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The aim of this study was to analyze the exhaled volatile organic compounds (VOCs) profile, airway microbiome, lung function and exercise performance in congenital diaphragmatic hernia (CDH) patients compared to healthy age and sex-matched controls. A total of nine patients (median age 9 years, range 6&ndash, 13 years) treated for CDH were included. Exhaled VOCs were measured by GC&ndash, MS. Airway microbiome was determined from deep induced sputum by 16S rRNA gene sequencing. Patients underwent conventional spirometry and exhausting bicycle spiroergometry. The exhaled VOC profile showed significantly higher levels of cyclohexane and significantly lower levels of acetone and 2-methylbutane in CDH patients. Microbiome analysis revealed no significant differences for alpha-diversity, beta-diversity and LefSe analysis. CDH patients had significantly lower relative abundances of Pasteurellales and Pasteurellaceae. CDH patients exhibited a significantly reduced Tiffeneau Index. Spiroergometry showed no significant differences. This is the first study to report the VOCs profile and airway microbiome in patients with CDH. Elevations of cyclohexane observed in the CDH group have also been reported in cases of lung cancer and pneumonia. CDH patients had no signs of impaired physical performance capacity, fueling controversial reports in the literature.

Background and Aims: Pulmonary vascular disease is frequent in chronic obstructive pulmonary disease (COPD) and even patients with normal or mildly elevated mean pulmonary arterial pressure (mPAP) at rest may have abnormal exercise hemodynamics. Hence, we aimed to investigate pulmonary hemodynamics during exercise and its association with exercise capacity. Patients and Methods: Patients with COPD (mPAP Results: We enrolled n=26 patients (66±11yr, FEV1:56±25%) and compared them to n=26 controls. At rest, COPD patients had slightly higher mPAP (19(15-24) vs. 17(14-19) mmHg, p=0.022) and pulmonary vascular resistance (PVR) (2.6(1.4-3.0) vs. 1.7(1.1-2.2) WU, p=0.025). COPD patients reached lower maximum work load (50(50-100) vs. 100(75-125)W, p=0.002) and reduced peak oxygen uptake (VO2) (64(48-80) vs. 96(88-102) %predicted, p Conclusion: Pulmonary hemodynamics during exercise show characteristic changes in COPD and may contribute to exercise limitation. Validation of these data in larger cohorts is warranted.

PVR >5 WU proved to be the strongest independent haemodynamic predictor of mortality in COPD patients. This threshold may best identify COPD patients with severe pulmonary vascular disease.https://bit.ly/3v4QE96