or distress caused by breathlessness in addition to the impact on quality of life should be routinely sought in a proactive manner so that appropriate management plans can be put in place.

This article elicits why critical care nurses need to become aware of the pulmonary issues of older adults. The population of older adults is increasing. Older adults undergo anatomic and physiologic changes of the protective mechanisms of the pulmonary system. These changes alter the rate and effort of breathing. Speech is slowed because of expiratory strength effort. Cognition changes may be the only indication of impaired oxygenation. Bedside nursing care provides protection from pulmonary complications. Health behaviors of smoking cessation, oral hygiene, and exercise promote pulmonary health even in older adults., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Whether respiratory symptoms are associated with mortality independent of lung function is unclear. The authors explored the association of the exposures i) lung function, ii) respiratory symptoms, and iii) lung function and respiratory symptoms combined, with the outcomes all-cause and cardiovascular mortality. The study included 10,491 adults who participated in the Nord-Trøndelag Health Study (HUNT) Lung Study in 1995-1997 and were followed through 2009. Cox regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals for all-cause and cardiovascular mortality associated with pre-bronchodilator% predicted forced expiratory volume in 1 second (ppFEV1), chronic obstructive pulmonary disease (COPD) grades, and respiratory symptoms (chronic bronchitis, wheeze, and levels of dyspnoea). Lung function was inversely associated with all-cause mortality. Compared to ppFEV1 ≥100, ppFEV1 <50 increased the HR to 6.85 (4.46-10.52) in women and 3.88 (2.60-5.79) in men. Correspondingly, compared to normal airflow, COPD grade 3 or 4 increased the HR to 6.50 (4.33-9.75) in women and 3.57 (2.60-4.91) in men. Of the respiratory symptoms, only dyspnoea when walking remained associated with all-cause mortality after controlling for lung function (HR 1.73 [1.04-2.89] in women and 1.57 [1.04-2.36] in men). Analyses of lung function and dyspnoea when walking as a combined exposure further supported this finding. Overall, associations between lung function and cardiovascular mortality were weaker, and respiratory symptoms were not associated with cardiovascular mortality. In conclusion, lung function was inversely associated with all-cause and cardiovascular mortality, and dyspnoea when walking was associated with all-cause mortality independent of lung function.

Background: Patients with acute respiratory symptoms still remain a diagnostic challenge. The aim of the study was to evaluate whether focused sonography could potentially diagnose life-threatening conditions missed at the primary assessment in a patient population consisting of admitted patients with acute respiratory symptoms., Methods: A prospective blinded observational study was conducted in a medical ED. Inclusion criteria were the presence of one or more of the following: respiratory rate &gt; 20/min, oxygen saturation &lt; 95%, oxygen therapy initiated, dyspnea, cough, or chest pain. After the initial assessment, focused sonography of the heart, lungs, and deep veins was performed by a physician blinded to patient history and the results of the primary assessment., Results: One hundred thirty-nine patients were included. The focused sonographic examinations could be performed in 134 patients (96%). Focused sonography identified 19 patients (14%) with an acute life-threatening condition missed at the primary assessment. Diagnostic performance of focused sonography for the diagnosis of an acute life-threatening condition, when using audit as gold standard, was as follows: sensitivity, 100% (95% CI, 85.2%-100%); specificity, 93.3% (95% CI, 86.7%-97.3%); positive predictive value, 76.7% (95% CI, 57.7%-90.1%); and negative predictive value, 100% (95% CI, 96.3%-100%)., Conclusions: Focused sonography of the heart, lungs, and deep veins is fast, highly feasible, and able to diagnose life-threatening conditions missed at the primary assessment in admitted patients with acute respiratory symptoms. In an ED setting sonography can be used both for ruling in and ruling out acute life-threatening conditions in these patients.

Purpose: To identify the incidence and the risk factors for pulmonary toxicity in children treated for cancer with contemporary lung irradiation., Methods and Materials: We analyzed clinical features, radiographic findings, pulmonary function tests, and dosimetric parameters of children receiving irradiation to the lung fields over a 10-year period., Results: We identified 109 patients (75 male patients). The median age at irradiation was 13.8 years (range, 0.04-20.9 years). The median follow-up period was 3.4 years. The median prescribed radiation dose was 21 Gy (range, 0.4-64.8 Gy). Pulmonary toxic chemotherapy included bleomycin in 58.7% of patients and cyclophosphamide in 83.5%. The following pulmonary outcomes were identified and the 5-year cumulative incidence after irradiation was determined: pneumonitis, 6%; chronic cough, 10%; pneumonia, 35%; dyspnea, 11%; supplemental oxygen requirement, 2%; radiographic interstitial lung disease, 40%; and chest wall deformity, 12%. One patient died of progressive respiratory failure. Post-irradiation pulmonary function tests available from 44 patients showed evidence of obstructive lung disease (25%), restrictive disease (11%), hyperinflation (32%), and abnormal diffusion capacity (12%). Thoracic surgery, bleomycin, age, mean lung irradiation dose (MLD), maximum lung dose, prescribed dose, and dosimetric parameters between V22 (volume of lung exposed to a radiation dose ≥22 Gy) and V30 (volume of lung exposed to a radiation dose ≥30 Gy) were significant for the development of adverse pulmonary outcomes on univariate analysis. MLD, maximum lung dose, and Vdose (percentage of volume of lung receiving the threshold dose or greater) were highly correlated. On multivariate analysis, MLD was the sole significant predictor of adverse pulmonary outcome (P=.01)., Conclusions: Significant pulmonary dysfunction occurs in children receiving lung irradiation by contemporary techniques. MLD rather than prescribed dose should be used to perform risk stratification of patients receiving lung irradiation., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Introduction: Internal and external air pollution that is gradually increasing due to urbanization and industrialization has a negative impact on the lung health. A health survey has been applied to evaluate the respiratory symptoms, respiration functions and smoking habbits of the workers of Izmir Konak Municipality whom have been reported to have a high rate of smoking habbit and be affected by the external air pollution due to their being working in the field by the Municipality's doctor., Materials and Methods: Questionnaire that are composed of the topics of work anamnesis, environmental anamnesis, curriculum vitae, symptoms (coughing, sputum, wheezing, dyspnea, hemoptysis) and smoking have been executed to 301 workers by face to face interview and their chest X-rays have been reviewed., Results: Dyspnea on exertion, sputum in the morning, wheezing and morning cough have been the most frequently observed complaints (respectively 37.2%, 32.2%, 27.9% and 24.9%). Sanitary workers have reported sputum in the morning more while maintanance shop workers have reported wheezing more (p values respectively 0.009, 0.008). No significance has been observed while the workers are evaluated one by one regarding to their work groups. No significant difference was identified between the addiction of smoking and nicotin addiction or pulmonary function test and chest X-rays (p> 0.05) but active smoking was much more seen in drivers (p= 0.047)., Conclusion: Although working on the hazardous work branch does not institute a sharp distinction, it becomes significant to trace and lead the workers in order to obtain their lung health protection in long term. Informing and influencing the workers about the harms of smoking and the ways to quit has been the most considerable acquisition of this survey.

Background: Few studies from the general population have investigated the role of anxiety in reporting dyspnoea. We examined the independent and combined association of lung function and anxiety symptoms with the prevalence of dyspnoea in different situations., Methods: The study included 5627 women and 5066 men who participated in the Lung study of the Nord-Trøndelag Health Study second survey in 1995-97. In a cross-sectional design we used logistic regression to calculate adjusted odds ratios (ORs) for reporting dyspnoea associated with levels of percent predicted FEV(1) (ppFEV(1)) and anxiety (Hospital Anxiety and Depression Scale)., Results: Overall, there was a linear inverse association between ppFEV(1) and dyspnoea (all P(trend) < 0.001), and a positive association between anxiety symptoms and dyspnoea (all P(trend) < 0.001). In combined analysis, using people with ppFEV(1) ≥100 without anxiety as reference, the OR (95% confidence interval) for reporting dyspnoea when walking on flat ground was 6.23 (3.45-11.28) in women with ppFEV(1) <80 without anxiety and 15.14 (7.13-32.12) in women with ppFEV(1) <80 with anxiety. The corresponding ORs among men were 5.75 (2.23-14.18) and 15.19 (4.74-48.64), respectively. Similar patterns were seen for dyspnoea when sitting still and woken at night by dyspnoea., Conclusion: Impaired lung function and anxiety symptoms were independently associated with reporting dyspnoea. Within lung function levels, reporting dyspnoea was more common among people with anxiety symptoms than among people without. This suggests that, in addition to its relation to reduced lung function, the subjective experience of breathing discomfort may also influence or be influenced by anxiety., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The presence and severity of lung lesions recorded post-mortem is commonly used as an indicator to assess the prevalence of respiratory problems in batches of bovines. In the context of a welfare monitoring based on on-farm measures, the recording of clinical signs on calves at the farm would be more convenient than the recording of lung lesions at slaughter. The aim of the present study was to investigate the relationship between clinical respiratory signs at farm and post-mortem analyses of lung lesions observed at slaughter in veal calves. If clinical signs were a good predictor of lung lesions it could be possible to integrate only those measures in a welfare monitoring system. One-hundred-and-seventy-four batches of calves were observed 3 times: at 3 and 13 weeks after arrival of the calves at the unit and at 2 weeks before slaughter. For each batch a maximum of 300 calves was observed and the proportions of calves showing abnormal breathing, nasal discharge and coughing were recorded. Post-mortem inspection was carried out on a sample of lungs belonging to calves from the observed batches. Each examined lung was classified according to a 4-point scale for pneumonia from healthy lung (score 0) to severe lesions (score 3). The clinical signs recorded infra vitam were significantly correlated with moderate and severe lung lesions for observations at 13 weeks and 2 weeks before slaughter and the level of the correlation was highly variable (r(sp) from 0.16 to 0.40). Receiver operating characteristic (ROC) curves were created and the area under the curves showed that batches with a high proportion of lungs with moderate or severe lesions could not be accurately detected by the three clinical signs of respiratory disorders. These results suggest that both clinical signs and post-mortem inspection of lung lesions must be included in a welfare monitoring schemes for veal calves., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The Japanese diet is high in soy products and fish. A case-control study was conducted in Japan to investigate the relationship between dietary intake of isoflavones and fatty acids and lung function, breathlessness and chronic obstructive pulmonary disease (COPD). A total of 278 referred patients aged 50-75 years with COPD diagnosed within the past 4 years, and 340 community-based controls were assessed for respiratory symptoms and undertook spirometric measurements of lung function. A validated food frequency questionnaire was administered face-to-face to obtain information on habitual food consumption. Dietary intakes of isoflavones and fatty acids were derived from the Japanese food composition tables. The COPD patients had significantly lower habitual intakes of isoflavones (genistein and daidzein) and polyunsaturated fatty acids (PUFA; both omega-3 and omega-6) than control subjects. Lung function measures were found to be positively associated with isoflavones and PUFA intake. Substantial reductions in prevalence of COPD and breathlessness were observed for isoflavones, the respective adjusted odds ratio being 0.36 (95% confidence interval 0.19-0.68) and 0.60 (95% confidence interval 0.33-1.10) for the highest versus lowest levels of total isoflavone intake. The corresponding tests for linear trend were significant. High intakes of PUFA and omega-6 fatty acids (derived from foods excluding oils and fats as seasonings) also appeared to reduce the risks of COPD and breathlessness symptom, but no evidence of association was found for other types of fatty acids. The study provided evidence of possible protective effect of traditional Japanese diet against tobacco carcinogens.

Background: Few studies have been carried out on acute effects of cement dust exposure. This study is conducted to investigate the associations between current "total" dust exposure and acute respiratory symptoms and respiratory function among cement factory workers., Methods: A combined cross-sectional and cross-shift study was conducted in Dire Dawa cement factory in Ethiopia. 40 exposed production workers from the crusher and packing sections and 20 controls from the guards were included. Personal "total" dust was measured in the workers' breathing zone and peak expiratory flow (PEF) was measured for all selected workers before and after the shift. When the day shift ended, the acute respiratory symptoms experienced were scored and recorded on a five-point Likert scale using a modified respiratory symptom score questionnaire., Results: The highest geometric mean dust exposure was found in the crusher section (38.6 mg/m3) followed by the packing section (18.5 mg/m3) and the guards (0.4 mg/m3). The highest prevalence of respiratory symptoms for the high exposed workers was stuffy nose (85%) followed by shortness of breath (47%) and "sneezing" (45%). PEF decreased significantly across the shift in the high exposed group. Multiple linear regression showed a significant negative association between the percentage cross-shift change in PEF and total dust exposure. The number of years of work in high-exposure sections and current smoking were also associated with cross-shift decrease in PEF., Conclusions: Total cement dust exposure was related to acute respiratory symptoms and acute ventilatory effects. Implementing measures to control dust and providing adequate personal respiratory protective equipment for the production workers are highly recommended.

The effects of ageing on the macroscopic appearance of the lung were recognized by Laennec, Andral suggesting that dyspnoea might be its clinical manifestation. At about the same time physiologists demonstrated the negative effects of ageing on the vital capacity, whereas anatomists defined its impact on the lung and thoracic cage structure. The prevalence of dyspnoea increases with ageing but co-morbid disease should always be sought. The prevalence of cough is strongly associated with active and passive smoking. With regard to physical signs, barrel chest and crepitations heard over the dependent lung zones do not necessarily have pathological significance. The usefulness of measuring the forced expiratory time remains to be established in the elderly. There is no characteristic radiological feature of a senile lung. If an X-ray abnormality is discovered during a routine examination, it should be regarded as pathological, but in most cases its detection will not alter management of the patient.

To estimate the prevalence of respiratory symptoms, bronchial hyperresponsiveness, smoking, and atopy in a population of Australians of Aboriginal descent (AAD), to determine the association of these and other factors with lung function, and to compare levels of lung function of AAD with Australians of European descent (AED) according to age and height, and to explore reasons for their differences, we conducted a study of 96 male (41 of whom were under 18 yr of age) and 111 female (48 of whom were under 18 yr of age) AAD living in a single remote tropical community in 1993. This population provided data on age, height, and lung function. A modified British Medical Research Council (MRC) questionnaire on respiratory symptoms and smoking was administered. FEV1, FVC, height, age, and bronchial responsiveness to inhaled methacholine were measured. Atopic status was assessed by skin prick tests for eight common allergens. Age- and sex-adjusted lung function was similar to that of other AAD groups and lower than in AED. For children, lung function increased less with increasing height in AAD than in AED. Lung function was reduced in adult AAD as compared with adult AED, although it was not possible to determine statistically whether lung function started to decline at an earlier age or declined faster with increasing age in AAD. A history of asthma, smoking, dyspnea, cough, or sputum production; atopic status; and increased bronchial responsiveness were all associated with lower levels of lung function. Differences in lung function between AAD and AED appear to be determined by characteristics that may be inherited, as well as by adverse external influences.